Gram (-) Cocci

Neisseriaceae

Gram (-) diplococci

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Kidney or coffee bean – shaped with flattened adjacent sides

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Oxidase (+)

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Catalase (+)

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Aerobic

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Facultative anaerobe; requires 5-10% CO2 tension

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Capnophilic and have optimum growth in moist atmosphere

Neisseriaceae

Encapsulated

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Non-motile

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Non-spore formers

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Produces cytochrome oxidase

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Fastidious organism with complex nutritional requirement

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Sensitive to adverse environmental conditions such as drying, chilling and exposure to unfavorable pH and sunligh

URT

N. gonorrheae is generally, normal human flora of the

genitalia, anorectal area, oropharynx or conjunctiva

N. gonorrheae always considered pathogen if found to be isolated from mucous membranes of _____

Sexual, mother to newborn during birth

N. gonorrheae MOT

N. meningitidis

are colonizers of oropharynx and nasopharynx

Branhamella catarrhalis

are occasional colonizers of female genital tract

N. animaloris

are animal oral and respiratory commensal

Animal contact particularly bites or scratches from dogs and cats

N. animaloris MOT

PILI

N. gonorrhea Principal virulence factor

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For attachment to host tissue

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Inhibits phagocytosis

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Aids in exchange of genetic material

T1 and T2

N. gonorrhea has been divided into five (5) colony types based on the presence or absence of pili (T1 to T5)

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posses pili and considered as virulent forms

T3, T4 and T5

N. gonorrhea has been divided into five (5) colony types based on the presence or absence of pili (T1 to T5)

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do not have pili and considered as avirulent strains

IgA Protease

Cleaves IgA on mucosal surfaces

Penicillinase Producing Neisseria gonorrheae (PPNG)

N. gonnorhea 10 %– 20% of strains produce β-Lactamase and are known as ______

10, 20

__ %– _ % of strains produce βLactamase and are known as Penicillinase Producing Neisseria gonorrheae (PPNG)

Gonorrhea

Sexually Transmitted Infection (STI)

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Venereal Disease (VD)

Can be seen in infants, children, adults

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Acute pyogenic infection of columnar and transitional epithelium (urethra, endocervix, anal canal, pharynx, conjunctiva)

asymptomatic carrier

Gonorrhea Primary reservoir is the

2 – 7 days

Gonorrhea incubation period

Ophthalmia neonatorum

Gonorrhea

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Eye is the area infected causing ____ leading to blindness if untreated

CREDE’S PROPHYLAXIS

1-2 drops of 1% AgNO3 in the eyes of the newborn

Acute urethritis resulting in purulent discharge and dysuria

Gonorrhea Disease in Men:

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Common Manifestation

Prostatitis and epididymitis

Gonorrhea Disease in Men

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Complications

3 – 5 %

Gonorrhea in men asymptomatic cases

Endocervix; results in vaginal discharge and dysuria

Gonorrhea Disease in Women:

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Common site of Infection

Pelvic Inflammatory Disease (PID)

Gonorrhea Disease in Women:

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Complications

up to 50 %

Gonorrhea Disease in Women asymptomatic

Ophthalmia neonatorum

a Gonococcal eye infection acquired by newborns during vaginal delivery through an infected birth canal

CEFTRIAXONE

Gonorrhea Treatment

Quinolone + Tetracycline

Gonorrhea Alternative Treatment

Urethral discharge

Gonorrhea Specimen of choice Male

Endocervical swab

Gonorrhea Specimen of choice Female

cold

Neisseria are susceptible to __ temperature

JEMBEC Plates

Gono-Pak

Transgrow Medium

Bio-Bag

Amies Medium with Charcoal

Gonorrhea Transport medium

pharyngeal specimens

Direct Microscopic Examination for N.gonorrheae is not recommended for ______ where saprophytic Neisseria are often present

urogenital specimens

N.gonorrheae Gram Stain is prepared from

GNID, GNED

Gram Stain

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Direct smear of male urethral discharge showing __ and __ is DIAGNOSTIC OF GONORRHEA

