Ann Sclavo, 1979 May-Jun, 21(3), 307 - 46 {Vaccine prophylaxis and chemoprophylaxis of cerebrospinal meningitis}; Soscia M; The Author points up a review on the argument accordingly to the most recent literatur . Particularly are treated the status of meningococcal vaccines anti-A, C and Y groups (their preparations and trends in Field-trials), and the status of proteic vaccines anti-B . In the second part the most important substances in chemio-antibiotic prophylaxis are considered (rifampin, minocyclin, sulphadiazine, TMP, etc.) accordingly to their efficacy, safety and side-effects . The status of the perspectives on the control of the desease is discussed at the end. An Esp Pediatr, 1979 May, 12(5), 411 - 8 {Acute meningococcal infection (author's transl)}; Perez-Yarza EG et al.; Authors report 49 patients bacteriologicallyly diagnosed of acute meningococcal infection collected during a 12 months period out of a series of 76 cases diagnosed on clinical grounds . "N . meningitidis" was found in 18 blood and 43 CSF cultures . 31 cases were of the B-group, one was A-group and 17 were not typed . All of them were sulphamide resistant . Hyperthermia with vomiting, cephalea, arthralgia and seizures were the initial symptoms . All patients showed pettechiae, purpura and/or ecchymoses . Endotoxic shock was diagnosed in 26,5% of the cases . In them systolic blood pressures were under p-5 . Overall mortality was 14%, and that of endotoxic patients 53% . Therapeutic routines and chemoprophylaxis are reviewed. Am J Epidemiol, 1979 May, 109(5), 563 - 71 Meningococcal colonization and infection in children and their household contacts; Marks MI et al.; A bacteriologic survey was performed to estimate the prevalence and duration of meningococcal carriage in children in Montreal, Canada . Infants and children with proven meningococcal infection, or with asymptomatic meningococcal nasopharyngeal (NP) carriage, and their household contacts, were also studied to define communicability . N . meningitidis was present in 30 (2.4%) of the NP cultures from 1238 asymptomatic infants and children in this civilian population during a non-epidemic period . Meningococcal carriage was not found in 278 subjects 1--60 days of age; there was no difference in carriage rates between the sexes and between hospitalized and non-hospitalized children in all age groups . Meningococci were initially isolated from 11 of 106 household contacts of 29 ill index cases and from 15 of 104 contacts of 29 asymptomatic carriers; 35% of all contacts (index cases and carriers) were colonized by the eighth week of surveillance . Duration of NP carriage was longer (mean 15.2 weeks) in disease-free families than in families of ill patients (mean 5.5 weeks) . Serogroups B and C were most commonly isolated from both ill and asymptomatic subjects . Resistance to sulfadiazine (MIC greater than or equal to mg/100 ml) was present in 6.5% and 39.4% of group B and group C strains, respectively . Although chemoprophylaxis was not used, there were no secondary cases among the 29 families of index cases. J Pediatr, 1979 May, 94(5), 828 - 32 Further characterization of responses of infants and children to meningococcal A polysaccharide vaccine; Wilkins J et al.; The responses to 10 or 50 microgram doses of meningococcal group A polysaccharide vaccine were evaluated in infants and children . Although the 50 microgram dose was shown to be more effective in the induction of detectable anti-A antibody in vaccinees of all ages, only 6.5% (7/108) of infants smaller than or equal to 12 months demonstrated a "protective level" (greater than or equal to 2 mug/ml antibody protein) at 28 or 35 days postinoculation . Unexpected variations in the response to different lots, supplied by three different manufactures, were observed . These findings indicate the need for additional studies before routine immunization of young infants can be recommended. Arch Ophthalmol, 1979 May, 97(5), 890 - 1 Meningococcal conjunctivitis; Brook I et al.; Meningococcal conjunctivitis is typically described as an acute purulent infection . An atypical case of mild catarrhal conjunctivitis occurred in a 19-year-old college student . The meningococci were identified as Neisseria meningitidis, group A, and were isolated from the throats of the patient and her roommate . The conjunctivitis responded rapidly to treatment with sodium sulfacetamide, and it was not treated systemically . A short review of the literature of meningococcal conjunctivitis is presented, and the current recommendation for prophylaxis is discussed. J Bacteriol, 1979 May, 138(2), 320 - 3 Metabolism of pyrimidine bases and nucleosides in Neisseria meningitidis; Jyssum S et al.; In Neisseria meningitidis, uridine, deoxyuridine, cytosine, cytidine, or deoxycytidine could not be used by uracil-requiring mutants as pyrimidine sources . Consistent with these findings, only 5-fluorouracil of the different fluoropyrimidine bases and nucleosides showed any inhibitory effect on the growth of four prototrophic strains of N . meningitidis . Likewise, only radioactive uracil was readily incorporated into nucleic acids, whereas uptake of radioactive uridine, cytosine, or cytidine could not be demonstrated . Uracil was converted to uridine 5'-monophosphate by uracil phosphoribosyltransferase, whereas enzyme activities for conversion of cytosine or any of the nucleosides were not detectable in meningococcal extracts. J Clin Microbiol, 1979 Apr, 9(4), 547 - 8 Serogroup identification of meningococci by a modified antiserum agar method; Craven DE et al.; Modifications in the antiserum agar method for serogroup identification of meningococci, which reduce the amount of group-specific antisera required and increase long-term storage of prepoured antiserum agar plates, are described. Infect Immun, 1979 Apr, 24(1), 194 - 201 Pili of Neisseria meningitidis: effect of media on maintenance of piliation, characteristics of Pili, and colonial morphology; McGee ZA et al.; In contrast to information in the literature which indicates that meningococci rapidly lose pili upon cultivation in vitro, we found that piliation of meningococci could be maintained in vitro for 15 or more passages . Pili were present on all eight isolates tested, whether from asymptomatic carriers or from subjects with meningococcal disease . Complete loss of piliation occurred in the same two strains on two of the three media tested . On one medium (Thayer-Martin medium with supplement B), there was partial or complete loss of pili by all strains . The optimal medium for maintaining pili was chocolate agar with 1% IsoVitaleX; 95% or more of the microorganisms of six of the eight strains tested were piliated after 15 passages in vitro, and more than 60% of the microorganisms of the other two strains were piliated . Meningococci passed on this medium generally maintained their initial density of piliation (3 to 34 pili per diplococcus) . The ability to predictably cultivate piliated meningococci in vitro and to select piliated and nonpiliated clones of the same strain should allow investigation of the biochemical and immunological properties of meningococcal pili as well as their possible role in the pathogenicity of Neisseria meningitidis. Am J Ophthalmol, 1979 Apr, 87(4), 567 - 8 Medical therapy of metastatic meningococcal endophthalmitis; Jay WM et al.; We treated a 15-year-old girl who had meningococcal meningitis and metastatic endophthalmitis with large doses of intravenously administered penicillin G . The patient promptly improved with this therapy, and the visual axis completely cleared during the subsequent five months. Acta Pathol Microbiol Scand {B}, 1979 Apr, 87B(2), 103 - 7 The interaction of penicillin and chloramphenicol against meningococci in vitro; Solberg O et al.; Combinations of penicillin and chloramphenicol are frequently used initially in the treatment of bacterial meningitis . The simultaneous effects against meningococci of these two drugs were examined in vitro in a chemically defined, proteinfree medium . The investigation was performed with different combinations of the antibiotics, including optimal concentrations . In most instances, penicillin and chloramphenicol seemed to have an additive, but not an iso-additive, effect . No antagonism was found, and only one out of nine strains showed indifference. Zh Mikrobiol Epidemiol Immunobiol, 1979 Apr, (4), 101 - 4 {Biological and chemical characteristics of allergen preparations from Neisseria (N . meningitidis, N . gonorrhoeae, N . perflava)}; Runova VF et al.; Various methods of isolating allergen fractions from N . meningitidis, N . gonorrhoeae and N . perflava were tested . The biological activity of the preparation was found to depend on the method of its production, which determined its chemical composition . When gonococcal and meningococcal allergens and N . perflava allergen were used in skin tests, cross reactions were observed . Nevertheless, as the intensity and size of skin reaction was much greater when a homologous preparation was administered, it was possible to differentiate the presence of sensitization to a definite microbial species . Electrophoresis in acrylamide gel revealed the heterogeneity of allergen preparations . The ability of the preparation to induce skin reaction was not connected with its serological properties. Clin Pediatr (Phila), 1979 Apr, 18(4), 233 - 4 Primary meningococcal conjunctivitis in an infant; Zagorzycki MT et al.; A case of primary meningococcal conjunctivitis in an infant was presented and its treatment is discussed . Because of the potential for systemic spread of the infection in the patient, local and systemic therapy was instituted . The current literature on meningococcal conjunctivitis with its potential complications is briefly reviewed. J Clin Lab Immunol, 1979 Apr, 2(1), 31 - 6 Occurrence of M-proteins in the CSF of a child with prolonged meningococcal meningitis; Siemes H et al.; CSF of a 4-month-old boy with prolonged, meningococcal meningitis revealed oligoclonal immunoglobulin G about 10 weeks after hospital admission . These proteins persisted for at least 4 months . In contrast to this child, a further 10 infants and young children with bacterial meningitis, whose CSF was examined between 4 weeks and 6 3/4 months subsequent to onset of the disease, showed no such abnormality . Since the presented boy was the only patient treated with a corticosteroid, his altered immune reaction could be related to the immunosuppressive effect of this drug. Bol Med Hosp Infant Mex, 1979 Mar-Apr, 36(2), 279 - 86 {Meningococcal meningitis in Costa Rica, 1970--1973 . Epidemiological study}; Feldman RA et al.; A retrospective hospital chart review of meningococcal meningitis cases in Costa Rica revealed a large number of cases confirmed in the laboratory by Gram-stained smear and/or culture of spinal fluid . A large percentage of the isolates studied were serogroup C and all of these were sulfonamide resistant . The age-specific attack rates were high in the preschool children with the highest attack rate in children 3 to 5 months of age . Case fatality ratios were 14% overall, with the low fatality rates in individuals 10 to 29 years of age . The outbreak of serogroup C meningitis in 1970--1971 was relatively brief, country-wide, and not predominantly a urban outbreak . The few secondary cases observed occurred within the first 2 weeks of the primary case. J Clin Pathol, 1979 Feb, 32(2), 136 - 42 Rapid serotyping of groups A, B, and C meningococci by rocket-line immunoelectrophoresis and co-agglutination; Danielsson D et al.; Rocket-line immunoelectrophoresis (R-LIE) with antigen containing intermediate gel, and co-agglutination utilising protein A-containing staphylococci coated with specific antibodies, were adapted for serotyping the prototypes of group B meningococci . Both were found to have the same specificity as agar gel double diffusion (AGDD) but they were more sensitive and more rapid than AGDD . R-LIE required, like AGDD, the extraction of relatively large quantities of bacteria, while the co-agglutination method, performed as a slide agglutination tests with results within a few minutes and no need of special equipment, required only a small amount of heated whole meningococcal cells . Meningococcal strains of serogroups B, C, and A from patients with carriers were serotyped and the results with all three methods were in agreement. J Med Microbiol, 1979 Feb, 12(1), 107 - 11 Development of antibodies to meningococcal protein and lipopolysaccharide serotype antigens in healthy-carriers; Jones DM et al.; The nasopharyngeal acquisition of meningococci was followed in healthy military recruits during their primary training . The production of antibodies to meningococcal serotype protein antigens and serotype lipopolysaccharide antigens accompanied the carrier state . Bactericidal antibody to protein serotype 2 was generated in response to the carriage of meningococci of low virulence that carried this antigen. J Clin Microbiol, 1979 Feb, 9(2), 186 - 8 Serotypes of Neisseria meningitidis isolated from patients in Norway during the first six months of 1978; Holten E; During the first 6 months of 1978, 114 strains of Neisseria meningitidis isolated from patients in Norway were serotyped . Among 27 group C strains, type 2 was most common, whereas 82% of the 82 group B isolates did not react with antisera to the standard serotypes 1 to 12 . These strains were shown to belong to a new serotype, type 15 . Also some group A and C strains had the type 15 antigen . Investigations on a possible immunoprophylaxis against group B meningococcal disease in Norway should accordingly proceed with type 15 rather than with type 2 meningococci. Br J Vener Dis, 1979 Feb, 55(1), 14 - 9 Pharyngeal colonisation by Neisseria gonorrhoeae and Neisseria meningitidis