J Hyg Epidemiol Microbiol Immunol, 1983, 27(4), 437 - 44 Antibodies to meningococcus polysaccharides in nonspecific gamma-globulins from different regions of the world; Demina AA et al.; Seventy-one batches of nonspecific gamma-globulin obtained from France, USSR and Mongolia were studied for presence of specific antibody to group A and C meningococcus polysaccharide . Specific activity was tested by two methods: radioimmunoassay (Lyon) and reaction of passive haemagglutination inhibition (Moscow) . Antibodies were detected in all the gamma-globulin batches tested, in some of them at high titres . The summary results indicated that approximately equal levels of specific A antibodies were present in preparations obtained from the different regions of the world . Antibodies to group C polysaccharide showed considerable variation in level from selection country to country; the highest level of C antibodies was in gamma-globulin from France . The authors feel entitled by the results to recommend testing of nonspecific gamma-globulin, selection of batches with a high level of specific antimeningococcus antibodies, and their judicious use. J Clin Immunol, 1983 Jan, 3(1), 90 - 9 Inherited deficiency of C8 in a patient with recurrent meningococcal infections: further evidence for a dysfunctional C8 molecule and nonlinkage to the HLA system; Densen P et al.; An adult male with recurrent meningococcal infections is reported whose serum lacked functional C8 activity but possessed antigenic C8 . The addition of 1500 U of purified C8/ml of serum restored hemolytic activity to normal . Four to five times more C8 was required to restore bactericidal activity than to restore hemolytic activity . Bactericidal activity could also be restored by mixing the patient's serum with a second C8-deficient serum that lacked detectable antigenic or functional C8 . The patient's serum contained bactericidal antibody for groups A, B, C, and Y meningococci and specific antibody to group Y capsular polysaccharide . There was two to three times more bactericidal antibody activity in the serum than in a pool of normal sera for the infecting strain . Family studies disclosed a sibling who was HLA identical to the patient but whose serum contained normal amounts of total hemolytic and C8 functional activity. Zh Mikrobiol Epidemiol Immunobiol, 1982 Dec, (12), 44 - 54 {Optimal inoculation doses of meningococcal chemical polyvalent ABC vaccine for immunizing children of various ages and adolescents . I . Safety and reactogenicity of different dosages of the preparation}; Ganzenko VP et al.; The investigation was carried out to study the safety and reactogenicity of meningococcal chemical polyvalent (ABC) vaccine with the aim of finding the optimum vaccination doses of this vaccine for the immunization of children of different age groups . The investigation, carried out in accordance with the methodological principles of a strictly controlled epidemiological field trial, showed the preparation to be safe, nonreactogenic and to produce no pronounced sensitizing effect. Infect Immun, 1982 Dec, 38(3), 1203 - 7 Class-specific antibody response to group B Neisseria meningitidis capsular polysaccharide: use of polylysine precoating in an enzyme-linked immunosorbent assay; Leinonen M et al.; An enzyme-linked immunosorbent assay was developed for measuring immunoglobulin class-specific antibodies to Neisseria meningitidis capsular polysaccharides . The polysaccharides were fixed to the solid phase by precoating the polystyrene surface with basic polyamino acids . Polylysine precoating was found to give optimal antibody values with the meningococcal polysaccharides studied . The enzyme-linked immunosorbent assay was used to measure antibodies against group B meningococcal polysaccharide in healthy adults and in patients with group B meningitis . Antibodies to group B polysaccharide in sera obtained from healthy adults were primarily immunoglobulin M (IgM) . Although the antibody response to disease was mostly IgM, both IgG and IgM antibodies increased . Infection with group B organisms stimulated anti-group B polysaccharide antibodies even in young patients, aged 6 to 7 months, and the magnitude of the B polysaccharide response increased with the age of the patient. Clin Exp Immunol, 1982 Nov, 50(2), 291 - 7 Properdin deficiency in a family with fulminant meningococcal infections; Sjoholm AG et al.; Three males in a large family showed a selective deficiency of properdin (P) . One of the P deficient individuals died from a fulminant infection with Neisseria meningitidis group C . The family history revealed three previous cases of similar infections with a fatal outcome . The deficiency did not appear to be associated with repeated bacterial infections . The pattern of inheritance suggested an X-linked mode of transmittance . However, heterozygous carriers were not clearly distinguished in the family . P deficient serum supported immune haemolysis in a normal fashion . Alternative pathway functions, such as the activation of C3 by inulin or zymosan, lysis of guinea-pig erythrocytes in agarose gel and opsonization of endotoxin coated oil particles, were grossly impaired in P deficient serum while efficient C3 activation was produced by addition of cobra venom factor. J Infect Dis, 1982 Nov, 146(5), 626 - 37 The epidemiology of infections due to Neisseria meningitidis and Neisseria lactamica in a northern Nigerian community; Blakebrough IS et al.; The epidemiology of infection due to Neisseria meningitidis and Neisseria lactamica was studied in a northern Nigerian community . A low meningococcal carriage rate was observed throughout the two-year survey . Initially, most meningococci isolated from nasopharyngeal carriers belonged to serogroup C or to serogroup Y . Following an outbreak of group A meningococcal disease, more group A meningococcal carriers were detected . Antibody studies indicated that infection with group A meningococci had been more widespread in the community than was suggested by regular carrier surveys . Carriage of meningococci was detected most frequently in children one to nine years of age . Children were identified as the first carriers in households more frequently than adults . The half-life of carriage was three months . The meningococcal carriage rate did not increase during the hot dry season when epidemics of meningococcal disease occur most frequently in Nigeria . Neisseria lactamica was isolated from the nasopharynx of children more frequently than were meningococci. Antimicrob Agents Chemother, 1982 Nov, 22(5), 926 - 9 Susceptibility of Neisseria meningitidis and Neisseria gonorrhoeae isolates to N-formimidoyl thienamycin; Dudek EJ et al.; A diverse collection of 123 meningococcal and 126 gonococcal isolates was tested for susceptibility to N-formimidoyl thienamycin (N-F-thienamycin; MK0787) and to penicillin G (PEN) . All of the meningococci were susceptible to both of these, as well as to rifampin . Among gonococci, beta-lactamase-producing strains, which were resistant to PEN, were susceptible to N-F-thienamycin . Among non-beta-lactamase-producing strains, the minimal inhibitory concentrations of N-F-thienamycin and PEN were less than or equal to 1.28 micrograms/ml . Of these, the strains with PEN minimal inhibitory concentrations toward the higher end of the range were likely to be more susceptible to N-F-thienamycin, whereas the strains that were highly susceptible to PEN were likely to have higher minimal inhibitory concentrations of N-F-thienamycin. Zh Mikrobiol Epidemiol Immunobiol, 1982 Oct, (10), 65 - 8 {Antigenic relations of meningococcal serogroups Z and 29E}; Zhukova LF et al.; Antigenic relations between meningococci, serogroups Z and 29E, have been studied with the use of serological methods . The thermolabile fractions of meningococci belonging to the above serogroups have been shown to contain common antigenic determinants which ensure the presence of serological cross reactions . Cross-reacting precipitating and agglutinating antibodies can be completely removed by the adsorption of meningococcal antisera, serogroups Z and 29E, with the cultures of heterologous serogroups . In the antisera adsorbed by meningococci belonging to heterologous groups a decrease in the titers of agglutinins, hemagglutinins and precipitins, particularly pronounced in adsorbed serogroup 29E antisera, has been observed. Acta Pathol Microbiol Immunol Scand {B}, 1982 Oct, 90(5), 335 - 40 Three types of growth inhibition among strains of Neisseria meningitidis isolated from patients in Norway; Jyssum K et al.; A survey has been made of Neisseria meningitidis strains isolated from patients in order to determine the prevalence of diffusible growth inhibitory substances active against other meningococci . Three types of growth inhibitory activity could be distinguished . The first type was release in cultures of nearly all strains after treatment with chloroform vapour . This activity inhibited all meningococci tested, including the donor strains . The properties were similar to those of the non-specific growth inhibitors observed among most strains of N . gonorrhoeae . The second type was demonstrated in cultures from four strains among 215 strains tested and may be present in a fifth strain . Bactericidal activity with high strain specificity was spontaneously released from cultures of the four strains . This type of activity was found to fit the description of a bacteriocin . The third type of inhibition was observed in one strain among the 215 strains tested . Cultures of this strain spontaneously released bacteriostatic activity . Products from the strain could inhibit almost all meningococcal strains except the donor strain itself . This activity was not entirely blocked by bovine serum albumin; it was not abolished by pronase and it was not stopped by dialysis membranes with cut-off 12000. J Clin Pathol, 1982 Oct, 35(10), 1153 - 7 Acquisition of new genes by oral Neisseria; Ison C et al.; It is suggested that part of the increased pharyngeal carriage of meningococci reported in patients with gonorrhoea is due to misidentification of gonococci which have been transformed to maltose fermenters by DNA from normal throat flora . The distribution of specific aminopeptidases in strains of gonococci, meningococci isolated from the throat and meningococci from systemic infections is consistent with this view . Gonococci oxidising maltose and gonococci with gamma-L-glutamyl aminopeptidase activity, both factors regarded as typical of Neisseria meningitidis, can be produced in vitro by transformation with DNA from N lactamica and N meningitidis . The clinical and theoretical implications of such changes are discussed. Lancet, 1982 Sep 11, 2(8298), 595 - 7 Shift in the age-distribution of meningococcal disease as predictor of an epidemic? Peltola H, Kataja JM, Makela PH. Demographic data for several years before, during, and after an epidemic of meningococcal meningitis show that the age-distribution of the disease shifts considerably during an epidemic--although the highest incidence of meningococcal infections was still that among children under 5 years old, the proportion of patients aged greater than 4 years increased significantly . The ratio of the number of cases aged over 4 years to that aged up to 4 years was 0.833 and 0.775 in two non-epidemic periods, but 2.95 and 2.29 in two epidemic years . Careful demographic surveillance may reveal the approach of a meningococcal epidemic sooner than do the present surveillance methods. Zh Mikrobiol Epidemiol Immunobiol, 1982 Sep, (9), 96 - 9 {Use of a dynamic conditional model for analyzing the epidemic process in meningococcal infection in the closed collective}; Cherniatina LF et al.; The article deals with the main trends of using the dynamic model of the epidemic process in meningococcal infection in close groups with a view of solving scientific and practical tasks connected with the analysis of the epidemic situation, the formation of conditional groups with specified properties in relation to the spread of meningococci . The parameters used in the model, characterizing the process in the closed group, are described, and possible sources of information allowing to determine these parameters are indicated . Limited possibilities for practical use of mathematical simulation of the epidemic process in meningococcal infection at the contemporary level of knowledge is shown. Soz Praventivmed, 1982 Sep, 27(4), 197 - 204 {Vaccination: 1982 status}; Herzog C et al.; This review discusses the indications for the routine immunizations covered by the Swiss "Immunization Schedule 1981" (diphtheria, tetanus, pertussis, poliomyelitis, measles, mumps, rubella, BCG), as well as the indications for special immunizations (hepatitis B, influenza, pneumococci, rabies, tickencephalitis) and for the immunisations for travellers (cholera, yellow fever, meningococci, typhoid fever) . Vaccination against measles, mumps and rubella should be given to girls and boys at the age of 18 (to 24) months as a combined injection . In view of the low prevalence of tuberculosis BCG vaccination is justifiable only at school leaving age, if at all . The indications for influenza and pneumococcal vaccines are still limited, the value of a general vaccination of all over 65 year old individuals is not proven for either vaccine . A nationwide vaccination campaign against hepatitis B was started early this year with a newly licensed vaccine for all population groups at risk . Only HDC-vaccines should be used for immunisation against rabies . The newly licensed, highly protective oral attenuated live typhoid vaccine will probably replace the parenteral typhoid vaccine. Med Trop (Mars), 1982 Sep-Oct, 42(5), 537 - 43 {Methods for analyzing the frequency, prevalence and the duration of asymptomatic carriage of Neisseria meningitidis . Longitudinal study of a school population in Belgium}; De Wals P et al.; In Belgium, during an outbreak of meningococcal disease mainly due to serogroup B, serotype 2 meningococcus, a prospective study of asymptomatic carriage was undertaken in two primary schools . From march 1975 to may 1976, 361 schoolchildren aged 3 to 14 years were surveyed . The result of nasopharyngeal cultures were adjusted to compensate the lack of sensitivity and specificity of the identification techniques . The hypotheses on which the adjustment rules are based were statistically validated . The mean prevalence of meningococcal carriage was 23 p . 