Clinical presentation of invasive disease caused byNeisseria meningitidisserogroup Y in Sweden, 1995 to 2012

Abstract

SUMMARYOver the period 1995–2012, the incidence of invasive meningococcal disease (IMD) caused by Neisseria meningitidis serogroup Y (NmY) increased significantly in Sweden. This is mainly due to the emergence of a predominant cluster named strain type YI subtype 1, belonging to the ST-23 clonal complex (cc). The aim of this study was to examine the clinical picture of patients with invasive disease caused by NmY and to analyse whether the predominant cluster exhibits certain clinical characteristics that might explain the increased incidence. In this retrospective observational study, the medical records available from patients with IMD caused by Nm serogroup Y in Sweden between 1995 and 2012 were systematically reviewed. Patient characteristics, in-hospital findings and outcome were studied and differences between the dominating cluster and other isolates were analysed. Medical records from 175 of 191 patients were retrieved. The median age was 62 years. The all-cause mortality within 30 days of admission was 9% (15/175) in the whole material; 4% (2/54) in the cohort with strain type YI subtype 1 and 11% (12/121) among patients with other isolates. Thirty-three per cent of the patients were diagnosed with meningitis, 19% with pneumonia, 10% with arthritis and 35% were found to have bacteraemia but no apparent organ manifestation. This survey included cases with an aggressive clinical course as well as cases with a relatively mild clinical presentation. There was a trend towards lower mortality and less-severe disease in the cohort with strain type YI subtype 1 compared with the group with other isolates.

Complete genome and methylome analysis of Neisseria meningitidis associated with increased serogroup Y disease

“…Instead, our results suggest that point mutations in genes involved in host cell interactions have led to a change in adhesion to epithelial cells, which may have improved colonization, in turn increasing transmission and resulting in expansion of this sublineage. This is also supported by a study showing that no significant differences were found in mortality or clinical outcome between the Swedish strain YI sublineages 60 . It is therefore probable that sublineage 1 has lower virulence but higher transmissibility; this may be due to either the genetic differences found in the present study or an immunologically-naïve host population.…”

“…These gene products are involved in adhesion, iron acquisition, bacterial immune system, endotoxin production, and mobile elements, and have been associated with meningococcal hyperinvasive lineages 38,[51][52][53][54][55][56] . Their absence could therefore explain the particular clinical outcomes such as pneumonia commonly associated with serogroup Y disease [57][58][59][60] . Furthermore, CRISPR-associated genes cas1 and cas2, which were found among all cc23 genomes, have previously been shown to be associated with carriage isolates 53 .…”

Impact of COVID-19 pandemic and the lockdown on invasive meningococcal disease

“…These isolates were frequently of serogroup Y (Supplementary Table). Indeed, IMD due to serogroup Y is frequently observed in elderly and associated with u and respiratory manifestations such as bacteremic pneumonia (4,12). Secondary invasive meningococcal infections were reported to occur 7 to 10 days after u infections (4, 6).…”

Acquisition of Beta-Lactamase by Neisseria meningitidis through Possible Horizontal Gene Transfer

“…IMD cases due to NmY cc23 have been increasing in France and in other European countries since 2010 (6). NmY (of cc23 and other cc) are frequently observed in the elderly and are involved in pneumonia (7). However, many NmY/cc23 cases are now occurring in adolescents and young adults who have a higher prevalence of meningococcal carriage (8), thereby perhaps providing an opportunity for concurrently carried bacterial species to exchange genetic material (Fig.…”