RESUMO
Meningococcal disease is a devastating infection caused by Neisseria meningitidis (meningococcus), and it is classified into serogroups according to its polysaccharide capsule composition. In Brazil, serogroup C is the most frequently responsible for the majority of cases, representing a serious public health challenge. In 2010, the meningococcal serogroup C conjugate vaccine was included in the calendar of the National Immunization Program. We have evaluated 163 meningococcal isolates collected during the pre (2006-2010) and post (2011-2016) vaccination periods. Epidemiological data were determined through Multilocus Sequence Typing (MLST) analysis, vaccine antigens and Bexsero Antigen Sequence Typing (BAST) variant. Clonal complex 103 remains the most prevalent in the country with a high number of serogroup C strains to which CC103 is directly associated. A total of 42 different ST were found. The two most prevalent ST were ST-3780 (CC103) with 38 strains and ST-10781, which was not associated with a CC with nine strains. Allele abcZ-276 was reported among 98% of the strains analyzed and it was not found among other CC103 strains worldwide, makes this allele an important genetic marker for a specific new clone only assigned to Brazilian serogroup C strains, ST-3780. FHbp-25 and NHBA-42 peptides were the most prevalent among isolates in both periods studied. BAST-824 and BAST-3073 have been expressed only in CC103 over the studied years, however, it was not possible to associate a BAST variant to a specific CC. Serogroup C phenotype [P1.22,14-6,36-2: F3-9: ST-3780 (CC103)] was the most prevalent according to the antigenic profiles of circulating strains in Brazil (2007-2016). Our study suggests that CC103 is still a major hypervirulent CC circulating in Brazil and ST-3780 is currently spreading all over the country even after the introduction of MenC in 2010.
Assuntos
Antígenos de Bactérias/genética , Infecções Meningocócicas/prevenção & controle , Vacinas Meningocócicas/administração & dosagem , Tipagem de Sequências Multilocus/métodos , Neisseria meningitidis Sorogrupo C/classificação , Anticorpos Antibacterianos/metabolismo , Antígenos de Bactérias/imunologia , Brasil , Variação Genética , Humanos , Infecções Meningocócicas/imunologia , Vacinas Meningocócicas/genética , Vacinas Meningocócicas/imunologia , Neisseria meningitidis Sorogrupo C/genética , Neisseria meningitidis Sorogrupo C/imunologia , Neisseria meningitidis Sorogrupo C/isolamento & purificação , Filogenia , Vigilância da População , SorogrupoRESUMO
Meningococcus serogroup B (MenB), clonal complex 32 (cc 32), was the Brazilian epidemic strain of meningococcal disease (MD) in the 1990's. Currently, meningococcus serogroup C (MenC), cc 103, is responsible for most of the cases of the disease in Brazil. The aim of this study was to investigate the seroprevalence of bactericidal antibody (SBA) against representative epidemic strains of MenC, (N753/00 strain, C:23:P1.22,14-6, cc103) and MenB, (Cu385/83 strain, B:4,7:P1.15,19, cc32) in students and employees of a university hospital in the State of Rio Grande do Sul (RS, Brazil). A second MenC strain (N79/96, C:2b:P1.5-2,10, cc 8) was used as a prototype strain of Rio de Janeiro's outbreak that occurred in the 1990's. Our previous study showed a 9% rate of asymptomatic carriers in these same individuals. A second goal was to compare the SBA prevalence in meningococcal carriers and non-carriers. Fifty-nine percent of the studied population showed protective levels of SBA titers (log2≥2) against at least one of the three strains. About 40% of the individuals had protective levels of SBA against N753/00 and Cu385/83 strains. Nonetheless, only 22% of the individuals showed protective levels against N79/96 strain. Significantly higher antibody levels were seen in carriers compared to non-carriers (P≤0.009). This study showed that, similar to other States in Brazil, a MenC (23:P1.22,14-6, cc103) strain with epidemic potential is circulating in this hospital. Close control by the Epidemiological Surveillance Agency of RS of the number of cases of MD caused by MenC strains in the State is recommended to prevent a new disease outbreak.
