Meningite bacteriana: uma revisão / Bacterial meningitis: a review

A meningite bacteriana é uma inflamação das leptomeninges que envolvem o Sistema Nervoso Central. Essa patologia, que possui diversos agentes etiológicos, apresenta-se na forma de síndrome, com quadro clínico grave. Entre as principais bactérias que causam a meningite, estão a Neisseria meningitis e Streptococcus pneumoniae. A transmissão ocorre através das vias aéreas por meio de gotículas, sendo a corrente sanguínea a principal rota para as bactérias chegarem à barreira hematoencefálica e, a partir dessa, até as meninges. Atualmente existem vários métodos de diagnóstico precisos, onde a cultura de líquido cefalorraquidiano (LCR) é o método padrão ouro. Ademais, a melhora na qualidade do tratamento com beta-lactâmicos e a maior possibilidade de prevenção, devido à elevação do número e da eficácia de vacinas, vem contribuindo para redução dos casos da doença e de sua gravidade. Porém, apesar desses avanços, ainda há um elevado número de mortalidades e sequelas causadas por essa síndrome.

Bacterial meningitis is an inflammation of the leptomeninges that surround the Central Nervous System. This pathology, which has several etiological agents, is presented as a syndrome with a severe clinical scenario. The main bacteria causing meningitis include Neisseria meningitis and Streptococcus pneumoniae. It can be transmitted by droplets through the airways, with the bacteria using the bloodstream as the main route to reach the blood-brain barrier, and from there to the meninges. There are currently several accurate diagnostic methods, with CSF culture being the gold standard. In addition, the improvement in the quality of beta-lactam treatment and the greater possibility of prevention due to the increased number and effectiveness of vaccines have contributed to reducing the number of cases and severity of the disease. Nevertheless, despite these advances, this syndrome still presents a high number of mortalities and sequelae.

Relationship of Microbial Profile With Airway Immune Response in Eosinophilic or Neutrophilic Inflammation of Asthmatics

PURPOSE: Different characteristics of airway microbiome in asthmatics may lead to differential immune responses, which in turn cause eosinophilic or neutrophilic airway inflammation. However, the relationships among these factors have yet to be fully elucidated.METHODS: Microbes in induced sputum samples were subjected to sequence analysis of 16S rRNA. Airway inflammatory phenotypes were defined as neutrophils (>60%) and eosinophils (>3%), and inflammation endotypes were defined by levels of T helper (Th) 1 (interferon-γ), Th2 (interleukin [IL]-5 and IL-13), Th-17 (IL-17), and innate Th2 (IL-25, IL-33, and thymic stromal lymphopoietin) cytokines, inflammasomes (IL-1β), epithelial activation markers (granulocyte-macrophage colony-stimulating factor and IL-8), and Inflammation (IL-6 and tumor necrosis factor-α) cytokines in sputum supernatants was assessed by enzyme-linked immunosorbent assay.RESULTS: The numbers of operational taxonomic units were significantly higher in the mixed (n = 21) and neutrophilic (n = 23) inflammation groups than in the paucigranulocytic inflammation group (n = 19; p < 0.05). At the species level, Granulicatella adiacens, Streptococcus parasanguinis, Streptococcus pneumoniae, Veillonella rogosae, Haemophilus parainfluenzae, and Neisseria perflava levels were significantly higher in the eosinophilic inflammation group (n = 20), whereas JYGU_s levels were significantly higher in the neutrophilic inflammation group compared to the other subtypes (P < 0.05). Additionally, IL-5 and IL-13 concentrations were correlated with the percentage of eosinophils (P < 0.05) and IL-13 levels were positively correlated with the read counts of Porphyromonas pasteri and V. rogosae (P < 0.05). IL-1β concentrations were correlated with the percentage of neutrophils (P < 0.05). had a tendency to be positively correlated with the read count of JYGU_s (P = 0.095), and was negatively correlated with that of S. pneumoniae (P < 0.05).CONCLUSIONS: Difference of microbial patterns in airways may induce distinctive endotypes of asthma, which is responsible for the neutrophilic or eosinophilic inflammation in asthma.