in black and white patients attending a venereal disease clinic; Noble RC et al.; Pharyngeal colonisation by Neisseria gonorrhoeae and Neisseria meningitidis was studies in 2000 patients attending a venereal disease clinic . Of these patients, 64% were white and 36% were black . The incidence of gonococcal infections was highest in the period from June to August . The incidence of genital or rectal infections or both was higher in the black patients . Pharyngeal colonisation by gonococci was present in 1.3% of the patients . There was no significant associations between pharyngeal colonisation and the pharyngeal symptoms, race, sex, or marital state of the patients . Pharyngeal colonisation was more frequent in patients with gonococcal infections at other sites . However, in 40.7% of the patients with pharyngeal colonisation, the pharynx was the only culture-positive site . There was no significant difference in the auxotypes or in the antibiotic susceptibility of the pharyngeal and the rectal-genital isolates except in the susceptibility to spectinomycin . Our findings do not indicate that gonococci isolated from the pharynx differ significantly from gonococci isolated from rectal or genital sites . It was notable that meningococcal colonisation of the pharynx was significantly more frequent in the white patients . This may be a genetically determined phenomenon. Can Med Assoc J, 1979 Jan 20, 120(2), 155 - 8 Meningococcal meningitis in children; Ellsworth J et al.; Forty-four cases of meningococcal meningitis in children at one hospital between 1971 and 1975 inclusive were studied to document the course and complications of this disease in children in the current therapeutic era . The mortality was 5% . Of the 41 survivors 76% were healthy 1 to 5 years after the episode of meningitis . Permanent severe sequelae (facial palsy, optic atrophy and ptosis) were seen in three (7%) of the survivors, and mild hearing loss, hyperactivity and nervousness were noted in seven (17%) . Electroencephalography was not useful in determining management or prognosis . Both the mortality and the frequency of early and late complications among the survivors were lower than those reported from earlier studies. Chir Pediatr, 1979, 20(6), 445 - 7 {Multiple extremities gangrene as complications of meningococcemia (author's transl)}; Delmas P et al.; Five limb extremities gangrene are reported in 54 meningococcemia . Prognosis depends first on early medical treatment . Extremities ischemia require large early aponeurotomy for limb preservation. Trans R Soc Trop Med Hyg, 1979, 73(6), 698 - 702 Single injection treatment of meningococcal meningitis . 2 . Long-acting chloramphenicol; Wali SS et al.; A single injection of a long-acting oily preparation of chloramphenicol (Tifomycine) was compared with a five-day course of crystalline and procaine penicillin in the treatment of 131 adult patients with meningococcal meningitis . The clinical response to treatment was similar in the two groups of patients . Serial lumbar punctures showed a parallel fall in CSF cell count, protein and lactate and all posttreatment cultures were sterile . Single injection chloramphenicol treatment was cheaper and much easier to administer than penicillin . Long-acting chloramphenicol is thus an effective form of treatment for meningococcal meningitis and is likely to prove of particular value in the management of epidemics in areas with limited medical resources. Trans R Soc Trop Med Hyg, 1979, 73(6), 693 - 7 Single injection treatment of meningococcal meningitis . 1 . Long-acting penicillin; Macfarlane JT et al.; A single injection of a long-acting preparation of penicillin (Triplopen) was compared with a five-day course of crystalline and procaine penicillin in the treatment of meningococcal meningitis . The clinical response of patients treated with Triplopen was very similar to that of patients treated with crystalline penicillin and much more convenient to administer . However, four patients treated with Triplopen had a positive CSF culture 48 or 72 hours after their injection . One injection of Triplopen cannot, therefore, be recommended as an entirely safe form of treatment for meningococcal meningitis unless patients can be carefully followed. Trans R Soc Trop Med Hyg, 1979, 73(5), 567 - 73 An epidemic of meningococcal infection at Zaria, Northern Nigeria . 3 . Meningococcal carriage; Hassan-King M et al.; Meningococcal carriage was studied in household contacts of patients with group A meningococcal disease and in controls . The carriage rate of group A meningococci among 1,098 household contacts was low (3.8%) and only slightly higher than the carriage rate found among 416 controls (2.6%) . However, higher carrier rates were found among those in close contact with a patient . Carriage was found most frequently among children and young adults and was commoner in adult females than in adult males . Sulphonamides had no effect on carriage and all 60 strains tested in vitro were resistant to sodium sulphadiazine at a concentration of 10 micrograms/ml. Trans R Soc Trop Med Hyg, 1979, 73(5), 563 - 6 An epidemic of meningococcal infection at Zaria, Northern Nigeria . 2 . The changing clinical pattern; Greenwood BM et al.; 1,003 patients with meningococcal disease admitted to a single hospital during the course of a three-month epidemic were studied . A progressive decline in mortality, especially among patients with acute meningococcaemia, and a falling incidence of systemic and severe neurological complications among patients with meningitis were observed . It is suggested that the virulence of the causative group A meningococcus declined as the epidemic progressed. Trans R Soc Trop Med Hyg, 1979, 73(5), 557 - 62 An epidemic of meningococcal infection at Zaria, Northern Nigeria . 1 . General epidemiological features; Greenwood BM et al.; In 1977 Zaria, in Northern Nigeria, was affected by a severe epidemic of group A meningococcal infection, 1,257 patients being admitted to hospital with the disease during a three-month period . The epidemic started towards the end of the dry season when it was hot, dry and dusty and finished shortly after the onset of the rains . The over-all attack rate was 3.6 per 1,000 but this varied considerably from area to area within the town . Few cases occurred amongst those belonging to the upper social classes . The disease was seen most frequently amongst those from five to 14 years old and there was a strong male preponderance . The over-all mortality was 8.3% but mortality was much higher (40.6%) amongst 67 patients with acute meningococcaemia. Scand J Infect Dis, 1979, 11(3), 229 - 32 Evaluation of spiramycin in meningococcal carriage; Kamme C et al.; Spiramycin was administered to healthy carriers of meningococci in doses of 1.5 g twice daily or 2.5 g once daily for 3 days, or 1.5 g once daily for 10 days . Meningococci were eliminated from the nasopharynx and throat in approximately 50% of the carriers with all dose schedules . In the remaining carriers only a temporary suppression of the strain was achieved . Elimination occurred only in carriers where spiramycin saliva concentrations reached or surpassed the MIC value of respective strain for 42 h or more . Evidence of reinfection from close contacts was not obtained . Due to side effects the dose of spiramycin could not be increased . Further trials with spiramycin as the sole agent for eliminating meningococci in carriers do not seem warranted. Paediatrician, 1979, 8 Suppl 1, 26 - 36 Vaccinations against bacterial infections; Ocklitz HW; The achieved or achievable standard of vaccination measures against bacterial infections is discussed with reference to 3 groups of vaccines . The first group involves well established and commonly used vaccines such as BCG and DPT vaccines . The second group includes newer vaccines or vaccines that are under development, for instance vaccines against meningococci, pneumococci, H . influenzae and enteropathogenic E . coli . The third group covers vaccines whose realisation at present appears to be difficult or hardly feasible, for instance vaccines against enterotoxins of enteropathogenic organisms, against lues, gonorrhea or, example, against organisms of hospital infections. Scand J Infect Dis, 1979, 11(2), 121 - 3 Hearing impairment in meningococcal meningitis; Habib RG et al.; Hearing affection as a sequel of meningococcal meningitis and its relation to age, sex, severity and duration of disease was studied in Cairo, Egypt during the period December 1966--December 1973 . The total incidence of impaired hearing in the 775 cases was 5.8% . This incidence was higher in the younger age groups, females, severe cases of meningitis and in patients who received specific therapy shortly after the onset of signs and symptoms of the disease . The aetiology of hearing impairment in meningitis was reviewed. Arch Dis Child, 1979 Jan, 54(1), 44 - 8 Prognostic factors in acute meningococcaemia; Lewis LS; During a meningococcal (group A) epidemic, 47 Nigerian children with acute meningococcaemia without meningitis were studied . Their mortality rate was 43% compared with 8% during the whole epidemic . Those presenting with coma and shock had a mortality of 93%, but without shock or coma mortality was only 6% . Coma or shock occurring alone carried an intermediate prognosis . The outcome correlated with initial serum antigen titre, but not with the serum levels of endotoxin, cortisol, or fibrin degradation products . Chloramphenicol was as effective as penicillin . A predictor of expected mortality, based on serum antigen titre and the presence of coma or shock, may allow new forms of treatment to be assessed. Padiatr Grenzgeb, 1979, 18(3), 137 - 46 Vaccinations against bacterial infections; Ocklitz HW; 1 . As with any therapeutic measure, prophylactic vaccination is to be jugded by the correlation between benefit and harm or expenditure . By benefit is meant a not to short-lived substantial decrease in the morbidity and/or mortality . Harm refers to the number and severity of side effects in the individual child vaccinated and expenditure means the economic burden placed upon society . 2 . The evaluation of many vaccinations at present varies between two extremes: On the one hand vaccination procedures are considered to provide an opportunity to eradicate most of the infectious diseases, on the other hand there is a tendency to assess side effects more drastically the more likely the danger of the particular disease seems eliminated once and for all . 3 . An attempt is made to discuss the achieved or achievable standard of vaccination measures against bacterial infections in the light of 3 classes of vaccines . The first class involves well established and commonly used vaccines such as BCG and DPT vaccines although differences in opinion exist on their future employment . 4 . The second class involves newer vaccines or vaccines that are under development as for instance vaccines against meningococci, pneumococci, H . influenzae and enteropathogenic E . coli . 5 . The third class includes vaccines whose realisation at present appears to be yet difficult or hardly feasible, for instance vaccines against enterotoxins of enteropathogenic organisms, against lues, gonorrhea or for example against organisms of the infectious hospitalism. Scand J Infect Dis, 1979, 11(2), 111 - 9 Meningitis and bacteremia due to Neisseria meningitidis: clinical and laboratory findings in 69 cases from Orebro county, 1965 to 1977; Olcen P et al.; The records for 69 patients with meningococcal disease during 13 years in Orebro County were reviewed . The mean incidence during this period was 2.0/100 000 persons/year . The age group less than 1 year had the highest incidence, 15/100 000 infants/year . The mortality was 7.2% and sequelae were found in 13% of the patients . Four factors were significantly more frequent in the 7 patients with psycho-neurological sequelae: (1) Age greater than 40 years; (2) A condition prior to meningococcal disease that might have been associated with a lowered resistance; (3) Muscular hypertonia and/or marked irritability on admission; (4) Fever greater than 8 days after initiation of adequate treatment . Prodromal symptoms from the upper respiratory tract were noted in 50% of the cases . Signs and symptoms before and on admission, laboratory data and complicating events were analysed for each of 4 groups: meningitis without meningococcemia (12 patients); meningitis with meningococcemia (46): fulminant meningococcemia without meningitis (6); and benign meningococcemia (5). Med Trop (Mars), 1979 Jan-Feb, 39(1), 71 - 9 {A study of the serological response of Sudanese children to three associated immunizations (measles, tetanus, meningococcal A meningitis) (author's transl)}; Lapeyssonnie L et al.; The authors first emphasize the efficiency and economic value of associated immunizations in developping countries . They report the first data collected in a campaign of immunization with a single injection of an extemporaneous mixture of antimeasles, antitetanus and antimeningococcal meningitis vaccines . This campaign took place in the Republic of Suddan from may 1976 to july 1977 and concerned 87 children . The specifications of each vaccine as well as the procedures of vaccination and serological control are given . The study of serological rates shows: -- a good response for measles with, in Africa, an optimal age of 6 months and a new injection 6 months later; -- a low and late antibodies rise in tetanus with a good immunological memory giving way to an acute rise under a 2nd injection one year later; -- an immediate increase of the basic low rate of meningococcic antibodies existing in most Suddanese children before the injection . The authors consider the advantage of using also anti C meningococcal vaccine