Special Issue "Neisseria Infections and Meningococcal Disease"

A special issue of Microorganisms (ISSN 2076-2607). This special issue belongs to the section "Medical Microbiology".

Deadline for manuscript submissions: closed (31 December 2022) | Viewed by 1677

Special Issue Editors

Department of Health Sciences, University of Genoa, 16132 Genoa, Italy
Interests: meningococcal vaccine; N. meningitidis disease

Special Issue Information

Dear Colleagues,

N. meningitidis is a bacterium with several virulence factors, comprising a bacterial capsule with anti-phagocytic properties, a lipopolysaccharide, a system for the uptake of iron, flagella and IgA1 protease, etc. The bacterium is a host of the upper respiratory tract and is present in the nose and in the throat of a relevant proportion of the healthy population (2 to 30%), despite carriers not showing any symptoms.

N. meningitidis infections strike generally healthy individuals, especially children and young adults, in the form of severe invasive meningitis, fulminant septicemia with septic shock and bacteremia.

Some conditions act as factors predisposing individuals to severe meningococcal disease, such as genetic polymorphisms related to complement and properdin, and defects borne by the Toll-like receptor 4; they exhibit at an increased risk of bacterial meningitis acquired in the community. Furthermore, diabetes mellitus, alcoholism, old age (over 60 years) and immunodeficiency are considered conditions favoring bacterial meningitis. Moreover, the high incidence of meningococcal disease in HIV-positive individuals confirms that immunodeficiency represents a condition of augmented risk for this type of infection.

There are 12 different serogroups of meningococcus, but only five (A, B, C, W 135 e Y) cause meningitis and other serious diseases; recently, the serogroup X has been recognized as responsible for several epidemics, mainly in the so-called African "band of meningitis". Due to the rapidity of its onset, meningococcal disease is associated with significant lethality despite the availability of antibiotics and intensive care, and can also lead to serious complications.

Neisseria meningitidis remains a major and insidious cause of death, even in industrialized countries. Indeed, meningococcal disease can develop extremely rapidly and is associated with a high case-fatality rate, although antibiotics, such as rifampicin or cephalosporins, usually have great bactericidal efficacy. However, some antibiotic resistance has recently been reported.

For this reason, efforts to control the disease have been directed at optimizing meningococcal vaccines and implementing appropriate vaccination policies.

The availability of vaccines directed towards four serogroups, A, C, W135 and Y, and the implementation of vaccination programs in young children and adolescents has allowed a reduction in the number of cases of meningococcal disease. Furthermore, the multicomponent vaccine against meningococcus B can contribute to prevent serogroup B meningococcal disease, the major cause of bacterial meningitis and fulminant septicemias in Europe.

New knowledge on meningococcus can address the lack of information about this microorganism and contribute to a better handling of this disease.

This Special Issue will focus on manuscripts covering a range of topics including available diagnostic armamentarium for surveillance, vaccine implementation strategies, antimicrobial sensitivity/resistance patterns, and novel treatment and management approaches.

Dr. Donatella Panatto
Dr. Daniela Amicizia
Guest Editors

Manuscript Submission Information

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Published Papers (1 paper)

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12 pages, 630 KiB  
Late-Onset Sepsis Mortality among Preterm Infants: Beyond Time to First Antibiotics
Microorganisms 2023, 11(2), 396; https://doi.org/10.3390/microorganisms11020396 - 03 Feb 2023
Viewed by 1243
Objective: To investigate the impact of timing, in vitro activity and appropriateness of empirical antimicrobials on the outcome of late-onset sepsis among preterm very low birth weight infants that are at high risk of developing meningitis. Study design: This retrospective study included 83 [...] Read more.
Objective: To investigate the impact of timing, in vitro activity and appropriateness of empirical antimicrobials on the outcome of late-onset sepsis among preterm very low birth weight infants that are at high risk of developing meningitis. Study design: This retrospective study included 83 LOS episodes in 73 very low birth weight infants born at ≤32 weeks’ gestation with positive blood and/or cerebrospinal fluid culture or polymerase chain reaction at >72 h of age. To define the appropriateness of empirical antimicrobials we considered both their in vitro activity and their ideal delivery through the blood-brain barrier when meningitis was confirmed or not ruled out through a lumbar puncture. The primary outcome was sepsis-related mortality. The secondary outcome was the development of brain lesions. Timing, in vitro activity and appropriateness of empirical antimicrobials, were compared between fatal and non-fatal episodes. Uni- and multi-variable analyses were carried out for the primary outcome. Results: Time to antibiotics and in vitro activity of empirical antimicrobials were similar between fatal and non-fatal cases. By contrast, empirical antimicrobials were appropriate in a lower proportion of fatal episodes of late-onset sepsis (4/17, 24%) compared to non-fatal episodes (39/66, 59%). After adjusting for Gram-negative vs. Gram-positive pathogen and for other supportive measures (time to volume administration), inappropriate empirical antimicrobials remained associated with mortality (aOR, 10.3; 95% CI, 1.4–76.8, p = 0.023), while timing to first antibiotics was not (aOR 0.9; 95% CI, 0.7–1.2, p = 0.408; AUC = 0.88). The association between appropriate antimicrobials and brain sequelae was also significant (p = 0.024). Conclusions: The risk of sepsis-related mortality and brain sequelae in preterm very low birth weight infants is significantly associated with the appropriateness (rather than the timing and the in vitro activity) of empirical antimicrobials. Until meningitis is ruled out through lumbar puncture, septic very low birth weight infants at high risk of mortality should receive empiric antimicrobials with high delivery through the blood-brain barrier. Full article
(This article belongs to the Special Issue Neisseria Infections and Meningococcal Disease)
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