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Rachina S, Shchendrygina A, de Silva HR, Tarasenko S, Mukhina N, Komarova I, Fedina L, Burmistrova E, Martens E, Sidorenko S, Gostev V, Polev D, Saitova A, Kraeva L, Goncharov N, Zvetkova I. A rare case of cardiac and ophthalmic manifestations of meningococcal septicemia. World J Emerg Med 2024; 15:328-330. [PMID: 39050214 PMCID: PMC11265629 DOI: 10.5847/wjem.j.1920-8642.2024.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 05/10/2024] [Indexed: 07/27/2024] Open
Affiliation(s)
- Svetlana Rachina
- Department of Hospital Therapy, I M Sechenov First Moscow State Medical University, Moscow 119048, Russia
- Outpatient Clinic #64, Moscow 119048, Russia
| | - Anastasia Shchendrygina
- Department of Hospital Therapy, I M Sechenov First Moscow State Medical University, Moscow 119048, Russia
| | - Heshan Radeesha de Silva
- Department of Hospital Therapy, I M Sechenov First Moscow State Medical University, Moscow 119048, Russia
| | | | - Nadezhda Mukhina
- Department of Hospital Therapy, I M Sechenov First Moscow State Medical University, Moscow 119048, Russia
| | - Irina Komarova
- Department of Hospital Therapy, I M Sechenov First Moscow State Medical University, Moscow 119048, Russia
| | - Ludmila Fedina
- Department of Cardiology, City Clinical Hospital n.a. S.S. Yudin, Moscow 119048, Russia
| | - Elena Burmistrova
- Department of Cardiology, City Clinical Hospital n.a. S.S. Yudin, Moscow 119048, Russia
| | - Elvira Martens
- Department of Medical Microbiology and Molecular Epidemiology, Pediatric Research and Clinical Center for Infectious Diseases, Saint Petersburg 197022, Russia
- Department of Medical Microbiology, North-Western State Medical University Named After I. I. Mechnikov, Saint Petersburg 191015, Russia
| | - Sergey Sidorenko
- Department of Medical Microbiology and Molecular Epidemiology, Pediatric Research and Clinical Center for Infectious Diseases, Saint Petersburg 197022, Russia
- Department of Medical Microbiology, North-Western State Medical University Named After I. I. Mechnikov, Saint Petersburg 191015, Russia
| | - Vladimir Gostev
- Department of Medical Microbiology and Molecular Epidemiology, Pediatric Research and Clinical Center for Infectious Diseases, Saint Petersburg 197022, Russia
- Department of Medical Microbiology, North-Western State Medical University Named After I. I. Mechnikov, Saint Petersburg 191015, Russia
| | - Dmitry Polev
- Department of Epidemiology, Saint-Petersburg Pasteur Institute, Saint Petersburg 197101, Russia
| | - Alina Saitova
- Department of Epidemiology, Saint-Petersburg Pasteur Institute, Saint Petersburg 197101, Russia
| | - Lyudmila Kraeva
- Department of Epidemiology, Saint-Petersburg Pasteur Institute, Saint Petersburg 197101, Russia
| | - Nikita Goncharov
- Department of Epidemiology, Saint-Petersburg Pasteur Institute, Saint Petersburg 197101, Russia
| | - Irina Zvetkova
- Department of Medical Microbiology and Molecular Epidemiology, Pediatric Research and Clinical Center for Infectious Diseases, Saint Petersburg 197022, Russia
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Bertrand-Gerentes I, Fanchon L, Coste F, Glover RE, Guiddir T, Taha MK. Range of Clinical Manifestations Caused by Invasive Meningococcal Disease Due to Serogroup W: A Systematic Review. Infect Dis Ther 2023; 12:2337-2351. [PMID: 37751017 PMCID: PMC10600084 DOI: 10.1007/s40121-023-00869-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 09/01/2023] [Indexed: 09/27/2023] Open
Abstract
