NEISSERIA

Neisseria
 Gram (-) diplococci
 Coffeebean-shaped bacteria
 Grown in chocolate agar media, Thayer-
Martin media, Muller-Hinton media
 Thayer Martin
 Vancomycin
 Colistin
 Nystatin
 Species
 N. gonorrhea
 N. meningitidis- epidemic meningitis
 N. flava
 N. flavesens
 N. sicca
 N. mucosa
 N. lactamica
 Gonorrhea Infection
 Caused by Neisseria gonorrhoeae
 Overallrates falling, but incidence in certain groups
remains high
 Most common in young adults and adolescents
 CT co-infection of GC cases remains at about 40%
 Resistance to medication is an spreading problem
 Gonorrhea Infections in Men,
Women and Neonoates
 Men are usually symptomatic (urethra), women
are commonly asymptomatic
 Men: urethral infection, epididymitis
◦ Usually gives pain with urination and heavy, thick
penile discharge; few may be asymptomatic carriers
 Women: cervical infection, PID
◦ ~50% women asymptomatic, others have pain with
urination, vaginal discharge or bleeding
 Othersites of infection: throat, rectum, eye
 Neonates: eye and skin infections
Gonorrhea Infections
Clinical Manifestations
 GC Partner Management
 Transmissibility:
Maleto female: 50 - 90%
Female to male: 20 - 80%

 Partners with contact during the 60 days

preceding the diagnosis should be
evaluated, tested and treated
 If no sex partners in previous 60 days,
treat the most recent partner
 Pelvic
Inflammatory Epididymitis
Disease
 Symptoms:
• pain, fever, chills Symptoms:
fever, chills,
 Complications: pain
• Ectopic pregnancy,
maternal death, Complications:
sterility sterility
 Treatment: antibiotics Treatment:
antibiotics
Gonorrheal Epididymitis

(VERY painful)
 Gonorrhea in Newborns
11

 Infected as they pass through birth

canal
 Eye inflammation, blindness
 Prevented by prophylaxis immediately
after birth
Gonorrhea-Treatment
 Ceftriaxone 125 mg intra-muscularly
 Oflaxacin 400 mg orally
 Treat for chlamydia at same time
 Pathogenesis
 Genital gonorrhea
 Gonococcal urethritis in males may cause
strictures
 May involve the epididymis leading to sterility
 Usually asymptomatic in females leading to
chronicity of the infection
 May lead to chronic cervicitis, salphingitis
causing strictures, female sterility and PID
 Gonococcal arthritis
 Rectal and pharyngeal gonorrhea
 Gonococcal conjunctivitis (Ophthalmia
neonatorum)
 Crede’s prophylaxis (1% AgNO3)
 PID
 Disseminated gonococcal infection:
lesions in the skin and mucus membranes
 Diagnosis
 Gram stain of urethral (male) or vaginal
discharge (female) smears
 Culture
 Presumptive test
 Oxidase test
 Confirmatory test
 FAT
 Degradation of CHO
 Management
 Penicillin G
 Spectinomycin, Ceftriaxone, Cefotaxime,
Quinolones
 Management of both sexual partners is
vital to prevent ping-pong infection
 Use of barriers such as condoms
 Neisseria meningitidis
 Meningococcus
 Encapsulated diplococci
 Resistant to phagocytosis
 Transmitted through droplet inhalation
 Carriers carry the organism in the
nasopharynx
Neisseria meningitidis
 Pathogenesis
 Produces an endotoxin that cause extensive
vascular damage
 Causes epidemic meningitis in children
 Cause bacteremia characterized by:
 Skin rash
 Arthritis
 Hemorrhage of the adrenal glands (Friedricksen-
Waterhouse syndrome)
 Can lead to DIC and shock
 Neisseria meningitidis: The
23
Meningococcus

Virulence factors:
capsule
pili
IgAprotease
endotoxin

 12
strains; serotypes A, B, C cause
most cases
 Epidemiology and
24 Pathogenesis
 Prevalent cause of meningitis; sporadic or epidemic
 Human reservoir – nasopharynx; 3-30% of adult
population; higher in institutional settings
 High risk individuals are those living in close quarters,
children 6months-3 years, children and young adults 10-
20 years.
 Disease begins when bacteria enter bloodstream, pass
into cranial circulation, and multiply in meninges
 Very rapid onset; neurological symptoms; endotoxin
causes hemorrhage and shock; can be fatal
25
 Clinical Diagnosis
26

 Gram stain CSF, blood, or

nasopharyngeal sample
Treatment and Prevention
 Treated with IV penicillin G,
chloramphenicol
 Prophylactic treatment of family
members, medical personnel, or children
in close contact with patient
 Vaccines exist for group A and C.