100, the incidence rate was 0.02 acquisition for month and for person . The median duration of carriage was estimated at 9.4 months, and the mean duration at 13.6 months . For the first time, the expected relationship between prevalence, incidence, and duration was confirmed for meningococcal carriage. Can J Microbiol, 1982 Sep, 28(9), 1022 - 31 Evaluation of the immunogenicity of a CaCl2 extract from Neisseria meningitidis group Y; Bisaillon JG et al.; Cross-protection has already been demonstrated in mice after vaccination with a CaCl2 extract from the Neisseria meningitidis group Y Slaterus strain . The immunogenicity of such extracts from group Y cells, cultivated in a fermenter in Neisseria chemically defined medium, against virulent groups A, B, and C meningococci has been evaluated by two different animal models and a microbactericidal procedure . The mouse challenge system has revealed that the active cross-production observed 7 days after a single immunization with the extract was probably nonspecific, since bacillus Calmette-Guerin gave similar results . However, after three vaccinations, active cross-protection was observed, mainly against the strains of groups B and C, for at least 35 days after the last injection . In the mouse bacteremia model, the extract had a protective effect mainly against the homologous group Y strain but in a few experiments a significant protection was also obtained against the strains of groups A and B . The microbactericidal test revealed that even after three injections of mice, guinea pigs, or humans with the extract only the homologous bactericidal activity was induced . Since there was no close correlation between the results obtained with the two animal models and also with the microbactericidal procedure, no definitive conclusion can be drawn on the protective potential of our extract. Lancet, 1982 Aug 7, 2(8293), 315 - 8 Epidemic of meningococcal meningitis in Bamako, Mali: epidemiological features and analysis of vaccine efficacy; Binkin N et al.; Many studies have demonstrated the efficacy of meningococcal vaccine in nonepidemic meningococcal meningitis, but few have examined its efficacy in epidemic conditions . The effects of the vaccine on the course of a meningococcal meningitis epidemic in Bamako, Mali, between January and April, 1981, were studied . The vaccine was effective in limiting further spread of the epidemic . The attack rate among those who received vaccine was lower than that in the unvaccinated (0.7/10 000 vs 4.7/10 000), and the case-fatality rate among vaccinees in whom meningitis developed was lower than that of the unvaccinated . Routine vaccination against meningococcal meningitis in Africa may be impracticable owing to the cost, the relatively short duration of effectiveness, and the irregular occurrence of epidemics . Vaccination early in the course of an epidemic, however, appears to be a useful and practicable method of limiting the spread of disease. Zh Mikrobiol Epidemiol Immunobiol, 1982 Aug, (8), 97 - 102 {Changes in specific and nonspecific immunity factors in saliva and serum of patients with different clinical variants of meningococcal infection}; Petina GK et al.; Local and humoral immunity factors have been studied in 152 patients with different forms of meningococcal infection . The peculiar pattern of the time course of changes in these factors, depending on the clinical form of the disease, has been revealed . In the generalized form of infection changes in the immunological characteristics of the saliva and blood serum (lysozyme, secretory immunoglobulin, immunoglobulins of the main classes and specific antimeningococcal antibodies) have been shown to be more essential than in the localized form. Arch Dis Child, 1982 Aug, 57(8), 616 - 21 Outcome of meningococcal group B meningitis; Moss PD; Sixty children who survived meningitis during the outbreak of meningococcal group B infection in Bolton 1971-74 were assessed between 5 and 9 years later . Each case, together with a matched control, has been examined clinically and subjected to a number of psychological tests and to routine audiology . The results, unlike those from other series, did not demonstrate any incoordination, ataxia, or other physical abnormality, nor was there any statistically significant impairment on psychological testing . The incidence of sensorineural deafness (5%), although marginally lower, was comparable with the best of other series . When compared with the incidence in controls (3%) it is not statistically significant . A 'mattress test', suggestive of vestibular damage, was positive in those with more severe degrees of sensorineural deafness . The high mortality in the Bolton series (17%) has been reconsidered and it is concluded that unless a potent meningococcus type B vaccine is developed, mortality would still be high in a similar outbreak today. Zh Mikrobiol Epidemiol Immunobiol, 1982 Aug, (8), 75 - 8 {Criteria of the epidemiological surveillance of meningococcal infection}; Deviatkina NP et al.; The results of studies carried out with the use of the unified, specially developed methods in eight regions of the USSR are generalized . Basing on the analysis of the results, the leading role of serogroup A meningococci in the rise of morbidity is emphasized, the relation of the morbidity level to the serogroup composition of meningococci circulating among healthy population is revealed, the necessity of carrying out selective bacteriological surveys with a view to establish the serogroups of meningococci circulating among the population is shown . The expedient criteria to be used in the system of epidemiological surveillance of meningococcal infection are presented. Acta Pathol Microbiol Immunol Scand {C}, 1982 Aug, 90(4), 223 - 7 Immune and non-immune precipitation of human sera with gonococci and meningococci; Rod TO et al.; Sera from 218 healthy humans were examined by double-diffusion and counter-electrophoresis against the ultrasonically-disrupted N . gonorrhoeae strain 8551 and the group B N . meningitidis strain Ne 15 . All the sera examined contained precipitins against one or more antigens common to the bacteria . On immunodiffusion analysis, the sera formed a precipitation line, called the curved line, close to the gonococcal antigen basin but not the meningococcal antigen basin . It was not formed after digestion of serum with pepsin . IgG prepared from human serum by DEAE cellulose chromatography or the F(ab')2 fragment of IgG did not produce the line . The serum component involved was separated from IgA, IgG, and IgM by gel filtration, and was eluted in fractions suggestive of a molecular weight close to that of albumin . Presumably, the curved line resulted from non-immune interaction of a constituent of the gonococcus with a human serum component of unknown identity. J Clin Microbiol, 1982 Aug, 16(2), 240 - 4 Sodium dodecyl sulfate-polyacrylamide gel typing system for characterization of Neisseria meningitidis isolates; Mocca LF et al.; Thirty to fifty percent of group B and group C Neisseria meningitidis carrier isolates are not serotypable with existing outer membrane protein typing sera . A typing system based on differences in the outer membrane protein profiles after sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) was therefore developed as an adjunct to existing serotyping methods . Although most N . meningitidis strains contain several outer membrane proteins visible by SDS-PAGE, there are only one to three predominant proteins . The SDS-PAGE profiles of these major proteins were used to establish 10 different PAGE types . Greater than 95% of all meningococcal isolates, regardless of serogroup, fit into 1 of the 10 PAGE types . The outer membrane protein profile of individual strains after SDS-PAGE was constant when outer membrane fractions were prepared from the same strain on several different days . A comparison of gel profiles of meningococcal isolates obtained from different sites of the same patient revealed no significant differences among both major and minor proteins for isolate sets thus far examined . Characterization of strains by PAGE type can be a valuable epidemiological tool in addition to serotyping and in the absence of specific serotype antisera. Infect Immun, 1982 Aug, 37(2), 579 - 85 Immunoglobulin M and G antibody responses and persistence of these antibodies in adults after vaccination with a combined meningococcal group A and group C polysaccharide vaccine; Beuvery EC et al.; Adult volunteers were injected with a combined meningococcal group A and group C polysaccharide vaccine . Immunoglobulin M (IgM) and IgG antibody levels against both polysaccharides were measured in serum samples taken 14 days as well as 3 years after vaccination . For both group A and group C polysaccharides, the IgM and IgG antibody levels at 14 days postvaccination were positively related . The IgM-to-IgG antibody ratio at 14 days postvaccination was an indicator for the persistence of both IgM and IgG antibodies during the next 3 years; a high ratio meant a short persistence, whereas a low ratio was associated with a long persistence. J Hyg (Lond), 1982 Aug, 89(1), 139 - 48 Prevalence of Neisseria meningitidis in family members of patients with meningococcal infection; Saez-Nieto JA et al.; The aim of the study was first, to determine the prevalence of Neisseria meningitidis among the family members living with patients suffering from meningococcal infections, and second, to ascertain the distribution among these family members of strains epidemiologically related to those isolated from patients . Forty-two family groups were studied and 135 nasopharyngeal samples were taken from family members living with patients . Twenty family groups were found to contain meningococcal carriers, and of these 20, 13 contained a carrier of the strain that caused the infection (65%) . Among the family members who were carriers, the mother and father most frequently yielded the strain which caused the illness . The serotypes most frequently encountered both in patients and carriers were 2 and 8, as well as nontypable strains . The polyacrylamide gel electrophoretic patterns (PAGE) most frequently found were II and IV . A notable feature of the study is the high resistance of the strains to sulphadiazine, since more than 90% of the strains found in patients and more than 75% of those from carriers possessed a minimum inhibitory concentration greater than or equal to 10 micrograms/ml. G Batteriol Virol Immunol, 1982 Jul-Dec, 75(7-12), 251 - 4 {Meningococcal meningitis: preliminary epidemiological results on the introduction of a prophylactic vaccine}; Galli MG; Knowledge on the epidemiology of meningococcal meningitis in Italy is, at present mostly based on isolations of N . meningitidis from healthy carriers, seldom on seroepidemiological surveys, and only occasionally on isolations of the microorganism from cases . Such an incomplete and biased information could be of little help for an epidemiological evaluation of the impact of A and C polysaccharide vaccines, should they begin to be used in this Country, and calls for an urgent assessment of the baseline situation. Pediatr Infect Dis, 1982 Jul-Aug, 1(4), 257 - 64 Chloramphenicol: properties and clinical use; Laferriere CI et al.; Chloramphenicol was introduced into medical practice in 1949 . At therapeutic concentrations of 10 to 20 micrograms drug per ml, the drug inhibits bacterial ribosomal and, to a lesser extent, mammalian mitochondrial protein synthesis but concentrations above 60 micrograms drug per ml induce progressive reduction of oxygen-dependent cellular metabolism . Some adverse reactions (e.g . bone marrow suppression and the "gray baby syndrome") reflect these effects . The pathogenesis of chloramphenicol-induced aplastic anemia remains unclear . Chloramphenicol is most bioavailable after oral administration and has a remarkable ability to diffuse into body fluids and tissues . However, there are wide interindividual variations in its metabolism and elimination, particularly in newborns . Chloramphenicol is indicated for invasive ampicillin-resistant H . influenzae infections; for patients allergic to penicillin with pneumococcal, meningococcal or H . influenzae meningitis; in patients under 8 years of age with Rocky Mountain spotted fever; and for the treatment of brain abscess and other severe anaerobic infections (excluding endocarditis) due to B . fragilis . Other indications include selected patients with Salmonella meningitis or carditis, rickettsioses and intraocular infections . Unravelling the pathogenesis of chloramphenicol-induced aplastic anemia is critical to more widespread application of this remarkable antimicrobial. Infect Immun, 1982 Jul, 37(1), 271 - 80 Protection against group B Neisseria meningitidis disease: preparation of soluble protein and protein-polysaccharide immunogens; Frasch CE et al.; Although effective polysaccharide vaccines have been developed for meningococcal groups A, C, Y, and W135, the purified group B polysaccharide has proven to be nonimmunogenic . Earlier studies indicated that serotype 2 outer membrane protein vaccines induced bactericidal antibodies in animals and protected them from meningococcal challenge . However, a similar vaccine induced only low levels of antiprotein antibodies in both adults and children (C.E . Frasch et al., in J.B . Robbins et al., ed., Seminars in Infectious Disease vol . 4, p . 