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1.
Bioorg Chem ; 57: 242-250, 2014 Dec.
Article in English | MEDLINE | ID: mdl-25245459

ABSTRACT

3-Deoxy-d-arabino-heptulosonate 7-phosphate synthase (DAH7PS) catalyses the first committed step of the shikimate pathway, which produces the aromatic amino acids as well as many other aromatic metabolites. DAH7PS catalyses an aldol-like reaction between phosphoenolpyruvate and erythrose 4-phosphate. Three phosphoenolpyruvate mimics, (R)-phospholactate, (S)-phospholactate and vinyl phosphonate [(E)-2-methyl-3-phosphonoacrylate], were found to competitively inhibit DAH7PS from Neisseria meningitidis, which is the pathogen responsible for bacterial meningitis. The most potent inhibitor was the vinyl phosphonate with a Ki value of 3.9±0.4µM. We report for the first time crystal structures of these compounds bound in the active site of a DAH7PS enzyme which reveals that the inhibitors bind to the active site of the enzyme in binding modes that mimic those of the predicted oxocarbenium and tetrahedral intermediates of the enzyme-catalysed reaction. Furthermore, the inhibitors accommodate the binding of a key active site water molecule. Together, these observations provide strong evidence that this active site water participates directly in the DAH7PS reaction, enabling the facial selectivity of the enzyme-catalysed reaction sequence to be delineated.


Subject(s)
3-Deoxy-7-Phosphoheptulonate Synthase/antagonists & inhibitors , 3-Deoxy-7-Phosphoheptulonate Synthase/metabolism , Enzyme Inhibitors/chemistry , Meningitis, Meningococcal/microbiology , Neisseria meningitidis/enzymology , Phosphoenolpyruvate/analogs & derivatives , 3-Deoxy-7-Phosphoheptulonate Synthase/chemistry , Catalytic Domain , Crystallography, X-Ray , Enzyme Inhibitors/pharmacology , Humans , Meningitis, Meningococcal/drug therapy , Meningitis, Meningococcal/enzymology , Models, Molecular , Neisseria meningitidis/chemistry , Neisseria meningitidis/drug effects , Phosphoenolpyruvate/pharmacology , Water/chemistry
2.
PLoS Pathog ; 10(6): e1004160, 2014 Jun.
Article in English | MEDLINE | ID: mdl-24945304

ABSTRACT

The interaction with brain endothelial cells is central to the pathogenicity of Neisseria meningitidis infections. Here, we show that N. meningitidis causes transient activation of acid sphingomyelinase (ASM) followed by ceramide release in brain endothelial cells. In response to N. meningitidis infection, ASM and ceramide are displayed at the outer leaflet of the cell membrane and condense into large membrane platforms which also concentrate the ErbB2 receptor. The outer membrane protein Opc and phosphatidylcholine-specific phospholipase C that is activated upon binding of the pathogen to heparan sulfate proteoglycans, are required for N. meningitidis-mediated ASM activation. Pharmacologic or genetic ablation of ASM abrogated meningococcal internalization without affecting bacterial adherence. In accordance, the restricted invasiveness of a defined set of pathogenic isolates of the ST-11/ST-8 clonal complex into brain endothelial cells directly correlated with their restricted ability to induce ASM and ceramide release. In conclusion, ASM activation and ceramide release are essential for internalization of Opc-expressing meningococci into brain endothelial cells, and this segregates with invasiveness of N. meningitidis strains.


Subject(s)
Brain/blood supply , Ceramides/metabolism , Endothelium, Vascular/microbiology , Host-Pathogen Interactions , Neisseria meningitidis/pathogenicity , Sphingomyelin Phosphodiesterase/metabolism , Up-Regulation , Bacterial Adhesion/drug effects , Bacterial Outer Membrane Proteins/genetics , Bacterial Outer Membrane Proteins/metabolism , Bacterial Proteins/genetics , Bacterial Proteins/metabolism , Brain/drug effects , Brain/metabolism , Brain/microbiology , Cell Line, Transformed , Cell Membrane/drug effects , Cell Membrane/enzymology , Cell Membrane/metabolism , Endothelium, Vascular/drug effects , Endothelium, Vascular/metabolism , Enzyme Activation/drug effects , Enzyme Inhibitors/pharmacology , Host-Pathogen Interactions/drug effects , Humans , Membrane Microdomains/drug effects , Membrane Microdomains/enzymology , Membrane Microdomains/metabolism , Meningitis, Meningococcal/enzymology , Meningitis, Meningococcal/metabolism , Meningitis, Meningococcal/microbiology , Microvessels/drug effects , Microvessels/metabolism , Microvessels/microbiology , Mutation , Neisseria meningitidis/physiology , Sphingomyelin Phosphodiesterase/antagonists & inhibitors , Surface Properties/drug effects , Transendothelial and Transepithelial Migration/drug effects , Type C Phospholipases/genetics , Type C Phospholipases/metabolism , Up-Regulation/drug effects
3.
BMC Infect Dis ; 14: 726, 2014 Dec 31.
Article in English | MEDLINE | ID: mdl-25551808

