Neonatal infection with Neisseria meningitidis: analysis of a 97-year period plus case study

The Diverse Spectrum of Invasive Meningococcal Disease in Pediatric and Adolescent Patients: Narrative Review of Cases and Case Series

INTRODUCTION

Invasive meningococcal disease (IMD) is a potentially life-threatening disease caused by Neisseria meningitidis infection. We reviewed case reports of IMD from newborns, infants, children, and adolescents, and described the real-life clinical presentations, diagnoses, treatment paradigms, and clinical outcomes.

METHODS

PubMed and Embase were searched for IMD case reports on patients aged ≤ 19 years published from January 2011 to March 2023 (search terms "Neisseria meningitidis" or "invasive meningococcal disease", and "infant", "children", "paediatric", pediatric", or "adolescent").

RESULTS

We identified 97 publications reporting 184 cases of IMD, including 25 cases with a fatal outcome. Most cases were in adolescents aged 13-19 years (34.2%), followed by children aged 1-5 years (27.6%), children aged 6-12 years (17.1%), infants aged 1-12 months (17.1%), and neonates (3.9%). The most common disease-causing serogroups were W (40.2%), B (31.7%), and C (10.4%). Serogroup W was the most common serogroup in adolescents (17.2%), and serogroup B was the most common in the other age groups, including children aged 1-5 years (11.5%). The most common clinical presentations were meningitis (46.6%) and sepsis (36.8%).

CONCLUSIONS

IMD continues to pose a threat to the health of children and adolescents. While this review was limited to case reports and is not reflective of global epidemiology, adolescents represented the largest group with IMD. Additionally, nearly half of the patients who died were adolescents, emphasizing the importance of monitoring and vaccination in this age group. Different infecting serogroups were predominant in different age groups, highlighting the usefulness of multivalent vaccines to provide the broadest possible protection against IMD. Overall, this review provides useful insights into real-life clinical presentations, treatment paradigms, diagnoses, and clinical outcomes to help clinicians diagnose, treat, and, ultimately, protect patients from this devastating disease.

Characteristics of Meningococcal Invasive Disease in Neonates and Virulence of the Corresponding Isolates

BACKGROUND

The highest incidence of invasive meningococcal disease (IMD) is observed in infants. However, its prevalence in neonates (≤28 days of age) and the characteristics of the corresponding isolates are less described. This report aimed to analyze meningococcal isolates from neonates.

METHODS

We first screened the database of the national reference center for meningococci in France for confirmed neonatal IMD cases between 1999 and 2019. We then performed whole-genome sequencing on all cultured isolates, and we evaluated their virulence in a mouse model.

RESULTS

Fifty-three neonatal cases of IMD (mainly bacteremia) were identified (50 culture-confirmed cases and 3 PCR-confirmed cases) of a total of 10,149 cases (0.5%) but represented 11% of cases among infants of under 1 year of age. Nine cases (17%) occurred among neonates of 3 days of age and younger (early onset). The neonate isolates were often of serogroup B (73.6%) and belonged to the clonal complex CC41/44 (29.4%) with at least 68.5% of coverage by vaccines against serogroup B isolates. The neonatal isolates were able to infect mice although to variable levels.

CONCLUSION

IMD in neonates is not rare and can be of early or late onsets suggesting that anti-meningococcal vaccination can target women planning to have a baby.

Preventing invasive meningococcal disease in early infancy

This review considers the pathogenesis, diagnosis, and epidemiology of invasive meningococcal disease in infants, to examine and critique meningococcal disease prevention in this population through vaccination. High rates of meningococcal disease and poor outcomes, particularly for very young infants, highlight the importance of meningococcal vaccination in early infancy. Although effective and safe meningococcal vaccines are available for use from 6 weeks of age, they are not recommended globally. Emerging real-world data from the increased incorporation of these vaccines within immunization programs inform recommendations regarding effectiveness, appropriate vaccination schedule, possible long-term safety effects, and persistence of antibody responses. Importantly, to protect infants from IMD, national vaccination recommendations should be consistent with available data regarding vaccine safety, effectiveness, and disease risk.