Molecular Analysis of Eight American Type Culture Collection Gonococcal Strains by Neisseria gonorrhoeae Multiantigen Sequence Typing and PorB Sequence Typing / 임상검사와정도관리

BACKGROUND: Molecular epidemiological typing of Neisseria gonorrhoeae is crucial for monitoring the spread of resistant strains. As reference strains can be used for laboratory internal quality control, we genetically characterised the American Type Culture Collection (ATCC) gonococcal strains by Neisseria gonorrhoeae multiantigen sequence typing (NG-MAST) and porB sequence typing using public multilocus sequence typing (PubMLST). METHODS: Eight ATCC gonococcal reference strains (ATCC 19424, ATCC 31426, ATCC 35541, ATCC 43069, ATCC 43070, ATCC 49226, ATCC 49926, and ATCC 49981) from Culti-Loops (Thermo Fisher Scientific, USA) were cultured. After DNA extraction, porB and tbpB were amplified and sequenced. Sequence types (STs) and allele numbers were each determined by NG-MAST (http://www.ng-mast.net) and porB sequence typing using PubMLST (http://pubmlst.org/neisseria/porB/). RESULTS: ATCC 19424 was identified as ST 266 by NG-MAST, and as Allele 946 by PubMLST. ATCC31426 was assigned a novel ST by NG-MAST, and was assigned Allele 958 with 1.2% mismatch by PubMLST. ATCC 35541 was identified as ST 12 by NG-MAST, and as Allele 624 by PubMLST. ATCC 43069 and ATCC 43070 were both identified as ST 681 by NG-MAST, and as Allele 984 by PubMLST. ATCC 49226 was identified as ST 1572 by NG-MAST, and as Allele 2110 by PubMLST. ATCC 49926 and ATCC 49981 were both identified as ST 16496 by NG-MAST, and as Allele 928 by PubMLST. CONCLUSIONS: The ST data obtained for ATCC gonococcal reference strains by NG-MAST and porB sequence typing using PubMLST can be used for quality assurance of molecular epidemiological typing in clinical microbiological laboratories.

Neisseria gonorrhoeae conjunctivitis in a prepuberal girl - a dilemma: sexual violence or non-sexual transmission? / Conjuntivite por Neisseria Gonorrhoea em menina prepubere ­ um dilema: violência sexual ou transmissão não sexual?

Introduction: Sexually transmitted infections (STIs) are a public health issue of global concern and frequently lead to important sequelae if not diagnosed and properly treated. Neisseria gonorrhoeae (NG) infection is one of the most prevalent STIs worldwide and recently presents increasing incidence and antimicrobial resistance rates. Apart from the neonatal period, NG infection during childhood is considered evidence of sexual violence (SV). However, defining perpetration of violence can be challenging in clinical practice. Objective: To report a case of conjunctivitis due to NG in a prepuberal girl and discuss possible means of infection acquisition and medical forensic implications. Case report: A 7-year-old female Caucasian student from São Paulo was referred to the Rape Care Center (Núcleo de Atendimento a Vítimas de Violência Sexual ­ NAVIS) outpatient clinic to investigate sexual violence in September 2013. At admission, she reported right ocular hyperemia for 10 days with no response to tobramycin eye drops. Personal history: nothing noteworthy. She lived with her mother and grandmother and visited her father every two weeks. Physical and gynecological examinations were normal. Eye examination: Left eye ­ nothing noteworthy. Right eye ­ palpebral edema, conjunctival hyperemia with purulent exudate and upper corneal perforation. Bacterioscopy of conjunctival secretion was positive for Gram-negative diplococci and NG was isolated in culture. The patient was submitted to suturing of right eye perforation and received 1g intravenous ceftriaxone per day for 10 days. During investigation at the NAVIS outpatient clinic, the mother denied any SV episode or school behaviour change. Multidisciplinary psychosocial care was provided to the child and her mother for over 6 months, but SV could not be characterized. STIs investigation for HIV, hepatitis B and C infections and syphilis resulted negative. Based on the literature, a hypothesis of accidental intra-familial non-sexual transmission of NG was then considered. Endocervical, vaginal and urethral secretions were collected from the mother and yielded isolation of endocervical beta-lactamase producing NG. Hygiene measures and contact isolation were recommended and the mother underwent treatment with ceftriaxone single dose 1G. During follow-up the child developed corneal opacity in her right eye. Conclusion: In prepuberal children presenting with unusual but compatible clinical manifestations, STIs should always be considered and investigated to enable prompt treatment and avoid sequelae. If gonococcal infection is diagnosed, the possibility of sexual violence should be thoroughly investigated, preferably in a comprehensive multidisciplinary approach to rule out non-sexual contamination and avoid emotional damage to the child and family. Clearly defining SV and proposing proper interventions in these circumstances is, however, challenging for healthcare providers.

