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Collis B, Guo C, Lee CC, Khan SF. Critical Microbiological Clues in a Critically Ill Patient With Pneumonia. Clin Infect Dis 2024; 78:1053-1055. [PMID: 38598565 DOI: 10.1093/cid/ciad729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2024] Open
Affiliation(s)
- Brennan Collis
- Department of Infectious Diseases, Alfred Health, Melbourne, Victoria, Australia
- Microbiology Unit, Department of Pathology, Alfred Health, Melbourne, Victoria, Australia
| | - Christina Guo
- Department of Infectious Diseases, Alfred Health, Melbourne, Victoria, Australia
| | - Chris C Lee
- Microbiology Unit, Department of Pathology, Alfred Health, Melbourne, Victoria, Australia
| | - Sadid F Khan
- Department of Infectious Diseases, Alfred Health, Melbourne, Victoria, Australia
- Microbiology Unit, Department of Pathology, Alfred Health, Melbourne, Victoria, Australia
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Deghmane AE, Taha S, Taha MK. Not Only Meningitis but Also Epiglottitis: An Emerging Clinical Presentation of Invasive Meningococcal Disease. Open Forum Infect Dis 2024; 11:ofad615. [PMID: 38192380 PMCID: PMC10773551 DOI: 10.1093/ofid/ofad615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 12/06/2023] [Indexed: 01/10/2024] Open
Abstract
The rebound of invasive meningococcal disease cases in France since the fall of 2022 was accompanied by an increase in adult epiglottitis. These cases were provoked mainly by isolates of serogroup W belonging to the clonal complex 11 of Neisseria meningitidis. Awareness and surveillance should be reinforced.
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Affiliation(s)
- Ala-Eddine Deghmane
- Institut Pasteur, Université Paris Cité, Invasive Bacterial Infections Unit and National Reference Centre for Meningococci and Haemophilus influnezae, Paris cedex 15, France
| | - Samy Taha
- Institut Pasteur, Université Paris Cité, Invasive Bacterial Infections Unit and National Reference Centre for Meningococci and Haemophilus influnezae, Paris cedex 15, France
| | - Muhamed-Kheir Taha
- Institut Pasteur, Université Paris Cité, Invasive Bacterial Infections Unit and National Reference Centre for Meningococci and Haemophilus influnezae, Paris cedex 15, France
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Arjarquah AK, Obodai E, Anie HA, Osei MA, Odoom JK, Bonney JHK, Behene E, Kotey EN, Aboagye J, Nyarko SO, Bentum J, Yeboah C, Kumordjie S, Agbodzi B, Attiku K, Mawuli G, Letizia A, Ampofo WK, Quaye O. Occurrence of influenza and bacterial infections in cancer patients receiving radiotherapy in Ghana. PLoS One 2022; 17:e0271877. [PMID: 35881575 PMCID: PMC9321433 DOI: 10.1371/journal.pone.0271877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 07/08/2022] [Indexed: 11/30/2022] Open
Abstract
Background Influenza co-infection with bacteria is a leading cause of influenza-related deaths and severe respiratory infections, especially among high-risk groups like cancer patients undergoing treatment. However, acute respiratory infection (ARI)-like symptoms developed by upper-torso cancer (UTC) patients receiving radiotherapy are considered as side-effects of the radiation. Hence influenza and bacterial pathogens implicated in ARI are not investigated. Methods This prospective cohort study examined 85 in-patients with upper-torso cancers undergoing radiotherapy at the National Radiotherapy, Oncology and Nuclear Medicine Centre (NRONMC) of Korle-Bu Teaching Hospital (KBTH) in Accra, Ghana. Eligible patients who consented were recruited into the study from September 2018 to April 2019. Influenza viruses A and B in addition to the following bacteria species Streptococcus pneumonia, Haemophilus influenzae, Neisseria meningitidis and Staphylococcus aureus were detected from oropharyngeal and nasopharyngeal swab specimens collected at three different time points. Presence of respiratory pathogens were investigated by influenza virus isolation in cell culture, bacterial culture, polymerase chain reaction (PCR) and next generation sequencing (NGS) assays. Results Of the 85 eligible participants enrolled into the study, 87% were females. Participants were 17 to 77 years old, with a median age of 49 years. Most of the participants (88%) enrolled had at least one pathogen present. The most prevalent pathogen was N. meningitidis (63.4%), followed by H. influenzae (48.8%), Influenza viruses A and B (32.9%), S. pneumoniae (32.9%) and S. aureus (12.2%). Approximately, 65% of these participants developed ARI-like symptoms. Participants with previous episodes of ARI, did not live alone, HNC and total radiation less than 50 Gy were significantly associated with ARI. All treatment forms were also significantly associated with ARI. Conclusion Data generated from the study suggests that ARI-like symptoms observed among UTC patients receiving radiotherapy in Ghana, could be due to influenza and bacterial single and co-infections in addition to risk factors and not solely the side-effects of radiation as perceived. These findings will be prime importance for diagnosis, prevention, treatment and control for cancer patients who present with such episodes during treatment.