Assuntos
Anticorpos Antibacterianos/sangue , Neisseria meningitidis Sorogrupo B/imunologia , Neisseria meningitidis Sorogrupo C/imunologia , Adulto , Brasil , Feminino , Hospitais Universitários , Humanos , Immunoblotting/métodos , Masculino , Infecções Meningocócicas/imunologia , Pessoa de Meia-Idade , Neisseria meningitidis Sorogrupo B/isolamento & purificação , Neisseria meningitidis Sorogrupo C/isolamento & purificação , Estudos Soroepidemiológicos , Sorogrupo , Ensaios de Anticorpos Bactericidas Séricos , Estatísticas não Paramétricas , Adulto JovemRESUMO
BACKGROUND: Routine infant immunization with meningococcal C conjugate (MCC) vaccination started in Brazil in November 2010, scheduled at three and five months plus a booster at 12-15months of age. No catch-up was implemented. We assessed the impact of vaccination on meningococcal C disease (MenC) four years after vaccination start in the National Immunization Program. METHODS: We performed an ecological quasi-experimental design from 2008 to 2014 using a deterministic linkage between the National Notification and the National Reference Laboratory databases for meningitis. We conducted an interrupted time-series analysis considering Brazil except for Salvador municipality, because an epidemic of serogroup C disease occurred in this city, which prompted a mass vaccination campaign with catch-up for adolescents in 2010. Observed MenC rates in the post-vaccination period were compared to expected rates calculated from the pre-vaccination years. Results for Salvador were presented as descriptive data. An additional time-series analysis was performed for the state of São Paulo. RESULTS: A total of 18,136 MenC cases were analyzed. The highest incidence rates were observed for infants aged <12months and no second incident peak was observed for adolescents. For Brazil, MenC rates were reduced by 67.2% (95%CI 43.0-91.4%) for infants <12months of age, 92.0% (77.3-106.8%) for the age-group 12-23months, and 64.6% (24.6-104.5%) for children aged 2-4years. For children 5-9years old, MenC rates reduced 19.2% (9.5-28.9%). Overall, 955 MenC cases were averted in Brazil in individuals aged <40years after MCC vaccination. Results from São Paulo State, mirror the patterns seen in Brazil. CONCLUSION: After four years of infants and toddlers vaccination start, MenC invasive disease reduced in the target population. This investigation provide a robust baseline to ascertain how much the upcoming catch-up dose in 12-13years of age will accelerate the decrease in MenC incidence rates among youths in Brazil.
Assuntos
Meningite Meningocócica/epidemiologia , Meningite Meningocócica/prevenção & controle , Vacinas Meningocócicas/administração & dosagem , Vacinas Meningocócicas/imunologia , Neisseria meningitidis Sorogrupo C/imunologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Criança , Pré-Escolar , Feminino , Humanos , Incidência , Lactente , Masculino , Pessoa de Meia-Idade , Neisseria meningitidis Sorogrupo C/isolamento & purificação , Ensaios Clínicos Controlados não Aleatórios como Assunto , Adulto JovemRESUMO
Meningococcus serogroup B (MenB), clonal complex 32 (cc 32), was the Brazilian epidemic strain of meningococcal disease (MD) in the 1990’s. Currently, meningococcus serogroup C (MenC), cc 103, is responsible for most of the cases of the disease in Brazil. The aim of this study was to investigate the seroprevalence of bactericidal antibody (SBA) against representative epidemic strains of MenC, (N753/00 strain, C:23:P1.22,14-6, cc103) and MenB, (Cu385/83 strain, B:4,7:P1.15,19, cc32) in students and employees of a university hospital in the State of Rio Grande do Sul (RS, Brazil). A second MenC strain (N79/96, C:2b:P1.5-2,10, cc 8) was used as a prototype strain of Rio de Janeiro’s outbreak that occurred in the 1990’s. Our previous study showed a 9% rate of asymptomatic carriers in these same