263-267, 1982) . Methods were therefore developed to produce more immunogenic serotype 2 protein vaccines . We found that, by growing the organism for 65 to 72 h at 32 degrees C, three to four times more outer membrane protein was released into the culture medium than could be extracted from overnight-grown cells . The outer membranes were therefore purified directly from the broth by ultrafiltration followed by ammonium sulfate precipitation . Most of the lipopolysaccharide was selectively removed from the membranes by treatment with the nonionic detergent Brij-96 . The Brij-96 was then removed and the resulting vaccine was filter sterilized . Some vaccines were prepared by combining equal parts of detergent-treated membrane protein and high-molecular-weight group B polysaccharide producing highly soluble vaccines . These new vaccines were compared by using an enzyme-linked immunosorbent inhibition assay to an insoluble vaccine (E-06) found to be poorly immunogenic in humans . A human serum with serotype 2 specificity was used in the inhibition assay, and 5 microgram of E-06 was required for 50% inhibition, whereas less than 1 microgram of the soluble vaccines was required . Addition of group B polysaccharide slightly increased the inhibitory capacity of the protein component. Infect Immun, 1982 Jul, 37(1), 264 - 70 Protection against group B Neisseria meningitidis disease: effect of serogroup B polysaccharide and polymyxin B on immunogenicity of serotype protein preparations; Peppler MS et al.; The inability to prepare an effective polysaccharide vaccine against group B Neisseria meningitidis was the impetus for these studies . Outer membrane protein vaccines used in our initial studies failed to induce bactericidal antibodies in humans . The particulate nature of these vaccines may have led to their clearance before effective immune stimulation . Less denaturing procedures, therefore, were developed for preparation of serotype 2 protein-containing vaccines . These procedures included isolation of naturally released outer membrane vesicles and selective removal of lipopolysaccharide from the vesicles by the nonionic detergent Brij-96 . The resultant protein vaccines were evaluated with and without noncovalently complexed group B meningococcal polysaccharide or polymyxin B sulfate or both . The new vaccines were at least 10-fold more immunogenic in mice and guinea pigs than the previous vaccines when assayed for bactericidal and enzyme-linked immunosorbent assay antibodies . The protein vaccines alone protected guinea pigs from intrachamber infection, and a single 0.1-microgram injection prevented meningococcal bacteremia in mice . Addition of group B polysaccharide to the protein significantly improved the immunogenicity of the protein, and this combined vaccine showed a greater protective effect . Polymyxin B generally reduced the immunogenicity of the vaccines in both mice and guinea pigs. Infect Immun, 1982 Jul, 37(1), 205 - 8 Human immune response to various doses of group Y and W135 meningococcal polysaccharide vaccines; Griffiss JM et al.; A divalent vaccine containing equal weights of Neisseria meningitidis group Y and group W135 capsular polysaccharides was inoculated subcutaneously into groups of 32 military recruit volunteers at doses of 10, 25, 50, and 100 micrograms in 10-microliter/microgram volumes . At 4 weeks, the two higher doses induced significantly greater binding antibody responses than did the two lower doses . Differences in response were not found between the two higher doses or between the two lower doses . An additional 32 volunteers received a dose of 25 micrograms in a 20-microliter/microgram volume . Binding antibody response to this vaccine did not differ from the response to doses of 10 and 25 microgram in 10-microliter/microgram volumes . In contrast, bactericidal antibody responses did not differ among doses . Bactericidal antibody was induced in 100% of individuals with low (greater than 4 log2) preexisting serum bactericidal activity, regardless of dose . Bactericidal antibody nonresponse was restricted to individuals with high preexisting serum bactericidal titers . The discrepant dose response between binding and bactericidal antibody resulted from the induction of nonlytic antibody by the higher doses . We conclude that there are no advantages to doses in excess of 5 micrograms of these two chemically similar polysaccharides for the target population of young adult military recruits. Infect Immun, 1982 Jul, 37(1), 155 - 9 Strains of Neisseria meningitidis isolated from patients and their close contacts; Frasch CE et al.; Neisseria meningitidis isolates from contacts, mostly family members, of 27 unrelated meningococcal disease patients were examined by serogrouping, serotyping, and a recently described sodium dodecyl sulfate-polyacrylamide gel electrophoresis typing procedure . Most of the isolates were serogroup B or C . Serotyping and sodium dodecyl sulfate-polyacrylamide gel electrophoresis typing now provide a more precise means than serogrouping for determining the epidemiological relationships among patient isolates and those of related carriers . In 70% of the families studied, all contact carriers had strains indistinguishable from that of the patient . In the other 30%, more than one meningococcal strain was recovered from the family . Sixty percent of the carrier isolates were recovered from adults . It was found that, among household contacts, the mother was most likely and the father was least likely to carry the disease isolate . Nonhousehold contacts were least likely to carry the disease isolate. Infect Immun, 1982 Jul, 37(1), 15 - 22 Comparison of the induction of immunoglobulin M and G antibodies in mice with purified pneumococcal type 3 and meningococcal group C polysaccharides and their protein conjugates; Beuvery EC et al.; The nature and kinetics of the serum antibody response to pneumococcal type 3 and meningococcal group C polysaccharides and their protein conjugates were studied in mice . Bovine serum albumin and diphtheria and tetanus toxoids were used as carrier proteins . The purified polysaccharides induced only immunoglobulin M (IgM) antibodies in thymus-bearing as well as congenic athymic (nude) mice . The polysaccharides covalently conjugated to proteins produced IgM and IgG antibodies in normal mice, but only IgM antibodies in nude mice . A second dose of the polysaccharide-protein conjugates resulted in a booster effect in the IgG response to the polysaccharides . Moreover, memory B-cells, generated after a primary injection with the polysaccharide-protein conjugates, could be triggered to the production of IgG antibodies after a second injection with the pure polysaccharides alone . These data indicate that the antibody response to the pure polysaccharides is thymus independent and that this response can be changed into a thymus-dependent response by covalent conjugation of the polysaccharide to a thymus-dependent protein. Infect Immun, 1982 Jul, 37(1), 132 - 7 Natural bactericidal activity of human serum against Neisseria meningitidis isolates of different serogroups and serotypes; Craven DE et al.; We used a microtiter assay, standardized with serum-sensitive and serum-resistant strains of Neisseria gonorrhoeae, to determine the serum sensitivity of Neisseria meningitidis isolates of different serogroups and serotypes . Numbers of serum-resistant isolates varied among serogroups: group A = 7/8 (88%), group B = 26/50 (52%), group C = 5/8 (63%), group Y = 4/6 (67%), group W135 = 5/8 (63%), group 29E (Z') = 0/8 (0%), nongroupable isolates = 0/8 (0%) . In comparison to group B isolates, group A isolates were more serum resistant (P less than 0.06), and group 29E and nongroupable isolates were more serum sensitive (P less than 0.001) . Poor correlation was observed between serum sensitivity results and group-specific levels of bactericidal antibody in the normal human serum of volunteers . The frequency of serum-resistant strains among group B disease isolates (45%) was not significantly different from throat isolates of asymptomatic carriers (52%) . Serotype 2 isolates of group B were no more serum resistant than were other serotypes examined . The serum sensitivity of meningococci appears to involve both capsular and noncapsular antigens and varies between serogroups . The increased serum sensitivity of nongroupable and group 29E isolates may account for the low incidence of disease caused by these organisms. Zh Mikrobiol Epidemiol Immunobiol, 1982 Jul, (7), 30 - 4 {Meningococcal infection in the Uzbek SSR}; Usmanov MK et al.; The epidemiological characteristics of meningococcal infection in Uzbekistan during the period of 8 years since its last epidemic rise in 1972 is presented . Differences in the intensity of the epidemic process among the urban and rural population due to a considerable isolation of most of the rural populated localities from the district centers and the low population density in the republic have been established . The seasonal distribution of the infection had a winter-spring character in urban areas and a spring character in rural areas . 63.4% of all cases were children under 14 years . In cities a high morbidity level among adolescents and young people was determined mainly by visitors from rural areas . A high epidemiological importance of healthy carriers, predominantly schoolchildren and young people was established . The immunological studies of humoral immunity in different groups of the population indicate that the process of immunization was more rapid in cities. Ann Intern Med . 1982 Jun;96(6 Pt 2):891. Epidemiologic comparisons of incidence of toxic shock syndrome; Peterson DR; Despite many imperfections in the nationwide reporting of toxic shock syndrome, the available data provide some useful information . The crude toxic shock morbidity rate has been estimated as approximately 0.50 per 100 000 United States population per year . This morbidity rate exceeds those for paralytic poliomyelitis, tetanus, tularemia, diphtheria, and typhoid fever, and is about one half of the rate for meningococcal infections and pertussis . The estimate of 8.9 cases of toxic shock syndrome per 100 000 menstruating women is similar to the crude rates for primary and secondary syphilis and mumps . From these comparisons, the incidence of toxic shock syndrome does not appear as low as some might suppose. Pathol Biol (Paris), 1982 Jun, 30(6 Pt 2), 522 - 5 {Bacteriological, pharmacological and clinical comparison between amoxycillin and ceftriaxone in the treatment of 300 purulent meningitis }; Cadoz M et al.; Two series of patients suffering purulent meningitis were treated: one (137 patients) with amoxycillin (200 mg/kg/day) by 4 intramuscular injections each day, the other with ceftriaxone (163 patients)/42 mg/Kg/day IM by intramuscular injections each day in the first 23 patients and then only one injection by day in the 140 other patients . Bacteriologically the superiority of CFTRX appears the whole studied strains: MIC of CFTRX are four times lower than those of AMOX for pneumococci, ten times lower for H . influenzae, hundred time lower for meningococci . Amongst the add strains the percentage of resistance to AMOX reaches 64 and only 7 to CFTRX . Pharmacologically, after a same dose of 50mg/kg the peak concentrations in CSF has the same level: CFTRX: 6.8 micrograms/ml, AMOX: 6 micrograms/ml . CSF levels remain efficient for 2 hours with AMOX and for 24 hours with CFTRX . The therapeutic index (mean antibiotic concentration in CSF/mean MIC of the strains) is higher with CFTRX than with AMOX (X 4 for pneumococci, X 15 for H . influenzae, X 100 for meningococci) . Clinical results are better with CFTRX than with AMOX in each of the aetiological groups except meningococcal meningitis but the only significative difference concerns pneumococcal meningitis . Clinical tolerance of the two treatments was good . However 2 neonates treated with CFTRX has a severe eczematous erythrodermia and 8 other patients treated with CFTRX had diarrhoea due to elimination of the sensitive flora. Br Med J (Clin Res Ed), 1982 May 29, 284(6329), 1618 - 21 Meningococcal disease in Scandinavia; Peltola H et al.; Scandinavia (Denmark, Finland, Iceland, Norway, and Sweden) comprises with mutual borders and 22.3 million inhabitants an area where the socioeconomic and cultural conditions are similar . Epidemic diseases, such as meningococcal infection, might therefore be expected to be uniformly distributed . An epidemiological study in the 10-year period 1970-9 shows, however, remarkable differences in the incidence, age, and serogroup and type distribution, as well as in the general dynamics of the disease . Three epidemics, two caused by different serotypes of group B (Norway and Iceland) and one by group A (Finland) occurred within the observation period . The annual overall incidence was generally around 3/100 000 but increased from fivefold (Finland) to eightfold (northern Norway) during epidemics . The epidemic strains caused infection in over 3000 patients and the loss of at least 250 lives . The overall case fatality rate was 8.6% (range 4.1-13.7%) . Men were more susceptible and had a worse prognosis than women of the same age group . The group A epidemic in Finland was influenced by a large vaccination campaign, but this possibility was not feasible in the two other epidemics. J Infect Dis, 1982 May, 145(5), 635 - 46 Complement-mediated opsonic activity in normal and infected human cerebrospinal fluid: early response during bacterial meningitis; Zwahlen A et al.; A local defense mechanism in bacterial meningitis was evaluated in humans by measuring complement-mediated opsonic activity (CMOA) in normal and infected cerebrospinal fluid (CSF) with a complement-dependent phagocytic bactericidal assay . CMOA was absent in normal untreated CSF and remained undetectable in 20 samples of CSF from patients with viral meningitis and five samples from patients with acute meningococcemia . In contrast, 15 of 27 samples of CSF from patients with acute bacterial meningitis had a measurable CMOA, which was correlated with protein concentrations (P less than 0.01) and C4 hemolytic activity (P less than 0.001) in the CSF . A favorable outcome of bacterial meningitis was associated with the presence of CMOA in CSF (P less than 0.005) . Recovery was also correlated with higher levels of C4 (P less than 