MODULE 4

GRAM-POSITIVE & GRAM-NEGATIVE

COCCI

Unit 3: Neisseriaceae and Moraxella catarrhalis

Unit Learning Outcome:

Describe the medically-significant members of the family Neisseriaceae, and Moraxella

cattarhalis as to their general characteristics, epidemiology, pathogenesis and clinical
manifestations, diagnosis, prevention and control.

Engage

Different from the staphylococci and streptococci, bacteria included in this module
unit are gram-negative cocci which are classified under the genera Neisseria and
Moraxella. Aside from their gram reaction, up to what extent do you think are they
different from the pathogenic gram-positive cocci in terms of pathology and
pathogenic mechanisms?

Explore

The genus Neisseria contains the two gram-negative cocci which are established as
human pathogens. These pathogenic species are Neisseria gonorrhoeae, the cause of
gonorrhea, and Neisseria meningitidis, a major cause of meningitis and bacteremia. N.
gonorrhoeae is always considered a pathogen, regardless of the site of isolation. N.
meningitidis may also colonize the human nasopharnyx without causing disease.

The genus also includes many commensal species, most of which are harmless
inhabitants of the mucus membranes of the upper respiratory and alimentary tracts.
These other neisseriae found in humans include N. lactamica, N. sicca, N. subflava, N.
mucosa, N. flavescens, N. cinerea, N. polysaccharea, and N. elongata.

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 Explain

GENERAL CHARACTERISTICS OF THE NEISSERIAE

• Gram-negative diplococci, whose adjacent sides are
flat or concave giving them “kidney- or coffee bean–
shaped” appearance; approximately 0.8 µm in
diameter.
N. elongata subspecies are medium-to-large, plump rods that
sometimes occur in pairs or short chains.
• Non-motile
• Non-spore-formers
• Aerobic/Facultative anaerobic
• Most are capnophilic
• Grow best in a moist environment; pathogens do not
survive long in the environment, where hostile
conditions of drying, cold, acidity, or light prevail.
• Catalase-positive (EXCEPT: N. elongata subspecies)
• Oxidase-positive
• Most oxidize carbohydrates producing acids, but NOT gas

Neisseria gonorrhoeae

Common name: Gonococcus

HABITAT AND TRANSMISSION

• NOT considered normal flora. Only found on the mucous membranes of

the genitourinary tract, rectum, throat, and the eye at time of infection;
typically are found associated with or inside polymorphonuclear cells.
• Transmission is primarily by direct contact (sexually or perinatally)

PATHOGENESIS AND CLINICAL MANIFESTATIONS

1. Gonorrhea
• A sexually transmitted infection (STI) in both men and women, characterized by
invasion of the mucous membranes of the genital tract causing inflammation;
also of the rectum and the throat.

a. Genital gonorrhea

• In males:
- Primary site of infection is the urethra.
- Incubation period ranges from 1 to 14 days or
longer, with an average of 2 to 7 days.
- Symptoms of urethritis occur in 90-95% of infected
males
‣ dysuria (burning sensation during urination) Male with purulent urethral
discharge characteristic of N.
‣ purulent urethral discharge (yellow, creamy gonorrheae infection.
pus)

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 - If left untreated, ascending infection may result in epididymitis, orchitis
(inflammation of the testicles), epididymo-orchitis, prostatitis, periurethral
abscess, and urethral stricture, which can reduce sperm passage and
can lead to sterility.

• In females:
- Primary site of infection is the
endocervix, with concomitant
urethral infection.
- Incubation period of 8 to 10
days,
- Symptoms of endocervicitis
occur in 10-20% of infected
Invasive gonorrhea
females in women.
‣ purulent cervicovaginal
discharge
‣ dysuria
‣ menorrhagia (intermenstrual bleeding)
‣ dyspareunia (painful vaginal intercourse)
- In untreated cases, ascending infection may
occur and can result in pelvic inflammatory
disease (PID) that is manifested as salpingitis
(infection of the Fallopian tubes), endometritis,
and tubo-ovarian abscess.
Salpingitis is a risk factor for ectopic pregnancy,
infertility, chronic pelvic pain, and Fitz–Hugh–Curtis
syndrome --- a perihepatitis, an infection and
inflammation of liver capsule and "violin string"
Fitz–Hugh–Curtis syndrome
adhesions of peritoneum to liver.

