Enfermedad meningocóccica invasora por serogrupo B en dos niños chilenos vacunados contra serogrupos ACWY / Meningococcal invasive disease caused by serogroup B in two Chilean children vaccinated against ACWY serogroups

Invasive meningococcal disease (IMD) by serogroup W has become predominant in Chile since 2012, prompting vaccination with conjugate ACWY. We reported two pediatric cases in patients already vaccinated, which evolved with IMD by serogroup B. This should remind us to keep the alertness with this pathology, despite the current vaccination system in Chile, emphasizing in improve our epidemiological case definition and its diagnosis.

La Enfermedad Meningocóccica Invasora (EMI) por serogrupo W ha llegado a ser predominante en Chile desde el 2012, motivando estrategias de inmunización con vacunas conjugadas contra los serogrupos ACWY. Presentamos dos casos pediátricos de pacientes vacunados contra meningococo ACWY que evolucionaron con EMI por serogrupo B, lo que debe recordarnos la alerta y sospecha de esta patología, inclusive con el esquema de vacunación actual chileno, poniendo énfasis en mejorar nuestra definición epidemiológica de caso sospechoso para optimizar su diagnóstico.

Comparison of PCR-based methods for the simultaneous detection of Neisseria meningitidis, Haemophilus influenzae, and Streptococcus pneumoniae in clinical samples

Abstract Background Several in-house PCR-based assays have been described for the detection of bacterial meningitis caused by Neisseria meningitidis, Streptococcus pneumoniae, and Haemophilus influenzae from clinical samples. PCR-based methods targeting different bacterial genes are frequently used by different laboratories worldwide, but no standard method has ever been established. The aim of our study was to compare different in-house and a commercial PCR-based tests for the detection of bacterial pathogens causing meningitis and invasive disease in humans. Methods A total of 110 isolates and 134 clinical samples (99 cerebrospinal fluid and 35 blood samples) collected from suspected cases of invasive disease were analyzed. Specific sets of primers frequently used for PCR-diagnosis of the three pathogens were used and compared with the results achieved using the multiplex approach described here. Several different gene targets were used for each microorganism, namely ctrA, crgA and nspA for N. meningitidis, ply for S. pneumoniae, P6 and bexA for H. influenzae. Results All used methods were fast, specific and sensitive, while some of the targets used for the in-house PCR assay detected lower concentrations of genomic DNA than the commercial method. An additional PCR reaction is described for the differentiation of capsulated and non-capsulated H. influenzae strains, the while commercial method only detects capsulated strains. Conclusions The in-house PCR methods here compared showed to be rapid, sensitive, highly specific, and cheaper than commercial methods. The in-house PCR methods could be easily adopted by public laboratories of developing countries for diagnostic purposes. The best results were achieved using primers targeting the genes nspA, ply, and P6 which were able to detect the lowest DNA concentrations for each specific target.

Meningitis neonatal por Neisseria meningitidis serogrupo B / Neonatal meningitis caused by serogroup B Neisseria meningitides

La meningitis meningocóccica es una infección poco frecuente en el período neonatal internacionalmente, y solo hay una publicación previa en la literatura médica cubana hace 25 años atrás, de recién nacidos con meningitis bacteriana causada por Neisseria meningitidis. Se presenta el caso de un recién nacido febril, con manifestaciones de toxicidad, fontanela abombada, y cuando se realizó punción lumbar, se encontró pleocitosis del líquido cefalorraquídeo y se aisló N. meningitidis serogrupo B, por lo que se diagnostica meningitis meningocóccica neonatal. Tuvo evolución favorable. Se describen algunas características de la infección meningocócica, y se destaca el diagnóstico y tratamiento recomendado para este tipo de infección, así como se hace referencia a reportes de casos publicados en la literatura internacional.

Meningoccocal meningitis is a rare infection in the neonatal period worldwide and there is just one publication in the Cuban medical literature dated 25 years ago, which presented some neonates with bacterial meningitis caused by Neisseria meningitides. This is a febrile neonate with toxicity manifestations and bulging fontanelle; he was performed a lumbar puncture to find spinal fluid pleocytosis and the serogroup B N. meningitides was then isolated, so he was diagnosed with neonatal meningococcal meningitis with favorable progression. Some characteristics of the meningococcal infection, the diagnosis and recommended treatment were described in addition to making reference to case reports published in the international literature.

