Forms Of Meningococcal Infection Research Articles

THE COURSE OF GENERALIZED FORMS OF MENINGOCOCCAL INFECTION IN CHILDREN OF THE LVIV REGION DURING 2011-2019

Relevance. Meningococcal infection (MI) is one of the most significant bacterial infections in children, it is characterized by life-threatening and unpredictable fulminant course in the structure of infectious diseases.
 Objective. To analyze the clinical and laboratory features of generalized forms of MI in children of Lviv region during 2011-2019.
 Materials and methods. Retrospective analysis of 254 case reports of patients with generalized forms of MI, hospitalized in regional infectious diseases clinical hospital during 2011 -2019 years, was conducted, as well as 14 protocols for post-mortem examination of deceased from generalized forms of MI children during 2011-2019. 203 medical records with confirmed diagnosis of the disease were selected.
 Results. Meningitis as a clinical form was diagnosed in 48 children (23.6%), meningoencephalitis in 6 (3%), meningococcemia − in 82 (40.4%), combined form − in 67 children (33%).
 In children aged 1 month to 1 year and aged 1 to 3 years the combined form of the disease occurred significantly more often than the isolated clinical form. Analysis of clinical symptoms and major laboratory parameters in various clinical forms of MI were exemplified.
 12 children from 5 months up to 4 years 10 months diagnosed with MI generalized form: meningococcemia fulminant form, and one 6-year-old child with purulent meningoencephalitis had died.
 Conclusions. Despite of gradual decrease of morbidity level and respectively amount of hospitalized patients throughout 2011-2019, a difficult course of generalized forms of MI with development of toxische Schocksyndrom in 77,9% in patients with meningoccocemia were observed. Mortality in meningococcemia was 8,1%, most of the deceased were children aged 3-5 years. Misdiagnosis at the primary level were observed in 14,3%.

Клинико-лабораторные особенности ко-инфекции COVID-19 и менингококковой инфекции

Objective. To analyze clinical and laboratory characteristics of patients with COVID-19 and meningococcal co-infection. Patients and methods. We analyzed cases of mixed infection caused by SARS-CoV-2 and meningococci in 8 patients treated in Moscow Multidisciplinary Clinical Center ‘Kommunarka.’ We used mass spectrometry for microbiological examination followed by culturing in accordance with the results of examination. All patients were tested positive for COVID-19 by PCR and meningococcal infection by bacteriological method. Results. Patients were admitted to hospital on average 5.88 ± 4.2 days after COVID-19 onset. Two patients had moderate disease, whereas 6 patients had severe disease and were admitted to the intensive care unit. Study participants presented with different forms of meningococcal infection, including nasopharyngitis (n = 1), meningitis (n = 1), pneumonia (n = 2), meningococcemia (n = 3), and mixed form meningitis and meningococcemia (n = 1). Fatal outcome was observed in 37.5% of cases. Conclusion. The problem of meningococcal infection remains highly relevant during the COVID–19 pandemic. Сo-infection is characterized by an increase in the proportion of rare forms (pneumonia), which requires special attention of clinicians. The implementation of mass spectrometry will allow early detection of meningococcal infection in patients with rare forms and timely initiation of adequate and optimal therapy. Key words: meningococcal infection, COVID–19, co-infection.

Clinical and epidemiological characteristics of meningococcal infection morbidity in Penza Region for the period 2007-2019

