ABSTRACT
A meningite bacteriana é uma inflamação das leptomeninges que envolvem o Sistema Nervoso Central. Essa patologia, que possui diversos agentes etiológicos, apresenta-se na forma de síndrome, com quadro clínico grave. Entre as principais bactérias que causam a meningite, estão a Neisseria meningitis e Streptococcus pneumoniae. A transmissão ocorre através das vias aéreas por meio de gotículas, sendo a corrente sanguínea a principal rota para as bactérias chegarem à barreira hematoencefálica e, a partir dessa, até as meninges. Atualmente existem vários métodos de diagnóstico precisos, onde a cultura de líquido cefalorraquidiano (LCR) é o método padrão ouro. Ademais, a melhora na qualidade do tratamento com beta-lactâmicos e a maior possibilidade de prevenção, devido à elevação do número e da eficácia de vacinas, vem contribuindo para redução dos casos da doença e de sua gravidade. Porém, apesar desses avanços, ainda há um elevado número de mortalidades e sequelas causadas por essa síndrome.
Bacterial meningitis is an inflammation of the leptomeninges that surround the Central Nervous System. This pathology, which has several etiological agents, is presented as a syndrome with a severe clinical scenario. The main bacteria causing meningitis include Neisseria meningitis and Streptococcus pneumoniae. It can be transmitted by droplets through the airways, with the bacteria using the bloodstream as the main route to reach the blood-brain barrier, and from there to the meninges. There are currently several accurate diagnostic methods, with CSF culture being the gold standard. In addition, the improvement in the quality of beta-lactam treatment and the greater possibility of prevention due to the increased number and effectiveness of vaccines have contributed to reducing the number of cases and severity of the disease. Nevertheless, despite these advances, this syndrome still presents a high number of mortalities and sequelae.
Subject(s)
Pregnancy , Child, Preschool , Child , Aged , Cerebrospinal Fluid , Meningitis, Bacterial/diagnosis , Meningitis, Bacterial/therapy , Streptococcus pneumoniae/pathogenicity , Syndrome , Bacteria/classification , Meningitis, Bacterial/drug therapy , beta-Lactams/therapeutic use , Gram-Negative Bacteria , Gram-Positive Bacteria , Meningitis, Pneumococcal/drug therapy , Neisseria/pathogenicityABSTRACT
BACKGROUND: Meningococcal disease (MD) presents a substantial public health problem in Brazil. Meningococcal C conjugate (MenC) vaccination was introduced into the routine infant immunization program in 2010, followed by adolescent vaccination in 2017. We evaluated changes in national and regional MD incidence and mortality between 2005 and 2018, serogroup distribution and vaccine coverage. METHODS: Data were obtained from national surveillance systems from 2005 to 2018. Age-stratified incidence and mortality rates were calculated and a descriptive time-series analysis was performed comparing rates in the pre-(2005-2009) and post-vaccination (2011-2018) periods; MD due to specific meningococcal serogroups were analyzed in the pre-(2007-2009) and post-vaccination (2011-2018) periods. RESULTS: From 2005 to 2018, 31,108 MD cases were reported with 6496 deaths; 35% of cases and deaths occurred in children < 5 years. Incidence and mortality rates declined steadily since 2012 in all age-strata, with significantly lower incidence and mortality in the post-vaccine introduction period in children aged < 1-year, 1-4 years, 5-9 years and 10-14 years. A significant decline in MenC disease in children < 5 years was observed following MenC vaccine introduction; infants < 1 year, from 3.30/100,000 (2007-2009) to 1.08/100,000 (2011-2018) and from 1.44/100,000 to 0.42/100,000 in 1-4-year-olds for these periods. Reductions in MenB disease was also observed. MenW remains an important cause of MD with 748 cases reported across 2005-2018. While initial infant vaccination coverage was high (>95% nationwide), this has since declined (to 83% in 2018); adolescent uptake was < 20% in 2017/18). Regional variations in outcomes and vaccine coverage were observed. CONCLUSION: A substantial decline in incidence and mortality rates due to MD was seen following MenC vaccine introduction in Brazil, especially among children < 5 years chiefly driven by reductions in MenC serogroup. While these benefits are considerable, the prevalence of MD due to other serogroups such as MenW and MenB remains a concern. A video summary linked to this article can be found on Figshare: https://doi.org/10.6084/m9.figshare.13379612.v1.
