Neisseria Species and Moraxella Catarrhalis (KINDA)

Neisseria species is Oxidase positive?

True

Neisseria species grows best on what agar?

CHOC

Neisseria species is grown best in what enviroment?

Capnophilic- grow best in increased Co2 environment.

Neisseria species and Moraxella Catarrhalis habitats are?

◦Upper respiratory tract

◦Genitourinary tract

◦Alimentary(Digestive) tract

Neisseria species and Moraxella Catarrhalis primary pathogens are?

◦N. gonorrhoeae

◦N. meningitidis

◦Other Neisseria species are normal flora

How are N. Gonorrhea and N. Meningitidis transmitted?

transmitted person to person

What are N. Gonorrhea and N. Meningitidis considered as?

primary pathogens.

Moraxella Catarrhalis Infections are usually what?

Respiratory

How are M. Catarrhalis respiratory infections transmitted?

By droplet

M. Catarrhalis are seen as Opportunistic pathogens in what?

Humans only

What is commonly caused by M. Catarrhalis?

Ear infections and sinus infections in children

VF Neisseria Species

—Receptors for Transferrin

—Fimbriae (common pili)-

—Lipooligosaccharide:

—Capsule

—Cell membrane proteins-

—IgA protease-

Neisseria species receptors for trensferrin?

◦Allows organism to compete with human host by binding human transferrin to specific surface receptors.

Neisseria Species Fimbriae(Pili)?

◦enhance the ability of bacterial cells to adhere to host cells and to each other

Neisseria Species Lipooligosaccharide?

◦endotoxin involved in damage to host tissue

Neisseria Species sell membrane proteins?

◦Protein I

◦Protein II

◦Protein III

Cell Membrane Proteins?

—the reason there is antigenic variation

Neisseria Species IgA protease?

◦cleaves IgA on mucosal surfaces

What is the natural host for N. Gonorrhoeae?

Humans are the only natural host

N. Gonorrhoeae is a causative agent of what?

◦sexually transmitted disease, gonorrhea.

Where do infections primarily occur in N. Gonorrhoeae?

urethra, endocervix, anal canal, pharynx and conjunctiva.

what disseminated infections can occur from the primary infection in N. Gonorrhoeae?

◦gonococcal arthritis.

N. Gonorrhoeae's primary reservoir?

usually an asymptomatic carrier

N. Gonorrhoeae is a disease that is reported in the USA

True

Gonorrhea is only second to Chlamydia Trachomatis in the number of confirmed sexually transmitted bacterial infections in the US

True

The highest rate of infections in men and women occur between (gonorrhea)?

20 & 24

N. Gonorrhoeae needs to incubate for a period of?

2-7 Days

N. Gonorrhoeae is transmitted by?

Sexual Contact

N. Gonorrhoeae causes pyogenic infection of?

Columnar and transitional epithelial cells

Pyogenic infections caused by N. Gonorrhoeae can occur where?

◦urethral, endocervix, anal canal, pharynx, and conjunctiva

N. Gonorrhoeae in males

◦95% show symptoms of acute infection

◦

◦Symptoms include dysuria, urethral discharge

◦

◦Complications include epididymitis and urethral stricture, and prostatitis

N. Gonorrhoeae in females

Approximately 50% are asymptomatic

Endocervix is most common are of infection.

Symptoms include:

◦Burning or frequency of urination, vaginal discharge, fever and abdominal pain

Complications include pelvic inflammatory disease (PID), sterility and ectopic pregnancy.

Perihepatitis ( Fitz-Hugh-Curtis syndrome)

Most common infection seen in females caused by N. Gonorrhoeae is?

Endocervix

N. Gonorrhoeae Blood Borne Disseminated Gonococcal Disease?

◦Acute form has the following symptoms: fever, chills, malaise, intermittent bacteremia, and skin lesions

◦

◦If untreated will progress to septic joint form of the disease (inflamed joints, swollen, hot, full of pus and fluid)

◦

◦Gonococcal arthritis occurs as a result of disseminated gonococcal bacteremia

How is N. Gonorrhoeae seen in children?