Objective. To study the clinical and epidemiological characteristics of meningococcal disease morbidity in the Penza Region population for the period 2007-2019.Materials and methods. The retrospective analysis carried out of archival documents of a specialized infectious diseases hospital in Penza and materials of the center of the Federal Service for Supervision of Consumer Rights Protection and Human Well-being. Methods of statistical processing were used for the analysis.Results and discussion. As a result of the analysis, it was revealed that the incidence of meningococcal infection in the Penza region exceeds the average level in Russia for almost the entire time period under study. We revealed the predominance of the share of the child population in the structure of total morbidity throughout the entire time tranche under study was revealed. The presence of 4 peaks in the mortality rate was found — in 2009, 2012, 2014 and 2016. On the territory of the Penza region, the infection has a pronounced winter-spring seasonality, there are generalized forms of meningococcal infection and localized forms of meningococcal infection.Conclusions. Thus, meningococci of serogroups B and C prevail in the serogroup landscape of meningococci in the Penza region. The excess of the average Russian indicators of the incidence of meningococcal infection was revealed by 2 or more times throughout the entire study period. patients under the age of 14 from unorganized groups predominate among patients with meningococcal infection. the Gender structure is dominated by males from rural areas. The infection has a pronounced winter-spring seasonality. The most common clinical forms are meningitis and mixed form.

Improving the therapy of generalized forms of Meningococcal infection in children using extracorporeal hemocorrection

Invasive meningococcal infection is a significant cause of death, reaching 80% in septic shock. The Pediatric Research and Clinical Center for Infectious Diseases (PRCCID) has developed an algorithm for the treatment of children with invasive meningococcal infection with refractory septic shock and multiple organ failure syndrome, which includes basic drug therapy with polymyxin hemoperfusion in combination with extended methods of extracorporeal hemocorrection.Purpose: to evaluate the effectiveness of extracorporeal hemocorrection operations in children with invasive meningococcal infection with refractory septic shock and multiple organ failure syndrome.Materials and research methods: to the intensive care unit of the PRCCID for the analyzed period 2006—2020 34 children were hospitalized with invasive meningococcal infection with refractory septic shock and multiple organ failure syndrome. Two groups were formed: Group 1 — children admitted to the PRCCID in the period 2014—2020 (n = 23), who underwent polymyxin hemoperfusion simultaneously with extended methods of extracorporeal hemocorrection, group 2 — children hospitalized in 2006—201 3 (n = 1 1), methods of extracorporeal hemocorrection were not performed. The Mann-Whitney U-test and ANOVA were used to evaluate the results.Results and discussion: the use of extracorporeal hemocorrection operations in the complex therapy of invasive forms of meningococcal infection with refractory septic shock and multiple organ failure syndrome in children provides stabilization of central hemodynamics, reduces clinical and laboratory inflammatory reactions, helps to reduce the dose of vasopressor drugs and parameters of respiratory support, and also increases patient survival rate by 82.6%.

СОВРЕМЕННЫЕ ОСОБЕННОСТИ МЕНИНГОКОККОВОГО СЕПСИСА (МЕНИНГОКОКЦЕМИИ) У ДЕТЕЙ

Meningococcal infection is a global health problem worldwide, which is caused by high mortality rates, difficulties in early diagnosis due to the nonspecific nature of the initial manifestations of the disease, and the unpredictability of the course. Invasive forms of infection are registered mainly in children of the first five years of life, which further actualizes this disease. In recent decades, the Republic of Belarus has seen a steady decline in morbidity rates, but given the epidemiological features of meningococcal infection (epidemiological ups and downs with a frequency of 10—20 years), experts are aware of the possible scale of the problem in the coming years. The article presents the results of the analysis (for the last 20 years) structures of invasive forms of meningococcal infection and clinical and laboratory features of meningococcal sepsis in children according to the data of the «City Children's Infectious Clinical Hospital» of Minsk.

The Level of Meningococcal Carriage and Genotyping of N. meningitidis Strains in the Group of Labor Migrants

