1887

Abstract

Scientific knowledge of meningococcal infection has increased greatly since the epidemic nature of the illness was first described by Vieusseux at the dawn of the nineteenth century. In fact, revolutionary advances have been made in public-health measures, antimicrobial therapy, diagnostic procedures, anti-inflammatory drugs and supportive care facilities. Based on the knowledge accumulated to date, it is generally accepted that the pathogenesis of meningococcal infection involves multiple links that interconnect in a complex web of phenomena from attachment to meningococcal sepsis or meningitis. In fact, a myriad of strongly interacting inflammatory molecules and cells have been implicated in neisserial infection, illustrating the complexity of meningococcal pathogenesis. In addition, many of these signallers are critically involved in outcomes in the human host. Deciphering the pathogenesis of meningococcal infection could expand our knowledge and provide important clues to the host–pathogen interaction, as well as leading to the development of new therapeutic tools. Herein, we review the history of the discovery and characterization of meningococcal disease, epidemiological features of the disease with an emphasis on recent developments in Brazil, the cellular and molecular basis of disease, and discuss diagnosis and therapy.

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2008-11-01
2024-03-28
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References

  1. Anderson M. S., Glodé M. P., Smith A. L. 1998; Meningococcal disease. In Textbook of Pediatric Infectious Diseases , 4th edn. pp 1143–1156 Edited by Feigi R. D., Cherry J. D. Philadelphia, PA: W. B. Saunders;
    [Google Scholar]
  2. Annane D., Bellissant E., Cavaillon J. M. 2005; Septic shock. Lancet 365:63–78 [CrossRef]
    [Google Scholar]
  3. Arias I. M., Henning T. D., Alba L. M., Rubio S. 2007; A meningococcal endocarditis in a patient with Sweet's syndrome. Int J Cardiol 117:e51–e52 [CrossRef]
    [Google Scholar]
  4. Baines P. B., Stanford S., Bishop-Bailey D., Sills J. A., Thomson A. P., Mitchell J. A., Fear S. C., Hart C. A., Petros A. J. 1999; Nitric oxide production in meningococcal disease is directly related to disease severity. Crit Care Med 27:1187–1190 [CrossRef]
    [Google Scholar]
  5. Barquet N., Gasser I., Domingo P., Moraga F. A., Macaya A., Elcuaz R. 1990; Primary meningococcal conjunctivitis: report of 21 patients and review. Rev Infect Dis 12:838–847 [CrossRef]
    [Google Scholar]
  6. Bhutta Z. A., Khan I. K., Agha Z. 1991; Fatal intrauterine meningococcal infection. Pediatr Infect Dis J 10:868–869 [CrossRef]
    [Google Scholar]
  7. Bille E., Zahar J. R., Perrin A., Morelle S., Kriz P., Jolley K. A., Maiden M. C., Dervin C., Nassif X., Tinsley C. R. 2005; A chromosomally integrated bacteriophage in invasive meningococci. J Exp Med 201:1905–1913 [CrossRef]
    [Google Scholar]
  8. Bjerre A., Brusletto B., Høiby E. A., Kierulf P., Brandtzaeg P. 2004; Plasma interferon- γ and interleukin-10 concentrations in systemic meningococcal disease compared with severe systemic Gram-positive septic shock. Crit Care Med 32:433–438 [CrossRef]
    [Google Scholar]
  9. Brandtzaeg P., van Deuren M. 2002; Current concepts in the role of the host response in Neisseria meningitidis septic shock. Curr Opin Infect Dis 15:247–252 [CrossRef]
    [Google Scholar]
  10. Brandtzaeg P., Mollnes T. E., Kierulf P. 1989a; Complement activation and endotoxin levels in systemic meningococcal disease. J Infect Dis 160:58–65 [CrossRef]
    [Google Scholar]
  11. Brandtzaeg P., Sandset P. M., Joo G. B., Ovstebo R., Abildgaard U., Kierulf P. 1989b; The quantitative association of plasma endotoxin, antithrombin, protein C, extrinsic pathway inhibitor and fibrinopeptide A in systemic meningococcal disease. Thromb Res 55:459–470 [CrossRef]