and to add an inactivated poliomyelitic vaccine . They give notice of the good stability in tropical environment of the vaccinal mixture they used. Can J Ophthalmol, 1979 Jan, 14(1), 51 - 2 Isolation of meningococci in meningococcal endophthalmitis; MacBeath DL et al.; We describe a case of bilateral hypopyon in a 7-year-old African male receiving systemic antibiotic therapy for meningococcal meningitis . Aqueous from paracentesis of the left eye contained intra- and extra-cellular Gram negative diplococci . We believe this is the first report of isolation of the organism since the advent of antibiotic treatment. J Clin Microbiol, 1978 Dec, 8(6), 748 - 55 Phagocytic resistance of Escherichia coli K-1 isolates and relationship to virulence; Weinstein R et al.; Blood culture isolates from 133 episodes of Escherichia coli bacteremia were typed for K-1 capsular antigen by immunodiffusion, utilizing equine antiserum raised against meningococcal group B polysaccharide . Twenty-six percent (34 of 133) of these isolates were positive for K-1 antigen . These 133 strains, 34 K-1 and 99 non-K-1, were tested for susceptibility to phagocytosis . K-1 strains were found to be more resistant to clearance (27%) than non-K-1 strains (71%) when tested in an in vitro opsonophagocytic/killing assay containing normal human granulocytes and plasma . Additional studies demonstrated that resistance was due to decreased phagocytosis rather than diminished intraleukocytic killing . K-1 strains obtained from stool showed a similar degree of resistance to phagocytosis when compared with K-1 blood isolates . A comparison of clinical data on non-neonatal patients with E . coli K-1 and non-K-1 bacteremia showed no significant differences in mortality for these two groups . The incidence of shock for patients bacteremic with K-1 strains (74%) was significantly greater than that for patients bacteremic with non-K-1 strains (33%) . These differences are attributed to the increased resistance to phagocytosis observed for K-1 versus non-K-1 E . coli isolates. Ann Intern Med, 1978 Dec, 89(6), 949 - 50 Meningococcal polysaccharide vaccines: recommendation of the Public Health Service Advisory Committee on Immunization Practices; Meningococcal infection and proteolytic control; Cascade enzyme inhibitors (C1-esterase inhibitor, C3b inactivator, antithrombin III) and other major proteolytic enzyme inhibitors (alpha 1 trypsin inhibitor, alpha 1 chymotrypsin inhibitor, inter-alpha-trypsin inhibitor, alpha 2 macroglobulin) as well as C3 and alpha 1 acid glycoprotein, have been examined in the sera of Nigerian patients suffering from meningococcal infection of varied severity . Patients with meningococcaemia had lower serum concentrations of important inhibitors than did patients with localised meningitic infection . Within the coccaemic group, those who died had the lowest values, notably of antithrombin III and alpha 2 macroglobulin (and also of C3) . The clinical end-result of meningococcal infection may be related to the degree of disequilibrium of the linked system of proteolytic control induced by the meningococcal endotoxin. N Engl J Med, 1978 Nov 2, 299(18), 973 - 6 IgA protease production as a characteristic distinguishing pathogenic from harmless neisseriaceae; Mulks MH et al.; IgA proteases are extracellular enzymes of bacteria that have human immunoglobulin A of the IgA1 subclass as their only known substrate . The identification of this enzyme in neisseria prompted us to determine whether IgA protease production correlates with pathogenicity within this genus . Multiple clinical isolates of Neisseria gonorrhoeae, N . meningitidis and eight species of non-pathogenic neisseria that commonly colonize the normal human nasopharynx were examined for IgA protease activity . All N . gonorrhoeae and N . meningitidis strains were enzyme positive; all non-pathogenic strains were negative . Among meningococci, the enzyme occurred in strains carried harmlessly in the nasopharynx as well as those isolated from systemic infections . Because mucosal immune defense is largely mediated by antibodies of the IgA isotype, the finding that IgA protease activity is linked specifically to the pathogenic neisseria suggests that the enzyme may be involved in the pathogenesis of neisserial infection. Clin Endocrinol (Oxf), 1978 Nov, 9(5), 401 - 6 Thyroxine, triiodothyronine and thyrotrophin levels in meningococcal meningitis, typhoid fever and other febrile conditions; Maharajan G et al.; Thyroid status was estimated serially by measuring triiodothyronine (T3), thyroxine (T4) and thyrotrophin (hTSH) in 20 patients suffering from meningococcal meningitis, typhoid fever and other acute febrile illnesses . Significantly low T3 and only slightly increased T4 were observed in all the patients . hTSH was normal in all of these . A significant reciprocal relationship was found between the degree of fever and fall in T3 concentrations . T3 tended to rise in patients who recovered but in those who deteriorated or died, T3 remained persistently low. Pediatrics, 1978 Nov, 62(5), 738 - 43 Pharmacologic evaluation of orally administered antibiotics in infants and children: effect of feeding on bioavailability; McCracken GH Jr et al.; The clinical pharmacology of orally administered antibiotics was investigated in 106 infants and children . The antibiotic suspensions studied were ampicillin, cephalexin, erythromycin estolate, erythromycin ethylsuccinate, penicillin G, and penicillin V . The feeding status of the patients was evaluated in relation to the concentrations of drugs in serum, saliva, and tears . Peak concentrations and area-under-the-curve values of cephalexin, penicillin V, and penicillin G were reduced 40% to 60% in patients given milk and drug concurrently . Absorption was enhanced when erythromycin ethylsuccinate was given milk . After administration of both erythromycin formulations, penicillin V and ampicillin, salivary concentrations exceeded the minimal inhibitory concentrations for most pneumococci and group A streptococci and for many meningococci . The clinical implications of these pharmacokinetic data are discussed. Zh Mikrobiol Epidemiol Immunobiol, 1978 Nov, (11), 109 - 13 {Model of meningococcal sepsis in mice}; Krasnoproshina LI et al.; The authors studied a possibility of obtaining experimental meningococcus sepsis model on mice . The use of cyclophosphane, iron compounds, yolk medium produced no significant organism . When 4--5% mucine was injected intraperitoneally together with meningococcus culture mice died with sepsis phenomena . Differences were revealed in the sensitivity of linear and mongrel mice to meningococcus infection--AKR mice proved to be more sensitive . At the same time it was found that mongrel mice weighing from 10 to 12 g could be used to induce meningococcus sepsis. Zh Mikrobiol Epidemiol Immunobiol, 1978 Oct, (10), 98 - 101 {Dynamics of humoral immunity indices in patients with the generalized form of meningococcal infection}; Ruzal' GI et al.; A possibility of using the passive hemagglutination test with meningococcus diagnostic agents of groups A and C for observing the changes in the infectious process was demonstrated . Sera of patients with generalized form of meningococcus infection showed an increase (by the 2nd--3rd week) and a rapid reduction (by the 4th week) of the specific antibodies titres to the levels seen during the first days of the disease . At the remote periods after the disease--in 2 to 5 years--hemagglutinins were revealed in the same titres as in healthy persons (1:10--1:13) . Study of physico-chemical nature of antibodies demonstrated that at the early stages of meningococcus infection there formed antibodies referred chiefly to macroglobulins, and at the remote periods (after 3 months)--to microglobulins. Ann Clin Res, 1978 Oct, 10(5), 280 - 7 Myocardial complications of immunisations; Helle EP et al.; Immunisation may induce myocardial complications . In this pilot study clinical, electrocardiographic, chemical and immunological findings have been studied during a six weeks' follow-up after routine immunisation (mumps, polio, tetanus, smallpox, diphtheria and type A meningococcal disease) among 234 Finnish conscripts at the beginning of their military service . Serial pattern of ECG changes suggestive of myocarditis was recorded in eight of the 234 conscripts one to two weeks after vaccination against smallpox and diphtheria . Changes were mainly minor ST segment elevations and T wave inversions and usually they disappeared in a few weeks . The ECG positives more often had a history of atopy, and their mean body temperatures and heart rates after the vaccinations were higher than among the other subjects (p less than 0.01) . However, clinical myocarditis was never noted, nor were immunological or enzymological changes different among the ECG positives . Thus in 3% of the study population, evidence of postvaccinal myocarditis was noted, based on serial ECG patterns, but without any other evidence of cardiac disease. Arch Pathol Lab Med, 1978 Oct, 102(10), 515 - 7 Experimental meningococcal septicemia . Effect of aspirin therapy; Dalldorf FG et al.; In previous studies we have presented morphological evidence that the terminal shock-like phase of fatal meningococcemia is caused by the occlusion of the pulmonary microcirculation with thrombi composed of platelets, leukocytes, and fibrin . We have also shown that in experimental meningococcemia, pretreatment of rabbits with heparin sodium prevents fibrin formation but does not influence the cellular pulmonary thrombi and does not prolong survival . If our theory is correct, drugs that inhibit platelet aggregation and leukocyte adhesion in rabbits should prolong life . The present experiment demonstrates that pretreatment with a small dose of aspirin doubles the survival time without altering the mortality. Surgery, 1978 Oct, 84(4), 471 - 5 Purulent pericarditis in children; Garvin PJ et al.; Acute purulent pericarditis was treated successfully in five children between the ages of 27 months and 11 1/2 years during the past 5 years . The responsible organism was Hemophilus influenzae, type b, in two cases and Meningococcus, Pneumococcus, and coagulase-positive Staphylococcus aureus in one case each . No primary source of infection could be identified in two patients . A high index of suspicion, combined with immediate echocardiograms and pericardiocentesis, led to the diagnosis . Immediate antibiotic therapy was instituted on the basis of the gram stain of the pericardial fluid . All five patients had a pericardial window established--four through subxyphoid approach and the fifth, because of a left pleural effusion, through a left thoracotomy . When the subxyphoid approach was used, sump drains were left for postoperative suction and irrigation . All five patients survived without sequalae during follow-up periods of from 18 months to 5 years . We advocate an aggressive approach to the diagnosis and treatment of this problem . This report documents the safety, ease, and effectiveness of the subxyphoid approach as a means of drainage. Zh Mikrobiol Epidemiol Immunobiol, 1978 Oct, (10), 93 - 7 {Epidemiological evaluation of the serological grouping of meningococci}; Kostiukova NN et al.; Use of the precipitation and hemagglutination inhibition tests to determine the serological group of 114 meningococcus strains which cannot be grouped by agglutination slide permitted to establish the serological group of 56% of the strains, this pointing to the greater diagnostic value of these tests . Nevertheless, 70% of 307 strains isolated from carriers could not be referred to any of the determinable groups (A, C, X, Y, and Z) . Strains (417) isolated from the cerebrospinal fluid of patients with meningitis were grouped depending on the epidemic curve: only half of the cultures could be classified in sporadic cases, but from 80 to 100% of the strains were classified at the "peak" of the meningitis incidence rise . This rise was connected with increase of the incidence of cases caused by meningococcus, group A; at the decline these strains were eliminated, and cases due to the rarely encountered serological groups and nongrouping strains occurred . Marking meningococc by serological groups proved to be of no use for detection of epidemiological relations between the infected persons. Acta Pathol Microbiol Scand {B}, 1978 Oct, 86B(5), 275 - 81 Liberation of endotoxin during growth of Neisseria meningitidis in a chemically-defined medium; Andersen BM et al.; Modified medium 199 is well suited to the growth of meningococci if rich growth is not necessary . The bacteria were very sensitive to changes in pH and needed a good buffer capacity of the medium . Four strains of Neisseria meningitidis were studied . After the stationary phase had been reached, the vital cell count decreased relatively slowly . However, the total cell count remained unchanged for at least 12 hours . The standardized E . coli endotoxin could be detected easily by the Limulus lysate test in different protein-free, pH-adjusted and ion-balanced liquids, and the determination of endotoxin was reproducible . The Limulus lysate test was more sensitive than the rabbit pyrogen test as regards meningococcal endotoxin . Liberation of endotoxin during growth in modified medium 199 varied with strain and growth conditions . Repeated investigations showed the same pattern of growth and endotoxin liberation for each strain, also under other growth conditions . When sonicating the bacteria, high yields of endotoxin were obtained from each strain. J Clin Pathol, 1978 Oct, 31(10), 936 - 8 A simple manganous chloride and Congo red disc method for differentiating Neisseria gonorrhoeae from Neisseria meningitidis; Odugbemi TO et al.; Manganous chloride and Congo red incorporated into blotting