INTRODUCTION Invasive meningococcal disease (IMD) due to serogroup W meningococci (MenW) is consistently reported with atypical clinical manifestations, including gastrointestinal symptoms, bacteremic pneumonia, and septic arthritis. We undertook a systematic review of the literature for a comprehensive assessment of the clinical presentation of IMD caused by MenW. METHODS PubMed and Embase databases were searched from inception to June 2022 using a combination of MeSH terms and free text for articles that reported symptoms and signs of MenW IMD, and associated manifestations. RESULTS The most commonly reported symptoms identified included: fever (range 36-100% of cases), nausea and/or vomiting (range 38-47%), vomiting (range 14-68%), cough (range 7-57%), sore throat (range 13-34%), headache (range 7-50%), diarrhea (range 8-47%), altered consciousness/mental status (range 7-38%), stiff neck (range 7-54%), and nausea (range 7-20%). Sepsis (range 15-83% of cases) was the most commonly reported manifestation followed by meningitis (range 5-72%), sepsis and meningitis (range 6-74%), bacteremic pneumonia (range 4-24%), arthritis (range 1-15%), and other manifestations (e.g., pharyngitis/epiglottitis/supraglottitis/tonsillitis/conjunctivitis; range 1-24%). The case fatality rates ranged from 8-40%, and among the survivors 4-14% had long-term sequelae. CONCLUSIONS Clinicians need to be aware of the nonspecific symptoms and signs of IMD, as well as of the atypical manifestations in regions where MenW is known to circulate to ensure timely diagnoses and treatment.
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Affiliation(s)
| | - Laurent Fanchon
- Global Medical Affairs, Sanofi, 14 Espace Henry Vallée, 69007 Lyon, France
| | - Florence Coste
- Global Medical Affairs, Sanofi, 14 Espace Henry Vallée, 69007 Lyon, France
| | - Richard E. Glover
- Springer Healthcare Ltd, Chowley Oak Lane, Tattenhall, CH3 9GA Chester UK
| | - Tamazoust Guiddir
- Department of Pediatrics, Paris-Saclay University, APHP, Bicêtre Hospital, 78 Avenue du Général Leclerc, 94270 Le Kremlin-Bicêtre, France
| | - Muhamed-Kheir Taha
- Institut Pasteur, Université Paris Cité, Invasive Bacterial Infections, National Reference Centre for Meningococci and Haemophilus Influenzae, 25-28 Rue du Dr Roux, 75015 Paris, France
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Chiou CS, Liao YS, Chen BH, Lu MC, Hong YP, Wang YW, Teng RH. Demographic Features of Invasive Meningococcal Disease in Taiwan, 1993 to 2020, and Genetic Characteristics of Neisseria meningitidis Isolates, 2003 to 2020. Microbiol Spectr 2022; 10:e0088222. [PMID: 35862973 PMCID: PMC9430714 DOI: 10.1128/spectrum.00882-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 06/23/2022] [Indexed: 11/23/2022] Open
Abstract
We present the demographic features of invasive meningococcal disease (IMD) in Taiwan between 1993 and 2020 and the genetic characteristics of Neisseria meningitidis isolates recovered from 2003 to 2020. IMD was rare in Taiwan between 1993 and 2020, with an annual incidence ranging from 0.009 to 0.204 per 100,000 people. The case fatality rate (CFR) declined from 18.1% for patients in 1993 to 2002 to 9.8% in 2003 to 2020. Infants less than 12 months were most susceptible to the disease. N. meningitidis serogroup B (NmB) was most predominant, responsible for 81.2% (134/165) of the IMD cases in 2003 to 2020. The majority of the isolates recovered from 2003 to 2020 belonged to 4 worldwide-spread hyperinvasive clonal complexes (cc), cc4821 (30.3%), cc32 (19.4%), cc41/44 (12.7%), cc23 (7.3%), and also a newly assigned clonal complex, cc3439 (10.3%). Core genome multilocus sequence typing (cgMLST) profile comparisons revealed that the cc4821 isolates with a T-to-I substitution at position 91 in gyrA were closely related to those originating from China. Of the 165 isolates, 20.0% and 53.3% were predicted to be covered by the Bexsero and Trumenba vaccines, respectively, whereas, 77.0% and 46.7% remained indeterminate. In conclusion, N. meningitidis isolates recovered in Taiwan between 2003 and 2020 were mostly highly diverse. Most IMD cases appeared sporadically and were caused by localized strains, although some patients were infected by recently introduced strains. cgMLST is a powerful tool for the rapid comparison of