RESUMEN

We had for aim to describe and illustrate the artefacts observed in biopsies of the oral mucosa, as well as the impact of sending non-representative histological material to a laboratory. This article was based on an international literature review, as well as on our experience. We analysed the problems raised, for the pathologists and the histology lab-technicians, by these artefacts as well as their impact on the pathology report patient management. We suggest simple solutions.

Asunto(s)

Biopsia/normas , Mucosa Bucal/patología , Anestesia/efectos adversos , Artefactos , Biopsia/instrumentación , Biopsia/métodos , Calibración , Equipos y Suministros/efectos adversos , Humanos , Estudios Retrospectivos , Fijación del Tejido/métodos

RESUMEN

The development of oral and head and neck squamous cell carcinomas occurs in relation with multiple events including mainly: loss of cycle cell control, evasion from apoptosis, telomerase reactivation. Complex interactions between a set of molecules, cell cycle proteins, tumour suppressor genes, oncogenes and the telomerase, occur in the multiple step process of carcinogenesis. The 2 main ways of control of the cell cycle rely on 2 tumour suppressor genes: the P53 gene and the retinoblastoma gene or RB gene. One of the regulation pathways or the 2 regulation pathways are disabled during the development of oral and head and neck squamous cell carcinomas. Most of the time, the inactivation of the P53 pathway results from a loss of function of the p53 protein, secondary to mutation and/or deletion of the P53 gene; It may also result of the amplification of the MDM2 gene and of the inactivation of the arf protein. The RB pathway leads to cell proliferation by loss of the p16 protein, by amplification of the cyclin D1 gene and less frequently by mutation of the RB gene or loss of the retinoblastoma protein. In India and South-East Asia, the activation of RAS and MYC oncogenes appears to be related with the presence of specific carcinogens in snuff and tobacco. By blocking apoptosis, the Bcl2 protein seems to increase the resistance of tumours to radiotherapy and chemotherapy.

Asunto(s)

Carcinoma de Células Escamosas/genética , Neoplasias de Cabeza y Cuello/genética , Neoplasias de la Boca/genética , Proteínas Musculares , Mutación , Proteínas Nucleares , Eliminación de Gen , Genes bcl-1/genética , Genes bcl-2/genética , Genes myc/genética , Genes p53/genética , Genes ras/genética , Humanos , Proteínas de Microfilamentos/genética , Proteínas Proto-Oncogénicas/genética , Proteínas Proto-Oncogénicas c-mdm2 , Proteína de Retinoblastoma/genética , Telomerasa

RESUMEN

Factors of prognosis and radioresistance in oral cavity and pharyngeal squamous cell carcinoma (OCPSCC) are limited. In the present study, the usefulness of tumor DNA content in predicting radioresistance in patients with OCPSCC has been investigated. Radioresistance has been defined as local recurrence or tumor persistence after radiation therapy. DNA-ploidy analysis was performed by static cytometry on smears of cell suspensions obtained from formalin-fixed paraffin-embedded material and stained with Feulgen. DNA-ploidy was correlated with the proliferation rate (Ki-67) and p53 protein accumulation obtained by immunohistochemistry. The follow-up of patients ranged from 8 to 62 months. Radioresistance was more common in non-diploid tumors; 14/28 (50%) non-diploid tumors recurred, whereas only 3 (10.7%) out of 28 diploid tumors had local failure (P=0.0019). Proliferation rate and p53 accumulation, evaluated by immunohistochemistry, also added prognostic information. Twelve out of 14 failures were from non-diploid tumors with a low proliferation rate (Ki-67<20%), whereas none of 20 p53-negative diploid tumors developed recurrences. This study showed that non-diploid tumors responded poorly to radiotherapy. DNA content appeared, therefore, as a significant prognostic marker for the evaluation of OCPSCC in patients receiving radiation therapy. This study also showed that DNA content adds information to p53 accumulation and the proliferation rate (Ki-67) for the purposes of determining patient management.

