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MENINGITE e VACCINI - Bibliografia
(English) -  Pag. 2
(nome scientifico = encefalite post-vaccinica)

Continua in: Pag. 1 - Pag. 3 -  Pag. 4 - Pag. 5 + Meningite dai Vaccini

vedi anche:
Vaccino pneumococcico
+  Siamo contro la cosiddetta "immunizzazione" vaccinale +  una delle principali cause della Meningite sono i vaccini

Italy: Ritirato vaccino Meningitec + info su Meningitec
- Encefalite post Vaccinica - creata e prodotta dai VACCINI

Associazione temporale di alcuni disturbi NeuroPsichiatrici DOPO la vaccinazione di bambini e adolescenti:
Uno studio Pilota con  casi-controllo

CDC e Conflitti di interesse - 1 + CDC e Conflitti di interesse - 2 + CDC e Conflitti di interesse - 3 + Corruzione
CDC conflitti di interesse anche per i vaccini

L’INCUBO "MENINGITE", il presunto nuovo TEST che invece “CREA” e diffonde, assieme ai VACCINI Pediatrici, l’EPIDEMIA.

Fino a ieri i DISINFORMATORI degli enti a tutela della salute, si ma di quella dei fatturati di Big Pharma, dicevano che i vaccini "proteggono dalle malattie", guardate invece cosa succede:

Lancet, 1998 Mar 28
, 351(9107), 950 - 3
 Anti-inflammatory cytokine profile and mortality in febrile patients; van Dissel JT et al.;
BACKGROUND: An anti-inflammatory cytokine profile on whole-blood stimulation in vitro is associated with fatal outcome of meningococcal disease . We investigated whether an anti-inflammatory cytokine profile in the circulation is associated with adverse outcome in other infectious diseases . METHODS: We enrolled 464 consecutive patients (272 men, 192 women) who presented to hospital with fever (> or = 38.2 degrees C) . On admission we measured plasma interleukin 10 (IL-10) and tumour necrosis factor alpha (TNF alpha), and collected clinical and microbiological data on the febrile illness, then followed up all patients for clinical outcome . FINDINGS: In at least 399 of the 464 patients fever was caused by infection . 33 patients died after a median hospital stay of 11 days (interquartile range 3-20) . Concentrations of IL-10 were significantly higher in non-survivors (median 169 pg/mL {IQR 83-530}) than in survivors (median 88 pg/mL {42-235}, p=0.042) . When dichotomised around the median, the mortality risk was two times higher in patients who had high concentrations of IL-10 than in those with low concentrations (relative risk 2.39 {95% CI 1.07-5.33}), in patients with low and high concentrations of TNF alpha . In the 406 patients without haemodynamic deterioration in the first 24 h, IL-10 was higher and TNF alpha lower in patients who died than in those who survived . The ratio of IL-10 to TNF alpha was higher in non-survivors (median 6.9 {3.0-21.0}) than in survivors (median 3.9 {2.0-7.0}, p=0.040) . This ratio was highest in patients who died without underlying disease (median 21.5 {5.0-25.0}) . Age, sex, and duration of fever before admission did not explain the differences in IL-10 and TNF alpha . INTERPRETATION: An anti-inflammatory cytokine profile of a high ratio of IL-10 to TNF alpha is associated with fatal outcome in febrile patients with community-acquired infection . Our findings caution against a widespread use of proinflammatory cytokine inhibition in patients with sepsis.
 J Clin Epidemiol, 1998 Sep, 51(9), 717 - 21
 Outcome of pre-hospital antibiotic treatment of meningococcal disease; Sorensen HT et al.; OBJECTIVE: To assess the effect of pre-hospital antibiotic treatment given by general practitioners to patients with meningococcal disease . DESIGN: A 16-year population-based historical follow-up study based on referral letters and hospital records in the County of North Jutland, Denmark . SUBJECTS: 320 patients with meningococcal disease, of whom 302 were examined by a general practitioner before admission to hospital . MAIN OUTCOME MEASURES: Death . RESULTS: 44 patients (14.6%) were given antibiotic treatment by the referring general practitioner . Nine of these (20.5%) died, compared with 16 (6.2%) patients who did not receive pre-hospital antibiotic treatment . The presence of skin bleeding, petechiae, and impaired consciousness were strongly associated with case fatality . Even after adjustment for these variables the odds ratio (OR) for death in patients treated with antibiotics was high (OR = 3.2; 95% CI, 0.9-10.6) . In the 15 patients with skin bleeding (ecchymoses, suggillations) the case fatality rate was 100% in patients treated with antibiotics, and 50% in patients who did not receive antibiotics before hospitalization . If skin bleeding was replaced in the models by the presence of disseminated intravascular coagulation on admission, the OR for death in patients with pre-hospital antibiotic treatment was 35.9 (95% CI, 2.9-441.8) in the presence of disseminated intravascular coagulation and 1.9 (95% CI, 0.2-19.5) in its absence . CONCLUSIONS: Pre-hospital treatment is mainly given to the most severe cases with expected high case fatality, and this confounding by indication was probably not fully adjusted for with the available data . The results contradict previous findings but provide reason to doubt the benefit of pre-hospital antibiotic treatment in patients with meningococcal disease.
 Scand J Infect Dis, 1998, 30(2), 198 - 200
 Pharyngolaryngitis caused by Neisseria meningitidis; Mattila PS et al.; Neisseria meningitidis is a causative agent of life-threatening cases of meningitis and sepsis, but it can also cause mild and self-limiting bacteraemia . Patients with N. meningitidis sepsis or meningitis often describe signs of upper respiratory tract infection before the onset of invasive disease. Viral respiratory infections have been associated with invasive meningococcal diseases and they may contribute to these prodromal symptoms.
