Neisseria meningitidis Serogroup X Sequence Type 2888, Italy

Behavioral responses of bobcats and coyotes to habitat fragmentation and corridors in an urban environment. 4. Centers for Disease Control and Prevention. Protocol for postmortem diagnosis of rabies in animals by direct fl uorescent antibody testing: a minimum standard for rabies diagnosis in the United States [cited 2009 Mar 31]. To the Editor: Neisseria men-ingitidis serogroup X was fi rst described in the 1960s and has been found to be responsible of rare cases of invasive meningococcal diseases, and the People's Republic of China (1–3). This serogroup has recently emerged in Africa as an increasing cause of meningitis; unfortunately, it is not covered by current vaccine programs. Serogroup X outbreaks have been reported in Niger, Ghana, and Kenya (4–6). In particular, in Niger during January–June 2006, N. menin-gitidis serogroup X represented 51% of confi rmed cases of meningitis (4). To investigate the population structure of serogroup X meningo-cocci isolated during recent decades in Africa, Europe, and North America, Gagneux et al. (1) compared the molecular characteristics among them. That study highlighted a low genetic variability between African serogroup X strains, which contrasts with higher genetic variability among isolates from Europe and the United States (1). We describe a case of invasive meningococcal disease caused by a serogroup X N. meningitidis strain isolated in Italy. The patient was a 55-year-old Italian woman with no immune defi ciency. The onset of disease started quickly with high fever (39°C) on June 1, 2009. No contacts with persons coming from abroad were reported. This case was diagnosed on the basis of clinical signs and symptoms and results of laboratory confi rmatory tests, including blood culture. The patient received ceftriaxone (2 g/day) for 7 days with a favorable outcome. The strain was susceptible to penicillin G, rifampin, ciprofl oxacin, and ceftriaxone, as determined by Etest method (bioMérieux, Florence, Italy). The breakpoints were those recommended by the Clinical and Laboratory Standards Institute (7). Serogroup was determined by serum agglutina-tion, and serotype/subtype, NT:P1.15, 19 were determined by standard whole-cell ELISA with monoclonal antibodies (obtained from the National Institute for Biological Standards and Control, South Mimms, UK) (8). PorA variable regions, FetA, and multilocus sequence typing analyses were performed according to standard procedures from the Neisseria Multi Locus Sequence Typing Web site (http://pubmlst.org/neisseria). The isolate from Italy had the pattern PorA VR1–19, VR2–15, and VR3–36; F5–5 and sequence type (ST)-2888. The same ST was already described in Greece …