title: Molecular epidemiological investigation to determine the source of a fatal case of serotype 22F pneumococcal meningitis.
abstract: A child's death due to pneumococcal meningitis after contracting the disease in an after-school programme prompted an investigation to assess nasopharyngeal (NP) carriage among her contacts. The serotype of the meningitis case isolate was determined, together with the serotypes of the NP specimens of contacts, comprising the case patient's brother, the case patient's after-school programme contacts and the brother's day-care centre (DCC) contacts. NP swabs from 155 children and 69 adults were obtained. Real-time PCR and conventional multiplex PCR (CM-PCR) assays were used to detect pneumococcal carriage and determine serotypes. Broth-enriched culture of NP specimens followed by pneumococcal isolation and Quellung-based serotyping were also performed. DNA extracts prepared from cerebrospinal fluid of the index case and from the NP strain isolated from the brother and from one attendee of the brother's DCC were subjected to genotyping. Pneumococcal carriage assessed by real-time PCR and culture was 49.6 and 36.6%, respectively (P<0.05). Twenty-three serotypes were detected using CM-PCR, with serotypes 6A/6B, 14, 19F, 6C/6D, 22F/22A, 23F and 11A/11D being the most frequent. All eight serotype 22F/22A NP specimens recovered were from children attending the brother's DCC. The meningitis case isolate and the NP carriage isolate from the patient's brother were both serotype 22F and shared the same new multilocus sequence type (ST6403) with the attendee of the brother's DCC. CM-PCR proved to be useful for assessing carriage serotype distribution in a setting of high-risk pneumococcal transmission. The causal serotype appeared to be linked to the brother of the case patient and attendees of his DCC.
authors.affiliation: Department of Microbiology, Immunology, Parasitology and Pathology, Federal University of Goiás, Goiânia, Brazil.
authors.forename: Juliana
authors.initials: J
authors.lastname: Lamaro-Cardoso
authors.affiliation: Adolfo Lutz Institute, São Paulo, Brazil.
authors.forename: Ana Paula S
authors.initials: APS
authors.lastname: de Lemos
authors.affiliation: Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: Maria da Glória
authors.initials: MDG
authors.lastname: Carvalho
authors.affiliation: Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: Fabiana Cristina
authors.initials: FC
authors.lastname: Pimenta
authors.affiliation: Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: Alexis
authors.initials: A
authors.lastname: Roundtree
authors.affiliation: Department of Community Health, Federal University of Goiás, Goiânia, Brazil.
authors.forename: Lorena
authors.initials: L
authors.lastname: Motta
authors.affiliation: Pontifical Catholic University of Goiás, Goiânia, Brazil.
authors.forename: Maria Aparecida
authors.initials: MA
authors.lastname: Vieira
authors.affiliation: Pontifical Catholic University of Goiás, Goiânia, Brazil.
authors.forename: Sabrina
authors.initials: S
authors.lastname: Sgambatti
authors.affiliation: Department of Community Health, Federal University of Goiás, Goiânia, Brazil.
authors.forename: Licia Kamila
authors.initials: LK
authors.lastname: Thörn
authors.affiliation: Department of Community Health, Federal University of Goiás, Goiânia, Brazil.
authors.forename: Vicente
authors.initials: V
authors.lastname: Pessoa-Junior
authors.affiliation: School of Nursing, Federal University of Goiás, Goiânia, Brazil.
authors.forename: Ruth
authors.initials: R
authors.lastname: Minamisava
authors.affiliation: Infectious Diseases Epidemiology Research Unit, University of Pittsburgh Graduate School of Public Health and School of 26 Medicine, Pittsburgh, PA, USA.
authors.forename: Lee H
authors.initials: LH
authors.lastname: Harrison
authors.affiliation: Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: Bernard W
authors.initials: BW
authors.lastname: Beall
authors.affiliation: Adolfo Lutz Institute, São Paulo, Brazil.
authors.forename: Maria Cristina de Cunto
authors.initials: MCC
authors.lastname: Brandileone
authors.affiliation: Department of Community Health, Federal University of Goiás, Goiânia, Brazil.
authors.forename: Ana Lucia
authors.initials: AL
authors.lastname: Andrade
mesh_terms: D000293:Adolescent; D000328:Adult; D002353:Carrier State / Q000453:epidemiology / Q000382:microbiology; D002648:Child; D002675:Child, Preschool; D005260:Female; D005838:Genotype; D006801:Humans; D007223:Infant; D008297:Male; D008586:Meningitis, Pneumococcal / Q000382:microbiology* / Q000635:transmission; D017720:Molecular Epidemiology; D058889:Molecular Typing; D009305:Nasopharynx / Q000382:microbiology; D016133:Polymerase Chain Reaction; D012703:Serotyping; D013296:Streptococcus pneumoniae / Q000145:classification* / Q000235:genetics* / Q000302:isolation & purification