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Affiliation(s)
- Augustina K. Arjarquah
- West African Centre for Cell Biology of Infectious Pathogens (WACCBIP), Department of Biochemistry, Cell and Molecular Biology (DBCMB), University of Ghana, Legon, Ghana
- College of Health Sciences, University of Ghana-Noguchi Memorial Institute for Medical Research (NMIMR), Legon, Ghana
- Cocoa Research Institute of Ghana (CRIG), New Tafo—Akim, Ghana
- * E-mail: (EO); (AKA)
| | - Evangeline Obodai
- College of Health Sciences, University of Ghana-Noguchi Memorial Institute for Medical Research (NMIMR), Legon, Ghana
- * E-mail: (EO); (AKA)
| | - Hannah Ayettey Anie
- National Radiotherapy, Oncology and Nuclear Medicine Centre (NRONMC), Korle-Bu Teaching Hospital, Accra, Ghana
| | - Michael Aning Osei
- National Radiotherapy, Oncology and Nuclear Medicine Centre (NRONMC), Korle-Bu Teaching Hospital, Accra, Ghana
| | - John Kofi Odoom
- College of Health Sciences, University of Ghana-Noguchi Memorial Institute for Medical Research (NMIMR), Legon, Ghana
| | - Joseph H. K. Bonney
- College of Health Sciences, University of Ghana-Noguchi Memorial Institute for Medical Research (NMIMR), Legon, Ghana
| | - Eric Behene
- College of Health Sciences, University of Ghana-Noguchi Memorial Institute for Medical Research (NMIMR), Legon, Ghana
- United States Naval Medical Research Unit No. 3 (US-NAMRU 3), Ghana Detachment, Accra, Ghana
| | - Erasmus N. Kotey
- College of Health Sciences, University of Ghana-Noguchi Memorial Institute for Medical Research (NMIMR), Legon, Ghana
| | - James Aboagye
- College of Health Sciences, University of Ghana-Noguchi Memorial Institute for Medical Research (NMIMR), Legon, Ghana
| | - Stephen O. Nyarko
- College of Health Sciences, University of Ghana-Noguchi Memorial Institute for Medical Research (NMIMR), Legon, Ghana
| | - Jeannette Bentum
- College of Health Sciences, University of Ghana-Noguchi Memorial Institute for Medical Research (NMIMR), Legon, Ghana
- United States Naval Medical Research Unit No. 3 (US-NAMRU 3), Ghana Detachment, Accra, Ghana
| | - Clara Yeboah
- College of Health Sciences, University of Ghana-Noguchi Memorial Institute for Medical Research (NMIMR), Legon, Ghana
- United States Naval Medical Research Unit No. 3 (US-NAMRU 3), Ghana Detachment, Accra, Ghana
| | - Selassie Kumordjie
- College of Health Sciences, University of Ghana-Noguchi Memorial Institute for Medical Research (NMIMR), Legon, Ghana
- United States Naval Medical Research Unit No. 3 (US-NAMRU 3), Ghana Detachment, Accra, Ghana
| | - Bright Agbodzi
- College of Health Sciences, University of Ghana-Noguchi Memorial Institute for Medical Research (NMIMR), Legon, Ghana
- United States Naval Medical Research Unit No. 3 (US-NAMRU 3), Ghana Detachment, Accra, Ghana
| | - Keren Attiku
- College of Health Sciences, University of Ghana-Noguchi Memorial Institute for Medical Research (NMIMR), Legon, Ghana
| | - Gifty Mawuli
- College of Health Sciences, University of Ghana-Noguchi Memorial Institute for Medical Research (NMIMR), Legon, Ghana
| | - Andrew Letizia
- United States Naval Medical Research Unit No. 3 (US-NAMRU 3), Ghana Detachment, Accra, Ghana
| | - William K. Ampofo
- College of Health Sciences, University of Ghana-Noguchi Memorial Institute for Medical Research (NMIMR), Legon, Ghana
| | - Osbourne Quaye
- West African Centre for Cell Biology of Infectious Pathogens (WACCBIP), Department of Biochemistry, Cell and Molecular Biology (DBCMB), University of Ghana, Legon, Ghana
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Valdez M, Sharma R, Joshi J, Sandhu H, Mishra S, Kuran R, Heidari A. A Double Whammy Pneumonia: The First Reported Case of Concurrent Neisseria meningitidis and SARS-CoV-2 Pneumonia. J Investig Med High Impact Case Rep 2022; 10:23247096221111764. [PMID: 35848082 PMCID: PMC9290109 DOI: 10.1177/23247096221111764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Meningococcal pneumonia (MP) is a rare manifestation of meningococcal disease. The MP was first described in 1907 when Neisseria meningitidis (NM) isolates were identified in sputum samples obtained from soldiers with pneumonia. Preceding and concurrent viral infections constitute a major risk for MP. During the 1918-1919 influenza pandemic, a significant increase in MP cases were reported in patients with preceding influenza infection. Despite the end of the last H1N1 influenza pandemic in 2010, seasonal influenza infections still pose a risk for simultaneous MP. History appears to be repeating itself with concomitant bacterial and viral coinfection amid the current SARS-CoV-2 pandemic. Herein presented is a unique case of an elderly woman who presented with, to the best of our knowledge, the first reported case of possible concurrent SARS-CoV-2 and MP infections.
