scholarly journals An unusual transmission event of Neisseria meningitidis serogroup W135 type 2a in a healthcare setting, England, 2012

2012 ◽  
Vol 17 (44) ◽  
Author(s):  
R Puleston ◽  
C Beck ◽  
M Tahir ◽  
M Bardhan ◽  
P Charlemagne ◽  
...  
Keyword(s):  
Neisseria Meningitidis ◽  
Meningococcal Disease ◽  
Older Persons ◽  
Close Contact ◽  
Healthcare Setting ◽  
Meningococcal Infection ◽  
Elderly Persons ◽  
Transmission Event ◽  
Asymptomatic Individuals ◽  
Current Guidelines

We report an outbreak of Neisseria meningitidis serogroup W135, associated with a transient transmission event between asymptomatic individuals in a healthcare setting. Two elderly persons subsequently developed invasive meningococcal disease. The duration and type of close contact for those directly involved in the probable transmission incident would not have warranted chemoprophylaxis according to current guidelines. Meningococcal infection in older persons usually presents with pneumonia rather than meningitis or septicaemia with purpura.

Apparent Meningococcemia: Clinical Features of Disease Due to Haemophilus influenzae and Neisseria meningitidis

PEDIATRICS ◽  
1983 ◽  
Vol 72 (4) ◽  
pp. 469-472
Author(s):  
Richard F. Jacobs ◽  
Steven Hsi ◽  
Christopher B. Wilson ◽  
Denis Benjamin ◽  
Arnold L. Smith ◽  
...  
Keyword(s):  
Haemophilus Influenzae ◽  
Neisseria Meningitidis ◽  
Meningococcal Disease ◽  
Clinical Signs ◽  
Meningococcal Infection ◽  
Disseminated Intravascular Coagulopathy ◽  
Etiologic Agents ◽  
Intravascular Coagulopathy ◽  
Time Of Admission ◽  
Mean Time

To determine the etiology of apparent meningococcemia, all cases of sepsis with coagulopathy, purpura, and/or adrenal hemorrhage (Waterhouse-Friderichsen syndrome) with and without shock occurring over a 12-year period were reviewed. A total of 42 cases were identified; 30 cases were caused by Neisseria meningitidis and 12 cases were caused by Haemophilus influenzae. Compared with patients with disease caused by H influenzae, patients with meningococcal disease were older, more often male, more often contracted the disease in winter-spring, and had a longer duration of antecedent symptoms; however, none of these differences was statistically significant. All patients were febrile (>38°C) and appeared toxic. Similar proportions in each group had shock and disseminated intravascular coagulopathy at the time of admission. Ten of 12 patients with H influenzae infection compared with 15/30 (P < .05) with meningococcal infection were lethargic or comatose at the time of admission. Nine of 12 patients with H influenzae infection died compared with 5/30 with meningococcal disease (P < .005); the mean time from onset of symptoms to death with H influenzae infection (20.7 ± 11.4 [SE] hours) was significantly shorter (P < .05) than with meningococcal infection (120 ± 74.4 hours). Children with clinical signs of sepsis and with purpura, petechiae, or coagulopathy may have N meningitidis or H influenzae as etiologic agents. Initial antibiotic therapy should be directed against these pathogens.

scholarly journals Prospects for Vaccine Prevention of Meningococcal Infection

2006 ◽  
Vol 19 (1) ◽  
pp. 142-164 ◽  
Author(s):  
Lee H. Harrison
Keyword(s):  
United States ◽  
High Risk ◽  
Bacterial Meningitis ◽  
Neisseria Meningitidis ◽  
Meningococcal Disease ◽  
Risk Groups ◽  
The United States ◽  
Meningococcal Infection ◽  
Meningococcal Vaccine ◽  
The Military

SUMMARY Neisseria meningitidis is the leading cause of bacterial meningitis in the United States and worldwide. A serogroup A/C/W-135/Y polysaccharide meningococcal vaccine has been licensed in the United States since 1981 but has not been used universally outside of the military. On 14 January 2005, a polysaccharide conjugate vaccine that covers meningococcal serogroups A, C, W-135, and Y was licensed in the United States for 11- to 55-year-olds and is now recommended for the routine immunization of adolescents and other high-risk groups. This review covers the changing epidemiology of meningococcal disease in the United States, issues related to vaccine prevention, and recommendations on the use of the new vaccine.

scholarly journals Carriage ofNeisseriaSpecies in Communities with Different Rates of Meningococcal Disease

