Gram Negative Cocci:

IAN LOON GENALDO, MD,

FPSMS
GULLAS COLLEGE OF
MEDICINE
DEPARTMENT OF
MICROBIOLOGY AND
PARASITOLOGY
 GENUS NEISSERIA:
2 important human pathogens:
1. Neisseria meningitidis ( a.ka.
Meningococcus )
2. Neisseria gonorrhoeae ( a.k.a
Gonococcus )
Important Properties: Neisseria
Are gram negative cocci that resembles
paired kidney beans.
 Important Properties: Neisseria meningitidis
( Meningococcus )
Has a prominent Polysaccharide capsule:
- enhance virulence by –
its ANTIPHAGOCYTIC
ACTION.

> CAN INDUCE PROTECTIVE

ANTIBODIES. A serotype or serovar is a distinct variation
within a species of bacteria or virus or among immune cells of
different individuals. These microorganisms, viruses, or cells are
classified together based on their cell surface antigens, allowing
the epidemiologic classification of organisms to the subspecies
level.
Important Properties: Neisseria meningitidis
( Meningococcus )
 Meningococci – are divided into 13 serologic group
( Basis: ANTIGENICITY OF THEIR CAPSULAR
POLYSACHHARIDES )
- 5 serotypes cause most cases of meningitis and
meningococcemia.
1. A – leading cause of epidemic meningitis world
wide
2.B – accounts for most disease in the US
3. C
4. Y
5. W 135
 Important Properties: Neisseria gonorrhoeae
( Gonococcus )
 Has NO Polysaccharide capsule - ( VS – N. meningitidis
Has a Polysaccharide capsule ).
 Instead they have – a Pilus protein ( Multiple Serotypes
on the basis of the ANTIGENICITY OF THE PILUS
PROTEIN )
Gonococci – has 3 outer membrane proteins
 Proteins I,II,III
 Proteins II – plays a role in the attachment of
organisms to cells ( varies antigenically as well )
 Neisseria
 Gram negative bacteria – contain ENDOTOXINS ( outer
membrane )
 Endotoxins consist of – LIPOOLIGOSACCHARIDE ( LOS
) ( VS – LIPOPOLYSACHARIDES present in enteric gram
negative rods )
LPS VERSUS LOS