ABSTRACT

BACKGROUND: Approximately 7% of survivors from meningococcal meningitis (MM) suffer from neurological sequelae due to brain damage in the course of meningitis. The present study focuses on the role of matrix metalloproteinases (MMPs) in a novel mouse model of MM-induced brain damage. METHODS: The model is based on intracisternal infection of BALB/c mice with a serogroup C Neisseria meningitidis strain. Mice were infected with meningococci and randomised for treatment with the MMP inhibitor batimastat (BB-94) or vehicle. Animal survival, brain injury and host-response biomarkers were assessed 48 h after meningococcal challenge. RESULTS: Mice that received BB-94 presented significantly diminished MMP-9 levels (p < 0.01), intracerebral bleeding (p < 0.01), and blood-brain barrier (BBB) breakdown (p < 0.05) in comparison with untreated animals. In mice suffering from MM, the amount of MMP-9 measured by zymography significantly correlated with both intracerebral haemorrhage (p < 0.01) and BBB disruption (p < 0.05). CONCLUSIONS: MMPs significantly contribute to brain damage associated with experimental MM. Inhibition of MMPs reduces intracranial complications in mice suffering from MM, representing a potential adjuvant strategy in MM post-infection sequelae.


Subject(s)
Blood-Brain Barrier/drug effects , Blood-Brain Barrier/pathology , Cerebral Hemorrhage/drug therapy , Cerebral Hemorrhage/pathology , Matrix Metalloproteinase Inhibitors/therapeutic use , Meningitis, Meningococcal/drug therapy , Meningitis, Meningococcal/pathology , Phenylalanine/analogs & derivatives , Thiophenes/therapeutic use , Animals , Apoptosis/drug effects , Cerebellum/drug effects , Cerebellum/metabolism , Cerebral Hemorrhage/complications , Cerebral Hemorrhage/enzymology , Chemokines/metabolism , Cytokines/metabolism , Dentate Gyrus/drug effects , Dentate Gyrus/pathology , Disease Models, Animal , Female , Kaplan-Meier Estimate , Matrix Metalloproteinase 2/metabolism , Matrix Metalloproteinase 9/metabolism , Matrix Metalloproteinase Inhibitors/pharmacology , Meningitis, Meningococcal/complications , Meningitis, Meningococcal/enzymology , Mice , Phenylalanine/pharmacology , Phenylalanine/therapeutic use , Thiophenes/pharmacology
4.
mBio ; 4(5): e00339-13, 2013 Oct 15.
Article in English | MEDLINE | ID: mdl-24129254