1992 ◽  
Vol 3 (2) ◽  
pp. 60-64 ◽  
Author(s):  
Nicole Le Saux ◽  
Fraser Ashton ◽  
Maksudar Rahman ◽  
Alan Ryan ◽  
Edward Ellis ◽  
...  
Keyword(s):  
Neisseria Meningitidis ◽  
Meningococcal Disease ◽  
Electrophoretic Analysis ◽  
Metabolic Enzymes ◽  
Single Clone ◽  
Asymptomatic Individuals

A single clone,Neisseria meningitidisserogroup C (C:2a:P1.2), was isolated from seven patients during a cluster of cases of meningococcal disease in Ontario in 1989. To determine whether the clone was present in asymptomatic individuals in the same population, pharyngeal swabs were taken from 7% (644 of 9125) of residents who were vaccinated during the outbreak. Rates of isolation ofNeisseriaspecies were also compared to those in two other geographical areas which did not have an elevated incidence of meningococcal disease. The rate of carriage ofN meningitidisin the asymptomatic individuals sampled was between 1.9% and 5.4%. The clone isolated from patients was not present among the carrier strains as determined by sero- and subtyping and electrophoretic analysis of metabolic enzymes. Age greater than six years was the only factor associated with colonization withN meningitidis.

scholarly journals Risk of transmitting meningococcal infection by transient contact on aircraft and other transport

2009 ◽  
Vol 137 (8) ◽  
pp. 1057-1061 ◽  
Author(s):  
T. RACHAEL ◽  
K. SCHUBERT ◽  
W. HELLENBRAND ◽  
G. KRAUSE ◽  
J. M. STUART
Keyword(s):  
Meningococcal Disease ◽  
Close Contact ◽  
Air Travel ◽  
Contact Tracing ◽  
Meningococcal Infection ◽  
Passenger Transport ◽  
School Bus ◽  
Transient Contact

SUMMARYContact tracing of persons with meningococcal disease who have travelled on aeroplanes or other multi-passenger transport is not consistent between countries. We searched the literature for clusters of meningococcal disease linked by transient contact on the same plane, train, bus or boat. We found reports of two clusters in children on the same school bus and one in passengers on the same plane. Cases within each of these three clusters were due to strains that were genetically indistinguishable. In the aeroplane cluster the only link between the two cases was through a single travel episode. The onset of illness (2 and 5 days after the flight) is consistent with infection from an unidentified carrier around the time of air travel. In contrast to the established risk of transmission from a case of tuberculosis, it is likely that the risk from a case of meningococcal disease to someone who is not identified as a close contact is exceedingly low. This should be considered in making international recommendations for passenger contact tracing after a case of meningococcal disease on a plane or other multi-passenger transport.

scholarly journals Factor H binding protein (fHbp)-mediated differential complement resistance of a serogroup C Neisseria meningitidis isolate from cerebrospinal fluid of a patient with invasive meningococcal disease

2021 ◽  
Vol 3 (9) ◽  
Author(s):  
Alessandra Facchetti ◽  
Jun X. Wheeler ◽  
Caroline Vipond ◽  
Gail Whiting ◽  
Hayley Lavender ◽  
...  
Keyword(s):  
Neisseria Meningitidis ◽  
Meningococcal Disease ◽  
Close Contact ◽  
Binding Protein ◽  
Integral Membrane Protein ◽  
Factor H ◽  
Invasive Meningococcal Disease ◽  
Content Type ◽  
Type Iv ◽  
Complement Resistance

During an outbreak of invasive meningococcal disease (IMD) at the University of Southampton, UK, in 1997, two Neisseria meningitidis serogroup C isolates were retrieved from a student (‘Case’), who died of IMD, and a close contact (‘Carrier’) who, after mouth-to-mouth resuscitation on the deceased, did not contract the disease. Genomic comparison of the isolates demonstrated extensive nucleotide sequence identity, with differences identified in eight genes. Here, comparative proteomics was used to measure differential protein expression between the isolates and investigate whether the differences contributed to the clinical outcomes. A total of six proteins were differentially expressed: four proteins (methylcitrate synthase, PrpC; hypothetical integral membrane protein, Imp; fructose-1,6-bisphosphate aldolase, Fba; aldehyde dehydrogenase A, AldA) were upregulated in the Case isolate, while one protein (Type IV pilus-associated protein, PilC2) was downregulated. Peptides for factor H binding protein (fHbp), a major virulence factor and antigenic protein, were only detected in the Case, with a single base deletion (ΔT366) in the Carrier fHbp causing lack of its expression. Expression of fHbp resulted in an increased resistance of the Case isolate to complement-mediated killing in serum. Complementation of fHbp expression in the Carrier increased its serum resistance by approximately 8-fold. Moreover, a higher serum bactericidal antibody titre was seen for the Case isolate when using sera from mice immunized with Bexsero (GlaxoSmithKline), a vaccine containing fHbp as an antigenic component. This study highlights the role of fHbp in the differential complement resistance of the Case and the Carrier isolates. Expression of fHbp in the Case resulted in its increased survival in serum, possibly leading to active proliferation of the bacteria in blood and death of the student through IMD. Moreover, enhanced killing of the Case isolate by sera raised against an fHbp-containing vaccine, Bexsero, underlines the role and importance of fHbp in infection and immunity.