PRESUMPTIVE EVIDENCE

Gram Stain

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The demonstration of Gram (-) Intracellular Diplococci (GNID) from a symptomatic male with discharge correlates at a rate of 95% with culture and is ____ of Gonococcal infection

50% - 70%

Gram Stain (Females)

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A direct smear correlates in only ____ of cases with cultur

cervical saprophytic flora

Females have vaginal and _____ that resemble gonococci

Non-Gonococcal Urethritis (NGI)

A gram-stained smear with >5 PMNs/HPF but no bacteria may suggest _____ with organisms such as Chlamydia trachomatis or Ureaplasma urealyticum

Chocolate Agar

Gonorrhea requires the use of

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This medium also supports the growth of many other organisms found as saprophytes in the specimens collected for recovery of gonococci

Thayer –Martin Medium (Vancomycin, Colistin and Nystatin)

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Modified Thayer-Martin Medium (Vancomycin, Colistin, Nystatin, Trimethoprim)

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Martin-Lewis ( Vancomycin, Colistin, Ansamycin , Trimethoprim lactate)

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New York City Medium (Vancomycin, Colistin, Amphotericin B, Trimethoprim lactate)

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GC-LECT (same as NYC Medium with Lincomycin)

SELECTIVE MEDIA for Gonorrhea

Oxidase Test (+)

Presumptive ID of Gonnorhea

CHO utilization in Cystine Trypticase Agar (CTA-CHO Utilization)

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Immunologic Methods

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Nucleic Acid Probe

Definitive of Gonnorhea

Neisseria meningitidis

May be found in nasopharynx and oropharynx of 3% - 30% of asymptomatic individuals

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Has also been recovered from urogenital and rectal sites as a result of oral-genital contact

Group A

Worldwide epidemic

Group Y

Meningococcal pneumonia

Group W-135

Invasive Disease

Epidemic Meningitis

Primary Source: Respiratory droplets from asymptomatic carriers

Close contacts in closed population

College Dormitories

Military Barracks

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Most often occurs in young adults

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Characterized by abrupt onset of frontal headache, stiff neck and sometimes fever

Meningococcemia

25% mortality rate even if treated

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Petechial skin lesions and thrombosis



May spread rapidly causing Disseminated Intravascular Coagulation(DIC), septic shock, hemorrhage in the adrenal glands (Waterhouse-Friderichsen Syndrome) and death

C5 to C8

Individual with a deficiency in complement components ___ are at increased risk of meningococcemia

Meningococcal Pneumonia

Usually affects older individuals with underlying pulmonary problems

Penicillin

Drug of Choice: for meningitidis

Rifampin or a Sulfonamide

Prophylaxis: for meningitidis

CSF

Blood

Nasopharyngeal Swabs

Aspirates

Specimen of Choice: for Neisseria

BAP and CAP

N.menigitidis will grow on

Oxidase (+)

Catalase (+)

CHO Utilization Test

Serogrouping

N.menigitidis DEFINITIVE ID

Neisseria catarrhalis

Branhamella catharrhalis is formerly known as

Branhamella catharrhalis

Separated from Neisseria due to difference in DNA base group

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Isolated only from humans as normal commensal of the RT

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Opportunistic pathogen and associated with a number of infections such as pneumonia, sinusitis, otitis media and systemic disease

Ampicillin, Amoxicillin

Branhamella catharrhalis most isolates produce β-Lactamase making them resistant to ____ and _ which are commonly used for otitis media

Staphylococcus parvulus

Veilonella is formerly known as

Veilonella

Small, strictly anaerobic

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Gram (-) diplococci which are part of normal oral flora

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G/S: Can also be seen arranged in pairs, short chains and in clumps

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Activities are detected within subgingival dental plaque, periodontal infections and osteoarthritic infections

carbohydrates

Veilonella cannot utilize __ including glucose and amino acids in the energy mobilization process and the active fermentation of organic acids primarily lactate for energy

putrescine, cadaverine

Some Veilonella members have an absolute growth requirement for __ or _