Neonatal meningococcal disease: an update

Purpose of the review: Neisseria meningitidis is a common cause of sepsis in the pediatric population but is only rarely observed in neonates. The true incidence of the disease in that age group remains undefined. The purpose of this review is to summarize the published data on meningococcal disease in the neonatal period.Materials and methods: All published studies reporting data on neonatal meningococcal disease were included for data extraction. Results: Published cases from around the world show that, while rare, neonatal meningococcal disease is characterized by a high mortality rate and serious neurodevelopmental complications. The initial clinical presentation is atypical and there is a rapid clinical deterioration. Predisposing factors have been described and they include immune deficiencies and maternal genitourinary tract colonization by the pathogen. Transmission can be intrauterine, intrapartum or postpartum. Intrapartum transmission has been linked to conjunctivitis, which serves as a point of entry for the pathogen. Conclusions: Neonatal meningococcal disease remains a rare but potentially fatal disease, whose true incidence is not known. Genitourinary colonization of the mother and nasopharyngeal carriage of both parents should be assessed, especially in early onset cases. N. meningitidis should be suspected in cases of neonatal sepsis and seizures, even in the absence of typical symptoms associated with meningococcemia. A high level of clinical suspicion and quick initiation of therapy are needed to improve the clinical outcome, and patients who survive require long term follow-up to detect possible neurodevelopmental sequelae. Transmission can be intrauterine, intrapartum or postpartum. Intrapartum transmission has been linked to conjunctivitis, which serves as a point of entry for the pathogen. Published case reports from around the world show that, while rare, neonatal meningococcal disease is characterized by a high mortality rate and serious neurodevelopmental complications. The initial clinical presentation is atypical and there is a rapid clinical deterioration within less than 12 h. The objective of this review is to summarize the latest literature on N. meningitidis infections in the neonatal period.

Controlled human infection with Neisseria lactamica in late pregnancy to measure horizontal transmission and microbiome changes in mother-neonate pairs: a single-arm interventional pilot study protocol

INTRODUCTION

Infant upper respiratory microbiota are derived partly from the maternal respiratory tract, and certain microbiota are associated with altered risk of infections and respiratory disease. Neisseria lactamica is a common pharyngeal commensal in young children and is associated with reduced carriage and invasive disease by Neisseria meningitidis. Nasal inoculation with N. lactamica safely and reproducibly reduces N. meningitidis colonisation in healthy adults. We propose nasal inoculation of pregnant women with N. lactamica, to establish if neonatal pharyngeal colonisation occurs after birth, and to characterise microbiome evolution in mother-infant pairs over 1 month post partum.

METHODS AND ANALYSIS

20 healthy pregnant women will receive nasal inoculation with N. lactamica (wild type strain Y92-1009) at 36-38 weeks gestation. Upper respiratory samples, as well as optional breastmilk, umbilical cord blood and infant venous blood samples, will be collected from mother-infant pairs over 1 month post partum. We will assess safety, N. lactamica colonisation (by targeted PCR) and longitudinal microevolution (by whole genome sequencing), and microbiome evolution (by 16S rRNA gene sequencing).

ETHICS AND DISSEMINATION

This study has been approved by the London Central Research Ethics Committee (21/PR/0373). Findings will be published in peer-reviewed open-access journals as soon as possible.

TRIAL REGISTRATION NUMBER

NCT04784845.

Plasmodium vivax and Neisseria meningitidis co-infection in a newborn

Invasive infections due to Neisseria meningitidis in Colombia are unusual in newborns, in contrast to infections due to Plasmodium vivax which is one of the main pathogens related to the presentation of fever in this age group, especially in the indigenous population. We report a case of co-infection of these two microorganisms in a child.

Neisseria Meningitidis Causing Multiple Cerebral Abscesses in Early Neonatal Period: Case Report and Review of Literature

Neisseria meningitidis is a rare cause of meningitis and septicemia in neonates. There are few published case reports of neonatal meningococcal meningitis complicated by subdural empyema, cerebral abscess and hydrocephalus. Few cases of neonatal meningococcal meningitis have been reported in the literature with none of them having the complication of multiple cerebral abscesses in early neonatal period (<seven days of life). We report a case of meningococcal meningitis with multiple cerebral abscesses which presented on fifth day of life and developed hydrocephalus at five weeks of life requiring a Ventriculo Peritoneal (VP) shunt. To the best of our knowledge, this is the first documented case of neonatal meningococcal meningitis with multiple cerebral abscesses.

Neonatal Meningococcal Meningitis In France From 2001 To 2013

Among 831 cases of neonatal bacterial meningitis occurring from 2001 to 2013, Neisseria meningitidis was the third most frequent bacterial species found. All cases occurred only in term neonates and were mainly late onset. Serogroup B accounted for 78% of cases. At diagnosis, 27% of cases had at least one sign of disease severity. All strains were susceptible to cefotaxime, but 12% showed intermediate susceptibility to penicillin G and to aminopenicillin.