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Wang B, Marshall HS. A new era for equity in meningococcal disease prevention. THE LANCET. INFECTIOUS DISEASES 2023; 23:1329-1330. [PMID: 37579772 DOI: 10.1016/s1473-3099(23)00232-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 03/30/2023] [Indexed: 08/16/2023]
Affiliation(s)
- Bing Wang
- Robinson Research Institute and Adelaide Medical School, The University of Adelaide, SA, Australia; Women's and Children's Health Network, Adelaide, SA 5006, Australia
| | - Helen S Marshall
- Robinson Research Institute and Adelaide Medical School, The University of Adelaide, SA, Australia; Women's and Children's Health Network, Adelaide, SA 5006, Australia.
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Shrestha R, Karki S, Khadka M, Sapkota S, Timilsina B, Khadka S. Meningococcemia in an 11 Months Old Infant. Case Rep Infect Dis 2023; 2023:8951318. [PMID: 36936066 PMCID: PMC10017207 DOI: 10.1155/2023/8951318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 10/10/2022] [Accepted: 10/13/2022] [Indexed: 03/21/2023] Open
Abstract
Meningococcemia is the infection of the blood caused by Neisseria meningitidis. Herein, we report a case of meningococcemia in an 11 months old infant who had a high-grade fever, nonblanching purpuric rash over the face and limbs, low blood pressure, tachycardia, and prolonged capillary refill time, but without neck rigidity and focal neurologic signs. He recovered after supportive care and treatment with antibiotics (intravenous ceftriaxone, vancomycin, and teicoplanin). Therefore, in a febrile, ill-looking child in shock with a nonblanching rash, meningococcal disease should be suspected. The study shows the importance of vaccination against meningococcal disease.
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Affiliation(s)
- Rachana Shrestha
- 1Department of Pediatrics, Shree Birendra Hospital, Kathmandu, Nepal
| | | | - Manoj Khadka
- 3Nepalese Army Institute of Health Sciences, Kathmandu, Nepal
| | - Suhail Sapkota
- 4Hospital for Advanced Medicine and Surgery, Kathmandu, Nepal
| | - Bibek Timilsina
- 4Hospital for Advanced Medicine and Surgery, Kathmandu, Nepal
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Spina G, Elena B, Rita C, Eva PM, Mascolo C, Roversi M, Alberto V. Follow-up evaluation of the immunological status of children admitted for acute cerebral nervous system infections: a retrospective study. Ital J Pediatr 2021; 47:22. [PMID: 33531057 PMCID: PMC7851811 DOI: 10.1186/s13052-021-00973-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 01/21/2021] [Indexed: 12/18/2022] Open
Abstract
Background Acute Cerebral Nervous System Infections (ACNS) may cause death or severe complications even to promptly treated children. The role of the immune system in influencing the course and the outcome of meningitis has been studied but it is not yet completely understood. The aim of the research is to ascertain whether children who experienced ACNS infection had a normal immune system. Methods Patients under 18 years of age admitted at Bambino Gesù Children from January 2006 till June 2016 for meningitis were asked to participate to the follow-up study. The immune status was evaluated both clinically and by laboratory investigations. Results Most of the patients over 3 years at follow up had at least one immunological alteration at follow-up evaluation (74%). Considering ACNS infection etiology, certain pathogens were almost exclusive of patients affected by some immunological alteration, regardless of their age. Discussion Our preliminary results indicate that sub-clinical immunological defects may be associated to ACNS pediatric infections. Moreover, to the best of our knowledges, this is the first study correlating pathogens to immune evaluation in ACNS infections. It is, however, important to underline the high frequency of persistent immunological alterations in the analyzed patients. Further studies are needed to confirm our conclusions. Conclusions We recommend an immunological assessment at follow up evaluation in children who experienced an ACNS infection.