◦In infancy, an eye infection (ophthalmia neonatorum) may occur during vaginal delivery

◦

◦May cause blindness if not treated

◦

◦Infection is preventable with the application of antibiotic eye drops at birth

How is N. Gonorrhoeae treated in children?

Erythromycin

Clinical Specimens of N. Gonorrhoeae?

◦Genital sites

Female: endocervix

Male: urethra

◦Anal

◦Oral/pharyngeal

◦Eye

◦Blood/joint fluids

What is the specimen collection of N. Gonorrhoeae?

Always follow standard operating procedure of your facility.

Dacron/Rayon swabs

How is N. Gonorrhoeae treansported?

◦Swabs transported in Amies medium with charcoal. If not inoculated immediately onto JEMBEC agar. -set up suspect gonorrhea swab just in case

N. Gonorrhoeae should be inoculated on a media within 6 hours of collection and drying should be avoided?

True

Transgrow or JEMBEC

= James E Martin Biological Environmental Chamber

If Blood cultures are ordered a Sodium Polyanethol Sulfonate (SPS) transport tube with a?

Decreased concentration of SPS should be used

Most N. Gonorrhoeae cultures are tested using what?

Molecular methods due to this organism being difficult to grow in the clinical lab.

—Direct Gram stain from genital culture from a MALE should always be done.

True

Morphology of MALE grsm-Stain?

◦Gram-negative, kidney-bean-shaped diplococci

Media selection

CHOC

Thayer-Martin

Modified Thayer-Martin

Chocolate Agar

◦Subject to overgrowth of normal flora

Thayer-Martin Agar

is chocolate agar with vancomycin, colistin, and nystatin

Modified Thayer-Martin Agar

is chocolate agar with vancomycin, colistin, and nystatin plus trimethoprim. This is preferred agar.

Organism will not grow on what?

Sheep Blood Agar

Specimen MUST be plated on warmed media ASAP

True

Inoculated culture media must be incubated at?

350 C in 3% to 5% CO2 or candle jar

N. Gonorrhoeae colony morph on modified Thayer-Martin agar?

◦Small, beige- gray

◦Translucent, smooth

Fresh growth must be used for testing because?

N. gonorrhoeae produces autolytic enzymes-will kill itself off

Oxidase test?

Test on filter paper or directly on plate

Oxidase reagent =Dimethyl or tetramethyl oxidase reagent

Violet-purple color indicates a positive result

CTA Test?

Cystine trypticase agar (CTA)

◦Contain 1% of a single carbohydrate

Glucose, maltose, lactose, sucrose

◦Phenol red is pH indicator

Read in 24-72 hours

Immunologic methods for N. Gonorhhoeae?

◦Use colonies from primary plate

◦Organisms do not need to be viable

Fluorescent antibody technique

Coagglutination

Non-Culture methods for N. Gonorhoeae?

◦Use direct patient specimen

◦ELISA, nucleic acid probe, and PCR testing

◦Expensive; usually used in high-risk populations with large volume of testing

◦Unable to perform on all sources

PPNG

Penicillinase Producing Neisseria gonorrhoeae 

PPNG is?

◦Plasmid-mediated

◦Beta-lactamase testing should always be done on N. gonorrheoae. Should use the Nitrocefin test method.

Treatment for N. Gonorrhoeae?

Penicillin

IF beta-Lactamase Positive?

Tetracycline, Can also use cephalosporins and flouroquinolones. Ceftrizxone is the current antibiotic of choice.

N. Meningitidis is found?

In humans ONLY

Is N. Meningitidis normal flora or a pathogen?

Can be found as both

What percentage of the population have N. Meningitidis as normal flora of upper respiratory tract?