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Affiliation(s)
| | - Rupam Sharma
- UCLA at Kern Medical Center, Bakersfield, CA, USA
| | | | | | | | - Rasha Kuran
- UCLA at Kern Medical Center, Bakersfield, CA, USA
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Deghmane AE, Taha S, Taha MK. Global epidemiology and changing clinical presentations of invasive meningococcal disease: a narrative review. Infect Dis (Lond) 2021; 54:1-7. [PMID: 34459329 DOI: 10.1080/23744235.2021.1971289] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Neisseria meningitidis (the meningococcus) causes significant morbidity and mortality worldwide through an epidemic or sporadic invasive infections. The epidemiology of N. meningitidis is changing and unpredictable. Certain emerging meningococcal genotypes seem to be associated with increasing unusual clinical presentations. Indeed, early symptoms may vary and are frequently non-specific. However, atypical clinical forms including abdominal presentations, septic arthritis, and bacteremic pneumonia may lead to misdiagnosis and some are usually associated with higher case fatality rates due to delayed optimal management. Improving awareness of clinicians and public health specialists about these unusual but potentially severe presentations should help establish prompt diagnoses and provide appropriate management of cases. In this review, we described unusual panels of clinical presentations of invasive meningococcal disease linked to the recent changes in meningococcal epidemiology.
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Affiliation(s)
- Ala-Eddine Deghmane
- Institut Pasteur, Invasive Bacterial Infections Unit and National Reference Centre for Meningococci and Haemophilus Influenzae, Paris, France
| | - Samy Taha
- Institut Pasteur, Invasive Bacterial Infections Unit and National Reference Centre for Meningococci and Haemophilus Influenzae, Paris, France.,Faculty of Medicine, Université de Paris Sud, Le Kremlin-Bicêtre, France
| | - Muhamed-Kheir Taha
- Institut Pasteur, Invasive Bacterial Infections Unit and National Reference Centre for Meningococci and Haemophilus Influenzae, Paris, France
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Symptomatic Female Genital Tract Infections Due to Neisseria meningitidis in Athens, Greece. Diagnostics (Basel) 2021; 11:diagnostics11071265. [PMID: 34359348 PMCID: PMC8305777 DOI: 10.3390/diagnostics11071265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 07/02/2021] [Accepted: 07/09/2021] [Indexed: 11/17/2022] Open
Abstract
Neisseria meningitidis is considered as an obligate human pathogen and can cause life-threatening diseases like meningitis and/or septicaemia. Occasionally, it can be recovered from infections outside the bloodstream or central nervous system, like respiratory, ocular, joint, urogenital or other unusual sites. Herein, we present two rare cases of female genital infections due to N. meningitidis within a two-year period (2019-2020), identified as serogroup B (MenB) and Y (MenY), respectively. Genotypic analysis for PorA, FetA and MLST revealed the following characteristics: MenB: 7-12, 14, F5-36, 1572cc and MenY: 5-1,10-1, F4-5, 23cc, respectively. Such unusual presentations should alert the clinicians and microbiologists not to exclude N. meningitidis from routine diagnosis and the need of early detection. This is the first report in Greece, and, to our knowledge, in Europe since 2005 describing meningococcal female genital infections.
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Sudbury EL, O'Sullivan S, Lister D, Varghese D, Satharasinghe K. Case Manifestations and Public Health Response for Outbreak of Meningococcal W Disease, Central Australia, 2017. Emerg Infect Dis 2021; 26:1355-1363. [PMID: 32568047 PMCID: PMC7323526 DOI: 10.3201/eid2607.181941] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Neisseria meningitidis serogroup W has emerged as an increasingly common cause of invasive meningococcal disease worldwide; the average case-fatality rate is 10%. In 2017, an unprecedented outbreak of serogroup W infection occurred among the Indigenous pediatric population of Central Australia; there were 24 cases over a 5-month period. Among these cases were atypical manifestations, including meningococcal pneumonia, septic arthritis, and conjunctivitis. The outbreak juxtaposed a well-resourced healthcare system against unique challenges related to covering vast distances, a socially disadvantaged population, and a disease process that was rapid and unpredictable. A coordinated clinical and public health response included investigation of and empiric treatment for 649 febrile children, provision of prophylactic antimicrobial drugs for 465 close contacts, and implementation of a quadrivalent meningococcal ACWY conjugate vaccine immunization program. The response contained the outbreak within 6 months; no deaths and only 1 case of major illness were recorded.
