Gram (-) Cocci

Thursday, March 18, 2021 11:48

Neisseriaceae

General Characteristics:
- Aerobic, nonmotile, non-spore forming, gram-negative diplococci (some are rod shape)
- Cytochrome oxidase (+), catalase (+)
- Require CO2 for growth (Capnophilic) and have optimal growth in humid atmosphere.
- Can grow anaerobically if alternative electron acceptors are available.
- Natural Habitat: mucous membranes of the respiratory and urogenital tracts.

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Neisseria meningitidis
Neisseria gonorrhoeae
Characteristics:
- Gram (-) coffee bean-shaped diplococci.
- Usually intracellular.
- Facultative anaerobes, growth enhanced in increased CO2 concentration.
- Fastidious organisms with complex nutritional requirement.
- Grow in CA (Chocolate Agar), not in NA (Nutrient Agar)
- Selective Medium: Thayer Martin (Modified CA by adding antibiotics)
- Colonies: Small, Translucent, Raised, Moist, Grayish White, usually Mucoid with entire to
lobate margins.
- Produce catalase and cytochrome oxidase.
- Very susceptible to adverse environmental and susceptible to disinfectants.
- Exclusive human pathogen.

Neisseria meningitidis (meningococcus)

- N. Meningitidis is also found only in humans.
- It is an important etiologic agent of endemic and epidemic meningitis and
meningococcemia and rarely pneumonia, purulent arthritis, or endophthalmitis.
- N. Meningitidis has also been recovered from urogenital and rectal sites as a result of
oral-genital contact.

Epidemiology

- N. Meningitidis can be found on the mucosal surfaces of the nasopharynx and

oropharynx in 30% of the population.
- The organism is transmitted by close contact with respiratory droplet secretions from a
carrier to a new host.
- Of the 12 meningococcal encapsulated serogroups, A, B, C, Y, and W-135 account for
most cases of disease in the world.

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 most cases of disease in the world.

Virulence Factors

- Capsule (Polysaccharide Capsule, Antiphagocytic)

- Pili (Fimbriae)
- Endotoxin (LPS, found on the outer membrane of a gram-negative bacteria) - diffuse
vascular damage and DIC (Discriminated Intravascular Coagulation).
- Protease (have the potential to destroy structural and functional proteins)
- Cell membrane proteins

Transmission: Droplet Spray

Clinical Syndrome

- Nasopharyngitis - majority are with mild symptoms

- Meningococcemia - fulminant septicemia (life-threatening).
○ Spread to Skin -> Petechial Skin Lesions -> Purpura
○ Tachycardia, Hypotension, and Thrombosis can develop during bacteremia.
○ Patients may develop DIC, septic shock, or hemorrhage in the adrenal glands.
(Waterhouse - Friderichsen Syndrome) Fulminant Septicemia
- Meningitis - frontal headache, stiff neck (nuchal rigidity), confusion, and photophobia.
- Other complications include arthritis, pericarditis, and pneumonia, conjunctivitis and
urethritis.

Laboratory Diagnosis

Specimen Collection and Transport

Specimens: Cerebrospinal Fluid (CSF), Blood, Nasopharyngeal swabs and aspirates, joint
fluids, and less commonly sputum and urogenital sites.

Collection and transport should be performed as specified by the laboratory for the various
specimen type.

- Presumptive diagnosis (Preliminary Test):

○ Microscopy
○ Culture
○ Oxidase Test
- Definitive diagnosis - CHO fermentation reaction:
Glucose (+) Sucrose (-)
○
Maltose (+) Lactose (-)

Treatment

- The drug of choice for treatment of confirmed N. meningitidis meningitis is penicillin;

meningococcemia is best treated with third-generation cephalosporins.
- Chemoprophylaxis with rifampin or ciprofloxacin is recommended for close contacts.
- Azithromycin can be used in areas where ciprofloxacin resistance is a problem.
- Chemoprophylaxis is not recommended for asymptomatic carriers.

Vaccine

The quadrivalent vaccine Menactra is a polysaccharide-protein conjugated vaccine with

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 - The quadrivalent vaccine Menactra is a polysaccharide-protein conjugated vaccine with
antigens to serogroups A, C, Y, and W-135.
- The Advisory Committee on Immunization Practices recommends routine vaccination be
administered to individuals at age 11 to 12 years with a booster dose at age 16 years.
- Individuals who receive their first dose at age 16 years or older do not need a booster
dose unless they are at a high risk of invasive meningococcal disease.

Prevention and Control

- Identification and treatment of carriers (Nasopharynx Swab Test)

- Antibiotic prophylaxis
- Polyvalent vaccines

Neisseria gonorrhoeae (gonococcus)

- Humans are the only natural host for N. gonorrhoeae, the agent of gonorrhea.
- Gonococcal infections are primarily acquired by sexual contact and occur primarily in the
urethra, endocervix, anal canal, pharynx, and conjunctiva.

