Pericarditis Secondary to Neisseria meningitidis: A Potential Cytokine Network Pathway

 C 2007, the Authors

C 2007, Blackwell Publishing, Inc. Journal compilation  DOI: 10.1111/j.1540-8175.2007.00537.x

LETTER TO THE EDITOR

Pericarditis Secondary to Neisseria meningitidis: A Potential Cytokine Network Pathway To the Editor: ˜ et al.1 deThe recent article by Falcao scribes presentation of pericarditis secondary to Neisseria meningitidis. Unfortunately, the authors do not address a potential link between meningococcal pericarditis and cytokine network pathway. Remarkable discoveries in the universe of infectious disease have occurred in the last decades, and have expanded our scientific knowledge of the meningococcal inflammation within the vascular tree2,3 as well as the potential of N. meningitidis to penetrate a wide range of compartments other than the leptomeninges.4–6 However, how penetration into the pericardial compartment occurs remains unexplored. To move from the environment into the pericardial space, the pathogen must succeed in crossing the mucosal barrier, accessing pathway into the bloodstream and, subsequently, initiating hematogenous seeding. Linkage of N. meningitidis to eukaryotic cells is an intricate phenomenon that involves multiple adhesive factors depending on the environment the bacteria encounter in us, human hosts.7 In addition, we recently reported an intriguing phenomenon of cytokine activation in the pericardial and peritoneal compartments.5,6 The cytokine concentrations were higher in the pericardial fluid than in blood. This cytokine pattern suggests a compartmentalized inflammatory response in which cytokines are potentially synthesized by activated local cells and/or inflammatory cells that have migrated from the bloodstream to the pericardial compartment.5,6 The higher levels of cytokines in the pericardial fluid also suggest their involvement in the pathogenesis of meningococcal pericarditis.5 Thus, a potential link explaining this phenomenon in the pericardial space is the effect of cytokines. In fact, the levels of key pro- and antiinflammatory cytokines in plasma have been shown to correlate with the degree of severity of meningococcal sepsis and can be used as a

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prognostic factor.3 As a final point, understanding the multiple connections between the infectious agents and the human host is critical for the development of new therapeutic tools for reducing mortality and morbidity linked to infectious diseases. Alexandre Leite de Souza, M.D.∗ Antonio Carlos Seguro, M.D., Ph.D.† ∗

Em´ılio Ribas Institute of Infectology, ˜ Paulo, Brazil Sao † Intensive Care Unit, Em´ılio Ribas ˜ Paulo, Institute of Infectology, Sao Brazil; Department of Nephrology, Laboratory of Basic Research, ˜ Paulo School of Medicine, University of Sao ˜ Paulo, Brazil Sao References 1. Falcao SN, Tsutsui JM, Ramires FJ, et al: The role of echocardiography in diagnosis and management of isolated meningococcal pericarditis. Echocardiography 2007;24(3):263–266. 2. de Souza AL, Sztajnbok J, Marques Salgado M, et al: Severe myalgia of the lower extremities as the first clinical feature of meningococcal purpura fulminans. Am J Trop Med Hyg 2007 (in press). 3. Moller AS, Bjerre A, Brusletto B, et al: Chemokine patterns in meningococcal disease. J Infect Dis 2005; 191(5):768–775. 4. de Souza AL, Salgado MM, Alkmin MD, et al: Purulent pericarditis caused by Neisseria meningitidis serogroup C and confirmed through polymerase chain reaction. Scand J Infect Dis 2006;38(2):143–145. 5. de Souza AL, Marques Salgado M, Romano CC, et al: Cytokine activation in purulent pericarditis caused by Neisseria meningitidis serogroup C. Int J Cardiol 2006;113(3):419–421. 6. de Souza AL, Sztajnbok J, Marques Salgado M, et al: Compartmentalization of interleukin-6 response in a patient with septic meningococcal peritonitis. Clin Vaccine Immunol 2006;13(11):1287–1290. 7. Serruto D, Adu-Bobie J, Scarselli M, et al: Neisseria meningitidis App, a new adhesin with autocatalytic serine protease activity. Mol Microbiol 2003;48(2):323– 334.

ECHOCARDIOGRAPHY: A Jrnl. of CV Ultrasound & Allied Tech.

Vol. 24, No. 7, 2007