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Affiliation(s)
- Giulia Spina
- University/Hospital Department of Pediatrics, Pediatric and Infectious Diseases Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
| | - Bozzola Elena
- University/Hospital Department of Pediatrics, Pediatric and Infectious Diseases Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Carsetti Rita
- B cell Physiopathology Unit, Immunology Research Area, Bambino Gesù Children Hospital, Rome, Italy
| | - Piano Mortari Eva
- B cell Physiopathology Unit, Immunology Research Area, Bambino Gesù Children Hospital, Rome, Italy
| | - Cristina Mascolo
- University/Hospital Department of Pediatrics, Pediatric and Infectious Diseases Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Marco Roversi
- University/Hospital Department of Pediatrics, Pediatric and Infectious Diseases Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Villani Alberto
- University/Hospital Department of Pediatrics, Pediatric and Infectious Diseases Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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Fulminant Neisseria meningitidis septicaemia with purpura fulminans requiring limb amputation. IDCases 2019; 19:e00673. [PMID: 31879595 PMCID: PMC6920294 DOI: 10.1016/j.idcr.2019.e00673] [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: 10/13/2019] [Revised: 11/17/2019] [Accepted: 11/17/2019] [Indexed: 12/05/2022] Open
Abstract
Despite the isolation of Neisseria meningitidis over 200 years ago, meningococcal disease remains a feared cause of bacterial sepsis, with significant morbidity and mortality, despite prompt antibiotic use and modern critical care support. Neisseria meningitides is a Gram-negative encapsulated diplococcus, which exists only in the human host (Kvalsvig and Unsworth, 2003). The bacterium can cause life-threatening septic shock and coagulopathy, which may rapidly manifest within a matter of hours from preceding mild symptoms (Kvalsvig and Unsworth, 2003). Whilst N. meningitidis is recognised as a common commensal organism in the nasopharynx, associated with asymptomatic carriage in up to 10 %, manifestation of life-threatening disease is rare (Rappuoli and Pizza, 2015). We report the case of 31-year-old male presenting with devastating meningococcal septicaemia with disseminated intravascular coagulopathy (DIC) and purpura fulminans, requiring surgical debridement and a right above-knee amputation for sepsis-driven skin necrosis. The patient suffered extensive tissue loss secondary to a type 3 immune hypersensitivity reaction involving immune-complex mediated inflammation and tissue necrosis. Due to a strong immune component driving the patient’s failure to convalesce pulsed intravenous methylprednisolone was used alongside antimicrobial therapy. The use of steroids was associated with fever subsidence and significant clinical improvement, highlighting the benefit of corticosteroid use in immune-complex mediated pathology.
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Abstract
BACKGROUND Bacterial meningitis is a significant burden of disease and mortality in all age groups worldwide despite the development of effective conjugated vaccines. The pathogenesis of bacterial meningitis is based on complex and incompletely understood host-pathogen interactions. Some of these are pathogen-specific, while some are shared between different bacteria. METHODS We searched the database PubMed to identify host risk factors for bacterial meningitis caused by the pathogens Streptococcus pneumoniae, Neisseria meningitidis and Haemophilus influenzae type b, because they are three most common causative bacteria beyond the neonatal period. RESULTS We describe a number of risk factors; including socioeconomic factors, age, genetic variation of the host and underlying medical conditions associated with increased susceptibility to invasive bacterial infections in both children and adults. CONCLUSIONS As conjugated vaccines are available for these infections, it is of utmost importance to identify high risk patients to be able to prevent invasive disease.
