Neisseria
Gram-negative diplococci, kidney-shaped, non motile, non
hemolytic and non pigmented, Colonies are opaque or transparent.
There are two pathogenic species for humans :
1. Neisseria gonorrhoeae (Gonococci) GC, the causative agent of
gonorrhea, neonatal conjunctivitis (ophthalmia neonatorum) and
pelvic inflammatory disease (PID).
2. Neisseria meningitidis (Meningococci) MC, the causative
agent of meningitis and meningococcemia.
Neisseria Spp. are oxidase-positive, The growth
of bacteria is inhibited by toxic trace elements
and fatty acids found in certain culture media e.
g., blood agar plate, therefore, they are culture
on chocolate agar. The organisms are rapidly
killed by drying, sunlight, moist heat and many
disinfectants. (they are fastidious).
Non pathogenic e. g. Moraxella catarrhalis
Neisseria gonorrhoeae
Classification :-
On the basis of morphology and their colonial mutation, there are
four biotypes :
(T1, T2) virulent small brown colonies (pilitated gonococci) posses
pili which are adherence factors.
(T3, T4) a virulent large non pigmented colonies (no pilitated
gonococci).
Virulence factors of GC are:-
1. pili acts as adhesions.
2. pore protein.
3. opa proteins.
4. Rmp (protein111).
5. Iipopolysaccharide (in gonococci is called a
lipooligosaccharide, LOS, as endotoxin).
6. IgA1 protease.
Pathogenesis :-
Gonococci cause a sexually transmitted disease STD called
gonorrhea (example urithritis, cervicitis).
-Ophthalemia neonatorum.
Gonorrhea is usually symptomatic in men but often asymptomatic
in women.
The transmission of these bacteria is occur by sexually contact and
through the placenta from mother-to-neonate during birth.
GC attack mucous membrane of genitourinary tract, eye, rectum
and-throat.
Clinical finding :-
Gonococci caused both localized infection in the genital tract and disseminated infections
with seeding of organs, GC reach these organs via the bloodstream(gonococcal bacteremia),
gonorrhea
-ln men is characterized primarily by urethritis accompanied by dysuria (painful urination)
and purulent discharge complication include (Epididymitis and prostatitis).
-In women cervicitis and the most frequent complication is an ascending infection of the
uterine tubes (salpingitis, PID) which can be result in sterility and ectopic pregnancy as a
result of scarring of the tubes.
Disseminated gonococci infections (DGI) arthritis, skin lesion.
In newborn infant GC. Can cause ophthalemia neonatorum, an infection of the eye of the
newborn, is acquired from the mother during passage through an infected birth canal.
Other sexually transmitted infections, example, syphilis and non gonococcal urithritis
(NGU) caused by Chlamydia trachomatis, can coexist with gonorrhea therefore appropriate
diagnostic and therapeutic measures must be taken.
Lab. Diagnosis :-
1. Specimens, pus, secretion from urethra, cervix, conjunctiva, throat and
rectum.
2. Gram stained smear, then we look intracellular Gram-negative diplococci in
PMNs )polymorphoneuclear cells) from urethral discharge in men is sufficient for
diagnosis while in women false positive because of the normal flora interference
3. Culture
A. Chocolate agar.
b. Thayer-Martin agar. (selective medium)
C. Modified Thayer-Martin agar. same as(Thayer-Martin agar plus
trimethoprim)
The culture is incubated in an atmosphere containing 5% CO2 at 37°c.
4. Oxidase test positive.
5. Sugar fermentation the differentiation between GC and MC is made on the
bases glucose and maltose fermentation. GC ferment glucose only.
6. Nucleic acid amplification test.
7. Serology by ELISA, antibodies against pili.
Treatment
Ceftriaxone plus doxycycline.
Some strain of GC called penicillinase producing N. gonorrheae or (PPNG) possess
plasmids containing the gene for penicillinase production(resistant to penicillin).
Control and prevention :-
Treatment of symptomatic patient with his partner, cases on gonorrhea must be
reported to the public health department to ensure proper follow up.
Gonococci conjunctivitis is preventive by the use of erythromycin ointment. Silver nitrate
drops are use less frequently.
No vaccine is available.
Neisseria meningitides (MC)
At least 13 serologic groups on the basis of the antigenicity of their
capsular
polysaccharide are presents (A, B, C, D, X, Y, Z, W135, 29E, H, I, K,
and L).
The route of infection is nasopharynx, MC present as normal flora
of nasopharynx, these MC stimulate the carrier antibodies( natural
immunity ) these carrier are asymptomatic.
Two organisms cause more than 80% of cases bacterial meningitis in
persons over 2 months of age :
Streptococcus pneumonia and Neisseria meningitides of these
organism. MC in
group A cause epidemics of meningitis.
virulence factors (antigenic structures):-
Meningococci have three virulence factors :-
a. polysaccharide capsule which act
antiphagocytic factor.
D. Endotoxin (LPS) which cause fever, shock.
C. IgA1 protease cleaves secretory IgA.
Pathogenesis and clinical finding :-
Disease meningitis and meningococcemia,
MC spread via respiratory secretions, MC via nasopharynx-blood
stream bacteremia (meningococcemia) intravascular coagulation
and spread-meningitis most common complication of
meningococcemia-fulminant meningococcemia
(septic shock).
Meningitis most common disease in children less than 1 year.
Lab. Diagnosis :-
1. Specimens from blood, CSf and nasopharyngeal swab.
2. Direct-Gram stain smear of centrifuged CSF shows MC as typical Neisseria within
polymorphonuclear leukocyte or extracellularly.
3. Culture, CSF specimen are plated on Choclate agar and incubated at 37oC with 5% CO2.
Also culturing in Thayer martin agar and modified TM.
4. Biochemical test :-
--Oxidase test-positive.
--Sugar fermentation test, ferment maltose and glucose.
5. Serology, antibodies to meningococcal polysaccharides can be measure by latex
agglutination test or by measuring the bactericidal activity. These antibodies give
Treatment :-
Penicillin G is the drug of choice.
Prevention and control :-
Vaccine contains capsular polysaccharide of strains A, C, Y
and W-135, rifampin or ciprofloxacin given to close contact
to decrease oropharyngeal carriage.
Moraxella catarrhalis :-normal flora of
the upper respiratory tract, it causes
bronchitis, pneumonia, otitis media and
conjunctivitis, this spp. Produce
beta-lactamase so its resistant to
peniciliin.
It produces butyrate esterase.
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