genetic relatedness among a large number of isolates. cgMLST profiling, based on 1,241 core genes, and strain tracking can be performed on the website of cgMLST@Taiwan (http://rdvd.cdc.gov.tw/cgMLST/). IMPORTANCE N. meningitidis can cause life-threatening invasive meningococcal disease (IMD), including meningitis and sepsis, resulting in a high CFR and long-term sequelae in survivors. Here, we report the demographic features of IMD in Taiwan over a 28-year period (1993 to 2020) and the genetic characteristics of N. meningitidis isolates recovered from patients with IMD over an 18-year period (2003 to 2020). We conducted a whole-genome sequence analysis to characterize the genetic features of the isolates and developed a cgMLST scheme for epidemiological investigation and strain tracking. The findings can be beneficial in understanding the epidemiology of IMD in Taiwan, the genetic characteristics of the bacterial strains, and the distribution of vaccine antigens for vaccine development and implementation.
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Affiliation(s)
- Chien-Shun Chiou
- Center for Diagnostics and Vaccine Development, Centers for Disease Control, Taichung, Taiwan
| | - Ying-Shu Liao
- Center for Diagnostics and Vaccine Development, Centers for Disease Control, Taichung, Taiwan
| | - Bo-Han Chen
- Center for Diagnostics and Vaccine Development, Centers for Disease Control, Taichung, Taiwan
| | - Min-Chi Lu
- Department of Microbiology and Immunology, School of Medicine, China Medical University, Taichung, Taiwan
| | - Yu-Ping Hong
- Center for Diagnostics and Vaccine Development, Centers for Disease Control, Taichung, Taiwan
| | - You-Wun Wang
- Center for Diagnostics and Vaccine Development, Centers for Disease Control, Taichung, Taiwan
| | - Ru-Hsiou Teng
- Center for Diagnostics and Vaccine Development, Centers for Disease Control, Taichung, Taiwan
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Daguerre C, Marx T, Desmettre T. Coup de chaleur ou sepsis ? Une bactériémie à méningocoque chez un ouvrier du bâtiment en période caniculaire. ANNALES FRANCAISES DE MEDECINE D URGENCE 2022. [DOI: 10.3166/afmu-2022-0410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Atypical presentation of Neisseria meningitidis serogroup W disease is associated with the introduction of the 2013 strain. Epidemiol Infect 2021; 149:e126. [PMID: 33910672 PMCID: PMC8161285 DOI: 10.1017/s0950268821001035] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Since 2015, the incidence of invasive meningococcal disease (IMD) caused by serogroup W (MenW) has increased in Sweden, due to the introduction of the 2013 strain belonging to clonal complex 11. The aim of this study was to describe the clinical presentation of MenW infections, in particular the 2013 strain, including genetic associations. Medical records of confirmed MenW IMD cases in Sweden during the years 1995–2019 (n = 113) were retrospectively reviewed and the clinical data analysed according to strain. Of all MenW patients, bacteraemia without the focus of infection was seen in 44%, bacteraemic pneumonia in 26%, meningitis in 13% and epiglottitis in 8%, gastrointestinal symptoms in 48% and 4% presented with petechiae. Phylogenetic analysis was used for possible links between genetic relationship and clinical picture. The 2013 strain infections, particularly in one cluster, were associated with more severe disease compared with other MenW infections. The patients with 2013 strain infections (n = 68) were older (52 years vs. 25 years for other strains), presented more often with diarrhoea as an atypical presentation (P = 0.045) and were more frequently admitted for intensive care (P = 0.032). There is a risk that the atypical clinical presentation of MenW infections, with predominantly gastrointestinal or respiratory symptoms rather than neck stiffness or petechiae, may lead to delay in life-saving treatment.