As infecções sexualmente transmissíveis (ISTs) são um problema de saúde pública global e com frequência deixam sequelas se não diagnosticadas e tratadas adequadamente. A infecção por Neisseria gonorrhoeae (NG) é uma das ISTs mais prevalentes em todo o mundo e, recentemente, tem apresentado crescentes taxas de incidência, além de resistência a antimicrobianos. Após o período neonatal, a infecção por NG na infância pode ser uma evidência de violência sexual (VS), no entanto a comprovação da violência é um desafio na prática clínica. Objetivo: Apresentar um caso de conjuntivite por NG em uma menina pré-púbere e discutir as possíveis vias de contaminação e implicações médicas forenses. Relato de caso: Trata-se de uma criança caucasiana de 7 anos de idade do sexo feminino, estudante, procedente de São Paulo, que, após uma internação, foi encaminhada ao Núcleo de Atendimento a Vítimas de Violência Sexual (NAVIS) para investigação de violência sexual, em setembro de 2013. Na admissão intra-hospitalar, houve relato de hiperemia ocular direita, iniciada havia 10 dias, sem resposta ao tratamento com colírio de tobramicina. Antecedentes pessoais: nada digno de nota. Ela morava com a mãe e a avó e visitava o pai a cada duas semanas. Os exames físico e ginecológico foram normais. Exame oftalmológico: olho esquerdo ­ nada digno de nota. Olho direito ­ edema palpebral, hiperemia conjuntival com exsudato purulento e perfuração da córnea superior. A bacterioscopia de secreção conjuntival foi positiva para diplococos gram-negativos e a NG foi isolada em cultura. A paciente foi submetida a sutura cirúrgica de perfuração do olho direito e, enquanto internada, recebeu 1 g de ceftriaxona endovenoso por dia, por um período de 10 dias. Durante a investigação no ambulatório de NAVIS, a mãe negou qualquer episódio de VS ou mudança de comportamento escolar. Foi oferecida assistência psicológica e social à criança e à mãe por mais de seis meses, mas a VS não pôde ser caracterizada. A investigação de IST para o HIV, infecções por hepatite B e C e sífilis resultou negativa. Com base na literatura, a hipótese de transmissão não sexual acidental de NG intrafamiliar foi então considerada. As secreções genitais da mãe (endocervical, vaginal e uretral) foram coletadas e o isolamento endocervical da NG produtora por betalactamase foi positivo. Medidas de higiene e isolamento de contato foram recomendados, além ser prescrito o tratamento com ceftriaxona em dose única de 1 g para a mãe. Durante o acompanhamento, a criança desenvolveu opacidade corneana em seu olho direito. Conclusão: Em crianças pré-púberes que apresentam manifestações clínicas incomuns, as ISTs devem sempre ser consideradas e investigadas para permitir o tratamento imediato e assim evitar sequelas. Se uma infecção gonocócica for diagnosticada, a possibilidade de (VS) deve ser minuciosamente investigada, de preferência com uma abordagem multidisciplinar abrangente para descartar a contaminação não sexual e evitar danos emocionais à criança e à sua família. Definir com precisão se houve VS e propor intervenções adequadas nessas circunstâncias mostra-se um desafio para os profissionais de saúde.