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8
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Mahmoud FM, Harhara T. Neisseria meningitidis pneumonia with bacteremia without meningitis: An atypical presentation. IDCases 2020; 21:e00897. [PMID: 32685370 PMCID: PMC7333626 DOI: 10.1016/j.idcr.2020.e00897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 06/29/2020] [Accepted: 06/29/2020] [Indexed: 11/18/2022] Open
Abstract
Neisseria meningitidis remains the most important cause of bacterial meningitis worldwide. The second most common and potentially severe end-organ manifestation of invasive meningococcal disease is meningococcal pneumonia. It occurs between 5 % and 15 % of all patients with invasive meningococcal disease. N. meningitidis sepsis and meningitis continue to be associated with high morbidity and mortality, however, meningococcal pneumonia is uncommon and often underreported. We describe a case of sepsis secondary to pneumonia with N. meningitidis bacteremia, without any evidence of meningitis. This case reports aims at highlighting pneumonia as a presentation of N. meningitidis bacteremia, and the need for a high level of clinical suspicion to establish the diagnosis.
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Affiliation(s)
| | - Thana Harhara
- Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
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Sudbury EL, O’Sullivan S, Lister D, Varghese D, Satharasinghe K. Case Manifestations and Public Health Response for Outbreak of Meningococcal W Disease, Central Australia, 2017. Emerg Infect Dis 2020. [DOI: 10.3201/eid2607.181491] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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10
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Stenmark B, Harrison OB, Eriksson L, Anton BP, Fomenkov A, Roberts RJ, Tooming-Klunderud A, Bratcher HB, Bray JE, Thulin-Hedberg S, Maiden MCJ, Mölling P. Complete genome and methylome analysis of Neisseria meningitidis associated with increased serogroup Y disease. Sci Rep 2020; 10:3644. [PMID: 32108139 PMCID: PMC7046676 DOI: 10.1038/s41598-020-59509-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 01/22/2020] [Indexed: 12/22/2022] Open
Abstract
Invasive meningococcal disease (IMD) due to serogroup Y Neisseria meningitidis emerged in Europe during the 2000s. Draft genomes of serogroup Y isolates in Sweden revealed that although the population structure of these isolates was similar to other serogroup Y isolates internationally, a distinct strain (YI) and more specifically a sublineage (1) of this strain was responsible for the increase of serogroup Y IMD in Sweden. We performed single molecule real-time (SMRT) sequencing on eight serogroup Y isolates from different sublineages to unravel the genetic and epigenetic factors delineating them, in order to understand the serogroup Y emergence. Extensive comparisons between the serogroup Y sublineages of all coding sequences, complex genomic regions, intergenic regions, and methylation motifs revealed small point mutations in genes mainly encoding hypothetical and metabolic proteins, and non-synonymous variants in genes involved in adhesion, iron acquisition, and endotoxin production. The methylation motif CACNNNNNTAC was only found in isolates of sublineage 2. Only seven genes were putatively differentially expressed, and another two genes encoding hypothetical proteins were only present in sublineage 2. These data suggest that the serogroup Y IMD increase in Sweden was most probably due to small changes in genes important for colonization and transmission.
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Affiliation(s)
- Bianca Stenmark
- Department of Laboratory Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
| | - Odile B Harrison
- Department of Zoology, University of Oxford, Oxford, United Kingdom
| | - Lorraine Eriksson
- Department of Laboratory Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | | | | | | | - Ave Tooming-Klunderud
- Centre for Ecological and Evolutionary Synthesis, Department of Biosciences, University of Oslo, Oslo, Norway
| | - Holly B Bratcher
- Department of Zoology, University of Oxford, Oxford, United Kingdom
| | - James E Bray
- Department of Zoology, University of Oxford, Oxford, United Kingdom
| | - Sara Thulin-Hedberg
- Department of Laboratory Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | | | - Paula Mölling
- Department of Laboratory Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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Campbell H, Andrews N, Parikh S, Ribeiro S, Gray S, Lucidarme J, Ramsay ME, Borrow R, Ladhani SN. Variable clinical presentation by the main capsular groups causing invasive meningococcal disease in England. J Infect 2019; 80:182-189. [PMID: 31715210 DOI: 10.1016/j.jinf.2019.11.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 11/01/2019] [Accepted: 11/02/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Invasive meningococcal disease (IMD) typically presents as meningitis, septicaemia or both. Atypical clinical presentations are rare but well-described. We aimed to assess the relationship between meningococcal capsular group, age, clinical presentation, diagnosis and outcome among IMD cases diagnosed in England during 2014. METHODS Public Health England conducts enhanced national surveillance of IMD in England. Clinical data for laboratory-confirmed MenB, MenW and MenY cases in ≥5 year-olds were used to classify presenting symptoms, diagnosis and outcomes. Multivariable logistic regression was used to assess independent associations between meningococcal capsular group, clinical presentation, gender, age and death. RESULTS In 2014, there were 340 laboratory-confirmed IMD cases caused by MenB (n = 179), MenW (n = 95) and MenY (n = 66). Clinical presentation with meningitis alone was more prevalent among MenB cases (28%) and among 15-24 year-olds (20%), whilst bacteraemic pneumonia was most prevalent among MenY cases (26%) and among ≥65 year-olds (24%). Gastrointestinal symptoms were recorded preceding or during presentation in 15% (40/269) cases with available information, including 5% (7/140) MenB, 17% (8/47) MenY and 30% (25/82) MenW cases. Upper respiratory tract symptoms were reported in 16% (22/141) MenB, 23% (11/47) MenY and 31% (26/84) MenW cases. Increasing age was also independently associated with bacteraemic meningococcal pneumonia, with no cases among 5-14 year-olds compared to 24% in ≥65 year-olds. Case fatality rates increased with age but no significant associations with death were identified. CONCLUSIONS Healthcare professionals should be aware of the atypical clinical presentations associated with the less prevalent meningococcal capsular groups in different age-groups.
