Anna Kružlíková, Viera Jančulová
Invasive meningococcus infections are despite the advance in medicine still serious, life-threatening conditions.
Aim of the work: Phenotypisation and genotypisation identifications of N. meningitidis strains, which caused invasive meningococcus
diseases (IMD) and identification of nasopharyngeal carrier strains in the SR in 2015. Testing of quantitative sensitivity
(MIC) of N. meningitidis against selected ATB. The epidemiological analysis of IMD sensitivity incidence in the SR in
2015. Overview of actual vaccination substances in the SR for IMD prevention. The aim of the work was also to publish general
knowledge on IMD as about their originator N. meningitidis, laboratory diagnostics, epidemiology, clinical picture, ATB
therapy and prophylaxis.
Methods: A mount stained according to Gram was prepared from each biological material for light microscopy. Biochemical
– metabolic properties of bacterial isolates from the liquor, blood and pathological material we verified with commercial diagnostic
sets (Erba Lachema). To determine a serogroup we used agglutination with specific antisera (Becton&Dickinson) and
PCR. PCR also helped to prove a molecular type identification. Minimal inhibitory concentration (MIC) of benzylpenicillin (PNC),
cefotaxim (CTX), ciprofloxacin (CIP), rafimpicin (RIF) we detected with E-tests (Liofilmchem s.r.l.). Antibiotic sensitivity was
evaluated according to present break-points for MIC and inhibition zone interpretation (European Committee on Antimicrobial
68 Neurológia 2/2016
Susceptibility Testing – EUCAST). Into the work there were involved results of the NRC laboratory for meningococci, molecular
biology laboratories (the Department for medical microbiology, UVZSR, Bratislava), reporting of disease cases into EPIS in cooperation
with the department of epidemiology.
Results: In the Slovak Republic in 2015 there were altogether 30 invasive meningococcal diseases (IMD). From these 30 cases
26 were laboratory confirmed, 4 ended in death – 1 x N. meningitidis C serogroup in a 2-year old child, 2 x N. meningitidis of
the B serogroup in 8-month old and 1-year old child. In a 5-month old child the cultivation examination of liquor was negative.
Clinically 17x it was meningitis, in other cases sepsis or meningitis with sepsis. The disease incidence was sporadic prevailingly,
two diseases occurred in one family. The group serotypisation of meningococci was done in 23 patients (76.67%). The serogroup
B prevailed (15x), 4x serogroup C, in 4 patients the group was not determined. In NRC for meningococci 315 carrier
strains of N. meningitidis were analysed: 145 from the serogroup B (46%), 8 strains from the serogroup C (2%), 24 strains of the
serogroup Y (8 %), 10 strains of the serogroup W135 (3%) and 15 strains of the serogroup 29E (5%). From 2 materials N. meningitidis
of the serogroup X was identified (1%). In 111 (35%) of carrier strains the serogroup was not detected. In 2015 and until
the end of April 2016 we noticed 3 resistant strains (MIC PNC – 0.75 mg/L – liquor, 0.38 mg/L – tonsils, 0.75 mg/L – nose,) and
23 strains of N. meningitidis with threshold sensitivity against PNC. Resistant strains were betalactam-negative.
Conclusion: In comparison with previous years 2014 (29 IMD) and 2013 (25 IMD), the number of diseases caused by N. meningitidis
does not differ significantly from 2015 (30). Compared with 2012 morbidity decreased by 26.83%. In the strains N. meningitidis
from IMD the predominance of serogroup B incidence over C was present during the whole monitored period. To prevent
the disease in the Slovak Republic there are available following vaccination substances with the valid registration:
1. conjugated polysaccharide vaccines - Meningococcal A+C (Sanofi Pasteur), NeisVacC (Pfizer), Nimenrix (Pfizer)
2. a conjugated oligosaccharide vaccine – Menveo (GSK Vaccines S.r.l.),
3. a component adsorbed vaccine – Bexsero (Novartis Vaccines and Diagnostics S.r.l).