FROM SAFE CARRIAGE TO PURULENT MENINGITIS


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Abstract

The paper considers the current views of the development of infection from mucosal colonization (carriage), including bacteremia, to acute purulent meningitis caused by the human commensal bacteria Neisseria meningitidis, Streptococcus pneumoniae, and Streptococcus agalactiae, etc. To reach the subarachnoid space, the pathogens of acute purulent meningitides use different virulence factors. Emphasis is laid on the role of bacterial capsules. Mucosal colonization manifests itself in microcolony and biof ilm formation. However, only a limited number of genotypes, the so-called hyperinvasive lineages, are able to cross the epithelial barrier and to enter the bloodstream. The epithelial barrier is overcome via transcellular (meningococcus) or transcellular and paracellular (pneumococcus, Serogroup B streptococcus) routes. The pathogens survive and multiply in the blood due to the capsules and complement-inactivating system. The blood-brain barrier is overcome mainly through the paracellular route although the role of transcytosis for meningococcus cannot be ruled out. Successfully overcoming both the epithelial barrier and the blood vessel endothelium requires the involvement of Type IV pili and other bacterial adhesins. The close interaction of the microorganism with the brain capillary endothelium gives rise to activated host cell signaling pathways, leading to the breakage of very strong bonds between the vascular wall cells. This underlines the need for mon itoring the clonal structure of circulating pathogens of acute purulent meningitides as an important element of epidemiological surveillance.

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About the authors

N. N KOSTYUKOVA

N.F. Gamaleya Research Institute of Epidemiology and Microbiology, Ministry of Health of Russia

Email: nathakos@mail.ru
Moscow

Vladimir A. BEKHALO

N.F. Gamaleya Research Institute of Epidemiology and Microbiology, Ministry of Health of Russia

Email: bekhalo@gamaleya.org
Moscow

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