• When gonorrhea is present in a child after the newborn period and before puberty, this infection
may be a sign of sexual abuse.
• In prepubertal girls, gonorrhea manifests as a vaginitis with a vaginal discharge, rather than a
cervicitis. The epithelium of the prepubertal vagina is composed of columnar epithelial cells,
which are the cell types that N. gonorrhoeae preferentially infects. With the onset of puberty,
these cells are replaced by a stratified squamous epithelium that is not susceptible to
gonococcal infection.

b. Extragenital gonorrhea

• Oropharyngeal gonococcal infection

- Seen in MSM (men having sex with men) and women who acquire the
infection by engaging in orogenital sexual contact with an infected
partner.
- Over 90% are asymptomatic.
- Patients with oropharyngeal gonococcal infection often have
gonococcal infection at genital and/or rectal sites as well.

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 • Anorectal gonococcal infection
- Seen primarily in MSM who practice unprotected receptive anal
intercourse; among MSM, gonococcal infection of the rectum may be
the only infected anatomic site.
- Women may also acquire rectal infections by receptive anal
intercourse, but most rectal infections in women are due to perianal
contamination with infected cervicovaginal secretions.
- Are often asymptomatic, but some individuals may experience
symptoms ranging from mild pruritis to acute proctitis with anorectal
pain and itching, a mucopurulent discharge, bleeding, tenesmus, and
constipation 5 to 7 days following infection.

• Ocular gonococcal infection

- Painful, purulent conjunctivitis
- Occurs in adults who become infected by self-inoculation of the eyes
from genital secretions

2. Gonococcal ophthalmia neonatorum

• An infection of the eye in newborns
• Acquired during passage through the birth canal of an
infected mother.
• Initial purulent conjunctivitis occurs 2-5 days after birth,
rapidly progresses and, if untreated, results in blindness.
Gonococcal ophthalmia
neonatarum in week-old
3. Disseminated Gonococcal Infection (DGI) infant.
• Results from the spread of gonococci into the
bloodstream
• Characterized by low-grade fever, painful, hemorrhagic
skin lesions (initially appear as papules that evolve into
necrotic pustules) on the hands, forearms, feet, and legs;
tenosynovitis and suppurative arthritis, usually of the knees,
ankles, and wrists.
• Complications include permanent joint damage,
endocarditis, and rarely, meningitis. Characteristic skin lesion of
disseminated gonococcal on
finger. Skin lesions are usually
located on the extremities.
VIRULENCE FACTORS

1.Pili
• Enhance attachment of gonococci to host
cells and resistance to phagocytosis
• Undergo antigenic variation (with more than
1 million pilin protein variants) such that pilins
of almost all strains of N gonorrhoeae are
antigenically different, and a single strain
can make many antigenically distinct forms
of pilin.
Collage and drawing of N. gonorrheae showing pili and
2. Outer Membrane Proteins (OM Proteins) three layers of the cell envelope.
a. Protein I (Por proteins)
- Associated with porins
- Undergo antigenic variation

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 - Prevents intracellular killing of gonococci within neutrophils by
preventing phagosome–lysosome fusion.
- Responsible for variable resistance of gonococci to killing by normal
human serum by selectively binding to complement components,
therefore prevents complement-mediated lysis of the organism

b. Protein II (Opa proteins),

- A portion is in the gonococcal outer membrane, and the rest is exposed
on the cell surface.
- Undergo antigenic variation.
- Functions in the adhesion of gonococci within colonies and attachment
of gonococci to host cell receptors.

c. Protein III (Reduction-modifiable Protein or Rmp)

- Structurally associates with Por in the outer membrane
- Is antigenically conserved in all gonococci, i.e, it does not display
antigenic variability
- Diminishes the bactericidal effects of normal human serum by Inducing
antibodies that block bactericidal antibodies directed against other
surface antigens (Por and LOS --- llipooligosaccharide).

3. Endotoxin
• In contrast with other gram-negative bacteria, the gonococcal
lipopolysaccharide (LPS) does not have an O polysaccharide side chain,
hence it is referred to as lipooligosaccharide or LOS.
• Also undergoes antigenic variation; hence, gonococci can express more than
one antigenically different LOS chain simultaneously.
• Associated with toxicity in gonococcal infections and causes ciliary loss and
mucosal cell death.

