• family- Neisseriaceae
• genus- Neisseria
• species
  • gonnorhoeae
  • meningitis

• aerobic, gram negative cocci
• typically in pairs
• nonmotile
• confirmation of Nesseria based on:
  • carbohydrate fermentations

• form transparent, nonpigmented, nonhemolytic on chocolate blood agar
• isolates with large polysac. capusules appear of mucoid colonies
• divided into serogroups and serotypes
• 13 serogroups based on capsular polysac.
• serotype classification based on proteins in outer membrane

• humans only natural reservoir
• meningococcal meningitis only bacterial meningitis assoc. with epidemics (ex: meningitis belt in central africa)
• seasonal increase in winter and spring
• most cases- serogroup B

• capsular polysac.- evade host phagocytosis
• pili- attach to and colonize nasopharynx
• extracellular proteases- cleave IgA to promote invasion of pharynx
• lipopolysac.- endotoxin in outer membrane enhance vascular damage
• outer membrane vesicles/blebs- associated with tissue damage (esp. invasion of meninges)

• meningococcemia w/o meningitis
• menigitis w/ or w/o meningococcemia
• mild transient bacteremia

• begins as upper resp. syndromes
  • fever, chills, malaise, weakness, myalgias, arthralgias, nasuea, vomit, headache
• petechial rash may be harbinger of infection
• rash begins as small discrete lesions on the trunk or lower extremities
  • initially commonly seen in clusters
  • usually advances rapidly
• lesions can coalesce and become ecchymotic
• CNS
  • apprehension, restlessness, delirium
  • disease is very rapidly progressive
  • DIC, vascular collapse with severe hypotension (shock)

HIGH MORTALITY

• abrupt onset w/fever, meningeal signs (nuchal rigidity), headache, altered mental status
• young children may only have fever and vomittin
• may be associated with meningococcemia

• mild transiet bacteremia
• insidious onset
• few or no skin lesions with no meningeal signs
• resolve in 24-48 hrs

• plate the CSF on chocolate agar
• gram stain and culture CSF
• blood cultures
• gram stain via needle aspiration or punch biopsies of skin lesions

• third generatioln cephalosporins
  • ex: ceftriaxone, cefipeme
• chloramphenicol (use in developing nations)
  • resistance is prevelant in serogroup B

• close contacts only after exposure to invasive disease
• close contacts including livin in same house, day care center conact, directly exposed to oral secretions
• routine prophylaxis of health care workers discouraged

• chemoprophylaxis
  • prescribe rifampin, ceftriaxone, ciprofloxacin (adults nly)
  • this will prevent invaseive meningococcal disease
• vaccine (for serogroups A, C, Y, W-135)
  • NOT for serogroup B (this is the majority of what we see)
  • recommended for:
    • military recruits
    • travelers of area w/epidemics
    • patients, family members w/ inherited complement deficiencies, asplenics
  • part of routine child immunization (age 10-12)

• only in humans
• major reservoir (asymp. carriage esp. in women)
• peak incidence in adolescents
• transmitted mainly via sexual conact
  • women- 50% chance of infection after single exposure of infected man
  • man- 20% chance of infection after single exposure of infected woman

• capsule
• pili- attachment to vaginal epithelium, fallopian tube, buccal cavity
• Por (protein I)- porin protein promote intracellular survival by preventing phagolysosome fusion in neutrophils
• Opa (protein II)- opacity proteins mediate firm attachment to epithelal cells and invaision in cells
  • w/o it, associated with PID, DGI, arthritis
• Rmp (reduction modifiable protein)- protects other surface Ag's from bactericidal Ab's
• Tbp1, 2- transferrin to bind iron for bact. metabolism
• Lbp- bind iron for bact. metabolism
• LOS (lipoligosac. endotoxin activity)- stimulate inflam. response and release of TNF alpha
• IgA1 protease
• beta lactamase

• follopian tube contain ciliated and non ciliated cells
• infection will cause
  • ciliary stasis
  • death of ciliated cells
  • attachment to nonciliated cells
  • inernalization via microvillia of nonciliated cell (engulf bact.)
  • intracellular replication (within phagocytic vacuoles)
  • intracellular traffic (bact. laden vacuoles fuse with basement membrane)
  • exocytosis- discharge into subendothelial space, leading to local inflam. and dissemination via bv's

• genital infection usually restricted to urethra
• incubation- 2-10 days
• 95% acute symptoms
  • burning on urination
  • dysuria
  • purulent urethral discharge
• complications
  • anorectal gonorrhea
  • epididymitis
  • prostatitis

• cervix is main site of infection
• symptoms
  • vaginal discharge
  • abdominal pain
  • dysuria
• 10-20 % ascending genital infec. with tubovarian abscess, PID
  • increase ectopic preg.
  • infertility
• bartholinitis

• symptoms
  • fever
  • migratory arhralgias
  • suppurative arthritis
  • pustular rash on extremities
  • PID (increase risk of infertility, ectopic preg.)

• purulent conjunctivitis particularly in newborns (opthalmia neonatorun)
• pharyngitis

• gram stain of pus (gram neg intracell diplococci)
  • men with symptomatic disease, very sensitive and specific
  • less sensitive in women and asymptomatic men
• for possible disseminated
  • blood culture
  • urethra, cervix
  • any involved joint
• inocculate culture specimens on Thayer Martin
• culturing sterile sites- use chocolate agar
• commercial probes- specific, sensitive, rapid
  • Ag detection kit
  • nucleic acid probe
  • allow distinction of gonnorhea and chlamydia
• urine amplification assay (SDA)

• penicillin R common
• ceftriaxone (quinolones, however increasing incidence of R)
• complicated infections (ex: PID) require prolonged therapy
• treat presumptively for chlamydia with azithromycin or doxycycline

• gram negative diplococcus
• indistinguishable from Neisseria by gram stain
• grows well on blood and chocolate agar

• the prevalence of colonization dependent on age
• adults with COPD have higher rates of colonization

• contagious spread od organism from colonizing position to cause clinical signs of infection
• otitis media
  • isolates recovered present in nasopharynx and travel via Eustachian tube

• 10-15% of otitis media
• third most common cause of bacterial sinusitis
• lower resp. tract infection esp. in patients with bronchitis and COPD
• pneumonia in elderly

• diagnosis- gram stain, culture
• treatment
  • all strains produce beta lactamase
  • macrolides (ex: clarithomycin, azithromycin)
  • flouroquinolones (ex: levofloxacin, moxifloxacin)
  • amoxicillin
  • clavulanate