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Neisseria Infections
Introduction
Neisseria species: Gram-negative diplococci, oxidase positive, grow aerobically
at 37°C.
Examples: Neisseria meningitidis, Neisseria gonorrhoeae, non-pathogenic
Neisseria.
Infections caused: Meningitis, gonorrhoea, septicaemia. Non-pathogenic species
are usually oral commensals.
Morphology: Occur in pairs (diplococci) or short chains; “coffee bean”
appearance; kidney-shaped.
Culture characteristics: Non-motile, non-spore forming, capnophilic, grow best
at 35–37°C on enriched medium (e.g., Modified Thayer Martin agar), oxidase
and catalase positive.
Species
Pathogenic: N. gonorrhoeae, N. meningitidis
Non-pathogenic: N. lactamica, N. sicca, N. subflava, N. mucosa, N. flavescens, N.
catarrhalis (Moraxella), N. cinerea, N. polysaccharea, N. elongata
Neisseria meningitidis
History
First reported in the 16th century; definitive description by Vieusseux (1805).
Isolated from CSF by Weichselbaum (1887); serotypes described in 1909.
Disease Spectrum
Meningococcemia (bacteraemia): 5–20% without meningitis
Meningitis: 50% of cases (most common)
Respiratory infections: URTI (1%), LRTI pneumonia (5–15%)
Other: arthritis (2%), myocarditis, skin lesions
Epidemiology
Humans are the only reservoir; 20% of population may carry, mostly non-
capsulated.
Epidemic carrier rate can reach 90%.
Endemic in Africa’s “meningitis belt” (Ethiopia → Senegal, N. Nigeria).
Epidemics: Serogroups A & C; occur every 8–12 years, attack rate 500–
1000/100,000.
Risk Factors
Age (3 months–3 years; 18–23 years)
Lack of bactericidal antibodies (IgG, IgM)
Travel to endemic areas, complement deficiencies (C5–C8)
Asplenia, host genetic polymorphisms, low socioeconomic status, overcrowding
Bar/nightclub exposure, alcohol, occupational exposure (lab workers)
Pathogenesis
Colonizes nasopharyngeal mucosa using pili → inflammation → bloodstream
invasion (<1% of carriers)
Capsule is major virulence factor; basis for serogrouping (13 serogroups: A, B, C,
D, 29E, X, Y, Z, W-135, H, I, K, L)
Clinical Features
Incubation: 2–10 days (commonly 3–4)
Abrupt onset: sore throat, headache → drowsiness, meningitis signs
Types: Meningitis, fulminant (shock), mixed meningococcemia-meningitis, mild
acute meningococcemia
Transmission
Respiratory droplets, prolonged close contact, facilitated by co-existing
respiratory infections
Epidemics start in dry season, stop in wet season
Diagnosis
Specimens: Blood, CSF, nasopharyngeal swab, puncture materials (do not
refrigerate)
CSF analysis: ↑ pressure, turbidity, WBC, protein; ↓ glucose; Gram-negative
intracellular diplococci
Culture: Chocolate agar or Thayer-Martin; incubate at 37°C with 5% CO₂
Non-culture: Latex agglutination, PCR, counter-immuno electrophoresis
Treatment
Hospitalization, isolation, monitoring, fluid/electrolyte balance
Antibiotics: Penicillin G, cephalosporins (3rd gen), chloramphenicol,
sulfonamides
Supportive: Antipyretics, mannitol for ↑ ICP, dexamethasone, treat
shock/respiratory failure
Prevention
Isolation of patients, monitoring of contacts
Good hygiene, avoid crowded places during epidemics
Vaccination: Polysaccharide (MPSV4) and conjugate vaccines (Menactra,
Menveo)
Chemoprophylaxis for close contacts: Rifampin, ciprofloxacin, ceftriaxone
Neisseria gonorrhoeae
History
“Gonococcus” first described by Neisser (1879); disease mentioned in Old
Testament
Microbiology
Gram-negative diplococcus, non-motile, non-spore forming; resembles N.
meningitidis
Grows only on selective media (Thayer Martin, NYC medium)
Sensitive to drying; requires CO₂ jar at 35–37°C
Epidemiology
~6 million cases/year globally; incidence declining in industrialized countries
Transmission: sexual intercourse, perinatal; infects urogenital, rectal,
pharyngeal mucosa
Neonatal conjunctivitis possible at birth
Pathogenesis
Antigenically variable to evade host defenses
Surface structures: pili (attachment, neutrophil resistance), LOS, POR (porins),
OPA (adhesion), RMP (structural modification)
Clinical Features
Men: Urethritis, discharge, dysuria, epididymitis (common complication)
Women: Cervicitis, urethritis, dysuria, intermenstrual bleeding, salpingitis, PID,
perihepatitis (Fitz-Hugh-Curtis)
Other: Rectal, pharyngeal, ocular infections; disseminated gonococcal infection
Diagnosis
Specimens: Urethral swab (men), endocervical/urethral swab (women),
rectal/pharyngeal swabs, Bartholin’s duct, synovial fluid, CSF
Gram stain: intracellular Gram-negative diplococci
Culture on selective media; glucose utilization test; beta-lactamase detection
Treatment
Cephalosporins (first line)
Management of sexual partners
Prevention: condoms, sexual health education
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