N . meningitidis can be cultivated from the throats of asymptomatic carriers and it likely enters the circulation through the upper respiratory tract . However, it is unclear whether N . meningitidis can cause simple pharyngitis . Here we describe a case of acute fulminant pharyngolaryngitis caused by N . meningitidis as verified by positive blood cultures.
 Scand J Infect Dis, 1998, 30(2), 196 - 8
 Acute meningococcal epiglottitis and septicaemia in a 65-y-old man; Sivalingam P et al.; We report a case of acute meningococcal epiglottitis in a 65-y-old man . He was noted to have stridor of acute onset . We highlight the importance of the diagnosis of acute epiglottitis, early establishment of an airway and appropriate antibiotic therapy . This case report mainly concerns the association of unusual pathogen Neisseria meningitidis and adult acute epiglottitis.
 J Infect Dis, 1998 Sep, 178(3), 870 - 4
 Induction of immunologic refractoriness in adults by meningococcal C polysaccharide vaccination; Granoff DM et al.; Thirty-four adults were vaccinated with 1/50 of the usual dose of meningococcal polysaccharide vaccine (1 microg of A, C, Y, and W135 polysaccharides, given intramuscularly) . This dose was selected as a probe to assess B cell memory . The probe elicited meningococcal C bactericidal antibody responses in all 18 adults who had been vaccinated 4 years earlier with an investigational meningococcal A and C oligosaccharide-protein conjugate vaccine and in the majority of the 11 subjects vaccinated for the first time . In contrast, the responses of the 5 adults given a full dose of licensed polysaccharide vaccine 4 years earlier were <1/10 of those of the other 2 groups . Thus, adults previously given a full dose of meningococcal polysaccharide vaccine show evidence of immunologic refractoriness to group C polysaccharide, whereas refractoriness is not observed after conjugate vaccination . These findings have implications for the use of meningococcal polysaccharide vaccine when the risk of disease is low.
 BMJ, 1998 Sep 5, 317(7159), 621 - 5
 Which contacts of patients with meningococcal disease carry the pathogenic strain of Neisseria meningitidis? A population based study; Kristiansen BE et al.; OBJECTIVES: To determine the prevalence of the pathogenic strain of Neisseria meningitidis in contacts of patients with meningococcal disease, and to determine which contact groups are likely to be carriers and warrant chemoprophylaxis . DESIGN: Population based study . SETTING: Norwegian county of Telemark . SUBJECTS: 1535 primary contacts of 48 patients with meningococcal disease, and 78 secondary contacts . INTERVENTIONS: Carriers of the pathogenic strain were treated with rifampicin . All household members and kissing contacts under 15 years of age were treated with oral penicillin . Contacts were taught to recognise the symptoms of meningococcal disease . RESULTS: In 27 of 48 cases investigated, contacts carrying the pathogenic strain of N meningitidis were found . A total of 42 such contacts were identified . Contacts were stratified into three classes according to the assumed closeness of contact with patients . In class 1 (household members and kissing contacts) the prevalence of the pathogenic strain was 12.4% (95% confidence interval 5.5% to 19.3%) . In classes 2 and 3 the prevalence was 1.9% (0.9% to 3.4%) and 1.6% (0.14% to 3.1%) . CONCLUSIONS: There is a high rate of carriage of the pathogenic strain of N meningitidis in patients' household members and kissing contacts, and this supports the practice of giving chemoprophylaxis to these contacts . The prevalence of carriage among other contacts is 2-3 times that found in the general population (0.7%); the benefits of chemoprophylaxis to these contacts may be marginal.
 Commun Dis Public Health, 1998 Mar, 1(1), 54 - 6
 Creating a national service for the diagnosis of meningococcal disease by polymerase chain reaction; Kaczmarski EB et al.; The widening gap observed between numbers of culture confirmed and notified cases of meningococcal infection has driven the development of non-culture based polymerase chain reactions (PCRs) to enhance the detection of meningococcal disease . The development of a national PCR-based service increased the number of laboratory confirmed cases of meningococcal disease by 35% in the first year . Advancing technology in the laboratory is reducing in-lab processing time.
 Nurse Pract, 1998 Aug, 23(8), 30, 33 - 6, 39-40 passim
 Meningococcal disease: recognition, treatment, and prevention; Herf C et al.; Meningococcal disease is an infection caused by Neisseria meningitidis, a gram-negative diplococcus that is the leading cause of bacterial meningitis in children and young adults in the United States, with an estimated 2,600 cases reported each year . N . meningitidis infection rates are highest in children 3 to 12 months of age . Four distinct clinical situations are associated with meningococcal infection . The most common is asymptomatic nasopharyngeal colonization . Benign bacteremia is discovered in the absence of classical clinical findings of meningococcemia, but blood cultures are positive for N . meningitidis . Meningitis, the most common pathologic presentation, is associated with fever, headache, and nuchal rigidity . The mortality rate is about 5% in children and 10% to 15% in adults . Meningococcemia, the most severe form of infection, may involve petechial rash, hypotension, and disseminated intravascular coagulation . It is a fulminant condition that can, if untreated, progress from initial symptoms to coma and death in 12 to 48 hours . Spread of these endemic cases can be controlled by administering prophylactic antibiotics to close contacts of patients.