Neonatal Sepsis and Meningitis Caused by Neisseria meningitidis Serogroup B: a Case Report

Sepsis and meningitis caused by Neisseria meningitidis are rare in neonates, but neonatal sepsis and meningitis are associated with a high rate of mortality. Meningococcal disease is commonly reported in older children and adolescents and is known to be more prevalent in community settings. In this study, a 16-day-old neonate was diagnosed with serogroup B meningococcal sepsis and meningitis. The baby was treated with antibiotics at the early stages of the infection and was discharged in good condition without any complications. This case report can serve to raise awareness of the incidence and importance of meningococcal infection in neonates, especially serogroup B.

Emergence of Neisseria meningitidis W135 in Cote d'Ivoire: laboratory based-surveillance / 한국역학회지

OBJECTIVES: To describe the emergence of Neisseria meningitidis (Nm) W135 in Côte d'Ivoire and its characteristics compared to NmA.METHODS: Data on Nm samples isolated at the National Reference Center for meningitis in Côte d'Ivoire between 2007 and 2012 were analyzed. Socio-demographic data and biological information on the samples were extracted from the database. Categorical variables, such as sex and the serotype of the bacteria, were compared using the Fisher exact test, while the distribution of continuous variables, such as age, was compared using the Wilcoxon test.RESULTS: Among the 175 Nm samples, 57 were NmA, 4 were NmB, 13 were NmC, and 99 were NmW135. The geographical distribution of NmA and NmW135 did not show a significant difference according to age or sex. NmW135 was more common than NmA in the northern health districts of Cote d'Ivoire (85.9 vs. 45.5%; p < 0.001). No sample of NmA has been isolated since 2009, while 95% of the type W135 samples were isolated between 2010 and 2012.CONCLUSION: This study highlighted the emergence of NmW135 in Côte d'Ivoire, as well as the simultaneous disappearance of NmA. It is important to improve laboratory-based surveillance of meningitis to assess trends in the circulation of bacteria and to detect the emergence of new serogroups earlier.

Recent Increase in the Incidence of TEM-135 β-Lactamase-harboring Neisseria gonorrhoeae in Korea

BACKGROUND: We investigated the molecular epidemiological characteristics and antimicrobial susceptibility pattern of penicillinase-producing Neisseria gonorrhoeae (PPNG) isolates to monitor the change in distribution of bla(TEM) in Korea. METHODS: We collected 804 PPNG isolates from diverse hospitals and clinics mainly located in Seoul, Korea, over a period of 11 years (2005–2015). Isolate susceptibility to seven antimicrobials was determined using the agar dilution test. The molecular epidemiological characteristics of the isolates were determined by Sanger sequencing of bla(TEM), N. gonorrhoeae multiantigen sequence typing (NG-MAST) and plasmid typing. RESULTS: Among 72 fully sequenced PPNG isolates, sixteen (22.2%) possessed TEM-135. All TEM-135 isolates had a common silent mutation (c.18C>T), which was previously unreported. We observed a pattern of continuous increase in the number of TEM-135 isolates since 2012. The median and 90% minimum inhibitory concentration of azithromycin were substantially lower in the TEM-135 group than in the non-PPNG and TEM-1 groups. All TEM-135 isolates showed different NG-MAST types and predominantly harbored Toronto/Rio (75%) plasmids. A comprehensive comparative analysis of PPNG with TEM-135 according to NG-MAST, plasmid type, and year of isolation revealed a wide distribution. CONCLUSIONS: The proportion of TEM-135 PPNG has continuously increased since 2012, in association with clonal spread. The difference at position 18 of the TEM-135 sequence can be interpreted as the existence of multiple clonal complexes. The possibility that TEM-135 was acquired via foreign plasmids requires careful follow-up and continuous monitoring of TEM-135 to ascertain whether it constitutes a step towards evolutionary change.

