First description of a rifampicin-resistant Neisseria meningitidis serogroup Y strain causing recurrent invasive meningococcal disease in Hungary

Abstract

A Hungarian soldier previously immunized against Neisseria meningitidis by quadrivalent polysaccharide vaccine was twice infected with meningococci within six weeks. The patient was treated with ceftriaxone during both episodes and he successfully recovered. His close contacts received rifampicin prophylaxis. An investigation was performed to characterize the genetic background of the pathogens to ascertain if the recurrent invasive meningococcal disease was caused by the same strain and to find out the reason for reinfection. Both meningococci belonged to the fine type Y:P1.5-2,10-1:F4-1:ST-23. This is the first description of the Europe-wide prevalent N. meningitidis serogroup Y in Hungary. In the first episode, we found wildtype rpoB allele in the non-culturable sample implying the susceptibility to rifampicin. The culturable isolate from the second episode proved resistant to rifampicin and had a point mutation in the rpoB gene. The rifampicin resistance might have evolved during the prophylactic treatment of contacts. Previous immunization of the patient with polysaccharide vaccine was ineffective due to his immunodeficiency, thus immunization with conjugate vaccine was proposed. We have proposed the implementation of centralized rifampicin susceptibility testing of N. meningitidis strains within a defined time frame to intervene and administer appropriate prophylaxis to close contacts.

Epidemiology and antibiotic resistance profile of bacterial meningitis in Morocco from 2015 to 2018

“…The resistance to rifampin observed in this study for the three isolates may have evolved as a result of the use of this prophylaxis for contact cases of N. meningitidis [32] and/or could be due to the use of rifampin in the treatment of tuberculosis patients in Morocco which remained a public health problem in the Kingdom [33]. Phenotypic studies and genotypic studies are useful for monitoring serogroup distribution and also assist national vaccination programs in the choice of vaccine to introduce [34].…”

Serogroup diversity and antibiotic susceptibility of Neisseria meningitidis: Meningococcus infection monitoring in Belarus

“…During this study, 9.5% of N. meningitidis strains were resistant to rifampicin (MIC > 0.25 mg/L): 8.7% among invasive meningococci and 10.7% among non-invasive. There are publications about rifampicin-resistant meningococci in European countries (Hungary, Germany, France, and Switzerland) [4,7,21], in America (Canada, USA, Uruguay, and Brazil) [5,9], and in Australia [7]. In Moscow, resistant meningococci serogroup B were also detected [22].…”

“…N. meningitidis is sensitive to most antibiotics, but in recent years, the frequency of isolates with intermediate sensitive and Figure 1. Meningococcal infection surveillance in the Republic of Belarus resistance has increased in European countries [4][5][6][7], America [7][8][9][10], Australia [7,11], and Asia [12]. Strains with reduced susceptibility to penicillins and chloramphenicol that circulated in Belarus were previously described [13].…”