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Affiliation(s)
- Lene Fogt Lundbo
- a Department of Infectious Diseases , Copenhagen University Hospital , Hvidovre , Denmark.,b Clinical Research Centre , Copenhagen University Hospital , Hvidovre , Denmark.,c Faculty of Health and Medical Sciences , University of Copenhagen , København , Denmark
| | - Thomas Benfield
- a Department of Infectious Diseases , Copenhagen University Hospital , Hvidovre , Denmark.,b Clinical Research Centre , Copenhagen University Hospital , Hvidovre , Denmark.,c Faculty of Health and Medical Sciences , University of Copenhagen , København , Denmark
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6
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Gupta N, Shah K, Singh M. An epitope-imprinted piezoelectric diagnostic tool forNeisseria meningitidisdetection. J Mol Recognit 2016; 29:572-579. [DOI: 10.1002/jmr.2557] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Revised: 05/07/2016] [Accepted: 06/25/2016] [Indexed: 11/11/2022]
Affiliation(s)
- Neha Gupta
- Department of Chemistry, MMV; Banaras Hindu University; Varanasi U.P. -221005 India
| | - Kavita Shah
- Institute of Environment and Sustainable Development; Banaras Hindu University; Varanasi U.P. -221005 India
| | - Meenakshi Singh
- Department of Chemistry, MMV; Banaras Hindu University; Varanasi U.P. -221005 India
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Khatami A, Pollard AJ. The epidemiology of meningococcal disease and the impact of vaccines. Expert Rev Vaccines 2014; 9:285-98. [DOI: 10.1586/erv.10.3] [Citation(s) in RCA: 100] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Khatami A, Snape MD, Davis E, Layton H, John T, Yu LM, Dull PM, Gill CJ, Odrjlin T, Dobson S, Halperin SA, Langley JM, McNeil SA, Pollard AJ. Persistence of the immune response at 5 years of age following infant immunisation with investigational quadrivalent MenACWY conjugate vaccine formulations. Vaccine 2012; 30:2831-8. [PMID: 22394992 DOI: 10.1016/j.vaccine.2012.02.046] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2011] [Revised: 01/14/2012] [Accepted: 02/20/2012] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND AIMS Serogroup A, C, W-135 and Y meningococcal (MenACWY) conjugate vaccines are recommended for routine adolescent immunisation in the United States and Canada. We evaluated the persistence of bactericidal antibodies through early childhood, following infant immunisation with varying schedules of MenACWY-CRM(197) vaccine. METHODS UK and Canadian infants were immunised with 2-3 doses of MenACWY-CRM(197) or 2 doses of serogroup C meningococcal (MenC) conjugate vaccine, and either MenACWY-CRM(197), 1/5 dose of MenACWY polysaccharide vaccine or no booster at 12 months. Control groups recruited at 60 months had received country-specific infant doses of MenC conjugate vaccine. hSBA titres were measured in participants at 40 and 60 months of age. RESULTS 382 children were enrolled in 12 groups (22-40 per group). By age 60 months, 3-11% of children primed and boosted with MenACWY-CRM(197) had hSBA titres≥1:8 against serogroup A, 14-45% against serogroup C, 57-85% against serogroup W-135 and 42-71% against serogroup Y. Children primed with MenC and boosted with MenACWY-CRM(197) had similar results, except for serogroup C (59%). In age-matched controls administered MenC vaccine at 2, 3, and 4 months (UK), 2 and 12 months or 12 months only (Canada), percentages with hSBA titres≥1:8 were 0-3%, 29-53%, 34-36% and 10-29% against serogroups A, C, W-135 and Y respectively. CONCLUSIONS Serogroup-specific bactericidal antibody wane following infant immunisation with MenACWY-CRM(197), most markedly against serogroup A. Best persistence against serogroup C is observed with MenC conjugate vaccine priming and MenACWY-CRM(197) at 12 months, compared to schedules using only MenACWY-CRM(197), with the potential for providing broader protection compared to monovalent MenC vaccines alone.
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Affiliation(s)
- Ameneh Khatami
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, UK.
