Coinfección por astrovirus y Neisseria meningitidis serogrupo B en una niña / Coinfection by astrovirus and Neisseria B meningitidis in a girl

La infección meningocócica tiene una elevada morbimortalidad. Las coinfecciones virales han sido descritas, fundamentalmente, por virus herpes y respiratorios. Se presenta una paciente que ingresó al Servicio de Emergencia con convulsión tónico-clónica, hipotensión, taquicardia y escala de Glasgow posterior baja. En la Unidad de Cuidados Intensivos mantuvo alteración del nivel de conciencia y requirió estabilización hemodinámica. Se inició antibioterapia de amplio espectro. La paciente mostró deposiciones líquidas malolientes, sin sangre, que fueron cultivadas y estudiadas mediante reacción en cadena de la polimerasa. El líquido cefalorraquídeo fue normal. Las deposiciones resultaron positivas para astrovirus. Se confirmó, mediante reacción en cadena de la polimerasa en sangre, la presencia de Neisseria meningitidis serogrupo B. Se presenta el primer caso pediátrico de coinfección por astrovirus y Neisseria meningitidis. Este virus debería incluirse entre las causas de coinfección para descartar en caso de clínica abdominal predominante, vómitos o deposiciones líquidas.

Meningococcal infection associates high morbidity and mortality. Viral coinfection has been described mainly with herpes and respiratory virus. We describe a child who suffered a tonic-clonic seizure with hypotension, tachycardia and low Glasgow Coma Scale. She maintained an altered mental status and required hemodynamic stabilization in the Pediatric Intensive Care Unit. Wide spectrum antibiotherapy was initiated. She suffered large and foul-smelling liquid not bloody stools which were cultured and studied by polymerase chain reaction. The cerebrospinal fluid was normal. Later the polymerase chain reaction stools were positive to astrovirus, and the blood polymerase chain reaction was positive to Neisseria meningitidis group B. As far as we know, this is the first case of astrovirus and Neisseria meningitidis coinfection described in children. This virus should be considered as new cause of viral coinfection to discard if unexplained abdominal pain or vomits and liquid stools are observed.

Seroprevalence of bactericidal antibodies against serogroup B and C Meningococci in a University Hospital

Meningococcus serogroup B (MenB), clonal complex 32 (cc 32), was the Brazilian epidemic strain of meningococcal disease (MD) in the 1990’s. Currently, meningococcus serogroup C (MenC), cc 103, is responsible for most of the cases of the disease in Brazil. The aim of this study was to investigate the seroprevalence of bactericidal antibody (SBA) against representative epidemic strains of MenC, (N753/00 strain, C:23:P1.22,14-6, cc103) and MenB, (Cu385/83 strain, B:4,7:P1.15,19, cc32) in students and employees of a university hospital in the State of Rio Grande do Sul (RS, Brazil). A second MenC strain (N79/96, C:2b:P1.5-2,10, cc 8) was used as a prototype strain of Rio de Janeiro’s outbreak that occurred in the 1990’s. Our previous study showed a 9% rate of asymptomatic carriers in these same individuals. A second goal was to compare the SBA prevalence in meningococcal carriers and non-carriers. Fifty-nine percent of the studied population showed protective levels of SBA titers (log2≥2) against at least one of the three strains. About 40% of the individuals had protective levels of SBA against N753/00 and Cu385/83 strains. Nonetheless, only 22% of the individuals showed protective levels against N79/96 strain. Significantly higher antibody levels were seen in carriers compared to non-carriers (P≤0.009). This study showed that, similar to other States in Brazil, a MenC (23:P1.22,14-6, cc103) strain with epidemic potential is circulating in this hospital. Close control by the Epidemiological Surveillance Agency of RS of the number of cases of MD caused by MenC strains in the State is recommended to prevent a new disease outbreak.

Neisseria meningitidis presenting as acute abdomen and recurrent reactive pericarditis

ABSTRACT Meningococcal meningitis is a well established potential fatal infection characterized by fever, headache, petechial rash, and vomiting in the majority of cases. However, protean manifestations including abdominal pain, sore throat, diarrhea and cough, even though rare, should not be overlooked. Similarly, although disseminated infection could potentially involve various organ-targets, secondary immune related complications including joints or pericardium should be dealt with caution, since they remain unresponsive to appropriate antibiotic regimens. We hereby report the rare case of an otherwise healthy adult female, presenting with acute abdominal pain masking Neisseria meningitidis serotype B meningitis, later complicated with recurrent reactive pericarditis despite appropriate antibiotic treatment. There follows a review of current literature.

Aislamiento de cepas invasivas de Neisseria meningitidis serogrupos B y Y en la ciudad de Cumaná, años 2009-2010 / Isolation of invasive strains of neisseria meningitides, serogroups B and Y, in Cumana, 2009-2010

Neisseria meningitidis es agente causal de meningitis y meningococcemia. Se realizó la presente investigación a fin de analizar fenotípicamente las cepas invasivas de N. meningitidis aisladas en Cumaná, estado Sucre. Se incluyó el total de cepas identificadas como N. meningitidis en el laboratorio de bacteriología del Hospital Universitario “Antonio Patricio de Alcalá”, durante los años 2009-2010; provenientes de muestras de líquido cefalorraquídeo (LCR) y sangre (hemocultivos). A cada aislamiento se le determinó la susceptibilidad antimicrobiana y el serogrupo respectivo. Durante el período en estudio se analizaron 10 cepas, de las cuales 5 provenían de LCR. El ensayo de susceptibilidad antimicrobiana reveló que las cepas presentaban sensibilidad a penicilina, cefotaxima, meropenem, rifampicina, ciprofloxacina y cloranfenicol siendo sólo resistentes al trimetoprim/ sulfametoxazol. El serogrupo más frecuente fue el B (8 cepas), aislándose un caso de serogrupo Y. Respecto al grupo etario de los pacientes, de las 10 cepas, 8 provenían de pacientes pediátricos. Este es el primer estudio con cepas de N. meningitidis aisladas en Cumaná, por lo que se hace imprescindible el análisis permanente de las cepas aisladas en la zona, con fines de monitoreo, principalmente, de la susceptibilidad antimicrobiana y los serogrupos circulantes.