Epidemiology

- N. gonorrhoeae infections are most commonly transmitted by sexual contact.

- The primary reservoir is the asymptomatic carrier.
- Gonorrhea is second do Chlamydia trachomatis in the number of confirmed sexually
transmitted bacterial infections in the United States.
- Sexually active teens and young adults have the highest rates of infection
- Overall, highest rates are recorded in urban areas where individuals are more likely to
have multiple partners and unprotected sexual intercourse.

Virulence Factors

- Pili (Fimbriae)
- Endotoxin (LPS)
- Protease
- Cell membrane proteins
- Beta-lactamase

Transmission: Sexual Contact

Clinical Infections/Syndrome

- Gonorrhea
Incubation Period: 2 to 7 days

- Men:
○ Infections are primarily restricted to the urethra
○ Acute urethritis
○ Earlies manifestation is dysuria (painful urination, burning sensation) -> followed
by the purulent urethral discharge.
○ 95% of infected male are symptomatic
○ Complications: prostatitis and epididymitis, periurethral abscess, urethral strictures
and painful erection.
Women:

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 - Women:
○ Primary site is the cervix and urethra
○ Many are asymptomatic (carriers or reservoirs)
○ Asymptomatic cases in women may lead to complications: salpingitis, pelvic
inflammatory disease (PID) which may cause sterility, ectopic pregnancy, or
perihepatitis (Fitz-Hugh-Curtis syndrome)
○ Symptoms: dysuria, cervical discharge, and lower abdominal pain
- Children:
○ Ophthalmia neonatorum - gonococcal eye infection in newborn
▪ Antimicrobial eyedrops, generally erythromycin
○ Gonococcal conjunctivitis - sexually abused children

Laboratory Diagnosis

Specimen Collection and Transport

Specimens collected for the recovery of N. gonorrhoeae may come from genital sources or
from other sites, such as the rectum, pharynx, and joint fluid.

The specimen of choice for genital infections in men is the urethra and in women is the
endocervix.

Best clinical specimens from infected males and females: urine, urethral/vaginal discharged,
synovial fluid, etc.

- Presumptive Diagnosis:
○ Microscopy
○ Culture
○ Oxidase test
- Definitive Diagnosis - CHO fermentation test:
Glucose (+) Lactose (-)
○
Maltose (-) Sucrose (-)

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Prevention and Control

Identification and Control

Treat sexual partner simultaneously
Condoms
Prophylaxis against ophthalmia neonatorum

Factors that will contribute to the difficulties encountered in the control of GC (Gonorrhea
coccus)
- Short IP which makes it possible for transmission before diagnosis of infection
- Asymptomatic females (carriers)
- Social acceptance of sexual activity with multiple partners - provide opportunity for
wider dissemination of GC and other STD
- Persistence of the organisms after recovery so that a single dose therapy may not be
enough
- Penicillinase - Producing N. gonorrhoeae (PPNG)
○ Normally gonococci are sensitive to penicillin
○ Resistance is due to penicillinase enzyme
○ Increasing prevalence
○ 1st isolated in Asia

Treatment
- According to the 2010 STD Treatment guidelines, cephalosporins (e.g., ceftriaxone,
cefixime) are currently recommended.
- Dual therapy is frequently prescribed, one of the primary therapies for N. gonorrhoeae
is used plus azithromycin or doxycycline for C. trachomatis.
- Routine use of dual therapy can decrease the prevalence of chlamydial infection, and
may reduce the development of resistant strains of N. gonorrhoeae.

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 may reduce the development of resistant strains of N. gonorrhoeae.

Moraxella catarrhalis
- Normal inhabitant of the upper respiratory tract
- May occasionally cause meningitis and OM but generally non-pathogenic
- Can grow on NA
- Oxidase, Catalase (+)
- CHO fermentation test = (-) for G (Glucose), M (Maltose), L (Lactose), S (Sucrose)

Clinical Infections

M. catarrhalis is an opportunistic pathogen and is recognized as a cause of:

- Upper respiratory tract infection
- Lower respiratory infections (adults with chronic obstructive pulmonary disease)
- Acute otitis media, sinusitis
- Rare infections: endocarditis, meningitis, and bacterial tracheitis

Laboratory Diagnosis

Specimen Collection and Identification

- Typical specimens: collected from middle ear effusion, nasopharynx, sinus aspirates,
sputum aspirates, or bronchial aspirates
- Organisms grows on both SBA and CHOC Agar
- Most strains of M. catarrhalis can grow well at 28 C
- M. catarrhalis is usually inhibited on gonococcal selective agars by colistin, but some
strains resistant to this antimicrobial may grow
- The organism is asaccharolytic, and it may be differentiated from Neisseria spp. by
positive DNase and butyrate esterase reactions.

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