Emergence of Neisseria meningitidis W135 in Cote d'Ivoire: laboratory based-surveillance / 한국역학회지

OBJECTIVES: To describe the emergence of Neisseria meningitidis (Nm) W135 in Côte d'Ivoire and its characteristics compared to NmA. METHODS: Data on Nm samples isolated at the National Reference Center for meningitis in Côte d'Ivoire between 2007 and 2012 were analyzed. Socio-demographic data and biological information on the samples were extracted from the database. Categorical variables, such as sex and the serotype of the bacteria, were compared using the Fisher exact test, while the distribution of continuous variables, such as age, was compared using the Wilcoxon test. RESULTS: Among the 175 Nm samples, 57 were NmA, 4 were NmB, 13 were NmC, and 99 were NmW135. The geographical distribution of NmA and NmW135 did not show a significant difference according to age or sex. NmW135 was more common than NmA in the northern health districts of Cote d'Ivoire (85.9 vs. 45.5%; p < 0.001). No sample of NmA has been isolated since 2009, while 95% of the type W135 samples were isolated between 2010 and 2012. CONCLUSION: This study highlighted the emergence of NmW135 in Côte d'Ivoire, as well as the simultaneous disappearance of NmA. It is important to improve laboratory-based surveillance of meningitis to assess trends in the circulation of bacteria and to detect the emergence of new serogroups earlier.

Utility of Conventional Culture and MALDI-TOF MS for Identification of Microbial Communities in Bronchoalveolar Lavage Fluid in Comparison with the GS Junior Next Generation Sequencing System

BACKGROUND: Diverse microbiota exist in the lower respiratory tract. Although next generation sequencing (NGS) is the most widely used microbiome analysis technique, it is difficult to implement NGS in clinical microbiology laboratories. Therefore, we evaluated the performance of conventional culture methods together with matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) in identifying microbiota in bronchoalveolar lavage (BAL) fluid. METHODS: BAL fluid samples (n=27) were obtained from patients undergoing diagnostic bronchoscopy for lung mass evaluation. Bacterial and fungal culture was performed with conventional media used in clinical microbiology laboratories. On an average, 20 isolated colonies were picked from each agar plate and identified by MALDI-TOF MS. Microbiome analysis using 16S rRNA NGS was conducted for comparison. RESULTS: Streptococcus spp. and Neisseria spp. were most frequently cultured from the BAL fluid samples. In two samples, Enterobacteriaceae grew predominantly on MacConkey agar. Actinomyces and Veillonella spp. were commonly identified anaerobes; gut bacteria, such as Lactobacillus, Bifidobacterium, and Clostridium, and fungi were also isolated. NGS revealed more diverse bacterial communities than culture, and Prevotella spp. were mainly identified solely by NGS. Some bacteria, such as Staphylococcus spp., Clostridium spp., and Bifidobacterium spp., were identified solely by culture, indicating that culture may be more sensitive for detecting certain bacteria. CONCLUSIONS: Culture and NGS of BAL fluid samples revealed common bacteria with some different microbial communities. Despite some limitations, culture combined with MALDI-TOF MS might play a complementary role in microbiome analysis using 16S rRNA NGS.

Bacteriemia por Neisseria subflava en un recién nacido / Neisseria subflava bacteremia in newborns: case report and review of the literature

Resumen Neisseria subflava es una especie considerada comensal dentro de la familia Neisseriaceae; sin embargo, en algunos hospederos inmunocomprometidos y en niños se ha documentado como agente causal de infecciones invasoras. Se presenta el caso clínico de un recién nacido con bacteriemia por N. subflava con buena respuesta a terapia con cefotaxima. Las bacterias del género Neisseria más frecuentes de causar infecciones en recién nacidos son N. meningitidis, de alta mortalidad y N. gonorrhoeae, que se manifiesta principalmente con oftalmia neonatorum. Se destaca la importancia de realizar un diagnóstico microbiológico adecuado dado que las pruebas biquímicas pueden ser no concluyentes. La técnica de espectrometría de masas MALDITOF resulta una herramienta de utilidad.