30%

How is N. Meningitidis Transmitted?

Organism is transmitted in close contact with respiratory droplets from carrier to host. Only a few colonized hosts develop meningitidis

What is N. Meningitidis usually seen in?

◦infants and adolescents.

N. Meningitidis requires close contact with a susceptible host?

True

With N. Meningitidis it is possible to spread to different individuals colonized with different stains?

True-◦Close living conditions facilitate the spread because individuals are colonized with different strains.

N. Meningitidis has a _____ Capsule that is _______?

◦Polycaccharide capsule that is antigenic. 12 know encapsulated groups that can be serotyped.

Incubation period of N. Meningitidis

1-10 Days

Host must have exposure to N. Meningitidis to obtain organism?

True

How does N. Meningitidis Colonize a host?

Bacteria adhere to the nasopharyngeal mucosa, leading to colonization.

Most N. Meningitidis infections are very mild?

True

What are the Encapsulated Strains of N. Meningitidis?

A, B, C, Y, W-135

When does N. Meningitidis become concerning?

Cross the epithelium and enter the circulatory system

Who is primarily affected by concerning N. Meningitidis?

the immunocompromised, young children, trauma victims

How is Concerning N. Meningitidis presented?

Fulminant meningococcemia

Waterhouse-Friderichesen Syndrome

Fulminant Meningococcemia?

this can develop into hemorrhaging into the skin with a petechial skin rash, tachycardia, hypotension and clot formation This will spread and cause hemorraghe in the adrenal glands. Known as Waterhouse-Friderichesen Syndrome. Death can rapidly occur.

Waterhouse-Friderichesen Syndrome?

Caused by Fulminant meningococcemia

How is Bacterial Meningitis transmitted?

by respiratory droplets and requires both close contact (ex: dormitories, military barracks, in institutions) and lack of specific antibody (susceptibility

What are the symptoms of bacterial meningitis?

fever, headache, stiff neck, nausea, vomiting, and purulent meningitis with increased WBCs

Serotypes of Bacterial Menigitis?

◦A, B, C , Y and W135 are the most common.

How many serotypes in bacterial meningitis that is based on the specific polysaccharide capsule present?

13

Other infections caused by N. Meningitidis?

Other infections include meningococcemia, pneumonia, purulent arthritis, & endophthalmitis.

Where else can N. Meningitidis colonize?

the oro and nasopharynyx as a nonpathogen and result in a carrier state.

Hemorrhage in the adrenal glands in Waterhouse-Fridericksen syndrome--

The infant has DIC which is triggered by the Lipopolysaccharide of the organism. Two thirds of patients die within 18 hours.

ID for N. Meningitidis?

◦Examine direct smear from CSF for intra & extra cellular g- dc

◦Examine smear for halo

Other body cites for N. Meningitidis?

◦Other body sites include nasopharyngeal swabs, sputum, and urogenital specimens

You should be suspicious of a gram positive cocci that have flattened edges and kidney bean shaped because?

N. Meningitidis has been known to not decolorize on the gram stain

Colony Morph of N. Meningitidis?

◦Small

◦Tan-grey color

◦Smooth

Lab diagnosis of N. Meningitidis Oxidase test?

Positive

N. Meningitidis CTA test?

◦Conventional CTA carbohydrates for biochemical identification (glucose+ and maltose+)

N. Meningitidis is treated with?

Penicillin

Other options: rifampin or sulfonamide

A vaccine is available for people with N. Meningitidis with the conditions of?

◦For use with people aged 11-55

◦Does not protect against all serotypes

◦Antigens to serotypes A, C, Y and W135 are available in U.S.

Nonpathogenic Neisseria Species

Normal flora of upper respiratory tract

Nonpathogenic Neisseria Species some members being?

◦Neisseria cinera

◦Neisseria lactamica

◦Neisseria mucosa

◦Neisseria sicca

◦Neisseria subflava