0.01) and C3 (P less than 0.05) in CSF and with lower concentrations of microorganisms in the sample of CSF collected at the time of admission (P less than 0.01) . Thus, CMOA, although absent in normal CSF, can appear in CSF during acute bacterial meningitis, particularly in patients who recover completely. Yale J Biol Med, 1982 May-Aug, 55(3-4), 207 - 12 The hemorrhagic fevers of Southern Africa with special reference to studies in the South African Institute for Medical Research; Gear JH; In this review of studies on the hemorrhagic fevers of Southern Africa carried out in the South African Institute for Medical Research, attention has been called to occurrence of meningococcal septicemia in recruits to the mining industry and South African Army, to cases of staphylococcal and streptococcal septicemia with hemorrhagic manifestations, and to the occurrence of plague which, in its septicemic form, may cause a hemorrhagic state . "Onyalai," a bleeding disease in tropical Africa, often fatal, was related to profound thrombocytopenia possibly following administration of toxic witch doctor medicine . Spirochetal diseases, and rickettsial diseases in their severe forms, are often manifested with hemorrhagic complications . Of enterovirus infections, Coxsackie B viruses occasionally caused severe hepatitis associated with bleeding, especially in newborn babies . Cases of hemorrhagic fever presenting in February-March, 1975 are described . The first outbreak was due to Marburg virus disease and the second, which included seven fatal cases, was caused by Rift Valley fever virus . In recent cases of hemorrhagic fever a variety of infective organisms have been incriminated including bacterial infections, rickettsial diseases, and virus diseases, including Herpesvirus hominis; in one patient, the hemorrhagic state was related to rubella . A boy who died in a hemorrhagic state was found to have Congo fever; another patient who died of severe bleeding from the lungs was infected with Leptospira canicola, and two patients who developed a hemorrhagic state after a safari trip in Northern Botswana were infected with Trypanosoma rhodesiense . An illness manifested by high fever and melena developed in a young man after a visit to Zimbabwe; the patient was found to have both malaria and Marburg virus disease. Zh Mikrobiol Epidemiol Immunobiol, 1982 May, (5), 98 - 100 {Sensitizing properties of bacterial fractions of different chemical compositions}; Runova VF et al.; The sensitizing activity of meningococcal cells and their fractions has been studied . Only protein-containing preparations have been shown to be capable of inducing delayed hypersensitivity, while polysaccharide fractions do not induce it. Zh Mikrobiol Epidemiol Immunobiol, 1982 May, (5), 94 - 8 {Serological heterogeneity of the immune response to the administration of a multicomponent meningococcal vaccine}; Belova TN et al.; The characteristic feature of meningococcal polycomponent vaccine is the serological heterogeneity of immune response to the injection of this vaccine, which is due to the fact that the vaccine contains antigens to antibodies detected in meningococcal antisera of all known serogroups: A, B, C, D, X, Y, Z, 29-E and W-135 . The hyperimmunization of rabbits with meningococcal polycomponent vaccine results in the formation of antibodies to more than 20 different meningococcal cell-wall antigens occurring in different combinations in 23 strains isolated from patients and in museum strains of every known meningococcal serogroup, as well as antibodies to serogroup A meningococcal lipopolysaccharide . The above-mentioned heterogeneity of immune response to the injection of meningococcal vaccine is observed in the hyperimmunization of rabbits, in the vaccination of humans in a single injection and can be detected in immune sera by the precipitation test, by counter and two-dimensional electrophoresis and by the passive hemagglutination test with erythrocytes sensitized with group-specific polysaccharides. J Clin Microbiol, 1982 May, 15(5), 810 - 4 Laboratory diagnosis of gonococcal infection by genetic transformation; Butler LO et al.; The transformation test for the detection of infection by Neisseria gonorrhoeae has been examined using pro gonococci as recipients and DNA preparations from 912 clinical isolates and from 240 direct swab specimens as donors . The reliability of the method was checked with DNA from clinical isolates; 82% of the N . meningitidis from throat swab specimens were capable of transforming the gonococcal recipients, but after identification of the meningococcus by the aminopeptidase profile, the transformation test was then 99.5% positive for the gonococcus with virtually no false-positives . The only other organism to give a positive reaction was N . lactamica, which occurred once in 912 specimens . When applied directly to swab specimens, the reliability of the test was reduced, but this may have been related to variability of the specimen itself . However, 7 of 15 specimens which were microscopically suspected to be gonococci but unculturable were positive; also, 9 out of 38 unculturable specimens that were not even suspected to be gonococci were positive . Hence the test was able to identify the presence of gonococci that were unculturable . The aminopeptidase activities were not sensitive enough to be detected in the direct swab specimens, and neither cys nor leu auxotrophs were suitable as recipients to give a differentiation between N . gonorrhoeae and N . meningitidis . Evidence was obtained which would support the proposition that the transfer of genetic material between N . gonorrhoeae and N . meningitidis may occur. Mikrobiyol Bul, 1982 Apr, 16(2), 101 - 6 {Meningococcic meningitis epidemic in Ankara}; Berkman E et al.; The meningococcic meningitis cases which appeared in Ankara in 1973 had ceased by 1976 . The monthly distribution of the cases conforms well with the distribution schemes of other countries, where the peak months were the late winter and the early spring months . Beside the peak months some cases were seen throughout the year . Although the peaks disappeared after 1977, a few cases continued to be seen again . In the identification of the aetiological agent, the serogroup B was the predominant (70 cases, 45.5%) and the serogroup A was the next in prevalence (41 cases, 26.6%) . When the aetiological agent was considered, no correlation could be established between the epidemic which had occurred in same periods in Ankara and in Istanbul. Antimicrob Agents Chemother, 1982 Apr, 21(4), 678 - 80 Activities of eight new beta-lactam antibiotics and seven antibiotic combinations against Neisseria meningitidis; Scribner RK et al.; Each of eight new beta-lactam antibiotics was highly active in vitro against Neisseria meningitidis, and activity was not reduced by combining some of these drugs with penicillin, ampicillin, or tobramycin . Antibacterial activity and lack of antagonism between moxalactam and ampicillin was confirmed in a model of lethal meningococcal infection in mice. Br J Vener Dis, 1982 Apr, 58(2), 109 - 12 Rapidity and reliability of gonococcal identification by coagglutination after culture on modified New York City medium; Young H et al.; The combination of culture on modified New York City (MNYC) medium and identification of neisserial isolates by the Phadebact gonococcus test was evaluated in routine laboratory practice . The sensitivity of coagglutination was 96.7% (318/329 isolates) and that of immunofluorescence (IF) 97.9% (322/329 isolates); the specificity of both methods was 96.8% (120/124 isolates) . Of the 329 gonococcal isolates, 286 (86.9%) could be tested by coagglutination and 309 (93.9%) by IF after only 24 hours' incubation . Identification by coagglutination from primary cultures on MNYC medium is considered to be very rapid, simple, and efficient for the cultural diagnosis of anogenital gonorrhoea in women and urethral gonorrhoea in men . Because of the high prevalence of meningococci in the pharynx and their not infrequent occurrence in the anorectum of homosexual men the identity of isolates from these sites is best confirmed by sugar utilisation tests. Infect Immun, 1982 Apr, 36(1), 107 - 13 Expression of a high-affinity mechanism for acquisition of transferrin iron by Neisseria meningitidis; Simonson C et al.; Iron-starved meningococci grown at either pH 7.2 or 6.6 were capable of removing and incorporating iron from human transferrin by a saturable, cell surface mechanism that specifically recognized transferrin rather than iron . The maximum expression of the iron uptake system occurred after 4 h of iron starvation . The uptake of the iron was dependent upon a functioning electron transport chain and was sensitive to 60 degrees C and trypsin . Cells grown under iron-sufficient conditions were incapable of accumulating iron from transferrin . No evidence was found for a primary role for cell-free soluble siderophores in the removal of iron from transferrin . The nonpathogenic neisseriae, Neisseria flava and N . sicca, were unable to utilize iron on transferrin. Zh Mikrobiol Epidemiol Immunobiol, 1982 Mar, (3), 110 - 3 {Evaluation, based on experimental data, of the coefficients of a mathematical model of a meningococcal infection focus}; Berezhnoi VF et al.; The method for the determination of the coefficients of the dynamic model of the epidemic process in the focus of meningococcal infection is discussed . The method is based on the statistical evaluation of the coefficients of the system of common differential equations, the confidence interval for these coefficients and for dynamic characteristics . The minimization of the root-mean-square value of the output characteristics of the model serves as the criterion for the determination of the coefficients. Pathol Biol (Paris), 1982 Mar, 30(3), 163 - 75 {Epidemiologic markers of Neisseria (author's transl)}; Riou JY et al.; The world-wide increase of gonococcal infections and meningococcal infections should incite to face up all necessary means of checking which can be actually envisaged against these diseases . The major phenomenon regarding gonococcal infections is the appearance, since 1976, of plasmidic resistance by a beta-lactamase secretion . Two different types of strains have been described: one originating from West-Africa, the other one from South-East Asia (that latter presenting a conjugating plasmid to totalizing 24,5 M-daltons involving coding plasmid for beta-lactamase) . Among approximately thirty strains isolated in France, these ones appear to be equally shared out between these two types, following the results of our actual studies . Catlin's auxotype, which has been used in France and in some African countries (study in progress) tends to confirm the previous studies: auxotypes variations according to clinical forms an geographical distribution of strains . The other markers described in the literature are debated . As to meningococcus serogoups that we have carried out, they show a distribution well known in France, i.e . group B is largely predominating, groups A and C coming afterwards . It should be noted the appearance of some cases caused by groups Y and W135 . The first results obtained thanks to serotyping, according to Frasch's technique appear to show a majority of type 2 or 2-associated in cases of diseases as other authors have proved. Infect Immun, 1982 Mar, 35(3), 915 - 20 Ability of Neisseria gonorrhoeae, Neisseria meningitidis, and commensal Neisseria species to obtain iron from lactoferrin; Mickelsen PA et al.; The ability of 107 Neisseria isolates to compete for iron with human lactoferrin (LF) was examined . Each of 15 meningococci, 53% of 59 selected gonococci, and 24% of 33 commensal Neisseria could use LF-bound iron for growth . Isolates which could not obtain iron from LF were growth inhibited when sufficient LF was added to defined agar medium to bind available free iron . No difference was observed in the ability of colony type 1 and colony type 4 gonococci of the same strain to compete with LF for iron . LF was growth inhibitory for 50% of 22 disseminated disease isolates (DGI strains) and 51% of 35 local urogenital disease isolates (UGI strains) . Only 14% of gonococcal isolates requiring arginine, hypoxanthine, and uracil for growth were able to compete with LF for iron, whereas 87% of all other gonococcal isolates could do so (P less than 0.005) . Ability to obtain iron from LF does not appear to be required for survival of Neisseria on mucosal surfaces, nor essential for invasion of the bloodstream by gonococci . However, ability to utilize LF as a source of iron may contribute to differences in pathogenicity among certain gonococcal isolates. J Immunogenet, 1982 Feb, 9(1), 25 - 9 Immunoglobulin allotypes and immune response to meningococcal polysaccharides A and C; Pandey JP et al.; Serum samples were collected from 113 healthy Caucasian volunteers before and after vaccination with meningococcal polysaccharides (MPS) group A and group C . Antibodies to MPS group A and group C were measured and sera were typed for several Gm and Km(1) allotypes . A significant association was found between the Gm 1,3,17; 5,13,14,21 phenotype and low immune responsiveness to MPS group A . These results suggest the possible existence of an immunoglobulin allotype-linked immune suppression (Is) gene(s) in man. J Clin Microbiol, 1982 Feb, 15(2), 324 - 9 Identification of immunoglobulin heavy-chain isotypes of specific antibodies of horse 46 group B meningococcal antiserum; Allen PZ et al.; Hyperimmune horse serum from a single animal (horse 46) immunized with group B (strain B-11) meningococcal vaccine provides a standardized, readily available diagnostic reagent used in primary isolation medium and for serogrouping of meningococci . Identification of the heavy-chain isotypes of specific anticapsular polysaccharide and anti-lipopolysaccharide isolated from horse 46 serum revealed a differential distribution in the occurrence of immunoglobulin classes . Meningococcal anticapsular antibodies of horse 46 serum were restricted predominately to the