Bacte Lec - Gram-negative cocci

Neisseria gonorrhoeae

→ Not part of normal human flora
→ Found on mucous membranes of genitalia, anorectal area, oropharynx, or conjunctiva at time of infection
→ Leading cause of sexually transmitted diseases

Neisseria gonorrhoeae (mode of transmission)

1. Person to person spread - sexual contact
2. Infected mother to newborn during birth
3. Asymptomatic carriers are a significant reservoir for increased disease transmission

Neisseria gonorrhoeae (virulence factors)

Pili, protein II, Outer membrane porin (PorB), Capsule, Lipooligosaccharide (endotoxin), Outer membrane proteins I-III

Pili

→ Mediate the exchange of genetic material between strains

→ Attachment to human mucosal cell surface
→ Invasion of host cells
→ Survival through the inhibition of phagocytosis

Opa (protein II)

facilitates adherence to phagocytic and epithelial cells

Reduction modification protein (RMP) - protein II

blocks the bactericidal effect of host IgG

Outer membrane porin (PorB)

provides protection from the host's immune response

Lipooligosaccharide

Endotoxin of Neisseria gonorrhea

male and female gonorrhea

Can cause acute purulent urethritis (painful urination along with a purulent urethral discharge)

male gonorrhea

Prostatitis & Epididymitis

Female gonorrhea

→ Acute cervicitis (lower abdominal discomfort, pain with sexual intercourse (dyspareunia), and a purulent vaginal discharge
→ Can lead to Pelvic Inflammatory Disease (PID)

Pelvic Inflammatory Disease (PID)

→ Infection of the uterus (endometritis)
→ fallopian tubes (salpingitis)
→ ovaries (oophoritis)

Pelvic Inflammatory Disease (PID)

SYMPTOMS
• Fever
• Lower abdominal pain
• Abnormal menstrual bleeding
• Cervical motion tenderness

Sterility

→ Inability to create offspring
→ Most commonly caused by scarring of the fallopian tubes, which occludes the lumen and prevents sperms from reaching the ovulated egg

Ectopic pregnancy

→ fetus developing at a site other than the uterus
→ Most common site: fallopian tubes

Peri-hepatitis (Fitz-Hugh-Curtis syndrome)

→ Infection of the capsule that surrounds the liver
→ Sx: right upper quadrant pain and tenderness

Peritonitis

Infection of peritoneal cavity

Complications of Neisseria gonorrhea

sterility, ectopic pregnancy, abscess, peritonitis, Peri-hepatitis

Fitz-Hugh-Curtis syndrome

Peri-hepatitis other name

Conjunctivitis (ophthalmia neonatorum of newborns)

→ Acquired during birth from an infected mother
→ Usually occurs on the first or second day of life and can damage the cornea, causing blindness

Disseminated infections of gonorrhea

→ Bacteremia
→ Arthritis
→ Metastatic infection at other body sites

Neisseria gonorrhoeae

Species are sensitive to drying and extremes of temperature, and material must be cultured promptly to enhance recovery

pus and secretions

N. Gonorrhoeae: __________ are taken from the urethra, cervix, rectum, conjunctiva, throat, or synovial fluid for culture and smear

Blood culture

N. Gonorrhoeae: _________is necessary in systemic illness

sodium polyanethol sulfonate (SPS)

N. gonorrhea and meningitidis are sensitive to _____________, the preservative typically found in blood culture broths

0.025%

sodium polyanethol sulfonate (SPS) content should not exceed

charcoal (Ames medium)

N. Gonorrhoeae: If cotton swabs are used, transport medium should contain __________ to inhibit toxic fatty acids present in the fibers

increased carbon dioxide

N. Gonorrhoeae: Sample should then be placed in a container able to
sustain an atmosphere of___________

JEMBEC plates

contain modified Thayer-Martin Medium and the CO2 generating tablet is composed of sodium bicarbonate and citric acid

Meningococcemia

If petechial rashes are accompanied by fever and leg pain
then it could be

Chocolate agar

Culture media for Neisseria gonorrhea

Colonial appearance of Neisseria gonorrhoeae

• Small

• Grayish white

• Convex

• Translucent

• Shiny colonies with either

smooth or irregular margins

• Facultative anaerobe
• Oxidase positive (+)
• Ferments glucose and maltose
• DNAse negative (-)

N. MENINGITIDIS:
An/aerobic
Oxidase test
Ferments
DNAse test

extended spectrum cephalosporins

Treatment for Neisseria gonorrhoeae

Neisseria gonorrhoeae

Gram-negative diplococci inside polymorphonuclear leukocytes

Neisseria gonorrhoeae and meningitidis

Kidney-bean shaped with adjacent sides flattened

1. THAYER-MARTIN MEDIUM
2. MODIFIED THAYER-MARTIN (MTM)
3. MARTIN LEWIS (ML)
4. GC-LECT AGAR
5. NEW YORK CITY (NYC)

CULTURE: SELECTIVE MEDIA for N. Gonorrhoeae

Neisseria meningitidis

Colonial appearance
→ Medium, smooth, round, moist, gray to white;
→ encapsulated strains are mucoid;
→ May be greenish cash in agar underneath colonies

Penicillin G

Neisseria meningitidis (drug of choice)

β-lactamase testing

If AST not available, ___________ can be performed by using the chromogenic cephalosporin test, the cefinase nitrocefin disk test

A, C, Y, and W135

Polysaccharide vaccine against N. meningitidis serogroups

Cefinase nitrocefin disk test

The chromogenic cephalosporin test

upper respiratory tract

OTHER NEISSERIA SP. normal human flora of the __________

→ spread of patient's endogenous strain to normally sterile sites
→ person-to-person spread may also be possible

OTHER NEISSERIA SP. (mode of transmission)

Neisseria animaloris

Some strains exhibit yellow to tan pigment; odor resembles popcorn

• Grows in Thayer-Martin medium
• Oxidase POSITIVE
• DNAse NEGATIVE

SIMILARITIES OF N. GONORRHOEAE AND N. MENINGITIDIS

Moraxella catarrhalis

→ Normal human flora of upper respiratory tract
→ Occasionally colonizes female genital tract

Moraxella catarrhalis (mode of transmission)

→ Spread of patient's endogenous strain to normally sterile sites
→ Person-to-person nosocomial spread by contaminated respiratory droplets

Moraxella catarrhalis

Factors associated with the cell envelope probably facilitate attachment to respiratory epithelial cells

Moraxella catarrhalis

Most infections are localized to sites Associated with the respiratory tract
o Otitis media
o Sinusitis
o Pneumonia

Moraxella catarrhalis

→ Gram-negative diplococci with adjacent sides flattened
→ Kidney-shaped diplococci
→ Similar to Neisseria spp.

5% sheep blood and chocolate agar

Moraxella catarrhalis (culture medium)

Moraxella catarrhalis

Large, nonpigmented or gray, opaque, smooth; Friable "hockey puck" consistency

Moraxella catarrhalis (biochemical characteristics)

Facultative anaerobe
Oxidase POSITIVE
Does not ferment any sugars & does not utilize carbohydrate
DNAse POSITIVE
Nitrate Reduction POSITIVE

Vancomycin, Colistin, Nystatin

VCN stands for

Moraxella catarrhalis

Generally, remain susceptible to cephalosporins, trimethoprim-sulfamethoxazole, and β-lactamase inhibitor combination

Vancomycin

inhibit gram-positive bacteria

Colistin

inhibit gram negative bacilli

Nystatin

inhibit yeast

✨PASAR BACTERIOLOGY✨

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