Thesis (doctoral)--University of Helsinki, 1998.

Thesis (doctoral)--University of Helsinki, 1998.

No description available.

No description available.

Objectif : To determine the frequency and the nature of complications and sequelae of serogroup B and serogroup C meningococcal disease, during a recrudescence caused by a virulent clone of serogroup C, serotype 2a Neisseria meningitidis. To evaluate the quality of life of survivors. Methods. The study population included all cases of culture-proven serogroup B and C meningococcal disease reported in the province of Quebec, Canada, between 1 January 1990 and 31 December 1994. Complications and sequelae were assessed by review of medical files, postal questionnaires, and telephone interviews. Results. There were 167 cases of serogroup B and 304 cases of serogroup C infection. The largest number of cases was observed in the under 1 year age group for serogroup B and in the 10-19 year age group for serogroup C. Fatality rates were 7% for serogroup B and 14% for serogroup C. %). Only 3% of survivors of serogroup B cases had physical sequelae. 15% of survivors of serogroup C infection had one or more significant physical sequelae (skin scars 12%, amputations 5%, significant sensorineural hearing loss 2%, renal failure 1%, other sequelae 4%. Among cases without identified physical sequelae who completed the questionnaire, 19% reported a reduction in their quality of life attributable to the disease. Conclusions. These results confirm the gravity of disease caused by serogroup C, serotype 2a Neisseria meningitidis and support vaccination for control of outbreaks and epidemics of disease caused by this particular strain.

No description available.

MSc (Med), Faculty of Health Sciences, University of the Witwatersrand, 2011 / Despite being a fulminant pathogen, Neisseria meningitidis (meningococcus) is part of the commensal flora of the human nasopharynx. Globally, five meningococcal serogroups (A, B, C, Y and W135) cause the majority of invasive disease. Most serogroup B cases occur sporadically but may be endemic or epidemic within a geographic region. In South Africa, there are limited data on invasive serogroup B clones and the antigenic diversity of certain meningococcal outer membrane proteins. This study examined the molecular epidemiology of serogroup B meningococci in South Africa from 2002 through 2006. Invasive meningococcal isolates were submitted to a national laboratory-based surveillance system. For this study, serogroup B isolates were characterised by pulsed-field gel electrophoresis (PFGE), PorA, FetA and multilocus sequence (MLST) typing. PorA, FetA and multilocus sequence (MLST) typing were performed on all 2005 isolates (n=58) and randomly selected isolates from other years (n=25). A total of 2144 invasive cases were reported over the study period. Of these, 76% (1627/2144) had viable isolates available for serogrouping and 307 (19%) were serogroup B. Serogroup B cases were reported from across the country however the majority were from the Western Cape province. The highest incidence of serogroup B was in children less than 5 years of age. Isolates displayed a high level of diversity by PFGE. Despite this diversity the majority of serogroup B meningococci collected over the 5-year period could be grouped into several clonal clusters representative of global invasive MLST clonal complexes. Overall, the most predominant MLST clones in South Africa were ST-32/ET-5 and ST-41/44/lineage 3. In addition, at least 19 PorA types and 16 FetA types were determined among selected isolates. Globally invasive serogroup B disease is caused by heterogeneous strains however, prolonged outbreaks in several countries have been due to strains of the ST-32/ET-5 and ST-41/44/lineage 3 clonal complexes. At present, serogroup B disease in South Africa is not dominated by an epidemic clone, however, global clonal complexes ST-32/ET-5 and ST-41/44/lineage 3 are circulating in Western Cape and Gauteng, respectively.

Development of a broadly cross-protective capsular group B meningococcal (MenB) vaccine has been hampered by poor capsular immunogenicity and often diverse and poorly cross-protective subcapsular antigens. The MenB MC58 strain genome has facilitated the discovery of novel, relatively conserved vaccine candidates. The four-component MenB (4CMenB) investigational vaccine contains factor H-binding protein (fHbp; variant 1), neisserial heparin-binding antigen (NHBA), Neisserial adhesin A (NadA) and PorA P1.4-containing outer membrane vesicles. The latter are known to elicit protection against homologous strains. Clinical trials have demonstrated protective responses in infants and adults against isolates expressing homologous PorA or fHbp (subvariant 1.P1), or heterologous NadA (variant 2). Cross-protective responses have also been demonstrated in adults and, to a lesser extent, infants, against isolates expressing heterologous fHbp variant 1 subvariants. The contribution of NHBA is still poorly understood. MenB currently accounts for 87% of invasive meningococcal disease in England and Wales. The proportion of disease due to the ST-269 clonal complex (cc269) peaked at 45.6% in 2006 and is currently approximately 24.2%. The aims of this study were (i) to genotypically assess potential 4CMenB coverage against recent English and Welsh invasive disease isolates and, specifically, cc269 isolates from England and Wales and other countries, (ii) to compare phenotypic expression levels of the 4CMenB antigens (excluding PorA) among typical cc269 isolates, and (iii) to assess 4CMenB responses against typical cc269 isolates among healthy adults administered 4CMenB.Full length alleles for fHbp variant 1, NHBA and NadA variants 1, 2 and 3 were present in 64.6%, >99% and 7.1%, respectively, of English and Welsh invasive disease isolates from 2007/8. Between 67.5% and >99% (adults) or 25.7% and 43.5% (infants) of the isolates were predicted to be covered by 4CMenB. cc269 comprised two antigenically distinct lineages (clusters) centred around ST-269 and ST-275, respectively. These accounted for 57% and 40% of cc269 in 2007/8. Both clusters effectively lacked nadA and PorA P1.4. The predominant fHbp;NHBA profiles represented by the respective clusters were 1.P15;P0021 and (1.P13 or 2.P19);P0017. Between 77.4% and 100% (adults) or 2.2% and 27.1% (infants) of cc269 isolates from 2007/8 were predicted to be covered by 4CMenB. Estimates for infants were conservative due to e.g. the exclusion of NHBA. Serum bactericidal antibody (SBA) analyses targeting typical fHbp variant 1-expressing cc269 strains, indicated high levels of coverage among adults administered 4CMenB. Notable differences among genotypically matched isolates e.g. in terms of SBA geometric mean titres, were not reflected in the relative fHbp and NHBA expression levels. Such differences may lead to conflicting estimates of coverage in infant populations. Whilst these are investigated further it seems prudent to use typical isolates giving mid-range responses when assessing SBA, and therefore protection, among infants. Potential 4CMenB coverage of cc269 and the broader meningococcal population in England and Wales was high among adults and encouraging among infants when compared to that of existing MenB vaccines.