immunoglobulin M (IgM) class, with only trace amounts of IgGa present, whereas anti-lipopolysaccharide concomitantly produced showed a heterogeneity in its heavy-chain isotypes, consisting of IgM, IgGa, IgGb, moderate amounts of IgB, and a small amount of IgA. Am Rev Respir Dis, 1982 Feb, 125(2), 255 - 7 Bacteremic W-135 meningococcal pneumonia; Witt D et al.; Two epidemiologically unrelated cases of bacteremic meningococcal pneumonia are reported . Both patients were civilians without antecedent viral illness . The organism involved was Neisseria meningitidis, Group W-135, a serogroup of rapidly increasing importance in the United States . The difficulties in diagnosis and scope of meningococcal pneumonia are discussed. Sem Hop, 1982 Jan 7, 58(1), 53 - 8 {Pericarditis occurring in the course of meningococcal meningitis . Description of a case and review of literary data . (author's transl)}; Mordowicz M et al.; The authors report a new case of acute pericarditis in a 21 month-old girl, occurring on the fourth day of a meningococcal meningitis . The patient's recovery from the pericarditis was achieved thanks to a surgical drain in association with antibiotherapy, and despite a relapse after a puncture . On the basis of this case and the literary data reviewed, they endeavor to assess the frequency of this rare complication, to examine the most likely physiopathological hypothesis and to study the most effective treatment. Zh Nevropatol Psikhiatr Im S S Korsakova, 1982, 82(2), 197 - 9 {Late sequelae of meningococcal infections in adults}; Cheremukhina AN; Long-term sequels of meningococcal infection were examined in 120 patients aged 16 to 73 years within periods of one month to 6 years after the disease . It was found that the meningococcal infection not infrequently left consequences, such as hypertensive (18%) and epileptiform (2%) syndromes, pyramid insufficiency (11%), impairments of the cranial nerves (8%), intellect derangement (12.5%), psychoorganic syndrome (3.3%) . Regular dispensary observation and treatment of such patients in the residual period is a socially important task. Zh Nevropatol Psikhiatr Im S S Korsakova, 1982, 82(2), 193 - 7 {Serum and cerebrospinal fluid enzyme spectra in meningitis and their differential diagnostic value}; Sirkis SI; Dynamic examinations of the activity of glutamate-aspartate and glutamate-alanine aminotransferases (AST, ALT), fructose diphosphate aldolase and alkaline phosphatase in the cerebrospinal fluid (CSF) were carried out in 512 patients (14 groups) suffering from viral and bacterial meningitis in the acute period, as well as in reconvalescents . The activity of the CSF enzymes was also determined in 70 healthy subjects . It was found that in the acute period of meningitis the activity of the CSF enzymes (mostly of the aminotransferases) rose, this rise being greater in meningococcal and tuberculous meningitis than in the viral one . In reconvalescents the activity of the aminotransferases dropped, and that of aldolase and alkaline phosphatase got normal . The activity of the blood serum enzymes showed no substantial changes . The differences in the activity of the enzymes may serve as a criterion for diagnostic differentiation of meningitis. Infection, 1982 Jan, 10(1), 23 - 7 Rare complications in a case of generalized meningococcal disease: immunologic reaction versus bacterial metastasis; Stephani U et al.; A 14-year-old girl was suffering from meningococcal sepsis with initial endophthalmitis . During a secondary and prolonged fever attack including aseptic meningitis, temporary complications such as pericarditis, arthralgic pains, headache and localized phlebitis were observed . There were three relapses of pericarditis within nine months . Their course was benign . The discussion deals with the pathogenesis of these complications as metastatic and immunologic reactions . The possibility of these complications should be considered during diagnostic investigation and therapeutic treatment. Antibiotiki, 1982 Jan, 27(1), 69 - 73 {Clinical laboratory basis for using kanamycin sulfate for treating meningococcal meningitis}; Ivanov KS et al.; Satisfactory penetration of lincomycin sulfate through the hematoencephalic barrier was shown in experimental meningococcic meningitis of rabbits and in treatment of patients with meningococcic meningitis . Constant high levels of the antibiotic in the cerebrospinal fluid, meninx vasculosa, penetration into the brain tissues may be achieved after intramuscular injection of the drug in a dose of 500 mg every 8 hours . The study showed therapeutic efficacy of kanamycin in the treatment of the patients with meningococcic meningitis . It may be recommended for the clinical use as a reserve antibiotic . As an independent etiotropic agent kanamycin may be used in sensitivity to benzylpenicillin or its inefficiency in treatment of the meningococcic infection . Kanamycin may be used in combination with benzylpenicillin in severe forms of meningitis, meningoencephalitis or purulent meningitis of an unknown etiology. Padiatr Padol, 1982, 17(1), 43 - 65 {Purulent meningitis in children . II . Treatment and prognosis}; Guggenbichler JP; In the years 1970 to 1979 312 patients with purulent meningitis were treated at the University of Innsbruck, Department of Pediatrics . The overall fatality rate was 16%, the majority of fatal cases were due to gram negative organisms before 1977 . The mortality rate of meningococcal meningitis due to H . influenzae was 5.6 and 1.6%, respectively and compares very well to reports in the literature . 12% of children are severely handicapped . Hearing impairment is the most frequent cause of retardation with 6.8% . We compared therapeutic results of two different treatment regimen in our clinic with the therapeutic results in other centers reported in the literature . The combination of ampicillin and chloramphenicol was superior to other treatment modalities particularly ampicillin monotherapy in H . influenzae meningitis and meningitis due to unknown organisms . Theoretical reservations against this combination have been eliminated by the proof of the bactericidal action of chloramphenicol against the most common meningeal pathogens and the synergistic action with beta lactam antibiotics . In pneumococcal meningitis the administration of high doses of Na-Penicillin G as i . v . bolus proved to be connected with unexpected complications and fatalities . The administration of 25000-40000 E Na Penicillin G as an i . v . infusion over 1 hour 4--6 times daily was a less hazardous yet effective therapy . Unsatisfying results in the treatment of gram negative meningitis in neonates prompted the investigation of a new compound fosfomycin for this indication . In vitro investigation of the antimicrobial activity against 68 meningeal pathogens and investigation of this drug in a lapine model showed encouraging results . In the last years a limited clinical trial in severely affected newborn infants was done with promising therapeutic efficacy . A larger scale investigation of this drug is now proceeding in form of a National cooperative Study of gram negative meningitis in Austria . Besides an effective antimicrobial treatment particular attention has to be paid to an adequate fluid and electrolyte replacement . Symptomatic therapy of complications e . g . seizures as well as continuous close monitoring of all vital signs is mandatory for optimal therapeutic success . Subdural effusions have been observed infrequently and only diagnostic subdural punctures have been performed. South Med J, 1982 Jan, 75(1), 68 - 9 Subdural empyema: an unusual complication of meningococcal meningitis; Edwards MS et al.; Subdural empyema rarely is associated with bacterial meningitis in infants, particularly when the etiologic agent is Neisseria meningitidis . We have described a 3-month-old infant in whom relapse of meningitis due to Meningococcus group C was accompanied by a right-sided subdural empyema . Full recovery followed appropriate antimicrobial therapy and closed drainage. J Occup Med, 1982 Jan, 24(1), 53 - 7 Consideration regarding infection during hospital employment; Schneider WJ; Among the most important responsibilities of a hospital's employees' health service is the prevention or prompt identification of infectious illnesses among staff members . Infections constitute a major health hazard of hospital employment and, both intrinsically or as a consequence of subsequent transmission to hospitalized patients, can have devastating consequences . The risks associated with tuberculosis, viral hepatitis, rubella, herpes, meningococcal disease, and scabies are generally acknowledged and methods of control have been suggested . In addition, immunizations against diphtheria and influenza have been advised under certain circumstances . Respiratory syncytial virus and pertussis probably account for some upper respiratory tract illnesses among personnel and may lead to serious morbidity in pediatric patients . Laboratory-acquired infections can be diverse and exotic . Control measures should include surveillance, appropriate immunizations, epidemiologic investigation coordinated with infection control, antibiotic prophylaxis when indicated and environmental safeguards. Med Clin North Am, 1982 Jan, 66(1), 293 - 302 The tetracyclines; Cunha BA et al.; Tetracyclines continue to be used extensively on a world-wide basis because of their unusually broad antimicrobial spectrum and their relative safety . The first generation tetracyclines are used almost exclusively via the oral route; the second generation tetracyclines may be used orally or intravenously . Intramuscular administration is not recommended . Doxycycline is preferred in the treatment of upper respiratory tract infections, atypical pneumonias, intraabdominal/pelvic sepsis or trauma, venereal diseases, and in the treatment of prostatitis . Minocycline is preferred for meningococcal prophylaxis, central nervous system infections (due to susceptible organisms), and in staphylococcal infections (when tetracycline is indicated). Ann Ophthalmol, 1982 Jan, 14(1), 29 - 30 Metastatic endophthalmitis: a complication of meningococcal meningitis; Hull DS et al.; A 13-month-old child with Neisseria meningitidis developed bilateral metastatic endophthalmitis . Treatment with systemic and periocular injections of penicillin G and steroids resulted in resolution of the meningitis and the endophthalmitis . This case should alert the pediatrician to the possibility of binding endophthalmitis in a patient with meningitis and ocular abnormalities. J Clin Microbiol, 1982 Jan, 15(1), 78 - 81 Prevalence of maltose-negative Neisseria meningitidis variants during an epidemic period in Spain; Saez-Nieto JA et al.; We studied the prevalence of maltose-negative variants of Neisseria meningitidis in Spain from 1978 to 1980 . Sugar utilization studies were performed with both CTA medium and Mueller-Hinton medium; bromothymol blue was used as the indicator in Mueller-Hinton medium . Of 1,714 isolates of N . meningitidis recovered from the cerebrospinal fluid or blood of patients with meningococcal infections, 64 (3.7%) were maltose-negative variants; 13 (3.3%) of the 363 isolates found in carriers had the same characteristic . All maltose-negative cultures isolated from both patients and carriers belonged to serogroup B and were resistant to sulfadiazine at a minimal inhibitory concentration, 10 micrograms/ml or more . Serotype 2 isolates were the most prevalent isolates in patients (68.8%), followed by nontypable isolates (20.3%) . Only serotype 2 isolates (66%) and nontypable isolates (33%) were found in carriers. Immunol Lett, 1982, 5(6), 301 - 3 A malaria 'mitogen'-induced depressed immune response to meningococcal polysaccharide vaccine in BALB/c mice; Oyeyinka GO; Uninfected female BALB/c mice were given a 4-daily intraperitoneal injection, of supernatants obtained from 24-h cultures of Plasmodium berghei infected and control mouse red blood cells, for 20 days . Each mouse was subsequently injected subcutaneously with 10 mg meningococcal (groups A and C combined) polysaccharide vaccine . Mean meningococcal haemagglutinating antibody titres obtained in mice pretreated with control supernatants were consistently higher, than those obtained in mice pretreated with supernatants from malaria-infected red blood cell cultures, over a period of 14 days . The results suggest that a malaria 'mitogen' may be involved in the pathogenesis of the immunosuppression characteristic of this infection. Infection, 1982, 10(4), 246 - 51 Serum IgA: modulation of complement activation and induction of susceptibility to bacterial dissemination; Griffiss JM; Data are presented that support the conclusion that serum IgA functions as a regulatory Ig that modulates activation of complement by bacteria entering the circulation in showers of low inoculum from mucosal sites of colonization, and that preserves the antigenic mass by shunting such low inocula into macrophages and away from polymorphonuclear leukocytes, thus permitting immunologic processing . This regulation is an integral part of the physiologic immune response to environmental antigens and occurs during the peripheralization of the IgA response following stimulation of Peyer's patches and their analog in the lung . Down-regulation of complement mediated immune effector mechanisms by circulating IgA is balanced delicately . Pathologic states that increase the level of circulating IgA or decrease the phagocytic capacity of the monocyte/macrophage compartment may result in an oligospecific increase in susceptibility to bacterial dissemination . Fortuitous, co-temporal colonization of both gut and distal mucosal lymphoid tissue may result in augmentation of the serum IgA response to levels which induce monospecific susceptibility . This latter mechanism appears to account for the epidemic acquisition of susceptibility to disseminated meningococcal disease . A model of the relation of serum IgA to other components of mucosal immunity is presented. Trans R Soc Trop Med Hyg, 1982, 76(3), 351 - 3 The immunological