Emergence of a virulent clone of Neisseria meningitidis serotype 2a that is associated with meningococcal group C disease in Canada.

Multilocus enzyme electrophoresis was used to characterize 378 isolates of Neisseria meningitidis serogroup C recovered during a period of an increase in group C meningococcal disease in Canada. Thirty-four enzyme electrophoretic types were found among the isolates, which were predominantly (96.0%) serotype 2a. One clone (ET 15), characterized by a rarely occurring allele for the enzyme fumarase, was responsible for a focal outbreak in Ontario followed by the spread of group C disease across the province. This clone, which occurred infrequently among strains isolated in 1986, accounted for over 65% of group C strains associated with meningococcal disease in Canada in 1990.     

An outbreak of group B meningococcal disease: tracing the causative strain of Neisseria meningitidis by DNA fingerprinting.

Following an outbreak of meningococcal disease in three schoolchildren in a small community in northern Norway, DNA fingerprinting, serotyping with monoclonal antibodies, serogrouping, and sulfonamide sensitivity testing were applied for characterization and tracing of the causative agent. The three case isolates were genomically indistinguishable, sulfonamide-resistant, serogroup B, serotype 15 meningococci. Throat specimens were collected from 552 healthy contacts, including all children below age 17 and their parents. Among the 36 carrier isolates (carrier rate, 6.5%) 13 showed DNA fingerprints identical, or almost identical, to the index pattern. All of these 13 isolates were sulfonamide resistant, 12 were of serotype 15, and 8 were of polysaccharide serogroup B (5 were nongroupable). These closely related isolates were almost exclusively recovered from schoolchildren of 2 of 15 small villages, one of which included the homes of two of the patients. The remaining 23 carrier isolates were nonresistant, non-type 15 meningococci of widely differing DNA restriction patterns. Our results confirm that DNA fingerprinting has potential as an efficient tool in practical meningococcal epidemiology.     

Antibody responses to the capsular polysaccharide of Neisseria meningitidis serogroup B in patients with meningococcal disease.

We measured antibody responses to meningococcal serogroup B (MenB) polysaccharide (PS) by enzyme-linked immunosorbent assay (ELISA) in sera from 94 patients from The Netherlands with disease caused by Neisseria meningitidis group B. The patients ranged in age from 3 to 73 years (mean age, 18.8 years). In initial studies we showed that the binding of a panel of MenB PS-reactive human immunoglobulin M (IgM) paraproteins to biotinylated MenB PS bound to avidin-coated microtiter wells was inhibited > 90% by the addition of soluble MenB PS or encapsulated group B meningococci. In contrast, inhibition of IgM anti-MenB PS antibody-binding activity in many of the patient sera was less than 50% (range, 20 to 94%). These data suggested a high frequency of nonspecific binding in the patient sera. Therefore, all serum samples were assayed in replicate in the presence or absence of soluble MenB PS, and only the inhibitable fraction of the binding signal was used to calculate the anti-MenB PS antibody concentrations. In 17 control patients with meningococcal disease caused by serogroup A or C strains, there was no significant difference in the respective IgM or IgG anti-MenB PS antibody concentrations in paired acute- and convalescent-phase sera. In contrast, in patients with MenB disease, the geometric mean IgM anti-MenB PS antibody concentration increased from 3.9 units/ml in acute-phase serum to 10.5 units/ml in convalescent-phase serum (P < 0.001). The corresponding geometric mean IgG anti-MenB PS antibody titers were 1:27 and 1:36 (P < 0.05). There was only a weak relationship between age and the magnitude of the logarithm of the antibody concentrations in convalescent-phase sera (for IgM, r2 = 0.06 and P < 0.05; for IgG, r2 = 0.08 and P < 0.01). Our data indicate that precautions are needed to avoid nonspecificity in measuring serum antibody responses to MenB PS by ELISA. Furthermore, although this PS is thought to be a poor immunogen, patients as young as 3 years of age recovering from MenB disease demonstrate both ImG and IgG antibody responses in serum.     

