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Neisseria
Moraxella catarrhalis
Acinetobacter baumanii

Characteristics of
Neisseria and Moraxella
catarrhalis

Gram-negative diplococci with


adjacent sides flattened

Frequently appear as intracellular


gram-negative diplococci within
polymorphonuclear neutrophils

Cytochrome oxidase positive

Neisseria gonorrhoeae fastidious


showing optimal growth on
enriched chocolate agar

Characteristics of Neisseria and


Moraxella catarrhalis

Growth of Neisseria meningitidis and


Moraxella catarrhalis occurs on both
sheep blood and chocolate agar

Neisseria gonorrhoeae, N.
meningitidis, and Moraxella
catarrhalis capnophilic (optimal
growth with 3-7% CO2)

Neisseria meningitidis and N.


gonorrhoeae closely related
genetically and distantly to
saprophytic species of Neisseria

Characteristics of Neisseria and


Moraxella catarrhalis

Neisseria meningitidis
encapsulated (capsule the major
virulence factor)

Thirteen capsular polysaccharide


serogroups

Invasive infection caused by


organisms with one of five capsular
serogroups (A, B, C, Y, and W135)
with 90% of meningococcal disease
due to serogroups A, B, and C

Characteristics of Neisseria and


Moraxella catarrhalis

Moraxella accepted taxonomically


as the genus designation for M.
catarrhalis (family Moraxellaceae)

Even though M. catarrhalis not a


member of the family
Neisseriaceae, morphologic and
biochemical similarity to Neisseria
allows clinical laboratory
identification of M. catarrhalis with
Neisseria species

Pathogenic Species
Neisseria

gonorrhoeae
Neisseria
meningitidis
Moraxella
catarrhalis

Saprophytic Species
Neisseria lactamica,
N.
polysaccharea, N.
cinera, N. flavescens,
N.subflava, N. sicca,
and N. mucosa

Neisseria: Natural
Habitats

Neisseria gonorrhoeae an obligate


pathogen with invasive infection of
anogenital, oropharyngeal, and
conjunctival mucous membranes

Neisseria meningitidis normally


colonizes oropharyneal and
nasopharyngeal mucous
membranes of humans (carrier rate
of 8-20%)

Neisseria: Natural
Habitats

Neisseria meningitidis rarely


colonize oropharyngeal and
nasopharyngeal mucous
membranes of humans

Saprophytic species are nonpathogenic (non-invasive) and


normally colonize the
oropharyngeal and nasopharyngeal
mucous membranes of humans

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Moraxella catarrhalis: Natural


Habitats
Present in the upper respiratory
tract of healthy individuals,
more
commonly in children (50%) and
elderly adults (25%)

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Neisseria gonorrhoeae:
Modes of Infection

Neisseria gonorrhoeae spread by


sexual contact, including genital,
anogenital, and orogenital.

Spread from infected mother to


neonate as ocular infection during
birth.

Non-sexual transmission not


documented.

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Neisseria: Types of
Infectious Disease

N. gonorrhoeae second most


common cause (after Chlamydia
trachomatis) of sexuallytransmitted lower genital tract
disease (acute urethritis in men,
endocervicitis in women)

N. gonorrhoeae untreated can


progress to epididymitis,
prostatitis, urethral stricture,
salpingitis, tubo-ovarian abscess,
and pelvic inflammatory disease

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Neisseria: Types of
Infectious Disease
N. gonorrhoeae causes oral and
anorectal infections as a result of
oral or anal intercourse
N. gonorrhoeae disseminates with
bacteremia and/or septic arthritis if
untreated
Disseminated infection
(bacteremia, pyogenic arthritis) by
N. meningitidis and N. gonorrhoeae
associated with deficiency in the
terminal components of
complement (C5-C8)

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Neisseria meningitidis:
Modes of Infection

Neisseria meningitidis transmitted


by inhalation of infectious air-born
respiratory droplets or direct
contact with infectious respiratory
secretions.

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Neisseria: Modes of
Infection

Neisseria meningitidis can also be


transmitted by sexual contact,
especially orogenital or anogenital
intercourse.

Person-to-person transmission
does not occur with saprophytic
Neisseria species and infection
(rare) is endogenous.

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Neisseria: Types of
Infectious Disease

N. meningitidis causes a rapidly


progressive meningitis in schoolaged children, adolescents, and
young adults with a mortality of 713%

N. meningitidis bacteremia
(mortality of 19-70%) a cause of
Waterhouse-Friderichsen syndrome
with petechiae, purpura, adrenal
hemorrhage, dissemin-ated
intravascular coagulation, and shock

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Neck rigidity

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Death from Waterhouse-Friderichsen syndrome

Neisseria: Types of
Infectious Disease
Neisseria meningitidis associated
with sexual transmission and
gonococcal-like urethritis, cervicitis,
salpingitis, and proctitis

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Moraxella catarrhalis:
Modes of Infection
Oropharyngeal endogenous
strains spread into normally sterile
regions of the tracheo-bronchial
tree, the middle,
ear, and sinuses

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Moraxella catarrhalis:
Types of Infectious
Disease
Acute purulent exacerbation of
chronic bronchitis

Causes 10-15% of episodes of otitis


media and sinusitis

Rarely associated with systemic


infection (endocarditis,
meningitits)

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Neisseria gonorrhoeae and


Neisseria meningitidis:
Isolation
Isolation often attempted from

specimens with abundant normal flora


(genital, oral, anorectal) (especially N.
gonorrhoeae)
Modified Thayer-Martin (MTM) agar an
enriched and selective medium for
pathogenic N. gonorrhoeae and N.
meningitidis
Nutritive base of MTM is chocolate
agar
Antibiotics present in MTM selective
for the growth of N. gonorrhoeae and
N. meningitidis