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Concomitant administration of Mycobacterium bovis BCG with the meningococcal C conjugate vaccine to neonatal mice enhances antibody response and protective efficacy. CLINICAL AND VACCINE IMMUNOLOGY : CVI 2011; 18:1936-42. [PMID: 21900528 DOI: 10.1128/cvi.05247-11] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Mycobacterium bovis BCG is administered to human neonates in many countries worldwide. The objective of the study was to assess if BCG could act as an adjuvant for polysaccharide-protein conjugate vaccines in newborns and thereby induce protective immunity against encapsulated bacteria in early infancy when susceptibility is high. We assessed whether BCG could enhance immune responses to a meningococcal C (MenC) conjugate vaccine, MenC-CRM(197), in mice primed as neonates, broaden the antibody response from a dominant IgG1 toward a mixed IgG1 and IgG2a/IgG2b response, and increase protective efficacy, as measured by serum bactericidal activity (SBA). Two-week-old mice were primed subcutaneously (s.c.) with MenC-CRM(197). BCG was administered concomitantly, a day or a week before MenC-CRM(197). An adjuvant effect of BCG was observed only when it was given concomitantly with MenC-CRM(197), with increased IgG response (P = 0.002) and SBA (8-fold) after a second immunization with MenC-CRM(197) without BCG, indicating increased T-cell help. In neonatal mice (1 week old) primed s.c. with MenC-CRM(197) together with BCG, MenC-polysaccharide (PS)-specific IgG was enhanced compared to MenC-CRM(197) alone (P = 0.0015). Sixteen days after the second immunization with MenC-CRM(197), increased IgG (P < 0.05), IgG1 (P < 0.05), IgG2a (P = 0.06), and IgG2b (P < 0.05) were observed, and only mice primed with MenC-CRM(197) plus BCG showed affinity maturation and detectable SBA (SBA > 128). Thus, vaccination with a meningococcal conjugate vaccine (and possibly with other conjugates) may benefit from concomitant administration of BCG in the neonatal period to accelerate and enhance production of protective antibodies, compared to the current infant administration of conjugate which follows BCG vaccination at birth.
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Misra N, Panda PK, Shah K, Sukla LB, Chaubey P. Population coverage analysis of T-Cell epitopes of Neisseria meningitidis serogroup B from Iron acquisition proteins for vaccine design. Bioinformation 2011; 6:255-61. [PMID: 21738325 PMCID: PMC3124689 DOI: 10.6026/97320630006255] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2011] [Accepted: 06/01/2011] [Indexed: 01/10/2023] Open
Abstract
Although the concept of Reverse Vaccinology was first pioneered for sepsis and meningococcal meningitidis causing bacterium, Neisseria meningitides, no broadly effective vaccine against serogroup B meningococcal disease is yet available. In the present investigation, HLA distribution analysis was undertaken to select three most promiscuous T-cell epitopes out of ten computationally validated epitopes of Iron acquisition proteins from Neisseria MC58 by using the population coverage tool of Immune Epitope Database (IEDB). These epitopes have been determined on the basis of their binding ability with maximum number of HLA alleles along with highest population coverage rate values for all the geographical areas studied. The comparative population coverage analysis of moderately immunogenic and high immunogenic peptides suggests that the former may activate T-cell response in a fairly large proportion of people in most geographical areas, thus indicating their potential for development of epitope-based vaccine.