Subject(s)
Meningococcal Infections , Meningococcal Vaccines , Neisseria meningitidis , Adolescent , Brazil/epidemiology , Child , Child, Preschool , Humans , Immunization Programs , Incidence , Infant , Meningococcal Infections/epidemiology , Meningococcal Infections/prevention & control , VaccinationABSTRACT
Introducción: La meningitis bacteriana aún constituye un importante problema de salud mundial. En Cuba hay limitadas investigaciones con una perspectiva histórica de esta temática. Objetivo: Describir el comportamiento de la meningitis bacteriana en Cuba (siglo XIX-XXI). Material y Métodos: Estudio descriptivo (corte histórico) entre finales de 1800 y 2017, utilizando el método histórico-lógico y un análisis deductivo-inductivo de múltiples fuentes bibliográficas. Desarrollo: La primera alusión a la meningitis bacteriana en Cuba data de 1877. También se sugiere su probable importación por el ejército de ocupación norteamericano en 1899. En 1901 se aisló el meningococo de Weichselbaum del líquido cefalorraquídeo, lo que constituye, probablemente, su primera notificación en Cuba. Iniciado el siglo XX, se reportan casos aislados y brotes hasta 1976 cuando inicia la mayor epidemia de Enfermedad Meningocócica (serogrupos C y B). En 1979 se vacuna contra el C. En 1980 se implementa una vigilancia epidemiológica especial. Se desarrolla la vacuna cubana VA-MENGOC-BC® (1984) que se usa masivamente (1987) y se contribuye al control, incluyéndose en el Programa Nacional de Inmunizaciones (1991). Haemophilus Influenzae pasa a ser la principal bacteria causante de meningitis bacteriana hasta 1999 en que se aplican vacunas (Vaxem-Hib® y QuimiHib®) y se controla. Su nicho ecológico es ocupado por neumococo hasta ahora. Conclusiones: Desde fines del siglo XIX hasta la segunda mitad del XX la meningitis bacteriana en Cuba se manifestaba como casos aislados y brotes. Durante y después de una gran epidemia, se implementan estrategias preventivas efectivas, incluidas dos vacunas cubanas contra estas enfermedades, que revierten el comportamiento a endemia muy baja hasta la actualidad.
Introduction: Bacterial meningitis remains an important health problem worldwide. In Cuba, there are limited research studies about this issue from a historical perspective. Objective: To describe the behavior of this disease in Cuba (19th - 21st centuries). Material and Methods: A descriptive historical study was carried out between the ends of 1800-2017, using the historical-logical method and a deductive-inductive analysis of multiple bibliographical sources. Development: The first reference to bacterial meningitis in Cuba was made in 1877. The probable introduction of the disease by the US occupation army in 1899 is also considered. In 1901, the meningococci of Weichselbaum was isolated from cerebrospinal fluid, which was probably it first report in Cuba. At the beginning of the 20th century, isolated cases and outbreaks were reported until 1976, when the biggest and larger invasive meningococcal disease began (serogroups C, B). Vaccination against serogroup C started in 1979. In 1980, a special epidemiological surveillance was implemented. The Cuban vaccine VA-MENGOC-BC® against the disease was developed in 1984, which was massively used in 1987. The vaccine contributed to the control of the disease and was included in the National Immunization Program in 1991. Haemophilus Influenzae became the main causative bacterial agent of meningitis until 1999, when the implementation of massive vaccination (Vaxem-Hib® and QuimiHib®) controlled disease. Up to the present, its ecological niche is occupied by pneumococci. Conclusions: From the end of the 19th century to the second half of the 20th century, bacterial meningitis in Cuba behaved as isolated cases and outbreaks. Effective preventive strategies were implemented during and after a huge epidemic, including Cuban vaccines against the disease, that pass on its behavior to a very low endemic disease up to the moment.
