Microbiology and pathobiology of Neisseria meningitidis
- Michael Apicella, MD
Michael Apicella, MD
- Emeritus Professor of Microbiology and Internal Medicine
- The University of Iowa
- Section Editors
- Stephen B Calderwood, MD
Stephen B Calderwood, MD
- Editor-in-Chief — Infectious Diseases
- Section Editor — Bacterial Infections
- Professor of Medicine (Microbiology and Immunobiology)
- Harvard Medical School
- Sheldon L Kaplan, MD
Sheldon L Kaplan, MD
- Editor-in-Chief — Pediatrics
- Section Editor — Pediatric Infectious Diseases
- Professor and Vice Chairman for Clinical Affairs
- Baylor College of Medicine
Infection with Neisseria meningitidis can produce a variety of clinical manifestations, ranging from transient fever and bacteremia to fulminant disease with death ensuing within hours of the onset of clinical symptoms. N. meningitidis is a common cause of community-acquired bacterial meningitis in both children and adults. (See "Bacterial meningitis in children older than one month: Clinical features and diagnosis", section on 'Causative organisms' and "Epidemiology of bacterial meningitis in adults", section on 'Community-acquired meningitis'.)
Mortality can be very high in patients with meningococcal disease if the infection is not treated appropriately, and long-term sequelae can be severe even in successfully managed cases due primarily to difficulty in managing the endotoxin-induced vascular collapse frequently induced by this organism. (See "Treatment and prevention of meningococcal infection", section on 'Prognosis'.)
The microbiology and pathobiology of N. meningitidis will be reviewed here. The epidemiology, clinical features, diagnosis, treatment, and prevention of meningococcal infections are discussed separately. (See "Epidemiology of Neisseria meningitidis infection" and "Clinical manifestations of meningococcal infection" and "Diagnosis of meningococcal infection" and "Treatment and prevention of meningococcal infection" and "Meningococcal vaccines".)
Meningococcal disease was first described in 1805 after an epidemic of meningitis in Geneva. It was not until 1882 that the pathogen responsible for this disease was first isolated from the cerebrospinal fluid of an infected patient. The fact that the organism could be carried in the nasopharynx of healthy individuals was first recognized in 1890. In 1909, immunologically distinct serotypes of the meningococcus were identified. This established the basis for serum therapy, which was instituted by Flexner in 1913 .
Meningococcal epidemics among military recruits were a major consequence of military mobilization. As a result, the military participated in a number of important studies dealing with meningococcal disease, including the development of chemoprophylactic and immunologic methods to prevent infection. During World War I, the British army recognized that the frequency of carriage of the case strain rose prior to and during epidemics. With the advent of sulfonamides as an early antimicrobial treatment for meningococcal disease, the United States army used chemoprophylaxis with sulfonamides to dramatically reduce the incidence of disease among recruits during World War II. After the war, the availability of penicillin G greatly improved the treatment of meningococcal meningitis and sepsis, resulting in a substantial drop in mortality rates.
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- Nasopharyngeal carriage
- Virulence factors
- - Pili (fimbria)
- - Opacity proteins
- - Lipooligosaccharide
- - Capsular polysaccharides
- - Human factor H-binding protein
- Cell entry
- Survival within epithelial cells
- Interaction with phagocytic cells and the complement system
- Biofilm formation by meningococcus