individuals. A second goal was to compare the SBA prevalence in meningococcal carriers and non-carriers. Fifty-nine percent of the studied population showed protective levels of SBA titers (log2≥2) against at least one of the three strains. About 40% of the individuals had protective levels of SBA against N753/00 and Cu385/83 strains. Nonetheless, only 22% of the individuals showed protective levels against N79/96 strain. Significantly higher antibody levels were seen in carriers compared to non-carriers (P≤0.009). This study showed that, similar to other States in Brazil, a MenC (23:P1.22,14-6, cc103) strain with epidemic potential is circulating in this hospital. Close control by the Epidemiological Surveillance Agency of RS of the number of cases of MD caused by MenC strains in the State is recommended to prevent a new disease outbreak.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Adulto Jovem , Anticorpos Antibacterianos/sangue , Neisseria meningitidis Sorogrupo B/imunologia , Neisseria meningitidis Sorogrupo C/imunologia , Brasil , Hospitais Universitários , Immunoblotting/métodos , Infecções Meningocócicas/imunologia , Neisseria meningitidis Sorogrupo B/isolamento & purificação , Neisseria meningitidis Sorogrupo C/isolamento & purificação , Estudos Soroepidemiológicos , Sorogrupo , Ensaios de Anticorpos Bactericidas Séricos , Estatísticas não ParamétricasRESUMO
OBJECTIVES: Neisseria meningitidis is a leading cause of meningitis and septicaemia. The hyperinvasive ST-11 clonal complex (cc11) caused serogroup C (MenC) outbreaks in the US military in the 1960s and UK universities in the 1990s, a global Hajj-associated serogroup W (MenW) outbreak in 2000-2001, and subsequent MenW epidemics in sub-Saharan Africa. More recently, endemic MenW disease has expanded in South Africa, South America and the UK, and MenC cases have been reported among European and North American men who have sex with men (MSM). Routine typing schemes poorly resolve cc11 so we established the population structure at genomic resolution. METHODS: Representatives of these episodes and other geo-temporally diverse cc11 meningococci (n = 750) were compared across 1546 core genes and visualised on phylogenetic networks. RESULTS: MenW isolates were confined to a distal portion of one of two main lineages with MenB and MenC isolates interspersed elsewhere. An expanding South American/UK MenW strain was distinct from the 'Hajj outbreak' strain and a closely related endemic South African strain. Recent MenC isolates from MSM in France and the UK were closely related but distinct. CONCLUSIONS: High resolution 'genomic' multilocus sequence typing is necessary to resolve and monitor the spread of diverse cc11 lineages globally.
Assuntos
Infecções Meningocócicas/epidemiologia , Infecções Meningocócicas/microbiologia , Tipagem de Sequências Multilocus , Neisseria meningitidis Sorogrupo B/genética , Neisseria meningitidis Sorogrupo C/genética , Neisseria meningitidis/genética , Surtos de Doenças , Doenças Endêmicas , França/epidemiologia , Homossexualidade Masculina , Humanos , Masculino , Neisseria meningitidis/classificação , Neisseria meningitidis/isolamento & purificação , Neisseria meningitidis Sorogrupo B/classificação , Neisseria meningitidis Sorogrupo B/isolamento & purificação , Neisseria meningitidis Sorogrupo C/classificação , Neisseria meningitidis Sorogrupo C/isolamento & purificação , América do Norte/epidemiologia , Filogenia , Sorogrupo , Sorotipagem , África do Sul/epidemiologia , América do Sul/epidemiologia , Reino Unido/epidemiologiaRESUMO
Outbreaks caused by serogroup C meningococci in the northeast region of Brazil from 2005 to 2011 were associated to the emergence of variant ET-15 of cc11, which has been replaced by cc103 from 2006 to date. The increase of cc103 should be closely monitored to prevent the spread of this clone to neighbouring regions.
