Neisseria meningitides

Neisseria meningitides is an aerobic, non-spore-forming Gram-negative coccobacilli that resides in its natural habitat within the nasopharyngeal tract of humans . 5-15% of the human population carries the bacteria in its nonpathogenic form .(a major step in infection is its colonization in the nasophrynx of the human carrier ) Neisseria meningitidis, also simply known as meningococcus is best known for its role in meningitis (meningitis is an inflammation of the membranes that cover the brain and spinal cord). It only infects humans, there is no animal reservoir. It is the only form of bacterial meningitis to cause epidemics.

Strains There are many strains of meningococcus, clinically the most important are A, B, C and W135:
• • • •

A - occurs most often in sub-sahara Africa and vaccination is recommended prior to travel B - is the most lethal form, comprising 40% of the cases. The changing nature of the B group has prevented formation of a general B vaccine in the UK.. C - caused approximately 60% of the cases before the introduction of successful vaccination programme for infants. W135 - is particularly a problem for those undergoing annual pilgrimage to Mecca. It is a requirement of Saudi Arabia that all those intending to go on Hajj have a certificate of Men W135 vaccination.

Diseases

Meningitis

1

meningitidis is its lipooligosaccharide. Transmission and Invasion Transmission is via nasal droplets from asymptomatic carriers. skin lesions and arthritis developing over a period of days to weeks. Signs and symptoms of meningococcal disease: 2 . The lesions occur as the LOS is shipped out of the cell. Invasion of the mucosal cells occurs by a mechanism similar to that observed with gonococci. The loss of leukotriene B4 deprives the leukocytes of a strong chemokinetic and chemotactic factor. including hearing loss. paralysis and mental retardation. loss of limbs. o The key feature of meningitis due to N. Meningococcal LOS has been shown to suppress leukotriene B4 synthesis in human polymorphonuclear leukocytes. meningococcal LOS is highly toxic and is lethal for mice and causes a dermal Shwartzman phenomenon (a characteristic type of inflammatory reaction) in rabbits. there are persistent neurological defects. and its mechanism is endotoxic. Pneumonia. become purpuric and eventually necrotic. They start as petechiae. Without treatment.• • • Local cytokine release causes brain damage. and systemic cytokine release leads to shock and DIC. meningitidis is its antiphagocytic polysaccharide capsule. In as many as 10-15% of survivors. The other important determinant of virulence of N. Meningococcemia alone o Meningococcemia is characterized by a low grade fever.LOS. fulminating DIC and shock. Most of these strains are not pathogenic. the mortality is 85%.uncommon o Virulence Factors • • • The major toxin of N. Attachment is mediated by fimbriae and possibly by other outer membrane components. Asymptomatic carriage is found in the nasopharynx in 5-10%. Waterhouse-Friderichsen syndrome o Waterhouse-Friderichsen syndrome is a syndrome characterized by the bilateral hemorrhagic destruction of the adrenal glands. meningitidis is skin lesions (65%).

vomiting. seizures. B. Currently. Y. W135. headache and stiff neck. • Immunity and Vaccines • There is a quadrivalent polysaccharide vaccine that provides protection against serogroups A. weakness. Sugar fermentations are required for final identification of the species.The symptoms of meningococcal meningitis are high fever. depending on a group-specific capsular polysaccharide antigen.e. sleepiness and. These symptoms usually appear in a range of 2 to 10 days after exposure. low blood pressure. Y. military recruits. confusion.) The vaccination of college students would be a good idea. and W-135. Treatment • • Treat with a high IV dose of penicillin (PCN) or a cephalosporin if meningococcemia or meningitis. Oxidase and catalase are biochemical markers for preliminary identification of this organism. not sucrose or lactose. and in areas where elastic pressure is applied (like underwear and socks). fever and rash are symptoms of meningococcemia. discomfort looking into bright lights. X. (PCN cannot be used because it cannot get into the surface of the uninflammed nasopharyngeal mucosa. Other signs and symptoms include nausea. and coma. groin.. Agglutination reactions with immune serum subdivide the species into serogroups A. in the extreme. Meningococcemic rash is non-blanching. Prophylaxis of carriers or those with close exposure with rifampin. C. blood or skin lesions N meningitidis is a gram-negative diplococcus that grows well on solid media supplemented with blood and incubated in a moist atmosphere enriched with carbon dioxide. although not cost effective for society as a whole. Diagnosis • • • • Gram stain of CSF Culture of CSF.) 3 . it is only required in high risk populations (i. develops rapidly and usually appears on the armpits. delirium. N meningitidis ferments glucose and maltose. C. travelers to Sub-Saharan Africa etc. and ankles. and Z.

They are fastidious organisms requiring: • • 4-8% CO2 to enhance growth. gonorrhoeae and N. Characteristics of the Pathogenic Members (Neisseria gonorrhoeae and Neisseria meningitidis) Pathogenic Neisseria are obligate human pathogens. They are highly susceptible to heat. cold and drying. 4 . Incubation temp. meningitidis Group Characteristics of Neisseria Neisseria are kidney bean shaped. vancomycin (to kill GM+). They have cytochrome c oxidase in the electron transport chain. which is chocolate agar plus the following antibiotics. two of which are pathogenic. Neisseria are oxidase positive. which is blood agar that has been heated. Gram negative diplococci. They are highly autolytic at stationary phase. colistin (to kill other GM-). They cannot tolerate free fatty acids in media. Other Neisseria species will grow at 22oC. of 30-37oC. Thayer Martin media. Media used to culture them include: o o Chocolate agar. trimethoprim (a broad spectrum antibiotic). which will oxidize phenylethylene diamine dye to black. There are 8 species of neisseria.Over view of Neisseria and a comparison between pathogenic N. and nystatin (to kill yeasts). The freed hemoglobin binds up the free fatty acids.

Attachment to endothelial cells follows. are used to identify Neisseria and related species. such as glucose. Neisseria spp. 4. They cause ciliostasis in ciliated cells with LOS and PDG.Comparison between both pathogenic members of Neisseria: 1)Sugar Utilization: • Patterns of acid production from sugars. and sucrose. produce acid by an oxidative pathway. lactose. 5 . maltose. They are egested into the basement membrane leading to massive inflammation. In contrast to most bacteria that produce acid using fermentation. 3. Dissemination of the organisms into the bloodstream (if bacteremia occurs). 2. Neisseria stick to mucous secreting but not ciliated cells by their pili and opa proteins. The Neisseria are transported through the cells. 6. 7. Ciliated and non-ciliated host cells are destroyed 5. The endocytosis is directed by porins. 2)Mechanism for Invasion of Epithelial Cells: (Deduced from Fallopian Tube Cell Culture with GC) 1. Organisms resist killing by antibody and complement in inflammatory fluids and blood.

gonorrhoeae (GC) Iron Binding • All organisms require an exogenous source of iron.) Capsule Major surface proteins: Pili Major surface proteins: Porins. (Review Bacterial Physiology for more information. meningitidis (MC) and N. (Remember Bacterial Structure?) 6 .3) Virulence Factors of N. • Porins are very wide channels that allow in a lot of hydrophilic solutes.

It cleaves IgA into Fab and Fc fragments. 7 . pneumoniae and H. Remember that both S.Major surface proteins: Target of Blocking Antibody Major surface proteins: Adherence Major surface proteins: LOS • The lipopolysaccharide of Neisseria has a short side chain. Major surface proteins: IgA protease • An IgA protease can be a handy virulence factor. It is a very potent endotoxin. and is called lipooligosaccharide or LOS. influenzae had one.

4) Diagnosis Epidemiology of Neisseria meningitidis A 8 .