Relevance. Population migration can play a crucial role in the spread of invasive strains of meningococcus, initiating outbreaks of meningococcal infection, and changing the incidence at the local level.Aim. To assess the prevalence of meningococcal carriage among migrants arriving in Moscow and to characterize the antigenic and genetic properties of carrier strains of meningococcus.Materials and methods. The study was conducted in March 2020 at the bases of the Multifunctional Migration Center of Moscow and the Federal Budget Institution of Science «Central Research Institute of Epidemiology». Samples of nasopharyngeal mucus were collected from 352 people. Nasopharyngeal strains of meningococcus were identified and identified using microbiological, serological, and molecular biological methods.Results. The overall level of the carriage was 5.7%. Of the twenty selected strains, 10 have a serogroup defined: Y – 5 strains, W - 3, A, and B – 1 each. The obtained genetic and antigenic characteristics do not allow talking about the import into the RF of representatives of known hypervirulent clonal complexes. In this study, strains were identified that are part of the clonal complex ST-175 complex, which has not been previously described in the Russian Federation.Conclusion. It seems promising to continue the dynamic monitoring of carriage of meningococcus in various groups, including among people entering the country to obtain a migration patent, as well as identifying risk factors for acquiring carriage. The data obtained will supplement current information on the incidence of the generalized form of meningococcal infection and will be crucial for determining the epidemiology at the country level, the population groups responsible for the transmission of the disease, and the need for targeted vaccination.

Meningococcal infection in modern conditions: clinical, microbiological and preventive aspects

The problem of meningococcal infection remains relevant due to the high epidemiological and social significance throughout the world, the unpredictability of the course, a wide range of clinical manifestations (from asymptomatic carriage to extremely severe generalized forms) with a high risk of life-threatening conditions and deaths, and a significant incidence of disability after past illness (loss of limbs, deafness, mental inferiority, and more). The changing serogroup landscape of meningococcal infection with an increase in the incidence of diseases caused by Neisseria meningitidis serogroup W, Y and others is noteworthy. The article presents an analytical review of literature and reflects current clinical, epidemiological, diagnostic and preventive trends in the Russian Federation and abroad. The review focuses on the epidemiological features of meningococcal infection, depending on the serogroup affiliation of meningococcus, the variety of clinical manifestations of the generalized form of meningococcal infection, including atypical manifestations, age-related features, depending on the serogroup of the pathogen. New diagnostic approaches and the possibilities of specific prophylaxis are highlighted. Attention is focused on the importance of monitoring the clinical and epidemiological characteristics of meningococcal infection depending on the genetic characteristics of the pathogen, and the need for further in-depth studies of this problem.

Rare generalized form of meningococcal disease caused by Neisseria meningitidis serogroup W

The article presents current data on the high epidemiological and social significance of meningococcal infection caused by Neisseria meningitidis W in the Russian Federation and abroad. The article contains a review of the literature on the clinical features of the course of generalized forms of meningococcal infection caused by serogroup W. The clinical observation of a rare variant of generalized meningococcal infection with the development of acute epiphyseal osteomyelitis of the distal epiphysis of the right tibia, arthritis of the right ankle joint, right wrist joint, joints of 1-st right toe in an early childhood is described.

Пневмония как клиническая форма менингококковой инфекции, вызванной менингококком серогруппы W

Пневмония как клиническая форма менингококковой инфекции, вызванной менингококком серогруппы W

Role of genotyping in prediction of disseminated intravascular coagulation and multiple organ failure in children with generalized forms of meningococcal infection

