A laboratory-acquired infection with Neisseria meningitidis

Four disease isolates of Neisseria meningitidis including one isolate from a case of laboratory-acquired meningococcal meningitis were characterised immunologically in an attempt to trace the source of the laboratory-acquired infection. The results strongly suggest the infecting organism was being routinely studied at the time of infection.     

Typing of non-serogroupable Neisseria meningitidis by means of sensitivity to R-type pyocines of Pseudomonas aeruginosa

Thirty-three (66 per cent) of 50 non-serogroupable isolates of Neisseria meningitidis could be typed on the basis of their sensitivities to partially purified rod-type (R-type) pyocines from 13 strains of Pseudomonas aeruginosa. Only seven (11 per cent) of 63 serogroupable meningococci were sensitive to the test pyocines. The pyocine typing method is particularly applicable to the labelling of strains in which autoagglutinability precludes the standard agglutination typing procedure.     

Conjugation of plasmids of Neisseria gonorrhoeae to other Neisseria species: potential reservoirs for the beta-lactamase plasmid

The discovery that penicillinase production in Neisseria gonorrhoeae was plasmid mediated and the spread of the beta-lactamase encoding plasmids in gonococcal isolates since 1976, raise the possibility that a nonpathogenic indigenous bacterium could serve as a reservoir for these plasmids. We initiated studies to define the ability of commensal Neisseria species and Branhamella catarrhalis strains, as well as strains of the pathogen Neisseria meningitidis, to serve as recipients in conjugation with Neisseria gonorrhoeae. We found that with N. gonorrhoeae as the donor, 3 of 5 Neisseria cinerea, 2 of 5 Neisseria flava, 0 of 1 Neisseria flavescens, 1 of 3 Neisseria subflava, 0 of 6 B. catarrhalis, 0 of 7 Neisseria lactamica, 1 of 5 Neisseria mucosa, 1 of 7 Neisseria perflava/sicca, and 0 of 13 N. meningitidis strains gave detectable conjugation frequencies (greater than 10(-8). N. cinerea was the only species found to maintain the gonococcal conjugal plasmid (pLE2451). A N. cinerea transconjugant containing pLE2451 was observed to transfer both the beta-lactamase plasmid and pLE2451 to N. gonorrhoeae at high frequency.     

Recent trends in gonorrhoea - an emerging public health issue ?

Neisseria gonorrhoeae infection remains one of the commonest bacterial sexually transmitted infections (STIs) in many developed countries. Its disproportionate burden on deprived, inner city populations and association with infertility have made its contr     

Gonococcal Perihepatitis: Diagnostic and Therapeutic Value of Laparoscopy

Two patients with pelvic and right hypochondrial pain and with purulent vaginal exudate in which Neisseria gonorrhoeae was isolated, are presented. Laparoscopy was used in both cases. A diagnosis of perihepatitis was made by demonstrating the typical adhesions in "violin string" shape and by obtaining clinical improvement after breaking up those adhesions. Our conclusion is that laparoscopy is a useful diagnostic and therapeutic procedure in young women with pain in the right upper quadrant of the abdomen and with signs of lower genital infection.     

Neisseria gonorrhoeae and Chlamydia trachomatis infections in patients attending STD and family planning clinics in Bissau, Guinea-Bissau

Accurate clinical and laboratory data about sexually transmitted diseases (STD) prevalence in Guinea-Bissau are not available. These data are important, since HIV2 is prevalent in this country, rates of HIV1 are increasing and STDs facilitate HIV transmission. Since DNA amplification methods have demonstrated to accurately diagnose chlamydial infections and gonorrhoea, the Amplicor CT/NG PCR Assay with Internal Control of Amplification (Roche Diagnostic System, Branchburg, NJ, USA) was used to estimate the prevalence of Neisseria gonorrhoeae and Chlamydia trachomatis genital infections in STDs and Family Planning Clinic attenders in Bissau, from March to July 1997. Two hundred and two cervical swabs and 31 urethral swabs were examined. Two women were excluded from this study because their cervical swabs contained inhibitory substances. N. gonorrhoeae was identified in 34/200 (17%) women and in 12/31 (38.7%) men. C. trachomatis was detected in 8/200 (4%) women there were no positive C. trachomatis results among the 31 men with urethritis. One woman presented a mixed infection with both organisms. The prevalence difference between men and women was not statistically significant (P=0.6) for C. trachomatis infection, but it was significant for N. gonorrhoeae infection (P=0.01). The prevalence rates of these infections found in this study, support the need for an urgent strategy to control STD in the region.     

