Trajectory of serogroups causing Invasive Meningococcal Disease in Santa Catarina state, Brazil (2007-2019)

Abstract The aim of this study was to compare the trajectory of serogroups causing Invasive Meningococcal Disease (IMD) in the Santa Catarina (SC) state with those of whole Brazil. A retrospective analysis of all IMD cases reported from January 2007 to December 2019 was carried out. During the study period, 26,058 IMD cases were registered in Brazil and 644 and in SC state alone. Overall, Brazil showed progressive reduction in cases since 2010, when the meningococcal C conjugate vaccine was introducted on National Immunization Program, while SC showed an increase in total cases since 2013, particularly from serogroups W and C. Serogroups distribution was significantly different between Brazil and SC. The emergence of serogroup W highlights the improved meningococcal surveillance through increased accuracy in identification methods in SC state. This finding is important for discussing recommendations of quadrivalent (ACWY) conjugate vaccines in different geographical areas of Brazil.

Púrpura en los pies: Meningococcemia? Reporte de caso clínico y revisión de la literatura / Purpura in the feet: Meningococcemia? Clinical case report and literature review

Neisseria meningitidis es la etiología de infecciones severas incluso letales, afectando principalmente a la población joven. No obstante, dado que el único reservorio es la nasofaringe humana, hay portadores asintomáticos. El meningococo es sensible a los antibióticos de uso habitual, como: cefalosporinas de tercera generación y quinolonas, pero el retraso en el diagnóstico por presentaciones clínicas infrecuentes y la administración tardía de la terapia, se asocian a elevada morbimortalidad. Presentamos una paciente de 18 años, con un cuadro de rápida evolución, con parámetros inflamatorios de laboratorio alterados, asociado a lesiones cutáneas purpúricas, que evolucionó con falla multiorgánica y desenlace fatal, lográndose la confirmación etiológica por el Instituto de Salud Pública. Reportamos el caso para tener en consideración el diagnóstico de meningococcemia, frente a pacientes con cuadro clínico y exámenes de laboratorio sugerentes de sepsis, que presentan lesiones cutáneas compatibles.

Neisseria meningitidis is the etiology of severe, even lethal infections, affecting mainly the young population. However, since the only reservoir is the human nasopharynx, there are asymptomatic carriers. Meningococcus is sensitive to commonly used antibiotics such as third generation cephalosporins and quinolones, but delayed diagnosis due to infrequent clinical presentation and delayed therapy are associated with high morbidity and mortality. We present an 18-year-old female patient with a rapid evolution, with altered inflammatory laboratory parameters, associated with purpuric skin lesions, which evolved with multiorgan failure and fatal outcome, and the etiological confirmation was obtained by the Public Health Institute. We report the case to take into account the diagnosis of meningococcemia in patients with clinical symptoms and laboratory tests suggestive of sepsis and compatible skin lesions.

A Case Report of Invasive Meningococcal Disease in an Adult without Identifiable Risk Factors.

Meningitis is the most common manifestation of invasive meningococcal disease (IMD), occurring in approximately 50% of all cases. It is characterized by sudden onset, very rapid progression, and a high case fatality rate even with early and appropriate treatment. The purpose of this case report is to increase the awareness of health care professionals about the seriousness of IMD, so it should be considered in differential diagnosis with top priority in certain cases even in absence of risk factors, and emphasize that excellent outcome can be achieved by early employment of appropriate therapy. In this case report, we review an adult male, with no past medical history of significance, who presented with IMD, and was successfully treated in the intensive care unit with prompt initiation of IV antibiotics, ventilation support and multidisciplinary approach in management.

Estimating Costs Associated with a Community Outbreak of Meningococcal Disease in a Colombian Caribbean City.

Meningococcal disease is a serious and potentially life-threatening infection that is caused by the bacterium Neisseria meningitidis (N. meningitidis), and it can cause meningitis, meningococcaemia outbreaks and epidemics. The disease is fatal in 9-12% of cases and with a death rate of up to 40% among patients with meningococcaemia. The objective of this study was to estimate the costs of a meningococcal outbreak that occurred in a Caribbean city of Colombia. We contacted experts involved in the outbreak and asked them specific questions about the diagnosis and treatment for meningococcal cases during the outbreak. Estimates of costs of the outbreak were also based on extensive review of medical records available during the outbreak. The costs associated with the outbreak were divided into the cost of the disease response phase and the cost of the disease surveillance phase. The costs associated with the outbreak control and surveillance were expressed in US$ (2011) as cost per 1,000 inhabitants. The average age of patients was 4.6 years (SD 3.5); 50% of the cases died; 50% of the cases were reported to have meningitis (3/6); 33% were diagnosed with meningococcaemia and myocarditis (2/6); 50% of the cases had bacteraemia (3/6); 66% of the cases had a culture specimen positive for Neisseria meningitidis; 5 of the 6 cases had RT-PCR positive for N. meningitidis. All N. meningitidis were serogroup B; 50 doses of ceftriaxone were administered as prophylaxis. Vaccine was not available at the time. The costs associated with control of the outbreak were estimated at US$ 0.8 per 1,000 inhabitants, disease surveillance at US$ 4.1 per 1,000 inhabitants, and healthcare costs at US$ 5.1 per 1,000 inhabitants. The costs associated with meningococcal outbreaks are substantial, and the outbreaks should be prevented. The mass chemoprophylaxis implemented helped control the outbreak.