Asunto(s)

Biomarcadores de Tumor/análisis , Carcinoma de Células Escamosas/radioterapia , ADN de Neoplasias/análisis , Antígeno Ki-67/análisis , Neoplasias de la Boca/radioterapia , Neoplasias Faríngeas/radioterapia , Tolerancia a Radiación , Colorantes de Rosanilina , Proteína p53 Supresora de Tumor/análisis , Adulto , Anciano , Anciano de 80 o más Años , Braquiterapia , Carcinoma de Células Escamosas/genética , Carcinoma de Células Escamosas/patología , División Celular , Colorantes , Diploidia , Femenino , Estudios de Seguimiento , Predicción , Humanos , Inmunohistoquímica , Masculino , Persona de Mediana Edad , Neoplasias de la Boca/genética , Neoplasias de la Boca/patología , Recurrencia Local de Neoplasia/patología , Estadificación de Neoplasias , Neoplasias Faríngeas/genética , Neoplasias Faríngeas/patología , Ploidias , Pronóstico , Dosificación Radioterapéutica

RESUMEN

Inflammatory pseudotumours (IPs) are rare lesions. Most commonly reported in the lung, they are almost ubiquitous, but few oral cases have been described. Their rapid growth, local invasiveness and recurrence, and their ultrasound, computed tomography (CT) and magnetic resonance imaging (MRI) aspects are confusing and mimic benign or malignant neoplasms. Their recognition and distinction from malignant tumors is of importance but their histopathological diagnosis may represent a challenge. In the case reported involving the submandibular gland, the spindle cells had the immunohistochemical profile of myofibroblasts, broader cells with a larger nucleus were CD68 and/or Mac387 positive and the dense plasmacytic infiltrate was polyclonal. Histopathology of IPs covers a spectrum of appearances according to the cellularity and the degree of fibrosis. The recognition of a variable mixture of three main cell types: histiocytes or macrophages, myofibroblasts or fibroblasts and abundant plasma cells, with low mitotic activity and absence of cytological abnormalities in an ill circumscribed and rather fibrous lesion is recommended for the diagnosis of oral IP.

Asunto(s)

Granuloma de Células Plasmáticas/patología , Enfermedades de la Glándula Submandibular/patología , Fibroblastos/patología , Histiocitos/patología , Humanos , Inmunohistoquímica , Masculino , Persona de Mediana Edad , Células Plasmáticas/patología

RESUMEN

Some cases of oral candidosis are refractory to antifungal treatment. This might be related to development of resistant Candida strains, but susceptibility testing is not standardized and not routinely available, and information related to this problem is scarce in non-AIDS patients. In this study, the in vitro antifungal resistance of oral Candida albicans strains was evaluated. The strains were obtained from a cohort of 72 HIV-negative patients with oral yeast carriage and clinical complaint. Laboratory identification revealed C. albicans in 93% of cases. None of these oral C. albicans isolates showed in vitro resistance to polyenes, but they showed varying resistance levels to fluorocytosine and azoles. This study confirms the usefulness of standardizing susceptibility testing so that it could be routinely available and of realizing a mycological diagnosis including an antifungigram when oral candidosis is suspected, whenever antifungal treatment with azoles is planned.

Asunto(s)

Antifúngicos/farmacología , Candida albicans/efectos de los fármacos , Candidiasis Bucal/tratamiento farmacológico , Antifúngicos/uso terapéutico , Azoles/farmacología , Azoles/uso terapéutico , Estudios de Cohortes , Relación Dosis-Respuesta a Droga , Farmacorresistencia Microbiana , Femenino , Flucitosina/farmacología , Flucitosina/uso terapéutico , Seronegatividad para VIH , Humanos , Masculino , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad , Polienos/farmacología , Polienos/uso terapéutico