Neisseria subflava belongs to Neisseriaceae family, is considered a comensal specie, however in certain host, mainly inmunosuppresed patientes and children, the literature has documented invasive infections. We present a case of a bacteriemia due to N. subflava in a newborn, treated with cefotaxime with good outcome. In newborns, the most common Neisseria bacteria to cause invasive infections are N. meningitidis, with highly fatal clinical course and N. gonorrhoeae which compromise the eye, oftalmia neonatorum, with uncommon invasive infections. It's very important the adequate microbiological diagnosis because the biochemical tests may be inconclusive. MALDITOF mass spectrometry technique is a useful tool.

Infective Endocarditis Caused by Neisseria cinerea in a 7-Year-Old Girl Who Had Undergone Surgical Pulmonary Valve Replacement / 이화의대지

A 7-year-old girl was admitted to the emergency department with a 2-week history of fever and general weakness. She had been diagnosed with tetralogy of Fallot and received surgical repair. Pulmonary prosthetic valve replacement was performed in January 2014 because of severe pulmonary regurgitation and moderate right ventricle dilatation. Echocardiography revealed suspicious vegetation around the prosthetic pulmonary valve. Neisseria cinerea was confirmed in blood culture. We diagnosed with bacterial infective endocarditis, and administered empirical intravenous antibiotics for endocarditis. However, the fever and general weakness continued, with mild muscle aches and coughing. Thus, we performed a chest radiography and pneumonia workup. Therefore, she was diagnosed with mycoplasma pneumonia and given oral clarithromycin twice daily for 2 weeks. She was successfully treated with antibiotics for 46 days. We report the first case of infective endocarditis caused by N. cinerea in Korea.

Characterization of Oropharyngeal Carriage Isolates of Neisseria meningitidis in Healthy Korean Adolescents in 2015

The meningococcus carriage rate is age-dependent, with a high prevalence in adolescents and young adults. This cross-sectional study aimed to estimate the oropharyngeal carriage rate of meningococcus among healthy Korean adolescents and its relationship with several population characteristics. The survey was conducted from April to May 2015 among 1,460 first-year high-school students in 9 high schools located in Gyeonggi province, Korea. Each student answered a short questionnaire assessing risk factors for carriage, and posterior pharyngeal wall swab samples were obtained. These samples were cultured on meningococcus-selective media, with colonies resembling meningococci identified using the Vitek® MS system (bioMérieux, Marcy l'Etoile, France). All isolates were characterized by molecular serogrouping and multilocus sequence typing (MLST). Meningococci were identified from 3.4% (49/1,460) swabs. Current smokers had significantly higher carriage rates than non-smokers (8.2% vs. 2.9%, P = 0.002), and boys had significantly higher carriage rates than girls (4.4% vs. 1.6%, P = 0.004). Serogroup B was the most common serogroup, followed by serogroup C, then 29E and Y. Twenty-seven different sequence types (STs) were identified; the most common were ST-3091, ST-11278, and ST-44. These belonged to clonal complexes (CCs) 269, 32, and 41/44, respectively, known as the hypervirulent clones. Evaluating meningococcal carriage is important to understand the epidemiology of meningococcal disease; however, little data exist in Korea. Similar to western countries, meningococcal serogroup B has emerged in Korea, and hypervirulent clones were identified. It is necessary to monitor the genetic and serologic characteristics of circulating meningococci and to assess the potential strain coverage of meningococcal vaccines.