Neisseria meningitidis is the causal agent for meningitis and meningococcemia. This research was performed to phenotypically analyze invasive strains of N. meningitidis isolated in Cumana, State of Sucre. The study included all strains identified as N. meningitidis isolated in the bacteriology laboratory at the University Hospital “Antonio Patricio de Alcalá,” during the years 2009-2010, coming from cerebrospinal fluid (CSF) samples and blood cultures. For each isolate, the antimicrobial susceptibility and respective serogroup were determined. During the period of study, 10 strains were analyzed, of which 5 came from CSF. The antimicrobial susceptibility test revealed that the strains showed sensitivity to penicillin, cefotaxime, meropenem, rifampicin, ciprofloxacin and chloramphenicol; they were resistant only to trimethoprim/ sulfamethoxazole. Serogroup B was the most frequent (8 strains); one case of serogroup Y was isolated. Regarding the patient’s ages, of the 10 strains, 8 were found in pediatric patients. This is the first study about strains of N. meningitidis isolated in Cumaná, so it is essential that permanent research regarding the strains isolated in the area is carried out for monitoring purposes, mainly in terms of antimicrobial susceptibility and the circulating serogroups.

Production of outer membrane vesicles (OMV) in batch cultivation of Neisseria meningitidis serogroup B

Meningococcal disease is an important cause of death and morbidity throughout the world. Nearly 330,000 cases and 35,000 deaths occur yearly. Neisseria meningitidis, serogroup B strain N.44/89, is prevalent in Brazil. Its outer membrane vesicles (OMV) with iron regulated proteins (IRP) are released to the culture medium and are used as antigen for vaccine production. In order to have knowledge about the kinetic parameters, especially the final OMV concentration values, 20-h batch cultivations were carried out in Catlin medium with iron restriction. Process conditions comprised: 7 L bioreactor, 36°C, 0.5 atm, overlay air flowrate of 1 L/min, agitation varying from 250 rpm to 850 rpm and dissolved oxygen control set at 10 percent of saturation condition. Biomass was determined by optical density at 540 nm and dry weight. Glycerol, lactate, pH and dissolved oxygen were measured from samples taken during cultivation. Outer membrane vesicle (OMV) concentration was determined by Lowry's method after ultracentrifugation. IRP presence was verified by SDS-PAGE. Highest biomass value, corresponding to the highest initial lactate concentration (7.84 g/L) was achieved at the 9th hour process time corresponding to 1.0 g/L dry biomass and 2.3 optical density at 540 nm. Lactate consumption was directly related to cell growth (yield factor: 0.24 g dry biomass / g lactate). Glycerol concentration in the medium did not change significantly during the process. OMV concentration reached the highest value of 80 mg/L at end cultivation time. The obtained results suggest that lactate is a main limiting growth factor and the maximum amount of antigen is obtained during stationary growth and cell death phases.

A doença meningocócica é uma causa importante de morte a nível mundial. Aproximadamente 330.000 casos e 35.000 mortes ocorrem anualmente. A cepa N.44/89 do sorogrupo B de Neisseria meningitidis é prevalente no Brasil. Suas vesículas de membrana externa (OMV - "outer membrane vesicles"), com proteínas reguladoras de ferro (IRP - "iron regulated proteins") liberadas no meio de cultura, são empregadas como antígeno para a produção da vacina. A fim ter o conhecimento sobre os parâmetros cinéticos, especialmente os valores finais da concentração de OMV, cultivos batelada de 20 hs foram realizados no meio de Catlin com limitação do ferro. As condições de processo compreenderam: biorreator de 7 litros, 36°C, 0,5 atm, vazão de ar de 1 L/min, agitação variando entre 250 a 850 rpm, controle do oxigênio dissolvido em 10 por cento da condição de saturação. A biomassa foi determinada pela densidade ótica em 540 nm e peso seco. Glicerol, lactato, pH e oxigênio dissolvido foram medidos das amostras retiradas durante o cultivo. A concentração de OMV foi determinada pelo método de Lowry após ultracentrifugação. A presença de IRP foi verificada por SDS-PAGE. O valor mais elevado de biomassa, correspondendo à concentração inicial mais elevada de lactato (7,84 g/L) foi obtido no tempo de processo de 9 horas, o qual corresponde a biomassa seca de 1,0 g/L e a densidade ótica de 2,3 em 540 nm. O consumo de lactato. foi relacionado diretamente ao crescimento celular (fator de conversão de 0,24 biomassa por lactato g/g). A concentração do glicerol no meio não se alterou significativamente ao longo do processo. A concentração de OMV alcançou o valor mais elevado de 80 mg/L no tempo final de cultivo. Os resultados obtidos sugerem que o lactato é o principal fator limitante do crescimento e o máximo do antígeno é obtido durante a fase estacionária de crescimento e de morte celular.