Evaluation of pulsed-field gel electrophoresis in epidemiological investigations of meningococcal disease outbreaks caused by Neisseria meningitidis serogroup C

Since 1990, the frequency of Neisseria meningitidis serogroup C (NMSC) outbreaks in the United States has increased. Based on multilocus enzyme electrophoresis (MEE), the current molecular subtyping standard, most of the NMSC outbreaks have been caused by isolates of several closely related electrophoretic types (ETs) within the ET-37 complex. We chose 66 isolates from four well-described NMSC outbreaks that occurred in the United States from 1993 to 1995 to evaluate the potential of pulsed-field gel electrophoresis (PFGE) to identify outbreak-related isolates specific for each of the four outbreaks and to differentiate between them and 50 sporadic isolates collected during the outbreak investigations or through active laboratory-based surveillance from 1989 to 1996. We tested all isolates collected during the outbreak investigations by four other molecular subtyping methods: MEE, ribotyping (ClaI), random amplified polymorphic DNA assay (two primers), and serotyping and serosubtyping. Among the 116 isolates, we observed 11 clusters of 39 NheI PFGE patterns. Excellent correlation between the PFGE and the epidemiological data was observed, with an overall sensitivity of 85% and specificity of 71% at the 95% pattern relatedness breakpoint using either 1.5 or 1.0% tolerance. For all four analyzed outbreaks, PFGE would have given public health officials additional support in declaring an outbreak and making appropriate public health decisions.     

Aberrant strain of group G Neisseria meningitidis.

A glucose-negative group B strain of Neisseria meningitidis isolated from a meningitis case is described. A brief review of Neisseria identification procedures is also presented.     

Neisseria meningitidis with decreased susceptibility to penicillin in Saskatchewan, Canada.

Moderately penicillin-resistant Neisseria meningitidis is rare in North America. We report an outbreak of meningococcal disease in Saskatoon, Saskatchewan, Canada, with serogroup C N. meningitidis. The MICs of penicillin ranged from 0.12 to 0.25 micrograms/ml, and all isolates showing decreased susceptibility had identical genomic fingerprints when they were compared by pulsed-field gel electrophoresis. Our data indicate that N. meningitidis that is moderately resistant to penicillin is prevalent in Saskatchewan, Canada.     

Applications of restriction endonuclease fingerprinting of chromosomal DNA of Neisseria meningitidis.

Restriction endonucleases are bacterial enzymes that cleave DNA at specific sites. The resulting DNA fragments may be separated electrophoretically in gel to form specific restriction patterns. In the present study, the restriction endonuclease method was successfully adapted to the analysis of the chromosomal DNA of Neisseria meningitidis. The endonucleases HindIII and EcoRI provided optimal restriction patterns of ca. 50 well-separated lines. The pattern of each bacterial isolate was characteristic, stable, and reproducible. Despite some general similarity, the restriction patterns of the closely related B15 meningococci were surprisingly heterogeneous.     

Evidence for indirect nosocomial transmission of Neisseria meningitidis resulting in two cases of invasive meningococcal disease

Nosocomial transmission of Neisseria meningitidis has only rarely been reported. Here, we present a significant spatiotemporal association of two cases of invasive meningococcal disease identified by retrospective cluster analysis with the program SaTScan. The most likely epidemiological link was simultaneous hospitalization, resulting in indirect nosocomial transmission.     

Homogeneity of protein serotype antigens in Neisseria meningitidis group A.

Serotype antigens (STA), which have been shown to be constituents of outer-membrane protein, were extracted from group A meningococci with 0.2 M LiCl and pelleted by centrifugation at 150,000 X g. The STAs from 100 group A strains, which had been isolated from cases and carriers in various geographical locations, were compared by sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE). Every STA produced three major protein bands with molecular weights of approximately 35,000, 39,000, and 45,000, respectively. This SDS-PAGE pattern is clearly distinct from that produced by the serotype of group B and C meningococci most commonly isolated from cases (group B type 2 and group C type 2). The group A STAs were also indistinguishable by immunodiffusion. However, differences in bactericidal reactions were demonstrated, suggesting that there are other antigens that play a role in antibody response.     

Activation of murine B lymphocytes by Neisseria meningitidis and isolated meningococcal surface antigens.