Aim: To investigate the features of allelic polymorphism, of several immune- and hemostasis-related genes in children with generalized, meningococcal infections and. to assess the usefulness of genotyping for prediction, of severe disseminated intravascular coagulation (DIC) and. multiple organ dysfunction, syndrome in these patients. Materials and methods : we studied. 20 children aged, from 8 months up to 17 years with generalized, meningococcal infections who developed DIC or/and multiple organ dysfunction syndrome. The control group consisted, of 200 blood, donors. Genomic DNA was isolated, from peripheral blood, leucocytes. Allelic variants of genes coding for plasma hemostatic factors (FI-A, FI-B, FXIII-A, PAI-1, ТРА ) or pro-inflammatory cytokines (IL-6, IL-1B, TNF-A) were detected by PCR and. subsequent restriction, analysis. Allele and. genotype frequencies were calculated, by direct counting, and. their differences between the groups were assessed, by Fisher's exact test. For statistical analysis, the GraphPad. Prism, ver.4.0 software was used. Results: in the group of children with generalized, meningococcal infections, the frequency of heterozygotes for the IL-6 -174 G/C polymorphism, was 1.5-fold higher than in the controls (75.0% vs. 50.0%, respectively, OR=3.0; 95% CI: 1.1-8.6; p=0.037). Genotype TPA Del/Del was detected 4-fold more frequently in children who developed multiple organ dysfunction syndrome than in those with the more favorable disease course (45.4% vs. 11.1%, respectively, OR=6.7; 95% CI: 0.6-73.1; p=0.16). Moreover, among the patients having multiple organ dysfunction, syndrome, we observed, more frequently individuals who possessed, at least 2 unfavorable genetic variants (p=0.022). Conclusion: Simultaneous assessment of nucleotide variations in 8 studied genes could help to define the group of children with high, risk of multiple organ dysfunction, syn-drome.Genotype TPA Del/Del, associated, with decreased, production, of this factor, might serve as a marker of unfavorable DIC course and possible predictor of multiple organ dysfunction. syndrome in children with generalized, meningpcoc-cal infections.

Clinical cases of meningococcal infection caused by Neisseria meningitidis serogroup W

Meningococcal infection remains a socially significant disease due to a wide range of clinical manifestations, severe course with high mortality, reaching 40-80% for certain forms. In recent years we observe a change in the serogroup picture of meningococcal infection, in particular, an increase in the proportion of meningococcal serogroup W, characterized by polymorphism of clinical manifestations. The authors present two their own clinical observations of a generalized form of meningococcal infection with a severe course in adolescents caused by Neisseria meningitidis of W serogroup with fatal outcome. They describe the peculiarities of the cases, namely, inconsistency of the clinical picture at the beginning of the disease and post-mortem changes. The article describes heart damage in the form of focal purulent septic myocarditis and purulent foci of destruction in the brain stem, hemorrhagic infarction of the choroid plexus with hemotamponade of the lateral ventricles of the brain, the predominance of septicopia over septicemia. The revealed changes are likely to reflect clinical and morphological features of meningococcal infection caused by N. meningitidis of serogroup W.

Meningococcal infection in children: factors influencing outcome

Generalized forms of meningococcal infection are characterized by high risk of complication and fatal outcomes. In Russian Federation, 2016, meningococcal infection was the second most common cause of pediatric deaths (25%) due to infectious diseases after community associated-pneumonia. Mandatory vaccination against meninococcal infection is not regulated, and immunization coverage according to epidemic indications is insufficient. During first 6–8 hours of illness clinical signs of this infection may be non-specific, because of that it is difficult to make correct diagnosis at outpatient department. Aim of the study was to analyze mistakes of diagnostics of meningococcal infection and to assess factors influencing the disease outcome. Material and methods. Retrospective cohort study was performed including 113 pediatric cases of generalized meningococcal infection occurred in Arkhangelsk region (46 cases with fatal outcome and 67 patients, who recovered). Factors influencing the outcome were recognized using Cox regression. Results. Median age of patients was 11 months. Clinical forms were meningitis (13,3%), meningococcemia (40,7%), mixed form (46%). The diagnosis of meningococcal infection was made at outpatient department in 36,9% of cases. The main causes of diagnostic mistakes were the lack of experience among primary care physicians and non-specificic symptoms during the first hours of the disease. Age younger 2 years, septic shock and time between onset of the diseases and admission to the hospital were associated with fatal outcome. Conclusion. To manage meningococcal disease we need to have good compliance with clinical guidelines for outpatient departments and hospitals; to optimize medical students education for prevention of diagnostic mistakes. Vaccination is the most effective method of prevention of deaths associated with meningococcal infection.

