1. G (-ve) Cocci
B. Nomanpour

2. Neisseriaceae
Neisseria
Kingella
Eikenella
Simonsiella
Alysiella

4. Neisseriaceae Neisseria- cocci Moraxella, Acinetobacter- rods
Subgenus Branhamella- cocci
Acinetobacter- rods
Kingella- rods

5. Characteristics Aerobic
Gram-negative cocci : arranged in pairs (diplococci) like coffe beans
Oxidase positive
Most catalase positive
Nonmotile
Acid from oxidation of carbohydrates

6. Pathogenic Species
Neisseria gonorrhoeae(plasmid+)
Neisseria meningitidis (capsule +)

7. Infectious Diseases
(Ophthalmia neonatorum)

8. Saprophytic Species Neisseria lactamica N. polysaccharea N. cinera
N. flavescens
N. subflava
N. sicca
N. mucosa

9. Neisseria gonorrhoeae
(gonococcus)

12. Gonorrhea STD Only in humans Asymptomatic carriage is major reservoir
Antigenic diversity of strains
Higher risk of disseminated disease in patients with late complement deficiencies
C5,6,7&C8
Urethritis; Epididymitis

13. Women Infection Cervicitis Vaginitis Pelvic Inflammatory Disease (PID)
Disseminated Gonococcal Infection (DGI)
Scarring of fallopian tubes : infertility or ectopic pregnancy

14. Disseminated Gonococcal Infection (DGI)
Gonococcal bacteremia
Skin lesions
Petechiae (small, purplish, hemorrhagic spots),Pustules on extremities
Arthralgias (pain in joints)
Tenosynovitis
Septic arthritis
Occasional Hepatitis; Rarely endocarditis or meningitis
Fitz-hugh-Curtis Syndrome

15. Gonococcal ophthalmia neonatorum
corneal epithelium causing microbial keratitis, ulceration and perforation

16. Pathogenicity Pili- (human columnar epithelial cells)
inhibit phagocytosis.
 Protein I (Por) a porin is important for intracellular survival.
Protein  II (Opa): genes
Heparin-related compounds and CD66 or carcinoembryonic antigen
Rmp (Protein III) a reduction-modifiable protein
the formation of pores
Blocks host serum bacteriocidal (IgG) action

17. Pathogenicity Lipooligosaccharide: LOS (blebs)
Causes ciliary loss and mucosal cell death
Molecular mimicry
Suppression of leukotreine B4 synthesis→ inhibits PMN activation
Activates alternative complement pathway
Activates TNF → inflammation
Lip (H8) is a surface exposed is heat modifiable like Opa.

18. Pathogenicity Tbp 1 & Tbp 2 (transferrin-binding proteins)
Fbp (ferric-binding protein)
IgA1 protease
Tbp 1 & Tbp 2 (transferrin-binding proteins)
Lbp (lactoferrin binding protein)
Hbp (hemoglobin-binding protein)
Plasmid-encoded beta-lactamase
Chromosomally-mediated :penicillins, tetracycline, erythromycin,aminoglycosides

20. Induced uptake

22. Prevention & Treatment
Ceftriaxone , cefixime or fluoroquinolone
Combined with doxycycline or azithromycin for dual infections with Chlamydia
Chemoprophylaxis of newborns against opthalmia neonatorum with 1% silver nitrate, 1% tetracycline, or 0.5% erythromycin eye ointments
Treatment of newborns with opthalmia neonatorum with ceftriaxone

23. Neisseria meningitidis
(meningococci)

24. N.meningitidis Second most common CA meningitis Capsule
Younger 20 years
Capsule
13 capsular serogroups (A, B, C, Y, and W135) with 90% of meningococcal disease due to serogroups A, B, and C
Pili-mediated, receptor-specific colonization of nonciliated cells of nasopharynx
Toxic effects by hyperproduction of LOS

25. Infectious Disease Meningitis
Septicemia (meningococcemia) with or without meningitis
Meningoencephalitis
Pneumonia
Arthritis
Urethritis

26. Infectious Disease N. meningitidis : rapidly progressive meningitis
School-aged children, adolescents, and young adults with a mortality of 7-13%
N. meningitidis bacteremia (mortality of 19-70%)
Waterhouse-Friderichsen syndrome
Petechiae
Purpura
Adrenal hemorrhage
Disseminated intravascular coagulation (DIC)
Shock

27. Waterhouse-Friderichsen syndrome

28. Pathogenesis GD1 ganglioside :receptor
Internalizing into phagocytic vacuoles
Replicate intracellularly and migrate to subepithelial space
LOS: blebbing
L2,L3,L7,L9
Thrombosis (clotting), disseminated intravascular coagulation (DIC)
Autolysin(amidase)

29. Diagnosis

30. Modified Thayer-Martin Agar
Colistin: Inhibits gram-negative flora (N. gonorrhoeae and N. meningitidis resistant to colistin, most saprophyic species of Neisseria susceptible)
Vancomycin: Inhibits gram-positive flora
Nystatin: Inhibits yeast flora
Trimethoprim: Inhibits swarming Proteus

31. Findings in CSF Clear , colorless 0-5 lymphocytes Sterile
Normal CSF:
Clear , colorless
0-5 lymphocytes
Sterile
mg /l protein
mmol/l glucose

32. Neisseria and Related Organisms
N. gonorrhoeae

33. Identification On chocolate agar :White
Acid from glucose but not maltose, sucrose, fructose, or lactose
Positive superoxol test (Catalase with 30% H2O2)
Colistin resistance (growth on Modified Thayer-Martin medium)

34. Neisseria and Related Organisms
N. meningitidis

35. Biochemical Reactions

36. Antimicrobial Therapy
Neisseria and Related Organisms
Antimicrobial Therapy
Pen-resist
Cefinase test (cephalosporin)
CMRNG (chromosome mediated resistant N.gonorrhoeae).
Tetracycline and Spectinomycin chromosomal mediated resistance strains also occur.
Ceftriaxone, a third generation cephalosporin, is recommended
N. meningitidis :Penicillin

37. N. meningitidis - Vaccines
Tetravalent capsular polysaccharide vaccine
(Menomune-A,C,Y,W-135) (Sanofi Pasteur, Inc.)
against four (A, C, Y, and W-135) of the five pathogen serogroups.
Highly effective in adults but not in infants and children less than two years of age; immunity ~3 years.
No vaccines available against serogroup B
N. meningitidis (MenB) disease, is responsible for
32% of meningococcal disease in the U.S. and
45% to >80% in Europe.

38. N. meningitidis - Vaccines
The MenB capsular polysaccharide is identical to a widely distributed human carbohydrate (a self-antigen).
The immunity to N. meningitidis group B must develop naturally after exposure to cross-reacting antigens.
Vaccination with Menomune - to control an outbreak of disease with a serogroup present in the vaccine,
for travelers to hyperendemic areas, or for individuals at increased risk (patients with complement deficiency).

39. In January 2005, a quadrivalent meningococcal
polysaccharide-diphtheria toxoid conjugate vaccine
[MCV4] Menactra (Aventis Sanofi Pasteur, Inc.) was
licensed for use among persons aged years.
CDC recommends routine vaccination of
young adolescents (at aged years)
with MCV4 at the preadolescent health-care visit
(at age years).
By 2008, the goal will be routine vaccination with
MCV4 off all adolescents beginning at age 11.

42. Acinetobacter