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Affiliation(s)
- Namrata Misra
- Bioresources Engineering Department, Institute of Minerals and Materials Technology (formerly Regional Research Lab), CSIR, Bhubaneswar-751013, Orissa,India
| | - Prasanna Kumar Panda
- Bioresources Engineering Department, Institute of Minerals and Materials Technology (formerly Regional Research Lab), CSIR, Bhubaneswar-751013, Orissa,India
| | - Kavita Shah
- Environmental Biochemistry and Bioinformatics Lab, Department of Zoology, Mahila Mahavidyalaya, Banaras Hindu University, Varanasi-221 005, India
| | - Lala Bihari Sukla
- Bioresources Engineering Department, Institute of Minerals and Materials Technology (formerly Regional Research Lab), CSIR, Bhubaneswar-751013, Orissa,India
| | - Priyanka Chaubey
- Environmental Biochemistry and Bioinformatics Lab, Department of Zoology, Mahila Mahavidyalaya, Banaras Hindu University, Varanasi-221 005, India
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Gupta SK, Smita S, Sarangi AN, Srivastava M, Akhoon BA, Rahman Q, Gupta SK. In silico CD4+ T-cell epitope prediction and HLA distribution analysis for the potential proteins of Neisseria meningitidis Serogroup B—A clue for vaccine development. Vaccine 2010; 28:7092-7. [DOI: 10.1016/j.vaccine.2010.08.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2010] [Revised: 07/22/2010] [Accepted: 08/02/2010] [Indexed: 01/11/2023]
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Abstract
The long pentraxin 3 (PTX3) is an important element of the innate immune system and has potential as a diagnostic tool in inflammatory conditions. We studied PTX3 in patients admitted to an intensive care unit with severe meningococcal disease and compared it with the short pentraxin C-reactive protein (CRP). Twenty-six patients with meningococcal disease were studied, 17 patients presented with meningococcal septic shock (shock group), and 9 patients presented with meningococcal meningitis or bacteremia (no-shock group). Pentraxin 3 and CRP were measured by enzyme-linked immunosorbent assay. High plasma concentrations of PTX3 (median, 579 microg/L) were seen at admission in patients with meningococcal disease. Concentrations were significantly higher in patients with shock compared with patients without shock (medians, 801 and 256 microg/L, respectively; P = 0.006). In contrast, CRP at admission was lower in the shock group as compared with the no-shock group (medians, 58 and 165 mg/L, respectively; P = 0.008). High PTX3 and low CRP concentration at admission discriminated between presence and absence of shock (area under the receiver operating characteristic curve, 0.85; P = 0.007 for PTX3 and area under the receiver operating characteristic curve, 0.84; P = 0.01 for CRP). PTX3 did not correlate with disease severity (pediatric risk of mortality) and days spent in the intensive care unit. PTX3 at admission and PTX3 peak concentration both showed a negative correlation with plasma fibrinogen concentrations. C-reactive protein concentration at admission correlated negatively with disease severity. In conclusion, PTX3 was an early indicator of shock in patients with severe meningococcal disease that followed a pattern of induction distinct from CRP.
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Brynjolfsson SF, Bjarnarson SP, Mori E, Del Giudice G, Jonsdottir I. Neonatal immune response and serum bactericidal activity induced by a meningococcal conjugate vaccine is enhanced by LT-K63 and CpG2006. Vaccine 2008; 26:4557-62. [PMID: 18597905 DOI: 10.1016/j.vaccine.2008.05.083] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2008] [Revised: 05/13/2008] [Accepted: 05/29/2008] [Indexed: 11/20/2022]
Abstract
Neonates have a poorly developed immune system. Therefore it is important to develop vaccination strategies that induce protective immunity and immunological memory against pathogens early in life. The immunogenicity of a meningococcal serogroup C polysaccharide conjugate (MenC-CRM(197)) was assessed in neonatal mice, and effects of LT-K63 and CpG2006 and immunisation routes were compared. Neonatal mice were primed subcutaneously (s.c.) or intranasally (i.n.) with MenC-CRM(197) with or without LT-K63 or CpG2006 and re-immunised 16 and 30 days later by the same route and formulation. Antibody levels were measured and generation of immunological memory assessed by affinity maturation and kinetics of the Ab response. Serum bactericidal activity (SBA) was measured to evaluate protective efficacy. The second and third dose of MenC-CRM(197) mixed with either LT-K63 or CpG2006 induced a rapid increase in MenC-specific IgG antibodies, to levels higher than elicited by MenC-CRM(197) alone (P<0.01) and in unimmunised mice (P<0.001), indicating efficient generation of memory by priming through both s.c. and i.n. routes. SBA was detected after three s.c. immunisations with MenC-CRM(197) s.c. alone. However, only two doses of MenC-CRM(197)+LT-K63 or MenC-CRM(197)+CpG2006 were needed to induce SBA levels>16. LT-K63 and CpG2006 enhanced neonatal antibody responses, affinity maturation, immunological memory to the conjugate MenC-CRM(197) and protective immunity. These results encourage the development of neonatal vaccination strategies to induce protective immunity and immunological memory against meningococcal disease.
