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    Healthcare-Associated Neisseria meningitidis W135 Conjunctivitis
    (Ankara Microbiology Soc, 2013) Unal Yilmaz, Gulizar; Alkan, Metin; Vatansever Ozbek, Ulfet; Tugrul, H. Murat
    Neisseria meningitidis is an unusual pathogen among the causes of acute bacterial conjunctivitis. Meningococcal conjunctivitis may present as primary or secondary infection, while primary meningococcal conjunctivitis may emerge as invasive or non-invasive forms. N.meningitidis W135 strain is not common in Turkey, and is rarely reported as the cause of meningitis. Moreover, no cases of conjunctivitis due to N.meningitidis W135 were reported from Turkey. In this report a case of N.meningitidis W135 conjunctivitis has been presented who acquired the infection from another patient with meningococcal meningitis by close contact in the hospital environment. A 2-month-old male infant was admitted to our hospital with poor health condition, feeding difficulty and weight loss. He was hospitalized in intensive care unit and fluid replacement started due to severe dehydration. The infant had stigmata of Down's Syndrome, and since conjunctivitis were detected on physical examination, swab samples were obtained from both eyes for direct microscopic examination and cultivation. Abundant lekocytes and gram-negative diplococci were observed in Gram-stained smears, and bacterial growth were detected in the culture from left eye samples. The isolate have been identified as N.meningitidis by conventional microbiological methods, and serotyping of the isolate yielded W135 strain. The infant was treated with systemic cefotaxime and ampicillin-sulbactam, together with topical tobramycin and gentamycin. Since no symptoms of meningitis appeared during the follow-ups, the case was diagnosed as non-invasive primary meningococcal conjunctivitis. Investigation for a probable source revealed that the infant had close contact with a six-year-old boy with high fever, unconsciousness and vomiting a week ago in the outpatient clinic of Tekirdag State Hospital. N.meningitidis was also isolated from the cerebrospinal fluid culture of probable index case with meningitis and identified as W135 strain by serotyping. Both strains isolated from these cases were found similar according to their phenotypical characteristics, however genotyping could not be performed. Since no other sources of exposure could be found, it was concluded that the infant with conjunctivitis acquired the bacteria from the other patient during their shared hospital visit. This patient is the first N.meningitidis W135 conjunctivitis case reported from Turkey.
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    Meningococcemia: Different Serotypes in the Same Region
    (Ankara Microbiology Soc, 2020) Aladag Ciftdemir, Nukhet; Duran, Ridvan; Vatansever Ozbek, Ulfet; Hancerli Torun, Selda; Acunas, Betul; Unal Sahin, Nuriye
    Meningococcal infections are important health problems causing high morbidity and mortality. Neisseria meningitidis have 13 serogroups. A, B, C, Y and W135 are the most common causes of invasive disease among those serogroups. The distribution of the serogroups differs according to the geographical regions and the age groups. In this case report, two cases of meningococcemia infected with serogroup C and Y of N.meningitidis rarely seen in our country were presented. First case was a two and a half year-old female patient who has admitted to our pediatric emergency unit with fever and rash spreading from lower extremities to her body. The patient had diffuse purpuric rash with generalized weakness and tendency to sleep at admission. The patient has been suspected as meningococcemia because of the skin rash, tendency to sleep and hypotension. Antibiotics treatment was started immediately and lumber puncture was performed. In blood tests, leukocyte count: 3600/mm(3) (61% neutrophils), hemoglobin: 11.1 g/dl, platelet count: 127.000/mm(3), C-reactive protein: 10 mg/dl, erythrocyte sedimentation rate: 6 mm/hour, prothrombin time: 28.8 seconds (normal value= 11-16), prothrombin activity: 36%, international normalized ratio (INR): 2.13 (normal value= 1-1.5), activated partial thromboplastin time: 57.7 seconds (normal value= 25-35 sec), fibrinogen: 246 mg/di (normal value= 200-400 mg/dl) and in cerebrospinal fluid protein: 21 mg/dl and glucose: 62 mg/dl were found. There were eight cells in the microscopic examination. Skin rashes were increased and the patient became hypotensive. No microorganisms were isolated in blood and cerebrospinal cultures. N.meningitidis serogroup C was isolated from the cerebrospinal fluid of the patient using polymerase chain reaction (PCR). The patient suffered from immune-mediated arthritis in the sixth day of treatment and nonsteroidal anti-inflammatory drugs were given. The patient has recovered with antibiotics, fresh frozen plasma and inotropic treatment. Second case was a 13 year-old male patient who has admitted three days after the first case with a pre-diagnosis of malignancy because of pancytopenia and fever. The patient had generalized weakness and a few petechial purpuric rashes at the facial region at admission. After the admission general status of the patient has worsened rapidly and he has died as a result of cardiovascular arrest. Blood tests in admission showed leukocyte count: 6000/mm(3) (79% neutrophils), hemoglobin: 17.3 mg/dl, platelet count: 16.000/mm(3), C-reactive protein: 8.63 mg/dl, prothrombin time: 92.6 seconds, prothrombin activity: 10%, INR: 6.78, activated partial thromboplastin time: 231.5 seconds. Cerebrospinal fluid obtained from postmortem lumbar puncture showed no growth (protein: 95 mg/dl, glucose: 35 mg/dl) and N.meningitidis serogroup Y was detected by PCR. Two meningococcemia cases caused by two different serogroups which are rarely seen in our region in recent years were presented at the same time period in the same hospital. This case report pointed out that surveillance has a great importance in such diseases.