scholarly journals COVID-19 Outbreak in a Hemodialysis Center Using Universal Masking and Eye Protection

2021 ◽  
Vol 1 (S1) ◽  
pp. s50-s50
Author(s):  
Costi Sifri ◽  
Joan Buckner ◽  
Cady Shelton
Keyword(s):  
Patient Adherence ◽  
Close Contact ◽  
Healthcare Providers ◽  
Healthcare Setting ◽  
Face Mask ◽  
Rt Pcr ◽  
Eye Protection ◽  
Increased Risk ◽  
Source Case ◽  
Asymptomatic Individuals

Background: Up to half of all new SARS-CoV-2 infections are acquired from presymptomatic or asymptomatic individuals. Hemodialysis patients and healthcare providers (HCPs) may be at increased risk for COVID-19 due to the need for extended close contact. Universal masking and eye protection are strategies used to reduce SARS-CoV-2 exposure, particularly from presymptomatic or asymptomatic individuals. We describe an outbreak of COVID-19 in an outpatient hemodialysis center despite universal masking and universal HCP eye protection. Methods: An COVID-19 outbreak investigation was performed in a hemodialysis center where universal masking was in use by all HCPs and patients and universal eye protection (goggles, safety glasses) was in use by all HCPs when directly encountering patients. After a cluster of cases was identified in early November 2020, all patients and HCPs were tested for SARS-CoV-2 by real-time reverse transcription polymerase chain reaction (RT-PCR) when symptomatic and weekly until the conclusion of the outbreak. Results: From November 12, 2020, through December 7, 2020, 14 (23.3%) of 60 patients and 9 (28.1%) of 32 HCPs tested positive for SARS-CoV-2 by RT-PCR (Figure 1). The median ages of the patients and HCPs were 64 years (range, 42–87) and 42 years (range, 29–68), respectively. Also, 5 (5.4%) individuals (3 patients and 2 HCPs) were asymptomatic at the time of testing. Furthermore, 7 (7.6%) individuals (5 patients and 2 HPCs) were hospitalized; 2 patients and no HCPs died. No lapses in universal masking or, for HCPs, eye protection prior to or during the outbreak were identified during the investigation. All HCPs and patients wore medical-grade face masks that were discarded at the end of the day; HCPs wore safety glasses or goggles during patient interactions. Although audits of face mask and eye protection compliance were not performed, independent interviews supported high HCP and patient adherence prior to the outbreak. Neither the staff nor patients shared meals at or outside the hemodialysis center. Most patients and HCPs shared the same hemodialysis shift, suggesting the presence of an index case; however, a source case could not be identified despite an extensive investigation. Conclusions: Universal masking and eye protection have been shown to reduce transmission of SARS-CoV-2 from presymptomatic or asymptomatic individuals in the healthcare setting. This report suggests that such measures cannot prevent all outbreaks. We speculate that certain factors associated with hemodialysis care, such as prolonged close patient–HCP contact, may have facilitated this outbreak. Whether nonadherence to universal masking and eye protection or failure of empiric droplet precautions contributed to this outbreak remains unknown.Funding: NoDisclosures: None

The Case of Thematic Tests Adapted to Older Adults

2011 ◽  
Vol 32 (1) ◽  
pp. 46-71 ◽  
Author(s):  
Benoît Verdon
Keyword(s):  
Older Adults ◽  
Older Persons ◽  
Older Men ◽  
Elderly Persons ◽  
Mental Processes ◽  
Men And Women ◽  
Projective Tests ◽  
New Material ◽  
Older Men And Women ◽  
Latent Content

Since the 1950s, the growing interest of clinicians in using projective tests to study normal or pathological aging processes has led to the creation of several thematic tests for older adults. This development reflects their authors’ belief that the TAT is not suitable to the concerns and anxieties of elderly persons. The new material thus refers explicitly to situations related to age; it aims to enable older persons to express needs they cannot verbalize during consultations. The psychodynamic approach to thematic testing is based on the differentiation between the pictures’ manifest and latent content, eliciting responses linked to mental processes and issues the respondent is unaware of. The cards do not necessarily have to show aging characters to elicit identification: The situations shown in the pictures are linked to loss, rivalry, helplessness, and renunciation, all issues elderly respondents can identify with and that lead them to express their mental fragilities and resources. The article first explains the principles underlying four of these thematic tests, then develops several examples of stories told for card 3BM of the TAT, thus showing the effectiveness of this tool for the understanding and differentiation of loss-related issues facing older men and women.