    [Google Scholar]
  12. Brandtzaeg P., Kierulf P., Gaustad P., Skulberg A., Bruun J. N., Halvorsen S., Sorensen E. 1989c; Plasma endotoxin as a predictor of multiple organ failure and death in systemic meningococcal disease. J Infect Dis 159:195–204 [CrossRef]
    [Google Scholar]
  13. Brandtzaeg P., Halstensen A., Kierulf P., Espevik T., Waage A. 1992a; Molecular mechanisms in the compartmentalized inflammatory response presenting as meningococcal meningitis or septic shock. Microb Pathog 13:423–431 [CrossRef]
    [Google Scholar]
  14. Brandtzaeg P., Ovsteboo R., Kierulf P. 1992b; Compartmentalization of lipopolysaccharide production correlates with clinical presentation in meningococcal disease. J Infect Dis 166:650–652 [CrossRef]
    [Google Scholar]
  15. Buysse C. M., Raat H., Hazelzet J. A., Hop W. C., Maliepaard M., Joosten K. F. 2008; Surviving meningococcal septic shock: health consequences and quality of life in children and their parents up to 2 years after pediatric intensive care unit discharge. Crit Care Med 36:596–602 [CrossRef]
    [Google Scholar]
  16. Constantin D., Cordenier A., Robinson K., Ala'Aldeen D. A., Murphy S. 2004; Neisseria meningitidis -induced death of cerebrovascular endothelium: mechanisms triggering transcriptional activation of inducible nitric oxide synthase. J Neurochem 89:1166–1174 [CrossRef]
    [Google Scholar]
  17. Danielson L., Mann E. 1806; The history of a singular and very mortal disease, which lately made its appearance in Medfield. Med Agric Reg 1:65–69
    [Google Scholar]
  18. de Moraes J. C., Barata R. B. 2005; Meningococcal disease in Sao Paulo, Brazil, in the 20th century: epidemiological characteristics. Cad Saude Publica 21:1458–1471
    [Google Scholar]
  19. den Brinker M., Joosten K. F., Visser T. J., Hop W. C., de Rijke Y. B., Hazelzet J. A., Boonstra V. H., Hokken-Koelega A. C. 2005; Euthyroid sick syndrome in meningococcal sepsis: the impact of peripheral thyroid hormone metabolism and binding proteins. J Clin Endocrinol Metab 90:5613–5620 [CrossRef]
    [Google Scholar]
  20. de Souza A. L., Seguro A. C. 2007; Pericarditis secondary to Neisseria meningitidis : a potential cytokine network pathway. Echocardiography 24:780 [CrossRef]
    [Google Scholar]
  21. de Souza A. L., Seguro A. C. 2008; Purpura fulminans secondary to Streptococcus pneumoniae sepsis: unraveling the pattern of cytokines. Am J Med 121:e5
    [Google Scholar]
  22. de Souza A. L., Marques Salgado M., Romano C. C., Alkmin M. G., Sztajnbok J., Vidal J. E., Duarte A. J., Seguro A. C. 2006a; Cytokine activation in purulent pericarditis caused by Neisseria meningitidis serogroup C. Int J Cardiol 113:419–421 [CrossRef]
    [Google Scholar]
  23. de Souza A. L., Sztajnbok J., Marques Salgado M., Romano C. C., Alkmin M. G., Duarte A. J., Seguro A. C. 2006b; Compartmentaflization of interleukin-6 response in a patient with septic meningococcal peritonitis. Clin Vaccine Immunol 13:1287–1290 [CrossRef]
    [Google Scholar]
  24. de Souza A. L., Salgado M. M., Alkmin M. D., Sztajnbok J., Seguro A. C. 2006c; Purulent pericarditis caused by Neisseria meningitidis serogroup C and confirmed through polymerase chain reaction. Scand J Infect Dis 38:143–145 [CrossRef]
    [Google Scholar]
  25. de Souza A. L., Rodrigues C., Sztajnbok J., Andrade L., Romano C. C., Duarte A. J., Seguro A. C. 2006d; Hypoelectrolytemia accompanied by acute renal failure in exertional heatstroke. Am J Emerg Med 24:888–889 [CrossRef]
    [Google Scholar]
  26. de Souza A. L., Andrade L., Seguro A. C. 2007a; Purpura fulminans without meningitis: a rare condition?. Am J Med 120:e17 [CrossRef]
    [Google Scholar]
  27. de Souza A. L., Sztajnbok J., Marques Salgado M., Romano C. C., Alkmin M. G., Duarte A. J., Seguro A. C. 2007b; Severe myalgia of the lower extremities as the first clinical feature of meningococcal purpura fulminans. Am J Trop Med Hyg 77:723–726