4. IgA1 protease
• Allows attachment to host mucosal surfaces by splitting and inactivating IgA1,
a major mucosal immunoglobulin of humans

5. β-lactamase
• Plasmid-mediated production responsible for penicillin resistance (PPNG =
penicillin-producing N. gonorrhoeae)

PREVENTION AND CONTROL

• The occurrence of gonorrhea can be reduced by:

- avoiding multiple sexual partners,
- rapid eradication gonococci from infected individuals by means of early
diagnosis and treatment, and case finding
- education and screening of populations at high risk
- use of mechanical prophylaxis such as condoms (only provides partial
protection)
- chemoprophylaxis (of limited value because of antibiotic resistance)

• Gonococcal ophthalmia neonatorum is previously prevented by instillation of

silver nitrate solution to the conjunctiva of newborns (more popularly known as
Crede’s Method). However, because of difficulties in the storage and resulting

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 conjunctival irritation, its use has largely been replaced by local application of
0.5% erythromycin or 1% tetracycline ointment at the site of infection.

Neisseria meningitidis

Common name: Meningococcus

HABITAT AND TRANSMISSION

• Habitat is the human nasopharynx; may form part of the transient flora of the
nasopharynx without producing symptoms, however, it may cause pharyngitis
in approximately 10% of healthy individuals, and the carrier state may last for a
few days to months
• Transmission by direct contact through inhalation of respiratory secretions or
droplets from an infected individual or a carrier.

PATHOGENESIS AND CLINICAL MANIFESTATIONS

1. Meningococcemia (meningococcal bacteremia)

• Results from the entry of meningococci from the
nasopharynx into the blood stream probably by way of
the cervical lymph node
• Symptoms: Abrupt onset with fever, chills, malaise,
prostration, and petechiae (small, non-raised, round,
reddish or purple spots caused by hemorrhage into the
skin) on the trunk and appendages of the infected
individual.
• Purpura fulminans occurs in about 10% of patients with
meningococcemia, characterized by:
- ecchymoses (larger form of petechiae)
- disseminated intravascular coagulation (DIC)
- shock
The appearance of
- coma meningococcemia.
- Waterhouse-Friderichsen Syndrome - acute
hemorrhage into the adrenal glands, resulting in death in 6-8 hours

2. Meningococcal meningitis
• Usually associated with epidemic meningitis; and the second most common
cause of bacterial meningitis in adults
• May occur simultaneously with meningococcemia , but meningitis alone
occurs most frequently.
• Symptoms usually begin with sudden onset of fever, with an intense headache,
stiff neck, convulsion, vomiting and progresses to coma within a few hours.

VIRULENCE FACTORS

1. Capsule
• The primary virulence factor of meningococci associated with blood stream
invasion

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 • Consists of polysaccharide, which classifies meningococci into 13 serogroups :
A, B, C, D, H, I, K, L, W135, X, Y, Z, and 29E; The most important serogroups
associated with disease in humans are A, B, C, X, Y, and W-135.
• Enables meningococci to resist the bactericidal activity of the complement
and prevents destruction of the organism by phagocytes.

2. Pili
• Protrudes through the organism’s capsule.
• Mediates initial attachment to surface proteins on non-ciliated cells in the
nasopharyngeal epithelium of the host.
• It aggregates the meningococcal cells into microcolonies allowing attachment
to epithelial microvilli and entry in to the bloodstream.

3. Endotoxin
• Specifically referred as meningococcal lipooligosaccharide (LOS).
• Responsible for many of the toxic effects found in meningococcal disease.
• Results to vascular damage and eventually hemorrhage when shed in to the
generalized circulation.

4. IgA1 Protease
• Neutralizes the protective action of the mucosal immunoglobulin IgA thus
facilitating attachment of the meningococci to host mucous membranes,
thereby initiating infection.

PREVENTION AND CONTROL

• Infections caused by the meningococci can be prevented by vaccination.

Currently, there are vaccines against serogroups A, C, Y, and W-135 available.
a. Polysaccharide tetravalent vaccine which in each dose consists of four
purified bacterial capsular polysaccharides is said to be poorly
immunogenic in children younger than age 18 months.
b. Tetravalent conjugate vaccine contains capsular polysaccharide
conjugated to diphtheria toxoid, and is licensed for use in persons 9
months to 55 years of age.