 Vaccine, 1998 Oct, 16(17), 1633 - 9
 Effect of adjuvants in the isotypes and bactericidal activity of antibodies against the transferrin-binding proteins of Neisseria meningitidis; Gomez JA et al.; Twenty-eight Neisseria meningitidis strains of different serogroups, serotypes, and TbpB isotypes were used to test the effect of five adjuvant formulations on the immune response to the meningococcal transferrin-binding proteins (Tbps) in mice . Levels of anti-Tbps antibodies were relatively low when purified TbpA-TbpB complexes were used for immunization, those obtained with the RAS adjuvant being the highest, and the isotype distribution reveals a prevalence of the non-bactericidal IgG1 . Specific anti-Tbps antibody levels were five to 125 times higher immunizing with whole outer membrane vesicles, with bactericidal isotypes prevailing, which suggests that presentation of these antigens in their natural conformation is crucial to elicit a good response . Nevertheless, bactericidal activity did not correlate with these characteristics, confirming that it must be also influenced by other factors, and direct evaluation of the killing ability is necessary to draw conclusions about the efficacy of antigens or adjuvants in vaccine design.
 J Clin Immunol, 1998 Jul, 18(4), 272 - 82
 Expression of properdin in complete and incomplete deficiency: normal in vitro synthesis by monocytes in two cases with properdin deficiency type II due to distinct mutations; Fredrikson GN et al.; Three properdin deficiency phenotypes have been reported--complete deficiency (type I), incomplete deficiency (type II), and dysfunction of properdin protein (type III)--all associated with increased susceptibility to meningococcal disease . Expression of properdin by monocytes was examined in type I deficiency and in two unrelated cases with type II deficiency, one from a Swedish and one from a Danish family . The properdin gene in the Danish family contained a point mutation in exon 8 causing a Gln316-->Arg substitution, distinct from a point mutation in exon 4 previously found in the Swedish family . Both genes coded for physicochemically abnormal properdin molecules with changed hydrophilicity . Monocytes from all the properdin-deficient individuals produced properdin mRNA in a normal fashion . In type I deficiency no intracellular or secreted properdin was found, indicating rapid intracellular degradation . Monocytes from the males with type II deficiency expressed and secreted properdin normally . Properdin in sera with type II deficiency showed abnormal oligomerization with a relative decrease in properdin trimers and tetramers . Our findings suggest that the low concentration of circulating properdin in type II deficiency is caused by increased extracellular catabolism . Analysis of properdin expression by monocytes in a female carrier in the family with properdin deficiency type I provided direct evidence of lyonization at the cellular level.
 J Burn Care Rehabil, 1998 Jul-Aug, 19(4), 324 - 9
 Integra Artificial Skin as a useful adjunct in the treatment of purpura fulminans; Besner GE et al.; Purpura fulminans is a devastating disorder characterized by rapidly progressing hemorrhagic necrosis of the skin, vascular collapse, and disseminated intravascular coagulation . It is most often seen in children, and it is usually preceded by meningococcemia or another infection . Most often, the disorder results in severe skin loss, but it can also result in the need for extremity amputations . In extreme cases, wound coverage after excision may be problematic because of the limited existence of donor sites and the need for amputation revisions . The case of a 21/2-year-old male requiring amputations of all four extremities due to severe purpura fulminans is presented to illustrate the use of Integra Artificial Skin (Integra Lifesciences Corp., Plainsboro, NJ) to obtain immediate wound closure . Integra Artificial Skin is a bilayered skin substitute that engrafts to a viable wound bed . In the case presented here, where the viability of the underlying tissue of the amputated stumps was questionable, the artificial skin acted as an indicator of that viability . It engrafted well onto the upper extremity stumps, which were of excellent viability, but it needed to be replaced on the lower extremity stumps, which required further debridement and amputation revisions . The use of artificial skin spared the patient the immediate use of his limited and valuable autograft sites . In conclusion, Integra Artificial Skin can be a useful adjunct in the treatment of severe purpura fulminans that includes skin and extremity necrosis.
 Anaesthesia, 1998 Jun, 53(6), 580 - 3
 Pneumopericardium: an unusual cause for cardiac arrest; Djaiani G et al.; A 1-year-old boy breathing via a T-piece system and recovering from meningococcal septicaemia in the intensive care unit suffered a severe bout of coughing and developed bilateral pneumothoraces and tension pneumopericardium resulting in electromechanical dissociation and asystole . Conventional cardiopulmonary resuscitation and adrenaline boluses were unsuccessful . Administration of 20 of colloid and 3 of sodium bicarbonate solutions produced instantaneous return of cardiac, output . The deleterious effects of cardiac tamponade appeared to decrease with increasing cardiac filling pressures . The patient was managed conservatively and he made a full recovery with no signs of residual neurological deficit.
 J Clin Microbiol, 1998 Sep, 36(9), 2623 - 8
 Clonal distribution of invasive Neisseria meningitidis isolates from the Norwegian county of Telemark, 1987 to 1995; Aakre RK et al.; Forty-two Neisseria meningitidis isolates were obtained from patients with meningococcal disease in the Norwegian county of Telemark (January 1987 to March 1995), and all were compared by PCR amplicon restriction endonuclease analysis (PCR-AREA) of the dhps gene, chromosomal DNA fingerprinting, and serological analysis . PCR-AREA divided the isolates into 11 classes, of which 4, comprising 15, 8, 6, and 2 isolates, were clonal while the remaining 8 classes were genetically heterogeneous or contained only 1 isolate . Three of the four clonal classes could be tentatively equated with recognized epidemic clones (ET5, ET37, and cluster A4) on the basis of their phenotypic characteristics, while the remaining clone appears to be new . There were significant differences in the geographical distribution of clones, with class 1 (ET5-like) isolates significantly overrepresented in rural parts of Telemark . Class 1 (ET5-like) isolates occurred throughout the study period and were dominant in 1987 . Class 2 (ET37-like) isolates occurred from 1988 to 1992, and class 3 isolates (with no recognizable ET affinities) were found only in 1991 and 1992.