Molecular epidemiology and emergence of worldwide epidemic clones of Neisseria meningitidis in Taiwan

Background  

Meningococcal disease is infrequently found in Taiwan, a country with 23 million people. Between 1996 and 2002, 17 to 81 clinical cases of the disease were reported annually. Reported cases dramatically increased in 2001–2002. Our record shows that only serogroup B and W135 meningococci have been isolated from patients with meningococcal disease until 2000. However, serogroup A, C and Y meningococci were detected for the first time in 2001 and continued to cause disease through 2002. Most of serogroup Y meningococcus infections localized in Central Taiwan in 2001, indicating that a small-scale outbreak of meningococcal disease had occurred. The occurrence of a meningococcal disease outbreak and the emergence of new meningococcal strains are of public health concern.     

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).

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.     

Gonorrhea update

This article provides a brief summary of recent US epidemiology, antimicrobial resistance, and treatment of Neisseria gonorrhoeae infections. Selected research regarding infections caused by N. gonorrhoeae is described, with particular emphasis on the advances made by new molecular methods.     

Selective C7 complement deficiency causing recurrent meningococcal infection

We report on two sisters both with complete absence of the 7th component of complement. This congenital immunodeficiency disorder is associated with recurrent bacterial infection, especially that due to Neisseria species. These cases illustrate many of the well-recognised features of this disorder, but in one patient the illness was complicated by infective endocarditis due to N. meningitidis, a feature not previously reported.     

Septic arthritis in systemic lupus erythematosus.

Five patients with systemic lupus erythematosus (SLE) developed septic arthritis. Neisseria gonorrheae, Staphyloccocus aureus, Proteus and Escherichia coli were the offending bacterial organisms. Predisposing factors included systemic and local corticosteroids, aseptic necrosis of bone and synovitis due to SLE. The diagnosis was made by culture of the organisms from the synovial fluid. Three patients recovered without residual joint damage, one required corrective arthroplasty and one died from overwhelming infection.     

Neisseria meningitidis in the anal canal of homosexual men.

Cultures were obtained from the oropharynx, urethra, and anal canal of 157 homosexual men. Neisseria gonorrhoeae was identified in 30 men (19.1%), Neisseria meningitidis in 32 men (20.4%), and Neisseria lactamicus and Branhamella catarrhalis in one man each. N. gonorrhoeae was isolated from the anal canal of three men (1.9%), and N. meninititidis was identified in the anal canal of seven men (4.5%). These findings suggest that confirmatory tests are indicated for homosexual males with rectal isolates presumptively identified as N. gonorrhoeae.     

The significance of nongonococcal, nonmeningococcal Neisseria isolates from blood cultures

Nongonococcal, nonmeningococcal neisseriae are part of the normal respiratory flora and infrequently cause disease. These organisms include Neisseria lactamica, Neisseria mucosa, Neisseria sicca, Neisseria flavescens, Neisseria subflava , Neisseria perflava , Neisseria flava , and Branhamella catarrhalis (previously classified as Neisseria catarrhalis). Blood cultures positive for these bacteria have been associated with serious infections, including endocarditis, septicemia, and meningitis. In a retrospective survey of a 10-year period, 1970-1980, eight patients were identified at Hartford Hospital (Hartford, Conn.) whose blood cultures were positive for nongonococcal, nonmeningococcal neisseriae. In four patients, the neisseria blood isolates were associated with serious infections: two with endocarditis, one with sepsis, and one with meningitis. In four other patients, the neisseria blood isolates were contaminants.     

Atypical clinical presentation of laboratory-acquired meningococcal disease

We report a case of laboratory-acquired meningococcal disease in a 31-y-old female research assistant. The clinical presentation of the case was atypical with polyserositis affecting knees, pleura and pericardium, without septicaemia or meningitis. The diagnosis was made by positive PCR for Neisseria meningitidis (genogroup C, genosubtype P1.7, 16, 35 and without mutations of the penA gene) in the patient's right knee. Serology confirmed the diagnosis after recovery. This case had an atypical clinical picture, exemplifies the use of non-culture methods for diagnosis and characterization, and reminds us about the importance of safe routines for the laboratory work.     