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Abstract
Neisseria meningitidis, a gram-negative diplococcus, is typically an asymptomatic coloniser of the oropharynx and nasopharynx. Passage of N. meningitidis into the bloodstream can cause invasive meningococcal disease (IMD), a potentially life-threatening illness with rapid onset that generally presents as meningitis, septicemia or both. Serogroup W IMD has been increasing in prevalence in recent years, and observations suggest that it may present with atypical signs and symptoms. Herein, a literature search was performed to identify trends in atypical serogroup W IMD presentation in order to review those that are most prevalent. Findings indicate that the most prevalent atypical presentations of serogroup W IMD include acute gastrointestinal (GI) symptoms, septic arthritis and bacteremic pneumonia or severe upper respiratory tract infection, notably epiglottitis. Atypical clinical presentation is associated with higher case fatality rates and can lead to misdiagnoses. Such risks highlight the need for clinicians to consider IMD in their differential diagnoses of patients with acute GI symptoms, septic arthritis or bacteremic pneumonia, primarily in regions where serogroup W is prevalent.
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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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Vossen M, Mitteregger D, Steininger C. Meningococcal pneumonia. Vaccine 2016; 34:4364-70. [PMID: 27443594 DOI: 10.1016/j.vaccine.2016.07.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 07/07/2016] [Accepted: 07/11/2016] [Indexed: 10/21/2022]
Abstract
Neisseria meningitidis remains the most important cause of bacterial meningitis worldwide, particularly in children and young adults. The second most common and a potentially severe end-organ manifestation of invasive meningococcal disease (excluding systemic sepsis) is meningococcal pneumonia. It occurs in between 5% and 15% of all patients with invasive meningococcal disease and is thus the second most common non-systemic end-organ manifestation. To establish the diagnosis requires a high level of clinical awareness - the incidence is therefore very likely underreported and underestimated. This review of 344 meningococcal pneumonia cases reported in the Americas, Europe, Australia, and Asia between 1906 and 2015 presents risk factors, pathogenesis, clinical manifestations, diagnostic approaches, treatment, and prognosis of meningococcal pneumonia.
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Affiliation(s)
- Matthias Vossen
- Department of Medicine I, Div. of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Vienna, Austria
| | - Dieter Mitteregger
- Department of Laboratory Medicine, Div. of Clinical Microbiology, Medical University of Vienna, Vienna, Austria
| | - Christoph Steininger
- Department of Medicine I, Div. of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Vienna, Austria.
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Bethea J, Makki S, Gray S, MacGregor V, Ladhani S. Clinical characteristics and public health management of invasive meningococcal group W disease in the East Midlands region of England, United Kingdom, 2011 to 2013. Euro Surveill 2016; 21:30259. [DOI: 10.2807/1560-7917.es.2016.21.24.30259] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 02/15/2016] [Indexed: 11/20/2022] Open
Abstract
In England and Wales, meningococcal disease caused by group W has historically been associated with outbreaks of disease among travellers to high-risk countries. Following a large outbreak associated with travel to the Hajj in 2000, the number of cases declined and, in 2008, only 19 laboratory-confirmed cases were identified nationally. In 2013, in the East Midlands region of England, eight cases of meningococcal disease caused by this serogroup were recorded, compared with six from 2011 to 2012. To explore this further, data for all cases with a date of onset between 1 January 2011 and 31 December 2013 were collected. Data collected included geographical location, clinical presentation and outcome. Fourteen cases were identified; two died as a result of their illness and two developed long-term health problems. No commonality in terms of geographical location, shared space or activities was identified, suggesting that group W is circulating endemically with local transmission. Clinical presentation was variable. Half presented with symptoms not typical of a classical meningococcal disease, including two cases of cellulitis, which may have implications for clinicians, in terms of timely identification and treatment, and public health specialists, for offering timely antibiotic chemoprophylaxis to close contacts.
