Characteristics of the major etiologic agents of bacterial meningitis isolated in Poland in 1997-1998

A decade of invasive meningococcal disease surveillance in Poland

Background

Neisseria meningitidis is a leading etiologic agent of severe invasive disease. The objective of the study was to characterise invasive meningococcal disease (IMD) epidemiology in Poland during the last decade, based on laboratory confirmed cases.

Methods

The study encompassed all invasive meningococci collected between 2002 and 2011 in the National Reference Centre for Bacterial Meningitis. The isolates were re-identified and characterised by susceptibility testing, MLST analysis, porA and fetA sequencing. A PCR technique was used for meningococcal identification directly from clinical materials.

Results

In the period studied, 1936 cases of IMD were confirmed, including 75.6% identified by culture. Seven IMD outbreaks, affecting mostly adolescents, were reported; all were caused by serogroup C meningococci of ST-11. The highest incidence was observed among children under one year of age (15.71/100,000 in 2011). The general case fatality rate in the years 2010–2011 was 10.0%. Meningococci of serogroup B, C, Y and W-135 were responsible for 48.8%, 36.6%, 1.2% and 1.2% of cases, respectively. All isolates were susceptible to third generation cephalosporins, chloramphenicol, ciprofloxacin, and 84.2% were susceptible to penicillin. MLST analysis (2009–2011) revealed that among serogroup B isolates the most represented were clonal complexes (CC) ST-32CC, ST-18CC, ST-41/44CC, ST-213CC and ST-269CC, and among serogroup C: ST-103CC, ST-41/44CC and ST-11CC.

Conclusions

The detection of IMD in Poland has changed over time, but observed increase in the incidence of the disease was mostly attributed to changes in the surveillance system including an expanded case definition and inclusion of data from non-culture diagnostics.

The pathogenicity of the Streptococcus genus

Streptococcus infections are still one of the important problems facing contemporary medicine. As the World Health Organization (WHO) warns, Streptococcus pneumoniae is responsible for the highest number of pneumonia cases all over the world. Despite an increasing number of pneumococcal vaccinations, incidences of disease connected to this pathogen's infection stay at the same level, which is related to a constantly increasing number of infections caused by nonvaccinal serotypes. Unfortunately, the pathogenicity of bacteria of the Streptococcus genus is also connected to species considered to be physiological flora in humans or animals and, additionally, new species exhibiting pathogenic potential have been discovered. This paper presents an opinion concerning the epidemiology of streptococci infections based on case studies and other publications devoted to this problem. It also sheds new light based on recent reports on the prevention of protective vaccinations application in the case of streptococci infections.

Phenotypic and molecular analysis of penicillin-nonsusceptible Streptococcus pneumoniae isolates in Poland

beta-Lactams are the drugs of choice for the treatment of infections caused by the important bacterial pathogen Streptococcus pneumoniae. The recent growth of resistance of this organism to penicillin observed worldwide is of the highest concern. In this study, using 887 surveillance pneumococcal isolates recovered in Poland from 1998 to 2002, we observed the increase in penicillin nonsusceptibility from 8.7% to 20.3%. All of the 109 penicillin-nonsusceptible S. pneumoniae (PNSP) isolates identified, together with 22 archival PNSP isolates from 1995 to 1997, were subsequently analyzed by susceptibility testing, serotyping, profiling of pbp genes, pulsed-field gel electrophoresis, and multilocus sequence typing (MLST). Four predominant serotypes, serotypes 6B, 9V, 14, and 23F, characterized 85.5% of the isolates. MLST revealed the presence of 34 sequence types, 15 of which were novel types. Representatives of seven multiresistant international clones (Spain(23F)-1, Spain(6B)-2, Spain(9V)-3, Taiwan(23F)-15, Poland(23F)-16, Poland(6B)-20, and Sweden(15A)-25) or their closely related variants comprised the majority of the study isolates. The spread of Spain(9V)-3 and its related clone of serotype 14/ST143 has remarkably contributed to the recent increase in penicillin resistance in pneumococci in the country.

Multilocus sequence types, serotypes, and variants of the surface antigen PspA in Streptococcus pneumoniae isolates from meningitis patients in Poland

Meningitis caused by Streptococcus pneumoniae represents an important factor of morbidity and mortality in humans. In a significant number of cases, this disease is associated with specific clones of the organism, the so-called invasive pneumococcal clones. The aim of the study was to analyze 156 S. pneumoniae isolates identified as etiological agents of meningitis in Poland in the years 1997 through 2002. The isolates were characterized by multilocus sequence typing (MLST), and the results were compared with those obtained by pulsed-field gel electrophoresis (PFGE) and with the MLST data on invasive pneumococci from other countries. Eighty-nine different sequence types were found in the group of isolates, 50 of which had been known before including 19 of the major invasive clones. However, a significant fraction of the isolates possessed novel combinations of known and new MLST alleles. The majority of penicillin-nonsusceptible isolates belonged to the group of international multiresistant clones (Spain(23F)-1, Spain(6B)-2, Spain(9V)-3, Poland(23F)-16, and Poland(6B)-20), which underlined the importance of these in the dissemination of antimicrobial resistance. The results of the MLST analysis correlated well with the PFGE data, thus again demonstrating good congruence between the two typing methods for S. pneumoniae. The majority of the isolates (95.5%) belonged to families 1 or 2 of the surface protein PspA, confirming its potential usefulness as the vaccine antigen candidate.