• With the availability of effective vaccines for meningococcal serogroups A, C, Y, and W135, serogroup B
N. meningitidis has become the major cause of bacterial meningitis worldwide.
• Polysaccharide vaccines do NOT contain group B polysaccharides because they are poorly immunogenic
in both children and adults. It is attributed to resemblance of group B capsular material, comprised of a
linear polymer of ⍶2-8 N-acetylneuraminic acid (sialic acid) to the polysialated form of the neural cell
adhesion molecules found in fetal brain tissue.
• Current efforts to develop group B vaccine have centered around the OMP (outer membrane proteins). It
is fairly new and not yet recommended as a routine vaccination for healthy people. CDC recommends
routine serogroup B meningococcal vaccination for people 10 years or older at increased risk for
meningococcal disease.

• Chemoprophylactic antimicrobial therapy is administered to individuals who

had close contacts with primary case of meningitis or meningococcemia,
ideally, within less than 24 hours after identification of the index case.

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 LABORATORY DIAGNOSIS of Neisseria species

Specimens
REVIEW notes on Supplementary Learning Material
for Ex. No. 9: Specimen Collection.
• For detection of Neisseria gonorrhoeae: General information on specimen collection and transport
for isolation of N. gonorrhoeae and N. meningitidis.
Pus/secretions from:
- Genital sites (male urethra, female cervix, or
vagina in prepubertal girls) Blood: Direct inoculation of blood culture bottles is
- Extragenital sites (conjunctiva, throat, rectum) preferred over SPS Vacutainer tubes owing to the
recognized inhibitory effects of SPS on gonococci or
- Blood, synovial fluid, or joint fluid in meningococci. If blood is first collected in Vacutainer
systemic illness tubes containing SPS, the specimen must be transferred
to the broth culture system within 1 hour of collection.
Joint /synovial fluids: Should be inoculated into aerobic
blood culture bottles.
• For detection of Neisseria meningitidis:

- Blood
Any specimens or cultures in which N. meningitidis is a
- CSF consideration should be handled in a biologic safety
- Puncture material from petechiae cabinet to prevent laboratory-acquired infections.
- Nasopharyngeal swab for carrier surveys

Procedure Notes
For the procedures of the tests and interpretation of results, please refer to Exercise No. 21: Neisseria species and Moraxella
catarrhalis on pages 86-90 of Laboratory Manual in Microbiology 1 (Bacteriology).

C. Microscopy
A
B
Neisseria gonorrhoeae

• Direct gram-stained smear of the specimen reveals

gram-negative kidney or coffee-bean-shaped
diplococci found intracellularly within
polymorphonuclear leukocytes (PMNs) or Gram-stained smear of urethral
extracellularly. discharge from a male patient.
A. Intracellular G- diplococci
B. Nuclei of PMN
• In urethral specimen from males: Diagnostic of
gonococcal infection with sensitivity of about 90%
and a specificity of 99%.

• In endocervical specimen in females or in rectal specimen: Only

presumptive evidence of gonococcal infection, because the normal
vaginal and rectal flora are composed of gram-negative coccobacilli,
which can resemble Neisseria spp. Diagnosis must be confirmed by
culture and additional testing.

• In conjunctival exudates: Can also be diagnostic.

• In pharyngeal specimens: NOT diagnostic of gonococcal infection,

because nonpathogenic, commensal Neisseria spp. may be present.
Diagnosis must be confirmed by culture and additional testing.

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 Neisseria meningitidis

• Direct gram-stained smear of blood, CSF, or other

specimen reveals gram-negative kidney or coffee-
bean-shaped diplococci found intracellularly within
polymorphonuclear leukocytes (PMNs) or
extracellularly.

• Heavily encapsulated strains may have a distinct

pink halo around the cells. N.meningitidis in Gram-stained
smear.

• Important: A positive blood or CSF gram stain is a

critical result that must be reported to the
requesting physician immediately.

D. Cultural method

• Culture media

1. Nonselective Media

Chocolate agar medium

Is preferred over BAM for isolation because heating the
blood to 80 oC inactivates fatty acids and trace metals in
blood which are inhibitory to the pathogenic Neisseria.