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Affiliation(s)
- Helen Campbell
- Immunisation and Countermeasures Division, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Nick Andrews
- Statistics, Modelling, and Economics Department, Public Health England, Colindale, London NW9 5EQ, UK
| | - Sydel Parikh
- Immunisation and Countermeasures Division, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Sonia Ribeiro
- Immunisation and Countermeasures Division, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Steve Gray
- Meningococcal Reference Unit, Public Health England, Manchester Royal Infirmary, Manchester, UK
| | - Jay Lucidarme
- Meningococcal Reference Unit, Public Health England, Manchester Royal Infirmary, Manchester, UK
| | - Mary E Ramsay
- Immunisation and Countermeasures Division, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Ray Borrow
- Meningococcal Reference Unit, Public Health England, Manchester Royal Infirmary, Manchester, UK
| | - Shamez N Ladhani
- Immunisation and Countermeasures Division, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK; Paediatric Infectious Diseases Research Group (PIDRG), St. George's University of London, Cranmer Terrace, London SW17 0RE, UK.
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Rashad E, Jamal R, Farooq M. Atypical Presentation of <i>Neisseria meningitidis</i>. DUBAI MEDICAL JOURNAL 2019. [DOI: 10.1159/000503029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
<i>Neisseria meningitidis</i> is an organism that can cause life-threatening infections of the meninges and blood. We present two patients with atypical presentation of meningococcemia without neurological or dermatological findings, and without evidence of infection on spinal fluid analysis. Both patients attended the Emergency Department with sepsis. The first patient presented with symptoms of a lower respiratory tract infection and had right-sided infiltrates on his chest X-ray, prompting the initial diagnosis of pneumonia. The second patient presented with abdominal pain and loose stools, suggesting gastroenteritis. Both patients’ blood cultures came back positive for <i>Neisseria meningitidis</i>. They received intravenous antibiotics and were discharged a week after admission in a stable condition without any complications. This case series highlights that <i>Neisseria meningitidis</i> can present without classical findings and should be considered in the differential diagnosis of respiratory tract infections as well as gastroenteritis in order to provide early treatment and prevent irreversible complications.
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Feldman C, Anderson R. Meningococcal pneumonia: a review. Pneumonia (Nathan) 2019; 11:3. [PMID: 31463180 PMCID: PMC6708554 DOI: 10.1186/s41479-019-0062-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 08/07/2019] [Indexed: 12/19/2022] Open
Abstract
Background Although Neisseria meningitidis is one of the major causes of meningitis, meningococcal pneumonia is the most common non-neurological organ disease caused by this pathogen. Methods We conducted a review of the literature to describe the risk factors, pathogenesis, clinical features, diagnosis, treatment and prevention of meningococcal pneumonia. Results Meningococcal pneumonia was first described in 1907 and during the 1918–1919 influenza pandemic large numbers of cases of meningococcal pneumonia occurred in patients following the initial viral infection. A number of publications, mainly case series or case reports, has subsequently appeared in the literature. Meningococcal pneumonia occurs mainly with serogroups Y, W-135 and B. Risk factors for meningococcal pneumonia have not been well characterised, but appear to include older age, smoking, people living in close contact (e.g. military recruits and students at university), preceding viral and bacterial infections, haematological malignancies, chronic respiratory conditions and various other non-communicable and primary and secondary immunodeficiency diseases. Primary meningococcal pneumonia occurs in 5–10% of patients with meningococcal infection and is indistinguishable clinically from pneumonia caused by other common pathogens. Fever, chills and pleuritic chest pain are the most common symptoms, occurring in > 50% of cases. Productive sputum and dyspnoea are less common. Diagnosis of meningococcal pneumonia may be made by the isolation of the organism in sputum, blood, or normally sterile site cultures, but is likely to underestimate the frequency of meningococcal pneumonia. If validated, PCR-based techniques may be of value for diagnosis in the future. While penicillin was the treatment of choice for meningococcal infection, including pneumonia, prior to 1991, a third generation cephalosporin has been more commonly used thereafter, because of concerns of penicillin resistance. Chemoprophylaxis, using one of a number of antibiotics, has been recommended for close contacts of patients with meningococcal meningitis, and similar benefits may be seen in contacts of patients with meningococcal pneumonia. Effective vaccines are available for the prevention of infection with certain meningococcal serogroups, but this field is still evolving. Conclusion Meningococcal pneumonia occurs fairly frequently and should be considered as a possible cause of pneumonia, particularly in patients with specific risk factors.