A 30-year-old male with corneal opacity and a rapidly progressing ulcer / Hombre de 30 años con opacidad y úlcera corneal de rápida progresión

Gonococcal keratoconjunctivitis is a rapidly progressing and aggressive infection caused by Neisseria gonorrhoeae . We report a case of a patient who presented keratoconjunctivitis with an opacity in the left cornea that progressed into an ulcerative lesion despite initial treatment with antibiotic eye drops. Gram stains from the purulent discharge of the left eye showed gram-negative diplococci, and the culture from the ocular discharge was positive for Neisseria gonorrhoeae . Resolution was achieved with the administration of 2 g of intramuscular ceftriaxone in a single dose, and the patient had no sequelae.

La queratoconjuntivitis gonocócica es un infección agresiva y de rápida progresión causada por Neisseria gonorrhoeae . Reportamos el caso de un paciente quien presentó queratoconjuntivitis con opacidad corneal izquierda, la cual progresó a lesión ulcerativa a pesar del tratamiento inicial con antibiótico en gotas oftálmicas. La tinción de Gram y el cultivo a partir de la secreción purulenta del ojo izquierdo mostró diplococos gramnegativos y crecimiento de Neisseria gonorrhoeae , respectivamente. La curación del paciente se logró tras la administración de 2 g de ceftriaxona intramuscular en dosis única; el paciente no presentó secuelas.

Identification of Non-Aggregatibacter actinomycetemcomitans Bacteria Grown on the Tryptic soy-Serum-Bacitracin-Vancomycin Medium

The aim of this study was to identify the non-Aggregatibacter actinomycetemcomitans bacteria grown on the tryptic soy-serum-bacitracin-vancomycin (TSBV) medium, an A. actinomycetemcomitans selective medium. A total of 82 unidentified bacterial isolates from the oral cavities of a Korean population were kindly provide by the Korean Collection for Oral Microbiology. All the clinical isolates were grown on TSBV medium and bacterial DNA purified from each isolate was subjected to PCR with universal primers specific for bacterial 16S rRNA genes (16S rDNAs) sequence. The each bacterial 16S rDNA was amplified by PCR and the nucleotide sequences of it was determined by the dideoxynucleotide chain termination method. They were identified by 16S rDNA sequence comparison method at the specie-level. The data showed that Neisseria spp. (42 strains), Fusobacterium spp. (10 strains), Capnocytophaga spp. (8 strains), Propionibacterium acnes (5 strains), Aggregatibacter aprophilus (4 strains), Campylobacter spp. (5 strains), Veillonella dispar (3 strains), Streptococcus sp. (1 strain), Haemophilus parainfluenzae (1 strain), Leptotrichia wadei (1 strain), Morococcus sp./Neisseria sp. (1 strain), and Staphylococcus sp. (1 strain) were identified. These results could be used to develop a new A. actinomycetemcomitans-selective medium which is more effective than the TSBV medium in future studies.

A Survey of Serum Bactericidal Antibodies against Neisseria meningitidis Serogroups A, C, W and Y in Adolescents and Adults in the Republic of Korea

BACKGROUND: This descriptive epidemiological study aimed to assess the prevalence of serum bactericidal antibodies against Neisseria meningitidis serogroups A, C, W and Y in adolescents and adults in the Republic of Korea. MATERIALS AND METHODS: In total, 987 subjects aged 11-55 years from five geographical regions of Korea were included in the study. Human serum bactericidal assay (hSBA) was used to measure hSBA titres for serogroups A, C, W and Y. Percentages of subjects with hSBA titres ≥4 and ≥8, geometric mean titres (GMTs), and associated 95% confidence intervals (CIs), were estimated. Analysis was performed for the entire study population and stratified by age group or region. No statistical hypotheses were tested. RESULTS: The highest percentage of subjects with hSBA titres ≥8 was observed for serogroup W (74%), was similar for serogroups C (34%) and Y (36%), and was lowest for serogroup A (9%). The percentages of subjects with hSBA titres ≥4 were similar to those with hSBA titres ≥8 for all serogroups. GMTs were 2.56 µg/mL (serogroup A), 5.14 µg/mL (serogroup C), 22.63 µg/mL (serogroup W) and 5.28 µg/mL (serogroup Y). Similar trends in GMTs across serogroups were seen for individual regions and age groups. The highest GMTs for serogroups A, W and Y were recorded in the >19-29 years group, and for serogroup C in the >49-55 years group. Across all regions, GMTs were very similar for serogroups A, C and Y, while more variation was seen for serogroup W. CONCLUSION: In the Korean population, among Neisseria meningitidis serogroups A, C, W and Y, serum bactericidal antibodies were most prevalent against serogroup W and least prevalent against serogroup A. These trends were maintained across age groups and regions. The highest GMTs for serogroups A, W and Y were observed in the >19-29 years group. The reasons behind the observed differences in prevalence of bactericidal antibodies against the serogroups are currently not understood, although carriage and cross-reactivity of the assay may be important influences.