Philosophiae Doctor - PhD / Neisseria meningitidis (the meningococcus), the causative agent of meningococcal disease (MD) was identified in 1887 and despite effective antibiotics and partially effective vaccines, Neisseria meningitidis (N. meningitidis) is the leading cause worldwide of meningitis and rapidly fatal sepsis usually in otherwise healthy individuals. Over 500 000 meningococcal cases occur every year. These numbers have made bacterial meningitis a top ten infectious cause of death worldwide. MD primarily affects children under 5 years of age, although in epidemic outbreaks there is a shift in disease to older children, adolescents and adults. MD is also associated with marked morbidity including limb loss, hearing loss, cognitive dysfunction, visual impairment, educational difficulties, developmental delays, motor nerve deficits, seizure disorders and behavioural problems. Antimicrobial peptides (AMPs) are molecules that provide protection against environmental pathogens, acting against a large number of microorganisms, including bacteria, fungi, yeast and virus. AMPs production is a major component of innate immunity against infection. The chemical properties of AMPs allow them to insert into the anionic cell wall and phospholipid membranes of microorganisms or bind to the bacteria making it easily detectable for diagnostic purposes. AMPs can be exploited for the generation of novel antibiotics, as biomarkers in the diagnosis of inflammatory conditions, for the manipulation of the inflammatory process, wound healing, autoimmunity and in the combat of tumour cells. Due to the severity of meningitis, early detection and identification of the strain of N. meningitidis is vital. Rapid and accurate diagnosis is essential for optimal management of patients and a major problem for MD is its diagnostic difficulties and experts conclude that with an early intervention the patient’ prognosis will be much improved. It is becoming increasingly difficult to confirm the diagnosis of meningococcal infection by conventional methods. Although polymerase chain reaction (PCR) has the potential advantage of providing more rapid confirmation of the presence of the bacterium than culturing, it is still time consuming as well as costly. Introduction of AMPs to bind to N. meningitidis receptors could provide a less costly and time consuming solution to the current diagnostic problems. World Health Organization (WHO) meningococcal meningitis program activities encourage laboratory strengthening to ensure prompt and accurate diagnosis to rapidly confirm the presence of MD. This study aimed to identify a list of putative AMPs showing antibacterial activity to N. meningitidis to be used as ligands against receptors uniquely expressed by the bacterium and for the identified AMPs to be used in a Lateral Flow Device (LFD) for the rapid and accurate diagnosis of MD.

This thesis describes the construction and evaluation of six knockout mutants in Neisseria meningitidis serogroup B strain MC58. The genes that were inactivated were NMB0711, NMB1048, NMB1525, NMB1898, NMB1948 and NMB1966. Attempts to inactivate a seventh gene, NMB0768, were not successful. These genes were chosen as they had been observed previously to be up-regulated following incubation in whole blood using Differential Fluorescence Induction. Mutant strains were constructed by allelic exchange with a plasmid construction in which a kanamycin resistance cassette had been incorporated within the coding sequence of each cloned target gene. Confirmation of successful allelic exchange was achieved by Southern blotting. The phenotype of all mutant strains were evaluated by assessment of in vitro growth and in the infant mouse model of infection. Of the six mutants, all except that involving NMB1966, showed no differences compared with wild-type. The mutant knockout of NMB1966 showed (1) impaired growth beyond the mid-logarithmic phase in shaking broth culture but normal growth on solid medium, (2) reduced virulence in a mouse model of infection, (3) impairment in its capacity to invade (although not adhere to) cultured human bronchial epithelial cells, and (4) more rapid killing in ex vivo human blood. NMB1966 is predicted to encode the ATP-binding subunit of an ABC transporter and, after experiments for this thesis had been completed, it was demonstrated, by others, that this ABC transporter is responsible for uptake of L-Glutamate at low sodium concentrations. It is likely that defective uptake of L-Glutamate explains the observed defect in shaking broth culture and intracellular survival, both of which are associated with low ambient concentrations of sodium. However, it is not certain if this mechanism explains the observed defect in survival in human blood and in the infant mouse model which test predominantly extracellular survival and represent environments with high sodium concentrations.