2. Selective Media
Contain antimicrobial
agents that inhibit other N. lactamica very rarely causes disease but is important
because it grows in the selective media used for cultures
microorganisms and of gonococci and meningococci from clinical specimens.
allow the selective N .lactamica can be cultured from the nasopharynx of
3–40% of persons and most often is found in children.
recovery of pathogenic
N. gonorrhoeae and N.
meningitidis

Thayer-Martin (TM), Modified Thayer-Martin (MTM), Martin-Lewis

(ML), and GC-Lect
Enriched chocolate agar-based media that are prepared
with nitrogenous GC agar base, hemoglobin , and
enrichment (IsoVitaleX - chemically defined supplement that
provide vitamins, amino acids cystine and cysteine),
coenzymes, dextrose, ferric ions and other factors)

New York City (NYC) medium

A clear peptone-corn starch agar-based medium
containing yeast dialysate, citrated horse plasma, and lysed
horse erythrocytes.

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 Media Formulation (µg/ml)
Antimicrobial Agent
TM MTM ML GC-Lect NYC

Vancomycin 3 3 4 2 2

Colistin 7.5 7.5 7.5 7.5 5.5

Nystatin 12.5 12.5 --- --- ---

Trimethoprim --- 5 5 5 5

Anisomycin --- --- 20 --- ---

Amphotericin B --- --- --- 1.5 1.2

Lincomycin --- --- --- 1 ---

Vancomycin and lincomycin - inhibit G+ bacteria

Colistin - inhibits G- bacteria, EXCEPT: N. gonorrhoeae, N. meningitidis, N. lactamica, Proteus species
Nystatin, anisomycin, and amphotericin B - inhibit yeasts and molds
Trimethoprim lactate - inhibit the swarming of Proteus species

3. Culture Media Transport System

- Consists of selective medium (MTM, ML, or GC-Lect) in a self-contained
CO2 environment
- Intended for transport and primary isolation of pathogenic Neisseria

a. Transgrow Medium
- Agar slant in a bottle has a formulation
similar to MTM but has a higher dextrose to
promote growth of Neisseria and a high
agar to provide a more rigid medium
Transgrow
suitable for mailing.
- Adequate CO2  is incorporated within the
media bottle.

b. Gono-Pak
- A tablet consisting of a mixture of citric
acid and sodium bicarbonate is activated
by the moisture (humidity) produced by
the culture medium within the sealed
plastic bag and generates CO2 levels
sufficient for the growth of Neisseria on the
selective media provided with the system. Gono-Pak

c. JEMBEC (John E. Martin Biological Environmental Chamber)

- A tablet consisting of a mixture of citric
acid and sodium bicarbonate is placed in
a well within the plate and is activated by
the moisture (humidity) produced by the
culture medium within the sealed plastic
bag. The CO 2 levels generated are
sufficient for the growth of Neisseria on
the selective media provided with the JEMBEC
system.

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 • Inoculation
- Specimen from sterile sites (blood, CSF, conjunctiva)
‣ Inoculate on nonselective CAM and sheep BAM.
- Specimen from sterile sites (urethra, cervix, vagina, rectum,
pharynx)
‣ Inoculate onto both selective (e.g., MTM, ML, NYC, or GC–
Lect agar) and nonselective media.

Various selective media may fail to support growth due to the susceptibility of some strains to
vancomycin, that is why the specimen should also be inoculated onto nonselective medium.

• Incubation
- 5% to 7% CO2 at 35°C (CO2 incubator or candle extinction jar)
- If incubating using a candle jar, only white, unscented candles
should be used because other types may be toxic to N.
gonorrhoeae and N. meningitidis.
- Humid atmosphere
- Humidity can be provided by placing a pan with water in the
bottom of a CO2 incubator or by placing a sterile gauze pad
soaked with sterile water in the bottom of a candle jar.
- Incubation of 24, 48, and 72 hours before a final report of “no
growth” is issued.
- Suspicious colonies are subcultured to blood and chocolate agar
for further identification.

• Colonial characterization

N. gonorrhoeae
- Colonies are small, grayish-
white, convex, translucent,
glistening colonies with either
smooth or irregular margins.

- Maybe up to 5 different colony

types (termed T1 through T5): N. gonorrhoeae colonies.

P+ and P++ colony types (formerly T1 and T2, respectively)

‣ Cells possess pili
‣ Predominantly obtained on primary cultures
‣ Colonies tend to be small, glistening, and raised
‣ Organism suspension tend
to be smooth and
homogeneous

P− colony types (T3, T4, and T5)

‣ Cells lack pili
‣ Obtained in subcultures
‣ Colonies tend to be larger, N. gonorrhoeae in gram-stained smear prepared from
flatter, and not glistening culture.
‣ Do not form smooth suspensions

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 N. meningitidis
- Colonies are larger than
gonococcal colonies, usually
attaining a diameter of about
1 mm or more after 18 to 24
hours’ incubation.
N. meningitidis colonies.
- Colonies are blue-gray, low
and convex, with a smooth,
moist entire edge and a
glistening surface.