paper discs have been used to differentiate gonococci from meningococci . The new technique is simple and reliable; the materials for the test are inexpensive . The method will increase the efficiency of distinguishing between the pathogenic Neisseria in any clinical bacteriology laboratory and especially in those in the tropical areas. Am J Trop Med Hyg, 1978 Sep, 27(5), 986 - 94 Acute bacterial meningitis in Cairo, Arab Republic of Egypt, 1 January 1971 through 31 December 1975; Miner WF et al.; Between 1 January 1971 and 31 December 1975, 1,333 patients with acute bacterial meningitis were admitted to the meningitis ward of the Abbassia Fever Hospital . These cases are tabulated by distribution of diagnosis, seasonal distribution, age and sex distribution, and age-specific case fatality ratio . Results are compared with those of other large series of cases reported from other parts of the world . The annual incidence of acute bacterial meningitis in Egypt varies widely . Recent data show this to be due to variations in the incidence of group A meningococcal meningitis . The study includes the declining phase of an epidemic of that disease and confirms a previously reported finding that the case fatality ratio in group A meningococcal meningitis varies inversely with the annual number of cases. J Infect Dis, 1978 Sep, 138(3), 387 - 91 The adrenal response to exogenous adrenocorticotrophin in patients with infections due to Neisseria meningitidis; Wajchenberg B et al.; The adrenal response to a soluble form of beta1-24-corticotropin (tetracosactrin {ACTH}: 250 microgram administered intramuscularly) was studied in 28 patients with meningitis due to Neisseria meningitidis (21 with petechiae and seven without) and in six patients with Salmonella typhi bacteremia . Six normal subjects also were tested for adrenal responsiveness at four different times of the day (8 A.M., 12 noon, 4 P.M., and 10 P.M.) and served as controls . The results showed that, whatever the time of testing, patients with meningococcal infections and typhoid fever had unstimulated (basal) levels of plasma cortisol above the 99% confidence limits for the mean unstimulated cortisol levels for the normal subjects . Furthermore, although patients with meningitis without petechiae and subjects with S . typhi bacteremia responded to ACTH stimulation in a manner similar to that of the normal subjects, most subjects with meningitis with petechiae did not have increased levels of plasma cortisol after treatment with ACTH . This lack of response could not be ascribed entirely to the higher basal levels of plasma cortisol in these patients . Patients with meningitis associated with petechiae may have a relatively decreased adrenal response to stimulation with exogenous ACTH. Med Trop (Mars), 1978 Sep-Oct, 38(5), 501 - 11 {Antibioprophylaxis of meningococcal meningitis: reality or utopia? (author's transl)}; Albert JP et al.; After restating the activity of the various antibiotics on Neisseria meningitidis, the authors review the results of 18 experiences of germ-carriers control by antibiotics, which were rather deceiving . Conditions for such a control are exposed but question of its real necessity is raised. J Infect Dis, 1978 Sep, 138(3), 359 - 68 Familial deficiency of the seventh component of complement associated with recurrent bacteremic infections due to Neisseria; Lee TJ et al.; The serum of a 29-year old woman with a recent episode of disseminated gonococcal infection and a history of meningococcal meningitis and arthritis as a child was found to lack serum hemolytic complement activity . The seventh component of complement (C7) was not detected by functional or immunochemical assays, whereas other components were normal by hemolytic and immunochemical assessment . Her fresh serum lacked complement-mediated bactericidal activity against Neisseria gonorrhoeae, but the addition of fresh normal serum or purified C7 restored bactericidal activity as well as hemolytic activity . The absence of functional C7 activity could not be accounted for on the basis of an inhibitor . Opsonization and generation of chemotactic activity functioned normally . Complete absence of C7 was also found in one sibling who had the clinical syndrome of meningococcal meningitis and arthritis as a child and in this sibling's clinically well eight-year-old son . HLA histocompatibility typing of the family members did not demonstrate evidence for genetic linkage of C7 deficiency with the major histocompatibility loci . This report represents the first cases of C7 deficiency associated with infectious complications and suggests that bactericidal activity may be important in host defense against bacteremic neisseria infections. Antibiotiki, 1978 Sep, 23(9), 794 - 7 {Evaluation of the sanative action of rifampicin on the meningococcal carrier state}; Deviatkina NP et al.; The results of the epidemiological control experiment on the efficacy of rifampicin in sanation of meningococci carriers are presented . The preliminary study of rifampicin sensitivity of 41 freshly isolated nasopharyngeal meningococcal strains showed that the MIC of the drug for 63 per cent of the isolates was 0.04--0.1 gamma/ml . Sanation was performed for 2 days; 1.2 g of the drug was used during the treatment course . The results of examination of 91 meningococci carriers showed that 4 days after the sanation the specific weight of the persons isolating no meningococci was reliably higher in the experimental group than that in the control group . The coefficient of rifampicin efficiency was 70.8 per cent . 10 days after sanation the difference in the level of the carriers isolating no meningococci in the experimental and the control groups was statistically insignificant . Therefore, the carriers treated with the drug received temporary protection from the causative agent at an average for 1 week . Later on they could become carriers again . As a result of sanation no changes in the meningococcal sensitivity to rifampicin was observed. Lancet, 1978 Aug 19, 2(8086), 403 - 5 Is group-specific meningococcal vaccination resulting in epidemics caused by groups of virulent meningococci? Nikoskelainen J, Leino A, Lahtonen E, Kalliomaki JL, Toivanen A. In 1976 routine vaccination against Neisseria meningitidis serogroups A and C was started in the Finnish Armed Forces . A case of fulminant, complicated pneumonia caused by group-Y meningococcus in a vaccinated recruit, prompted a study of the distribution of the meningococcal groups isolated from the recruits in the same unit . 14 (46%) of the 31 isolates from 84 recruits were group Y . Group-Y meningococcus was rarely isolated from unvaccinated controls . These results suggest that widespread vaccination against serogroups A and C may have led to an increase in the frequency of meningococcus group Y. Zh Mikrobiol Epidemiol Immunobiol, 1978 Aug, (8), 60 - 7 {Incidence of meningococcal infection in the RSFSR}; Favorova LA et al.; The authors present characteristics of meningococcus infection epidemic process in case of sporadic cases and under epidemic conditions (1965--1976) . A scheme of epidemiological analysis suggested by the authors permitted to differentiate and to record the incidence of various clinical forms of meningococcus infection, to present data on the age, seasonal characteristics, focality, etc . Comparison of intensive morbidity indices for 10 years, both at the individual administration territories and in the Republic as a whole demonstrated morbidity level of 1.5--2.0 to be one of prognostic signs of the beginning epidemic . The main features differentiating the sporadic and epidemic morbidity periods were revealed . The presence of group diseases, a greater percentage of children among those who fell ill, and marked signs of seasonality and territorial difference characterized the period of rise caused by meningococcus of serological group A. J Clin Pathol, 1978 Jul, 31(7), 688 - 91 A cerebrospinal fluid leucocidin in pyogenic meningitis; Greenwood BM; Cerebrospinal fluid (CSF) samples were tested for their cytotoxicity to polymorphonuclear neutrophil leucocytes (PMN) using a 51Cr release assay . Most samples from patients with pyogenic meningitis damaged PMN while normal CSF samples did not . No difference was found between the cytotoxic activity of CSF from patients with pneumococcal meningitis and from patients with meningococcal meningitis . It is, therefore, unlikely that a CSF leucocidin plays an important part in producing the high mortality of pneumococcal meningitis. Lancet, 1978 Jun 24, 1(8078), 1328 - 9 Impairment of the immune response to vaccination after acute malaria; Williamson WA et al.; Children with acute malaria were vaccinated with Salmonella typhi and meningococcal vaccines at varying times after the onset of their illness . The immune response to both vaccines was depressed when they were given on the day of presentation at hospital . Immune responsiveness to S . typhi vaccine was rapidly regained after treatment, but a month after the attack the immune response to meningococcal vaccine was still impaired. Clin Nephrol, 1978 Jun, 9(6), 249 - 53 Post meningococcal acute glomerular nephritis; Rainford DJ et al.; A case of meningococcal meningitis is described in which 10 days later there developed the histological lesions of acute exsudative proliferative glomerular nephritis without proteinuria, hematuria, hypertension or salt and water retention . The relationship between structural and functional changes in the kidney in glomerular nephritis is discussed in the light of these findings. Zh Mikrobiol Epidemiol Immunobiol, 1978 Jun, (6), 75 - 9 {Study of molecular heterogeneity and chemical nature of polymeric components of the Meningococcus cell wall}; Belova TN et al.; The high-molecular fraction of substances of the cell wall of meningococci, groups A and B, isolated in free volume in gel filtration through sepharose 4B and containing both group and intergroup antigens proved to be consisting of 2 subfractions in gel-filtration through Bio-Gel A-150m . Molecular weight of the first was within the range of 100--150 million dalton, and of the second--of 3 to 100 million dalton . In dissociation in sodium deoxycholate the high molecular fraction complex compound of the cell wall of meningococcus strain, group A, isolated from the cerebrospinal fluid of a patient suffering from meningitis broke down into 5 fragments differing in chemical nature and mol wt . There were revealed protein and protein-lipopolysaccharide components with a relatively high mol wt . polypeptide components and low molecular residues of the initial lipopolysaccharide. J Trop Med Hyg, 1978 Jun, 81(6), 106 - 9 Identification of Neisseria gonorrhoeae by carbohydrate disc reactions on a modified fermentation medium; Odugbemi TO et al.; The identification of Neisseria gonorrhoeae by the use of a carbohydrate disc reaction on a modified fermentation medium is described . 70 out of the 71 strains tested produced detectable acid in 18--24 hours from the dextrose disc and no acid from Maltose, sucrose or lactose discs . One strain required 48 hours for good growth and acid production from dextrose disc only . The carbohydrate disc method was compared with a standard fermentation method using sugars incorporated in serum-free medium, 64 out of 71 strains of gonococci tested were identified after 18--24 hours incubation . All the strains gave clear-cut confirmatory results after 48 hours incubation . The importance of serum-free fermentation media in the identification of gonococci in tropical areas where meningococcal infections are also prevalent is discussed. Acta Pathol Microbiol Scand {C}, 1978 Jun, 86C(3), 123 - 9 Precipitating antibodies against Neisseria meningitidis in normal sera and their possible origin; Hoff GE et al.; Crossed immunoelectrophoresis was used to study precipitating antibodies against Neisseria meningitidis in sera from 214 normal persons and in human gammaglobulin . A polyspecific meningococcal antigen preparation and a corresponding rabbit antiserum constituted the reference system . All the sera contained one to five precipitins against N . meningitidis which could be identified and quantified by means of the reference system . The precipitin score, which expresses the number and titre of precipitins in each serum, increased with age . More than 25 precipitins were found in the gammaglobulin preparation, including antibodies against the groupspecific polysaccharides A, B and C . Absorption of three of the five normally occurring precipitins (nos . 4, 19, 22) with antigens from various bacteria showed that precipitins nos . 