response to polyvalent meningococcal vaccine in Bauchi State, Nigeria; Mohammed I et al.; The post-vaccination antibody response to both Group A and Group C meningococcal polysaccharide antigen was studied in 397 male and 359 female vaccinated persons aged between 4 and 40 years from Bauchi Town and neighbouring villages in Nigeria . No difference in response was observed between the sexes . Highest antibody levels occurred in those aged between 13 and 28 years . Haemoglobin genotype did not affect response . Malnourished children had significantly lower mean IgG, IgA and IgM levels and the response to meningovaccine was also lower than in normal children. J Hyg Epidemiol Microbiol Immunol, 1982, 26(1), 57 - 64 The Slidex-mĕningite-Kit (Bio-Mĕrieux) tested for exoantigen detection in spinal fluids from purulent meningitis cases; Kuzemenska P et al.; The Slidex-meningite-Kit allows the used of the rather highly sensitive and specific latex-agglutination method for the detection of N . meningitis group A and C and H . influenzae b exoantigens within a few minutes . In model experiments positive results persisted at unchanged intensity for prolonged periods of time regardless of storage temperature . However, in practical trials performed in a set of 60 spinal fluids from purulent meningitis patients etiological agent identification by the slidex-meningite-Kit failed at least as frequently as by cultivation; in the case of meningococci the kit even failed more often than cultivation . Hence the Slidex-meningite-Kit should be regarded as an auxiliary tool in the diagnosis of purulent meningitis and one that cannot replace the classical methods of cultivation and preparation staining . In the case of positive results, advantages of the Slides-meingite-Kit are rapidity in etiological agent identification and prolonged persistence of positivity in the spinal fluid samples. Zh Mikrobiol Epidemiol Immunobiol, 1982 Jan, (1), 95 - 7 {Bactericidal antibodies to meningococcal serogroups A, B and C in persons inoculated with a polycomponent meningococcal vaccine}; Belova TN; Three groups consisting of 56, 55 and 57 subjects were immunized with polycomponent meningococcal vaccine incorporating microbial cell-wall substance in the polymeric form . The vaccine was introduced in doses of 0.25 ml, 0.5 ml and 1.0 ml, respectively, which corresponded to 100 microns, 200 microns and 400 microns of the dry substance of the vaccine . Each of 53 subjects in the control group received placebo (physiological saline) in a dose of 0.5 ml . Serum specimens were taken from all vaccinees prior to injection and on days 21-24 . After the injection of the vaccine in a dose of 0.25 ml the arithmetical mean of the antimeningococcal titers increased approximately 70-fold to serogroup A, 20-fold to serogroup B and 120-fold to serogroup C, and after the injection of the vaccine in doses of 0.5 ml and 1.0 ml the titers increased 225-fold, 80-fold and 480-fold, respectively . The fact of the formation of bactericidal antibodies to serogroup B meningococci is particularly noteworthy. Zh Mikrobiol Epidemiol Immunobiol, 1982 Jan, (1), 67 - 71 {Immunoepidemiological study of the meningococcal carrier state in groups of children and adolescents}; Deviatkina NP et al.; Immunoepidemiological study in groups of children of different ages was carried out . The study comprised the monthly bacteriological examination of the members of these groups and selective determination of the presence of specific meningococcal A- and C-antibodies, IgA, IgM and IgG in the blood serum, as well as the lysozyme activity of the saliva . The results thus obtained indicated that during the whole year two rises in the level of meningococcal carriership, in autumn and in spring, were registered, while the cases of meningococcal diseases were absent . The first rise was due to the influence of the conditions under which the groups had been formed, as well as to some decrease in specific immunity characteristics and nonspecific protective factors; the second rise occurred simultaneously with a considerable decrease in the content of specific meningococcal A- and O-antibodies. Can Med Assoc J, 1982 Jan 1, 126(1), 38 - 41 Seroepidemiologic aspects of Neisseria meningitidis in homosexual men; Salit IE et al.; Neisseria meningitidis has been isolated with increasing frequency from specimens obtained from patients attending venereal disease clinics and is an occasional cause of genital infection . Among 383 homosexual men attending either a venereal disease clinic or a community screening clinic meningococci were cultured from specimens obtained from 35.0% of all the subjects, and with similar frequency in the two groups . Of the positive specimens 93.5% were from the throat, 5.8% from the rectum and 0.72% from the urethra . The serogroups and serotypes of the isolates were characteristic of those commonly found in nasopharyngeal specimens from other asymptomatic carriers . Gonococci were isolated from 8.6% of all the subjects and were 1.4 times more common in those who also harboured meningococci . Of the cultures positive for gonococci, 14.7% were from the throat and 85.3% from the rectum . The two bacteria were rarely isolated from the same site in the same individual . Gonococci, but not meningococci, were significantly more common (P less than 0.05) in the group attending the venereal disease, clinic than in the group attending the screening clinic, the rates being 17.1% and 7.0%. Infection, 1982, 10(3), 192 - 5 Attachment of pathogenic Neisseria to human mucosal surfaces: role in pathogenesis; Stephens DS et al.; Studies of the interaction between Neisseria gonorrhoeae and human fallopian tube mucosa in organ culture suggest that attachment of gonococci is important, not only to secure th organism in the host, but also to initiate the disease process . The steps observed in gonococcal infection of fallopian tube organ cultures are: 1) attachment of gonococci to microvilli of nonciliated cells; 2) release from gonococci of lipopolysaccharide and possibly other toxic moities to cause mucosa damage; 3) engulfment or phagocytosis of gonococci by nonciliated cells; 4) transport of phagocytic vacuoles containing gonococci to the base of the nonciliated cells; and 5) exocytosis of gonococci within phagocytic vacuoles into the subepithelial tissues . In vivo, these steps might result in extensive local disease (e.g . salpingitis) or in the invasion of blood vessels to cause disseminated disease . Preliminary studies of human nasopharyngeal tissue in organ culture infected with Neisseria meningitidis indicate that meningococci attach to microvilli of nonciliated cells and are phagocytized by these cells . Meningococci subsequently appear in subepithelial tissues, though the route they take is not yet certain . These observations suggest at least some of the ways in which attachment may play a role in disease caused by N . gonorrhoeae and N . meningitidis . Mechanisms to block this attachment may provide new approaches to the prevention of infections caused by the pathogenic Neisseria. Sem Hop, 1981 Dec 8-15, 57(45-46), 1925 - 9 {Mechanisms of acute pulmonary edema during meningococcal shock in children (author's transl)}; Kahn A et al.; Meningococcic shocks may induce fatal acute pulmonary edemas . Ten children, who died in this condition, have been compared to 19 others, who during the treatment of the shock, developed right heart failure, without acute pulmonary edema (8 deaths, 11 survivals) . The three groups of children could not be differentiated regarding their clinical status on admission, during the shock phase, or the treatments administered . Composition, volume and speed of administration of fluids were similar in the three groups . An increase in pulmonary capillary permeability could have occurred, and lead to the development of acute pulmonary failure, as presented by the children of the first group. Antibiotiki, 1981 Dec, 26(12), 932 - 6 {Effect of glucocorticoids on benzylpenicillin penetration across the hemato-encephalic barrier and on the clinical course and outcome of meningococcal meningitis}; Ivanov KS et al.; It was shown experimentally on rabbits and clinically in patients with meningococcal meningitis that glucocorticoids had no direct effect on penetration of penicillin through the hematoencephalic barrier . A decrease in the penicillin concentration in the liquor correlated with a decrease in the inflammation level of the meninges under the effect of a long-term (more than 3--4 days) corticosteroid therapy . As a result the penicillin concentration in the cerebrospinal fluid (0.09--0.4 units/ml) could not provide, in some cases, the bactericidal effect on the low sensitive meningococcal strains which induced protracted sanation of the liquor, slow progression of the diseases and worse outcomes . A short-term treatment with glucocorticoids (1--2 days) had a significant detoxifying effect without prolongation of the inflammation periods in the tissues of the central nervous system and did not make worse the disease outcomes according to the clinical and electroencephalographic data . When the use of glucocorticoids is required for a long period of time, it is advisable to increase the penicillin daily dose to 500 000 units per 1 kg of the body weight. Infect Immun, 1981 Dec, 34(3), 725 - 32 Safety and immunogenicity of group Y and group W135 meningococcal capsular polysaccharide vaccines in adults; Griffiss JM et al.; Serogroup Y and W135 Neisseria meningitidis capsular polysaccharide vaccines were tested as monovalent and divalent preparations in groups of 10 adult human volunteers at a dose of 50 (monovalent) or 100 micrograms (divalent) injected subcutaneously . Reactogenicity was low for the group Y vaccine and the group Y-W135 combined vaccine; 3 of 10 volunteers developed systemic reactions after group W135 vaccination . All three vaccines induced significant homologous and heterologous binding and bactericidal antibody . Except for group W135 bactericidal antibody, homologous responses exceeded heterologous responses, and divalent and monovalent vaccines induced equivalent homologous responses . Homologous bactericidal antibody responses were maintained for 4 weeks in 85% of group W135 vaccinates and in 100% of group Y vaccinates . Bactericidal antibody was induced in 11 of 11 group Y and 12 of 15 group W135 volunteers without preexisting respective bactericidal activities, regardless of which vaccine they received . For all three vaccines, antibody levels declined only slightly over 6 months . Prevaccination antibody levels positively affected postvaccination binding antibody levels, but not bactericidal levels. Infect Immun, 1981 Dec, 34(3), 751 - 6 Monoclonal antibody analysis of lipopolysaccharide from Neisseria gonorrhoeae and Neisseria meningitidis; Apicella MA et al.; A hybridoma produced by the polyethylene glycol fusion of the NS-1 variant of the P3x63Ag8 BALB/c plasmacytoma to splenocytes harvested from a BALB/c mouse immunized with whole gonococci was found to be producing antibody to a common region on gonococcal lipopolysaccharide (LPS) . Enzyme-linked immunosorbent assay inhibition systems were established by utilizing this antibody, designated 3F11, and 100% inhibition occurred with both LPS and the LPS-LPS and LPS-derived polysaccharides partially inhibited the enzyme-linked immunosorbent assay, whereas similar preparations isolated from Escherichia coli O:111, the J-5 mutant of this strain, and Salmonella minnesota Re595 failed to inhibit the assay . Studies utilizing whole gonococcal strains 4505 and the isogenic variant 4505r, which lacks both the LPS serotype and common determinants as inhibitors, demonstrated that the determinant recognized by the 3F11 antibody was present on the surface of 4505 and absent on 4505r . Inhibition studies were performed with beta-glucose, beta-galactose, D-glucosamine, D-galactosamine, heptose, 2-keto-3-deoxyoctanoate, N-acetylglucosamine, N-acetylgalactosamine, alpha-lactose, and beta-lactose . Complete inhibition of the enzyme-linked immunosorbent assay occurred with D-galactosamine, and partial inhibition was achieved with both alpha-lactose and beta-lactose . Based on these observations, the 3F11 antibody recognizes a site common to gonococcal LPS which is partially shared by meningococcal LPS . The chemical structure of the determinant appears to be a D-galactosamine-O-D-galactopyranosyl-(1-4)-D-glucopyranose . Additional specificity may be conferred by the steric relationship of the determinant on the intact LPS. JAMA, 1981 Nov 6, 246(18), 2060 - 1 Neisseria meningitidis serogroup W 135 disease in adults; Brandstetter RD et al.; Five adults had infection caused by Neisseria meningitidis serogroup W135 . Their ages ranged from 19 to 74 years, and the spectrum of illness included meningitis, pneumonia, and acute peritonitis . Two patients had systemic lupus erythematosus and were receiving corticosteroids at the time of their infection . One patient died of fulminant meningococcemia . All isolates were sensitive to sulfonamides . The recent increase in the national incidence of N meningitidis serogroup W135 infections emphasizes the need for continuing surveillance and justifies its inclusion in a polyvalent meningococcal vaccine. Bull Soc Pathol Exot Filiales, 1981 Nov-Dec, 74(6), 693 - 8 {Antibiotherapy of purulent meningitis in Africa in 1981}; Cadoz M; The place of the different anti-bacterial drugs in the treatment of purulent meningitis must be reconsidered in view of the bacteriological pharmacological and socio-economical data . Sulphonamids have no more interest because of the multiplication of resistant strains in most of the bacterial species . Penicillin G, with a narrow spectrum, keeps good indications (Meningococci and Pneumococci) but its use lacks convenience . With its very broad spectrum of activity, its long half life and its low cost, Chloramphenicol is actually the reference drug well adapted to the particular conditions of Africa . Ampicillins, often too expensive, show a more and limited activity against gram negative pathogens and should