Gram negative COCCI

List of genera of pathogenic bacteria and

microscopy features
• Genus Species Gram staining

• Neisseria •Neisseria gonorrhoeae

Negative
•Neisseria meningitidis
• Pseudomonas •Pseudomonas aeruginosa Negative
Negative,
• Rickettsia •Rickettsia rickettsii stains poorly
• Salmonella
•Salmonella typhi Negative
•Salmonella typhimurium
Gram negative COCCI
Neisseria
• The genus Neisseria contains two important human
pathogens: Neisseria meningitidis and Neisseria gonorrhoeae.
• It tests positive for the enzyme cytochrome c oxidase
Difference between N. meningitidis and N. gonorrhoeae

• On the basis of sugar fermentation:

• Meningococci ferment maltose
• Gonococci do not ferment maltose
• (both organisms ferment glucose)
• Immunofluorescence can also be used to identify these species
Neisseria Meningitidis
Pathogenesis & Epidemiology
• Humans are the only natural hosts for meningococci.
• Transmitted by airborne droplets
• They colonize the membranes of the nasopharynx and
become part of the transient flora of the upper respiratory
tract
• Carriers are usually asymptomatic
• Meningococci have three important virulence factors:
• (1) A polysaccharide capsule
• (2) Endotoxin
• (3) An immunoglobulin A (IgA) protease
Clinical Findings
Meningococcemia
• The most severe form of meningococcemia is the life
threatening waterhouse–friderichsen syndrome(high fever,
shock, widespread purpura, disseminated intravascular
coagulation, thrombocytopenia, and adrenal insufficiency)
Meningitis
• Fever, headache, stiff neck, and an increased level of PMNs in
spinal fluid
Laboratory Diagnosis
• The principal laboratory procedures are smear and culture of
blood and spinal fluid samples.
• The organism grows best on chocolate agar incubated at 37°C
in a 5% CO2 atmosphere.
• Oxidase-TEST(presumptive diagnosis)
• Latex agglutination test (rapid diagnosis) (detects capsular
polysaccharide in the spinal fluid)
• Tests for serum antibodies are not useful for clinical diagnosis
Treatment
• Penicillin G is the treatment of choice for meningococcal
infections.
• A third generation cephalosporin such as ceftriaxone can also
be used.
Prevention
• Chemoprophylaxis
• Prophylaxis(Either rifampin or ciprofloxacin can be used in
people who have had close contact with the index case)
Neisseria gonorrhoeae
Pathogenesis & Epidemiology
• Gonococci cause both
• Localized infections, usually in the genital tract, and
• Disseminated infections with seeding of various organs
• In men
• Primarily urethritis
• Dysuria and a purulent discharge
• Epididymitis can occur
• In women
• Primarily in the endocervix, purulent vaginal discharge and
intermenstrual bleeding (cervicitis)
• Ascending infection of the uterine tubes (salpingitis, PID)
pelvic inflammatory disease
Transmission
• N. gonorrhoeae is transmitted from person to person during
sexual relations.
• It can also be transmitted to the fetus in utero and afterward
become apparent as a neonatal infection.
Symptoms
• In females, mild symptoms are usually present that resemble a
bladder or vaginal infection; or sometimes they are not even
present.
• Symptoms can appear within 2-5 days for males, but may not
be present in females for over 30 days.
• The following include painful urination and bloody or yellow
vaginal or penile discharge
Laboratory Diagnosis
• The diagnosis of urogenital infections depends on Gram
staining and culture of the discharge
• However, nucleic acid amplification tests are widely used as
screening tests
• Specimens from mucosal sites, such as the urethra and cervix,
are cultured on Thayer-Martin medium(a chocolate agar
containing antibiotics)
• Specimens from sterile sites, such as blood or joint fluid, can
be cultured on chocolate agar without antibiotics
Treatment
• Ceftriaxone is the treatment of choice in uncomplicated
gonococcal infections.
• Azithromycin or ciprofloxacin should be used if the patient is
allergic to penicillins or cephalosporins
Prevention
• The prevention of gonorrhea involves the use of safe sexual
contact
• Prompt treatment of symptomatic patients
• Cases of gonorrhea must be reported to the public health
department to ensure proper follow-up
• Gonococcal conjunctivitis in newborns is prevented most often
by the use of erythromycin ointment.
• No vaccine is available.