4 and 19 could be completely absorbed by antigens from other Neisseria species, but not by antigens from other genera . This indicates that these two precipitins may have been induced by non-pathogenic Neisseria species or by meningococci . The finding of protective antibodies in gammaglobulin might indicate the possibility of its use in prophylaxis or therapy meningococcal infections. J Infect Dis, 1978 Jun, 137(6), 728 - 39 Safety and immunogenicity of a Neisseria meningitidis type 2 protein vaccine in animals and humans; Zollinger WD et al.; Two Neisseria meningitidis vaccines consisting principally of outer membrane protein (lot 138I-0) or outer membrane protein plus group C polysaccharide (lot 138I-M1) were prepared from the group C type 2 strain 138I . Lipopolysaccharide and lipid were removed by gel filtration in the presence of sodium deoxycholate . The vaccines were found to be nontoxic and nonpyrogenic in animals . They provided active protection in mice against mucin-enhanced killing by group B type 2 meningococci and induced good titers of type-specific bactericidal and hemagglutinating antibodies in rabbits . In five volunteers the vaccines were well tolerated and induced significant increases in serum bactericidal activity against both group C and group B strains . Three of five volunteers had a two- to fourfold increase in antibodies to the outer membrane proteins, but these antibodies did not appear to have bactericidal activity . The bactericidal antibodies to both group B and group C strains were directed against the capsular polysaccharides. Br Med J, 1978 May 20, 1(6123), 1317 - 9 Prevention of secondary cases of meningococcal disease in household contacts by vaccination; Greenwood BM et al.; Household contacts of patients with group A meningococcal infection were vaccinated with either meningococcal vaccine or tetanus toxoid . Five of the 523 subjects who received tetanus toxoid developed meningococcal meningitis and another four probably had meningococcal disease . Only one possible case of meningococcal infection occurred among 520 contacts vaccinated with meningococcal vaccine . Vaccination had no effect on nasopharyngeal carriage of meningococci . Vaccination of household contacts of patients with group A meningococcal infections is an effective way of using limited supplies of meningococcal vaccine, though its value would be limited in an epidemic . Secondary cases of meningococcal infection often occur within a few days of the index case, and, although vaccine alone seemed to provide adequate prophylaxis in these Nigerian subjects, additional chemoprophylaxis may be needed to cover this critical period. J Pediatr, 1978 May, 92(5), 818 - 22 Meningococcus group A vaccine in children three months to five years of age . Adverse reactions and immunogenicity related to endotoxin content and molecular weight of the polysaccharide; Peltola H et al.; Vaccination of 21,007 children between the ages of three months and five years was completed with five different lots of the meningococcal group A capsular polysaccharide vaccine . A correlation was found between the frequency and severity of adverse reactions and the endotoxin content of the vaccine lots . All vaccine lots elicited a serum antibody response . The endotoxin content of the vaccines did not correlate with the serum antibody response. J Clin Microbiol, 1978 May, 7(5), 410 - 4 Serogroup identification of Neisseria meningitidis: comparison of an antiserum agar method with bacterial slide agglutination; Craven DE et al.; A serum agar method for serogrouping Neisseria meningitidis is described and compared with conventional bacterial slide agglutination . There was 93% agreement for 300 strains examined individually by each method . Among strains from serogroups A, B, C, Y, and W135, there was 100% correlation, whereas strains from serogroup 29E (Z') had only 67% correlation . The serum agar method was rapid, as well as easy to perform and interpret . The potential benefits of this method for epidemiological studies and reference laboratories processing large numbers of meningococcal isolates are emphasized. Zh Mikrobiol Epidemiol Immunobiol, 1978 May, (5), 106 - 10 {Neuraminidase activity of nonpathogenic Neisseria}; Zhuravleva GV; It was revealed earlier by the authors that N . meningitidis of the principal serological groups A, B, and C possessed neuraminidase activity . In the present work it was shown that this sign was genus-specific, and that this property was also possessed by the representatives of nonpathogenic neisseria habituating in the nasopharynx, However, the enzymatic activity in nonpathogenic neisseria was less pronounced than in meningococci, and required more prolonged contact of the enzymatic-substrate mixture for its detection . There was revealed a direct relationship between the neuraminidase activity and the growth phase of the microorganisms, whose maximum coincided with the exponential phase of bacterial growth, this apparently being associated with the extracellular character of its origin. J Exp Med, 1978 Apr 1, 147(4), 1007 - 17 Neutralization of meningococcal endotoxin by antibody to core glycolipid; Davis CE et al.; Antibodies to Escherichia coli J5, a uridine 5'-diphosphate-galactose epimerase-less mutant of E . coli 0111, neutralized meningococcal endotoxemia from all three major capsular serogroups . We chose the dermal necrosis of the local Shwartzman phenomenon and the renal cortical necrosis of the general Shwartzman phenomenon as assays because these are the hallmarks of meningococcemia, and because meningococcal lipopolysaccharide (LPS) is a uniquely potent cause of dermal purpura and necrosis . Meningococcal antisera raised against LPS from MGC A, B, and C also provided good protection against endotoxemia from the homologous capsular groups, but it was inconsistent against the heterologous serogroups . The superiority of J5 antibodies (purified IgG as well as antiserum) is probably due to the fact that J5 LPS contains only the endotoxin core . Consequently, immunization with this mutant stimulates production of antibodies to core LPS without interference by the "0" antigenic determinants of the side chains . These observations indicate that the endotoxin core is the toxic moiety of meningococcal LPS, that the core LPS of meningococcus (MGC) is immunologically similar to enteric LPS, and that the antigenically variable "0" side chains of MGC LPS interfere with antibody production against the common core . They also suggest that antibodies prepared against this E . coli mutant could interrupt the devastating course of meningococcal endotoxemia in man, regardless of the capsular serogroup of the infecting strain. J Infect Dis, 1978 Apr, 137(4), 458 - 63 Anogenital infection with Neisseria meningitidis in homosexual men; Judson FN et al.; Among monosexual men anal infection with Neisseria meningitidis was more prevalent (15 of 731 men) than expected and significantly more prevalent than urethral infection with N . meningitidis (three of 669 men, P less than 0.01) . Anal infection was also significantly more prevalent among homosexual men than among heterosexual women (two of 1,197 women, P less than 0.001) . These differences in rates of prevalence may be best explained by a preference of meningococci for anal mucosa and by the common homosexual practice of oral-anal sexual contact . Serogrouping of the 17 anal and three urethral isolates revealed a broad representation of serogroups often found in meningococcal pharyngeal carriage in the community . Of 14 patients who returned for a test-of-cure culture within seven days of treatment with an antibiotic regimen recommended for anogenital gonococcal infection, each was culture-negative for N . meningitidis . Minor and symptoms in three men and profuse urethral discharges in two men resolved with treatment. J Clin Pathol, 1978 Apr, 31(4), 355 - 8 Comparison of susceptibility of Neisseria meningitidis to sodium sulphadiazine and sodium fusidate in vitro; Miles RS et al.; Out of 100 strains of meningococci examined 62 were resistant to 1 mg/l or more of sodium sulphadiazine, including 82% of group W135 strains and 69% of group B strains . All strains were sensitive in vitro to 0.5 mg/l of sodium fusidate . Sodium fusidate should be considered as a chemoprophylactic agent for those who may be at risk of meningococcal disease. J Clin Microbiol, 1978 Apr, 7(4), 332 - 6 Effects of two blood culture anticoagulants on growth of Neisseria meningitidis; Rintala L et al.; Tests of 25 strains of Neisseria meningitidis for sensitivity to sodium polyanethol sulfonate (SPS) showed that the sensitivity of strains varied with both inoculum size and SPS concentration . In Trypticase soy broth (TSB), 2 out of 13 strains were sensitive to 0.05% SPS, whereas 8 out of 13 strains were sensitive to the same concentration of SPS in brain heart infusion (BHI) . In artificial blood cultures with six strains of meningococci, the addition of 10% defibrinated blood was found to eliminate the sensitivity of all six strains to SPS in BHI, but not of the two strains in TSB . Addition of 1.2% gelatin to artificial blood cultures eliminated the inhibitory effect of 0.05% SPS, whereas the addition of 1% yeast extract to blood cultures containing 0.025% or 0.05% SPS enhanced the inhibitory effect of this anticoagulant . None of the 13 strains tested was inhibited by 0.05% sodium amylosulfate in TSB or BHI alone or in artificial blood cultures with these media. Zh Mikrobiol Epidemiol Immunobiol, 1978 Apr, (4), 107 - 10 {Antagonistic and bacteriocinogenic activity of Meningococci}; Bochkov IA et al.; Antagonistic and bacteriocinogenic activity was studied in 169 strains of meningococci of various serological groups and with different localization in the human organism at the time of isolation . Bacteriocinogenic activity was revealed in all the meningococcus strains (by delayed antagonism method), and, in addition, antagonistic activity was found in 100 strains . The inhibitory activity was the greatest in meningococci isolated from the cerebrospinal fluid . The data obtained suggest an important inhibitory activity of meningococci, along with their resistance to the antagonistic activity of the nasopharyngeal microorganisms, in the manifestation of pathogenic properties in them. J Clin Microbiol, 1978 Apr, 7(4), 379 - 84 Piliation and colonial morphology among laboratory strains of meningococci; DeVoe IW et al.; Colonial morphology and piliation were studied on twelve strains from various serogroups of Neisseria meningitidis . Six different colony types (M1 to M6) were identified . Most strains elaborated only an M1 colonial type, which is similar to gonococcus T4 . Several combinations of piliation and colonial morphology were observed: (i) colonial variation in which neither parent nor variant were piliated; (ii) colonial variation involving piliated and nonpiliated cells; (iii) dissociation of piliated from nonpiliated cells with no colonial change; and (iv) colonial variation in which both variants were piliated but with distinctly different pili . Results of this study demonstrate that correlations between piliation and colony morphology within N . meningitidis are exceptions rather than the rule. J Clin Microbiol, 1978 Apr, 7(4), 372 - 8 Outer membrane protein antigens in an enzyme-linked immunosorbent assay for Salmonella enteric fever and meningococcal meningitis; Sippel JE et al.; Outer membrane protein preparations were obtained from strains of Salmonella and Neisseria meningitidis . Solubilized cell envelope (CE) fractions from S . typhi and Salmonella groups A, B, C, and E had very similar electrophoretic mobilities on polyacrylamide gel, and common antigens were demonstrated by immunodiffusion . CE appeared to be a more satisfactory antigen than the more purified preparation (T/TEI) in the enzyme-linked immunosorbent assay (ELISA) with sera from typhoid and paratyphoid patients . With either antigen, however, the presence of antibodies was demonstrated in acute- and vonvalescent-phase sera . In the case of N . meningitidis infections, the crude (STA) and the more purified antigens (T/TEI) were equally satisfactory, and a rise in antibody titer could easily be demonstrated with paired acute- and convalescent-phase sera . The ELISA appears to be a simple but highly sensitive test for the detection of antibodies by using outer membrane protein antigens. Zentralbl Bakteriol {Orig A}, 1978 Apr, 240(3), 409 - 10 {Bactericidal antibody micro-assay for detection of antibodies against meningococci (author's transl)}; Stanek G; The best way to detect protective antibodies against meningococci in human serum seems to prove its bactericidal activity . For this a bactericidal antibody assay was described by WHO . For this test, however, a high amount of baby rabbit-serum is required . Therefore a modification was introduced by reducing the test volumes, performing the test in microtiterplates and using TTC (triphenyl tetracolium chloride), as a growth indicator that changes from colourless to purple red in the presence of growing meningococci . The end point of serum titration is the last well containing colourless medium. Infect Immun, 1978 Apr, 20(1), 228 - 34 Degradation of the polysaccharide component of gonococcal lipopolysaccharide by gonococcal and meningococcal sonic extracts; Apicella MA et al.; An extract made from the supernatant of Neisseria gonorrhoeae Gc2 strain 1291 degraded the Gc2 polysaccharide antigen . Chemical analysis of this polysaccharide indicated it contains glucose, galactose, glucosamine, galactosamine, glucosamine-6-phosphate, heptose, 2-keto-3-deoxyotonate, and ethanolamine and is the polysaccharide component of gonococcal lipopolysaccharide . Degradation of the polysaccharide by sonic extracts resulted either in complete loss of antigenicity and immunogenicity or in partial degradation to subunits that could inhibit the Gc2-specific hemagglutination inhibition . The factors responsible for degradation were destroyed by heating at 100 degrees C for 5 min or by Pronase digestion, but were unaffected by ribonuclease, deoxyribonuclease, Mg2+, Ca2+, or ethylenediaminetetraacetic acid . The process was pH dependent, with optimal activity occurring at pH 7 . Sonic extract supernatants from group B and C meningococcal strains contained degrading properties, whereas similar extracts produced from Escherichia coli, Staphylococcus aureus, Klebsiella pneumoniae, and Streptococcus pneumoniae type II failed to degrade the Gc2 polysaccharide. Zh Mikrobiol Epidemiol Immunobiol, 1978 Mar, (3), 100 - 4 {Detection of the etiologic structure of generalized and localized forms of meningococcal infection using the passive hemagglutination test}; Kostiukova NM et al.; Preparations of formalin-treated erythrocytes sensitized with meningococcus polysaccharides of serological groups A, C, X, Y, and Z were used for the purpose of examination of patients with meningococcus infection; these preparations were highly specific