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Affiliation(s)
- Jane Bethea
- Centre for Medicine, Department of Health Sciences, College of Medicine, Biological Sciences and Psychology, The University of Leicester, Leicester, United Kingdom
| | - Sophia Makki
- Public Health England East Midlands, Nottingham, United Kingdom
| | - Steve Gray
- Public Health England, Manchester, United Kingdom
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Huang LM, Chiu NC, Yeh SJ, Bhusal C, Arora AK. Immunogenicity and safety of a single dose of a CRM-conjugated meningococcal ACWY vaccine in children and adolescents aged 2-18 years in Taiwan: results of an open label study. Vaccine 2014; 32:5177-84. [PMID: 25075804 DOI: 10.1016/j.vaccine.2014.07.063] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Revised: 06/21/2014] [Accepted: 07/17/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND MenACWY-CRM (Menveo®, Novartis Vaccines, Siena, Italy) is a quadrivalent meningococcal conjugate vaccine developed to help prevent invasive meningococcal disease caused by Neisseria meningitidis serogroups A, C, W, and Y. It is approved within the European Union in persons >2 years of age and in persons from 2 months to 55 years of age in the United States, among other countries. Little is known about the immunogenicity and safety of this vaccine in Taiwanese children >2 years and adolescents. This study assessed the immunogenicity and safety of a single injection of MenACWY-CRM vaccine in Taiwanese subjects aged 2-18 years old. METHODS In this phase III, multicentre, open-label study 341 subjects received one dose of MenACWY-CRM. Immunogenicity measures were rates of seroresponse (defined as the proportion of subjects with a postvaccination hSBA ≥1:8 if the prevaccination (baseline) titre was <1:4, or at least a fourfold higher hSBA titre than baseline if the prevaccination titre was ≥1:4), percentages of subjects with serum bactericidal activity (hSBA) ≥1:8 for serogroups A, C, W and Y and hSBA geometric mean titres (GMTs). Local and systemic reactions and all adverse events (AEs) were recorded for 7 days, and medically attended AEs for 1 month post-vaccination. RESULTS Seroresponse rates after MenACWY-CRM vaccination at Day 29 for the serogroups A, C, W, and Y were 83%, 93%, 50%, and 65%, respectively. At Day 29 the percentages of subjects with hSBA ≥1:8 against all four serogroups A, C, W and Y were: 83%, 96%, 96% and 82%, respectively. GMTs against all serogroups rose by ≥7-fold from baseline to Day 29. The vaccine was well tolerated. CONCLUSIONS A single dose of MenACWY-CRM demonstrated a robust immune response, and an acceptable safety profile in Taiwanese children and adolescents.
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Affiliation(s)
- Li-Min Huang
- Department of Pediatrics, National Taiwan University Hospital, No. 8, Chung-Shan S. Rd., Taipei 10048, Taiwan
| | - Nan-Chang Chiu
- Department of Pediatrics, Mackay Memorial Hospital, No. 92, Sec. 2, Chung-Shan N. Rd., Taipei 10449, Taiwan
| | - Shu-Jen Yeh
- Far Eastern Memorial Hospital, No. 21, Nan-Ya S. Rd., Sec. 2, Pan-Chiao, Taipei 22060, Taiwan
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11
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Vermeulen RCW, Vermeulen van Eck IWG. Decreased oxygen extraction during cardiopulmonary exercise test in patients with chronic fatigue syndrome. J Transl Med 2014; 12:20. [PMID: 24456560 PMCID: PMC3903040 DOI: 10.1186/1479-5876-12-20] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Accepted: 01/22/2014] [Indexed: 12/03/2022] Open
Abstract