- On sheep blood agar, colonies

are usually gray, and heavily
encapsulated strains may be
mucoid. N. meningitidis in gram-stained smear prepared from
culture. Notice the halo surrounding the cells indicating
the presence of capsules.

For the colonial characteristics of other Neisseria species, please refer to the page 90 of the
Laboratory Manual in Microbiology 1 (Bacteriology).

C. Identification tests

1. Catalase test

• Neisseria species (EXCEPT N. elongata) and M. catarrhalis are catalase-

positive.

2. Cytochrome Oxidase Test

• Principle: Microorganisms that possess a cytochrome c oxidase, which

acts in the presence of air, oxidize certain aromatic amines to produce
colored indophenol compounds. A positive reaction will be indicated by
a color change.

• ALL Neisseria species and M. catarrhalis species are oxidase-positive.

Other, unrelated, bacterial species with cytochrome c in the respiratory chain (e.g., Pseudomonas
aeruginosa Haemophilus influenzae, Campylobacter, and Pasteurella are also oxidase-positive.

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 • Reagent/result:

- Kovac’s oxidase reagent:

N,N,N,N-tetramethyl-ρ-phenylenediamine dihydrochloride
1% [w/v] aqueous solution

(+) Purple color within 10 seconds

(color changes from pink, maroon,
dark red, to finally purplish-black)
Because the oxidase reagent used for
the test is very unstable in liquid form, it
- Gordon and McLeod’s oxidase is required that the reagent be made
fresh, the dye being active only a few
reagent: hours.
Dimethyl-ρ-phenylenediamine
monohydrochloride
1% [w/v] aqueous solution

(+) Blue color within 10 – 30 minutes

- Taxo N test
Commercial disks containing 6% p-aminodimethylaniline
monohydrochloride

Disk is moistened with water before use.

(+) Red, purple to black color within 10 seconds

• Methods:
Kovac's oxidase test: Direct plate technique

Kovac's oxidase test: Indirect filter paper strip

technique .

Colonies may be picked and rubbed onto the reagent with a

platinum loop, a cotton swab, or a wooden applicator stick.

Iron-containing wires (steel, nichrome) are NOT used because

they may give false-positive results due to surface oxidation
products formed during flame sterilization

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 Taxo N disk test:
The disk is applied directly among the colonies on the plate.

N
N
Taxo N disk test:
Colonies are applied to moistened disk.

3. Carbohydrate utilization test

• Principle: Most neisseriae oxidize carbohydrates, producing acid but not

gas, and their carbohydrate patterns are a means of distinguishing them.

• Medium: Cystine-trypticase agar (CTA) medium containing 1%

carbohydrate and a phenol red pH indicator

The usual test battery includes:

CTA-glucose
CTA-maltose
CTA-lactose
CTA-sucrose
Carbohydrate-free CTA control

CTA media must not be incubated in high CO2

atmosphere because carbonic acid formed in the
media results in false-positives.

Pattern of carbohydrate utilization by N. gonorrhoeae. Pattern of carbohydrate utilization by N. meningitidis.

For the pattern of carbohydrate utilization by other Neisseria species, please refer to the page 90 of the
Laboratory Manual in Microbiology 1 (Bacteriology).

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 Conventional Carbohydrate Utilization Test: The small amounts of acid produced oxidatively by some strains of
Neisseria species may not be detected.

Rapid Carbohydrate Utilization Test: Carbohydrate utilization patterns are currently determined by inoculating an
extremely heavy suspension of the organism to be tested in a small volume of buffered, low- peptone substrate with
the appropriate carbohydrate. These methods do not require subculture or growth, and results are available in
approximately 4 hours.

• Serotyping
- For detection of capsular polysaccharides of meningococcal serogroups A, B, C, H, I, K, L, W135, X, Y, Z
using known antisera.
- Direct tests for meningococcal capsular antigens in CSF, serum, and urine are also available.