Bactériologie des méningites communautaires dans la région de Sfax, Tunisie (1993-2001)

OBJECTIVE

The aim of this study was to analyze the distribution of bacteria responsible for community-acquired meningitis and the pattern of resistance of common species.

DESIGN

All bacteriologically confirmed cases of community-acquired meningitis were recorded between 1993 and 2001.

RESULTS

Two hundred twenty-four cases of bacterial meningitis were recorded. The most frequent species were Haemophilus influenzae and Streptococcus pneumoniae followed by Neisseria meningitidis with respectively 37.1%, 32.1%, and 10.7% of cases. The yearly distribution of these bacteria did not show any epidemic peak. Enterobacteria and group B Streptococcus were the most frequently identified pathogens in neonatal meningitis. H. influenzae was the predominant microorganism in children between one month and five years of age, (66.4%) followed by S. pneumoniae (23.5%). S. pneumoniae was the predominant bacteria responsible fore more than half of the cases over five years of age. 28.8% of H. influenzae strains produced beta-lactamase. 27.2% of S. pneumoniae strains were less susceptible to penicillin. Resistance rates for amoxicillin and cefotaxime were respectively 10.6% and 7.5%. Only one strain of N. meningitidis (4.2%) presented with a decreased susceptibility to penicillin.

CONCLUSIONS

In our study, H. influenzae and S. pneumoniae were the main microorganisms responsible for community-acquired meningitis. High resistance rates were found for these bacteria: 28.8% of H. influenzae to ampicillin and 27.2% of S. pneumoniae to penicillin.

Characteristics of Haemophilus influenzae type b responsible for meningitis in Poland from 1997 to 2004

Two hundred forty-five H. influenzae isolates responsible for meningitis in Poland from 1997 to 2004 were studied. Among these, 233 (95.1%) belonged to serotype b (Hib), 2 belonged to serotype f, and 10 were noncapsulated. The relatedness of all isolates was evaluated by pulsed-field gel electrophoresis (PFGE), and selected representatives were evaluated by multilocus sequence typing. Resistance to ampicillin was identified in 34 (14.6%) of the Hib isolates and was associated with the production of beta-lactamase only. Except for four isolates nonsusceptible to chloramphenicol, all isolates were susceptible to cefotaxime, ciprofloxacin, and rifampin. The PFGE analysis divided the Hib isolates into five PFGE types; however, all of them were possibly related. The most common PFGE type, with 25 subtypes, was characteristic for 97.4% of the isolates. The most prevalent PFGE subtype found in our study was also the most common among the Hib isolates responsible for invasive disease in Italy and the Czech Republic and was found among isolates causing lower respiratory tract infections in Poland. The most prevalent sequence types (STs) in the studied group were ST6 and ST92. Four new STs were found: ST188, ST189, ST190, and ST268. Results of this study support the evidence that the genetic structure of encapsulated H. influenzae is clonal. The continuing high number of meningitis cases due to Hib in Poland underlines the need for mass vaccination against Hib in Poland.

Characteristics of Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis isolated from the nasopharynges of asymptomatic children and molecular analysis of S. pneumoniae and H. influenzae strain replacement in the nasopharynx

Nasopharyngeal carriage of Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis in 226 children in different settings (in a crèche [day care center], in an orphanage, and at home) during two seasons (winter and spring) was studied. The rates of carriage of S. pneumoniae and H. influenzae were markedly higher in the crèche and in the orphanage than in the home setting (e.g., 56.5, 63.3, and 25.9%, respectively, for S. pneumoniae in winter). Approximately 80% of the S. pneumoniae isolates identified in the crèche and in the orphanage belonged to the serotypes represented in the seven-valent pneumococcal vaccine, and 4.4% of the children were colonized by H. influenzae type b. Almost all H. influenzae isolates were fully susceptible to the antimicrobial agents tested, and only five (3.6%) produced beta-lactamase; in contrast, 100% of the M. catarrhalis isolates were beta-lactamase positive. Among S. pneumoniae isolates, 36.2% were nonsusceptible to penicillin (PNSP) and 11.8% were fully resistant to penicillin (PRP). All PNSP isolates were obtained from children at the crèche and at the orphanage but not among children brought up at home, and all PRP isolates showed a multiresistant phenotype. Colonization by PRP isolates correlated well with prior treatment with beta-lactams. For the majority of children colonized at both sampling times, strain replacement of S. pneumoniae and H. influenzae was observed; long-term colonization by a single strain was rare.

Genetic relatedness, antibiotic susceptibility, and serotype distribution of Streptococcus pneumoniae responsible for meningitis in Poland, 1997-2001

Streptococcus pneumoniae is the third most frequent etiologic agent of bacterial meningitis in Poland. Therefore, the objective of this study was to characterize S. pneumoniae isolates responsible for meningitis in Poland from 1997 to 2001 by determining their serotypes, antimicrobial susceptibility, and genetic relatedness. Among 36 serotypes and rough isolates, the most common were serotypes 3, 8, 19F, 6B, 4, and 23F, altogether accounting for 45.3% of cases. Penicillin-nonsusceptible pneumococci constituted 14.8% of all isolates. A high heterogeneity of pneumococcal isolates concerning serological features as well as genetic relatedness based on pulsed-field gel electrophoresis analysis was observed. With the exception of some serotypes (e.g., 3, 7F, 19F), isolates of the same serotype do not appear to be more closely related to each other than to isolates of different serotypes.