Assuntos
Meningite Meningocócica/microbiologia , Neisseria meningitidis Sorogrupo C/genética , Neisseria meningitidis Sorogrupo C/patogenicidade , Antibacterianos/uso terapêutico , Brasil/epidemiologia , Células Clonais , Farmacorresistência Bacteriana/genética , Humanos , Incidência , Meningite Meningocócica/tratamento farmacológico , Meningite Meningocócica/epidemiologia , Tipagem de Sequências Multilocus , Neisseria meningitidis Sorogrupo C/classificação , Neisseria meningitidis Sorogrupo C/isolamento & purificação , Sorotipagem , VirulênciaRESUMO
Objetivos: Analisar o comportamento da doença meningocócica (DM) no Distrito Federal (DF), no período de 2000 a 2011, investigar fatores associados à gravidade da doença e avaliar o impacto da introdução, em 2010, da vacina conjugada contra o meningococo C. Métodos: Trata-se de um estudo com um componente descritivo e outro analítico, abrangendo os residentes no DF que apresentaram DM. Foram incluídos os casos confirmados de DM registrados nos sistemas de informação de notificação e/ou de mortalidade e/ou do laboratório. Para a investigação de fatores associados ao óbito por DM, a variável dependente foi evolução e as variáveis independentes foram sexo, idade, forma clínica e sorogrupo da Neisseria meningitidis. Na avaliação do impacto da introdução da vacina conjugada contra o meningococo C, foram comparadas as taxas de incidência do período pré e pósvacina, por grupo etário. Resultados: Foram analisados 490 casos confirmados de DM no período. A cepa que predominou antes de 2005 foi a B:4,7:P1.19,15 com 67,8 por cento (61/90) e, a partir desse ano, predominaram as cepas C:23:P1.14-6 com 40,9 por cento (61/149) e C:2a:P1.5,2 com 12,8 por cento (19/149). As taxas médias anuais de incidência e de mortalidade por DM, no período, foram, respectivamente, 1,7 e 0,4/100.000 habitantes/ano e a letalidade média foi 21 por cento . A taxa de incidência de DM foi maior nas crianças menores de um ano, variando de 13,1 em 2011 a 38,7/100.000 habitantes/ano em 2000. A letalidade foi maior no grupo de 40 anos e mais, 40 por cento , e entre as crianças com dois anos, 32 por cento . A região administrativa (RA) do Paranoá foi a que apresentou as mais elevadas taxas médias anuais de incidência, 3,3/100.000 habitantes, e de mortalidade, 0,6/100.000 habitantes. Os menores de dois anos e os com idade maior ou igual a 30 anos tiveram risco significativamente maior para óbito, assim como as formas clínicas meningococcemia e meningite com meningococcemia. Houve uma redução estatisticamente significativa (p = 0,02) da incidência de DM em menores de dois anos do ano de 2009, 21,3/100.000 habitantes/ano, para o ano de 2011, 6,6/100.000 habitantes/ano. Conclusão: Esse estudo possibilitou verificar os grupos etários mais atingidos por DM, os fenótipos circulantes, as RA com as maiores taxas de incidência e de mortalidade e fazer uma avaliação preliminar do impacto da vacina conjugada contra o sorogrupo C, após o primeiro ano de sua introdução no calendário infantil de imunização.
Assuntos
Humanos , Infecções Meningocócicas/epidemiologia , Infecções Meningocócicas/transmissão , Neisseria meningitidis Sorogrupo C/isolamento & purificação , Vacinas Meningocócicas/provisão & distribuição , Brasil , Infecções Meningocócicas/epidemiologia , Infecções Meningocócicas/mortalidadeRESUMO
SUMMARYAn outbreak of meningococcal disease (MD) with severe morbidity and mortality was investigated in midwestern Brazil in order to identify control measures. A MD case was defined as isolation of Neisseria meningitidis, or detection of polysaccharide antigen in a sterile site, or presence of clinical purpura fulminans, or an epidemiological link with a laboratory-confirmed case-patient, between June and August 2008. In 8 out of 16 MD cases studied, serogroup C ST103 complex was identified. Five (31%) cases had neurological findings and five (31%) died. The attack rate was 12 cases/100 000 town residents and 60 cases/100 000 employees in a large local food-processing plant. We conducted a matched case-control study of eight primary laboratory-confirmed cases (1:4). Factors associated with illness in single variable analysis were work at the processing plant [matched odds ratio (mOR) 22, 95% confidence interval (CI) 2·3-207·7, P<0·01], and residing <1 year in Rio Verde (mOR 7, 95% CI 1·11-43·9, P<0·02). Mass vaccination (>10 000 plant employees) stopped propagation in the plant, but not in the larger community.