Heat-killed Neisseria meningitidis was found to be a potent mitogen for mouse splenic lymphocytes. Results obtained with different cell separation techniques indicated that the bacteria acted to selectively induce proliferation of B lymphocytes. First, partial or total depletion of T lymphocytes by treatment with various anti-T-cell antisera plus complement did not affect the ability of the remaining spleen cells to proliferate in response to N. meningitidis. Second, T lymphocytes purified by affinity chromatography through an immunoglobulin-antiimmunoglobulin-coated glass bead column were unresponsive to meningococcal stimulation, even when provided with a source of macrophages (irradiated or mitomycin C-treated spleen cells). Finally, treatment of spleen cells with soy bean agglutinin showed that, whereas the soy bean agglutinin-positive population (B-enriched lymphocytes) was highly responsive to stimulation by N. meningitidis, the soy bean agglutinin-negative population (T-enriched lymphocytes) displayed only a background level of proliferation when exposed to the bacteria. Isolated meningococcal surface antigens such as lipopolysaccharide (LPS) and outer membranes also possessed mitogenic activity and induced proliferation of B lymphocytes in a dose-dependent manner. Both LPS and non-LPS components contributed to the mitogenicity of outer membranes since the addition of outer membrane preparations to spleen cells from the low LPS responder C3H/HeJ mouse strain gave rise to a high level of proliferative activity.     

Acquisition of heme iron by Neisseria meningitidis does not involve meningococcal transferrin-binding proteins.

Similarities in size between hemin-binding protein 1 (HmBP1) and transferrin-binding protein 1 (TBP1) of Neisseria meningitidis suggest that these proteins are functionally homologous. However, a meningococcal mutant lacking the transferrin-binding proteins retained the capacity to acquire iron from heme and hemoglobin. In immunoblots, hyperimmune polyclonal antiserum against TBP1 did not react with HmBP1.     

Fluorescent amplified-fragment length polymorphism genotyping of Neisseria meningitidis identifies clones associated with invasive disease

Fluorescent amplified-fragment length polymorphism (FAFLP), a genotyping technique with phylogenetic significance, was applied to 123 isolates of Neisseria meningitidis. Nine of these were from an outbreak in a British university; 9 were from a recent outbreak in Pontypridd, Glamorgan; 15 were from sporadic cases of meningococcal disease; 26 were from the National Collection of Type Cultures; 58 were carrier isolates from Ironville, Derbyshire; 1 was a disease isolate from Ironville; and five were representatives of invasive clones of N. meningitidis. FAFLP analysis results were compared with previously published multilocus sequence typing (MLST) and pulsed-field gel electrophoresis (PFGE) results. FAFLP was able to identify hypervirulent, hyperendemic lineages (invasive clones) of N. meningitidis as well as did MLST. PFGE did not discriminate between two strains from the outbreak that were classified as similar but distinct by FAFLP. The results suggest that high resolution of N. meningitidis for outbreak and other epidemiological analyses is more cost efficient by FAFLP than by sequencing procedures.     

Septicemia due to a maltose-positive, glucose-negative strain of group C Neisseria meningitidis

A glucose-negative, maltose-positive strain of group C Neisseria meningitidis was isolated from the blood of a 63-year-old man. Interestingly, maltose degradation was detected by radiometric methods but not by growth methods.     

Group C Neisseria meningitidis variant polysaccharide vaccines in children.

The currently United States-licensed group C Neisseria meningitidis vaccine, composed of the O-acetyl-positive capsular polysaccharide, is poorly immunogenic and does not afford protection from disease to infants and young children. Group C N. meningitidis O-acetyl-negative polysaccharide vaccine induces higher titers in adults than does the O-acetyl-positive vaccine. We compared the immunogenicity of these vaccines in 2-year-old children. Reactions were minimal and did not differ between the two vaccines. The postvaccination geometric mean titer was twofold greater in the O-acetyl-negative group (1.58 versus 0.73 micrograms of antibody per ml). The rates of decline in titer were similar in both groups. Further study regarding immunogenicity of and the anamnestic response to the O-acetyl-negative vaccine is warranted in the age group (less than 18 months) at highest risk for invasive meningococcal disease.     

Conjugation of meningococcal lipopolysaccharide R-type oligosaccharides to tetanus toxoid as route to a potential vaccine against group B Neisseria meningitidis.

Oligosaccharides were obtained by the mild acid hydrolysis of the lipopolysaccharides from a number of different strains of Neisseria meningitidis, serotypes L2, L3, L4, L5, and L10. The dephosphorylated oligosaccharides were conjugated to tetanus toxoid as their 2-(4-isothiocyanatophenyl)-ethylamine derivatives, which resulted in the incorporation of from 18 to 38 oligosaccharides per molecule of tetanus toxoid. When injected in rabbits, the conjugates produced oligosaccharide-specific antibodies which were predominantly serologically specific but which also exhibited some cross-reactivity. These serological results can be attributed to regions of structural dissimilarity and similarity within the oligosaccharides. The oligosaccharide-specific antibodies were also lipopolysaccharide serotype specific, thus indicating that the oligosaccharides are the determinants associated with this serotype specificity. Consistent with the serological results, the conjugate antisera were bactericidal for the homologous serotype meningococcal organisms and in some cases for heterologous serotype organisms.     