be supplied by the Cephalosporins "of the last generation" if not so costly. J Clin Invest, 1981 Nov, 68(5), 1378 - 80 Immunoglobulin allotypes and immune response to meningococcal group B polysaccharide; Pandey JP et al.; Serum samples were collected from 120 healthy adult volunteers (105 Caucasians and 15 Negros) before and after immunization with meningococcal polysaccharide (MPS) group B vaccine . Antibodies to MPS group B were measured and sera were typed for several Gm and Km(1) allotypes . A significant association was found between the Km(1) allotype and immune response to MPS group B in Caucasians. Nouv Presse Med, 1981 Oct 17, 10(37), 3057 - 9 {Recurrent meningococcal meningitis associated with complement C6 deficiency (author's transl)}; Avril MF et al.; In a young West-Indian woman recurrent meningococcal meningitis was found to be associated with hereditary deficiency of the C6 component of complement . Such an association has already been reported in 8 patients, all black . Measuring the total haemolytic complement would provide an easy way of detecting high risk subjects, who would benefit from immunization. An Esp Pediatr, 1981 Oct, 15(4), 343 - 8 {Clinical-therapeutical correlations in meningococcal infection: prophylactic heparin therapy (author's transl)}; Rodriguez-Vigil Lorenzo E et al.; A number of 241 patients with meningococcal infection, treated between 1972 and 1978, is analysed . Some new therapeutic patterns are established based on the application of the prognosis score of Stiehm . With these patterns consisting in the use of volume expansors with anti-aggregating properties and low dosage prophylactic heparin administration, authors have considerably improved their results reported in 1972, succeeding in diminishing the global mortality to 3.73%, a figure inferior to that of all known series to date. Radiology, 1981 Oct, 141(1), 77 - 82 Late sequelae of infantile meningococcemia in growing bones of children; Patriquin HB et al.; Multiple, irregular ball-and-socket deformities at the ends of long bones were noted in four children several years after they had had meningococcemia . Even though these lesions were clinically unsuspected at the time of the fulminant disease, they were probably the result of ischemia secondary to septic emboli to the epiphyseal vessels, which occurred at the same time as soft-tissue necrosis elsewhere . The individual lesions were radiologically identical to the metaphyseal cupping that has been reported following trauma to the growth plate. J Pediatr, 1981 Oct, 99(4), 540 - 5 Complications and sequelae of meningococcal infections in children; Edwards MS et al.; Eight-six children with meningococcal meningitis or bacteremia were evaluated prospectively between 1977 and 1979 to determine the incidence of complications and features predictive of their development . The majority (83%) of these infections were caused by serogroup B strains . Twenty-seven percent of survivors experienced one or more suppurative, allergic, or neurologic complications . Hearing loss, noted in 9% of children, occurred significantly more often in patients with admission leukocytosis or leukopenia, or with CSF leukocytosis greater than 10,000/mm3 than in those with an uncomplicated course (P less than 0.01) . Ten percent of survivors developed allergic complications manifested as cutaneous vasculitis or arthritis with onset five to eight days after admission . Shock, purpuric skin lesions, and fever persisting longer than five days occurred significantly more often in these children than in those who developed hearing loss or those with an uncomplicated course (P less than 0.05) . Resolution of allergic complications occurred within 14 days of their onset . Compared to Neisseria meningitidis groups A and C, group B strains appear to be intermediate in their potential for allergic complications associated with childhood infection. Zh Mikrobiol Epidemiol Immunobiol, 1981 Oct, (10), 48 - 52 {Experimental allergic encephalomyelitis in guinea pigs caused by meningococci}; Kanchurin AKh et al.; The sensitization of guinea-pigs with the mixture of meningococci and heterologous-cerebral tissue commonly induces the development of the typical clinical and pathomorphological picture of allergic encephalomyelitis . Unlike Mycobacterium tuberculosis and other acid-resistant bacterial and much like Bordetella pertussis, meningococci are capable of inducing allergic encephalomyelitis when introduced in mixture with oil without cerebral tissue . The vaccinal strain induces allergic encephalomyelitis with a more moderate course of the disease. Zh Mikrobiol Epidemiol Immunobiol, 1981 Oct, (10), 38 - 41 {Role of Streptococcus salivarius in maintaining the ecologic balance of the human nasopharynx}; Bochkov IA et al.; Most of Str . salivarius strains isolated from the nasopharynx of healthy persons suppressed the growth of meningococci in vitro . Their antagonistic activity varied within a wide range, which suggested that different strains were unequal in their capacity for protection from meningococcal infection . The monthly comparison of the activity of various strains also allowed revealing considerable differences . These results confirm the earlier hypothesis on the decisive role of Str . salivarius in the protection of the nasopharynx from colonization by meningococci. Infect Immun, 1981 Oct, 34(1), 144 - 6 Group C Neisseria meningitidis variant polysaccharide vaccines in children; Steinhoff MC et al.; The currently United States-licensed group C Neisseria meningitidis vaccine, composed of the O-acetyl-positive capsular polysaccharide, is poorly immunogenic and does not afford protection from disease to infants and young children . Group C N . meningitidis O-acetyl-negative polysaccharide vaccine induces higher titers in adults than does the O-acetyl-positive vaccine . We compared the immunogenicity of these vaccines in 2-year-old children . Reactions were minimal and did not differ between the two vaccines . The postvaccination geometric mean titer was twofold greater in the O-acetyl-negative group (1.58 versus 0.73 micrograms of antibody per ml) . The rates of decline in titer were similar in both groups . Further study regarding immunogenicity of and the anamnestic response to the O-acetyl-negative vaccine is warranted in the age group (less than 18 months) at highest risk for invasive meningococcal disease. Br J Vener Dis, 1981 Oct, 57(5), 315 - 9 Evaluation of the coagglutination test for the identification of Neisseria gonorrhoeae in primary cultures; Johnston NA; The coagglutination (COA) test for the identification of Neisseria gonorrhoeae was compared with immunofluorescence and sugar degradation tests on 1710 gonococcal isolates, 72 of which produce beta-lactamase . The COA test gave a positive result for 98.6% of the strains . Treatment of suspensions with Streptomyces enzyme reduced the incidence of inconclusive results due to autoagglutination to 1.2% . Cross-reactivity of the gonococcal antiserum was minimised by absorption with meningococci and Moraxella species . The COA provide a simple, quick, and reliable method for identifying N gonorrhoeae in culture. J Biol Chem, 1981 Sep 10, 256(17), 8915 - 21 Lipid on capsular polysaccharides of gram-negative bacteria; Gotschlich EC et al.; Hydrolysis of the meningococcal group A, B, and C, and Escherichia coli K92 polysaccharides by 60% aqueous hydrofluoric acid liberated various 1,2-diacylglycerols . These were extracted with chloroform, trimethylsilylated, and analyzed by gas chromatography-mass spectrometry . Two 1,2-diacylglycerols were the major components isolated . In each polysaccharide, 80 to 90% dipalmitoyl glycerol and 10 to 20% distearoyl glycerol were identified . No monoacylglycerols or mixed diacylglycerols were noted . The presence of the hydrophobic end causes the polysaccharides to aggregate in a micellar form and may be the entity by which the polysaccharide remains attached to the outer membrane of the bacterium giving rise to the structure recognized as a capsule. Scand J Haematol, 1981 Sep, 27(3), 219 - 23 Deactivation of leucocyte chemotaxis in vivo . Locomotion of cells isolated from a patient with meningococcal meningitis; Dahlgren C et al.; This report concerns the properties of polymorphonuclear leucocytes isolated from a patient with meningococcal meningitis . No differences in phagocytic capacity and random locomotion between the patient's polymorphonuclear leucocytes and normal PMNL were found, but by using activated normal human serum as chemo-attractant it was found that PMNL isolated from the cerebrospinal fluid had lost their ability to respond chemotactically . The deactivation was found to be accompanied by surface property changes of the cells. Res Commun Chem Pathol Pharmacol, 1981 Sep, 33(3), 395 - 402 Behavioural and body temperature effects of meningococcal lipopolysaccharide after intraventricular injection in adult fowls Gallus domesticus; Rotiroti D et al.; The effects of the meningococcal lipopolysaccharide (LPS), given into the II cerebral ventricle of adult fowls, were studied on behaviour and body temperature . Immediately after the administration a marked and dose- dependent behavioural sedation or sleep lasting over 2 hours or more according to the dose was observed . The body temperature effects of LPS were biphasic, i.e . and immediate initial phase of hypothermia lasting about 100 min, followed by a longer-lasting fever response . A pretreatment with phentolamine, an antagonist at alpha-adrenoceptors prevented the hypothermic phase following the endotoxin administration . In conclusion, present experiments show that in comparison to 0-somatic antigen of Shigella dysenteriae, meningococcal endotoxin possesses more marked behavioural effects and a different profile in body temperature effects. Arch Inst Pasteur Tunis, 1981 Sep-Dec, 58(3), 387 - 99 {Concern of the bacteriology laboratory in the diagnosis and surveillance of gonococcal and meningococcal infections}; Riou JY; The usual laboratory of bacteriology has an essential role in isolation, bacteriological diagnostic and testing of resistance towards antibiotics of gonococcal infections . Searching of beta-Lactamase will be carried out when inhibition diameters around penicillinase C disks will be inferior to 18 mm . The specialized laboratory will bring along useful information through the study of epidemiologic markers: auxotyping, plasmid characterization (connection with african types (2.6 and 3.7 M-daltons) and with South-East Asia (2.6; 4.5 and 24.5 M-daltons) and eventually serotypings by using proteins from outer-membrane . A similar action will be taken by all laboratories of bacteriology: isolation, identification, susceptibility searching and serogrouping from meningococci isolated from rhinopharynx and from C.S.F . or from blood culture . Eight groups whose specificities are carried by capsular polysaccharides are actually described (A, B, C, X, Y, Z, 29E and W135) . The electrosyneresis will be useful when bacteria will not be possible to isolate . Serotyping techniques whose importance is essential are still depending on specialized laboratory. J Immunol, 1981 Sep, 127(3), 1011 - 8 Immunochemistry of groups A, B, and C meningococcal polysaccharide-tetanus toxoid conjugates; Jennings HJ et al.; The successful coupling of the meningococcal groups A, B, and C polysaccharides to tetanus toxoid to yield water soluble conjugates is described . Reactive aldehyde groups were strategically introduced into the terminal residues of the polysaccharides by the controlled periodate oxidation of the native groups B and C polysaccharides and of the group A polysaccharide previously modified by the reduction of its terminal reducing N-acetyl-mannosamine residue . This produced essentially monovalent polysaccharide molecules, which were subsequently covalently linked to tetanus toxoid by means of reductive amination . Although the groups A and C polysaccharides proved to be poor immunogens in rabbits and mice, their tetanus toxoid conjugates produced high levels of polysaccharide-specific antibodies in both animals . By contrast, even in the form of its tetanus toxoid conjugate, the group B polysaccharide failed to elicit homologous polysaccharide-specific antibodies in either animal; a major proportion of the antibodies actually produced had a specificity for the linkage area of the conjugate . This evidence is compatible with the hypothesis of the poor immunogenicity of the group B polysaccharide being structure related . Hyperimmunization of mice with the groups A and C polysaccharide-tetanus toxoid conjugates produced antisera with good bactericidal activity against their respective homologous organisms, and indicated the potential of these conjugates as potential human vaccines. Zh Mikrobiol Epidemiol Immunobiol, 1981 Sep, (9), 29 - 32 {Use of ristomycin diffused into the culture medium for separation of meningococci from nasopharyngeal mucus}; Fel'dman IuM et al.; The method for enhancing the growth of meningococci after the inoculation of the specimens of nasopharyngeal mucus is proposed . The method is based on the diffusion of ristomycin into agar from ristomycin-impregnated filter paper strips . During the study of 694 specimens of nasopharyngeal mucus the above-mentioned method allowed isolation of 108 meningococcal cultures, while in serum agar only 21 cultures were isolated . The effectiveness coefficient of this method was found to be 80.6%, its effectiveness index being 5.1 . The method facilitated the isolation of meningococci and in some cases reduced the time of analysis by 1 day. S Afr Med J, 1981 Aug 15, 60(7), 271 - 5 Meningococcal disease at Tygerberg Hospital; Donald PR et al.; From June 1978 to November 1979, 298 patients with meningococcal disease were seen at Tygerberg Hospital, Parowvallei, CP . The manner of presentation, the diagnosis and some of the clinical features of these patients are reviewed and certain aspects discussed. Infect Immun, 1981 Aug, 33(2), 555 - 64 Ability of Neisseria gonorrhoeae, Neisseria meningitidis, and commensal Neisseria species to