    [Google Scholar]
  28. de Souza A. L., de Oliveira A. C., Romano C. C., Sztajnbok J., Duarte A. J., Seguro A. C. 2008a; Interleukin-6 activation in ischemic stroke caused by Neisseria meningitidis serogroup C. Int J Cardiol 127:e160–e163 [CrossRef]
    [Google Scholar]
  29. de Souza A. L., Sztajnbok J., Seguro A. C. 2008b; Cerebellar hemorrhage as an atypical complication of meningococcal meningitis. Int J Infect Dis 12:558–559 [CrossRef]
    [Google Scholar]
  30. DeVoe I. W. 1982; The meningococcus and mechanisms of pathogenicity. Microbiol Rev 46:162–190
    [Google Scholar]
  31. Eisenhut M., Wallace H., Barton P., Gaillard E., Newland P., Diver M., Southern K. W. 2006; Pulmonary edema in meningococcal septicemia associated with reduced epithelial chloride transport. Pediatr Crit Care Med 7:119–124 [CrossRef]
    [Google Scholar]
  32. Emonts M., Hazelzet J. A., de Groot R., Hermans P. W. 2003; Host genetic determinants of Neisseria meningitidis infections. Lancet Infect Dis 3:565–577 [CrossRef]
    [Google Scholar]
  33. Faur Y. C., Weisburd M. H., Wilson M. E. 1975; Isolation of Neisseria meningitidis from the genito-urinary tract and anal canal. J Clin Microbiol 2:178–182
    [Google Scholar]
  34. Faust S. N., Levin M., Harrison O. B., Goldin R. D., Lockhart M. S., Kondaveeti S., Laszik Z., Esmon C. T., Heyderman R. S. 2001; Dysfunction of endothelial protein C activation in severe meningococcal sepsis. N Engl J Med 345:408–416 [CrossRef]
    [Google Scholar]
  35. Fiorito S. M., Galarza P. G., Sparo M., Pagano E. I., Oviedo C. I. 2001; An unusual transmission of Neisseria meningitidis : neonatal conjunctivitis acquired at delivery from the mother's endocervical infection. Sex Transm Dis 28:29–32 [CrossRef]
    [Google Scholar]
  36. Flexner S. 1906; Experimental cerebrospinal meningitis and its serum treatment. JAMA 47:560–566
    [Google Scholar]
  37. Flexner S. 1913; The results of the serum treatment in thirteen hundred cases of epidemic meningitis. J Exp Med 17:553–576 [CrossRef]
    [Google Scholar]
  38. Godinho V. 1906; Meningite cerebroespinhal epidêmica. Revista Médica de São Paulo IX:129–132
    [Google Scholar]
  39. Hardman J. M., Earle K. M. 1969; Myocarditis in 200 fatal meningococcal infections. Arch Pathol 87:318–325
    [Google Scholar]
  40. Herrick W. W. 1919; Extrameningeal meningococcus infections. Arch Intern Med 23:409–418 [CrossRef]
    [Google Scholar]
  41. Holland P. C., Hancock S. W., Hodge D., Thompson D., Shires S., Evans S. 2001; Degradation of albumin in meningococcal sepsis. Lancet 357:2102–2104 [CrossRef]
    [Google Scholar]
  42. Holland P. C., Thompson D., Hancock S., Hodge D. 2002; Calciphylaxis, proteases, and purpura: an alternative hypothesis for the severe shock, rash, and hypocalcemia associated with meningococcal septicemia. Crit Care Med 30:2757–2761 [CrossRef]
    [Google Scholar]
  43. Inkelis S. H., O'Leary D., Wang V. J., Malley R., Nicholson M. K., Kuppermann N. 2002; Extremity pain and refusal to walk in children with invasive meningococcal disease. Pediatrics 110:e3 [CrossRef]
    [Google Scholar]
  44. Johansson L., Rytkonen A., Bergman P., Albiger B., Kallstrom H., Hokfelt T., Agerberth B., Cattaneo R., Jonsson A. B. 2003; CD46 in meningococcal disease. Science 301:373–375 [CrossRef]
    [Google Scholar]
  45. Joosten K. F., de Kleijn E. D., Westerterp M., de Hoog M., Eijck F. C., Hop W. C. J., Voort E. V., Hazelzet J. A., Hokken-Koelega A. C. 2000; Endocrine and metabolic responses in children with meningococcal sepsis: striking differences between survivors and nonsurvivors. J Clin Endocrinol Metab 85:3746–3753 [CrossRef]
    [Google Scholar]