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Holub M, Scheinostová M, Džupová O, Fišerová A, Beran O, Kalmusová J, Musílek M, Křížová P. Neisseria meningitidis strains from patients with invasive meningococcal disease differ in stimulation of cytokine production. Folia Microbiol (Praha) 2007; 52:525-8. [DOI: 10.1007/bf02932114] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Affiliation(s)
- C Anthony Hart
- Department of Medical Microbiology, University of Liverpool, Liverpool L69 3GA.
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Kvalsvig AJ, Baker M, Mills G. Prehospital parenteral penicillin for meningitis: Urgent review of treatment criteria is needed. BMJ 2006; 332:1451. [PMID: 16777895 PMCID: PMC1479676 DOI: 10.1136/bmj.332.7555.1451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Robinson K, Wooldridge KG, Wells DB, Hasan A, Todd I, Robins A, James R, Ala'Aldeen DAA. T-cell-stimulating protein A elicits immune responses during meningococcal carriage and human disease. Infect Immun 2005; 73:4684-93. [PMID: 16040981 PMCID: PMC1201220 DOI: 10.1128/iai.73.8.4684-4693.2005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
In recognition of the need for immunological memory-inducing components for future Neisseria meningitidis group B vaccines, we previously searched the proteome of N. meningitidis and identified T-cell-stimulating protein A (TspA). This study was designed to confirm the immunogencity of TspA and to examine the subset of T-helper cell responses to the protein in patients and nasopharyngeal carriers. The tspA gene was reconstructed, cloned, and expressed in Escherichia coli, and the recombinant TspA (rTspA) protein was affinity purified. T-cell proliferative responses to rTspA were detected in the peripheral blood mononuclear cells (PBMCs) of convalescent patients and carriers, confirming that TspA-specific T-cell responses were stimulated by invasive disease and nasopharyngeal colonization. Following stimulation of PBMCs with meningococcal lysate, increased frequencies of both Th1 and Th2 cells were observed, indicating that, as during carriage, invasive meningococcal disease induced an unbiased T-helper subset response. A similar unbiased T-helper response was also detected against rTspA in the PBMCs of convalescent patients. The response of PBMCs from the carriers to TspA stimulation, however, was very weak, and the frequencies of cytokine-positive CD4 cells were not significantly greater than the frequencies in unstimulated control cultures. All of the patients and carriers responded with serum antimeningococcal immunoglobulin G (IgG) antibodies, while four of six samples from patients and 5 of 14 samples from carriers contained detectable anti-rTspA IgG antibodies. Taken together, the results of this study confirmed the immunogenicity of TspA in humans during natural meningococcal infection, and therefore, TspA is worthy of further investigation as a possible T-cell stimulating component of future vaccines.