Increased genetic diversity of Neisseria meningitidis isolates after the introduction of meningococcal serogroup C polysaccharide conjugate vaccines

During the 1990s, the incidence of meningococcal disease was high in the United Kingdom. This was due primarily to an increase in serogroup C disease, particularly that within the ET-37/ST-11 genetic lineage. Serogroup C meningococcal polysaccharide conjugate vaccines were introduced in the United Kingdom in 1999, but the sequence types of meningococci causing disease since that time have not yet been reported. We have used serogrouping and multilocus sequence typing to characterize meningococci from patients with invasive disease over a 4-year period and show that there is a significant increase in genetic diversity but no genetic evidence of capsule switching.     

Protection against group B Neisseria meningitidis disease: preparation of soluble protein and protein-polysaccharide immunogens.

Although effective polysaccharide vaccines have been developed for meningococcal groups A, C, Y, and W135, the purified group B polysaccharide has proven to be nonimmunogenic. Earlier studies indicated that serotype 2 outer membrane protein vaccines induced bactericidal antibodies in animals and protected them from meningococcal challenge. However, a similar vaccine induced only low levels of antiprotein antibodies in both adults and children (C.E. Frasch et al., in J.B. Robbins et al., ed., Seminars in Infectious Disease vol. 4, p. 263-267, 1982). Methods were therefore developed to produce more immunogenic serotype 2 protein vaccines. We found that, by growing the organism for 65 to 72 h at 32 degrees C, three to four times more outer membrane protein was released into the culture medium than could be extracted from overnight-grown cells. The outer membranes were therefore purified directly from the broth by ultrafiltration followed by ammonium sulfate precipitation. Most of the lipopolysaccharide was selectively removed from the membranes by treatment with the nonionic detergent Brij-96. The Brij-96 was then removed and the resulting vaccine was filter sterilized. Some vaccines were prepared by combining equal parts of detergent-treated membrane protein and high-molecular-weight group B polysaccharide producing highly soluble vaccines. These new vaccines were compared by using an enzyme-linked immunosorbent inhibition assay to an insoluble vaccine (E-06) found to be poorly immunogenic in humans. A human serum with serotype 2 specificity was used in the inhibition assay, and 5 microgram of E-06 was required for 50% inhibition, whereas less than 1 microgram of the soluble vaccines was required. Addition of group B polysaccharide slightly increased the inhibitory capacity of the protein component.     

Analysis of C3 deposition and degradation on Neisseria meningitidis and Neisseria gonorrhoeae.

The deposition and degradation of human complement component C3 on the cell surfaces of Neisseria meningitidis and Neisseria gonorrhoeae were studied. Bacteria were incubated in human serum, and ester-linked C3 fragments were analyzed by hydroxylamine release and immunoblot detection. Similar patterns of C3 degradation were found for both serum-resistant and serum-sensitive meningococcal strains of serogroups A, B, C, Y, and W135, as well as for serum-sensitive gonococcal strains and their sialylated serum-resistant variants. The predominant fragments in all cases were the 40-kDa alpha' 2 chain of iC3b and the 75-kDa beta chain common to both C3b and iC3b. The 67-kDa alpha' 1 chain of iC3b was also detected. The 105-kDa alpha' chain of intact C3b represented a minor proportion of deposited C3. Capsule-specific immunoglobulin G or immunoglobulin A1 did not alter the observed degradation patterns, nor did incubation of meningococci in properdin-deficient serum. The degradation of C3 in C5-, C6-, or C8-deficient serum was the same as that in normal serum, although the deposition of C3 was severely limited, based as indicated by the intensity of the fragments. With the use of an enzyme-linked immunosorbent assay that measured total iC3b and C3, I found that both iC3b deposition and C3 deposition varied among meningococcal and gonococcal strains and that the amounts of iC3b and C3 were independent of the relative quantities of cell surface sialic acid and of serum sensitivity for meningococci but not for gonococci. I conclude that complement activation on neisserial cell surface results in the formation of an identical repertoire of predominantly iC3b fragments of ester-linked C3b molecules regardless of the presence of sialic acid in either the capsule or the lipooligosaccharide or of the sensitivity of the organism to complement-mediated lysis but that the quantities of both ester- and amide-linked iC3b molecules deposited exhibit strain variability.