Background The insufficient metabolic adaptation to exercise in Chronic Fatigue Syndrome (CFS) is still being debated and poorly understood. Methods We analysed the cardiopulmonary exercise tests of CFS patients, idiopathic chronic fatigue (CFI) patients and healthy visitors. Continuous non-invasive measurement of the cardiac output by Nexfin® (BMEYE B.V. Amsterdam, the Netherlands) was added to the cardiopulmonary exercise tests. The peak oxygen extraction by muscle cells and the increase of cardiac output relative to the increase of oxygen uptake (ΔQ’/ΔV’O2) were measured, calculated from the cardiac output and the oxygen uptake during incremental exercise. Results The peak oxygen extraction by muscle cells was 10.83 ± 2.80 ml/100ml in 178 CFS women, 11.62 ± 2.90 ml/100 ml in 172 CFI, and 13.45 ± 2.72 ml/100 ml in 11 healthy women (ANOVA: P=0.001), 13.66 ± 3.31 ml/100 ml in 25 CFS men, 14.63 ± 4.38 ml/100 ml in 51 CFI, and 19.52 ± 6.53 ml/100 ml in 7 healthy men (ANOVA: P=0.008). The ΔQ’/ΔV’O2 was > 6 L/L (normal ΔQ’/ΔV’O2 ≈ 5 L/L) in 70% of the patients and in 22% of the healthy group. Conclusion Low oxygen uptake by muscle cells causes exercise intolerance in a majority of CFS patients, indicating insufficient metabolic adaptation to incremental exercise. The high increase of the cardiac output relative to the increase of oxygen uptake argues against deconditioning as a cause for physical impairment in these patients.
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Affiliation(s)
- Ruud C W Vermeulen
- CFS/ME Medical Centre Amsterdam, Waalstraat 25-31, Amsterdam 1078BR, Netherlands.
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Jafri RZ, Ali A, Messonnier NE, Tevi-Benissan C, Durrheim D, Eskola J, Fermon F, Klugman KP, Ramsay M, Sow S, Zhujun S, Bhutta ZA, Abramson J. Global epidemiology of invasive meningococcal disease. Popul Health Metr 2013; 11:17. [PMID: 24016339 PMCID: PMC3848799 DOI: 10.1186/1478-7954-11-17] [Citation(s) in RCA: 251] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Accepted: 09/06/2013] [Indexed: 11/16/2022] Open
Abstract
Neisseria meningitidis is one of the leading causes of bacterial meningitis globally and can also cause sepsis, pneumonia, and other manifestations. In countries with high endemic rates, the disease burden places an immense strain on the public health system. The worldwide epidemiology of invasive meningococcal disease (IMD) varies markedly by region and over time. This review summarizes the burden of IMD in different countries and identifies the highest-incidence countries where routine preventive programs against Neisseria meningitidis would be most beneficial in providing protection. Available epidemiological data from the past 20 years in World Health Organization and European Centre for Disease Prevention and Control collections and published articles are included in this review, as well as direct communications with leading experts in the field. Countries were grouped into high-, moderate-, and low-incidence countries. The majority of countries in the high-incidence group are found in the African meningitis belt; many moderate-incidence countries are found in the European and African regions, and Australia, while low-incidence countries include many from Europe and the Americas. Priority countries for vaccine intervention are high- and moderate-incidence countries where vaccine-preventable serogroups predominate. Epidemiological data on burden of IMD are needed in countries where this is not known, particularly in South- East Asia and Eastern Mediterranean regions, so evidence-based decisions about the use of meningococcal vaccines can be made.
