Gram Negative Bacteria

By: M Shahram Tanveer

Neisseriaceae

 The genus Neisseriaceae to which the organism Gonococcus

belongs, consists of both pathogenic and nonpathogenic gram negative organisms.
 The two pathogenic organisms with ocular manifestation are N. gonorrhea and N. meningitidis.

 The former causes more ocular lesions than the latter.

 Can pass through intact corneal epithelium.
Neisseria gonococci

 Humans are the only known reservoir.

 The organism is gram-negative, bean-shaped cocci that are mostly seen in pairs.
 The organisms are mostly intracellular in polymorphs, extracellular organism are seen in chronic infection.
 The organisms are nonmotile, nonsporing, strict aerobic and oxidase positives.
 They are capsulated in fresh specimen.
Classification

 The pili enhance its virulence.

 The pili inhibit phagocytosis.
 On the basis of presence of pili, the gonococci have been divided into two groups, i.e
 virulent form—those that possess pili
 nonvirulent—those that do not have pili.
Diseases

 Gonococcal Conjunctivitis
 Corneal Ulceration and Perforation
 Endophthalmitis and Panophthalmitis
 Orbital Cellulitis
 Lid Edema
Treatment

 Sensitive to many antibiotics and sulphonamides.

 Most of the strains have developed resistance to sulpha drugs.
 The incidence of B. lactamase (penicillinase) producing strains are becoming more frequent.
 The organism has developed resistance to tetracycline and many
cephalosporins.
 Cefotaxime and kanamycin have proved to be the best alternative.
 Other drugs to which the organism is sensitive are norfloxacin, ciprofloxacin and ofloxaein.
Meningococcus (N. meningitidis)

 Causative organism to produce purulent meningitis especially in children.

 Same morphological and cultural characteristics of gonococci, i.e. they are gram negative diplococci, which do not grow on
ordinary media. They differ from gonococci
biochemically and in antigenicity.
 Strict aerobes, catalase and oxidase positive.

 Do not survive outside the body for long-time.

 They are destroyed by heat, change in pH and usual disinfectants.
 They can invade the cornea in presence of intact epithelium. They differ from gonococci
biochemically and in antigenicity.
Ocular Lesions

 They can invade the cornea

 They do not have affinity for mucous membrane of genitourinary tract or conjunctiva but may cause
conjunctivitis.
 The organism is sensitive to many antibiotics such as penicillin and sulphonamides.
 Many strains have developed resistance to them.
 The other drugs used are chloremphenicol, ceftriaxone and ceflazidime.
Moraxella lacunata

 The organism M. lacunata is pathogenic only to ocular tissues

 The genus Moraxella besides M. lacunata consists of Moraxella liquefaciens,
nonliquefaciens as well.
 M. lacunata is the largest gram-negative cocci to cause ocular pathogenecity.
 It is pleomorphic.The organism is nonmotile, nonsporing, aerobe that requires
enriched media to grow.
 It is oxidase and gelatine positive. It is urease and citrate negative. It produces a proteolytic enzyme that
causes maceration of skin.
 It is differentiated from other Neisseria by its ability to produce oxidase
and catalase but not fermenting sugar.
Ocular lesions

 Conjuctivitis
 Keratitis
 Endophthalmitis
 The organism in spite of its variability is sensitive to many antibiotics including fluoroquinolones,
clindamycin, erythromycin but not penicillin.
 A nonantibiotic drug that gives uniformly good result is zinc sulphate eye drop 0.25-0.5% TDS or QID.
 Adding zinc sulphate to antibiotics enhances efficacy of antibiotics.