in the tests of precipitation, hemagglutination and hemagglutination inhibition . Indirect hemagglutination test with the sera of 99 patients suffering from generalized forms of meningococcus infection was conducted with the mentioned preparations in Moscow and Novosibirsk in 1974--1975 when a stable morbidity decline was noted in these towns after an epidemic rise . The diagnostic value of this test was confirmed: it permitted to diagnose meningococcus etiology beginning from the 5th day of the disease and to decipher it from the aspect of individual serological groups . As shown, the incidence of cases caused by serological group A, reaching 87% at the height of the epidemic rise, fell to 49.5% at the stage of decline . Cases caused by group Y which was not encountered formerly were revealed in 16.2% of the patients . Among 127 patients with miningitis of nonmeningococcus etiology meningococcus antibodies to groups A and Y were revealed with the same frequency (in titres of not over 1 : 20--1 : 80), but the leading role of serological group A in the etiology of the manifest forms permitted to draw a conclusion on the presence of a higher invasiveness in the strains of group A. J Clin Pathol, 1978 Mar, 31(3), 213 - 6 Chemotactic activity of cerebrospinal fluid in pyogenic meningitis; Greenwood BM; Cerebrospinal fluid from patients with pyogenic meningitis was found to be chemotactic for polymorphonuclear neutrophil leucocytes . No significant difference was found between the mean chemotactic activity of cerebrospinal fluid obtained from patients with pneumococcal meningitis or meningococcal meningitis . The chemotactic factor present in cerebrospinal fluid is probably a low molecular weight protein, perhaps a complement component. J Exp Med, 1978 Mar 1, 147(3), 629 - 44 Protection against group B meningococcal disease . III . Immunogenicity of serotype 2 vaccines and specificity of protection in a guinea pig model; Frasch CE et al.; Protein vaccines were prepared from the serotype antigen of group B Neisseria meningitidis strain M986 . The detergents Triton X-100, Emulphogene BC-720, and deoxycholate were used to removed the toxic lipopolysaccharide (LPS) portion of the serotype antigen . The LPS was most preferentially solubilized by Emulphogene . Guinea pigs were immunized with one or two doses of vaccine given intramuscularly without adjuvants and the antibody response quantitated by an enzyme-linked immunosorbant assay . Immunization with graded doses of vaccine between 25 to 200 microgram protein indicated a wide range of effective dosage and that a two-dose immunization schedule was superior to a single immunization . The vaccines elicited peak mean serum antibody levels of approximately 30 microgram/ml with bactericidal titers of 1:1,600-1:6,400 . The peak antibody levels occurred 5-6 wk after immunization and persisted above preimmune levels for several months . To evaluate the protective effects of immunization, stainless steel springs were implanted subcutaneously into the guinea pigs . The resulting chambers, in unimmunized animals, could be infected with less than 100 type 2 organisms . A single 25-50 microgram dose of vaccine protected 50% of animals from challenge by 5 X 10(5) type 2 meningococci, and as little as 1 microgram vaccine significantly reduced the severity of infection . A two-dose immunization schedule was best and provided nearly complete protection for at least 4 mo against type 2 strains of meningococcal groups B, C, and Y. J Exp Med, 1978 Mar 1, 147(3), 619 - 28 Protection against group B meningococcal disease . II . Infection and resulting immunity in a guinea pig model; Frasch CE et al.; A guinea pig subcutaneous chamber model was used to evaluate the specificity of the immune response resulting from Neisseria meningitidis infection . Small numbers of meningococci easily infected the chambers . The infections persisted for 6-8 days with relatively high levels of organisms (10(5)-10(6)/milliliter) in the chambers, and were then rapidly eliminated and no organisms could be cultured beyond day 14 . Clearance of infection correlated with appearance of circulating antibody . Antibody against both the protein serotype antigen and the capsular polysaccharide were induced as a result of meningococcal infection . The group-specific polysaccharide response peaked 2-3 wk after the animals were inoculated, while the type-specific protein response peaked at 5-6 wk . The animals were quite resistant to reinfection with either the homologous serogroup or serotype. J Bacteriol, 1978 Mar, 133(3), 1300 - 6 Cell-free biosynthesis of the O-acetylated N-acetylneuraminic acid capsular polysaccharide of group C meningococci; Vann WF et al.; A cell-free system was established to study the biosynthesis of group C meningococcal capsular polysaccharide, an alpha-2 leads to 9-linked N-acetylneuraminic acid (NeuAc) homopolymer containing O-acetyl groups at either C7 or C8 . Sialyltransferase activity, isolated from group C meningococcus strain C-11, catalyzed incorporation of {14C}NeuAc from CMP (CMP--{14C}NeuAc) into polymeric form . This sialyltransferase was stimulated by addition of meningococcus group C and Escherichia coli K92 capsular polysaccharides, the latter being an alpha-2 leads to 8- and alpha-2 leads to 9-linked NeuAc heteropolymer . Group C meningococcal sialyltransferase did not require divalent ions but was stimulated by Mn2+ . Attempts to demonstrate a lipid-soluble intermediate in the biosynthesis of this NeuAc polymer were unsuccessful . Meningococcal group C sialyltransferase incorporated NeuAc into a membrane-associated product . The polysaccharide can be extracted from the membrane-bound fraction with Triton X-100 . The newly synthesized polysaccharide coprecipitates with authentic group C antigen in meningococcal group C antiserum and is degraded by sodium metaperiodate, indicating that the NeuAc polymer synthesized by the cell-free system consists of alpha-2 leads to 9 linkage . Meningococcal group C spheroplast membranes contain an O-acetylase that can catalyze the transfer of acetyl groups from acetyl coenzyme A to the in vitro-synthesized polysaccharide. MMW Munch Med Wochenschr, 1978 Feb 24, 120(8), 247 - 8 {Smallpox vaccination--Waterhouse-Friderichsen syndrome (author's transl)}; Pfister JA et al.; A fatal acute meningococcal sepsis (Waterhouse-Friderchsen syndrome) appearing 25 days after smallpox vaccination (re-vaccination) on military service is reported . In order to assume a causal connection between the vaccination reaction and the acute infectious complication on atypically long "unspecific negative phase" after the vaccination is postulated . The morphological findings at the vaccination pustule, which shows the same changes as a first vaccination, also support a pathological post-vaccinal course . In consideration of these observations, revaccination after 20 years is apparently a risk. Biochemistry, 1978 Feb 21, 17(4), 645 - 51 Structural elucidation of the 3-deoxy-D-manno-octulosonic acid containing meningococcal 29-e capsular polysaccharide antigen using carbon-13 nuclear magnetic resonance; Bhattacharjee AK et al.; The capsular polysaccharide antigen from Neisseria meningitidis serogroup 29-e contains equimolar quantities of 2-acetamido-2-deoxy-D-galactose and 3-deoxy-D-manno-octulosonic acid (KDO), the latter of which is rarely found in biopolymers other than lipopolysaccharides . Carbon-13 nuclear mangetic resonance in conjunction with other chemical data indicated that the polysaccharide is composed of an alternating sequence of these two residues, the linkages being at C-3 of galactosamine and C-7 of KDO in the alpha-D and beta-D configuration, respectively . The native 29-e polysaccharide is O-acetylated, the O-acetyl groups being located at C-4 and C-5 of the KDO residues . Assignments of signals in the 13C nuclear magnetic resonance spectrum of the 29-e polysaccharide were made by consideration of those in the spectra of the monomer models, which necessitated the first recorded syntheses of methyl-alpha- and beta-D-3-deoxy-manno-octulopyranosonic acid . Like the methyl alpha- and beta-D-ketosides of sialic acid (Na+ salts), the equivalent methyl alpha- and beta-D-ketosides of KDO exhibit large chemical shift differences in the exocyclic C-8 position dependent on anomeric configuration . This can again be attributed to hydrogen bonding between the axial carboxylate group of the methyl beta-D anomer of KDO (C1 conformation) and the primary hydroxyl group at C-8 . This phenomenon is also exhibited by the beta-D-linked KDO units of the 29-e polysaccharide. Biochemistry, 1978 Feb 7, 17(3), 442 - 5 Neisseria pili proteins: amino-terminal amino acid sequences and identification of an unusual amino acid; Hermodson MA et al.; The amino-terminal amino acid sequences of the pili proteins from four antigenically dissimilar strains of Neisseria gonorrhoeae, from Neisseria meningiditis, and from Escherichia coli were determined . Although antibodies raised to the pili protein from a given strain of gonococcus cross-reacted poorly or not at all with each of the other strains tested, the amino-terminal sequences were all identical . The meningococcal protein sequence was also identical with the gonococcal sequence through 29 residues, and this sequence was highly homologous to the sequence of the pili protein of Moraxella nonliquifaciens determined by other workers . However, the sequence of the pili protein from E . coli showed no similarity to the other sequences . The gonococcal and meningococcal proteins have an unusual amino acid at the amino termini, N-methylphenylalanine . In addition, the first 24 residues of these proteins have only two hydrophilic residues (at positions 2 and 5) with the rest being predominantly aliphatic hydrophobic amino acids . The preservation of this highly unusual sequence among five antigenically dissimilar Neisseria pili proteins implies a role for the amino-terminal structure in pilus function . The amino terminus may be directly or indirectly (through preservation of tertiary structure) important for the pilus function of facilitating attachment of bacteria to human cells. J Infect Dis, 1978 Feb, 137(2), 112 - 21 Carriage of Neisseria meningitidis and Neisseria lactamica in infants and children; Gold R et al.; Asymptomatic carriage of Neisseria meningitidis and Neisseria lactamica was studied in a total of 2,969 healthy infants and children in Danbury, Conn., between October 1971 and June 1975 . The prevalence of N . meningitidis averaged 0.71% during the first four years of life and increased to 5.4% by 14--17 years . Rates of carriage of N . lactamica increased from 3.8% in three-month-old infants to a peak of 21.0% at 18 months and then declined to 1.8% by 14--17 years of age . Of the children who acquired N . lactamica, 66% developed fourfold or greater rises in titers of IgG antibody to groups A, B, and/or C meningococci as determined by immunofluorescence compared with only 5% of control children . Of new carriers of N . lactamica, 40% developed increased titers of bactericidal antibody to groups A, B, and/or C meningococci as compared with 7% of noncarriers . Carriage of N . lactamica may assist in the development of natural immunity to N . meningitidis by induction of cross-reactive antibodies. Am J Dig Dis, 1978 Feb, 23(2), 119 - 22 Spontaneous meningococcal peritonitis: a report of two cases; Bar-Meir S et al.; Two patients with spontaneous bacterial peritonitis caused by Neisseria meningitidis are described . In both cases immediate diagnosis was possible by examination of the ascitic fluid . Meningococcal peritonitis supports the hypothesis that the hematogenous spread of bacteria into the ascitic fluid may be one of the mechanisms of spontaneous bacterial peritonitis. Zh Mikrobiol Epidemiol Immunobiol, 1978 Feb, (2), 91 - 3 {Hyaluronidase in meningococcus}; Mironova TK; A total of 204 meningococcus strains were tested for the presence of hyaluronidase, and 45.5% of the strains were found to contain it . Strains penetrating into the cerebrospinal fluid were the ones which largely produced the enzyme (in 83% of the cases) . The enzyme was revealed only in 25.5% of the strains habituating on the nasopharyngeal mucosa . Hyaluronidase was mostly found in the meningococcus strains referred to the serological group A; strains of other serological groups and ungrouped strains produced the enzyme in 23.7% of the case only . There was no correlation between the capacity to form hyaluronidase and the virulence determinable in intraperitoneal infection of mice. Acta Pathol Microbiol Scand {C}, 1978 Feb, 86(1), 1 - 9 Crossed immunoelectrophoretic analysis of Neisseria meningitidis antigens and of corresponding antibodies in patients with meningococcal disease; Hoff GE et al.; Sixty-three different antigens of Neisseria meningitidis groups A, B and C were demonstrated by means of crossed immunoelectrophoresis against rabbit antiserum . The group-specific polysaccharides A and C were identified in the immunoprecipitate pattern . The majority of the remaining antigens were common to all three groups of meningococci . A clearcut rise in antibodies was found in all of 27 patients with meningococcal meningitis or septicaemia . These antibodies were directed against both group-specific antigens and common antigens . No such rise was seen among the 22 patients with purulent meningitis of non-meningococcal etiology . Altogether 15 precipitins were detected in the patients with meningococcal disease . Nine of these antibodies could be identified by comparison with the rabbit antiserum . The antibody rise was semiquantified by means of a scoring system . The rise in the precipitin score of antibodies against common antigens in patients infected with group B meningococci was significantly higher than in patients