Assuntos
Surtos de Doenças , Controle de Infecções/métodos , Infecções Meningocócicas/epidemiologia , Infecções Meningocócicas/microbiologia , Neisseria meningitidis Sorogrupo C/isolamento & purificação , Exposição Ocupacional , Adolescente , Adulto , Brasil/epidemiologia , Estudos de Casos e Controles , Criança , Pré-Escolar , Infecções Comunitárias Adquiridas/epidemiologia , Infecções Comunitárias Adquiridas/microbiologia , Infecções Comunitárias Adquiridas/mortalidade , Infecções Comunitárias Adquiridas/prevenção & controle , Feminino , Manipulação de Alimentos , Humanos , Lactente , Masculino , Vacinação em Massa/métodos , Infecções Meningocócicas/mortalidade , Infecções Meningocócicas/prevenção & controle , Pessoa de Meia-Idade , Vacinas Pneumocócicas/administração & dosagem , Análise de Sobrevida , Adulto JovemRESUMO
OBJECTIVE: To characterize meningococcal strains isolated from five cases of meningococcal disease (MD) associated with an outbreak in Trancoso - BA, occurred in October 2009. All cases, with the exception of a 39-year-old male, attended a dance party with approximately 1000 youngsters in a rural site. MATERIALS AND METHODS: The epidemiological investigation was conducted by the Epidemiological Surveillance Service of Bahia State. Meningococcal strains were characterized at Adolfo Lutz Institute, the Brazilian National Reference Laboratory for Bacterial Meningitis by conventional techniques (serotype, serosubtype and antimicrobial susceptibility test) and by molecular methods (Pulsed-field gel electrophoresis - PFGE and Multilocus Sequence Typing - MLST). RESULTS: The PFGE showed 2 closely related restriction profiles, designated as PFGE types A and A1, having 92% relatedness to each other. MLST characterization showed both A and A1 clones were ST-3780, which belongs to the ST-103 complex. All isolates displayed the phenotype C:23:P1.5 and were susceptible to all antibiotics tested. CONCLUSIONS: This is the first reported MD outbreak associated with serogroup C ST-103 complex in Brazil, as well as the party and illicit drug-use associated outbreak.
Assuntos
Surtos de Doenças , Meningite Meningocócica/microbiologia , Neisseria meningitidis Sorogrupo C/isolamento & purificação , Adolescente , Adulto , Brasil/epidemiologia , Busca de Comunicante , Aglomeração , DNA Bacteriano/genética , Farmacorresistência Bacteriana Múltipla , Eletroforese em Gel de Campo Pulsado , Feminino , Genoma Bacteriano , Humanos , Masculino , Meningite Meningocócica/epidemiologia , Meningite Meningocócica/transmissão , Neisseria meningitidis Sorogrupo C/classificação , Neisseria meningitidis Sorogrupo C/efeitos dos fármacos , Neisseria meningitidis Sorogrupo C/genética , Fenótipo , População Rural , Comportamento Social , Adulto JovemRESUMO
We reviewed confirmed cases of pediatric invasive meningococcal disease in Tijuana, Mexico, and San Diego County, California, USA, during 2005-2008. The overall incidence and fatality rate observed in Tijuana were similar to those found in the US, and serogroup distribution suggests that most cases in Tijuana are vaccine preventable.