ANALYSIS OF SOCIAL AND MEDICAL PORTRAIT OF CHILDREN WITH PERTUSSIS, MENINGOCOCCAL INFECTIOUS, SCARLET FEVER AND ESTIMATION OF THEIR ASSIGNED PHARMACOTHERAPY

Introduction: The level of childhood bacterial diseases incidence does not have a downward trend. The aim: Conduction of a sociological analysis of medical cards for children with pertussis, meningococcal infection (MI), scarlet fever, and evaluation of consumed pharmacotherapy according to real clinical practice in Ukraine. Materials and methods: 1215 medical cards of inpatients; methods: sociological - document analysis, retrospective frequency. Results: Among the cards of children with pertussis: 50.2% - female, 49.8%- male; by age children up to 1 year (49.3%) were prevailed. In 79.6% incidence - medium-hard form pertussis, 42.2% with complications. Among patients with MI by sex there were: 50.5 % - boys and 49.5% - girls; by age - children aged 1-4 (40.2%); the structure of generalized forms of MI: 40.2% - meningococcemia, 11.4% - meningitis, 48.4% - combination. Scarlet fever was more frequently: boys (56.4%), children aged 5-9 (44.7%), urban residents (79.7%); it was 93.4% of a medium-hard form. Most of medicines were prescribed to children with MI - 15.8 trade names per 1 person, it was prescribed 191 INN, most often - Sodium chloride (90.0%), Ascorbic acid (68.5%), Ceftriaxone (65.8%); patients with pertussis - 11.2, 196 INN (Chlorpromazine (69.1%), Dexamethasone (53.2%), Butamirate (51.8%)); scarlet fever - 9.3 medicines, 114 INN (local action Comb drug for throat diseases treatment (94.4%), Ceftriaxone (48.7%), Metamizole sodium (38.1%)). Conclusions: Frequency analysis data of consumed pharmacotherapy in real pediatric practice in Ukraine shows the need for its further optimization in accordance with the principles of evidence-based medicine, the results of research on the socio-demographic characteristics of patients, forms and complications of course of the basic disease.

Meningococcal infection: clinical and epidemiological characteristics in modern conditions

The problems of the incidence of meningococcal disease and the epidemiological situation in the world, in the Russian Federation and in the Armed Forces are consecrated. In the past decade, there has been a global decline in the incidence of meningococcal disease, but there is still the possibility of new outbreaks and epidemics. From 1996 to 2016, a decrease in the incidence of meningococcal disease was also noted in Russia. In certain regions of the Russian Federation, an increase in incidence was recorded, which did not affect the general trend. Against this background, the idea was formed that in the coming years, thanks to a favorable epidemiological situation and the possibility of preventing meningococcal infection with the help of a vaccine, it is possible to achieve control of this infection. However, meningococcus showed all the classic properties of variability and fitness. Changes in the structure of circulating serogroups of meningococcus led to the formation of a non-immune layer of the population in the face of increasing pathogenicity of the dominant serogroups. The activity of the epidemic process is indirectly indicated by the high diversity of genetic and serological clonal complexes, serogroups and serotypes of the pathogen. The incidence of meningococcal disease over the past ten years in the Armed Forces of the Russian Federation can be assessed as low, but mortality has high values. The peak incidence was in 2010, but the maximum percentage of mortality was in 2017-18,2%. The increase in mortality from invasive forms of meningococcal infection, on the one hand, is associated with an increase in the total number of sources of this infection, on the other hand, with errors in early diagnosis and, as a consequence, in the incorrect provision of emergency care at the prehospital stage, which recur from year to year and are of a similar nature.

Whole genome characterization of Neisseria meningitidis serogroup W isolates, circulating in Moscow