RESUMEN

PURPOSE: The lack of accurate criteria to predict the response to radiotherapy for individual patients with squamous cell carcinoma of the head and neck (HN-SCC) remains a major problem. The purpose of this study was to investigate the role of several biologic tumor markers to complement clinical prognostic factors in the assessment of response to radiotherapy in SCCs. PATIENTS AND METHODS: p53, ki-67, c-erb B-2, heat-shock protein-27 (HSP-27), and glutathione S transferase (GSTpi) were evaluated by immunohistochemistry on biopsies from 101 patients treated for head and neck cancer by radical radiotherapy. Expression of each marker was correlated with local control and survival using Kaplan-Meier curves. A Cox regression multivariate analysis was also performed that included all clinical and immunohistochemical variables. RESULTS: Expression of p53 and low cell proliferation allowed identification of patients whose tumors did not respond to radiation. Patients with p53-expressing tumors displayed a relative risk (RR) of 3.78 for not being controlled by radiotherapy compared with patients with p53-negative tumors. For tumors with a high growth fraction (ki-67 > 20%) the RR was 0.25 compared with tumors with a low growth fraction (ki-67 < 20%). When p53 expression and cell proliferation were considered simultaneously in a Cox model, the association with resistance to radiation was significant (P = .000004). The RR for resistance with one (p53 staining or ki-67 < 20%) or two (p53 staining and ki-67 < 20%) unfavorable markers was, respectively, 3.8 and 14.87. CONCLUSION: Patients whose tumor expressed p53 with low growth fraction (ki-67 < 20%) had a strong probability not to respond to radiation therapy. Similarly, absence of p53 expression with a high cell proliferation predicted an excellent outcome after radiotherapy even for patients with advanced disease. Prediction of the outcome of radiotherapy would eventually facilitate the early choice of an adequate treatment.

Asunto(s)

Biomarcadores de Tumor/análisis , Carcinoma de Células Escamosas/química , Carcinoma de Células Escamosas/radioterapia , Neoplasias de Cabeza y Cuello/química , Neoplasias de Cabeza y Cuello/radioterapia , Tolerancia a Radiación , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma de Células Escamosas/patología , Femenino , Glutatión Transferasa/análisis , Neoplasias de Cabeza y Cuello/patología , Humanos , Antígeno Ki-67/análisis , Masculino , Persona de Mediana Edad , Análisis Multivariante , Estadificación de Neoplasias , Dosificación Radioterapéutica , Receptor ErbB-2/análisis , Proteína p53 Supresora de Tumor/análisis

RESUMEN

Salivary cryptococcosis was disclosed at autopsy in an AIDS patient with disseminated C. neoformans infection. H & E staining was not suitable to demonstrate the occurrence of C. neoformans in many tissues; Alcian blue gave the best results.

Asunto(s)

Infecciones Oportunistas Relacionadas con el SIDA/microbiología , Criptococosis/diagnóstico , Cryptococcus neoformans/aislamiento & purificación , Enfermedades de las Glándulas Salivales/diagnóstico , Infecciones Oportunistas Relacionadas con el SIDA/diagnóstico , Adulto , Azul Alcián , Colorantes , Criptococosis/etiología , Humanos , Masculino , Enfermedades de las Glándulas Salivales/etiología , Enfermedades de las Glándulas Salivales/microbiología

RESUMEN

Helicobacter pylori is a microaerophilic, motile bacterium, especially adapted to life in the human stomach. The presence of H. pylori in the stomach is strongly associated with chronic gastritis and ulcer disease and is a risk factor for gastric cancers. The microorganism may be transmitted orally and has been detected in dental plaque, saliva, and feces, but the hypothesis that oral microflora may be a permanent reservoir of H. pylori is still controversial. A review of the literature suggests that the recovery of H. pylori in the mouth is probably intermittent, associated with gastroesophageal reflux but not with specific oral disease. Nonetheless, the PCR identification of oral H. pylori may become helpful, particularly in cases of gastritis or ulcer relapse after antimicrobial therapy. Eradication of oral H. pylori by local medication or periodontal procedures would rely on the precise identification of its ecological niche. Within family groups, prophylactic methods should be practiced to avoid oral carriage of H. pylori. The risk of iatrogenic transmission during dental care, however, is already circumscribed by standard professional hygiene procedures.

Asunto(s)

Portador Sano , Placa Dental/microbiología , Infecciones por Helicobacter/etiología , Helicobacter pylori/aislamiento & purificación , Saliva/microbiología , ADN Bacteriano/análisis , Reflujo Gastroesofágico/complicaciones , Reflujo Gastroesofágico/microbiología , Enfermedades Gastrointestinales/etiología , Enfermedades Gastrointestinales/microbiología , Infecciones por Helicobacter/prevención & control , Humanos

RESUMEN

Hyposalivation is related to decreased salivary flow, with xerostomia as an ultimate degree. Prolonged severe hyposalivation or xerostomia may induce oral pain, poor tolerance to dentures, loss in taste acuity and increased incidence of oral infections: gingivitis, periodontitis, oral candidosis, infectious sialadenitis and multiple dental caries. Most of the time hyposalivation is a reversible drug-induced side-effect. Hyposalivation is frequent, particularly in elderly people with numerous drugs prescribed on a long-term continuous basis, and in psychiatric patients. It remains a neglected clinical problem. Besides the well-known antimuscarinics, antihistaminics, imipraminic antidepressants and phenothiazic neuroleptics, many drugs may induce hyposalivation. This work aims to review drug-induced xerostomia in 1997 (French pharmacopeae), and high-risk associations.