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Affiliation(s)
- Charles Feldman
- 1Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ronald Anderson
- 2Department of Immunology and Institute for Cellular and Molecular Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
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Tolaj I, Ramadani H, Mehmeti M, Gashi H, Kasumi A, Gashi V, Jashari H. Does Dexamethasone Helps in Meningococcal Sepsis? Med Arch 2018; 71:173-177. [PMID: 28974828 PMCID: PMC5585801 DOI: 10.5455/medarh.2017.71.173-177] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Purpose: Prompt recognition and aggressive early treatment are the only effective measures against invasive meningococcal disease (IMD). Anti-inflammatory adjunctive treatment remains controversial and difficult to assess in patients with IMD. The purpose of this study was to evaluate the effect of dexamethasone (DXM) as adjunctive treatment in different clinical forms of IMD, and attempt to answer if DXM should be routinely used in the treatment of IMD. Methods: In this non-interventional clinical study (NIS), 39 patients with meningococcal septicaemia with or without of meningitis were included, and compared regarding the impact of dexamethasone (DXM), as an adjunctive treatment, on the outcome of IMD. SPSS statistics is used for statistical processing of data. Results: Thirty (76.9%) patients with IMD had sepsis and meningitis, and 9 (23.1%) of them had sepsis alone. Dexamethasone was used in 24 (61.5%) cases, in both clinical groups. The overall mortality rate was 10.3%. Pneumonia was diagnosed in 6 patients (15.4%), arthritis in 3 of them (7.7%), and subdural effusion in one patient (2.6%). The data showed a significant statistical difference on the length of hospitalization, and WBC normalization in groups of patients treated with DXM. Conclusion: The use of DXM as adjunctive therapy in invasive meningococcal disease has a degree of proven benefits and no harmful effects. In fighting this very dangerous and complex infection, even a limited benefit is sufficient to recommend the use of DXM as adjunctive treatment in invasive meningococcal disease.
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Affiliation(s)
- Ilir Tolaj
- Department of Infectious Diseases, University Clinical Centre in Pristina, Kosovo
| | - Hamdi Ramadani
- Department of Infectious Diseases, University Clinical Centre in Pristina, Kosovo
| | - Murat Mehmeti
- Department of Infectious Diseases, University Clinical Centre in Pristina, Kosovo
| | - Hatixhe Gashi
- Department of Infectious Diseases, University Clinical Centre in Pristina, Kosovo
| | - Arbana Kasumi
- Department of Infectious Diseases, University Clinical Centre in Pristina, Kosovo
| | - Visar Gashi
- Department of Infectious Diseases, University Clinical Centre in Pristina, Kosovo
| | - Haki Jashari
- Department of Infectious Diseases, University Clinical Centre in Pristina, Kosovo
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15
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Meningococcal Pneumonia in a Young Healthy Male. Case Rep Infect Dis 2018; 2018:2179097. [PMID: 30225154 PMCID: PMC6129844 DOI: 10.1155/2018/2179097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 06/22/2018] [Accepted: 07/29/2018] [Indexed: 12/17/2022] Open
Abstract
A 23-year-old male presented to the emergency department with one-day history of right-sided pleuritic chest pain, haemoptysis, and fever. In the emergency department, the blood pressure was 140/60 mmHg, heart rate 89/min, body temperature 40°C, respiratory rates 20 breaths/min, and oxygen saturation 98% in room air. Physical examination revealed rales and bronchial breathing in the right infrascapular region. Laboratory analysis showed raised white blood cell counts and elevated inflammation markers. Chest X-ray showed right lower lobe consolidation. Intravenous(IV) ceftriaxone and doxycycline were started for the management of community-acquired pneumonia as per the local guideline. Later, on admission, blood culture was positive for Neisseria meningitidis (N. meningitidis). Ceftriaxone was continued for 4 days, and the patient was discharged while being on oral amoxicillin (1 gm TDS) for another 3 days. He remained well during the outpatient follow-up.
