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PH 152: MEDICAL & PUBLIC HEALTH MICROBIOLOGY

Neisseria
Dr. Evalyn A. Roxas | February 14, 2017

OUTLINE
Main Heading Content Formatting
A. Subheading III. Review Questions
B. Subheading Font and IV. Citation
Sub-subheading References

I. NEISSERIA GONORRHOEA
A. CHARACTERISTICS
Morphology
 Gram-negative diplococcus (also known as gonococcus)
 Fastidious organism that grows only in vitro in a narrow temperature range (35 oC to 38oC) on complex media
 Usually found around (extracellular) or inside (intracellular) polymorphonuclear cells, especially neutrophils

Virulence Factors

 Pili (Fimbriae)
 Hair-like appendages
 Enhance attachment to host cells and resistance to phagocytosis

 Por
 Por protein extends through the gonococcal cell membrane
 Form pores in the surface through which some nutrients enter the cell
 Prevents phagosome-lysosome fusion

 Opa Proteins
 Function in adhesion of gonococci within colonies and in attachment of gonococci to host cell receptors

 Rmp Protein (Protein III)
 Associates with Por in the formation of pores on the cell surface

 Lipooligosaccharide (LOS)
 Low molecular weight form of bacterial lipopolysaccharide (LPS)
 Due to absence of any long O-antigen side chains and lack of polysaccharide capsule
 Responsible for the endotoxic effects of bacteria

B. PATHOGENESIS
 Exclusive human pathogen
 Causes gonorrhea
 A sexually transmitted infection (STI)
 Refers to a variety of clinical syndromes and infections caused by pathogens that can be acquired and transmitted through sexual activity
 Differing symptoms for men and women:
 Men: dysuria; presence of mucopurulent urethral discharge; symptomatic; (distinguishable from Chlamydia trachomatis which has non-
purulent mucoid discharge)
 Women: asymptomatic; carriers until complications such as Pelvic Inflammatory Disease (PID) have occurred

Epidemiology
 High Risk Populations based on sexual activity
 Teenagers and Young Adults (15-24)
 Multiple Sexual Partners
 Unprotected Sexual Intercourse
 Anal Sex
Clinical Syndromes
 Urethritis and Cervitis
 Can be classified as Gonococcal Urethritis (GU) or Non-Gonococcal Urethritis (NGU)
 Vaginal Discharge
 Bacterial Vaginosis
 Trichomoniasis
 Vulvovaginal/Candidiasis
 Genital, Anal, or Perianal Ulcers
 Chancroid
 Genital HSV Infections
 Granuloma Inguinale (Donovanosis)
 Lymphogranuloma Venereum
 Pelvic Inflammatory Disease
Trans # 1 Group X: Surname, Surname, Surname 1 of 3

and meningitis  Men are less likely to have complications as they experience tangible symptoms. Surname. sicca. gonorrhoeae will utilize only glucose and not maltose as opposed to N. trachomatis or N. Roxas] C.  Epididymitis  Human Papillomavirus Infection (HPV) Urethritis  Urethral inflammation  Mostly infectious. or Purulent Discharge  Infectious Urethritis is caused by N. Mucopurulent = combination of both  Gram stain of urethral secretions demonstrating >2 WBC per oil immersion field  Positive Leukocyte Esterase test on first-void urine or microscopic examination of sediment from a spun first-void urine demonstrating >10 WBC per high power field Cervicitis  Inflammation of the cervix  Can be caused by either C. elevated. epididymitis. and N.g. clinical diagnosis is unnecessary as gonorrhea is easily identifiable based on the distinct mucopurulent discharge in the patient’s underwear [Dr. gonorrhea as well as Chlamydia trachomatis and Mycoplasma genitalium  Diagnostic Criteria: any of the following signs or laboratory tests  Mucoid. flavescens. N. arthritis. sometimes Legionella)  Nystatin – kills fungi  Trimethoprim – inhibits other gram-negative organisms not completely killed (i. leading them to get treatment earlier than women. urethral discharge will almost always be N.e. infertility in males  Rarely – septicemia. glistening. Purulent = formation of pus. in an atmosphere containing 5% CO2 (e. who might not even realize they are infected [Dr. intermenstrual vaginal bleeding Complications  Males: Prostatitis. Candle Jar)  Form convex. subflava) which are part of the normal flora  Martin-Lewis Medium  Biochemical Tests  Confirmatory identification: to differentiate the species  Sugar Fermentation  N. N. Surname 2 of 3 . Roxas]  Specimen  biggest clue to the identity of the specimen (i. gonorrhoaea  Two major diagnostic characteristics:  Mucopurulent cervicitis: purulent or mucopurulent endocervical exudate visible in the endocervical canal or on an endocervical swab specimen  Sustained endocervical bleeding easily induced by gentle passage of a cotton swab through the cervical os  Either or both signs might be present  May be asymptomatic or produce abnormal vaginal discharge. cervical smears and swabs  Smear  Gram-negative intracellular (sometimes extracellular) diplococcus  Typically found associated with or inside polymorphonuclear cells  Culture Media  Although facultative. nonpigmented. meningitidis which utilizes both  Oxidase Test  Bacteria are spotted on a filter paper soaked with tetramethylparaphenylenediamine hydrochloride (oxidase)  Presence of Neisseria indicated by rapid appearance of dark purple color  Latex Agglutination Trans # 1 Group X: Surname. DIAGNOSIS  Most of the time. swarming Proteus)  Absence of growth may indicate presence of non-pathogenic Neisseria species (i. N. gonorrhea between the two)  Men: Urethral discharge or swabs (rarely)  Women: Urethral discharge. mucopurulent. gonorrhea grows best under aerobic conditions. or purulent discharge  Mucoid = clear white mucous. urethra stricture  Females: Salpingitis. some secondary to non-infectious  Symptoms include:  Dysuria  Urethral Pruritus  Mucoid. Mucopurulent. mucoid colonies 1-5mm in diameter  Colonies are transparent or opaque. and nonhemolytic  Modified Thayer-Martin Medium  5% Chocolate Sheep Blood  Contains antibiotics and nutrients that facilitate growth of Neisseria species while inhibiting the growth of contaminating bacteria or fungi (selective medium)  Antibiotics include:  Vancomycin – kills Gram-positive organisms (except Lactobacillus)  Colistin – kills Gram-negative organisms (except Neisseria.e.e.

Identification Schema of Neisseria species [2017 Trans] Trans # 1 Group X: Surname.  Usually to differentiate N. Surname 3 of 3 . Surname. meningitidis as it makes use of CSF samples Figure *.