Asunto(s)

Xerostomía/inducido químicamente , Humanos , Enfermedad Iatrogénica , Sistema Nervioso/efectos de los fármacos , Salivación/efectos de los fármacos

RESUMEN

As a tumour suppressor gene, the inactivation of p53 induces the development of numerous human cancers. Mutations of p53 have been implicated in the pathogenesis of head and neck squamous cell carcinoma (HN-SCC) at a high incidence. In premalignant lesions and in situ carcinomas, p53 overexpression is not exclusively restricted to neoplastic cells, but frequently affects the normal appearing keratinocytes adjacent to p53 positive neoplasms or present in dysplastic areas. These results suggest that as contributors to the early phases of HN-SCC development, p53 alterations may be excellent biomarkers that indicate the predisposition of a particular oral cavity premalignant lesion toward malignancy. In most cases, the p53 overexpression status of a tumour metastasis is identical to that of a primary tumour, indicating that a p53 mutation precedes metastatic spread. In patients with multiple primary tumours, multiple foci of p53 overexpression are observed in epithelia distant from the tumour. So the expression of p53 in normal epithelium would indicate an increased risk for transformation to second or third primary cancers. Distinct p53 mutations in different primary tumours of the same patient indicate that these cancers arise as independent events; these results support the existence of multifocal polyclonal processes. Regardless of the aforementioned results that support p53 as a valid tumour biomarker, most studies have shown no relationship between the expression of p53 and clinical and histopathological parameters. The role played by p53 mutations in the progression and vital prognosis of HN-SCC has not yet been demonstrated.

Asunto(s)

Biomarcadores de Tumor/metabolismo , Neoplasias de Cabeza y Cuello/metabolismo , Proteína p53 Supresora de Tumor/metabolismo , Biomarcadores de Tumor/genética , Expresión Génica , Neoplasias de Cabeza y Cuello/genética , Humanos , Mutación , Lesiones Precancerosas/metabolismo , Proteína p53 Supresora de Tumor/genética

RESUMEN

In the Mediterranean basin area, visceral leishmaniasis is an endemic disease caused by Leishmania donovani infantum. This study describes the clinical and pathological features of one patient with AIDS who had oral (tonsillar) leishmaniasis, caused by a viscerotropic zymodeme, concurrent with a Kaposi's sarcoma and with a CMV infection.

Asunto(s)

Infecciones Oportunistas Relacionadas con el SIDA/parasitología , Leishmaniasis Visceral/etiología , Tonsila Palatina/parasitología , Enfermedades Faríngeas/parasitología , Sarcoma de Kaposi/etiología , Neoplasias Cutáneas/etiología , Adulto , Infecciones por Citomegalovirus/etiología , Humanos , Masculino , Enfermedades Faríngeas/etiología , Sarcoma de Kaposi/microbiología , Sarcoma de Kaposi/parasitología , Neoplasias Cutáneas/microbiología , Neoplasias Cutáneas/parasitología

RESUMEN

Bacillary angiomatosis (BA) is a new clinicopathological entity defined as a pseudo-neoplastic capillary proliferation secondary to an opportunistic infection by one of two Rochalimaea sp.: R. quintana or R. henselae. Although BA is a recently recognised entity, numerous cases have been reported. Most of the patients affected are reported to have low absolute CD4 lymphocyte counts associated with AIDS. Yet, very few oral cases associated or not with cutaneous lesions have been reported or simply identified. Histopathological and ultrastructural features of one case of oral BA with gingival and palatal lesions are presented. Clinical aspects of oral BA do not hold pathognomonic features and the lesions may resemble either a reactive lesion of the gingiva, pyogenic granuloma or Kaposi's sarcoma. The lesion is characteristically composed of circumscribed lobular capillary proliferations and the presence of granular amphophilic material on haematoxylin and eosin sections surrounded by neutrophils and neutrophilic debris is a clue to diagnosis. Demonstration of bacilli in the interstitium by the Warthin-Starry silver method or, better, by electron microscopy is diagnostic. BA may contribute to the death of the patient but erythromycin has proved to be very effective treatment.