 J Clin Microbiol, 1998 Sep, 36(9), 2465 - 70
 Necessity of molecular techniques to distinguish between Neisseria meningitidis strains isolated from patients with meningococcal disease and from their healthy contacts; Vogel U et al.; Serogroup C strains of Neisseria meningitidis were isolated from a Germany patient with severe meningococcal disease after a trip to the Czech Republic . These strains (case isolates) were characterized by classical and molecular techniques, as were other strains (carrier isolates) isolated from healthy contacts . Five of 10 carrier isolates had switched off the expression of capsular polysaccharide, as demonstrated by a serogroup-specific PCR . The two case isolates were indistinguishable by multilocus sequence typing and belonged to the ET-37 complex . The carrier isolates belonged to four different sequence types, all unrelated to that of the case strains . Pulsed-field gel electrophoresis showed that the case isolates differed from reference ET-37 complex strains from the Czech Republic and Canada as well as from all the carrier isolates . The isolate from the patient's nasopharynx was indistinguishable from the blood isolate except for a 40,000-bp chromosomal deletion that had occurred during systemic spread.
 Hum Genet, 1998 Jun, 102(6), 605 - 10
 Nonsense mutation in exon 4 of human complement C9 gene is the major cause of Japanese complement C9 deficiency; Kira R et al.; Deficiency of the ninth component of human complement (C9) is the most common complement deficiency in Japan but is rare in other countries . We studied the molecular basis of C9 deficiency in four Japanese C9-deficient patients who had suffered from meningococcal meningitis . Direct sequencing of amplified C9 cDNA and DNA revealed a nonsense substitution (CGA-->TGA) at codon 95 in exon 4 in the four C9-deficient individuals . An allele-specific polymerase chain reaction system designed to detect exclusively only one of the normal and mutant alleles indicated that all the four patients were homozygous for the mutation in exon 4 and that the parents of patient 2 were heterozygous . The common mutation at codon 95 in exon 4 might be responsible for most Japanese C9 deficiency.
 Rev Saude Publica, 1998 Feb, 32(1), 89 - 97
 {Meningococcal disease: epidemiology and control of secondary cases}; Barroso DE et al.; Epidemiological features of meningococcal disease described as from the second half of the 80's inclusive, have motivated a revision of current guidelines for sporadic disease and outbreak control . The increase of disease among teenagers and linked cases involving schools are the two most significant aspects that have prompted the revision of control measures . Vaccination routines and advice for the disease management of clusters are also relevant features recently revised . This present paper describes the management and some epidemiological features of secondary cases.
 J Infect Dis, 1998 Aug, 178(2), 451 - 9
 Dynamics of carriage of Neisseria meningitidis in a group of military recruits: subtype stability and specificity of the immune response following colonization; Jones GR et al.; Meningococcal carriage and the immune response to colonization were studied in a group of military recruits undergoing basic training . Subtyping by determination of the class 1 protein sequence clearly differentiated between strains and demonstrated the dynamics of carriage and transmission . Expression of class 1 protein by each strain remained stable during prolonged carriage by different subjects . Following colonization, a marked increase in serum bactericidal response occurred, which was specific for the subtype of the acquired strain and was associated with an increase in reactivity by Western blot to the homologous class 1 protein . Subjects colonized by multiple strains showed evidence of a specific immune response to the class 1 protein of each strain acquired . The subtype specificity of the bactericidal response to meningococci and the stability of expression of the class 1 protein have important implications for the design of vaccines for prevention of serogroup B meningococcal disease.
 J Emerg Med, 1998 Jul-Aug, 16(4), 643 - 7
 Rupert Waterhouse and Carl Friderichsen: adrenal apoplexy; Varon J et al.; The Waterhouse-Friderichsen (WFS) syndrome, also known as purpura fulminans, is described as acute hemorrhagic necrosis of the adrenal glands and is most often caused by meningococcal infection . This clinical entity is more frequently seen in the pediatric than the adult population and is associated with a high morbidity and mortality . The initial presenting complaints for patients with the WFS usually include a diversity of nonspecific, vague symptoms such as cough, dizziness, headache, sore throat, chills, rigors, weakness, malaise, restlessness, apprehension, myalgias, arthralgias, and fever . These symptoms are usually abrupt in their onset . Petechiae are present in approximately 50-60% of patients . The clinical diagnosis of WFS may be relatively straightforward or extremely challenging . Patients who appear in the initial and nontoxic-appearing stage without any skin lesions may be difficult to distinguish from a benign viral illness . When a patient presents with fever and petechiae, WFS must be considered, even when the patient has a non-toxic appearance . Due to the rapid progression and often devastating consequences, therapy should be instituted as soon as the diagnosis is suspected.