Elaborate

Moraxella catarrhalis

• The genera Branhamella and Moraxellla is included in the same family as Neisseria
because of morphological and biochemical similarities.
• Most species are either relatively harmless commensals of humans and other
mammals or are saprobes living in soil and water. In past few years, however, one
species in particular has emerged as a significant opportunists in host with disturbed
immune functions (immunocompromised or immunosuppressed). This species,
Moraxella catarrhalis is found in the normal human nasopharynx and can cause
purulent disease.
• M. catarrhalis was previously named Branhamella catarrhalis and before that
Neisseria catarrhalis.
• It is associated with several clinical syndromes such as meningitis, endocarditis,
sinusitis, otitis media, bronchopulmonary (i.e. pneumonia, bronchitis) infections, and
neonatal conjunctivitis. Individuals that are most susceptible to infections caused by
the organism are those adult patients with leukemia, alcoholism, malignancy,
diabetes or rheumatoid disease.

• For the colonial characteristics of Moraxella catarrhalis, please refer to the page 90 of the Laboratory Manual in
Microbiology 1 (Bacteriology).

• Moraxella catarrhalis can be differentiated from the neisseriae by its lack of carbohydrate fermentation, by its
production of DNase, and by butyrate esterase in tributyrin hydrolysis.

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MLS 223_Evaluate 4.3

Multiple Choice: Select a single best answer.

1. Characterized by acute suppuration, tissue inflammation that progresses to chronic

inflammation and fibrosis of organs in the genito-urinary tract.
A. Gonococcal bacteremia
B. Gonorrhea
C. Gonococcal ophthalmia neonatorum
D. Gonococcal meningitis

2. Favors intracellular survival of pathogenic neisseriae within phagocytes by

preventing formation of phagosome-lysosome complex.
A. Pili
B. Opa proteins
C. Por proteins
D. Reduction-Modifiable Proteins

3. Mediates attachment of bacterial cells by neutralizing secretory antibodies on

mucosal surfaces.
A. Pili
B. Polysaccharide capsule
C. Endotoxin
D. IgA Protease

4. Includes generalized intravascular clotting (DIC), cardiac failure, circulatory

collapse, bilateral hemorrhagic damage to the adrenal gland.
A. Waterhouse-Friderichsen Syndrome
B. Fitz–Hugh–Curtis syndrome
C. Meningococcal meningitis
D. Pelvic inflammatory disease

5. Risk factors for acquisition of M. catarrhalis infection include the following, EXCEPT:
A. Alcoholism
B. Leukemia
C. Past STIs
D. Diabetes mellitus

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MLS 223_Evaluate S21

Multiple choice: Select the BEST answer.

1. Gram-stained smear of Neisseria species would reveal:

A. Gram-positive cocci in grapelike clusters
B. Gram-positive lancet-shaped diplococci
C. Gram-positive kidney-shaped diplococci
D. Gram-negative coffee bean-shaped diplococci

2. The diagnosis of Neisseria gonorrhoeae in females is best made from:

A. clinical history
B. Gram-stain of cervical secretions
C. a cervical culture
D. serotyping

3. Which of the following DOES NOT correctly describe the action of antibiotics listed
for Modified Thayer-Martin medium?
A. Trimethoprim inhibits Proteus swarming
B. Nystatin inhibits fungi
C. Colistin inhibits Neisseria gonorrhoeae
D. Vancomycin inhibits gram-positive bacteria

4. Which of the following carbohydrates does Neisseria meningitidis produce acids

from?
A. Maltose
B. Glucose
C. Both maltose and glucose
D. Neither maltose nor glucose

5. All species of Neisseria have the enzyme to oxidize:

A. hydrogen peroxide
B. glucose
C. tetramethyl-p-phenylenediamine
D. tributyrin

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References:

Carroll, K. C. (2016). Jawetz, Melnick & Adelberg's medical microbiology (27th

ed.). New York: McGraw-Hill Education.

Melnick, J. L., Jawetz, E., Adelberg, E. A., & Riedel, S. (2020). Jawetz, Melnick y
Adelberg Microbiología médica. México: McGraw-Hill.

Procop, G. W., Church, D. L., Hall, G. S., Janda, W. M., Koneman, E. W.,
Schreckenberger, P. C., & Woods, G. L. (2017). Color Atlas and Textbook of
Diagnostic Microbiology (7th ed.). Philadelphia: Wolters Kluwer Health.

Talaro, K. P., & Chess, B. (2018). Foundations in Microbiology (10th ed.). McGraw
Hill.

Tille, P. M. (2017). Bailey & Scott's Diagnostic Microbiology (14th ed.). St. Louis,
Missouri: Elsevier.

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