  46. Judson F. N., Ehret J. M., Eickhoff T. C. 1978; Anogenital infection with Neisseria meningitidis in homosexual men. J Infect Dis 137:458–463 [CrossRef]
    [Google Scholar]
  47. Kennedy K. J., Roy J., Lamberth P. 2006; Invasive meningococcal disease presenting with cellulitis. Med J Aust 184:421
    [Google Scholar]
  48. Kiefer F. 1896; Zur differential diagnose des erregers der epidemischen cerebrospinalmeningitis und der gonorrhoea. Berl Klin Wochenschr 33:628–630
    [Google Scholar]
  49. Kolb-Maurer A., Unkmeir A., Kammerer U., Hubner C., Leimbach T., Stade A., Kampgen E., Frosch M., Dietrich G. 2001; Interaction of Neisseria meningitidis with human dendritic cells. Infect Immun 69:6912–6922 [CrossRef]
    [Google Scholar]
  50. Kornelisse R. F., Hazelzet J. A., Hop W. C., Spanjaard L., Suur M. H., van der Voort E., de Groot R. 1997; Meningococcal septic shock in children: clinical and laboratory features, outcome, and development of a prognostic score. Clin Infect Dis 25:640–646 [CrossRef]
    [Google Scholar]
  51. Lourenco M. C., Reis R. S., Andrade A. C., Tuyama M., Barroso D. E. 2006; Subclinical infection of the genital tract with Neisseria meningitidis . Braz J Infect Dis 10:154–155 [CrossRef]
    [Google Scholar]
  52. Marotto M. S., Marotto P. C., Sztajnbok J., Seguro A. C. 1997; Outcome of acute renal failure in meningococcemia. Ren Fail 19:807–810 [CrossRef]
    [Google Scholar]
  53. Mogensen T. H., Paludan S. R., Kilian M., Ostergaard L. 2006; Live Streptococcus pneumoniae , Haemophilus influenzae , and Neisseria meningitidis activate the inflammatory response through Toll-like receptors 2, 4, and 9 in species-specific patterns. J Leukoc Biol 80:267–277 [CrossRef]
    [Google Scholar]
  54. Musher D. M. 2003; How contagious are common respiratory tract infections?. N Engl J Med 348:1256–1266 [CrossRef]
    [Google Scholar]
  55. Nadel S., Kroll J. S. 2007; Diagnosis and management of meningococcal disease: the need for centralized care. FEMS Microbiol Rev 31:71–83 [CrossRef]
    [Google Scholar]
  56. Nadel S., Goldstein B., Williams M. D., Dalton H., Peters M., Macias W. L., Abd-Allah S. A., Levy H., Angle R. other authors 2007; Researching severe sepsis and organ dysfunction in children: a global perspective (RESOLVE) study group. Drotrecogin alfa (activated) in children with severe sepsis: a multicentre phase III randomised controlled trial. Lancet 369:836–843 [CrossRef]
    [Google Scholar]
  57. Nassif X. 2000; Microbiology. a furtive pathogen revealed. Science 287:1767–1768 [CrossRef]
    [Google Scholar]
  58. Nassif X., Bourdoulous S., Eugene E., Couraud P. O. 2002; How do extracellular pathogens cross the blood-brain barrier?. Trends Microbiol 10:227–232 [CrossRef]
    [Google Scholar]
  59. Pathan N., Hemingway C. A., Alizadeh A. A., Stephens A. C., Boldrick J. C., Oragui E. E., McCabe C., Welch S. B., Whitney A. other authors 2004; Role of interleukin 6 in myocardial dysfunction of meningococcal septic shock. Lancet 363:203–209 [CrossRef]
    [Google Scholar]
  60. Robboy S. J. 1972; Atrioventricular-node inflammation – mechanism of sudden death in protracted meningococcemia. N Engl J Med 286:1091–1093 [CrossRef]
    [Google Scholar]
  61. Rothbaum E., Nicholson O., Prince A. 2006; Cerebral abscess associated with meningococcal meningitis. Pediatr Infect Dis J 25:754–756 [CrossRef]
    [Google Scholar]
  62. Rytkonen A., Albiger B., Hansson-Palo P., Kallstrom H., Olcen P., Fredlund H., Jonsson A. B. 2004; Neisseria meningitidis undergoes PilC phase variation and PilE sequence variation during invasive disease. J Infect Dis 189:402–409 [CrossRef]
    [Google Scholar]
  63. Sacchi C. T., Zanella R. C., Caugant D. A., Frasch C. E., Hidalgo N. T., Milagres L. G., Pessoa L. L., Ramos S. R., Camargo M. C., Melles C. E. 1992; Emergence of a new clone of serogroup C Neisseria meningitidis in São Paulo. Brazil. J Clin Microbiol 30:1282–1286
