MICROBIOLOGY LECTURE 6 – Genus Neisseria

Notes from Lecture

USTMED ’07 Sec C – AsM

1. Gram negative cocci that usually occurs in pairs

2. Some are normal inhabitants of the human respiratory
tract
3. Some are pathogenic for humans and found associated
with or inside the polymorphonuclears
a. Neisseria meningitidis(meningococci)
b. Neisseria gonorrheae(gonococci)
4. Gonococci and meningococci are closely related with 70%
homology
5. Differences between gonococci and meningococci
a. meningococci have polysaccharide capsules;
gonococci do not.
b. meningococci rarely have plasmids; most gonococci
do
c. meningococci typically are found in the upper
respiratory tract and cause meningitis; gonococci
cause genital infection
6. Neisseria meningitides
a. has a prominent polysaccharide capsule that
enhances virulence by its antiphagocytic action
and induces protective antibodies
b. divided into at least 13 serologic groups on the
basis of the antigenicity of their capsular
polysaccharides
7. Neisseria gonorrheae(gonococcus)
a. has no polysaccharide capsule but has multiple
serotypes based on the antigenicity of its pilus
protein
b. marked antigenic variation in the gonococcal pili NEISSERIA MENINGITIDIS
as a result of chromosomal rearrangement; more
than 100 serotypes are known Pathogenesis
c. have three outer membrane proteins (proteins
1. Humans are the only natural hosts for meningococci.
I,II,and III) 2. They are transmitted by airborne droplets; they
d. Protein II plays a role in attachment of the colonize the membranes of the nasopharynx and
organism to cells and varies antigenically as well. become part of the transient flora of the upper
8. Neisseria are gram negative bacteria and contain respiratory tract.
endotoxin in their outer membrane. 3. From the nasopharynx, the organism can enter the
a. Meningococcus – lipopolysaccharide (LPS) blood-stream and spread to specific sites, such as the
meninges or joints or be disseminated throughout the
b. Gonococcus – lipooligosaccharide (LOS)
body (meningococcemia)
Both contain lipid A but LOS lacks the long repeating sugar side 4. Meningococci have three important virulence factors:
chains of LPS. a. Polysaccharide capsule – enables the
organism to resist phagocytosis by
polymorphonuclear leukocytes
9. The growth of both organisms is inhibited by toxic metals
b. Endotoxin(LPS) – causes fever, shock, and
and fatty acids found in certain culture media as in BAP. other pathophysiologic changes
They are therefore cultured on “chocolate agar”
containing blood heated to 80 C which inactivates the c. Immunoglobulin A (IgA) protease- helps the
inhibitors. bacteria attach to the membranes of the
10. Neisseriae are oxidase positive, ie, they possess the upper respiratory tract by cleaving
enzyme cytochrome c. – important laboratory diagnostic secretory IgA
test wherein the colonies turn purple when exposed to
phenylenediamine as a result of oxidation of the reagent Clinical Findings
by the enzyme
1. Meningitis – symptoms are those of typical bacterial
Antigenic structure of Neisseria Gonorrhea meningitis – fever, headache,vomiting, stiff neck and
an increased level of PMN’s in spinal fluid
2. Meningococcemia – clinical presentation is one of
severe septicemia and shock

Waterhouse Frederichsen syndrome – the most severe form of

meningococcemia characterized by high fever,shock,
widespread purpura, disseminated intravascular coagulation
and adrenal insufficiency.

Meningococcal rash
1. Initial rash – characterized by
discrete, round,erythematous
macules.
2. Petechiae can be found in the
skin, mucous membranes and
Neisseria gonorrhea virulence factors conjunctivae; nailbeds are
spared
3. As the rash evolves, petechial
and purpuric lesions are most
pronounced on the trunk and
lower extremities.

