Unal Yılmaz Gülizar, Alkan Metin, Vatansever Özbek Ulfet, Tuğrul H Murat
Trakya University Faculty of Medicine, Department of Medical Microbiology, Edirne, Turkey.
Mikrobiyol Bul. 2013 Oct;47(4):722-6. doi: 10.5578/mb.5798.
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.
脑膜炎奈瑟菌在急性细菌性结膜炎的病因中是一种不常见的病原体。脑膜炎球菌性结膜炎可表现为原发性或继发性感染，而原发性脑膜炎球菌性结膜炎可呈现侵袭性或非侵袭性形式。脑膜炎奈瑟菌W135菌株在土耳其并不常见，很少被报告为脑膜炎的病因。此外，土耳其没有报告过由脑膜炎奈瑟菌W135引起的结膜炎病例。在本报告中，介绍了一例脑膜炎奈瑟菌W135结膜炎病例，该婴儿在医院环境中通过与另一名患有脑膜炎球菌性脑膜炎的患者密切接触而感染。一名2个月大的男婴因健康状况不佳、喂养困难和体重减轻入住我院。他被收治在重症监护病房，由于严重脱水开始进行补液治疗。该婴儿有唐氏综合征的体征，因体格检查时发现结膜炎，从双眼采集拭子样本进行直接显微镜检查和培养。革兰氏染色涂片观察到大量白细胞和革兰氏阴性双球菌，左眼样本培养中检测到细菌生长。通过传统微生物学方法将分离株鉴定为脑膜炎奈瑟菌，分离株的血清分型为W135菌株。该婴儿接受了全身用头孢噻肟和氨苄西林-舒巴坦治疗，同时局部用妥布霉素和庆大霉素。由于随访期间未出现脑膜炎症状，该病例被诊断为非侵袭性原发性脑膜炎球菌性结膜炎。对可能的感染源进行调查发现，该婴儿一周前在泰基尔达州立医院门诊与一名高热、昏迷和呕吐的6岁男孩密切接触。从可能的脑膜炎指数病例的脑脊液培养中也分离出脑膜炎奈瑟菌，并通过血清分型鉴定为W135菌株。根据其表型特征，从这些病例中分离出的两种菌株相似，但无法进行基因分型。由于未发现其他暴露源，得出结论，患有结膜炎的婴儿在共同的医院就诊期间从另一名患者那里感染了细菌。该患者是土耳其报告的首例脑膜炎奈瑟菌W135结膜炎病例。