Asunto(s)

Infecciones Oportunistas Relacionadas con el SIDA/patología , Angiomatosis Bacilar/etiología , Bartonella/aislamiento & purificación , Seropositividad para VIH/microbiología , Enfermedades de la Boca/microbiología , Mucosa Bucal/patología , Adulto , Angiomatosis Bacilar/patología , Bartonella/ultraestructura , Biopsia , Encía/patología , Seropositividad para VIH/complicaciones , VIH-1 , Humanos , Masculino , Microscopía Electrónica , Enfermedades de la Boca/patología , Mucosa Bucal/microbiología , Mucosa Bucal/ultraestructura , Hueso Paladar/patología

RESUMEN

The highly sensitive and specific methods of molecular biology emphasize the frequency of subclinical infections in the genital tract tissues by the human papillomaviruses (HPVs). The purpose of this work was to investigate occult viral infections by the HPV type 6, 11, 16, and 18 in the gingival tissues. The Southern blot method with 32P-radiolabeled DNA probes applied under stringent conditions to 20 interproximal gingival papilla specimens revealed homologous viral sequences in 1 of 6 cases of adult periodontitis (HPV 16), 1 of 2 cases of rapidly progressive periodontitis (RPP) (HPV 6/HPV 11), 2 of 2 cases of acute gingivitis in psychiatric institutionalized patients (HPV 6; HPV 6/HPV 11), and 2 of 10 cases of acute gingivitis in AIDS patients (HPV 6/HPV 11/HPV 16; HPV 6). No periodontal or extra-periodontal specimen hybridized with the HPV 18 probe. Simultaneous hybridization with two or three HPV types was common (3/6 cases). The present detection of HPV 6, 11, 16 DNAs or related-DNAs in periodontal tissues without obvious clinical signs of viral infection suggests that the gingival epithelium may act as a reservoir.

Asunto(s)

ADN Viral/análisis , Encía/microbiología , Papillomaviridae/genética , Adulto , Anciano , Anciano de 80 o más Años , Southern Blotting , Sondas de ADN , Femenino , Genoma Viral , Encía/química , Gingivitis/microbiología , Seropositividad para VIH/microbiología , Humanos , Mucosa Laríngea/microbiología , Masculino , Persona de Mediana Edad , Mucosa Bucal/microbiología , Mucosa Nasal/microbiología , Hibridación de Ácido Nucleico , Papillomaviridae/clasificación , Papillomaviridae/aislamiento & purificación , Periodontitis/microbiología

RESUMEN

The main oral manifestation of Epstein-Barr virus (EBV) infection is hairy leukoplakia, a lesion associated with the acquired immunodeficiency syndrome (AIDS) and occasionally in other immunocompromised patients. However, the recent literature describes the presence of viral genome in clinically normal oral tissues. The purpose of this work was to investigate these occult EBV infections in gingival epithelium. The Southern blot method with 32P-radiolabelled DNA probes under stringent conditions was applied to 20 interproximal gingival papillae specimens and revealed homologous EBV sequences in 4 of 10 AIDS patients as well as in 4 of 10 HIV negative patients. In order to determine whether EBV has a predilection for the gingival tissues, samples of nasal, laryngeal and oral mucosa, other than gingival mucosa, were collected from 10 HIV-negative patients undergoing surgical treatment for a variety of clinical conditions. None of these extra-periodontal mucosal specimens contained homologous EBV DNAs, except an edentulous palatal gingival specimen. With the present detection of EBV DNAs in the gingival tissues of patients undergoing surgical extractions, it would be of interest to investigate more systematically these subclinical infections in order to determine their exact implications in oral disease.