NEISSERIA GONORRHEAE

Pathogenesis
 eye, especially the cornea
1. Pili constitute one of the most important virulence (keratitis).
factors, because they mediate attachment to
mucosal cell surfaces and are antiphagocytic.
2. Piliated gonococci are usually virulent, whereas
nonpiliated strains are avirulent. Pustular lesion of disseminated gonococcal infection on the
3. Two virulence factors in the cell wall are: heel
a. LOS (a modified form of endotoxin)
b. outer membrane proteins
4. The organism’s IgA protease can hydrolyze secretory
IgA which could also block attachment to the mucosa.
5. Gonococci have no capsules.
6. The main host defenses against gonococci are
antibodies (IgA and IgG, complement and neutrophils)
7. Antibody mediated opsonization and killing within Laboratory Diagnosis
phagocytes occur, but repeated gonococcal infections
are common primarily as a result of antigenic 1. Microscopy
changes of pili and the outer membrane proteins. - Gram stain of Neisseria
8. Gonococci infect primarily the mucosal surfaces eg.
spp.Gram stained smear of
the urethra and vagina but dissemination occurs.
a blood culture showing
9. The occurrence of dissemination is a function of the:
gram negative diplococci
a. strain of the gonococcus – important
suggestive of Neisseria spp.
feature is the resistance to being killed by
The adjacent sides of the
antibodies and complement
cell pairs look flattened
b. effectiveness of the host
and kidney bean shaped.
i. Deficiency of the late acting
complement components
ii. Women during pregnancy and - Gram stain of Neisseria
menses meningitides from a blood
culture broth RBC and
Clinical findings gram negative cocci in
singles and pairs. The
1. Urethritis – characterized by thick, yellow purulent adjacent sides of the
diplococci appear
exudates containing bacteria and numerous
flattened.
neutrophils; frequent painful urination and possibly
an erythematous meatus
2. Complications of urethritis such as epididymitis and
- Gram stain of a urethral
discharge
prostatitis in males and pelvic inflammatory disease
Polymorphonuclears and
in females; repeated infection may cause scarring
gram negative intracellular
with subsequent sterility in both sexes and may
diplococci is suggestive of
predispose females to ectopic pregnancy
Neisseria gonorrheae
3. Rectal infections (prevalent in homosexual males) –
characterized by painful defecation, discharge,
2. culture
constipation and proctitis
4. Pharyngitis – characterized by purulent exudate; mild - Neisseria meningitidis on
form mimics viral sore throat; severe form mimics 5% sheep blood agar plate
streptococcal sore throat Colonies are round ,
5. Disseminated infection (bloodstream invasion) – smooth, opaque, glistening
organisms initially localize in the skin, causing and 1-1.5 um in diameter
dermatitis (a single maculopapular, erythematous and grayish in color but
lesion), then spread to the joints, causing overt can appear Pink in color.
painful arthritis of the hands, wrists, elbows and
ankles
6. Infant eye infection (opthalmia neonatorum) –
- Neisseria gonorrheae on
modified Thayer
contracted during the passage through the birth
Martin(MTM) agar Colonies
canal; characterized by severe, bilateral purulent
are small(0.5 to 1.0 mm. in
conjunctivitis that may lead to blindness
diameter), gray, Glistening
and opaque.
Gonococcal urethritis with urethral discharge

- On physical
- Neisseria meningitidis on
examination, a
chocolate agar Colonies
mucopurulent urethral
are more gray than yellow
discharge is seen in 90%
and nonhemolytic. In older
to 95% of men.
cultures, a greenish cast
- It may appear appear beneath the
spontaneously at the Colonies in the area of
urethra without urethral heavy growth
manipulation(stripping)
3. Oxidase test

Mucopurulent gonococcal cervicitis

- This test demonstrates
that the organism is a
Mucopurulent gonococcal cervicitis
member of the Neisseria
Typical appearance of gonococcal
family and is sufficient for
infection in women – Cervical
presumptive diagnosisof
edema, erythema and
Neisseria infection
mucopurulent discharge

- Tetramethyl-p-phenylene
Gonococcal opthalmia with corneal opacification diamine hydrochloride is
applied to colonies-----à
If untreated, it can rapidly purple color
progress to inflammation of other
anatomical structures within the
 - Dimethyl compound(1%) opthalmic ointment or 1% tetracycline
ointment to the conjunctiva of the
may be used----à black newborn
color

4. Identification of Neisseria spp. by carbohydrate - fin -

utilization

- The standard method for audsmartinez@gmail.com

identifying Neisseria spp. Is to ustmedc3@yahoogroups.com
determine acid in CTA(cystine-
Trypticase agar)medium, a
Semisolid agar with 1% of each
Of the carbohydrates glucose,
Lactose, maltose and sucrose.

Neisseria meningitidis – acid is

Produced in both glucose and
maltose

TREATMENT

1. Neisseria meningitides
a. high doses of penicillin or ampicillin which
may pass the blood brain barrier
b. alternative antibiotics – chloramphenicol
and the broad spectrum cephalosporins like
cefotaxime and cextriaxone
2. Neisseria gonorrhea
a. Uncomplicated gonorrhea – initial therapy
is ceftriaxone combined with tetracycline
to manage dual infections with Chlamydia
b. aqueous procaine penicillin G with oral
probenecid
c. if gonococci contain penicillinase, treat
with spectinomycin

PREVENTION

1. Neisseria meningitides
a. Prophylactic treatment of persons who
have significant exposure to disease
patients.
i. Minocycline and rifampin – used
effectively for antibiotic
mediated chemoprophylaxis
ii. sulfonamide is recommended for
persons exposed to sulfonamide
susceptible strains with rifampin
used for sulfonamide-resistant
strains.
b. enhancement of immunity to serogroups
most commonly associated with disease
i. Polyvalent vaccine – can be
administered to children older
than 2 yrs of age against groups
A,C,Y and W135

Immunity to N. meningitidis group B must develop naturally

after exposure to cross reacting antigens.

Vaccination can be used to:

a. Control an outbreak of disease with a serogroup
present in the vaccine
b. For travelers to hyperendemic areas
c. For individuals at increased risk for disease
(patients with complement deficiency)

2. Neisseria gonorrhea
a. avoiding multiple sexual partners.
b. rapidly eradicating gonococci from infected
individuals by means of early diagnosis and
treatment
c. finding cases and contacts through
education and screening of populations at
high risk
d. mechanical prophylaxis(condoms) provides
partial protection
e. Chemoprophylaxis is of limited value
because of the rise in antibiotic resistance
of the gonococcus
f. Gonococcal opthalmia neonatorum – local
application of O.5 % erythromycin