ABSTRACT
La meningitis bacteriana aguda es una emergencia infectológica ya que puede ocasionar secuelas graves o incluso la muerte. Es rara la presentación de este cuadro con sordera súbita y ataxia. Se presenta el caso de una adolescente del sexo femenino de 14 años, que presentó meningitis bacteriana por meningococo serogrupo C con ataxia vestibular y sordera súbita, que fue tratada con corticoides y pentoxifilina, además de antibióticos para la infección de base. La recuperación de la audición no fue adecuada y persistió con sordera e hipoacusia severa unilateral y ataxia vestibular persistente e inhabilitante.
Acute bacterial meningitis is an infectious emergency as it can lead to serious sequelae or even death. The presentation of this condition with sudden deafness and ataxia is rare. We present the case of a 14-year old female adolescent, who presented with vestibular ataxia and sudden deafness and was subsequently diagnosed with bacterial meningitis due to serogroup C meningococcus. She was treated with corticosteroids and pentoxifylline, in addition to antibiotics, for the baseline infection. Hearing recovery was not adequate; she persisted with severe deafness, unilateral hearing loss and persistent and disabling vestibular ataxia.
ABSTRACT
During 2010, outbreaks of serogroup C meningococcal (MenC) disease occurred in 2 oil refineries in São Paulo State, Brazil, leading to mass vaccination of employees at 1 refinery with a meningococcal polysaccharide A/C vaccine. A cross-sectional study was conducted to assess the prevalence of meningococci carriage among workers at both refineries and to investigate the effect of vaccination on and the risk factors for pharyngeal carriage of meningococci. Among the vaccinated and nonvaccinated workers, rates of overall meningococci carriage (21.4% and 21.6%, respectively) and of MenC carriage (6.3% and 4.9%, respectively) were similar. However, a MenC strain belonging to the sequence type103 complex predominated and was responsible for the increased incidence of meningococcal disease in Brazil. A low education level was associated with higher risk of meningococci carriage. Polysaccharide vaccination did not affect carriage or interrupt transmission of the epidemic strain. These findings will help inform future vaccination strategies.
Subject(s)
Carrier State/epidemiology , Meningitis, Meningococcal/classification , Meningococcal Infections/epidemiology , Meningococcal Infections/prevention & control , Meningococcal Vaccines/immunology , Adolescent , Adult , Brazil/epidemiology , Cross-Sectional Studies , Disease Outbreaks , History, 21st Century , Humans , Incidence , Meningitis, Meningococcal/genetics , Meningitis, Meningococcal/immunology , Meningococcal Infections/history , Multilocus Sequence Typing , Risk Factors , Serotyping , Vaccination , Young AdultABSTRACT
En la actualidad, se cuenta con un grupo de vacunas desarrolladas para la prevención de infecciones bacterianas, incluso para realizar profilaxis. En la década de los 80 del siglo XX apareció la primera vacuna contra Haemophilus influenzae tipo b que redujo y prácticamente eliminó la enfermedad invasiva por esta bacteria. A inicios del año 2000 se observó una dramática reducción de enfermedad invasiva por neumococo, gracias a la introducción de la vacuna PCV-7 contra este germen. Sin embargo, surgieron serotipos no incluidos en esta vacuna, por lo cual se desarrollaron la PHiD-CV 10 y la PCV-13, con 10 y 13 serotipos, respectivamente. En contra del meningococo se han desarrollado vacunas polisacáridas que han demostrado efectividad, así como las conjugadas que pueden ser monovalentes y tetravalentes. La quimioprofilaxis se indica en casos específicos que se explican en forma detallada en este capítulo
Nowadays, several vaccines have been developed for the prevention of bacterial infections, and also for prophylaxis. In the 80's of the twentieth century came the first vaccine against Haemophilus influenzae type b, which reduced and virtually eliminated invasive disease by this bacterium. In early 2000, there was a dramatic reduction in invasive pneumococcal disease, with the introduction of PCV-7 vaccine against this germ. However, there were serotypes not included in the vaccine, which was developed by the Phido-CV 10 and PCV-13, 10 and 13 serotypes, respectively. Against meningococcus, polysaccharide vaccines have been developed that have demonstrated effectiveness, as well as the conjugate vaccines, which may be monovalent and tetravalent. Chemoprophylaxis is indicated in specific cases that are reviewed in detail in this chapter