Acute Cellulitis Caused by Neisseria skkuensis / 대한임상미생물학회지

A 73-year-old man visited our hospital because of pain with swelling and redness on the right foot dorsum. He was diagnosed with liver cirrhosis and nodular hepatic cellular carcinoma. Lower extremity CT scan and MRI showed abscess formation in the right foot dorsum. Gram-negative cocci were recovered from the culture of drained pus at the site and identified as Neisseria skkuensis by 16S rRNA gene sequencing. Here, we report the first case of cellulitis due to N. skkuensis and provide a literature review.

Identification and Antibiotic Susceptibility of the Bacteria from Non-odontogenic Infectious Lesions

The purpose of this study was to isolate and identify bacteria from the 4 patients with non-odontogenic infectious lesions (mucormycosis, chronic inflammation from wound infection, and two actinomycosis) and determine their antimicrobial susceptibility against eight antibiotics. Bacterial culture was performed under three culture conditions (anaerobic, CO2, and aerobic incubator). The bacterial strains were identified by 16S rRNA gene (16S rDNA) sequence comparison analysis method. For investigating the antimicrobial susceptibility of the bacteria against eight antibiotics, penicillin G, amoxicillin, tetracycline, cefuroxime, erythromycin, clindamycin, vancomycin, and Augmentin(R) (amoxicillin + clavulanic acid), minimum inhibitory concentration (MIC) measurement was performed using broth microdilution assay. Nosocomial pathogens such as Enterococcus faecalis, Klebsiella pneumoniae, Bacillus subtilis, and Neisseria flavescens were isolated from mucormycosis. Veillonella parvula, Enterobacter hormaechei, and Acinetobacter calcoaceticus were isolated from chronic inflammatory lesion. Actinomyces massiliensis was isolated from actinomycosis in parotid gland. Capnocytophaga ochracea was isolated from actinomycosis in buccal region in anaerobic condition. There was no susceptible antibiotic to all bacteria in mucormycosis. Tetracycline was susceptible to all bacteria in chronic inflammation. C. ochracea was resistant to vancomycin and penicillin G; and other antibiotics showed susceptibility to all bacteria in actinomycosis. The results indicated that the combined treatment of two or more antibiotics is better than single antibiotic treatment in mucormycosis, and penicillin is the first recommended antibiotic to treat actinomycosis.

Characterization of oral bacterial diversity of irradiated patients by high-throughput sequencing / 国际口腔科学杂志·英文版

The objective of this study was to investigate the compositional profiles and microbial shifts of oral microbiota during head-and-neck radiotherapy. Bioinformatic analysis based on 16S rRNA gene pyrosequencing was performed to assess the diversity and variation of oral microbiota of irradiated patients. Eight patients with head and neck cancers were involved in this study. For each patient, supragingival plaque samples were collected at seven time points before and during radiotherapy. A total of 147,232 qualified sequences were obtained through pyrosequencing and bioinformatic analysis, representing 3,460 species level operational taxonomic units (OTUs) and 140 genus level taxa. Temporal variations were observed across different time points and supported by cluster analysis based on weighted UniFrac metrics. Moreover, the low evenness of oral microbial communities in relative abundance was revealed by Lorenz curves. This study contributed to a better understanding of the detailed characterization of oral bacterial diversity of irradiated patients.