Assuntos
Infecções Meningocócicas/epidemiologia , Neisseria meningitidis Sorogrupo C/classificação , Neisseria meningitidis/classificação , Vigilância da População/métodos , Adolescente , Distribuição por Idade , California/epidemiologia , Criança , Pré-Escolar , Humanos , Incidência , Lactente , Recém-Nascido , Infecções Meningocócicas/microbiologia , Infecções Meningocócicas/prevenção & controle , México/epidemiologia , Neisseria meningitidis Sorogrupo C/isolamento & purificação , Fatores de Risco , Estados Unidos/epidemiologiaRESUMO
OBJECTIVES: The aim of this study was to characterize Neisseria meningitidis strains causing invasive disease in Rio Grande do Sul (RS), during 2003-2005, monitoring the occurrence of hypervirulent lineages, as well as to determine the diversity of PorA VR types for the corresponding isolates and clinical specimens. METHODS: Isolates and clinical specimens were characterized by MLST and PorA VR typing. RESULTS: This study demonstrated high prevalence of some hypervirulent lineages and emergence of new ones, including the emergence of lineages W135:P1.5,2:ST-11 complex, and C:P1.22,14-6:ST-103 complex. These lineages are probably responsible for the increasing incidence of serogroups C and W135, despite the overall decrease in serogroup B cases during the period. The most prevalent complex was serogroup B ST-32/ET-5 complex. The most prevalent PorA types found for serogroup B were P1.19,15, P1.7,16, and P1.18-1,3, representing a different distribution of PorA types compared to other states of Brazil. CONCLUSIONS: This study highlights the importance of monitoring each population, even within the same country. The different distribution of PorA VR types in RS has implications in vaccine design and efficacy. Detailed and accurate meningococcal characterization is an important element in studies of meningococcal epidemiology, population biology, and evolution and provides information for the design of control strategies.
Assuntos
Meningite Meningocócica/epidemiologia , Infecções Meningocócicas/epidemiologia , Neisseria meningitidis Sorogrupo W-135 , Neisseria meningitidis , Técnicas de Tipagem Bacteriana , Brasil/epidemiologia , Pré-Escolar , DNA Bacteriano/genética , Humanos , Lactente , Meningite Meningocócica/microbiologia , Infecções Meningocócicas/microbiologia , Epidemiologia Molecular , Neisseria meningitidis/classificação , Neisseria meningitidis/genética , Neisseria meningitidis/isolamento & purificação , Neisseria meningitidis/patogenicidade , Neisseria meningitidis Sorogrupo B/classificação , Neisseria meningitidis Sorogrupo B/genética , Neisseria meningitidis Sorogrupo B/isolamento & purificação , Neisseria meningitidis Sorogrupo C/classificação , Neisseria meningitidis Sorogrupo C/genética , Neisseria meningitidis Sorogrupo C/isolamento & purificação , Neisseria meningitidis Sorogrupo W-135/classificação , Neisseria meningitidis Sorogrupo W-135/genética , Neisseria meningitidis Sorogrupo W-135/isolamento & purificação , Vigilância da População , Porinas/genética , Prevalência , Análise de Sequência de DNA , SorotipagemRESUMO
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 2,610 g, 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.
Assuntos
Meningite Meningocócica/diagnóstico , Neisseria meningitidis Sorogrupo C/isolamento & purificação , Sepse/microbiologia , Feminino , Humanos , Recém-Nascido , Meningite Meningocócica/tratamento farmacológico , Penicilinas/uso terapêutico , Sepse/diagnóstico , Sepse/tratamento farmacológicoRESUMO
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.
Assuntos
Humanos , Feminino , Recém-Nascido , Meningite Meningocócica/diagnóstico , Neisseria meningitidis Sorogrupo C/isolamento & purificação , Penicilinas/uso terapêutico , Sepse/microbiologia , Meningite Meningocócica/tratamento farmacológico , Sepse/diagnóstico , Sepse/tratamento farmacológicoRESUMO
The high genetic diversity found among the PorA regions VR1 and VR2 of 101 Neisseria meningitidis isolates from patients with meningococcal disease and healthy carriers in Brazil contrasts with the stability found in the PorA VR3 of these isolates. The presence of VR3 epitope variant 35 or 36 on the surfaces of 87% of the strains analyzed suggests that these antigens should be considered for inclusion in new formulations of vaccines against serogroup B meningococci in Brazil.