Méningites à méningocoque en milieu pédiatrique sénégalais. A propos de 79 cas

La méningite cérébrospinale constitue un problème majeur de santé publique, du fait de son potentiel épidémique. Objectifs : L'objectif de ce travail était de décrire les caractéristiques cliniques, épidémiologiques, cliniques, bactériologiques et évolutives des méningites à méningocoque au Centre Hospitalier National d'Enfants Albert Royer (CHNEAR). Méthodes : Il s'agit d'une étude rétrospective, descriptive, et analytique. Tous les enfants âgés de 0 à 15 ans, hospitalisés pour méningite à méningocoque au CHNEAR, entre le 1er janvier 2004 et le 31 décembre 2013, étaient inclus dans cette étude. Résultats : Nous avons colligé 79 cas de méningite à méningocoque parmi les 1491 cas de méningites bactériennes pédiatriques (MBP). Ce qui représentait 3,45% des méningites bactériennes et 0,18% de l'ensemble des hospitalisations. Le sex-ratio 1,92 était en faveur des garçons. L'âge moyen était de 53,3 mois. La majorité des cas était survenue durant la saison sèche, soit 72%, avec des pics en mars et avril. La malnutrition a été décrite chez 4 enfants. La symptomatologie clinique était dominée par la fièvre (95%), la raideur méningée (82,3%), les céphalées (34,2%) et les troubles digestifs (34,2%). Le sérogroupe W135 (54 cas) était le plus isolé suivi des sérogroupes B (7 cas), C (7 cas), et A (5 cas). Dans 6 cas, le sérogroupe était indéterminé. La létalité était de 3,8%. Conclusion : L'incidence des méningites à méningocoques est de 0,18% en milieu pédiatrique sénégalais. Le sérogroupe W135 est en responsable de 2/3 des cas, d'où la nécessité de sa prise en compte dans les stratégies vaccinales actuelles au Sénégal

Resultats du Pastorex dans le diagnostic de méningite à Neisseria Meningitidis comparés à la culture

Introduction : La meningite est un probleme de sante publique dans les pays tropicaux. Elle atteint surtout les enfants et les jeunes adultes et sevit sous forme d'epidemies explosives tous les 10 a 12 ans. En Republique Democratique du Congo (RDC); on a recense au premier trimestre de 2010; 1852 cas dont 182 deces. Une epidemie a fait 17 morts a Kisangani en 2009.Cette etude avait pour objectifs d'identifier le germe en cause dans l'epidemie de 2009; de comparer les resultats biologiques de la meningite selon la coloration au gram; la culture et le test au latex de Pastorexrealises au niveau du liquide cephalorachidien (LCR).Materiel et Methode : Notre echantillon est fait de 33 echantillons de LCR sur lesquels la coloration de Gram; la culture et le test serologique au latex de Pastorex ont ete effectues. Ces echantillons ont ete preleves chez des malades atteints de meningite.Resultat : La coloration au gram a ete positive pour 94 des echantillons contre 6 des echantillons negatifs; 82 des echantillons ont montre des diplocoques gram negatifs. Le test de Pastorex a pour sa part identifie Neisseria meningitidis type C(NMC) dans 87;9 comme agent causal de cette epidemie de meningite. La culture sur gelose au sang du LCR etait concluante chez seulement 51;5 des echantillons. Conclusion : Dans la meningite a N. meningitidis; le test de Pastorexaun avantage diagnostic plus que la culture sur gelose au sang et permet egalement d'identifier le type de N.meningitidis

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.