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16
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Khatami M. Cancer; an induced disease of twentieth century! Induction of tolerance, increased entropy and 'Dark Energy': loss of biorhythms (Anabolism v. Catabolism). Clin Transl Med 2018; 7:20. [PMID: 29961900 PMCID: PMC6026585 DOI: 10.1186/s40169-018-0193-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Accepted: 05/29/2018] [Indexed: 12/15/2022] Open
Abstract
Maintenance of health involves a synchronized network of catabolic and anabolic signals among organs/tissues/cells that requires differential bioenergetics from mitochondria and glycolysis (biological laws or biorhythms). We defined biological circadian rhythms as Yin (tumoricidal) and Yang (tumorigenic) arms of acute inflammation (effective immunity) involving immune and non-immune systems. Role of pathogens in altering immunity and inducing diseases and cancer has been documented for over a century. However, in 1955s decision makers in cancer/medical establishment allowed public (current baby boomers) to consume million doses of virus-contaminated polio vaccines. The risk of cancer incidence and mortality sharply rose from 5% (rate of hereditary/genetic or innate disease) in 1900s, to its current scary status of 33% or 50% among women and men, respectively. Despite better hygiene, modern detection technologies and discovery of antibiotics, baby boomers and subsequent 2–3 generations are sicker than previous generations at same age. American health status ranks last among other developed nations while America invests highest amount of resources for healthcare. In this perspective we present evidence that cancer is an induced disease of twentieth century, facilitated by a great deception of cancer/medical establishment for huge corporate profits. Unlike popularized opinions that cancer is 100, 200 or 1000 diseases, we demonstrate that cancer is only one disease; the severe disturbances in biorhythms (differential bioenergetics) or loss of balance in Yin and Yang of effective immunity. Cancer projects that are promoted and funded by decision makers are reductionist approaches, wrong and unethical and resulted in loss of millions of precious lives and financial toxicity to society. Public vaccination with pathogen-specific vaccines (e.g., flu, hepatitis, HPV, meningitis, measles) weakens, not promotes, immunity. Results of irresponsible projects on cancer sciences or vaccines are increased population of drug-dependent sick society. Outcome failure rates of claimed ‘targeted’ drugs, ‘precision’ or ‘personalized’ medicine are 90% (± 5) for solid tumors. We demonstrate that aging, frequent exposures to environmental hazards, infections and pathogen-specific vaccines and ingredients are ‘antigen overload’ for immune system, skewing the Yin and Yang response profiles and leading to induction of ‘mild’, ‘moderate’ or ‘severe’ immune disorders. Induction of decoy or pattern recognition receptors (e.g., PRRs), such as IRAK-M or IL-1dRs (‘designer’ molecules) and associated genomic instability and over-expression of growth promoting factors (e.g., pyruvate kinases, mTOR and PI3Ks, histamine, PGE2, VEGF) could lead to immune tolerance, facilitating cancer cells to hijack anabolic machinery of immunity (Yang) for their increased growth requirements. Expression of constituent embryonic factors would negatively regulate differentiation of tumor cells through epithelial–mesenchymal-transition and create “dual negative feedback loop” that influence tissue metabolism under hypoxic conditions. It is further hypothesized that induction of tolerance creates ‘dark energy’ and increased entropy and temperature in cancer microenvironment allowing disorderly cancer proliferation and mitosis along with increased glucose metabolism via Crabtree and Pasteur Effects, under mitophagy and ribophagy, conditions that are toxic to host survival. Effective translational medicine into treatment requires systematic and logical studies of complex interactions of tumor cells with host environment that dictate clinical outcomes. Promoting effective immunity (biological circadian rhythms) are fundamental steps in correcting host differential bioenergetics and controlling cancer growth, preventing or delaying onset of diseases and maintaining public health. The author urges independent professionals and policy makers to take a closer look at cancer dilemma and stop the ‘scientific/medical ponzi schemes’ of a powerful group that control a drug-dependent sick society before all hopes for promoting public health evaporate.
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Affiliation(s)
- Mahin Khatami
- Inflammation, Aging and Cancer, National Cancer Institute (NCI), National Institutes of Health (NIH), Bethesda, MD, USA.
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17
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Walayat S, Hussain N, Malik AH, Vazquez-Melendez E, Aulakh BS, Lynch T. Invasive meningococcal disease without meningitis: a forgotten diagnosis. Int Med Case Rep J 2018; 11:87-90. [PMID: 29695936 PMCID: PMC5905520 DOI: 10.2147/imcrj.s154807] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Neisseria meningitidis, a Gram-negative diplococcus, is an uncommon cause of pneumonia. There have been only about 344 cases reported worldwide from 1906 to 2015. To our knowledge, there have been only 3 cases reported in the USA in the past 2 decades. We present a case of a 72-year-old male with a past medical history of severe COPD, obstructive sleep apnea, and stage I lung cancer status post-stereotactic body radiation therapy 1 year ago, who was admitted with a 6-day history of productive cough with yellowish sputum, shortness of breath, extreme myalgias, and fatigue. Chest X-ray revealed an infiltrative process in the left lower lung field and left-sided pleural effusion. Blood cultures grew beta-lactamase-negative N. meningitidis after 24 hours. Our patient was initially treated with broad-spectrum antibiotics, which were later switched to amoxicillin to complete a total of 14 days of antibiotics. Diagnosing meningococcal pneumonia requires a high level of suspicion, as sputum cultures may be falsely positive due to asymptomatic carriage of the organism in the upper respiratory tract in up to 10% of outpatient population. We highlight this case as early recognition and treatment is critical. The case fatality rate for N. meningitidis pneumonia has been reported to be higher compared with meningococcal meningitis.