Enfermedad invasiva por Neisseria Meningitidis, alerta epidemiológica / Neisseria Meningitidis invasive disease, epidemiological alert

En países que han incorporado vacunas conjugadas contra Streptococcus pneumoniae y Haemophilus influenzae, la Neisseria meningitidis es el principal patógeno bacteriano causante de enfermedad invasiva. La enfermedad invasiva por meningoco se asocia con una alta tasa de letalidad. Objetivos. Describir una agregación inesperada de casos de enfermedad invasiva por Neisseria meningitidis en los Municipio Salmeron Acosta y Sucre, Estado Sucre,Venezuela. Metodos. Cohorte de inicio. Casos con diagnóstico definido o probable de infección por Neisseria meningitidis. Se registraron datos pertinentes acerca del paciente, de su enfermedad, del agente causal y del medio ambiente. Se determinó la tasa de incidencia por grupos de edad y municipio de residencia, serogrupos de Neisseria meningitidis, y patron de susceptibilidad a antibióticos. Resultados. Entre las semanas epidemiológicas 1-41 de 2012 se detectaron 15 casos de enfermedad invasiva por meningococo en niños menores de 15 años con residencia en el Estado Sucre, Venezuela. La tasa de incidencia para los Municipios Cruz Salmerón Acosta y Sucre del Estado Sucre fue 33,7 x 105 y 6,7 x 105 niños <15 años respectivamente. La enfermedad muestra mayor dispersión en la tasa de ataque de niños de 5-14 años, agregación en espacio y tiempo así como tendencia cíclica. Los casos confirmados fueron 10 de 15, Neisseria meningitidis serogrupo B, 4 casos y Neisseria meningitidis serogrupo C, 6 casos. La letalidad observada fue 6 de 15; se observaron secuelas en un tercio de los sobrevivientes. Conclusiones. Se describe una frecuencia inesperada de enfermedad invasiva por Neisseria meningitidis en los Municipio Salmeron Acosta y Sucre, Estado Sucre,Venezuela. La información generada puede orientar el diseño de medidas de intervención y control.

In countries were conjugate vaccines against Streptococcus pneumoniae and Haemophilus influenzae, have been incorporated, Neisseria meningitidis is the major bacterial pathogen causing invasive disease. Invasive meningococcal disease is associated with a high mortality rate. Objectives. To describe unexpected aggregation of invasive meningococcal disease. Methods. Inception cohort: Definite or probable cases of infection with Neisseria meningitidis. Information about the patient and his disease, the causative agent and the environment was registered. Incidence rate by age and municipality of residence, serogroups of Neisseria meningitidis, and antibiotic susceptibility pattern were determined. Results. Between the epidemiological weeks 1-41 of 2012, 15 cases of invasive meningococcal disease in children under 15 years of age, living in the state of Sucre, Venezuela were identified. The incidence rate for Cruz Salmerón Acosta and Sucre municipalities was 33.7 x 105 and 6.7 x 105 children <15 years of age, respectively. The disease shows greater dispersion in incidence by age group, aggregation in space and time and a cyclical trend. Confirmed cases were 10 of 15, 4 cases of Neisseria meningitidis serogroup B and 6 cases of Neisseria meningitidis serogroup C. Overall mortality rate was 6 of 15; sequelae were present in one third of the survivors. Conclusions. This study describes an unexpected frequency of invasive meningococcal disease in the Sucre and Salmeron Acosta Municipalities, Sucre State, Venezuela. This information may be useful to guide intervention measures design.

Invasive meningococcal disease / Doenca meningococica invasiva

Invasive meningococcal disease (IMD) is a major public health and continues to cause substantial mortality and morbidity. Serotype C is the most frequent in Brazil. The clinical spectrum of IMD is broad (meningitis, meningococcemia or both) and the clinical evolution may be unpredictable. Main features associated with mortality are: age higher than 50 years old, seizures, shock, and meningococcemia without meningitis. Blood cultures should be obtained immediately. Lumbar puncture can be performed without previous computed tomography scan (CT) in most cases. Clinical features can be useful to predic patients where an abnormal CT scan is likely. Cerebrospinal fluid (CSF) culture and Gram stain should always be required. Latex agglutination sensitivity is highly variable. Polymerase chain reaction is specially useful when other methods are negative or delayed. Usually ceftriaxone should not be delayed while awaiting CSF study or CT. Dexamethasone can be used in meningococcal meningitis. Early suspicion of IMD and antibiotic in primary care before hospitalization, rapid transportation to a hospital, and stabilization in an intensive-care unit has substantially reduced the case-fatality rate. Vaccines against serotypes A, C, W-135, and Y are available while vaccines against serotype B are expected.

A doença meningocócica invasiva (DMI) é um problema de saúde pública e continua causando importante mortalidade e morbidade. O sorotipo C é o mais frequente no Brazil. O espectro clínico da DMI é amplo (meningite, meningococcemia ou ambos) e a evolução clínica pode ser imprevisível. As principais características associadas a mortalidade são: idade acima de 50 anos, convulsões, choque, e meningococcemia sem meningite. Culturas de sangue devem ser obtidas imediatamente. Punção lombar pode ser realizada sem tomografia computadorizada (TC) prévia na maioria dos casos. Características clínicas podem ajudar a predizer pacientes com elevada probabilidade de apresentar TC alterada. Cultura e Gram no líquido cefalorraquiano devem ser sempre solicitadas. Aglutinação do látex apresenta sensibilidade muito variável. Reação em cadeia da polimerase é especialmente útil quando os outros métodos são negativos ou demorados. O uso de ceftriaxona não deve ser retardado enquanto se esperam os resultados do líquor ou TC. Dexametasona pode ser utilizada na meningite meningococóca. Suspeita precoce de DMI, antibiótico no primeira atendimento, antes da admissão hospitalar, transporte rápido para hospital, e estabilização em unidade de terapia intensiva reduz substancialmente a taxa de letalidade. Vacinas contra os sorotipos A, C, W-135, e Y estão disponíveis, entretanto, vacinas contra o sorotipo B são esperadas.