Asunto(s)

Síndrome de Inmunodeficiencia Adquirida/microbiología , ADN Viral/análisis , Encía/microbiología , Seropositividad para VIH/microbiología , Herpesvirus Humano 4/genética , Extracción Dental , Adulto , Anciano , Southern Blotting , Sondas de ADN , Femenino , Técnica del Anticuerpo Fluorescente , Gingivitis/microbiología , Humanos , Mucosa Laríngea/microbiología , Masculino , Persona de Mediana Edad , Mucosa Bucal/microbiología , Mucosa Nasal/microbiología , Hibridación de Ácido Nucleico , Periodontitis/microbiología

RESUMEN

Calcium antagonists are drugs restricting transmembrane calcium delivery. They possess a wide range of action against vasoconstriction and spastic reactions and were therefore initially recommended for the treatment of angina pectoris. With the increasing number and classes of calcium antagonists new therapeutic indications have emerged. Cases of gingival hyperplasia associated with their use are repeatedly reported, therefore the question deserves to be restated. The aim of the present study was to discuss the clinical, pathologic and pathogenetic features bases on an investigation carried out in a Department of Cardiology, on a case observation and on review of published cases in the international literature.

Asunto(s)

Diltiazem/efectos adversos , Hiperplasia Gingival/inducido químicamente , Nifedipino/efectos adversos , Adulto , Anciano , Anciano de 80 o más Años , Epitelio/efectos de los fármacos , Epitelio/patología , Femenino , Fibroblastos/patología , Encía/efectos de los fármacos , Encía/patología , Hiperplasia Gingival/patología , Humanos , Linfocitos/patología , Masculino , Persona de Mediana Edad

RESUMEN

Although dermal lesions in patients with drug poisoning have been widely documented, similar oral conditions are seldom reported. A case of cutaneous and oral mucosal necrosis related to barbiturate-induced coma is reported.

Asunto(s)

Enfermedades de la Boca/etiología , Secobarbital/envenenamiento , Úlcera Cutánea/inducido químicamente , Adulto , Humanos , Masculino , Enfermedades de la Boca/patología , Mucosa Bucal/patología , Necrosis/etiología , Necrosis/patología

RESUMEN

A study of hair follicle development has enabled us to differentiate four stages by relating them to corresponding gestation ages. Stage I of the hair bud is characterized by an epiblastic proliferation penetrating the subjacent mesenchyma at the extremity of which mesenchymal cells accumulate. This appears, at the level of the lower lip, before the 11th week of intrauterine life. Stage II of the hair bulb is reached on the 12th-13th week of intrauterine life, as soon as the distal extremity of the hair bud, which has extended, becomes depressed at the mesenchymal papilla level. Stage III is defined by the observation of hair cone and rough sebaceous glands on the 15th week of intrauterine life. Finally, stage IV shows a differentiated sebaceous gland with a hair which comes through the skin surface on the 18th week of intrauterine life.

Asunto(s)

Cabello/embriología , Feto/anatomía & histología , Edad Gestacional , Humanos , Glándulas Sebáceas/embriología

RESUMEN

This study was carried out on the heads of 20 foetuses aged between 11 and 26 weeks. Four stages were distinguished in the development of labial salivary glands, each stage corresponding to gestational age. Stage I is characterized by a localized, rounded thickening of the stomodial epiblast into the mesenchyma of the mucosal side of the lower lip. This occurs at the 9th-10th week of gestation. Stage II is reached when the epiblastic thickening assumes the form of a single cord. It is oval when sectioned transversally and is the result of the proliferation of epiblastic cells into the underlying mesenchyma during the 11th-12th week. Stage III corresponds to a branching process which takes place at the 13th week. The single cord branches to form the future secretory lobes, which rapidly assume a grape-like appearance. The number of rudimentary glands increases during the first three stages of development, i.e. as long as the first formed glands have not developed ducts. Stage IV corresponds to the process of duct formation at the 18th week. Simultaneous differentiation of acinal and duct cells is observed and this procedes the onset of secretory activity.

Asunto(s)

Glándulas Salivales Menores/embriología , Membrana Basal/embriología , Epitelio/embriología , Feto , Edad Gestacional , Humanos , Labio/embriología , Glándulas Salivales Menores/metabolismo

Asunto(s)

Odontólogos , Infecciones por VIH/transmisión , Hepatitis B/transmisión , Enfermedades Profesionales/etiología , Femenino , Francia , Infecciones por VIH/epidemiología , Hepatitis B/epidemiología , Humanos , Masculino , Cirugía Bucal

Asunto(s)

Meningitis Meningocócica/epidemiología , Humanos , Meningitis Meningocócica/microbiología , Meningitis Meningocócica/terapia , Neisseria meningitidis/inmunología , Polisacáridos Bacterianos/inmunología