Introduction. The invasive meningococcal disease (meningitis and/or septicemia) is actual problem of public health in Russia. Neisseria meningitidis isolates are classified into serogroups, PorA/FetA VRs, sequence types and clonal complexes. The growth of the invasive forms of meningococcal infection caused by isolates with «W: P1.5,2: F1-1: ST-11 (cc11)» profile requires attention for extended genotyping because the discriminating ability of classical MLST and antigens typing does not allow to answer the question about genetic and antigenic features of the pathogens and their epidemic potential. Materials and Methods. Four N. meningitidis serogroup W isolates associated with invasive meningococcal disease in Moscow (Russia) were characterized by next-generation sequencing. Three isolates were sequenced directly from cerebrospinal fluid samples and one -as a bacterial culture. All isolates were characterized earlier and the data were published in the PubMLST data base (id38565, id38573, id50225 and id50241). Genomic DNA was sequenced on Illumina MiSeq instrument. Results and Discussion. Obtained sequences allowed us to characterize four meningococci isolates for more than 1400 loci from the core genome MLST scheme. We have analyzed the core genome MLST scheme information about surface-antigen coding sequences. Housekeeping genes sequences were used to determine eMLST profile, ribosomal protein genes and some antibiotic resistance associated genes. We have characterized some ribosomal protein genes and antibiotic resistance associated genes. Based on eMLST profiles we noticed that there are at list two clones of N. meningitidis serogroup W inside complex ST-11/ET-37 clonal complex circulating in Moscow during 2016. An eMLST profile of isolates id50225 and id50241 differs in 3 loci out of 20. Application of the approach based on next-generation sequencing in routine epidemiological surveillance dramatically increases the amount of data and genotyping discriminating ability.

CLINICAL-EPIDEMIOLOGICAL FEATURES AND OUTCOME OF GENERALIZED FORMS OF MENINGOCOCCAL INFECTION IN CHILDREN

The objective of the research was to study clinical and epidemiological features and outcomes of generalized forms of meningococcal infection in children from Krasnoyarsk and Krasnoyarsk Territory during the period from 2012 to 2016. Materials and methods. A retrospective analysis of 57 medical records of hospital patients with generalized forms of meningococcal infection was carried out in the infectious and resuscitative departments of the Krasnoyarsk Clinical Hospital No. 1 from 2012 to 2016, including 12 protocols of pathologoanatomical studies of the deceased patients and 45 medical cards of ambulatory patients – convalescents of the disease from 2012 to 2016. Results. The epidemic situation for meningococcal infection in Krasnoyarsk Territory from 2012 to 2016 is characterized by signs of inter-epidemic period. Children of the first 3 years of life are in the group of high risk for the development of GFMI, which accounts for 74% of the total number of cases of children aged 14. There are signs of meningococcal infection « aging » – in the age structure the number of children in the first year of life decreased, while the proportion of children aged 4 – 7 and 7 – 14 increased compared to previous decades. There is a tendency to a decrease in the proportion of the combined forms with an increase in the frequency of « pure » meningococcemia. In recent years there has been an « atypical » course of generalized forms of the disease, when classical hemorrhagic necrotic rashes appear only on the 3rd – 4th day of the disease. In convalescents who underwent a combined form of MI and « pure » meningitis severe residual effects leading patients to disability are possible to develop. Conclusion. The use of polyvalent conjugated vaccines in potential risk groups will allow us to reduce the morbidity and mortality from generalized forms of meningococcal infection, including younger children.

INNOVATIONS IN THE MANAGEMENT OF CHILDREN’S NEUROINFECTIONS

The article describes some topical problems of neuroinfections in children and the ways of their solutions on the basis of the experience of a leading institution — Pediatric Research and Clinical Center for Infectious Diseases. There are introduced some innovation approaches of diagnostics and therapy of bacterial purulent meningitis tested at the institution. There are described diagnostic markers of meningitis in children, method of ultrasound evaluation monitoring of the condition of kidneys, renal blood flow, adrenal glands in the patients with a fulminant course of generalized form of meningococcal infection, and innovation therapeutic approach by recombinant interleukin-2 — roncoleukin introduction to the complex therapy. There is reflected an innovation method of differential diagnostics by the determination of acute-phase protein haptoglobin in cerebrospinal fluid. There are presented the tested methods to diagnose sensorineural deafness in children with bacterial purulent meningitis, critical condition polyneuropathy, and inflammatory polyneuropathy by the technique of rehabilitation potential evaluation.