 Biochem J, 1998 Aug 15, 334 ( Pt 1), 269 - 73
 Transferrin-binding protein B isolated from Neisseria meningitidis discriminates between apo and diferric human transferrin; Boulton IC et al.; Neisseria meningitidis utilization of human serum transferrin (hTF)-bound iron is an important pathogenicity determinant . The efficiency of this system would clearly be increased through preferential binding of diferric hTF over the iron-free form . To characterize this process, functionally active meningococcal transferrin-binding protein A (TbpA) and TbpB have been purified from N . meningitidis using a novel purification procedure . The association of isolated Tbps and Tbps in the presence of hTF was investigated by gel filtration . Co-purified TbpA+B formed a complex of molecular mass 300 kDa which bound 1-2 molecules of hTF . Purified TbpA formed a complex of 200 kDa, indicating association as a dimer, whereas TbpB aggregated to form multimers of variable sizes . On recombining TbpA and TbpB, a stable complex of equivalent size to co-purified TbpA+B was formed . This complex may be composed of a single TbpA dimer and 1 molecule of TbpB . The technique of surface plasmon resonance (SPR) was used to demonstrate clearly that TbpB of either high (85 kDa) or low (68 kDa) molecular-mass preferentially bound diferric hTF in comparison with iron-free hTF . This selectivity was not observed with TbpA, but was found at low levels with co-purified TbpA+B . Individual TbpA and TbpB, recombined in a 1:1 molecular ratio, showed iron-mediated discriminatory binding at an intermediate level . SPR was also used to show that TbpA and TbpB bound to distinct regions of hTF, and that prior saturation with TbpB reduced subsequent TbpA binding . The results demonstrated that hTF bound more TbpA than TbpB, with an approximate ratio of 2:1 . We have demonstrated that in vitro, TbpA+B exists as a receptor complex composed of a TbpA dimer and one molecule of TbpB, and that TbpB selectively binds diferric hTF . We propose that, in vivo, TbpA and TbpB also exist as a receptor complex, with TbpB selectively binding diferric hTF, bringing it close to TbpA, the transmembrane component, where the ferric iron can be transported to the periplasm.
 Epidemiol Infect, 1998 Jun, 120(3), 263 - 70
 A cluster of meningococcal disease in western Sydney, Australia initially associated with a nightclub; Jelfs J et al.; Fourteen cases of meningococcal disease (MD) occurred in August September 1996 in western Sydney, Australia . Seven of the 10 young adults affected had a direct or indirect link with a local nightclub . Ten of 11 systemic meningococcal isolates had the phenotype C:2a:P1.5 and showed close genetic relationship by pulsed-field gel electrophoresis (PFGE) . Organisms of this phenotype have not previously caused outbreaks in Australia, but have been associated with outbreaks and hyperendemic serogroup C MD in Europe, Canada, and the United States . This is the largest cluster of serogroup C MD reported in urban Australia, and the first involving a nightclub . The strain differentiation results were available rapidly enough to augment epidemiological investigations on a daily basis . Public health staff could thus establish links between cases quickly, follow the spread of new cases in the community, give accurate information to health officials and the press, and utilize existing knowledge about the characteristics of this phenotype to predict likely developments during the outbreak and afterwards . The strain differentiation data was also very helpful when the role of vaccination was considered, and existing guidelines on the management of outbreaks of MD could be used effectively for the first time in western Sydney.
 Epidemiol Infect, 1998 Jun, 120(3), 257 - 62
 Amplification of the meningococcal porB gene for non-culture serotype characterization; Urwin R et al.; Since 1992, the proportion of culture-confirmed meningococcal infections compared with numbers of notified cases of meningococcal disease has decreased in England and Wales . As most meningococcal strain characterization methods depend on a clinical isolate, this has resulted in a loss of epidemiological information . To address this problem, and to aid nonculture diagnosis, a semi-nested PCR protocol for the amplification of the meningococcal porB gene from clinical specimens was developed . This gene encodes the meningococcal serotyping antigen; strain typing data was provided by hybridization of allele-specific oligonucleotide probes to the digoxigenin-labelled porB amplicon in a 'PCR ELISA' . This assay was specific for meningococcal DNA and sensitivities of 0.81 for cerebrospinal fluid (CSF), 0.57 for serum, and 0.62 for whole blood taken from patients with proven meningococcal infection were obtained.
 Sante, 1998 May-Jun, 8(3), 245 - 8
 {Optimizing the response to epidemics of meningococcal meningitis: report of a workshop of experts at CERMES (Niamey, Niger, 12th to 14th January 1998)}; Chippaux JP et al.; Recent meningitis epidemics in West Africa have drawn attention to shortcomings in the response of the health services . The health ministries of the countries involved have identified particular requirements . Following WHO recommendations, OCCGE organized a meeting of experts at CERMES, Niamey, in January 1998 . The aim of this workshop was to consider the problems common to these countries, identify their needs and to produce concrete recommendations defining the roles of OCCGE and CERMES . Difficulties in mobilization, as no procedure had been established, and a lack of resources limited the efficiency of the response to epidemics . There was also insufficient training of personnel and laboratory facilities were often inadequate . OCCGE could draft a procedure manual specifying tasks and responsibilities for the control of an epidemic . It was suggested that a sub-regional stock of drugs, vaccines and injection equipment should be set up at CERMES . This should improve the speed of the response and complement national and international distribution systems . The group stressed the importance of improving the surveillance of meningitis epidemics . This approach depends on a structured network based around a reference laboratory . CERMES plans to support government initiatives by training and by maintaining the network . Efforts will be made to report and make best use of epidemiological information at all levels of the "health pyramid" . Some OCCGE institutes (e.g . IPR and CERMES) have computer tools such as the Geographical Information System, which can be made available to governments . Analysis of sub-regional epidemics demonstrated the limitations of an alert threshold of 15 cases per 100,000 people . The sensitivity and specificity of this threshold differs between climatic zones OCCGE recommends that each country carry out its own research to determine the most appropriate alert threshold for each zone . Epidemics are currently managed by treatment with short courses of chloramphenicol in oil (injected into muscle) . This approach may change as ceftriaxone becomes more affordable . The systematic use of ceftriaxone in infants under the age of 1 year presenting with meningitis is justified by the frequency of non-meningococcal bacterial causes . A consensus was reached on the most appropriate vaccination strategies: Emergency vaccination implemented rapidly in response to an epidemic . The entire population of a district between the age of 6 months and 30 years are vaccinated . Prophylactic vaccination in high-risk zones . This is carried out in the zone itself or in neighboring regions where there was an epidemic the preceding year . There is evidence that those not infected during an epidemic are at high risk the following year . These vaccinations should be carried out as soon as possible, at least before the start of the next epidemic season . Systematic vaccination is currently limited to special groups (e.g . school children, military personnel and pilgrims) . It is hoped that the conjugated vaccine will become available for integration into the infant vaccination program.
