Underestimation of meningococci in tonsillar tissue by nasopharyngeal swabbing

doi:10.1016/S0140-6736(00)03162-7

The Lancet

Volume 356, Issue 9242, 11 November 2000, Pages 1653-1654

https://doi.org/10.1016/S0140-6736(00)03162-7 Get rights and content

Summary

The relation between carriage of Neisseria meningitidis and progression to invasive disease is not fully understood. We assessed the rate of N meningitidis carriage by conventional swabbing and immunohistochemistry in patients undergoing tonsillectomy. Swabbing detected only a quarter of carriers, and bacteria were identified beneath the mucosal surface in tonsillar tissue by immunochemical testing. Our results indicate that N meningitidis is more widespread in the population than previously thought, and have broad implications for disease prevention and cure.

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Cited by (101)

Meningococcal Biofilm Formation: Let's Stick Together
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Citation Excerpt :
Such mechanisms are in contrast to the long-term carriage stage of Nm in the host. Nm has evolved various strategies to evade the host's immune system and persist for a long time, including microcolony formation [3]. Microcolonies resemble biofilms, which are defined as organized microbial communities enmeshed in a self-produced extracellular matrix (ECM) composed of polymeric substances [4].
Extracellular DNA (eDNA) is an essential constituent of the extracellular matrix of biofilms of many microorganisms. In spite of many studies, it has long remained unclear how exactly eDNA exerts its role in biofilm formation. Here, we describe recent advances that have been made in understanding biofilm formation in the human pathogen Neisseria meningitidis. Several cell-surface-exposed proteins have been identified that bind DNA and other negatively charged polymers, such as heparin, by electrostatic interactions. By virtue of these proteins, eDNA can act as an adhesive that binds the bacteria together. We provide examples that indicate that the mechanism of binding eDNA via DNA/heparin-binding proteins is a conserved feature in biofilms of many different microorganisms, including fungi.
Neisseria
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Towards understanding the epidemiology of Neisseria meningitidis in the African meningitis belt: a multi-disciplinary overview
2017, International Journal of Infectious Diseases
Neisseria meningitidis is the major cause of seasonal meningitis epidemics in the African meningitis belt. In the changing context of a reduction in incidence of serogroup A and an increase in incidence of serogroups W and C and of Streptococcus pneumoniae, a better understanding of the determinants driving the disease transmission dynamics remains crucial to improving bacterial meningitis control.
The literature was searched to provide a multi-disciplinary overview of the determinants of meningitis transmission dynamics in the African meningitis belt.
Seasonal hyperendemicity is likely predominantly caused by increased invasion rates, sporadic localized epidemics by increased transmission rates, and larger pluri-annual epidemic waves by changing population immunity. Carriage likely involves competition for colonization and cross-immunity. The duration of immunity likely depends on the acquisition type. Major risk factors include dust and low humidity, and presumably human contact rates and co-infections; social studies highlighted environmental and dietary factors, with supernatural explanations.
Efforts should focus on implementing multi-country, longitudinal seroprevalence and epidemiological studies, validating immune markers of protection, and improving surveillance, including more systematic molecular characterizations of the bacteria. Integrating climate and social factors into disease control strategies represents a high priority for optimizing the public health response and anticipating the geographic evolution of the African meningitis belt.
Neisserial Molecular Adaptations to the Nasopharyngeal Niche
2015, Advances in Microbial Physiology
Citation Excerpt :
Sim and colleagues however, using an elegant polyclonal antibody approach, demonstrated that small aggregates of the meningococcus could be identified beneath the epithelium of tonsil tissue. This observation suggests that nasopharyngeal swabbing underestimates the frequency of meningococcal carriers, and implies that these sub-epithelial bacteria represent the true reservoir of meningococci in the human nasopharynx (Sim, Harrison, Moxon, & Tang, 2000). The finding also implies that the environment of the nasopharynx makes the formation of ‘classical’ biofilm structures, such as those formed by pulmonary pathogens like P. aeruginosa in the context of CF (Yoon et al., 2002), unlikely.
The exclusive reservoir of the genus Neisseria is the human. Of the broad range of species that comprise the Neisseria, only two are frequently pathogenic, and only one of those is a resident of the nasopharynx. Although Neisseria meningitidis can cause severe disease if it invades the bloodstream, the vast majority of interactions between humans and Neisseria are benign, with the bacteria inhabiting its mucosal niche as a non-invasive commensal. Understandably, with the exception of Neisseria gonorrhoeae, which preferentially colonises the urogenital tract, the neisseriae are extremely well adapted to survival in the human nasopharynx, their sole biological niche. The purpose of this review is to provide an overview of the molecular mechanisms evolved by Neisseria to facilitate colonisation and survival within the nasopharynx, focussing on N. meningitidis. The organism has adapted to survive in aerosolised transmission and to attach to mucosal surfaces. It then has to replicate in a nutrition-poor environment and resist immune and competitive pressure within a polymicrobial complex. Temperature and relative gas concentrations (nitric oxide and oxygen) are likely to be potent initial signals of arrival within the nasopharyngeal environment, and this review will focus on how N. meningitidis responds to these to increase the likelihood of its survival.
Compartmental models for seasonal hyperendemic bacterial meningitis in the African meningitis belt
2019, Epidemiology and Infection
The Neisseria meningitidis iron acquisition protein HpuA moonlights as an adhesin and inhibits host cell migration
2022, bioRxiv

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The Lancet

Summary

References (5)

The Stonehouse survey: nasopharyngeal carriage of meningococci and Neisseria lactamica

Epidemiol Infect

A gonococcal porA pseudogene: implications for understanding the evolution and pathogenicity of Neisseria gonorrhoeae

Mol Microbiol

Cited by (101)

Meningococcal Biofilm Formation: Let's Stick Together

Neisseria

Towards understanding the epidemiology of Neisseria meningitidis in the African meningitis belt: a multi-disciplinary overview

Neisserial Molecular Adaptations to the Nasopharyngeal Niche

Compartmental models for seasonal hyperendemic bacterial meningitis in the African meningitis belt

The Neisseria meningitidis iron acquisition protein HpuA moonlights as an adhesin and inhibits host cell migration

Research LettersUnderestimation of meningococci in tonsillar tissue by nasopharyngeal swabbing

Summary

The Stonehouse survey: nasopharyngeal carriage of meningococci and Neisseria lactamica

Epidemiol Infect

A gonococcal porA pseudogene: implications for understanding the evolution and pathogenicity of Neisseria gonorrhoeae

Mol Microbiol

Research Letters
Underestimation of meningococci in tonsillar tissue by nasopharyngeal swabbing