    [Google Scholar]
  64. Scheld W. M., Koedel U., Nathan B., Pfister H. W. 2002; Pathophysiology of bacterial meningitis: mechanism(s) of neuronal injury. J Infect Dis 186 (Suppl. 2):S225–S233 [CrossRef]
    [Google Scholar]
  65. Serruto D., Adu-Bobie J., Scarselli M., Veggi D., Pizza M., Rappuoli R., Arico B. 2003; Neisseria meningitidis App, a new adhesin with autocatalytic serine protease activity. Mol Microbiol 48:323–334 [CrossRef]
    [Google Scholar]
  66. Stephens D. S., Greenwood B., Brandtzaeg P. 2007; Epidemic meningitis, meningococcaemia, and Neisseria meningitidis . Lancet 369:2196–2210 [CrossRef]
    [Google Scholar]
  67. Swartz M. N. 2004; Bacterial meningitis – a view of the past 90 years. N Engl J Med 351:1826–1828 [CrossRef]
    [Google Scholar]
  68. Thompson M. J., Ninis N., Perera R., Mayon-White R., Phillips C., Bailey L., Harnden A., Mant D., Levin M. 2006; Clinical recognition of meningococcal disease in children and adolescents. Lancet 367:397–403 [CrossRef]
    [Google Scholar]
  69. Urra E., Alkorta M., Sota M., Alcala B., Martinez I., Barron J., Cisterna R. 2005; Orogenital transmission of Neisseria meningitidis serogroup C confirmed by genotyping techniques. Eur J Clin Microbiol Infect Dis 24:51–53 [CrossRef]
    [Google Scholar]
  70. van Amersfoort E. S., Van Berkel T. J., Kuiper J. 2003; Receptors, mediators, and mechanisms involved in bacterial sepsis and septic shock. Clin Microbiol Rev 16:379–414 [CrossRef]
    [Google Scholar]
  71. van der Flier M., Geelen S. P., Kimpen J. L., Hoepelman I. M., Tuomanen E. I. 2003; Reprogramming the host response in bacterial meningitis: how best to improve outcome?. Clin Microbiol Rev 16:415–429 [CrossRef]
    [Google Scholar]
  72. van Deuren M., Neeleman C., Assmann K. J., Wetzels J. F., van der Meer J. W. 1998; Rhabdomyolysis during the subacute stage of meningococcal sepsis. Clin Infect Dis 26:214–215 [CrossRef]
    [Google Scholar]
  73. van Deuren M., Brandtzaeg P., van der Meer J. W. 2000; Update on meningococcal disease with emphasis on pathogenesis and clinical management. Clin Microbiol Rev 13:144–166 [CrossRef]
    [Google Scholar]
  74. Vermont C. L., den Brinker M., Kakeci N., de Kleijn E. D., de Rijke Y. B., Joosten K. F., de Groot R., Hazelzet J. A. 2005; Serum lipids and disease severity in children with severe meningococcal sepsis. Crit Care Med 33:1610–1615 [CrossRef]
    [Google Scholar]
  75. Vieusseux M. 1805; Mémoire sur la maladie qui a regné a Genêve au printemps de 1805. J Med Chir Pharm 11:163–182
    [Google Scholar]
  76. Visser J. J., Scholten R. J., Hoekman K. 1994; Nitric oxide synthesis in meningococcal meningitis. Ann Intern Med 120:345–346 [CrossRef]
    [Google Scholar]
  77. Waage A., Halstensen A., Espevik T. 1987; Association between tumour necrosis factor in serum and fatal outcome in patients with meningococcal disease. Lancet 1:355–357
    [Google Scholar]
  78. Waage A., Brandtzaeg P., Halstensen A., Kierulf P., Espevik T. 1989; The complex pattern of cytokines in serum from patients with meningococcal septic shock. Association between interleukin 6, interleukin 1, and fatal outcome. J Exp Med 169:333–338 [CrossRef]
    [Google Scholar]
  79. Weichselbaum A. 1887; Üeber die Aetiologie der akuten Meningitis Cerebrospinalis. Fortschr Med 5:573–587
    [Google Scholar]
  80. Weisfelt M., Determann R. M., de Gans J., van der Ende A., Levi M., van de Beek D., Schultz M. J. 2007; Procoagulant and fibrinolytic activity in cerebrospinal fluid from adults with bacterial meningitis. J Infect 54:545–550 [CrossRef]
    [Google Scholar]
  81. Yazdankhah S. P., Caugant D. A. 2004; Neisseria meningitidis : an overview of the carriage state. J Med Microbiol 53:821–832 [CrossRef]
    [Google Scholar]
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