Emergencia de la cepa W135 causante de enfermedad meningocócica invasora en Chile 2012 / Emergence of W135 meningococcal serogroup in Chile during 2012

The epidemiologic behavior of the Invasive Meningococcal Disease (IMD) in Chile has changed. At the end of 2011, the W135 serogroup belonging to the hypervirulent clone ST-11 emerged. It affected diverse countries of the world, after the Mecca pilgrimage in 2000. In Chile, there have been 133 IMD cases during 2012. These figures represent an incidence of 0.7 per 100,000 inhabitants, which is 30% higher than expected. Eighty eight percent of cases were confirmed by the National Reference Laboratory at the Chilean Public Health Institute. The serogroup was determined in 103 strains and 58% belonged to the W135 serogroup, surpassing for the first time the B serogroup (37%). The Metropolitan Region concentrated 80% of these cases, and the remaining 20% affected other seven regions of the country. Forty seven percent of cases corresponded to children less than 5 years of age. The predominant clinical presentation of the W135 serogroup was a sepsis in 67% of cases. The fatality ratio of IDM during 2012 was 27%, the highest in the past 20 years. With this information, the Chilean Ministry of Health decreed a sanitary alert and implemented an integrated approach to control and prevent W-135 IDM, denominated "W-135 Action Plan".

Enfermedad meningocócica: epidemiología, diagnóstico y vacunación / Meningococcal disease: epidemiology, diagnosis and vaccination

La enfermedad meningocócica invasiva causada por N. meningitidis es un problema global de salud pública, por su alta morbilidad y mortalidad. Esta patología es causada en su mayoría por los serogrupos A,B,C, W-135 e Y. La prevención mediante la vacunación es la mejor herramienta para disminuir la carga mundial de esta enfermedad. Las vacunas no conjugadas que toman como base solo el polisacárido externo, aun cuando son beneficiosas en epidemias, producen pobre inmunogenicidad a largo plazo en los niños menores de dos años de edad, que representan la población de mayor riesgo. Las vacunas de nueva generación, en donde el polisacárido es conjugado con proteína transportadoras, producen respuestas inmune en niños menores de 2 años, lo cual podría producir una reducción importante de la enfermedad en esta población de alto riesgo. Las nuevas técnicas de detección están constituyendo a mejorar el pronóstico de la enfermedad, al permitir un diagnóstico más temprano y específico, conducentes a un tratamiento más oportuno. La creación de vacunas que confieran una protección más amplia, especialmente contra el serogrupo B, y protejan a la población en mayor riesgo, sigue siendo un reto...

A doença meningocócica na região de Sorocaba no período de 1999 a 2008 / Meningococcal disease in Sorocaba region in the period from 1999 to 2008

Este trabalho descreve a ocorrência da doença meningocócica na região de abrangência da Divisão Regional de Saúde de Sorocaba-SP, no período de 1999 a 2008. Fundamentado em dados fornecidos pelo Instituto Adolfo Lutz e pelo Grupo de Vigilância Epidemiológica, a incidência e a letalidade foram calculadas, para toda a população e por faixa etária. Os valores obtidos foram comparados com os dados do Estado de São Paulo e do Brasil. Além disso, foram obtidas as distribuições de ocorrência por manifestação clínica e de critérios diagnósticos utilizados, permitindo a análise da situação epidemiológica da doença meningocócica, na região em estudo. Ao verificar os resultados relativos aos sorogrupos, sorotipos e soross ubtipos identificados, foi possível estabelecer o fenótipo das cepas que, predominantemente, causam a doença na região. Em relação à incidência, conclui-se que, durante praticamente todo o período em estudo, é maior do que os valores endêmicos encontrados nos países desenvolvidos. A faixa etária mais atingida, tanto do ponto de vista da incidência como da letalidade é a de 0 a 4 anos, indicando a necessidade de incremento e continuidade dos programas de vacinação relativos a esse grupo populacional. Em relação às cepas circulantes, os fenótipos B:4,7:P1.19,15 e C:23:P1.14-6 predominam, fato coerente com os resultados obtidos para a Grande São Paulo e Baixada Santista.

Comparison of dot-ELISA and standard ELISA for detection of Neisseria meningitidis outer membrane complex-specific antibodies