infected with group A meningococci. Med Trop (Mars), 1978 Jan-Feb, 38(1), 9 - 12 {The new features of meningococcal meningitis (author's transl)}; Lapeyssonnie L; According to a previous pattern epidemics of meningococcal meningitis (MM) were localized in North tropical Africa, caused by A serotype, easily treated with sulfanilamides and prevented by a polyosidic vaccine, A type . Changes have occured : epidemics in Finland and Brazil, with an African A type germ, in place of the American, sulfa-resistant, C type; outburst of epidemics in South tropical Africa; presence of C type in Tchad, Niger and Nigeria . In the same time dramatic evolutions due to endotoxinic processes and drug-resistances are more frequently observed. Scand J Infect Dis, 1978, 10(3), 187 - 91 Disseminated intravascular coagulation in patients with meningococcal infection: laboratory diagnosis and prognostic factors; Vik-Mo H et al.; In 36 patients with meningococcal infection a close association between the laboratory evidence of disseminated intravascular coagulation (DIC) and unfavourable prognostic factors was established . Patients with platelet count lessthan 100000/microliter, Normotest lessthan 50% and plasma fibrinogen concentration less than 100 mg/dl had a serious prognosis . No significant differences could be extablished between patients with infection from serogroup A and B meningococci for either laboratory evidence of DIC or prognostic factors. Arkh Patol, 1978, 40(3), 13 - 20 {Characteristics of the morphofunctional state of the adrenals in generalized forms of meningococcal infection}; Semashko MI; Changes in the cortical and medullar substances of the adrenals were found to develop in generalized forms of meningococcal infection, the picture of the adrenal involvement changing in relation to the clinical form of infection . In meningococcemia, the leading findings are disturbed circulation and marked affection of the vessel walls in the microcirculatory bed . In meningitis, with spasm of arterioles and small arteries and involvement of the large arteries most important are dystrophic changes in the adrenal parenchyma which depend upon the duration of the disease . Constant finding of lipids, cholesteron and RNA in cells of the extended cortex and RNA, noradrenaline and adrenaline in chromaffin cells, as well as cell proliferation indicate the functional activity and high potentials of the adrenals. Zh Nevropatol Psikhiatr Im S S Korsakova, 1978, 78(2), 206 - 10 {Functional state of the sympathetic-adrenal system in meningococcal infections}; Sirina LK et al.; A study of the functional state of the sympathico-adrenal system by determining the diurnal urine excretion of catecholamines and DOPA was conducted in 29 patients with meningoencephalitis of a meningococcal etiology . These studies demonstrated a significant activation of its adrenal link and a tendency to an increase of activity in the sympathical link with a drop of the reserve possibilities . These changes were most distinctly expressed in cases with prevalent localization of the pathological process in the deep brain structures . These facts made it possible to conclude that there is a lesion in the link of a control of the sympathico-adrenal system . These data were confirmed by results of a study in 18 patients with meningococcal infections by physiological loadings with insulin and adrenalin and a study of the catecholamines and DOPA in the urine portions, which exert specific influence on the state of activity of the sympathico-adrenal system through the hypothalamus and reticular formation. Scand J Infect Dis, 1978, 10(1), 41 - 4 Group A meningococcal polysaccharide vaccine and course of the group A meningococcal epidemic in Finland; Peltola H; A group A meningococcal epidemic started in Finland in 1973 and had its peak in 1974 . Its rapid decline and end after large scale vaccinations in 1975-76, involving approximately one quarter of the population, is described . It gives further proof of the clinical efficacy of the group A polysaccharide vaccine . No corresponding increase in the other serogroups has been seen in the 1 1/2 years elapsed after these vaccinations. Dev Biol Stand, 1978, 41, 97 - 108 {Controlled tests of anti-meningococcal polysaccharide A vaccine in the African Sahel area (Upper Volta and Mali) }; Saliou P et al.; After the first tests of this vaccine in Egypt (1972) and in the Sudan (1973), two controlled tests in the field were performed in two high-risk areas for meningitis: --firstly, in the region of Koudougou (Upper-Volta), in November-December 1973 (17,300 vaccines) . Its major aim was to solve operational and logistical problems; --secondly, in the Koutiala (Mali) area, according to a very strict schedule, in November-December 1975 and December 1975 (37,979 vaccines) . The complete innocuousness of the vaccine was proven and excellent seroconversion was observed after its administration . On the individual level, it was confirmed that the vaccine ensures excellent protection for a period of at least three years . This new prophylactic weapon inspires the authors to suggest a new strategy in the fight against meningitis epidemics caused by meningococcus in the African Sahel area, taking into account the current increase there in serogroup C, against which there is also a vaccine whose efficacy has already been demonstrated. Bull Soc Pathol Exot Filiales, 1978 Jan-Feb, 71(1), 34 - 45 {A new strategy of fight against meningococcal meningitis epidemics in Sahelian Africa}; Saliou P et al.; An acquired sulfamido-resistance to menigococcus having appeared, the authors propose a single injection of a cheap and efficient antibiotic, chloram-phenicol, suspended in oil for cerebrospinal meningitis treatment . This treatment has been successfully applied at the Bobo-Dioulasso hospital (recovery in 82.5% of the cases) . Two controlled experiments on the field of the group A polysaccharidic antimeningococcic vaccine in the Koudougou (Haute-Volta) and Koutiala (Mali) areas confirmed its efficiency and innocuity, the conferred immunity persisting two years at least . The appearance of serogroup C meningococcus at the origin of the epidemic attacks in Nigeria 1975 has been confirmed at Niamey (Niger) . In consequence of this new experience of the logistic and economic conditions in the countries of the "meningitic belt" the following strategy for meningococcus epidemic control may be proposed:--a strict epidemiologic supervision by nurses in rural dispensaries;--as soon as a few cases are reported in a medical sector, application of the "minute treatment" with chloramphenicol to all meningitic patients, which permits the "lethality prophylaxis"; the national authorities shall be then warned; they will make the diagnostic of the causal serogroup (A or C) thanks to the electroimmunodiffusion technique;--as soon as the serogroup is demonstrated, a specific "circonstance vaccination" campaign for the whole population of the sector shall be carried out, in order to stop the development of the disease. Scand J Infect Dis, 1978, 10(1), 36 - 40 Carriage of Neisseria meningitidis in a semi-isolated arctic community; Holten E et al.; The carriage of Neisseria meningitidis was examined in the Norwegian population of Svalbard (1150 persons) after a fatal case of meningococcal septicaemia . The overall carrier rate was 39.0% . The rate was highest among males (47.8%), with a maximum of 63.4% in the age group 15-24 years . The carrier rate was low among children aged 3 to 15 years (6.5%) . Children below 3 years were frequent meningococcal carriers, however (37.5%) . Sulphonamide-resistant strains were often found, 22.6% of the total material being resistant . Group B was the most frequent serogroup, and accounted for 44.5% of the isolated strains . Non-groupable strains were second in frequency (23.8%), followed by group Y (15.8%) . Only a few strains belonged to the serogroups A, C, X and Z . N . lactamica was isolated from 26.9% of children below 15 years, but seldom in older age groups. Zh Mikrobiol Epidemiol Immunobiol, 1978 Jan, (1), 25 - 7 {Ultrastructure of the L forms of meningococcus}; Konstantinova ND et al.; The authors carried out an electron microscope study of the ultrastructure of the L-form of meningococcus . Several types of cells differing by shape, size, and electron density were revealed . Sharply angular cells closely adjacent to one another prevailed in the culture . Structureless material, possibly representing material of cellular wall was not infrequently revealed around the cells . Elemental bodies and membranous structures of the lamellar type were revealed within the cells. Scand J Infect Dis, 1978, 10(4), 277 - 82 Mortality in meningococcal infections; Andersen BM; Among 124 patients with meningococcal infections between 1966-1976, 108 had meningitis with a fatality rate of 7.4%, and 16 septicaemia with 18.8% fatality . High risk patients (more than 3 prognostically unfavourable characteristics) increased from 3.5% 1966-1970 to 15.6% 1971-1976, and the total mortality from 3.6 to 10.4% . The most unfavourable prognostic factor was low blood pressure at admission . High risk patients were more common among those who had meningococci with complete or partial sulfonamide resistance (25.7%) than among those having sensitive meningococci (11.9%) . When the meningococci were at least partially sulfonamide-resistant, initial therapy with the combination of benzylpenicillin, sulfaisodimidine and chloramphenicol seemed to be more successful than benzylpenicillin alone in patients above 10 years . Ampicillin was used only in children, and these all survived. Dev Biol Stand, 1978, 41, 209 - 16 Combination of attenuated measles vaccine (Schwarz) with meningococcus A and A + C vaccine; Ajjan N et al.; There is an obvious interest in a combined meningococcus-measles vaccine since the two diseases are widespread and serious in Third World countries among children under five years of age . The purpose of our study was to show the safety and effectiveness of such a combined preparation . The study covered 110 children between 8 months and 4 years of age who were followed systematically in a maternal child health center in the Paris area . Only 93 of them were checked before and after the immunization . The serologic titrations by the hemagglutination assay (IHA) for measles, and by radioimmunological assay (RIA) for meningococcus A and C showed that the Schwarz strain measles vaccine combined with meningococcus A or the association A+C does not interfere with the increase of A or C titers . 100% of the children showed a seroconversion equal to or less than 2 micrograms per ml, in the case of meningococcus A, as well as for C, regardless of age . Furthermore, 88% of the subjects showed a titer greater than or equal to 4 micrograms for the meningococcus A and 79% for C . On the other hand, meningococcus A or the association A+C seem to depress measles vaccine activity . Nevertheless, more than 80% of the children tested showed seroconversion when the measles vaccine was combined with meningococcus A, and only 69% when combined with meningococcus A and C. Scand J Rheumatol, 1978, 7(2), 101 - 8 Induction of DNA synthesis in lymphocytes in vitro by various bacteria, with special reference to Neisseria gonorrhoeae, in patients with uro-arthritis (Reiter's disease); Rosenthal L et al.; Antigen-induced lymphocyte proliferation was studied by quantitation of 14C-thymidine uptake in cell cultures . The induction of DNA synthesis in vitro in lymphocytes from patients with uro-arthritis after stimulation by whole cells of virulent and avirulent N . gonorrhoeae, meningococci group B, and apathogenic Neisseria (N . pharyngis) was compared with the DNA synthesis in lymphocytes from healthy controls after stimulation with the same Neisseria antigens . The difference between patients and the controls was found to be highly significant after stimulation with virulent or avirulent N . gonorrhoeae organisms but not after stimulation with apathogenic Neisseria . An analysis of the correlation of the lymphocyte reactivity to all the Neisseria antigens showed a highly significant correlation between the response of uro-arthritis patients to the two types of gonococcal antigen (0.932*** and 0.859***), a lower correlation coefficient for group B meningococci and virulent or avirulent gonococci (0.724*** and 0.714***) and no correlation at all between apathogenic Neisseria and gonococci . The DNA synthesis in lymphocytes stimulated by N . gonorrhoeae and other Gram-positive and Gram-negative bacteria was also studied in cell cultures obtained from other healthy controls as well as uro-arthritis patients . There was no significant difference between the patients and the controls with regard to the response to apathogenic Neisseria and other non-Neisseria antigens. Scand J Infect Dis, 1978, 10(2), 107 - 11 Benign meningococcemia in childhood . A report of five cases with clinical and diagnostic remarks; Olcen P et al.; Five children aged 1/2--10 years with benign meningococcemia are reported . The clinical picture was quite uniform: good general condition, spikes of fever, skin eruptions as maculopapules--sometimes haemorrhagic, appearing in association with febrile periods, and arthralgia (big joints) . The diagnosis involves either isolation of meningococci (MC) from blood, demonstration of MC with immunofluorescence in skin eruptions, or a significant elevation of MC antibody titre in connection with typical clinical signs and symptoms . Important differential diagnoses are Henoch-Schonlein syndrome, disseminated gonococcal infection, septicemia of other origins, subacute bacterial endocarditis, viral infections, hypersensitivity reactions and subsepsis allergica . By co-agglutination technique, the causative agent of meningococcemia in 