Neisseria Infections and Meningococcal Disease

Dear Colleagues,

N. meningitidis is a bacterium with several virulence factors, comprising a bacterial capsule with anti-phagocytic properties, a lipopolysaccharide, a system for the uptake of iron, flagella and IgA1 protease, etc. The bacterium is a host of the upper respiratory tract and is present in the nose and in the throat of a relevant proportion of the healthy population (2 to 30%), despite carriers not showing any symptoms.

N. meningitidis infections strike generally healthy individuals, especially children and young adults, in the form of severe invasive meningitis, fulminant septicemia with septic shock and bacteremia.

Some conditions act as factors predisposing individuals to severe meningococcal disease, such as genetic polymorphisms related to complement and properdin, and defects borne by the Toll-like receptor 4; they exhibit at an increased risk of bacterial meningitis acquired in the community. Furthermore, diabetes mellitus, alcoholism, old age (over 60 years) and immunodeficiency are considered conditions favoring bacterial meningitis. Moreover, the high incidence of meningococcal disease in HIV-positive individuals confirms that immunodeficiency represents a condition of augmented risk for this type of infection.

There are 12 different serogroups of meningococcus, but only five (A, B, C, W 135 e Y) cause meningitis and other serious diseases; recently, the serogroup X has been recognized as responsible for several epidemics, mainly in the so-called African "band of meningitis". Due to the rapidity of its onset, meningococcal disease is associated with significant lethality despite the availability of antibiotics and intensive care, and can also lead to serious complications.

Neisseria meningitidis remains a major and insidious cause of death, even in industrialized countries. Indeed, meningococcal disease can develop extremely rapidly and is associated with a high case-fatality rate, although antibiotics, such as rifampicin or cephalosporins, usually have great bactericidal efficacy. However, some antibiotic resistance has recently been reported.

For this reason, efforts to control the disease have been directed at optimizing meningococcal vaccines and implementing appropriate vaccination policies.

The availability of vaccines directed towards four serogroups, A, C, W135 and Y, and the implementation of vaccination programs in young children and adolescents has allowed a reduction in the number of cases of meningococcal disease. Furthermore, the multicomponent vaccine against meningococcus B can contribute to prevent serogroup B meningococcal disease, the major cause of bacterial meningitis and fulminant septicemias in Europe.

New knowledge on meningococcus can address the lack of information about this microorganism and contribute to a better handling of this disease.

This Special Issue will focus on manuscripts covering a range of topics including available diagnostic armamentarium for surveillance, vaccine implementation strategies, antimicrobial sensitivity/resistance patterns, and novel treatment and management approaches.

Dr. Donatella Panatto
Dr. Daniela Amicizia
Guest Editors

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