Dot-ELISA using the outer membrane complex antigens of Neisseria meningitidis as a target was standardized for rapid detection of meningococcal-specific antibodies in human serum. We investigated the level of meningococcal-specific IgG, IgA, and IgM in serum using dot-ELISA with outer membrane antigens prepared from Neisseria meningitidis serotype B:4.19:P1.15,3,7,9 (a strain isolated from a Brazilian epidemic). The dot-ELISA is based on the same principles as the standard ELISA and is useful for detection of anti-N. meningitidis B antibodies in serum of patients with meningococcal infections. For the assay, outer membrane complexes (OMCs) were absorbed by nitrocellulose membrane and blocked with a 5 percent skim milk solution. Serum samples were drawn upon hospital admission and during convalescence from patients with meningococcal septicemia, and single samples were drawn from uninfected controls. We retrospectively examined a total of 57 serum samples: 35 from patients infected with N. meningitidis B, 12 from patients infected with Haemophilus influenzae b, and 10 from health individuals. When performed at room temperature, dot-ELISA took approximately four hours to perform, and the optimum antigen concentration was 0.42 µg per dot. The specificity of IgG, IgM, and IgA demonstrates that dot-ELISA using OMCs from N. meningitidis B as a target is suitable for serologic verification of clinically suspected meningococcal disease in patients and for titer determination of antibodies produced during different phases of natural infection. Furthermore, the sensitivity of dot-ELISA was comparable to that of standard ELISA. Overall, dot-ELISA is simple to perform, rapid, and low cost. Further validation of the test as a screening tool is required.

[Hereditary complement C5 deficiency: study of 3 Tunisian adult cases and litterature review]

The complement system is one of the main effectors of both innate and adaptive immunity. Hereditary complement deficiency, mainly those of the terminal pathway [C5-C9], is at increased risk for septic meningitides particularly meningococcal ones. To assess clinical and biochemical features of 3 Tunisian adults with C5 hereditary complement deficiency [C5D], with a familial study performed for two of them. Functional activity of the classical and the alternative pathway of complement [CH50 and AP50 respectively] were measured according to standards haemolytic procedures. Serum concentration of complement components were determined by nephelemetry and ELISA. C5D was diagnosed when CH50, AP50 and C5 antigenic level were highly decreased. Our patients were 2 men and one woman. All these patients presented clinical symptoms of septic meningitides. Meningococcal origin was confirmed in one case. C5 level varies between 0 and 0,4%. Levels of other complement components: Clq, C3, C4, properdine, C6, C8 and C9 were normal. Antigenic C7 level was 50% in the female patient. Familial study revealed no similar hereditary complement deficiency in relatives. Only 27 cases with C5D were reported in the literature. The description of 3 cases in our series demonstrates that: C5D is not rare in Tunisia, C5D is clinically commonly complicated by meningitides with unconstant severity, C5D is biologically caracterised by a variable level of the plasmatic C5 component

Meningococcemia crónica / Chronic menigococcemia

La meningococcemia crónica es una forma clínica infrecuente dentro del espectro de infecciones producido por Neisseria meningitidis. Clásicamente esta forma clínica se caracteriza por fiebre, lesiones cutáneas, compromiso articular, y desarrollo en hemocultivo de la bacteria responsable, habitualmente con ausencia de compromiso meníngeo. Generalmente afecta a adultos jóvenes previamente sanos. Se desconoce la razón por la cual estos pacientes, a diferencia de los que presentan meningitis aguda por Neisseria meningitidis y meningococcemia aguda, pueden sobrevivir sin complicaciones durante semanas en ausencia de tratamiento antibiótico útil. Se ha planteado que debido a la alta sensibilidad de esta bacteria a los antibióticos beta-lactámicos, muchos casos podrían ser tratados inadvertidamente. Describimos un caso de meningococcemia crónica en una mujer joven que presenta un cuadro clásico no reconocido inicialmente.

Chronic meningococcemia is an unfrequent clinical picture within the spectrum of infections produced by Neisseria meningitidis. It is classically characterized by fever, skin lesions and joint involvement, usually without meningeal involvement, and with blood culture growth of the responsible bacteria. It generally affects previously healthy young people. It is unknown why these patients, unlike patients with Neisseria meningitidis’s acute meningitis and with acute meningococcemia, can survive without complications during weeks, in abscence of an useful antibiotic treatment. It has been hypothesized that owing to high susceptibility to beta-lactam antibiotics of Neisseria meningitidis, many cases may be treated inadvertently. We describe a case of chronic meningococcemia in a young woman who presented a classical clinical picture, not recognized initially.