Epidemiological Characteristics of Meningococcal Infection in Moscow

2020 ◽  
Vol 19 (2) ◽  
pp. 56-62
Author(s):  
M. I. Gritsay ◽  
M. A. Koroleva ◽  
N. N. Fomkina ◽  
I. S. Koroleva
Keyword(s):  
Young Adults ◽  
Mortality Rate ◽  
Incidence Rate ◽  
Meningococcal Disease ◽  
Invasive Meningococcal Disease ◽  
Meningococcal Infection ◽  
Epidemic Process ◽  
Epidemiological Features ◽  
Teenagers And Young Adults ◽  
Epidemiological Characteristics

Aims. The purpose of this study was to identify current epidemiological features of meningococcal infection in Moscow.Materials and methods. Cases of invasive meningococcal disease in Moscow from 2014 to 2018 and the biomaterial from patients with an invasive meningococcal disease were analyzed.Results. The features of the epidemic process of meningococcal disease in Moscow were revealed: increasing in the incidence rate involving teenagers and young adults into the epidemic process; meningococcal strains of serogroups W and A increased in the etiology of the invasive meningococcal disease; high mortality rate.Conclusions. It seems reasonable to recommend vaccination against meningococcal disease by including adolescents, young adults and persons over 65 years old.

Prevalence and Correlates of Depression in Elderly Persons

1980 ◽  
Vol 47 (3_suppl) ◽  
pp. 1055-1061 ◽  
Author(s):  
Edward F. Raymond ◽  
Timothy J. Michals ◽  
Robert A. Steer
Keyword(s):  
Health Care ◽  
Regression Analysis ◽  
Health Care Providers ◽  
Older Persons ◽  
Stepwise Regression ◽  
The Elderly ◽  
Elderly Persons ◽  
Care Providers ◽  
Self Assessment ◽  
Psychiatric Intervention

A sample of 504 elderly persons living within a metropolitan area were questioned about their socio-medical characteristics and administered the Wakefield Self-assessment Depression Inventory. The distribution of depression scores indicated that 34.5% were depressed. Stepwise regression analysis was next used to examine the relationships between the characteristics and depression scores. Total number of self-reported symptoms and being partially housebound were positively associated with depression. Recommendations were made that health care providers for the elderly be alerted that older persons with physical complaints and those who are partially restricted to their homes may tend to develop levels of depression which might require psychiatric intervention.

scholarly journals MisR/MisS Two-Component Regulon in Neisseria meningitidis

2007 ◽  
Vol 76 (2) ◽  
pp. 704-716 ◽  
Author(s):  
Yih-Ling Tzeng ◽  
Charlene M. Kahler ◽  
Xinjian Zhang ◽  
David S. Stephens
Keyword(s):  
Neisseria Meningitidis ◽  
Target Genes ◽  
Inner Core ◽  
Consensus Sequence ◽  
Meningococcal Infection ◽  
Type I ◽  
Mobility Shift ◽  
Iron Assimilation ◽  
Wide Range ◽  
Two Component

ABSTRACT Two-component regulatory systems are involved in processes important for bacterial pathogenesis. Inactivation of the misR/misS system in Neisseria meningitidis results in the loss of phosphorylation of the lipooligosaccharide inner core and causes attenuation in a mouse model of meningococcal infection. One hundred seventeen (78 up-regulated and 39 down-regulated) potential regulatory targets of the MisR/MisS (MisR/S) system were identified by transcriptional profiling of the NMBmisR mutant and the parental wild-type meningococcal strain NMB. The regulatory effect was further confirmed in a subset of target genes by quantitative real-time PCR and β-galactosidase transcriptional fusion reporter assays. The MisR regulon includes genes encoding proteins necessary for protein folding in the bacterial cytoplasm and periplasm, transcriptional regulation, metabolism, iron assimilation, and type I protein transport. Mutation in the MisR/S system caused increased sensitivity to oxidative stress and also resulted in decreased susceptibility to complement-mediated killing by normal human serum. To identify the direct targets of MisR regulation, electrophoretic mobility shift assays were carried out using purified MisR-His6 protein. Among 22 genes examined, misR directly interacted with 14 promoter regions. Six promoters were further investigated by DNase I protection assays, and a MisR-binding consensus sequence was proposed. Thus, the direct regulatory targets of MisR and the minimal regulon of the meningococcal MisR/S two-component signal transduction system were characterized. These data indicate that the MisR/S system influences a wide range of biological functions in N. meningitidis either directly or via intermediate regulators.

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