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Affiliation(s)
- Rabab Z Jafri
- Department of Pediatrics and Child Health, Division of Women and Child Health, Aga Khan University, Stadium Road, Karachi, Pakistan
| | - Asad Ali
- Department of Pediatrics and Child Health, Division of Women and Child Health, Aga Khan University, Stadium Road, Karachi, Pakistan
| | | | - Carol Tevi-Benissan
- Immunisation, Vaccines and Biologicals, World Health Organisation, Geneva, Switzerland
| | - David Durrheim
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Health Protection, Hunter New England Area, Wallsend, Australia
| | - Juhani Eskola
- Finnish National Institute for Health and Welfare (THL), Helsinki, Finland
| | - Florence Fermon
- International vaccination working group, Médécins Sans Frontières, Paris, France
| | - Keith P Klugman
- Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Respiratory and Meningeal Pathogens Research Unit, University of Witwatersrand and Medical Research Council, Johannesburg, South Africa
| | - Mary Ramsay
- Immunisation Department at the Health Protection Agency, Centre for Infections in Colindale, London, UK
| | - Samba Sow
- Center for Vaccine Development, Ministry of Health, Bamako, Mali
- School of Medicine, University of Maryland, Baltimore, MD, USA
| | - Shao Zhujun
- Institute for Communicable Disease Control and Prevention, Beijing, People’s Republic of China
| | - Zulfiqar A Bhutta
- Department of Pediatrics and Child Health, Division of Women and Child Health, Aga Khan University, Stadium Road, Karachi, Pakistan
| | - Jon Abramson
- Wake Forest School of Medicine, Winston-Salem, NC, USA
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13
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Ladhani SN, Lucidarme J, Newbold LS, Gray SJ, Carr AD, Findlow J, Ramsay ME, Kaczmarski EB, Borrow R. Invasive meningococcal capsular group Y disease, England and Wales, 2007-2009. Emerg Infect Dis 2012; 18:63-70. [PMID: 22261040 PMCID: PMC3310110 DOI: 10.3201/eid1801.110901] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Increases may result from mutations that allow the organism to evade the immune system. Enhanced national surveillance for invasive meningococcal disease in England and Wales identified an increase in laboratory-confirmed capsular group Y (MenY) disease from 34 cases in 2007 to 44 in 2008 and 65 in 2009. For cases diagnosed in 2009, patient median age at disease onset was 60 years; 39% of patients had underlying medical conditions, and 19% died. MenY isolates causing invasive disease during 2007–2009 belonged mainly to 1 of 4 clonal complexes (cc), cc23 (56% of isolates), cc174 (21%), cc167 (11%), and cc22 (8%). The 2009 increase resulted primarily from sequence type 1655 (cc23) (22 cases in 2009, compared with 4 cases each in 2007 and 2008). cc23 was associated with lpxL1 mutations and meningitis in younger age groups (<25 years); cc174 was associated with nonmeningitis, particularly pneumonia, in older age groups (>65 years). The increase in MenY disease requires careful epidemiologic and molecular monitoring.
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Affiliation(s)
- Shamez N Ladhani
- Department, Health Protection Agency Colindale, 61 Colindale Ave, London NW9 5EQ, UK.
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Hollanda LM, Cury GC, Pereira RF, Ferreira GA, Sousa A, Sousa EM, Lancellotti M. Effect of mesoporous silica under Neisseria meningitidis transformation process: environmental effects under meningococci transformation. J Nanobiotechnology 2011; 9:28. [PMID: 21787408 PMCID: PMC3152511 DOI: 10.1186/1477-3155-9-28] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2011] [Accepted: 07/25/2011] [Indexed: 11/17/2022] Open
Abstract
Background This study aimed the use of mesoporous silica under the naturally transformable Neisseria meningitidis, an important pathogen implicated in the genetic horizontal transfer of DNA causing a escape of the principal vaccination measures worldwide by the capsular switching process. This study verified the effects of mesoporous silica under N. meningitidis transformation specifically under the capsular replacement. Methods we used three different mesoporous silica particles to verify their action in N. meningitis transformation frequency. Results we verified the increase in the capsular gene replacement of this bacterium with the three mesoporous silica nanoparticles. Conclusion the mesouporous silica particles were capable of increasing the capsule replacement frequency in N. meningitidis.