 Rev Cubana Med Trop, 1997, 49(3), 196 - 203
 {Adverse reactions and immune response to Heberbiovac-HB vaccine administered to infants simultaneously with DPT and VA-MENGOC-BC}; Diaz Gonzalez M et al.; The Cuban recombinant yeast-derived hepatitis B vaccine (Heberbiovac-HB) was administered to 2 groups of infants aged 3 months . A dosage of 10 micrograms was used through a scheme of 0, 1 and 6 and 0, 1, 2 and 12, coinciding with the DPT and anti-meningococcal vaccines, according to the immunization schedule . Reactogenicity and immunogenicity were studied in both groups . The reactions observed were mild and similar to other studies, where fever , erythema and induration were the most common signs . These 2 groups had high percentages of children with titres of antibodies anti HBs above 100 UI/L-1 . It is demonstrated the acceptable reactogenicity of the vaccine and the non-immunological interference of other vaccines.
 Intensive Care Med, 1998 Jun, 24(6), 616 - 9
 Combined lung injury, meningitis and cerebral edema: how permissive can hypercapnia be?
 Tasker RC, Peters MJ.
 We describe a patient with combined meningococcal septicemia and meningitis, cerebral edema and acute respiratory distress syndrome, in whom we balanced the conflicting carbon dioxide strategies for optimal pulmonary and neurological management using jugular oxygen saturation (SjvO2) monitoring to identify the upper limit of "tolerable" hypercapnia . Our observations suggest that significant acidosis was not well tolerated; however, cautious induction of pH down to 7.32 and an arterial carbon dioxide tension (PaCO2) < 5.9 kPa was tolerated acutely without significant cerebral hyperemia . Moreover, with the development of metabolic compensation and normal pH, higher levels of PaCO2 could be permitted . In similar cerebro-pulmonary circumstances we suggest that these findings warrant consideration . Alternatively, invasive monitoring of SjvO2 could be undertaken so that patient-specific criteria for permissive hypercapnia can be determined.
 J Accid Emerg Med, 1998 Jul, 15(4), 249 - 51
 Prospective study of "door to needle time" in meningococcal disease; Riordan FA et al.; OBJECTIVE: To measure the promptness of antibiotic treatment in children with meningococcal disease . METHODS: "Door to needle time" for parenteral antibiotics in children with meningococcal disease was recorded prospectively as part of a larger study . The time from arrival at hospital until the first dose of parenteral antibiotics was recorded in 100 children with meningococcal disease (median (range) age 21 (3-168) months) admitted to four Merseyside hospitals . RESULTS: Forty five children presented directly to the accident and emergency (A&E) department . Parenteral penicillin was given before admission to 19 of the 55 children referred by general practitioners (GPs) . Median door to needle time was 36 minutes . All children with a typical petechial rash on arrival received antibiotics within 60 minutes . Antibiotics were given sooner to those with severe disease (p = 0.01) and later to those without a rash (p = 0.007) . CONCLUSIONS: The first dose of parenteral antibiotics for most children with meningococcal disease was given in A&E . When awareness of meningococcal disease is heightened by ongoing research, those with a petechial rash are treated within 60 minutes . Strategies to improve immediate treatment of meningococcal disease should include education of A&E staff as well as GPs.
 Mol Microbiol, 1998 Jun, 28(6), 1153 - 63
 Pilus-mediated adhesion of Neisseria meningitidis: the essential role of cell contact-dependent transcriptional upregulation of the PilC1 protein; Taha MK et al.; Pilus-mediated adherence makes an essential contribution to the pathogenesis of Neisseria meningitidis by allowing the initial localized adherence . Pili are assembled from a protein subunit called pilin . Two proteins, PilC1 and PilC2, are also key elements in the formation of pili as the production of at least one PilC protein is required for pilus assembly . In addition, PilC1 but not PilC2 modulates adhesiveness, most probably by being the adhesin . Recently, both genes have been demonstrated to be controlled by different promoters, pilC2 is expressed from a single transcription starting point (TSP), whereas pilC1 has three TSPs . One of these, PC1.1, corresponds to the unique TSP of pilC2, and two others, PC1.2 and PC1.3, are located in a region upstream of pilC1 but not pilC2 . This suggests that both genes may be under the control of separate regulatory pathways . In this work, by engineering pilC1-lacZ and pilC2-lacZ transcriptional fusions, we provide evidence that expression of pilC1, but not that of pilC2, is transiently induced by bacterial cell contact . This induction required viable cells, did not need the presence of pili and relied on the expression of pilC1 from PC1.3 . Destruction of this TSP by site-directed mutagenesis did not significantly diminish the piliation level or the basal expression of PilC1, but led to the loss of cell contact-dependent upregulation of pilC1 and to a dramatic decrease in bacterial adhesiveness . Taken together, these data demonstrate that cell contact-dependent upregulation of the transcription of pilC1 at PC1.3 is essential for meningococcal pilus-mediated adhesion.
 Ugeskr Laeger, 1998 Jul 13, 160(29), 4325 - 6
 {Parvovirus B19 infection--a meningococcus-like sepsis}; Frederiksen EH et al.; Two otherwise healthy adults with fever and haemorrhagic exanthema are described . In both, primary human parvovirus infection was diagnosed . The clinical picture of fever and haemorrhagic exanthema should always arouse suspicion of serious disease such as meningococcal infection . If the patient is unaffected, however, primary human parvovirus infection should be borne in mind.