obtain iron from transferrin and iron compounds; Mickelsen PA et al.; The ability of Neisseria species to use iron compounds and to compete with iron-binding proteins was examined with deferrated defined medium and the iron chelator deferoxamine . All Neisseria species were able to assimilate a variety of ferric and ferrous iron salts . They were not able to efficiently solubilize an inorganic iron salt such as ferric nitrate, but were able to use iron chelated by citrate, oxalacetate, pyrophosphate, or nitrilotriacetate . Each of the 95 Neisseria isolates examined was able to use hemin as a sole source of iron, and most, but not all, of the isolates were able to obtain iron from hemoglobin . Heated human serum stimulated growth of all gonococci, meningococci, and some commensal Neisseria species in iron-deficient medium . All gonococci and meningococci were able to scavenge iron from 25% saturated transferrin, whereas most commensal organisms were inhibited by this iron-binding protein . The ability to compete with transferrin was specific, since partially saturated conalbumin was bacteriostatic for all Neisseria species . Although the pathogenic Neisseria species were able to compete more efficiently with transferrin for iron than were the nonpathogenic Neisseria species, no correlation was observed between the virulence of different strains or colony types of gonococci and the ability to scavenge iron in vitro from transferrin or other chelators. Carbohydr Res, 1981 Aug 1, 94(2), 193 - 203 Sialic acid polysaccharide antigens of Neisseria meningitidis and Escherichia coli: esterification between adjacent residues; Lifely MR et al.; Colominic acid and meningococcal Group B polysaccharide, both (2 leads to 8)-alpha-linked homopolymers of sialic acid, are made water-insoluble either by reaction with a carbodiimide in aqueous solution at pH 4.75 or by treatment with 48% aqueous hydrofluoric acid at 0 degrees for 48 h . I.r . spectra of the products show a major band near 1750 cm-1, consistent with ester formation; this band virtually disappears after mild, alkali treatment . Esterification also occurs by incubating the native polysaccharides below pH 6.0, and their i.r . spectra show that the degree of esterification increases as the pH is lowered . The relatively low molecular weight of these partially esterified, water-soluble polymers is consistent with intra- rather than inter-molecular ester formation . Counter-current immunoelectrophoresis shows that esterification of approximately 9% is sufficient to abolish immunoprecipitation . 13C-N.m.r . spectroscopy of fully esterified colominic acid provides strong evidence for cross-linking between the carboxyl group of one residue and HO-9 of an adjoining residue . Meningococcal serogroup C polysaccharide, a (2 leads to 9)-alpha-linked homopolymer of sialic acid containing O-acetyl groups at C-7 and/or C-8, does not undergo intramolecular esterification after carbodiimide treatment . However, upon O-deacetylation of the polysaccharide, esterification occurs. Br J Vener Dis, 1981 Aug, 57(4), 253 - 5 Wheat-germ agglutination of Neisseria gonorrhoeae . A laboratory investigation; Curtis GD et al.; Wheat-germ agglutination (WGA) was used to identify 168 strains of Neisseria gonorrhoeae and 105 strains of other Neisseria species in a routine laboratory . About one-third of the meningococci reacted with the lectin and titres with some organisms varied on repeat testing . The technique is regarded as unreliable for the identification of Neisseria species. Arch Otolaryngol, 1981 Aug, 107(8), 518 - 9 Tonsillitis due to neisseria meningitidis . Its treatment with rifampin; Dudley JP et al.; The Neisseria species with which most otolaryngologists are familiar is N gonorrhoeae, which can cause acute pharyngitis or tonsillitis . Less well known is N meningitidis, responsible for potentially fatal meningococcal meningitis and meningococcemia . Although present in the carrier state in the pharynx of asymptomatic individuals, N meningitidis previously has not been associated with symptomatic pharyngeal or tonsillar disease . Its isolation from a patient with acute tonsillitis and failure to eliminate the symptoms and organism with penicillin led to use of rifampin . Disappearance of sore throat following use of this antibiotic and inability at completion of therapy to isolate the organism from a homogenate of excised tonsil would appear to implicate the organism as a cause of acute pharyngeal and tonsillar infection . It should be added to the list of organisms capable of producing acute tonsillitis, and rifampin should be considered a chemotherapeutic agent. Nouv Presse Med, 1981 Jul 4, 10(29), 2427 - 30 {The latex agglutination test for the diagnosis of meningococcal A and C, pneumococcal and H . influenzae b meningitis . A study of 920 purulent cerebrospinal fluids (author's transl)}; Denis F et al.; The cerebrospinal fluids of 920 Senegalese patients with purulent meningitis wee examined by latex particle agglutination (LA) and the results were compared with those of conventional bacteriology and of counter immuno electro phoresis (C.I.E.) . For all three organisms taken globally, CSF culture was positive in 72.7% of the patients, the LA test in 78.8% and the C.I.E . test in 89.0% . The LA test was positive in 17.9% of subjects with negative CSF culture . When the results wee analysed for each organism separately, the LA test was positive in 69.3%, 74.7% and 85.9% respectively of patients with meningococcal, pneumococcal and H . influenzae b meningitis . False agglutinations were found in 6.7% of meningitis due to other pathogens . Cross-reactions and autoagglutinations were rare (0.4% and 3.7% respectively) . The sensitivity, specificity, simplicity and rapidity of the LA test make it extremely useful for the diagnosis of purulent meningitis, particularly in Africa. Zh Mikrobiol Epidemiol Immunobiol, 1981 Jul, (7), 59 - 63 {Various aspects of humoral immunity in meningococcal infections . II . Formation of antibodies to group A meningococci in adults with generalized meningococcal infections}; Golovina LI et al.; Altogether 258 serum samples obtained from 102 patients with generalized meningococcal infection were studied by means of the immune bacteriolysis test and the indirect hemagglutination test . This study revealed a pronounced increase in the titer of bactericidal and hemagglutinating antibodies to group A meningococcus in the process of the disease . The dynamics and intensity of antibody formation, revealed by means of the two tests, were found to be in complete correspondence . Antibody formation was most intensive in meningitis accompanied by meningococcemia . In most cases these antibodies were found to belong to the class of IgM on account of their physico-chemical nature . The highest bactericidal activity was found in the sera with high hemagglutinin titers; the summary titers of these sera were 4-64 times higher than the titers of cystein-resistant antibodies. Infect Control, 1981 Jul-Aug, 2(4), 312 - 4 Recurrent meningococcal meningitis caused by poly groups X-W135: importance of chemoprophylaxis; Jacobs RF et al.; Presented is a case report and literature review of the causes of recurrent meningococcal meningitis . After all factors were analyzed, the cause of reinfection in this child was postulated to be ineffective chemoprophylaxis of close contacts following the initial episode . The efficacy of chemoprophylaxis in household members and close contacts in meningococcal disease, although not demonstrated in controlled trials, has been recommended since 1974 by the Meningococcal Disease Surveillance Group . Considering known carriage rates, reports of secondary infections in close contacts, reinfection in the same person, and a high case fatality ratio, chemoprophylaxis in such cases seems justified. Can J Microbiol, 1981 Jul, 27(7), 738 - 41 Differences in virulence for mice between disease and carrier strains of Neisseria meningitidis; Holbein BE; The virulence of 11 prototype strains of Neisseria meningitidis, which had been used in the development of the serotyping scheme for serogroup B meningococci, were examined in mice treated with iron dextran . These strains, together with those previously examined, allowed for a good assessment of the virulence differences between carrier and disease strains . All of a total of 17 disease strains displayed virulence for mice (60% with high virulence), whereas only approximately 50% of 13 carrier strains possessed virulence (only 15% with high virulence) . Because the ability to initiate infection in mice is independent of exogenous iron, this model system for infection appears particularly suited to studies of the physiological bases for virulence in N . meningitidis. Isr J Med Sci, 1981 Jul, 17(7), 678 - 81 Protective efficacy of Mycoplasma pneumoniae polysaccharides; Brunner H; Mycoplasma pneumoniae accounts for up to 35% of all pneumonias at times when influenza epidemics are not prevalent . Therefore, considerable efforts have been directed towards the developmemt of a vaccine against mycoplasmal respiratory tract disease . The protective efficacy of inactivated M . pneumoniae vaccine, prepared so far, did not exceed 67% . This incomplete protective effect may have been due to insufficient immunogenicity and/or to failure of vaccines administered by the parenteral route to stimulate local immune mechanisms on the mucosal surfaces of the respiratory tract . Intranasal inoculation of attenuated strains, either of high passage level on artificial medium or temperature-sensitive mutants, were therefore tested as vaccine candidates for M . pneumoniae disease, but the attenuation for man, achieved so far, was not sufficient . Therefore, the successful development of polysaccharide vaccines for pneumococcal and meningococcal diseases stimulated a study on similar approaches for the development of the prophylaxis for mycoplasma pneumonia . The immunogenicity and the protective efficacy of M . pneumoniae polysaccharides and glycolipids were investigated in hamsters . Staphylococcal radioimmunoassay antibodies could be detected in the sera of the animals after intramuscular injection of M . pneumoniae polysaccharides . A significant reduction in the lung lesion score and in the number of viable organisms in the lung was observed in animals immunized with polysaccharides by the intramuscular or intranasal route, 10 d after challenge with virulent organisms . A protective effect was not seen in animals previously immunized with reaggregates of M . pneumoniae glycolipids and membrane protein of Acholeplasma laidlawii, although serum antibodies could be detected prior to challenge . The results encourage the continuation of experiments on polysaccharides as vaccines against mycoplasmal pneumonia. J Clin Microbiol, 1981 Jul, 14(1), 20 - 3 Enhancement of recovery of Neisseria meningitidis by gelatin in blood culture media; Pai CH et al.; The efficacy of gelatin for the recovery of Neisseria meningitidis from blood cultures was evaluated in a clinical setting . The organism was isolated from seven patients with meningococcal infections in blood culture media containing 1% gelatin . In contrast, only two blood cultures from these patients were positive in media without gelatin (P less than 0.05) . Gelatin did not influence the recovery of other organisms isolated during this study . Conventional blood culture media may be supplemented with gelatin when meningococcemia is suspected. Infect Immun, 1981 Jul, 33(1), 59 - 66 Increased virulence of Neisseria meningitidis after in vitro iron-limited growth at low pH; Brener D et al.; At low pH (6.6) and under conditions of iron limitation, Neisseria meningitidis group B (strain SD1C) exhibited an atypical outer membrane protein profile and an increased relative virulence for the mouse . Cells grown in a buffered medium were effectively deprived of iron by the addition of ethylenediamine-diorthohydroxyphenylacetate . The pH of the medium selected for characteristic colonial morphologies: type M3 predominated at pH 6.6, and type M5 predominated at pH 7.7 . A mixed population of M1, M3, and M5 colonies was observed at pH 7.2 . Isolated outer membrane proteins were analyzed by sodium dodecyl 99 99 sulfate-polyacrylamide gel electrophoresis, and surface exposed proteins were labeled by the {125I}lactoperoxidase method and subsequently identified by autoradiography . Cells grown at pH 6.6 elaborated a major outer membrane protein (protein III; molecular weight, 69,000), which was also present in the outer membrane of iron-limited cells grown at pH 7.2 . At pH 7.2 in an iron-sufficient medium, protein III was present only in small quantities in sodium dodecyl sulfate-polyacrylamide gel was present only in small quantities in sodium dodecyl sulfate-polyacrylamide gel electrophoresis gels . A study of the relative virulence (50% lethal dose) of the meningococcus for C57/BL mice revealed that iron-limited cells grown at low pH had an increased relative virulence 1,200-fold (50% lethal dose, 4.0 CFU) greater than that of cells grown in the same medium but at pH 7.2 and with sufficient iron . These studies indicate that pH and iron can be important factors in the determination of meningococcal virulence. Zh Mikrobiol Epidemiol Immunobiol, 1981 Jun, (6), 67 - 71 {Parameters for constructing a test system for the isoenzymatic detection of meningococcal antibodies}; Semina NA et al.; The optimum conditions for the detection of specific humoral antibodies in patients with meningococcal infection by the immunoenzymatic method have been determined: the sensitizing dose of the antigen is 20 microgram of protein per 1 ml for group A meningococcal antigen and 25 microgram of protein per 1 ml for group C meningococcal antigen, the pH of the buffer solutions is 5.0-6.0 for group A meningococcal antigen and 12.0 for group C meningococcal antigen, the time and temperature of incubation should be 18-20 hours at 14 degrees C . The diagnostic test system developed in this research is capable of detecting antibodies with the accuracy of several ng. Pediatrics, 1