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Affiliation(s)
- Karen Robinson
- Division of Microbiology and Infectious Diseases, A Floor West Block, University Hospital, Nottingham, NG7 2UH United Kingdom
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Jordens JZ, Williams JN, Jones GR, Christodoulides M, Heckels JE. Development of immunity to serogroup B meningococci during carriage of Neisseria meningitidis in a cohort of university students. Infect Immun 2004; 72:6503-10. [PMID: 15501781 PMCID: PMC523012 DOI: 10.1128/iai.72.11.6503-6510.2004] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Understanding the basis of protective immunity is a key requirement for the development of an effective vaccine against infection with Neisseria meningitidis of serogroup B. We have conducted a longitudinal study into the dynamics of meningococcal acquisition and carriage in first-year university students. The detection of carriage of serogroup B meningococci correlated with an increase in detection of serum bactericidal activity (SBA) against both colonizing and heterologous serogroup B strains. Once induced, SBA remained high throughout the study. Although students showed increases in antibodies reactive with capsular polysaccharide and lipopolysaccharide (LPS), these antibody responses were transitory, and their decline was not accompanied by a corresponding decline in SBA. In contrast, there was a significant correlation between the presence of antibodies to the PorA outer membrane protein and SBA against both homologous and heterologous strains. SBA induced by a PorA-negative mutant confirmed the contribution of PorA to heterologous activity. Increases in SBA against a range of serogroup B strains were also observed in students in whom no meningococcal carriage was detected. This heterologous protection could not be associated with the presence of antibodies reacting with capsule, LPS, PorA, PorB, Rmp, Opa, Opc, or pilin, demonstrating that other, as yet unidentified, antigens contribute to the development of immunity to serogroup B meningococci. Identification of such antigens with the ability to induce an effective cross-reactive bactericidal response to a range of strains would be a major step in the production of a universally effective vaccine against infections caused by serogroup B meningococci.
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Affiliation(s)
- J Zoe Jordens
- Molecular Microbiology and Infection Group, University of Southampton Medical School, UK
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19
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Haase MR. Acute Bacterial Meningitis in Children. J Pharm Pract 2004. [DOI: 10.1177/0897190004270422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Despite advances in recent decades in management, including new and effective antimicrobials, children with bacterial meningitis still incur significant morbidity and mortality. Pathophysiologic processes including colonization and migration of the bacteria to blood, seeding of the meninges, and meningeal and brain inflammation have been largely elucidated, but more specific knowledge could lead to new effective therapies. Outside of the neonatal period, the most common causative organisms have been Haemophilus influenzae, Streptococcus pneumoniae, and Neisseria meningitidis. However, conjugate vaccines, especially the H influenzae type b preparation, have contributed significantly to steep declines in the incidence of meningitis. Optimal management consists of rapid diagnosis and administration of bactericidal antibiotics with properties allowing adequate penetration of the inflamed blood-brain barrier. Recently, development of microbial resistance has resulted in changes to recommended empiric antibiotic regimens. Novel therapies are under investigation; however, until controlled trials can be conducted, these therapies cannot be recommended.
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Affiliation(s)
- Mark R. Haase
- Texas Tech University, HSC School of Pharmacy, 1300 S. Coulter, Suite 206, Amarillo, TX 79106-1712
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Parsons HK, Vitovski S, Sayers JR. Immunoglobulin A1 proteases: a structure–function update. Biochem Soc Trans 2004; 32:1130-2. [PMID: 15506988 DOI: 10.1042/bst0321130] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
IgA1 (immunoglobulin A1) antibodies are the first line of defence against microbial pathogens such as Neisseria meningitidis and Haemophilus influenzae. However, these bacteria secrete a site-specific protease that is capable of cleaving human IgA1 and interacting with other host components. The IgA proteases are released by the type V secretion pathway, which involves translocation through two membranes and an autolytic, post-translational processing step. Results reported recently throw light on the type V secretion pathway and on the roles of the multifunctional IgA protease. The IgA1 protease-recognition sequence is present within the IgA1 hinge region as well as in the variable sequence connecting the IgA1 protease to its translocator domain. Recent results suggest that neisserial IgA1 proteases are capable of cleaving substrates lacking the classical recognition sequence. This review will cover recent advances in the IgA protease field.
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Affiliation(s)
- H K Parsons
- School of Medical and Biomedical Sciences, University of Sheffield, Henry Wellcome Laboratories for Medical Research, Beech Hill Rd, Sheffield S10 2RF, UK
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