ABSTRACT

UNLABELLED: The identification of "factor H binding protein (fHbp)-null" invasive meningococcal isolates and the realization that widespread use of fHbp-based vaccines could herald selection of such strains prompted us to characterize novel mechanisms of alternative pathway (AP) inhibition on meningococci. Of seven strains engineered to lack four known AP-inhibiting molecules, capsular polysaccharide, lipooligosaccharide sialic acid, fHbp, and neisserial surface protein A (quadruple mutants), four strains inhibited human AP-mediated C3 deposition. All four expressed the porin B2 (PorB2) molecule, and three strains belonged to the hypervirulent ST-11 lineage. Consistent with reduced C3 deposition, the rate of C3a generation by a PorB2 isolate was lower than that by a PorB3 strain. Allelic replacement of PorB3 with PorB2, in both encapsulated and unencapsulated strains, confirmed the role of PorB2 in AP inhibition. Expression of PorB2 increased resistance to complement-dependent killing relative to that seen in an isogenic PorB3-expressing strain. Adult rabbit and mouse APs were unimpeded on all mutants, and human fH inhibited nonhuman C3 deposition on PorB2-expressing strains, which provided functional evidence for human fH-dependent AP regulation by PorB2. Low-affinity binding of full-length human fH to quadruple mutants expressing PorB2 was demonstrated. fH-like protein 1 (FHL-1; contains fH domains 1 through 7) and fH domains 6 and 7 fused to IgG Fc bound to one PorB2-expressing quadruple mutant, which suggested that fH domains 6 and 7 may interact with PorB2. These results associate PorB2 expression with serum resistance and presage the appearance of fHbp-null and hypervirulent ST-11 isolates that may evade killing by fHbp-based vaccines. IMPORTANCE: The widespread use of antimeningococcal vaccines based on factor H (fH) binding protein (fHbp) is imminent. Meningococci that lack fHbp were recently isolated from persons with invasive disease, and these fHbp-null strains could spawn vaccine failure. Our report provides a molecular basis for an explanation of how fHbp-null strains may evade the host immune system. Meningococci possess several mechanisms to subvert killing by the alternative pathway (AP) of complement, including production of the fHbp and NspA fH binding proteins. Here we show that a meningococcal protein called porin B2 (PorB2) contributes to inhibition of the AP on the bacterial surface. A majority of the "fHbp-null" isolates identified, as well as all members of a "hypervirulent" lineage (called ST-11), express PorB2. Our findings highlight the potential for the emergence of fHbp-negative strains that are able to regulate the AP and may be associated with fHbp vaccine failure.


Subject(s)
Complement C3-C5 Convertases, Alternative Pathway/immunology , Complement Factor H/immunology , Meningitis, Meningococcal/immunology , Neisseria meningitidis/pathogenicity , Porins/immunology , Animals , Antigens, Bacterial/genetics , Antigens, Bacterial/immunology , Bacterial Proteins/genetics , Bacterial Proteins/immunology , Complement C3-C5 Convertases, Alternative Pathway/genetics , Down-Regulation , Female , Humans , Male , Meningitis, Meningococcal/enzymology , Meningitis, Meningococcal/microbiology , Mice , Mice, Inbred BALB C , Neisseria meningitidis/genetics , Neisseria meningitidis/immunology , Porins/genetics , Rabbits , Virulence
5.
J Biol Chem ; 288(17): 11718-30, 2013 Apr 26.
Article in English | MEDLINE | ID: mdl-23439648

ABSTRACT

Neisseria meningitidis (Nm) is a leading cause of bacterial meningitis and sepsis. Crucial virulence determinants of pathogenic Nm strains are the polysaccharide capsules that support invasion by hindering complement attack. In NmW-135 and NmY the capsules are built from the repeating units (→ 6)-α-D-Gal-(1 → 4)-α-Neu5Ac-(2 →)n and (→ 6)-α-D-Glc-(1 → 4)-α-Neu5Ac-(2 →)n, respectively. These unusual heteropolymers represent unique examples of a conjugation between sialic acid and hexosyl-sugars in a polymer chain. Moreover, despite the various catalytic strategies needed for sialic acid and hexose transfer, single enzymes (SiaDW-135/Y) have been identified to form these heteropolymers. Here we used SiaDW-135 as a model system to delineate structure-function relationships. In size exclusion chromatography active SiaDW-135 migrated as a monomer. Fold recognition programs suggested two separate glycosyltransferase domains, both containing a GT-B-fold. Based on conserved motifs predicted folds could be classified as a hexosyl- and sialyltransferase. To analyze enzyme properties and interplay of the two identified glycosyltransferase domains, saturation transfer difference NMR and mutational studies were carried out. Simultaneous and independent binding of UDP-Gal and CMP-Sia was seen in the absence of an acceptor as well as when the catalytic cycle was allowed to proceed. Enzyme variants with only one functionality were generated by site-directed mutagenesis and shown to complement each other in trans when combined in an in vitro test system. Together the data strongly suggests that SiaDW-135 has evolved by fusion of two independent ancestral genes encoding sialyl- and galactosyltransferase activity.