Localization of and immune response to the lipid-modified azurin of the pathogenic Neisseria.

The development of vaccines to prevent Neisseria infections has been impeded by antigenic diversity of most Neisseria surface components. The lipid-modified azurin (Laz), one of two distinct surface proteins recognized by the H.8 monoclonal antibody, is present in all pathogenic Neisseria. The mature protein has two domains; one contains an H.8 epitope and the other has extensive homology to azurins, a class of bacterial copper-binding proteins. The cellular location of Laz and the serum immune response to Lax were examined in patients with disseminated Neisseria infections. The data demonstrated that Laz is probably contained in the Neisseria outer membrane, although unlike most outer membrane proteins it is Sarkosyl soluble. By probing recombinant bacteriophages encoding the H.8 and azurin domains of Laz, results showed that whereas the H.8 epitope is immunogenic in patients with disseminated Neisseria infections, the azurin domain of Laz plays little role in eliciting an antibody response in these patients.     

Aseptic arthritis after gonorrhoea.

Sixteen patients with aseptic arthritis developing after gonorrhoea and 14 patients with arthritis after nongonococcal urogenital infection have been analysed with respect to clinical course, roentgenological signs, and humoral as well as cellular immune responses to Neisseria gonorrhoeae antigen. Fifty-eight healthy blood donors were used as controls. The clinical pattern did not differ significantly between the 2 groups. Eye or skin lesions indicative of Reiter's syndrome were found in 5 patients of both groups. Signs of sacroiliac arthritis were found in 8 and 6 patients respectively. Gonococcal complement fixation was positive in 9 of 16 patients in the postgonorrhoeal arthritis group and in 0 of 14 patients in the arthritis group with nongonococcal urogenital infection. The lymphocyte stimulation induced by gonococcal antigen was significantly greater in patients with postgonorrhoeal arthritis than in healthy controls. When reference was made to the results of stimulation of the lymphocytes with PPD, there was also a significant difference in the lymphocyte reactivity to gonococcal antigen between the group of patients with postgonorrhoeal arthritis and that of patients with arthritis after non-gonococcal urogenital infection. No such difference was noted between the latter group and the healthy controls. The clinical and immunologic data argue in favour of the hypothesis that Neisseria gonorrhoeae may induce an aseptic arthritis which sometimes presents as a complete Reiter's syndrome.     

Epidemiology and molecular basis of penicillin-resistant Neisseria meningitidis in Spain: a 5-year history (1985-1989).

Penicillin-resistant (penr) clinical isolates of Neisseria meningitidis, which do not produce beta-lactamase, were first identified in Spain in 1985; the frequency of their recovery, which has been increasing in the past few years, reached 20% in 1989. Serogrouping, determination of serotypes and subtypes, and multilocus enzyme electrophoresis of the penr strains showed an extensive diversity. Resistance is due, at least in part, to a decreased affinity of penicillin-binding protein (PBP) 2 for penicillin. Similar low-affinity forms of PBP 2 are also found in penr isolates of Neisseria lactamica, Neisseria polysaccharea, and Neisseria gonorrhoeae. Genetic transformation of an N. meningitidis type strain to low-level penicillin resistance with DNA from resistant meningococci and other Neisseria species resulted in transformants that possessed low-affinity forms of PBP 2. These altered forms of PBP 2 have been shown to arise from recombinational events that replace parts of the PBP 2 gene with the corresponding regions from the PBP 2 genes of commensal Neisseria species.     

河北省首例B群流脑死亡病例病原学分析

目的对河北省首例B群流行性脑脊髓膜炎（流脑）死亡病例进行病原学分析。方法采集患儿血和脑脊液标本,进行生化鉴定和PCR目的基因的检测,对分离菌株进行Etest法药敏试验和多位点序列分型（multiiocussequencetyping,MLST）分析。结果该病例证实为B群脑膜炎奈瑟菌引起的脑膜炎病例,该菌株对磺胺甲基异嗯唑、环丙沙星、萘啶酸耐药,对米诺霉素、阿奇霉素等敏感。MLST结果分析该菌为ST-9754型,属于ST-4821高致病克隆群。结论该病例为河北省首例B群流脑死亡病例,病原菌为具有高致病性的ST-9754型脑膜炎奈瑟菌,提示应要加强流脑病原学监测。