The utility of the polymerase chain reaction assay for aetiologic definition of unspecified bacterial meningitis cases

Most patients with acute suppurative meningitis are otherwise healthy individuals with regard to immune mechanisms against invasive bacterial disease. This medical emergency is among the most dramatic and potentially ravaging diseases that affect humans, particularly young children. The illness often strikes suddenly, and can either result in death or leave the survivors with significant neurological dysfunctions. The demonstration of a bacterial aetiology is necessary for decisions regarding treatment and prophylaxis. Conventional bacteriological methods frequently fail to identify an agent, as a result of administration of antibiotics or delayed lumbar punctures. We investigated the major aetiologic sources of unspecified bacterial meningitis cases (G00.9, ISCD-10) by polymerase chain reaction (PCR)-based identification of Neisseria meningitidis (crgA), Streptococcus pneumoniae (ply) and Haemophilus influenzae (bexA) in cerebrospinal fluid samples. The multiplex PCR detected N. meningitidis in 92 percent, S. pneumoniae in 4 percent and H. influenzae in 1 percent of the 192 clinical samples assayed; 3 percent were negative for all three DNA targets. Bacterial DNA detection was found to be a valuable adjunct to enhance bacterial meningitis surveillance when the yield of specimens by culture is reduced. The implementation of PCR assays as a diagnostic procedure in Public Health Laboratories is perceived to be a significant advance in the investigation of bacterial meningitis.

Recent outbreak of meningococcal meningitis--a microbiological study with brief review of literature.

Meningococcal disease presents in various clinical forms, most common being meningitis and meningococcemia. A spurt of meningococcal cases was seen in medicine and pediatric wards of Dr. Ram Manohar Lohia Hospital during the recent outbreak from Dec 2005 - June 2006. These had presented either with the classical features of acute purulent meningitis or as fever with rash. The patients were investigated microbiologically for the causative organism which was identified as Neisseria meningitidis in 257 out of 531 cases (48.39%). The classic finding of gram negative diplococci on gram stain remained the mainstay of diagnosis. N. meningitidis isolates from culture were sensitive to all commonly used antibiotics.

Neonatal sepsis and meningitis caused by Neisseria meningitidis: a case report

OBJECTIVE: To report a full-term newborn infant that developed a sepsis associated to meningitis caused by Neisseria meningitidis serogroup C on the 14th day of life. CASE DESCRIPTION: The patient was a term female infant, born to a mother with Systemic Lupus Erythematosus, with birth weight of 2,610g, Apgar Score 1, 4 and 8, who needed mechanical ventilation for 24 hours. On the 7th day of life, the neonate was discharged from the hospital with good overall condition. On the 15th day of life, the newborn infant presented fever and respiratory failure. The cerebrospinal fluid showed 1042 cells/mm³, with neutrophilic predominance, protein of 435 mg/dL, and glucose < 10 mg/dL. The blood and the cerebrospinal fluid cultures were positive for Neisseria meningitidis serogroup C. The neonate was hospitalized, needing mechanical ventilation and vasoactive drugs, and received 21 days of crystalline penicillin. After hospital discharge, there were no signs of neurological sequels and the infant was able to be breastfed. The case report presents a unique situation: an uncommon etiology of neonatal meningitis and favorable evolution, despite neurological sequels reported in the literature. This report emphasizes the need to prevent the premature exposure of newborn infants to pathological agents, especially if they presented birth injuries and/or are preterm, due to their lack of immunological capacity.

OBJETIVO: Relatar o caso de um recém-nascido de termo que apresentou no 14° dia de vida sepse associada à meningite, cujo agente etiológico foi a Neisseria meningitidis sorotipo C. DESCRIÇÃO DO CASO: recém-nascido de termo, cuja mãe é portadora de lupus eritematoso sistêmico, feminino, peso de nascimento de 2610g, Escala de Apgar 1, 4 e 8, sendo intubado e ventilado por 24 horas. Recebeu alta no 7° dia de vida em boas condições. No 15° dia de vida apresentou febre e desconforto respiratório. O líquido cefalorraquidiano mostrou 1042 células/mm³, com predomínio de neutrófilos, proteinorraquia de 435 mg/dL e glicorraquia < 10 mg/dL; a bacterioscopia revelou a presença de diplococos. Foi internado na Terapia Intensiva Neonatal, necessitou de ventilação mecânica e de drogas vasoativas. A hemocultura e a cultura do líquido cefalorraquidiano foram positivas para Neisseria meningitidis C. O recém-nascido foi tratado por 21 dias com penicilina cristalina. Recebeu alta hospitalar em boas condições, em aleitamento materno exclusivo e sem seqüelas neurológicas. O caso descrito apresenta como peculiaridades: etiologia incomum de meningite neonatal e evolução favorável, apesar dos relatos em literatura mostrarem seqüelas neurológicas. Destaca-se ainda, a necessidade de enfatizar a não exposição precoce do recém-nascido, especialmente se tiver tido agravos ao nascimento ou for prematuro, devido à sua inexperiência imunológica.