 Burns, 1998 May, 24(3), 272 - 4
 Surgical treatment of extensive skin necrosis secondary to purpura fulminans in a patient with meningococcal sepsis; Arevalo JM et al.; Meningococcal sepsis is associated with a high mortality rate . These patients may show severe disseminated intravascular coagulation (DIC) and skin necrosis . There is very little published experience regarding the surgical treatment of this complication . The similarity between skin necrosis secondary to DIC and full thickness cutaneous burns provides the rationale for its treatment as if it was a deep burn . We report the surgical treatment of extensive skin necrosis in a patient with meningococcal sepsis and DIC . This treatment is similar to that used in full thickness burns, including excision of necrotic tissue and coverage with autografts, as well as amputation of extremities if distal coverage is not possible.
 Carbohydr Res, 1998 Feb, 307(3-4), 311 - 24
 The lipooligosaccharide (LOS) of Neisseria meningitidis serogroup B strain NMB contains L2, L3, and novel oligosaccharides, and lacks the lipid-A 4'-phosphate substituent; Rahman MM et al.; The complete structure of the lipooligosaccharide (LOS) from Neisseria meningitidis strain NMB (serotype 2b:P1.2,5), a serogroup B cerebrospinal fluid isolate, was determined.Two oligosaccharide (OS) fractions and lipid-A were obtained following mild acid hydrolysis of the LOS . The structures in these fractions were determined using glycosyl composition and linkage analyses, N spectroscopy and mass spectrometry . One oligosaccharide fraction (OS1) consists of a molecule having a glycosyl sequence identical to that previously reported for the LOS from immunotype L2 N . meningitidis {A . Gamain, M . Beurret, F . Michon, J.-R . Brisson, and H.J . Jennings, J . Biol . Chem.,267,(112) 922-925} i.e., a lacto-N-neotetraose is attached to heptose I (Hep I), with terminally linked N-acetylglucosaminosyl and glucosyl residues attached to Hep II of the inner core . Approximately 70% of this structure is acetylated at O-6 of the terminally linked alpha-N-acetyl-glucosaminosyl residue . As with the L2 structure, the NMB LOS contained phosphoethanolamine (PEA) at O-6 or O-7 of the Hep II residue . The second oligosaccharide fraction (OS2) contains a a mixture of three different molecules, all of which vary from one another in their glycosyl substitution patterns of the Hep II residue . The most abundant molecule in OS2 has a structure identical to that of OSI, i.e., it has the L2 glycosyl sequence . A second molecule (OS2a) lacks the terminal glucosyl residue at O-3 of Hep II; i.e., it has a glycosyl sequence identical to that of the mild acid released oligosaccharide of N . meningitidis immunotype L3, L4, or L7 LOSs . The third molecule (OS2b) is a novel structure that lacks the terminal N-acetylglucosaminosyl residue linked to O-2 of Hep II . Overall, 76% of OS released from NMB LOS has the L2 structure, 15% is OS2a (L3), and 9% is OS2b . A portion (20%) of the molecules in the NMB LOS preparation also contained terminally linked sialic acid attached to O-3 of the lacto-N-neotetraose galactosyl residue, which is also consistent with the L3, or L4 LOS structures . In contrast to the previously reported structure of N . meningitidis lipid-A {V . A . Kulshin, U . Zahringer, B . Linder, C.E . Frasch, C-M . Tsai, B.A . Dmitriev, and E.T Rietschel, J . Bacteriol., 174, (1992)1793-1800}, only 30% of the lipid-A from NMB LOS possesses 4'-phosphate . Comparison with the lipid-A of LOS purified from an isogenic acapsulate mutant, M7, revealed that the 4'-position was almost completely occupied with phosphate . These data emphasize the structural heterogeneity of the OS and phosphate substituents of Hep II, and 4'-phosphorylation of lipid-A of meningococcal LOS.
 APMIS, 1998 May, 106(5), 505 - 25
 Population genetics and molecular epidemiology of Neisseria meningitidis; Caugant DA; Under non-epidemic conditions, Neisseria meningitidis causes disease primarily in children under the age of 5 and the cases are sporadic without any evident relationship between them . Occasionally, localized outbreaks of meningococcal disease occur, and sometimes epidemic waves of disease may spread to several countries or even continents and constitute a pandemic . In the past 10 years or so, population genetic analyses have provided insights into the biology of the bacterium and the epidemiology of meningococcal disease, improving our understanding of the cause of epidemics . Through the application of molecular methods, and especially multilocus enzyme electrophoresis, to N . meningitidis strains of worldwide origin, it has been possible to identify virulent clones and provide a surveillance system to warn of meningococcal epidemics . The characteristics of the predominant clones which are nowadays causing meningococcal disease in the world are summarized here and the importance of population genetics in interpreting the epidemiological data is illustrated.
 Lik Sprava, 1998 Mar-Apr, (2), 118 - 21
 {The clinical use of Amoxiclav in patients with suppurative meningoencephalitis}; Kononenko VV et al.; Clinical use of Amoxiclav showed high therapeutic efficacy in patients with purulent meningoencephalitis both alone and in combination with cefalosporinum of the first generation . Against the background of treatment of patients with overt manifestations of meningoencephalitis and neurotoxicosis meningeal and encephalitic manifestations got attenuated during the first week, with liquorodynamics being stabilized, cerebrospinal fluid ameliorating by day 8-10 of the disease course . Bacteriologic assays showed that up to 83.4% of bacterial flora most common in Ukraine are sensitive to Amoxiclav, with such pathogenic organisms as Pneumococcus, Meningococcus, hemophilia bacillus that are actually main pathogens implicated in acute meningoencephalitis in Ukraine being sensitive to the above drug preparation in 100% of cases.
