Kingdom: Bacteria Phylum: Proteobacteria Class: Beta Proteobacteria Order: Neisseriales Family: Neisseriaceae Genus: Neisseria

Neisseria
N. gonorrhoeae and N. meningitidis

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 Gram Negative Diplococci

Aerobic- Require CO2 For Growth In Culture Media

Oxidase (+)

Non-motile, Non-spore Forming, Non Acid-fast

2 Important Human Pathogens:

N. Gonorrhea: Have A High Prevalence And Low Mortality

N. Meningitides: Infections Have A Low Prevalence And High Mortality

Both secret IgA protease

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N. gonorrhoeae

N. gonorrhoeae
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Courtesy by CDC

 Gram (-), Diplococci with adjacent flattened sides Facultative intracellular parasite Ferment glucose but not maltose Fastidious growth

chocolate agar + co2 at 35-36 o C

Specific medium is VCN or Thayer-Martin agar

Susceptible Temperature Changes, Drying, Uv Light, And Other

Environmental Stresses
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Virulent Factors
PilE initial binding to columnar epithelial cells vary antigenically P.II (Opa) outer memberane protein second attachment PII attaches to LOS of other gonococci makes micro colonies Attach to microvilli of non cilialated columnar epithelium P.I (porin outer membrane protein ) Most abundant OMP Change ionic permeability host cell survival in neutrophils
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 LOS (Lipooligosaccharide):
Highly-branched Basal Oligosaccharide And The Absence Of Repeating O-antigen Lipooligosaccharide Release As Blebs (Endotoxin)
Complement Attraction And Feeding By Phagocytes, Lysis Of The Phagocytes Contributes To The Purulent Discharge TNF Activity Cell Death (Fallopian Tubules)
Release As LOS

LOS + sialic acid from the serum microcapsule (sialylated LOS)

Tbp1 and Tbp2

Iron Acquisition For Growth

Lbp
Iron Acquisition For Growth

P.III (Rmp)
ineffective antibodies block bactercidal antibodies against P.I and LOS

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Epidemiology
Obligate Human Pathogen

Major Reservoir The Asymptomatic Carrier (30% Women And 10% Men)
Transmission Sexual Contact (50% In Women And 20% Men) Infected Mother To Child Infective dose is minimum 1000 organisms

Most At Risk Multiple Sexual Encounters Deficiencies Of Complement Components (DGI)

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GonorrheaRates by State, United States and Outlying Areas, 2011

The total rate of gonorrhea for the United States and outlying areas (Guam, Puerto Rico, and Virgin Islands) was 103.1 per 100,000 population.
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Pathogenesis

Adhesion : PilE and P.II Colonization: IgA protease & Tbp1,Tbp2 and Lbp

DGI arthritis and dermatitis

Entry: endocytosis and Replicates: P.I (por) Exocytosis in sub mucosa

Sub Mucosa: Take iron LOS - Inflammatory response macrophages and neutrophils engulf TNF Cell death Suppuration

TNF & LOS sialylated LOS

Blood vessel
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Dr.Aravind

Clinical features
Urethritis In men: urethral discharge, dysuria, epididymitis, prostatis Infection of the genitals can result in a purulent (or pus-like) discharge from the genitals which may be foul smelling In women: increase urine urgency, dysuria, abdo pain, irregular menstrual cycle, v. mild symptoms Rectal intercourse- rectal discharges, tenesmus, bleeding Oral Gonorrhea- sore threat, cervical lymphadenitis
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 Opthalmia Neonatrum:
Severe, Acute Conjuctivitis-main Cause Of Blindness In Old Days- Decrease With Erythromycin Eyedrops

Pelvic Inflammatory Disease (PID):

Infections Ascending To Pelvis From Vaginal Regions- Oophoritis, Endometritis, Salpingitis Complications - Sterility, Ectopic Pregnancy, Abscesses, Peritonitis, Perihepatitis (Fitz-hugh-curtis Syndrome)

Disseminated Gonococcal Infections:

Arthralgia, dermatitis, And Pericarditis etc
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Opthalmia Neonatrum

discharge from the genitals

Oral Gonorrhea Dr.Aravind

Diagnosis
Direct Microscopy:
Gram Negative diplococci Seen in PMNs Men urethral specimens 95% Females mostly negative
N. gonorrhoeae in PMNs

Culture:
Thymer-Martin agar or VCN media Chocolate agar

oxidase + Ferment glucose, but not maltose Rapid Tests: enzyme immunoassay & fluorescence
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Treatment
Ceftriaxone, Cefixime, Ciprofloxacin, Or Oflaxacin Prevention: Safe sex practice and screening pregnant women.

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N. meningitidis

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 Identical To Neisseria Gonorrhoeae (Gram Staining)

Polysaccharide Capsule 12 Serotypes:
A, B,C, W-135, Y Serotypes Pathogenic To Humans

Growth
Chocolate Agar + Co2 At 35-36 O C Specific Medium Is VCN Or Thayer-martin Agar

Ferment Maltose & Glucose

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Virulent Factors
Fimbriae
Lipooligosaccharide: Endotoxin Main virulence Polysaccharide capsule anti phagocytic undergo antigenic variation Takes iron from host
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Epidemiology
Meningococci Only Infect Humans

Present In Humans- Nasopharyngeal Region

Most People Are Carriers- Cough- Immune Deficient Person Can

Get The Disease

Higher Instance- Army Recruits, Schools, Dorms (Close Quarters)

2-18 Years More Prone

Can Get Infection From Y, B, C Serotypes
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Pathogenesis

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Clinical Features
Meningococcemia:
sudden onset of fever, headache, vomiting, arthritis, seizures, petechial rash and prostration.

Fulminant meningococcemia (Waterhouse-Friderichsen syndrome):

Severe symptoms and high mortality adrenal glands insufficiency hypotension, enlarging petechial skin lesions, disseminated intravascular coagulation, organ failure, death

Meningitis:
usually striking infants < 1 year display nonspecific findings- fever, vomiting, irritability, lethargy, petechial rashes In adults- stiff neck (Brudzinskis sign), headache, nausea, fever, arthralgia (joint pain)
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Diagnosis
Gram staining of Blood, CSF, skin lesions-see diplococci Fermentation- see Maltose

Oxidase test- (+)

Enrichment media- Thymer-Martin agar- VCN media- Vancomycin (Gram +), Colistin (Gram -), Nystatin (fungi)- organisms present will get destroyed, except diplococci Rapid Diagnosis- use Latex Particle Agglutination Test- serological test

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Treatment
Penicillin Is The Drug Of Choice Cefotaxime Or Ceftriaxone alternate To Penicillin's Prevention: Vaccination (no vaccine for B serotype)

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