Doença meningocócica: comparação entre formas clínicas / Meningococcal disease: comparison between clinical forms

Visando avaliar formas clínicas da doença meningocócica, foram revistos 201 casos diagnosticados como doença meningocócica, em Hospital Universitário da Universidade Federal Fluminense; durante o período de 1971 a 1996, dos quais 185 preencheram os critérios de inclusão. A caracterização clínico-laboratorial permitiu reagrupá-los nas formas de doença meningocócica com meningite, 18 por cento, meningite e septicemia, 62 por cento, e septicemia, 20 por cento. Dados epidemiológicos disponíveis não diferenciaram formas clínicas. Na meningite meningocócica foi significativamente maior: tempo de história clínica; freqüência de manifestações neurológicas; e positividade da bacterioscopia, cultura e teste do látex no líquor. Na septicemia menigocócica, houve predomínio significativamente de: choque; letalidade e níveis maiores de tempo parcial de tromboplastina. Septicemia meningogócica e septicemia com meningite se diferenciaram da meningite meningocócica quanto a: tempo de história clínica; ocorrência de sinais neurológicos focais; coagulação intravascular disseminada e artrite. Dados clínico-laboratoriais levam a admitir meningite como forma localizada de doença meningocócica, e septicemia com meningite e septicemia como variações de gravidade da forma sistêmica da doença.

In order to asses the clinical forms of meningococcal disease, we reviewed 201 cases diagnosed as meningococcal disease in the University Hospital of the Fluminense Federal University in Rio de Janeiro, 185 of which met the inclusion criteria. Clinical and laboratorial characterization allowed for grouping of the cases as follows: meningococcal meningitis, 18 percent; meningitis with septicemia, 62 percent; and septicemia, 20 percent. Available epidemiological data did not differentiate clinical forms. The following were significantly greater in meningococcal meningitis: duration of clinical history; frequency of neurological manifestations; positive bacterioscopy; culture and latex test in cerebrospinal fluid. The following were significantly predominant in septicemia: shock; fatal outcome and higher partial thromboplastin time. Septicemia and meningitis with septicemia were differentiated from meningococcal meningitis in the following: duration of clinical history; occurrence of focal neurological signs; disseminated intravascular coagulation; and arthritis. Clinical and laboratory data lead us to admit meningococcal meningitis as a localized form of Meningococcal disease, and meningitis with septicemia and septicemia as variations in severity of the systemic form of the disease.

Doença meningocócica: aspectos epidemiológicos, fatores de risco e prevenção / Meningococcal disease: epidemiological aspects, risk factors and prevention

A doença meningocócica é uma infecção bacteriana aguda, causada pela Neisseria meningitidis. Apresenta-se sob diversas formas clínicas que vão desde a assintomática até a meningo­coccemia. Existem 13 sorogrupos identificados do microorga­nismo, porém os que mais causam a doença são os A, B, C, Y e W 135. No Brasil, o sorogrupo B predomina desde 1988. A doença ocorre em todo o mundo, sendo um problema de saúde pública, especialmente em algumas regiões, como na área hiperendêmica da África. Acomete, principalmente, crian­ças e adultos jovens e é transmitida por meio das secreções respiratórias de portadores, favorecendo maior contaminação nos contactantes íntimos. Pelo seu caráter epidêmico e alta letalidade, causa pânico na população e impõe a notificação imediata do paciente para que as medidas de controle sejam desencadeadas. O conheci­mento do comportamento epidemiológico da doença meningocócica subsidia estas medidas de controle: quimioprofilaxia e vacinação. O surgimento de vacinas antimeningocócicas conjugadas oferece a perspectiva de um controle efetivo da doença e moti­va esta revisão sobre o tema...