 Gram-negative LPS
 It is the outer membrane (external to the cell wall) in
all Gram-negative bacteria.
It is large molecule consist of lipid and polysaccharide.
 This membrane contains many proteins, ex: porins.
 This membrane protects the cell wall from the host
defense substance and impede the entrance of many
antibiotics.
Lipopolysaccharides (LPS):
 Components of LPS (from inside to outside):
1. Lipid A: endotoxin when released into the
bloodstream may lead to endotoxic shock. 2. Core
(oligosaccharide). 3. O Ag (polysaccharide capsule):
protect from phagocytosis.
LPS
 Surface Structure of N.gonorrhoeae
 Lipooligosaccharide (LOS)= LPS without O Ag
 Porin proteins
 Opacity proteins
 Pili
LIPOOLIGOSACCHARIDES
Important Properties: Neisseria
 Oxidase positive – PURPLE COLOR.
 Possess the enzyme
- CYTOCHROME
C
Pathogenesis: Neisseria meningitidis:
 The ONLY Natural host ( meningococci ) - Man
 MOT: by AIRBORNE DROPLETS
 Habitat: colonize the membranes of the nasopharynx
and become part of the transient flora of the URT.
can enter the bloodstream and spread to
specific sites such as – meninges and joints or be
DISSEMINATED throughout the body
( MENINGOCOCCEMIA )
Carrier state:
 are ASYMPTOMATIC
 5% of people become CHRONIC CARRIER ( serves
as the source of infection to others )
 carriage rate – as high as 35% in people living in close
quarters ( e.g. military recruits ) – explains the high
frequency of outbreaks of meningitis in the armed
forces prior to the use of the vaccine.
- HIGH in close family contacts.
Two Organisms cause more than 80% of cases of
Bacterial meningitis in infants older than 2
months of age:
 Streptococcus pneumoniae
 Neisseria meningitidis – ( meningococci – Group A )
more likely to cause epidemics of meningitis.
3 Important Virulence Factors
( Meningococcemia ):
 Polysaccharide capsule
 Endotoxins
 IgA proteases
Polysaccharide capsule:
 enables the organism to resist phagocytosis by PMNs
Endotoxins:
 causes fever, shock
 pathophysiologic changes – can reproduce many of
the clinical manifestations of meningococcemia.
Immunoglobulin A ( IgA ) Protease:
 Helps the bacteria ATTACH to the cell membranes of
the upper respiratory tract by cleaving secretory IgA.
( IgA secretory form – is an Ab that plays a crucial
role in the immune function of the mucuos
membrane )
Resistance to Disease:
 correlates with the presence of antibody to the
capsular polysaccharide ( most carriers develop
protective antibody titers within 2 weeks of
colonization )
 IMMUNITY IS GROUP SPECIFIC – it is possible to
have protective antibodies to one group of organism
yet be susceptible to infection by organism s other
groups.
Complement system:
 Important feature of the host defenses ( part of the
immune system that enhances – (COMPLEMENT) –
the ability of antibodies and phagocytic cells to clear
microbes and damage cells from an organism,
PROMOTES INFLAMMATION and ATTACKS THE
PATHOGENS CELL MEMBRANE )
- People with complement deficiencies
( particularly in the late acting complement components
– C6 – C9 ) – have INCREASED incidence of
meningococcal bacteremia )
 Complement deficiency
 Deficiencies of the terminal pathway
Predispose to –
INFECTIONS ( N. meningitidis )
- Due to the role of
 MEMBRANE ATTACK COMPLEX
- Plays in attacking
Gram Negative Bacteria.
Clinical findings:2 most important
manifestation of the disease
 Meningococcemia
 Meningitis
Waterhouse Friderichsen Sydrome:
 Characterized by:
- High Fever
- Shock
- Wide spread purpura
- DIC
- Thrombocytopenia
- Adrenal insufficiency

Meningitis
 Bacteremia can result in the seeding of many organs –
MENINGES
 SYMPTOMS ( MENINGOCOCCAL MENINGITIS )
– TYPICAL BACTERIAL MENINGITIS:
- fever
- headache
- stiffneck
- Increased level of PMNs in the CSF
Diagnosis
 Principal Laboratory Procedure – SMEAR and
CULTURE OF BLOOD AND CSF SAMPLES.
 PRESUMPTIVE DIAGNOSIS –
( MENINGOCOCCAL MENINGITIS )
- GRAM NEGATIVE COCCI SEEN IN
SMEAR OF CSF.

- GROWS BEST: CHOCOLATE AGAR

INCUBATED AT 37 DEGREES CELCIUS IN A 5%
CO2 ATMOSPHERE.
Diagnosis:
 PRESUMPTIVE DIAGNOSIS OF NEISSERIA:
- OXIDASE POSITIVE COLONIES OF GRAM
NEGATIVE DIPLOCOCCI.
The Differentiation between N. meningitidis
and N. gonorrhoeae
 BASIS OF SUGAR FERMENTATION:
- Meningococci: Ferments maltose
- Gonoccoci: DO NOT Ferments maltose
BOTH ORGANISMS: Ferments Glucose
Neisseria meningitidis:
 Glucose – DEXTROSE
Neisseria gonorrhoea
 N. gonorrhoea
Latex Agglutination Test:
 For rapid diagnosis of meningococcal meningitis
 CSF: Detects –CAPSULAR POLYSACCHARIDE
Treatment:
 Penicillin G – DOC ( meningococcal infections )
 3rd Generations Cephalosporins: can also be used
Prevention:
 Chemoprophylaxis and Immunization: BOTH used to
prevent meningococcal disease
 For Prophylaxis: ( efficiently secreted in the saliva VS
– Penicillins )
- Rifampin
- Ciprofloxacin
3 Forms of Meningococcal vaccine
 All of which contains capsular polysaccharide of
groups A,C,Y,W135 ( as the immunogen ) – Group B
Polysaccharide NON IMMUNOGENIC TO
HUMANS
Referrences:
 Medical Microbiology by Jawetz, Melnick, &
Adelberg’s 28th ed.