Assuntos
Variação Antigênica , Neisseria meningitidis Sorogrupo B/imunologia , Neisseria meningitidis Sorogrupo C/imunologia , Porinas/genética , Brasil/epidemiologia , Portador Sadio/epidemiologia , Portador Sadio/microbiologia , Líquido Cefalorraquidiano/microbiologia , Humanos , Meningite Meningocócica/epidemiologia , Meningite Meningocócica/microbiologia , Infecções Meningocócicas/epidemiologia , Infecções Meningocócicas/microbiologia , Dados de Sequência Molecular , Nasofaringe/microbiologia , Neisseria meningitidis Sorogrupo B/genética , Neisseria meningitidis Sorogrupo B/isolamento & purificação , Neisseria meningitidis Sorogrupo C/genética , Neisseria meningitidis Sorogrupo C/isolamento & purificação , Porinas/química , Porinas/imunologia , Análise de Sequência de DNARESUMO
Meningococcal disease is characterized by cyclic fluctuations in incidence, serogroup distribution, and antigenic profiles. In greater São Paulo, Brazil, there has been a constant increase in the incidence of serogroup C meningococcal disease since the late 1980s. To gain an understanding of changes in serogroup C meningococcal disease over three decades in greater São Paulo, Brazil, 1,059 invasive Neisseria meningitidis serogroup C isolates from 1976 and 2005 were analyzed. Three major clone complexes, sequence type (ST)-11, ST-8, and ST-103, were identified by multilocus sequence typing, and the isolates were characterized by serotyping and 16S rRNA typing. During the 30-year period, there were two major antigenic replacements: from 2a:P1.(5,2) to 2b:P1.3 and subsequently to 23:P1.14-6. All strains of clone ST-103 were characterized as serotype 23 and serosubtype P1.14-6. The origin of 23:P1.14-6 ST-103 complex strains is unknown, but efforts are needed to monitor its spread and define its virulence. The antigenic replacements we observed likely represent a mechanism to sustain meningococcal disease in the population as immunity to circulating strains accumulated.
Assuntos
Meningite Meningocócica/microbiologia , Neisseria meningitidis Sorogrupo C/classificação , Neisseria meningitidis Sorogrupo C/isolamento & purificação , Antígenos de Bactérias/imunologia , Brasil/epidemiologia , DNA Bacteriano/química , DNA Bacteriano/genética , DNA Ribossômico/química , DNA Ribossômico/genética , Evolução Molecular , Humanos , Meningite Meningocócica/epidemiologia , Epidemiologia Molecular , Dados de Sequência Molecular , Neisseria meningitidis Sorogrupo C/genética , RNA Ribossômico 16S/genética , SorotipagemRESUMO
We here report the case of a previously healthy 20-y-old male with disseminated meningococcal disease and purulent pericarditis. Polymerase chain reaction was used to identify Neisseria meningitidis serogroup C as the causative agent in the pericardial fluid.
Assuntos
Infecções Meningocócicas/complicações , Neisseria meningitidis Sorogrupo C/patogenicidade , Pericardite/etiologia , Adulto , Ceftriaxona/uso terapêutico , Humanos , Masculino , Neisseria meningitidis Sorogrupo C/isolamento & purificação , Pericardiocentese , Pericardite/fisiopatologia , Pericardite/terapia , Reação em Cadeia da PolimeraseRESUMO
Polysaccharide of N. meningitidis serogroup C constitutes the antigen for the vaccine against meningitis. The goal of this work was to compare three cultivation media for production of this polysaccharide: Frantz, modified Frantz medium (with replacement of glucose by glycerol), and Catlin 6 (a synthetic medium with glucose). The comparative criteria were based on the final polysaccharide concentrations and the yield coefficient cell/polysaccharide (Y P/X). The kinetic parameters: pH, substrate consumption and cell growth were also determined. For this purpose, 9 cultivation runs were carried out in a 80 L New Brunswick bioreactor, under the following conditions: 42 L of culture medium, temperature 35°C, air flow 5 L/min, agitation frequency 120 rpm and vessel pressure 6 psi, without dissolved oxygen or pH controls. The cultivation runs were divided in three groups, with 3 repetitions each. The cultivation using the Frantz medium presented the best results: average of final polysaccharide concentration = 0.134 g/L and Y P/X=0.121, followed by Catlin 6 medium, with results of 0.095 g/L and 0.067 respectively. Considering the principal advantages in the use of the synthetic medium, i.e. facilitation of a cultivation and purification steps of the polysaccharide production process, there is a possibility that in the near future, Catlin 6 will replace the traditional Frantz medium.