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Modified Thayer-Martin
Agar

Colistin: Inhibits gram-negative


flora (N. gonorrhoeae and N.
meningitidis resistant to colistin,
most saprophyic species of
Neisseria susceptible)

Vancomycin: Inhibits gram-positive


flora

Nystatin: Inhibits yeast flora

Trimethoprim: Inhibits swarming


Proteus

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Patient-Side Inoculation of
Selective Media
Optimal recovery of gonococci obtained
when species inoculated onto growth
medium immediately after collection
JEMBEC plate: Inoculation of selective
agar, placement of a CO2-generating
citric acid, and plate covered for
transport to laboratory
Moisture in the covered JEMBEC plate
sufficient to generate CO2 from the
citric acid/sodium bicarbonate tablet
Candle jar: Agar plates placed in a jar,
a candle lit, and jar sealed; candle
extinguished at 3% CO2 atmosphere

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Neisseria gonorrhoeae:
Identification
white

colonies on chocolate
agar with no discoloration of
agar
Acid from glucose but not
maltose, sucrose, fructose, or
lactose
Positive oxidase test
Colistin resistance (growth on
Modified Thayer-Martin
medium)

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Laboratory Detection and


Identification of Neisseria
gonorrhoeae

Direct PCR detection for urogenital


specimens with culture
confirmation when PCR positive
Culture isolation and biochemical
identification for urogenital
specimens with gonorrhea
refractory to treatment, and nonurogenital specimens
Molecular strain typing for isolates
of N. gonorrhoeae in sexual abuse
cases

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Neisseria meningitidis:
Identification
Gray

colonies on chocolate agar


with green haze in agar
immediately under and adjacent
to colonies

Acid

from glucose and maltose


but not sucrose, fructose, or
lactose

Colistin

resistance (growth on
modified Thayer-Martin medium)

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Moraxella catarrhalis:
Identification

Pink coloration of colonies on


chocolate agar not apparent on
blood agar
No acid from glucose, maltose,
sucrose, fructose, or lactose
(asaccharolytic)
Produces DNase
Possesses the enzyme butyrate
esterase

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Selected Biochemical Reactions


for Identification of Neisseria and
Moraxella catarrhalis1
Glu Mal Lac
Suc
DNa
BE
N. gon +

N. men + +

N. lac2 + + +

M. cat
+
+
1Glu=glucose, Mal=maltose, Lac=lactose,
Suc=sucrose, DNa=DNase,
BE=butyrate esterase (indoxyl
butyrate substrate), N. gon=N.
gonorrhoeae, N. men=N. meningitidis,
N. lac=N. lactamica, M. cat=Moraxella
catarrhalis
2Colistin-resistant saprophytic species of
Neisseria

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Prevention & Treatment

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Penicillin no longer drug of choice due to:
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Continuing rise in the MIC
Plasmid-encoded beta-lactamase production
Chromosomally-mediated resistance
Uncomplicated: ceftriaxone, cefixime or
fluoroquinolone
Combined with doxycycline or azithromycin for dual
infections with Chlamydia

Prevention & Treatment

Chemoprophylaxis of newborns against opthalmia 3


neonatorum with 1% silver nitrate, 1% tetracycline, or 5
0.5%
erythromycin eye ointments
Treatment of newborns with opthalmia neonatorum with
ceftriaxone
Measures to limit epidemic include education, aggressive
detection, and follow-up screening of sexual partners, use of
condoms or spermicides with nonoxynol 9

Safe Laboratory Handling


of Neisseria meningitidis

Use of biosafety cabinet for mechanical


manipulation of samples with risk of
aerosolization or droplet formation (grinding,
centrifuging, blending)
Use of a biosafety cabinet for manipulation of
sterile site isolates of N. meningitidis
Informed decision by microbiology workers of
vaccination by quadrivalent meningococcal
polysaccharide vaccine (A, C, Y, W-135)
Antimicrobial prophylaxis (rifampin, ciprofloxacin,
or ceftriaxone) for potential inhalational exposure
(aerosolization or droplet formation) or mucosal
exposure to invasive N. meningitidis isolate

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Acinetobacter baumanii

Acinetobacter baumannii is a pleomorphic aerobic


gram-negative cocobacillus (similar in appearance
to Haemophilus influenzae on Gram stain)

The genus Acinetobacter, comprises Gramnegative, strictly aerobic, non-fermenting, nonfastidious, non-motile, catalase-positive, oxidasenegative bacteria

commonly isolated from the hospital environment


and hospitalized patients. A baumannii is a water
organism and preferentially colonizes aquatic
environments.

The organism is often cultured from hospitalized


patients' sputum or respiratory secretions,
wounds, and urine. In a hospital setting,
Acinetobacter commonly colonizes irrigating
solutions and intravenous solutions.

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Appeareance, culture

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Antibiotic resistance

The rapid emergence of multi- and pandrugresistant strains of Acinetobacter highlights the
organisms ability to quickly acclimatize to
selective changes in environmental pressures

Numerous outbreaks of pandrug-resistant A.


baumannii have been documented

The phenomenon of multidrug-resistant (MDR)


pathogens has increasingly become a cause for
serious concern with regard to both nosocomial
and community-acquired infections.Indeed, the
World Health Organization (WHO) has recently
identified antimicrobial resistance as one of the
three most important problems facing human
health

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