Turhan Vedat, Acar Ali, Kılıç Abdullah, Budak Sinem, Oncül Oral, Haznedaroğlu Tunçer, Görenek Levent
GATA Haydarpaşa Eğitim Hastanesi, Enfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Servisi, İstanbul, Türkiye.
Mikrobiyol Bul. 2010 Jul;44(3):473-8.
Meningococcal infections may develop as episodic or endemic cases particularly among children attending day-care centers, boarding schools or among military personnel. Bivalent (A/C) meningococcal vaccine is applied to all new military stuff since 1993 in Turkey. In this report two cases of meningococcemia and meningitis, developed in two soldiers vaccinated with meningococcal vaccine, were presented. The first case was a 21 years old male patient who was admitted to the emergency service with the complaints of high fever, headache, fatigue and vomiting. He was conscious, cooperative and oriented with normal neurological findings. Maculopapular exanthems were detected at the lower extremities. The patient was hospitalized with the initial diagnosis of sepsis or meningococcemia and empirical treatment was initiated with ceftriaxone and dexamethasone. Cerebrospinal fluid (CSF) examination yielded 10 cells/mm3 (lymphocytes) with normal CSF biochemical parameters. A few hours later skin rashes spread over the body rapidly, the symptoms got worse, confusion, disorientation and disorientation developed, and the patient died due to cardiac and respiratory arrest at the seventh hour of his admission. The second case was also a 21 years old male patient who was admitted to the hospital with the complaints of fever, headache, painful urination, confusion and agitation. He was initially diagnosed as acute bacterial meningitis due to clinical (stiff neck, positive Kernig and Brudzinsky signs) and CSF (8000 cells/mm3; 80% polymorphonuclear leukocytes, increased protein and decreased glucose levels) findings. Empirical antibiotic therapy with ceftriaxone was initiated and continued for 14 days. The patient was discharged with complete cure and no complication was detected in his follow-up visit after two months. The first case had an history of vaccination with bivalent (A/C) meningococcal vaccine three months ago and the second case had been vaccinated one month ago. The bacteria isolated from the blood culture of the first case and the CFS culture of the second case, were identified as Neisseria meningitidis by conventional and API NH system (BioMerieux, France). The isolates were serogrouped as W135 by slide agglutination method (Difco, USA), and both were found to be susceptible to penicillin and ceftriaxone. As far as the last decade's literature and these two cases were considered, it might be concluded that N.meningitidis W135 strains which were not included in the current bivalent meningococcal vaccine, gained endemic potential in Turkey. Since N.meningitidis W135 strains may lead to serious diseases, vaccination of the risk population with the conjugate tetravalent meningococcal vaccine (A/C/Y/W135) should be taken into consideration in Turkey.
脑膜炎球菌感染可能以散发病例或地方病形式出现，尤其在日托中心、寄宿学校就读的儿童或军人中。自1993年起，土耳其对所有新兵接种二价（A/C）脑膜炎球菌疫苗。本报告介绍了两例接种脑膜炎球菌疫苗后发病的士兵，分别出现脑膜炎球菌血症和脑膜炎。第一例是一名21岁男性患者，因高热、头痛、乏力和呕吐主诉入住急诊。他意识清醒、配合，神经学检查正常。下肢发现斑丘疹。患者最初诊断为败血症或脑膜炎球菌血症并住院，开始用头孢曲松和地塞米松进行经验性治疗。脑脊液（CSF）检查显示每立方毫米有10个细胞（淋巴细胞），脑脊液生化参数正常。几小时后皮疹迅速蔓延至全身，症状加重，出现意识模糊、定向障碍，患者入院第七小时因心脏和呼吸骤停死亡。第二例也是一名21岁男性患者，因发热、头痛、尿痛、意识模糊和烦躁不安入院。根据临床症状（颈部僵硬、凯尔尼格征和布鲁津斯基征阳性）和脑脊液检查结果（每立方毫米8000个细胞；80%为多形核白细胞，蛋白升高，葡萄糖水平降低），最初诊断为急性细菌性脑膜炎。开始用头孢曲松进行经验性抗生素治疗并持续14天。患者完全治愈出院，两个月后的随访未发现并发症。第一例患者三个月前接种过二价（A/C）脑膜炎球菌疫苗，第二例患者一个月前接种过。通过传统方法和API NH系统（法国生物梅里埃公司），从第一例患者的血培养物和第二例患者的脑脊液培养物中分离出的细菌被鉴定为脑膜炎奈瑟菌。通过玻片凝集法（美国迪福公司）将分离株血清群鉴定为W135，二者均对青霉素和头孢曲松敏感。就过去十年的文献及这两例病例而言，可以得出结论，目前二价脑膜炎球菌疫苗未包含的脑膜炎奈瑟菌W135菌株在土耳其已具有地方病流行潜力。由于脑膜炎奈瑟菌W135菌株可能导致严重疾病，土耳其应考虑对高危人群接种结合四价脑膜炎球菌疫苗（A/C/Y/W135）。
