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Journal of Clinical Microbiology, March 2006, p. 861-871, Vol. 44, No. 3
0095-1137/06/$08.00+0     doi:10.1128/JCM.44.3.861-871.2006
Copyright © 2006, American Society for Microbiology. All Rights Reserved.

Characterization of Neisseria meningitidis Isolates from Recent Outbreaks in Ethiopia and Comparison with Those Recovered during the Epidemic of 1988 to 1989

Gunnstein Norheim,¹ Einar Rosenqvist,¹ Abraham Aseffa,² Mohammed Ahmed Yassin,^3,4 Getahun Mengistu,^5,6 Afework Kassu,⁵ Dereje Fikremariam,⁷ Wegene Tamire,⁷ E. Arne Høiby,¹ Tsegaye Alebel,⁸ Degu Berhanu,² Yarid Merid,⁴ Morten Harboe,^2,9 and Dominique A. Caugant^1,10*

Division of Infectious Disease Control, Norwegian Institute of Public Health, Oslo, Norway,¹ Armauer Hansen Research Institute, Addis Ababa, Ethiopia,² Liverpool School of Tropical Medicine, Liverpool, United Kingdom,³ Southern Nations, Nationalities, and Peoples' Region Health Bureau, Awassa, Ethiopia,⁴ Gondar College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia,⁵ Department of Internal Medicine, Faculty of Medicine, Addis Ababa University, Addis Ababa, Ethiopia,⁶ Sidamo Regional Hospital, Yirgalem, Ethiopia,⁷ North Gondar Zone Health Bureau, Gondar, Ethiopia,⁸ Institute of Immunology, University of Oslo and Rikshospitalet University Hospital, Oslo, Norway,⁹ Department of Oral Biology, University of Oslo, Oslo, Norway,¹⁰

Received 15 July 2005/ Returned for modification 16 September 2005/ Accepted 18 November 2005

The objectives of this study were to collect and characterize epidemic meningococcal isolates from Ethiopia from 2002 to 2003 and to compare them to 21 strains recovered during the previous large epidemic of 1988 to 1989. Ninety-five patients in all age groups with clinical signs of meningitis and a turbid cerebrospinal fluid (CSF) sample were included in the study of isolates from 2002 to 2003. Seventy-one patients (74.7%) were confirmed as having Neisseria meningitidis either by culture (n = 40) or by porA PCR (n = 31) of their CSF. The overall case fatality rate (CFR) was 11.6%; the N. meningitidis-specific CFR was 4.2%. All 40 strains were fully susceptible to all antibiotics tested except sulfonamide, were serotyped as A:4/21:P1.20,9, and belonged to sequence type 7 (ST-7). The strains from 1988 to 1989 were also equally susceptible and were characterized as A:4/21:P1.20,9, but they belonged to ST-5. Antigenic characterization of the strains revealed differences in the repertoire of lipooligosaccharides and Opa proteins between the old and the recent strains. PCR analysis of the nine lgt genes revealed the presence of the lgtAHFG genes in both old and recent strains; lgtB was present in only some of the strains, but no correlation with sequence type was observed. Further analysis showed that in addition to their pgm alleles, the Ethiopian ST-5 and ST-7 strains also differed in their tbpB, opa, fetA, and lgtA genes. The occurrence of new antigenic structures in strains sharing the same serogroup, PorA, and PorB may help explain the replacement of ST-5 by ST-7 in the African meningitis belt.

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* Corresponding author. Mailing address: Department of Bacteriology and Immunology, Division of Infectious Disease Control, Norwegian Institute of Public Health, P.O. Box 4404, Nydalen, NO-0403 Oslo, Norway. Phone: 47 22 04 23 11. Fax: 47 22 04 25 18. E-mail: dominique.caugant{at}fhi.no.

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Journal of Clinical Microbiology, March 2006, p. 861-871, Vol. 44, No. 3
0095-1137/06/$08.00+0     doi:10.1128/JCM.44.3.861-871.2006
Copyright © 2006, American Society for Microbiology. All Rights Reserved.

This article has been cited by other articles:

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