Uncloaking the meningococcus: dynamics of carriage and disease

Abstract

In 1805, the first description of epidemic cerebrospinal meningitis and meningococcaemia was reported by Vieusseaux. 1 Vieusseaux M Mémoire sur la maladie qui a règné a Geneve au printemps de 1805. J Med Chir Pharmacol. 1805; 11: 163 Google Scholar Surprisingly, excellent descriptive treatises of disease before this time had not mentioned the distinctive epidemic outbreaks of rash, fever, headache, meningismus, and rapid death that characterise meningococcaemia and meningococcal meningitis, hence the speculation that epidemic meningococcal disease was a new syndrome that emerged around 1800. 2 North E Concerning the epidemic of spotted fever in New England. (Reprinted from a treatise on a malignant epidemic commonly called spotted fever New York; T & J Swords, 1811). Kass E, ed. Rev Infect Dis. 1980; 2: 811-816 Crossref PubMed Google Scholar Subsequent studies revealed the cause to be the human pathogen Neisseria meningitidis, and the main reservoir of carriage and site of meningococcal dissemination to be the human upper respiratory tract. Despite this understanding, the dynamics of meningococcal carriage and the relation between such carriage and invasive meningococcal disease remain shrouded—in part because of the difficulty in distinguishing and tracking meningococci. This difficulty was due to non-discriminative serological techniques (eg, serogrouping) and to phenotypic variations caused by genetic switching and recombination.