OBJECTIVES: Chronic meningococcemia is an uncommon manifestation of meningococcal disease. Our objective was to asses whether a bacterial factor, a mutation in the lpxL1 gene resulting in underacylated lipopolysaccharide, might be important in chronic meningococcemia. METHODS: We identified 15 patients with chronic meningococcemia over a 50-year period. Chronic meningococcemia episodes were defined by a febrile episode of at least one week and presence of meningococci in blood and/or cerebrospinal fluid (CSF). Meningococcal isolates from these patients were characterised by serogrouping, multi-locus sequence typing, and in vitro interleukin 6 inducing capacity. lpxL1 gene mutations were determined by direct sequencing. RESULTS: The median age was 21 years (range, 2-62) and median duration of symptoms before diagnosis was four weeks (range, 1-12). Of the 15 isolates, seven (47%) strains had a reduced interleukin 6 inducing capacity and were found to have a mutation in lpxL1 resulting in penta-acylated lipid A. This frequency is higher than previously reported among adult patients with meningococcal meningitis (7%; p < 0.0001) and invasive meningococcal disease (9%; p = 0.001). CONCLUSIONS: We conclude that chronic meningococcemia patients are often infected with meningococci with a mutation in lpxL1 resulting in underacylated lipid A. The lpxL1 mutations may well explain the protracted and benign clinical course in these patients.
OBJECTIVES:Chronic meningococcemia is an uncommon manifestation of meningococcal disease. Our objective was to asses whether a bacterial factor, a mutation in the lpxL1 gene resulting in underacylated lipopolysaccharide, might be important in chronic meningococcemia. METHODS: We identified 15 patients with chronic meningococcemia over a 50-year period. Chronic meningococcemia episodes were defined by a febrile episode of at least one week and presence of meningococci in blood and/or cerebrospinal fluid (CSF). Meningococcal isolates from these patients were characterised by serogrouping, multi-locus sequence typing, and in vitro interleukin 6 inducing capacity. lpxL1 gene mutations were determined by direct sequencing. RESULTS: The median age was 21 years (range, 2-62) and median duration of symptoms before diagnosis was four weeks (range, 1-12). Of the 15 isolates, seven (47%) strains had a reduced interleukin 6 inducing capacity and were found to have a mutation in lpxL1 resulting in penta-acylated lipid A. This frequency is higher than previously reported among adult patients with meningococcal meningitis (7%; p < 0.0001) and invasive meningococcal disease (9%; p = 0.001). CONCLUSIONS: We conclude that chronic meningococcemiapatients are often infected with meningococci with a mutation in lpxL1 resulting in underacylated lipid A. The lpxL1 mutations may well explain the protracted and benign clinical course in these patients.
Authors: Xiyou Zhou; Xi Gao; Peter M Broglie; Chahnaz Kebaier; James E Anderson; Natalie Thom; Michael A Apicella; Gregory D Sempowski; Joseph A Duncan Journal: Infect Immun Date: 2013-10-14 Impact factor: 3.441
Authors: Constance M John; Nancy J Phillips; Richard Din; Mingfeng Liu; Einar Rosenqvist; E Arne Høiby; Daniel C Stein; Gary A Jarvis Journal: J Biol Chem Date: 2015-12-11 Impact factor: 5.157
Authors: Jay Lucidarme; Kevin J Scott; Roisin Ure; Andrew Smith; Diane Lindsay; Bianca Stenmark; Susanne Jacobsson; Hans Fredlund; J Claire Cameron; Alison Smith-Palmer; Jim McMenamin; Steve J Gray; Helen Campbell; Shamez Ladhani; Jamie Findlow; Paula Mölling; Ray Borrow Journal: Euro Surveill Date: 2016-11-10
Authors: Rita S B Cardona; Fabiana Bononi do Carmo; Suenia Vasconcelos Beltrão; Aída de Fátima T Barbosa Gouvêa; Reinaldo Salomão; Regina Célia de Menezes Succi; Daisy Maria Machado Journal: IDCases Date: 2020-04-21