Subject(s)
Bacterial Capsules/metabolism , Bacterial Proteins/metabolism , Evolution, Molecular , Neisseria meningitidis, Serogroup W-135/enzymology , Polysaccharides, Bacterial/biosynthesis , Sialyltransferases/metabolism , Bacterial Capsules/chemistry , Bacterial Capsules/genetics , Bacterial Proteins/chemistry , Bacterial Proteins/genetics , Gene Fusion/physiology , Humans , Meningitis, Meningococcal/enzymology , Meningitis, Meningococcal/genetics , Meningitis, Meningococcal/pathology , Mutagenesis, Site-Directed , Neisseria meningitidis, Serogroup W-135/genetics , Neisseria meningitidis, Serogroup W-135/pathogenicity , Polysaccharides, Bacterial/chemistry , Polysaccharides, Bacterial/genetics , Protein Structure, Tertiary , Sepsis/enzymology , Sepsis/genetics , Sepsis/pathology , Sialyltransferases/chemistry , Sialyltransferases/genetics , Uridine Diphosphate Galactose/chemistry , Uridine Diphosphate Galactose/genetics , Uridine Diphosphate Galactose/metabolism
6.
BMC Microbiol ; 4: 34, 2004 Aug 31.
Article in English | MEDLINE | ID: mdl-15339342

ABSTRACT

BACKGROUND: DNA adenine methyltransferase (Dam) activity is absent in many, but not all, disease isolates of Neisseria meningitidis, as a consequence of the insertion of a restriction endonuclease-encoding gene, the 'dam replacing gene' (drg) at the dam locus. Here, we report the results of a survey to assess the prevalence of drg in a globally representative panel of disease-associated meningococci. RESULTS: Of the known meningococcal hyper-invasive lineages investigated, drg was absent in all representatives of the ST-8 and ST-11 clonal complexes tested, but uniformly present in the representatives of the other hyper-invasive lineages present in the isolate collection (the ST-1, ST-4, ST-5, ST-32 and ST-41/44 clonal complexes). The patterns of sequence diversity observed in drg were consistent with acquisition of this gene from a source organism with a different G+C content, at some time prior to the emergence of present-day meningococcal clonal complexes, followed by spread through the meningococcal population by horizontal genetic exchange. During this spread a number of alleles have arisen by mutation and intragenic recombination. CONCLUSION: These findings are consistent with the idea that possession of the drg gene may contribute to the divergence observed among meningococcal clonal complexes, but does not have a direct mechanistic involvement in virulence.


Subject(s)
Neisseria meningitidis/enzymology , Neisseria meningitidis/genetics , Site-Specific DNA-Methyltransferase (Adenine-Specific)/deficiency , Site-Specific DNA-Methyltransferase (Adenine-Specific)/genetics , Bacterial Proteins/genetics , DNA, Bacterial/genetics , Genetic Variation/genetics , Meningitis, Meningococcal/enzymology , Meningitis, Meningococcal/genetics , Prevalence
7.
J Infect Dis ; 182(6): 1784-7, 2000 Dec.
Article in English | MEDLINE | ID: mdl-11069255

ABSTRACT

Cytidine deaminase (CDD) catalyzes the hydrolytic deamination of cytidine, which thereby is converted to uridine. CDD is found in serum and different tissues, with particularly high concentrations in polymorphonuclear neutrophils (PMN). We measured the CDD levels in plasma from patients with systemic meningococcal disease. Thirty-seven patients had significantly higher plasma levels of CDD than did 29 healthy control subjects (P=.0001). CDD levels in plasma or serum increased from a median of 96 ng/mL in healthy control subjects to medians of 168 ng/mL in patients without persistent shock (n=23; P=.001) and 422 ng/mL in patients with fulminant meningococcal septicemia (n=14; P=.0001). In most patients with fulminant septicemia, CDD levels in plasma increased during the first 3-53 h after the initiation of therapy (P=.003). CDD alone had no immediate harmful effect when injected into mice during a 4-day period. CDD may modulate the stimulatory effect of colony-stimulating factors on PMN in patients.