Meningococcal Infection in Children in the Krasnoyarsk Territory: Analysis of Fatal Outcomes

Meningococcal infection (MI) for many years has occupied one of the most important places in the structure of acute neuroinfections in children. Some decline in MI morbidity in recent years has reduced the alertness of doctors to early detection of the disease that in some cases becomes the cause of late hospitalization, development of decompensated shock and ineffective resuscitation. The purpose of the given research is to identify the causes of deaths from generalized forms of MI and the prospects of mortality reduction. The paper gives the expert analysis of 22 medical histories of children who died of generalized forms of MI during the period from 2005 to 2014 in Krasnoyarsk. The work describes the features of the clinical picture of MI generalized forms in children at the present stage, reveals the causes of deaths during the period of sporadic morbidity in the Krasnoyarsk Territory and determines the adverse prognostic features that indicate the particular severity and the development of fulminant course of the disease.

Genomic signature of multi-drug resistant Salmonella typhi related to the massive outbreak in Zambia year 2010 to 2012

Background: The interepidemic meningococcal infection (MI) period inMoscowhas been going since the 1989. Outbreaks of general forms of MI (GFMI) were registered in 1996, 2003, 2008 with their morbidity rates per 100,000 persons (MR) of 4.23, 3.63 and 2.59. In 2012 MR was at 1.56. Methods & Materials: Meningococcus strains isolated from GFMI patients in Moscow Infectious Diseasaes Clinic were serogrouped, and the specifics of the immunological structure of the population of Moscow were defined. Results: The predominance of meningococcal serogroup A (MSA)was shown. The highestMSAdensitywas registered in 1996, 2003, 2008 (78.6, 61.5, 76.2%%). MSA density increased in2009 2012 (47.7 83.7%%). The study of the immunological structure of the population using passive hemagglutination test showed, that in 1993-2003 the number of MSA seropositive persons was high (70-90%). The study conducted in 2004-2012 using enzyme immunoassay allowed both to estimate the state of immunity and indirectly asses the MSA circulation. The presence in the blood serum of IgM antibodies indicates a fresh infection; IgG a previous infection and the presence of immunity; IgM+ IgG a fresh infection or reinfection. The years 2004 2005 marked significant MSA circulation with a small amount of non-immune individuals. The proportion of adults with IgM, IgM+ IgG antibodies was 65%, with IgG 24%. In the years 2006-2010 the proportion of individuals with IgM, IgM+ IgG, IgG decreased and the proportion of seronegative individuals increased. The year 2011 resumed the tendency for the growth of the proportionofpersonswith IgM, IgM+ IgGantibodies. In2012 it reached 21.9% in adults and 15.6% in children. Proportion of persons with IgG antibodies decreased to less than 2%. Seronegative were 76.4% of adults and 83.1% of children. Conclusion: The sporadic incidence of MI in Moscow does not diminishMSA’s significance in the structure of GFMI. There is a tendency towards increased MSA circulation with the parallel large amount of non-immune individuals. The studies have to be continued in order to assess changes in the epidemiological situation and at the first sign of trouble to carry out adequate preventive measures.

Therapierefraktäre fulminante Meningokokkensepsis

Two cases of the severe form of meningococcal infection are described. A 17-year-old girl and a (unrelated) 2-year-old boy suddenly developed fever and rigor. Several hours later petechiae of the skin were noted: they rapidly spread. On admission the girl was found to have a severe consumptive coagulopathy (prothrombin 24%, partial thromboplastin time 104 sec, fibrinogen 73 mg/dl, platelets 35,000/microliters). She died two-and-a-half hours after admission of treatment-resistant shock. The boy had at first only a low prothrombin value (39%), but later the other coagulation values also became abnormal. He died 16 hours after admission from the consumptive coagulopathy and profound anaemia (haemoglobin 7.4 g/dl, haematocrit 0.23). Neither patient had any clinical signs of meningitis. Isolation of Neisseria meningitidis from blood cultures confirmed the diagnosis.