4 of the 5 children was shown to be MC group B . These have some features in common with gonococci, whereby an incorrect diagnosis might be suggested as demonstrated in one of our patients . The question is raised whether MC group B is the main causative agent in benign meningococcemia. Zh Mikrobiol Epidemiol Immunobiol, 1978, (12), 63 - 7 {Makeup and properties of a polycomponent meningococcal vaccine}; Efimov DD et al.; The polycomponent meningococcae vaccine represented a preparation of the high-molecular fraction of meningococcus cell wall substances . Meningococcae strains for the vaccine preparation were chosen in such a way that the end preparation contained antigens of group specificity A, B, C and also other antigens detected in the cell wall of strains of epidemiological significance . Protein, group polysaccharides., lipopolysaccharides and nucleic acids were included into the vaccine composition . In doses used inhumans the vaccine was safe for mice causing no retardation in weight gain . In immunization of mice the vaccine produced formation of antigbodies to the antigens of group specificity A, B, and C, and protected them from infection with the srtrain isolated from the patient's cerebrospinal fluid . THE VACCINE PRODUCED NO HARMFUL ACTION IN ADMINISTRATION TO MAN . Antibodies to antigens of group specificity A, B, C and also to proteins and lipopolysaccharides of the meningococcus cell wall formed in the vaccinated persons . Sera of the vaccinated individuals lysed meningococci of groups A, B, and C. J Hyg Epidemiol Microbiol Immunol, 1978, 22(2), 230 - 6 Evaluation of the prophylactic effect of gamma globulin in meningococcal infection; Pokrovskii VI et al.; Results of two controlled epidemiological tests evaluating the prophylactic effect of gamma globulin of Monogolian and Soviet production against meningococcal infection are presented . Observations were carried out on children aged 3 months to 4 years, not attending children's establishments . The results of the observation revealed the following prophylactic effect of gamma globulin of Mongolian production in the first two months after administration: index of efficiency--5.0, coefficient of efficiency--80%, P greater than 0.01 . The efficiency of the prophylactic effect of Soviet gamma globulin was limited to one month: the index of efficiency amounted to 5.3, the coefficient of efficiency to 82.2%, P greater than 0.01 . The course of meningococcal infection in the children who had received gamma globulin was less severe than in the children of the control group . Lethal outcome was recorded only in the group of children who had not received gamma globulin . The duration of the prophylactic effect of gamma globulin was found to depend on the height of the titres of specific antibodies in the preparation . The preparations are recommended as prophylactic means for children aged from 3 months to 4 years in doses of 1.5 ml (one dose) in the foci of meningococcal infection. Zh Mikrobiol Epidemiol Immunobiol, 1978 Jan, (1), 79 - 84 {Antigenic characteristics and various biological properties of glycoprotein from Neisseria meningitidis of serological group A}; Ezepchuk IuV et al.; It was shown that the antigen determining the group specificity of meningococcus belonging to serological group A was of mixed polysaccharide-protein nature . Carbohydrate component is responsible for the interaction with the group-specific antibodies in this antigen . Glycoprotein can be isolated both from the cells and from the culture fluid where it passes during the N . meningitidis cultivation in fluid nutrient medium . The described antigen possesses no properties of endotoxin. Schweiz Med Wochenschr, 1977 Dec 17, 107(50), 1900 - 3 {Allergic reaction to meningococcal antigen . Clinical aspects, pathogenesis and diagnosis related to a case history}; Sundal E et al.; A case report illustrates a complication of meningococcal meningitis which often causes differential-diagnostic problems: allergic reaction to the meningococcal antigen . The pathogenesis and diagnostic principles are discussed in the light of the literature. J Infect Dis, 1977 Dec, 136(6), 733 - 9 Immunoepidemiology of meningococcal disease in military recruits . II . Blocking of serum bactericidal activity by circulating IgA early in the course of invasive disease; Griffiss JM et al.; The potential role of IgA antibody to Neisseria meningitidis, which blocks bacteriolysis by IgG and IgM, in producing the susceptible state in military recruits, a population at greater than expected risk, was investigated in 28 patients with meningococcal disease . IgA was removed from acute-phase sera by immunoadsorption; IgG was separated by ion-exchange, and IgM by gel-filtration chromatography . The bactericidal activity of acute-phase sera, before and after removal of IgA, and of IgG and IgM fractions from the sera, was tested against each of the homologous infecting strains . Bactericidal activity, the correlate of protective immunity, was deficient in 24 of 28 unabsorbed sera, but uniformly present after the removal of IgA in a median titer of 1:16 . IgM accounted for all or nearly all of the bactericidal activity . IgG was largely inactive . Susceptibility to meningococcal disease may be affected by the blocking of bactericidal IgM by circulating IgA. Rev Rhum Mal Osteoartic, 1977 Dec, 44(12), 715 - 20 {Post-meningococcal rheumatism (apropos of 3 cases)}; Doury P et al.; A report is given on 3 cases of arthritis after cerebrospinal meningitis caused by B meningococci, with a relapsing course in 1 case . The observations are compared with the literature and the characteristics of articular manifestations of meningococcal infections are outlined . Three types are distinguished . Type I is characterized by banal arthralgias masked by the symptoms of meningitis . Type II encompasses septic arthritides preceding or concurring with the meningitis and like the latter sensitive to antibiotics . Type III includes postmeningococcal arthritides with sterile articular fluid refractory to antibiotics and showing a spectacular reaction to non-steroid anti-inflammatory drugs . These arthritides constitute a true infective rheumatism, post-meningococcal rheumatism, and should be related to other post-meningococcal manifestations such as pericarditis, myocarditis, cutaneous and ocular changes . All these manifestations are attributed to the production of immune complexes . Postmeningococcal arthritides, whose characteristics are described, may occur after septic meningococcal arthritis or appear as such . The distinction of postmeningococcal rheumatism where only anti-inflammatory treatment is effective might lead to the question whether certain postgonococcal arthritides refractory to antibiotics and responding to anti-inflammatory drugs are not provoked by an immuno-allergic mechanism leading to postgonococcal rheumatism -a nosological entity that has been abandoned possibly too fully and definitively. An Esp Pediatr, 1977 Dec, 10(12), 903 - 4 {Incidence, clinical, forms and complications of meningococcal infections (author's transl)}; Fidalgo I et al.; Eighty four cases of meningococcal infections are reviewed . Fifty seven cases presented themselfs as meningococcal meningitis, twelve cases as sepsis with moderate hypotension and 15 cases were sepsis with septic shock . A brief course of the disease, shock, echymosis, absence of meningeal signs, leucopenia and intravascular coagulation were findings more frequent in the group of patients with hiperacute sepsis, whereas other signs as fever, headaches, vomiting and petechiae were present with equal frequency in the three groups . N . meningitis was isolated in 73% of the cases . Shock (18.85%) and intravascular coagulation (12%) were the complications more frequently found, followed by convulsions (4.81%), arthritis (4.81%), skin necrosis (4.81%), subdural efusion (3.57%), cerebral palsy (3.40%), thrombophlebitis (1.20%), recurrence (1.20%), inapropiate antidiuretic hormone secretion (1.20%) and subaracnoideal hemorrage (1.20%) . The overall mortality was 10.70% and 60% of the patients which initially presented with shock and intravascular coagulation died . Autopsy findings included wide spred hemorragic lesions and intravascular thrombi in skin, mucous membranes and viscera . Adrenal hemorrhage was present in five of the six cases studied. Br J Vener Dis, 1977 Dec, 53(6), 394 - 7 Which Neisseria? Willcox RR, Spencer RC, Ison C. A case of disseminated gonococcal infection in which the gonococcus was isolated from the blood and genitalia and the meningococcus from the throat is described . A second patient, in whom the meningococcus was isolated from the throat and the gonococcus from the genitals but in whom no organisms were recovered from the blood, had lesions resembling those of a disseminated infection . The results of 150 throat cultures from patients who were examined at a clinic because they had a history of oral sexual intercourse are presented . The meningococcus was isolated nearly six times more often in patients with genital gonorrhoea than in those in whom genital cultures were negative, while the gonococcus was found 2 1/2 times more often in those who carried the meningococcus in the throat than in those who did not . If these findings can be confirmed it could indicate an individual susceptibility to the acquisition of Neisserian organisms that would merit further investigation. Br J Vener Dis, 1977 Dec, 53(6), 353 - 9 Cell-mediated immune response in gonococcal infections; Wyle FA et al.; Peripheral blood lymphocyte (PBL) transformation stimulated by gonococcal and meningococcal antigens was studied in 29 men and 21 women with uncomplicated gonorrhoea . The blastogenic responses of PBLs from these men and women were substantially higher than from normal controls . Cross-reactivity between Neisseria gonorrhoeae and Neisseria meningitidis was manifested by the PBL transformation responses in patients with gonorrhoea to non-purified meningococcal antigen (MGC-I) . In both male and female patients the PBLs were stimulated by non-purified gonococcal antigen (GC-I) and by non-purified meningococcal antigen . The extent of the blastogenic response in women was much greater than in men . Partial purification of these antigens by gel chromatography resulted in reduced cross-reactive responses to the semi-purified meningococcal antigen (MGC-II) . Female patients demonstrated marked stimulation with the semi-purified gonococcal antigen (GC-II), while male patients showed slight stimulation with GC-II . It is possible that cell-mediated immunity may act to limit the spread of gonococcal infection beyond the genital mucous membranes. Zh Mikrobiol Epidemiol Immunobiol, 1977 Dec, (12), 96 - 100 {Sensitivity of meningococci to the antagonistic activity of nasopharyngeal microflora and antibiotics}; Bochkov IA et al.; Comparative study of the meningococcus sensitivity of various serological groups with different localization in the human organism to the antagonistic activity of normal microbes of the nasopharynx and the antibiotics it was found that strains isolated from the cerebrospinal fluid of patients suffering from cerebrospinal meningitis, chiefly of serological group A, had the greatest resistance to the antagonists . Taking into consideration the leading epidemiological role of the cultures belonging to the serological group A in the USSR, it can be supposed that meningococcus sensitivity to the nasopharyngeal antagonists was of significance for the manifestation of their pathogenic properties . No association of the antibiotic sensitivity of the same strains with reference to a definite serological group or the site of the microbe localization was revealed. J Clin Microbiol, 1977 Dec, 6(6), 548 - 50 Isolation of bacteriophages specific for the K1 polysaccharide antigen of Escherichia coli; Gross RJ et al.; Five bacteriophage stocks were prepared after enrichment of a sewage sample using Escherichia coli 02:K1:H4 (strain U9/41) . The bacteriophages were tested for their ability to lyse 224 strains of E . coli that had been tested for the presence of the K1 antigen by means of an antiserum-agar diffusion technique, using a meningococcus group B antiserum known to detect the E . coli K1 antigen . The standard test strains for E . coli K antigens 2 to 99 were used as control strains . Of the 101 strains found to possess the K1 antigen using the antiserum-agar technique, 93 were lysed by at least one of the bacteriophages, whereas 8 of the 123 strains apparently lacking K1 were lysed by one or more of the bacteriophages . None of the standard test strains for K antigens 2 to 99 was lysed by any of the bacteriophages . The eight strains thought to lack K1 but that were lysed by bacteriophage were re-examined by immunoelectrophoresis, using meningococcus group B antiserum; five of the eight strains gave a precipitin line corresponding to K1 . The use of K1-specific bacteriophages offers an inexpensive and easy method for the identification of the K1 antigen. Pediatrics, 1977 Nov, 60(5), 673 - 80 Persistence of antibody following immunization of children with groups A and C meningococcal polysaccharide vaccines; Lepow ML et al.; Persistence of antibody following immunization with groups A and C meningococcal polysaccharides was studied in two groups of children . Cohort 1 (20 children, 2 to 11 years of age) received two doses of A vaccine three years apart; cohort 2 (1,345 children, 6 to 8 years of age) received A or C vaccine initially and the heterologous vaccine one year later . No significant reactions were observed . Geometric mean anti-A concentrations one month after primary and booster immunization in cohort 1 were 8.77 and 13.08 microgram/ml, respectively . Mean anti-A concentration declined 32% one year after booster immuniz