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Affiliation(s)
- Saqib Walayat
- Department of Internal Medicine, University of Illinois College of Medicine at Peoria, Peoria, IL, USA
| | - Nooreen Hussain
- Department of Internal Medicine, University of Illinois College of Medicine at Peoria, Peoria, IL, USA
| | - Abdullah H Malik
- Department of Internal Medicine, University of Illinois College of Medicine at Peoria, Peoria, IL, USA
| | - Elsa Vazquez-Melendez
- Department of Internal Medicine, University of Illinois College of Medicine at Peoria, Peoria, IL, USA
| | - Bhagat S Aulakh
- Department of Pulmonary/Critical Care Medicine, University of Illinois College of Medicine at Peoria, Peoria, IL, USA
| | - Teresa Lynch
- Department of Internal Medicine, University of Illinois College of Medicine at Peoria, Peoria, IL, USA
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Bernstein H, Bernstein C, Michod RE. Sex in microbial pathogens. INFECTION GENETICS AND EVOLUTION 2018; 57:8-25. [DOI: 10.1016/j.meegid.2017.10.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 10/25/2017] [Accepted: 10/26/2017] [Indexed: 10/18/2022]
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Famularo G, Sordillo P, Stasolla A, Parisi MG. A 58-Year-Old Woman With Pneumonia and Gram-Negative Diplococci. Chest 2017; 152:e95-e97. [PMID: 28991556 DOI: 10.1016/j.chest.2017.05.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 05/13/2017] [Accepted: 05/25/2017] [Indexed: 11/19/2022] Open
Abstract
CASE PRESENTATION A 58-year-old woman with COPD, cor pulmonale, diabetes, and hypertension had a productive cough of greenish and purulent sputum, low-grade fever, and shortness of breath. Medications were metformin, losartan, cholecalciferol, folic acid, a multivitamin, fluticasone by inhalation, and, as needed, ipratropium by inhalation. She lived alone and worked as a physician, had received that year's seasonal influenza vaccine, was a heavy smoker, did not drink alcohol or use illicit drugs, and had no personal or family history of allergy and autoimmunity.
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Affiliation(s)
| | - Pasquale Sordillo
- Department of Infectious Diseases, University of "Tor Vergata", Rome, Italy
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Parent du Chatelet I, Deghmane A, Antona D, Hong E, Fonteneau L, Taha M, Lévy-Bruhl D. Characteristics and changes in invasive meningococcal disease epidemiology in France, 2006–2015. J Infect 2017; 74:564-574. [DOI: 10.1016/j.jinf.2017.02.011] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 02/03/2017] [Accepted: 02/24/2017] [Indexed: 01/09/2023]
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21
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Clinical presentation of invasive disease caused by Neisseria meningitidis serogroup Y in Sweden, 1995 to 2012. Epidemiol Infect 2017; 145:2137-2143. [PMID: 28478773 PMCID: PMC5968308 DOI: 10.1017/s0950268817000929] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Over the period 1995–2012, the incidence of invasive meningococcal disease (IMD) caused by Neisseria meningitidis serogroup Y (NmY) increased significantly in Sweden. This is mainly due to the emergence of a predominant cluster named strain type YI subtype 1, belonging to the ST-23 clonal complex (cc). The aim of this study was to examine the clinical picture of patients with invasive disease caused by NmY and to analyse whether the predominant cluster exhibits certain clinical characteristics that might explain the increased incidence. In this retrospective observational study, the medical records available from patients with IMD caused by Nm serogroup Y in Sweden between 1995 and 2012 were systematically reviewed. Patient characteristics, in-hospital findings and outcome were studied and differences between the dominating cluster and other isolates were analysed. Medical records from 175 of 191 patients were retrieved. The median age was 62 years. The all-cause mortality within 30 days of admission was 9% (15/175) in the whole material; 4% (2/54) in the cohort with strain type YI subtype 1 and 11% (12/121) among patients with other isolates. Thirty-three per cent of the patients were diagnosed with meningitis, 19% with pneumonia, 10% with arthritis and 35% were found to have bacteraemia but no apparent organ manifestation. This survey included cases with an aggressive clinical course as well as cases with a relatively mild clinical presentation. There was a trend towards lower mortality and less-severe disease in the cohort with strain type YI subtype 1 compared with the group with other isolates.
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