Laboratory‐Acquired Serogroup A Meningococcal Meningitis

Kessler, Alexander T.; Stephens, David S.; Somani, Jyoti

doi:10.1539/joh.49.399

Cited by 12 publications

(5 citation statements)

References 16 publications

(31 reference statements)

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“…Several studies have reported clinical laboratory acquired meningococcemia [32]–[38]. These reports focussed on tracing the infecting strain amongst those manipulated by the patient during the weeks before the disease.…”

Section: Introductionmentioning

confidence: 99%

Genotypic and Phenotypic Modifications of Neisseria meningitidis after an Accidental Human Passage

et al. 2011

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A scientist in our laboratory was accidentally infected while working with Z5463, a Neisseria meningitidis serogroup A strain. She developed severe symptoms (fever, meningism, purpuric lesions) that fortunately evolved with antibiotic treatment to complete recovery. Pulse-field gel electrophoresis confirmed that the isolate obtained from the blood culture (Z5463BC) was identical to Z5463, more precisely to a fourth subculture of this strain used the week before the contamination (Z5463PI). In order to get some insights into genomic modifications that can occur in vivo, we sequenced these three isolates. All the strains contained a mutated mutS allele and therefore displayed an hypermutator phenotype, consistent with the high number of mutations (SNP, Single Nucleotide Polymorphism) detected in the three strains. By comparing the number of SNP in all three isolates and knowing the number of passages between Z5463 and Z5463PI, we concluded that around 25 bacterial divisions occurred in the human body. As expected, the in vivo passage is responsible for several modifications of phase variable genes. This genomic study has been completed by transcriptomic and phenotypic studies, showing that the blood strain used a different haemoglobin-linked iron receptor (HpuA/B) than the parental strains (HmbR). Different pilin variants were found after the in vivo passage, which expressed different properties of adhesion. Furthermore the deletion of one gene involved in LOS biosynthesis (lgtB) results in Z5463BC expressing a different LOS than the L9 immunotype of Z2491. The in vivo passage, despite the small numbers of divisions, permits the selection of numerous genomic modifications that may account for the high capacity of the strain to disseminate.

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Section: Introductionmentioning

confidence: 99%

Genotypic and Phenotypic Modifications of Neisseria meningitidis after an Accidental Human Passage

et al. 2011

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“…In one study, 16 cases of probable laboratory-acquired meningococcal disease were identified nationwide between the years 1985-2001; the vast majority of cases (15/16; 94%) arose in clinical microbiologists manipulating isolates without respiratory protection (14). The increased rates of laboratory-acquired meningococcal disease-as well as other infectious diseases-have been reported by multiple other authors as well (15)(16)(17)(18)(19). Within the US it is estimated that the incidence of meningococcal disease among microbiologists is 50fold higher than in the general population, i.e., 13 per 100 000 persons versus a general incidence rate of 0.2 per 100 000 (14,15,20).…”

Section: At Risk Populationsmentioning

confidence: 97%

Autopsy Biosafety

Brooks¹,

Utley-Bobak²

2018

Academic Forensic Pathology

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Introduction: As invasive meningococcal disease progresses rapidly, often affects youth, and has a fairly high mortality rate, such cases are likely to fall under medical examiner/coroner (ME/C) jurisdiction. Morgue personnel may be at risk of contracting secondary meningococcal disease. We review the current scientific literature regarding Neisseria meningitidis infection and provide recommendations for the prevention of meningococcal disease at autopsy. Methods:A PubMed search utilizing applicable medical subject heading terms was performed retrieving articles for review from the preceding two decades. Pertinent current guidelines from multiple national organizations were also retrieved. Results:Invasive meningococcal disease is transmitted by direct contact with large respiratory droplets or oral secretions. While a surgical mask would normally provide adequate protection from large droplet spread, it does not prevent inhalation of smaller aerosolized particles such as those generated at autopsy. Prosectors are advised to routinely wear N-95 respirator masks or powered respirator hoods. All published cases of secondary meningococcal disease transmission to healthcare workers invariably arose in scenarios in which face masks/respirators were not employed; none of these cases involved meningococcal disease transmission to ME/C or other morgue staff. Discussion:In the event that no mask-or inadequate coverage such as a surgical mask-is employed during autopsy of a decedent suspected/confirmed to have invasive meningococcal disease, antibiotic prophylaxis is advisable. Assuming appropriate personal protective equipment is utilized, chemoprophylaxis is unnecessary. Routine meningococcal vaccination is not recommended, except for ME/C with specified immunocompromising conditions or traveling to hyperendemic/endemic meningococcal regions. Acad Forensic Pathol. 2018 8(2): 328-339 Downloaded from www.afpjournal.com by an AFP Journal subscriber This article is for personal use only and may not be shared or distributed in any fashion REVIEW ARTICLEImage 1: Recommended personal protective equipment (PPE) includes a surgical cap, impervious surgical gown with full sleeve coverage, shoe covers, respirator mask, full face shield, and double gloves.

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“…At that point, the student denied vaccination and admitted to subculturing five isolates of serogroup A out on the bench. Fortunately, he recovered completely (Kessler, 2007).…”

Section: Karen B Byersmentioning

confidence: 98%