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Affiliation(s)
- Luciana M Hollanda
- Department of Biochemistry, Institute of Biology CP6109, State University of Campinas UNICAMP, CP: 6109-CEP 13083-970, Campinas, SP, Brazil
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VYSE A, WOLTER JM, CHEN J, NG T, SORIANO-GABARRO M. Meningococcal disease in Asia: an under-recognized public health burden. Epidemiol Infect 2011; 139:967-85. [PMID: 21492496 PMCID: PMC3105449 DOI: 10.1017/s0950268811000574] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2011] [Indexed: 01/02/2023] Open
Abstract
A literature search traced existing information on meningococcal disease in Asia. Reviewed data describing the epidemiology of meningococcal disease in Asia are incomplete, due in part to absence of surveillance in many countries, poor bacterial detection methods and social and healthcare barriers to disease reporting. This suggests that meningococcal disease in some Asian countries may be under-recognized, with a need to introduce/improve existing surveillance and case identification systems. Nevertheless, in some developing Asian countries, the disease burden may be significant. Serogroup A meningococcal epidemics are responsible for high morbidity and mortality in some countries and continue to be an ongoing threat, particularly in developing countries. There is an increasing role played by serogroups C, Y, and W-135 in invasive disease, indicating evolving meningococcal disease epidemiology in some countries. Multivalent meningococcal conjugate vaccines offer new opportunities in the region for reducing the meningococcal disease burden.
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Affiliation(s)
- A. VYSE
- GlaxoSmithKline Biologicals Group of Companies, Wavre, Belgium
| | | | - J. CHEN
- GlaxoSmithKline Biologicals Group of Companies, Wavre, Belgium
| | - T. NG
- GlaxoSmithKline Biologicals Group of Companies, Wavre, Belgium
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16
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Abstract
BACKGROUND/AIM Meningococcal disease most often manifests itself as meningitis or sepsis. During the course of these diseases, other clinical events sometimes develop such as pneumonia, pericarditis, arthritis, and they are referred to as extrameningeal or systemic manifestations of the meningococcal disease. The aim of this study was to investigate the type and the incidence of particular extrameningeal/systemic manifestations among patients with meningococcal meningitis and sepsis, including time of their onset and the influence on the disease outcome. METHODS The retrospective study of the medical records of 246 patients treated for meningococcal disease over the 25-year period in the Institute for Infectious and Tropical Diseases, Belgrade was conducted. The patients, aged 3 months to 82 years both sexes, were divided into two groups. RESULTS Out of 246 patients extrameningeal/systemic manifestations were found in 42 (17.1%) patients: 35 (14.2%) occurred during meningitis, and seven (2.8%) during sepsis. Pulmonary manifestations (mostly pneumonia) were the most prevalent, found in 12 (4.9%) patients, followed by heart involvement in nine (3.6%) patients (mostly pericarditis, in seven or 2.8% patients). Various ophthalmic manifestations occurred in seven (2.8%), arthritis in 4 (1.6%) and sinusitis in six (2.4%) patients. Otitis, multiple renal embolisms with hematuria, osteomyelitis and thrombophlebitis were evidenced in one patient, each. Most of the systemic manifestations (30 patients or 71.4%), developed within the initial three days of the disease (p < 0.01), suggesting direct pathogenic mechanism induced by meningococci per se, while only three (7.1%) developed after seven days, when immune-mediated disease was more likely. Even though these manifestations complicate and prolong treatment of the meningococcal disease, they had no major influence on the disease outcome. Lethal outcome occurred in 2 (4.76%) patients, both with the meningococcal type of the disease. CONCLUSION Extrameningeal or systemic manifestations are uncommon complications during the course of both meningococcal meningitis and sepsis. The onset of pneumonia, pericarditis, eye involvement, and arthritis, within the initial seven days of the disease, were most prevalent in the course of meningitis. They had no major influence on the disease outcome.
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W135 invasive meningococcal strains spreading in South America: significant increase in incidence rate in Argentina. J Clin Microbiol 2009; 47:1979-80. [PMID: 19357205 DOI: 10.1128/jcm.02390-08] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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von Gottberg A, du Plessis M, Cohen C, Prentice E, Schrag S, de Gouveia L, Coulson G, de Jong G, Klugman K. Emergence of Endemic Serogroup W135 Meningococcal Disease Associated with a High Mortality Rate in South Africa. Clin Infect Dis 2008; 46:377-86. [DOI: 10.1086/525260] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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