Conjunctivitis Secondary to Neisseria meningitidis: A Potential Vertical Transmission Pathway

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Clinical Pediatrics

Conjunctivitis Secondary to Neisseria meningitidis: A Potential Vertical Transmission Pathway A.L. de Souza and Antonio Carlos Seguro Clin Pediatr (Phila) 2009; 48; 119 originally published online Jul 3, 2008; DOI: 10.1177/0009922808320978 The online version of this article can be found at:

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Conjunctivitis Secondary to Neisseria meningitidis: A Potential Vertical Transmission Pathway

Clinical Pediatrics Volume 48 Number 1 January 2009 119 © 2009 Sage Publications 10.1177/0009922808320978 hosted at

A. L. de Souza, MD, and Antonio Carlos Seguro, MD, PhD he recent article by Gupta et al1 describes presentation of conjunctivitis secondary to Neisseria meningitidis infection in a previously healthy 4-mounth-old boy. The authors stated that “Primary meningococcal conjunctivitis is presumably due to direct inoculation of N meningitidis into the conjunctival sac from an exogenous source, either airborne or manual.” Nevertheless, the authors failed to explore a potential vertical transmission pathway. N meningitidis, an obligate commensal of humans, normally colonizes the mucosa of the upper respiratory tract without affecting the host, a phenomenon known as carriage.2 In addition, because N meningitidis is a strict human pathogen and most patients have not been in contact with other cases, asymptomatic carries are presumably the major source of the pathogenic strains.2 Classically, N meningitidis spreads from person to person by airborne droplets or direct physical contact such as kissing. However, there have been relevant changes in the epidemiological behavior of N meningitidis nowadays, and the human nasopharynx is no longer the only recognized primary site of the initial step of neisserial infection.3 Indeed, the bacterial pathogen N meningitidis has been found in atypical sites, such as the mucous membranes of the endocervix,3 conjunctiva,4 urethra,5 and anus.6 The power of meningococcal pathogen to colonize these atypical mucous sites is potentially associated with orogenital sex5,6 or vertical transmission.3 In fact, orogenital contact has become a critical pathway for the transport of meningococci from the


From the Intensive Care Unit, Emílio Ribas Institute of Infectology (ALdS) and Department of Nephrology, Laboratory of Basic Research, University of São Paulo School of Medicine (ACS), São Paulo, Brazil. Address correspondence to: A. L. de Souza, MD, Rua da Consolação, 2270 Ap 304, CEP 01302-001, São Paulo, SP, Brazil; e-mail: [email protected]

habitual nasopharyngeal habitat to the genital organs.3,5,6 Therefore, meningococcal transmission can occur initially via orogenital contact and, subsequently, mother to infant transmission may occur when mothers colonized with meningococci infect their babies as they are born vaginally.3 Colonization is a key step in the sequence of events leading to neisserial infection. In general, meningococcal infection occurs less than 10 days after colonization. However, there have been cases of neisserial infection following a prolonged period of carriage with a pathogenic strain. Now, the increase of orogenital practice has posed a new epidemiological challenge, and although meningococci have been implicated in various conjunctival disturbances, they have typically been unexplored and overlooked as potential etiological factors in such clinical events.

References 1. Gupta R, Levent F, Healy CM, Edwards MS. Unusual soft tissue manifestations of Neisseria meningitidis infections. Clin Pediatr (Phila). 2008;47:400-403. 2. Yazdankhah SP, Caugant DA. Neisseria meningitidis: an overview of the carriage state. J Med Microbiol. 2004;53(Pt 9):821-832. 3. Fiorito SM, Galarza PG, Sparo M, Pagano EI, Oviedo CI. An unusual transmission of Neisseria meningitidis: neonatal conjunctivitis acquired at delivery from the mother’s endocervical infection. Sex Transm Dis. 2001;28:29-32. 4. Barquet N, Gasser I, Domingo P, Moraga FA, Macaya A, Elcuaz R. Primary meningococcal conjunctivitis: report of 21 patients and review. Rev Infect Dis. 1990;12:838-847. 5. Urra E, Alkorta M, Sota M, et al. Orogenital transmission of Neisseria meningitidis serogroup C confirmed by genotyping techniques. Eur J Clin Microbiol Infect Dis. 2005;24:51-53. 6. Judson FN, Ehret JM, Eickhoff TC. Anogenital infection with Neisseria meningitidis in homosexual men. J Infect Dis. 1978;137:458-463. 119

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