Gram Negative Cocci

Neisseria

Gram negative cocci

Family Neisseriaceae
Genera
Neisseria
Morexella.flora throat URT
Kingella flora throat
Acinetobacter.. Flora opportunistic pathogen
in immuno-compromised

Neisseria species

N. meningitidis
N. gonorrhoeae
N. lactimica..commensals in throat
N. sicca. //
N. subflava //
N. mucosa //
N. flavescens.. //
N. cinerea //

General characteristics
Kidney or bean shaped 0.8 1 m
Growth: Strict aerobe, 37oC, pH 7.2 -7.4,
moisture, enriched medium (Chocolate,
Thayer martin, MNYC ), 48 hrs incubation
Colonies
Pathogenic species: round convex, gray
white glistening 1-2 mm
Non pathogenic: opaque, brittle, wrinkled

General characteristics

Oxidase positive
Intracellular
Pili
genetic heterogeneity
Endotoxin
Sensitive to drying. Transmission requires
close contact

Neisseria meningitidis meningococci

Pathogenesis: Natural host only human
Predisposing factors:
carriage rate 35% in people living in close
quarters (crowded), military recruits, hostel
dormitories, small houses, pilgrimage
Children over 2 months age esp. 2 -18 yrs
Complement deficiency C6-C9
IgG IgM

Pathogenesis
Transmission:
air droplets, flora naso-pharynx, transient flora
upper respiratory tract
5% people chronic asymptomatic carriers
Virulence factors
polysaccharide Capsule : antiphagocytic, antigenic
13 serotypes, A, B type causes meningitis
Endotoxins LPS: fever, shock
IgA protease: cleave IgA. adherence to upper
respiratory mucosa

Pathogenesis
N. meningitidis enters nasopharynx colonize
URT Enter blood bacteraemia spread to
distant sites e.g. meninges, joints, throughout
body (meningococemia)
antibodies to capsular antigens develop in 2 wks
& are protective group specific immunity in
carriers

Diseases & Clinical Features

Meningitis: (gp A) 2nd common cause after
S.pneumoniae. Commonest cause in 2-18
yrs age group. Fever, Headache, vomiting,
stiff neck, coma, thrombosis, PMNLs in
spinal fluid
Meningococcemia: Severe form - Water
house Friderichsen syndrome (fever, rash,
shock, DIC, thrombocytopenia, adrenal
insufficiency)
Organs- thrombosis in small blood
vessels, petechial hemorrhages.

Lab diagnosis
Specimen blood, CSF, naso-pharyngeal swab
Microscopy: diplococci in PMNLs or extra-cellular
Culture: 5% CO2, chocolate agar, modified thayer
martin ( Vancomycin, Colistin, Trimethoprim, Nystatin)
Biochemical tests:
Oxidase +ve, Catalase +ve, ferments maltose and
glucose
Serological:
latex agglutination for capsular polysaccharides in
CSF
Immunofluorescence for species

Treatment & Prevention

Treatment
Penicillin G, 3rd generation Cephalosporin,
Chloremphenicol, Ciprofloxacin
Carrier Rifampicin 600mg 2 x day 2 days
Prevention
Vaccine (gp A, C, Y & W-135 strain) exposed
persons, military, travelers (conjugate and
unconjugated)
Chemoprophylaxis for close contact
Rifampicin, Ciprofloxacin

Neisseria gonorrhoeae
Pathogenesis
Virulence factors:

Pili: adherence, anti-phagocytic, affinity for urethral

mucosa. Pilin Antigenic variation, 100 serotypes.
Outer membrane protein OMP: III, Por - pores in
membrane for nutrients. Op II - attachment to cell.
Rmp - pore formation. Antigenic heterogeniety of pilin
and OMP repeated infections.
Endotoxin LOS lippooligosaccharides, weaker
antigen
IgA protease, Beta lactamase.
Porin A in cell wall inactivates C3b. Resistance to
killing by antibody and complement

Pathogenesis
Transmission: sensitive to dehydration and cooling.
sexual contact, newborn during delivery. Ano-rectal
and pharyngeal infections in homos.
Local Infection: genitourinary tract, of mucosal
surfaces inflammation tissue invasion
suppuration fibrosis.

Pathogenesis
Dissemination depends on host resistance.
Asymptomatic dissemination
Host defence IgA & IgG antibodies and
complement. Resistance to antibodies and
complement, cause is uncertain, may be Porin
A.
C6-9 deficiency risk for dissemination esp.
during menses and pregnancy.

Diseases and C/F

Gonorrhoea
Male- urethritis, dysuria, purulent discharge,
epidydmitis.
Female- asymptomatic, vulvovaginitis,
endocervicitis (purulent vaginal discharge,
intermenstrual bleeding).
Complications: salpingitis, PID, ascending
infection scarring of tubes - sterility, ectopic
pregnancy.
Disseminated gonococcal infection DGI - septic

arthritis, tenosynovitis, pustules in skin,

Diseases and C/F

Anorectal area. Anorectal infectionproctitis- purulent bloody discharge.
Eye, throat Pharyngitis, Opthalmia
neonatorum conjunctivitis (s/t in adults)
Co-infections with other STDs (Syphilis,
Chlamydia trachomatis urethritis.

Diagnosis
Specimen: urethral discharge, vaginal swab
Microscopy: Intracellular diplococci in PMNL
differentiate from flora. cervical smear
Culture: Thayer martin medium - gray or translucent
colonies, chocolate agar- colorless
Biochemical tests: oxidase+, glucose+, maltose ve
Flourescent antibody staining
Rapid tests for gonococcal nucleic acids
Serological tests not useful

Treatment

Ceftriaxone + Doxycyclin, Ciprofloxacin

Erythromycin or Silver nitrate eye drops
T/M of co-infections
PPNG, Plasmid mediated resistance to Penicillin BY
Penicillinase, Tetracycline and Chloremphenicol.
Strains resistant to Ciprofloxacin are also emerging.
Prevention
Use of condoms
t/m of contacts and patients
Silver nitrate eye drops, Erythromycin ointment
No vaccine