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NEISSERIANEISSERIA
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IntroductionIntroduction The Neisseriae are G-ve diplococci Pathogens are:- N.meningitidis N.gonorrhoeae Exacting growth requirements Commensals easy to grow on ordinary media
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N. gonorrhoeaeN. gonorrhoeae
Obligate parasite of human urogenital tract. Morphology: Gram -ve diplococci (bean shaped). Culture: enriched media (lysed blood or chocolate),
moist aerobic atmosphere +5-10% CO2. Temp.35-37oC.
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Gram stain of N.gonorrhoea
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Selective mediaSelective media
Thayer-Martin medium contains vancomycin, colistin, nystatin & trimethoprim.
Colonies: 48hrs incubation.
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IdentificationIdentification
Oxidase +ve. Carbohydrate utilization: N.gonorrhoeae
produces acid from glucose only. Slide agglutination with specific antisera
(Phadebact test).
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PathogenicityPathogenicity
Causes gonorrhoea Arthritis, Septicemia, Ophthalmia neonatorum.
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GonorrhoeaGonorrhoea
Acute pyogenic infection of urethra and (in females) cervix.
Acute purulent urethral , vaginal discharge , dysuria Asymptomatic in females Rectum & oropharynx may be involved.
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ComplicationsComplications
Prostatitis, epididymitis , urethral stricture in males.
Salpingitis , infertility in females Septicemia Arthritis Meningitis (rare).
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DiagnosisDiagnosis
Specimen: urethral,cervical smears &swabs (transport medium).
Gram film: intracellular Gram -ve diplococci Culture: selective media Oxidase +ve acid production from glucose Latex agglutination
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Treatment of gonorrhoeaTreatment of gonorrhoea
One curative dose Sens. Testing Blind treatment: ceftriaxone, ciprofloxacin Spectinomycin Penicillin: resistance common.
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N. meningitidisN. meningitidis
Habitat: human nasopharynx (10-25%) Similar to N. gonorrhoea but less exacting ? Can grow in BA, Chocolate agar without selective
media from CSF ? Id. CHO utilization: acid from glucose & maltose.
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Gram stain of Neisseria meningitis
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Haemorrhagic rash
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Death from Waterhouse-Friderichsen syndrome
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Neck rigidity
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Antigenic structureAntigenic structure
Polysaccharide antigens Three main groups A,B,C Other groups Y,W135. Grouping: slide agglutination with specific
antisera
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PathogenicityPathogenicity
Meningococcal meningitis, as a spread from nasopharynx blood stream meninges in susceptible hosts.
Direct spread to meninges Rash Adrenal haemorrhage (Waterhouse-Friderchsen
syndrome)
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MeningitisMeningitis
Clinically: rapid deterioration of flu like illness Headache, neck stiffness, +ve kerning’s sign, fever,..
… Diagnosis: CSF + blood culture CSF: WBC , RBCs Gram stain: bacteria & cells
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Meningitis (Continue)Meningitis (Continue)
Culture deposit into blood & chocolate agars and glucose broth 7 cooked meat media
Incubate in air + 5%CO2 Id : sugar utilization + latex For partially treated meningitis: detection of bacterial
antigen by: latex agglu, CCIE.. for common serogroups of meningitis pathogens.
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TreatmentTreatment
Parenteral antimicrobial Start blind treatment after collection of specimens
by: Ceftriaxone or cefotaxime Change later according to sens. Test. Contacts: rifampicin Prevention: vaccination (polyvalent)
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Commensal NeisseriaeCommensal Neisseriae
N.pharyngis, N.flava, N.sicca,.. In mucous mem. Of mouth,nose, pharynx, less common in
genital tract. Differ. From pathogenic one:
grow in ordinary media( no CO2) at room temp. rough, pigmented acid from a number of CHOs
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Other causes of meningitisOther causes of meningitis
Bacterial causes: Three primary pathogens: N. meningitidis, HI, S.pneumoniae N.menningitidis all ages HI 2m-5y S.pneumoniae all ages but more
common in adult with underlying illnesses.
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Other causative bacteria (Continue)Other causative bacteria (Continue)
E.coli & other coliforms Listeria Strept.group B Salmonella spp. Favobacteria.. All common in neonates
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After surgery or trauma S.aureus S.pneumoniae AFB chronic meningitis Spirochaetes
Other causative bacteria (ContinueOther causative bacteria (Continue
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Other CausesOther Causes
Viral :enterivirus, Paramyxovirus, Herpes
viruses, adenoviruses, arboviruses. Fungi: yeasts (Candida, cryptococcus spp.) Aspergillus spp. Mucor
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Findings in CSFFindings in CSF
Normal CSF:
Clear , colorless 0-5 lymphocytes Sterile 150-450 mg /l protein 2.8-3.9mmol/l glucose
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CSF in bacterial meningitisCSF in bacterial meningitis
Turbid 500-20,000 cells mainly polys,few lymphocytes Bacteria in Gram stain Markedly raised protein Reduced or absent glucose
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CSF in TB meningitisCSF in TB meningitis
Clear or slightly turbid 10-500 cells,mainly lymphocytes( polys early) AFB in Z-N stain Grow in LJ medium Moderately raised protein Sugar reduced
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CSF in viral meningitisCSF in viral meningitis
Clear or slightly turbid 10-500 cells mainly lymphocytes Stool culture, or serology +ve Normal or slightly raised protein Normal glucose
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Cerebral abscessCerebral abscess
Clear or slightly turbid Bacteria: S. milleri, Bacteroides, S.aureus.
Proteus(Causative bacteria) 0-500 mainly polymorphs Often no organisms in CSF Normal or raised protein Normal glucose
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Complication of meningitisComplication of meningitis
Death ( 30% with pneumococci,10% Hi & N.meningitidis.
Ventriculitis hydrocephalus Paralysis Cerebral abscess..
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Treatment of meningitisTreatment of meningitis
Depends on age ,causal bacteria Urgent ,parenteral Ceftriaxone Neonates: amp+ gm (or ceftriaxone) Sens.testing Anti TB