 Scand J Infect Dis, 1998, 30(1), 69 - 75
 Epidemiological markers in Neisseria meningitidis: an estimate of the performance of genotyping vs phenotyping; Weis N et al.; In order to estimate the performance of genotypic vs phenotypic characterization of Neisseria meningitidis, 2 methods, DNA fingerprinting and multilocus enzyme electrophoresis (MEE), were assessed as regards applicability, reproducibility and discriminating capacity . 50 serogroup B and 52 serogroup C Neisseria meningitidis strains from 96 patients with meningococcal disease and 22 serogroup C strains from healthy carriers were investigated . Both methods were 100% applicable to meningococcal strains and results of DNA fingerprinting as well as of MEE were reproducible . The number of types defined by DNA fingerprinting and MEE as compared to that defined by phenotypic characteristics (serogroup, serotype, serosubtype and sulphonamide resistance) was as follows: for serogroup B strains from patients, 11 and 12 vs 8; for serogroup C strains from patients, 10 and 15 vs 8; and for serogroup C carrier strains, 12 and 19 genotypes vs 10 phenotypes were defined . By use of both DNA fingerprinting and MEE the number of genotypes defined for the 3 groups of strains was 14, 17 and 19, respectively . DNA fingerprinting and MEE showed a discriminating capacity superior to that of phenotyping, and as applied in the study MEE was superior to DNA fingerprinting . Clusters of invasive strains were reliably identified by phenotyping alone, whereas determination of identity of carrier strains and an invasive strain required genotyping.
 ASDC J Dent Child, 1998 May-Jun, 65(3), 191 - 3
 Meningococcal septicemia and disseminated intravascular coagulation affecting the premaxillary permanent tooth germs; Walton AG et al.; The following case describes the dental effects resulting from a case of meningococcal septicemia which caused a disseminated intravascular coagulation and premaxillary osteomyelitis at age two years . The effects went unnoticed for eight years when delayed development of the maxillary incisors was noted . Treatment involved surgical removal of the dental remnants and provision of a removable partial denture . Implants and ridge augmentation will be considered in early adulthood.
 Br J Gen Pract, 1998 Apr, 48(429), 1167 - 71
 Recognizing meningococcal disease: the case for further research in primary care; Granier S et al.; Most studies describing the clinical presentation of meningococcal disease use data derived from hospital-based studies . This paper reviews current knowledge on the presentation of meningococcal disease from a primary care perspective . In a small proportion of cases with classical features, making the diagnosis may be relatively simple . In many cases, however, the general practitioner (GP) is faced with the difficulty of discriminating between the rare patient with life-threatening illness and the vast majority who present with similar symptoms secondary to self-limiting viral illness . In the absence of reliable means of excluding the disease, GPs will need to consider the possibility of meningococcal disease in all ill and febrile patients in whom no cause is apparent . Planned follow-up and clearer explanation to patients may increase the chance of identifying earlier those cases that evolve with time . More research is required to identify key clinical and contextual features that help GPs to predict or exclude serious disease, and to describe how this information is used in decision-making . A framework for conceptualizing the problems of researching illness is provided, which takes into account the many factors that influence clinical practice in primary care.
 J Clin Microbiol, 1998 Aug, 36(8), 2342 - 5
 Characterization of Neisseria meningitidis strains causing disease in complement-deficient and complement-sufficient patients; Fijen CA et al.; Serotyping and serosubtyping of meningococci showed no difference between isolates from 44 complement-deficient persons and from 50 complement-sufficient persons with meningococcal disease . Multilocus enzyme electrophoretic typing of the meningococci revealed 54 electrophoretic types that were equally distributed among isolates from complement-deficient and complement-sufficient patients . Analysis of strains isolated from eight complement-deficient persons with 11 recurrences of meningococcal disease showed that one strain was identical to the strain previously isolated from the same individual . Our results indicate that there are no differences between the clonal distributions of strains infecting complement-deficient and complement-sufficient patients . Most recurrences were infections caused by different strains.
 J Clin Microbiol, 1998 Aug, 36(8), 2205 - 9
 Diagnosis of meningococcal meningitis by broad-range bacterial PCR with cerebrospinal fluid; Kotilainen P et al.; We used broad-range bacterial PCR combined with DNA sequencing to examine prospectively cerebrospinal fluid (CSF) samples from patients with suspected meningitis . Fifty-six CSF samples from 46 patients were studied during the year 1995 . Genes coding for bacterial 16S and/or 23S rRNA genes could be amplified from the CSF samples from five patients with a clinical picture consistent with acute bacterial meningitis . For these patients, the sequenced PCR product shared 98.3 to 100% homology with the Neisseria meningitidis sequence . For one patient, the diagnosis was initially made by PCR alone . Of the remaining 51 CSF samples, for 50 (98.0%) samples the negative PCR findings were in accordance with the negative findings by bacterial culture and Gram staining, as well as with the eventual clinical diagnosis for the patient . However, the PCR test failed to detect the bacterial rRNA gene in one CSF sample, the culture of which yielded Listeria monocytogenes . These results invite new research efforts to be focused on the application of PCR with broad-range bacterial primers to improve the etiologic diagnosis of bacterial meningitis . In a clinical setting, Gram staining and bacterial culture still remain the cornerstones of diagnosis.

Continua in: Pag. 1 - Pag. 3 -  Pag. 4 - Pag. 5 + Meningite dai Vaccini
vedi: Bibliografia sui danni neurologici (meningite ed altro) da Vaccino