Subject(s)
Bacteremia/enzymology , Cytidine Deaminase/blood , Meningococcal Infections/enzymology , Adolescent , Adult , Animals , Colony-Forming Units Assay , Colony-Stimulating Factors/antagonists & inhibitors , Disseminated Intravascular Coagulation/blood , Female , Granulocytes/physiology , Humans , Macrophages/physiology , Meningitis, Meningococcal/blood , Meningitis, Meningococcal/enzymology , Meningococcal Infections/blood , Mice , Mice, Inbred C57BL , Shock, Septic/blood
8.
Ann Neurol ; 44(4): 592-600, 1998 Oct.
Article in English | MEDLINE | ID: mdl-9778257

ABSTRACT

In this study, we investigated the involvement of matrix metalloproteinases (MMPs) in the pathophysiology of bacterial meningitis. By using an enzyme immunoassay, high concentrations of MMP-9 were detected in the cerebrospinal fluid (CSF) of adult patients with bacterial meningitis but not in controls, and in patients with Guillain-Barré syndrome. Moreover, we observed significantly elevated concentrations of the tissue inhibitor of metalloproteinase-1 (TIMP-1) in the CSF of patients with bacterial meningitis, compared with controls. In a rat model of meningococcal meningitis, intracisternal injection of heat-killed meningococci caused a disruption of the blood-brain barrier (BBB), an increase in intracranial pressure, and CSF pleocytosis paralleled by the occurrence of MMP-9 activity in the CSF 6 hours after meningococcal challenge. The MMP inhibitor batimastat (BB-94) significantly reduced the BBB disruption and the increase in intracranial pressure irrespective of the time of batimastat administration (15 minutes before and 3 hours after meningococcal challenge) but failed to significantly reduce CSF white blood cell counts. In conclusion, our results suggest that MMPs are involved in the alterations of BBB permeability during experimental meningococcal meningitis.


Subject(s)
Blood-Brain Barrier/physiology , Collagenases/physiology , Meningitis, Meningococcal/physiopathology , Adult , Aged , Animals , Capillary Permeability/drug effects , Capillary Permeability/physiology , Cerebrospinal Fluid/cytology , Collagenases/cerebrospinal fluid , Female , Humans , Intracranial Pressure/drug effects , Intracranial Pressure/physiology , Leukocyte Count , Male , Matrix Metalloproteinase 9 , Meningitis, Meningococcal/enzymology , Metalloendopeptidases/antagonists & inhibitors , Middle Aged , Phenylalanine/analogs & derivatives , Phenylalanine/pharmacology , Rats , Rats, Wistar , Thiophenes/pharmacology , Tissue Inhibitor of Metalloproteinase-1/cerebrospinal fluid
9.
Epidemiol Infect ; 116(2): 103-14, 1996 Apr.
Article in English | MEDLINE | ID: mdl-8620900

ABSTRACT

The objective of the study was to assess whether genotypic characterization by means of DNA-fingerprinting pattern (DFP) and multilocus enzyme electrophoresis (MEE) profile as compared to phenotypic characterization would improve the differentiation of Neisseria meningitidis strains associated with outbreaks from strains associated with sporadic cases of meningococcal disease. In addition, the differentiation of serogroup C carrier strains from those associated with an outbreak of serogroup C meningococcal disease was investigated. A total of 118 N. meningitidis strains were available for the study: 59 from patients involved in outbreaks of meningococcal disease (2 serogroup B and 2 serogroup C), 37 patients considered to be sporadic cases and 22 serogroup C carrier strains. Among the 59 strains from patients involved in outbreaks the 4 strains isolated from the patient registered as the first in each outbreak were designated the index strains. Among the remaining 55 outbreak strains 52 were either DFP-identical or DFP-indistinguishable when compared with the one relevant out of the 4 index strains. This was only the case for 17 of the 37 strains isolated from sporadic cases caused by the same serogroup of meningococci during the outbreak periods, and 5 of the 22 meningococcal strains isolated from healthy carriers. Among the 56 (52 + 4) DFP-identical or DFP-indistinguishable outbreak strains 5 different electrophoretic types were identified by MEE. Among 59 assumed outbreak strains a total of 4 were identified as genotypically distinct. Among the 37 mainly DFP-indistinguishable or DFP-different strains from sporadic cases 17 different ETs were identified, and among the 22 mainly DFP-different carrier strains 13 different ETs were identified. Two strains among those selected from sporadic cases were identical to the outbreak strain. None of the local serogroup C carrier strains isolated during the outbreak of serogroup C disease were identical to the outbreak strain. Both DNA-fingerprinting and MEE improved the differentiation of meningococci when compared with phenotypic characterization. The results indicate that tracing a virulent strain within a open group of contacts is irrelevant.


