title: Pathogenesis and diagnosis of human meningococcal disease using immunohistochemical and PCR assays.
abstract: Neisseria meningitidis remains the leading cause of fatal sepsis. Cultures may not be available in fulminant fatal cases. An immunohistochemical assay for N meningitidis was applied to formalin-fixed samples from 14 patients with meningococcal disease. Histopathologic findings in 12 fatal cases included interstitial pneumonitis, hemorrhagic adrenal glands, myocarditis, meningitis, and thrombi in the glomeruli and choroid plexus. Meningeal inflammation was observed in 6 patients. Skin biopsies of 2 surviving patients showed leukocytoclastic vasculitis and cellulitis. By using immunohistochemical analysis, meningococci and granular meningococcal antigens were observed inside monocytes, neutrophils, and endothelial cells or extracellularly. By using real-time polymerase chain reaction (PCR) on formalin-fixed tissue samples, meningococcal serogroup determination was possible in 11 of 14 cases (8 serogroup C, 2 Y, and 1 B). Diagnosis and serogrouping of N meningitidis can be performed using immunohistochemical analysis and PCR on formalin-fixed tissue samples. Immunohistochemical analysis determined the distribution of meningococci and meningococcal antigens in tissue samples, allowing better insights into N meningitidis pathogenesis.
authors.affiliation: Infectious Disease Pathology Activity, Division of Viral Rickettsial Diseases, National Centers for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
authors.forename: Jeannette
authors.initials: J
authors.lastname: Guarner
authors.forename: Patricia W
authors.initials: PW
authors.lastname: Greer
authors.forename: Anne
authors.initials: A
authors.lastname: Whitney
authors.forename: Wun-Ju
authors.initials: WJ
authors.lastname: Shieh
authors.forename: Marc
authors.initials: M
authors.lastname: Fischer
authors.forename: Elizabeth H
authors.initials: EH
authors.lastname: White
authors.forename: George M
authors.initials: GM
authors.lastname: Carlone
authors.forename: David S
authors.initials: DS
authors.lastname: Stephens
authors.forename: Tanja
authors.initials: T
authors.lastname: Popovic
authors.forename: Sherif R
authors.initials: SR
authors.lastname: Zaki
mesh_terms: D000293:Adolescent; D000328:Adult; D000818:Animals; D001921:Brain / Q000382:microbiology / Q000473:pathology; D002675:Child, Preschool; D005260:Female; D005557:Formaldehyde; D006801:Humans; D007150:Immunohistochemistry / Q000379:methods*; D007223:Infant; D008168:Lung / Q000382:microbiology / Q000473:pathology / Q000648:ultrastructure; D008297:Male; D008589:Meningococcal Infections / Q000175:diagnosis*; D008854:Microscopy, Electron; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology; D009345:Neisseria meningitidis / Q000302:isolation & purification*; D010053:Ovary / Q000382:microbiology / Q000473:pathology; D011014:Pneumonia / Q000382:microbiology; D020133:Reverse Transcriptase Polymerase Chain Reaction; D012703:Serotyping; D016707:Tissue Fixation
chemical_list: D005557:Formaldehyde