Subject(s)
Bacterial Typing Techniques , Disease Outbreaks , Meningitis, Meningococcal/microbiology , Neisseria meningitidis/classification , Carrier State/microbiology , DNA Fingerprinting , Denmark/epidemiology , Electrophoresis , Humans , Meningitis, Meningococcal/enzymology , Meningitis, Meningococcal/epidemiology , Neisseria meningitidis/enzymology
10.
Ter Arkh ; 62(11): 25-7, 1990.
Article in Russian | MEDLINE | ID: mdl-2094984

ABSTRACT

A study was made of the time-course of changes in the activity of the enzymic antioxidant system of blood platelets from patients with meningococcemia and meningitis (mixed form) of medium gravity. As a result a steady unbalance in the redox system of glutathione was established: a decrease of glutathione reductase activity and rise of the activity of glutathione peroxidases to hydrogen peroxide and tertiary butyl hydroperoxide until the clinical recovery. The patients with meningococcal meningitis and with the mixed form of medium gravity manifested impairment of the interrelations between superoxide dismutase and glutathione peroxidase to hydrogen peroxide, with that impairment being eliminated by the end of the disease. Potential mechanisms by which the enzymic antioxidant system is impaired in meningococcal infection are discussed.


Subject(s)
Antioxidants , Blood Platelets/enzymology , Meningococcal Infections/enzymology , Acute Disease , Adolescent , Adult , Glutathione Peroxidase/blood , Glutathione Reductase/blood , Glutathione Transferase/blood , Humans , Male , Meningitis, Meningococcal/enzymology , Sepsis/enzymology , Superoxide Dismutase/blood
12.
Microbios ; 45(183): 113-29, 1986.
Article in English | MEDLINE | ID: mdl-3086672

ABSTRACT

Proteolytic enzymes are produced by animal as well as human pathogens. Several micro-organisms including Neisseriae produce IgA1 specific proteases. This protease specifically hydrolyses IgA1 protein. IgA1-specific protease(s) synthesized by Neisseria species are briefly reviewed with particular reference to their role in infection.


Subject(s)
Neisseria gonorrhoeae/enzymology , Neisseria meningitidis/enzymology , Peptide Hydrolases/metabolism , Serine Endopeptidases , Aminopeptidases/metabolism , Asparaginase/metabolism , Edetic Acid/pharmacology , Endopeptidases/metabolism , Female , Gonorrhea/enzymology , Gonorrhea/microbiology , Humans , Immunoglobulin A/immunology , Immunoglobulin A/metabolism , Immunoglobulin A, Secretory/immunology , Immunoglobulin A, Secretory/metabolism , Male , Meningitis, Meningococcal/enzymology , Meningitis, Meningococcal/microbiology , Meningococcal Infections/enzymology , Meningococcal Infections/microbiology , Substrate Specificity
15.
Acta Med Scand ; 203(1-2): 71-4, 1978.
Article in English | MEDLINE | ID: mdl-626116

ABSTRACT

The concentration of lysozyme (LZM) in cerebrospinal fluid was determined in 25 patients with bacterial meningitis, in 18 patients with viral meningitis and in 25 control patients who had other fibrile illnesses. The concentration of LZM was less than 1.5 microgram/ml in all control patients, and slightly to markedly raised in 10 patients with viral meningitis and in 11 out of 13 patients with untreated bacterial meningitis. The concentration of LZM was significantly different in the viral and bacterial meningitis patients (p less than 0.001). Most raised concentrations of cerebrospinal fluid LZM persisted for at least one week after the start of antibiotic treatment. The concentrations of LZM correlated well with concentrations of lactic dehydrogenase. These results show that the determination of cerebrospinal fluid LZM is a useful tool in the differential diagnosis of meningitis, particularly when the prehospital treatment with antibiotics may be responsible for a diagnostically misleading negative bacterial culture of the cerebrospinal fluid and altered cerebrospinal fluid cytology.


Subject(s)
Meningitis, Meningococcal/diagnosis , Meningitis, Pneumococcal/diagnosis , Meningitis, Viral/diagnosis , Muramidase/cerebrospinal fluid , Diagnosis, Differential , Echovirus Infections/diagnosis , Echovirus Infections/enzymology , Humans , L-Lactate Dehydrogenase/cerebrospinal fluid , Meningitis, Meningococcal/enzymology , Meningitis, Pneumococcal/enzymology , Meningitis, Viral/enzymology , Mumps/complications , Mumps/enzymology
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