1. Neisseria By: Maria Rosario L. Lacandula,MD,MPH Department of Microbiology and Parasitology College Of Medicine Our Lady of Fatima University

2. Neisseria German Physician- A.L.S. Neisser German Physician- A.L.S. Neisser 2 specie- N. gonorrhea 2 specie- N. gonorrhea N. meningitidis N. meningitidis Strict human pathogen Strict human pathogen Fastidious organism Fastidious organism Aerobic,gram negative cocci, pairs, coffee bean shaped Aerobic,gram negative cocci, pairs, coffee bean shaped Non motile, non sporing Non motile, non sporing

4. Neisseria Oxidase positive Oxidase positive Acid production by oxidation Acid production by oxidation N. meningitidis- maltose, glucose N. gonnorhea- glucose Growth-non specific- blood agar Growth-non specific- blood agar specific- Thayer Martin media specific- Thayer Martin media VCN antibiotics enhance-exposure to 5% CO2 enhance-exposure to 5% CO2

5. Organism

6. Neisseria gonorrhea Optimum growth-tempt. is 35 C to 37 C with poor survival –cool temperature Optimum growth-tempt. is 35 C to 37 C with poor survival –cool temperature Structure is typical of Gram negative Structure is typical of Gram negative Outer surface is not covered with a true CHON capsule Outer surface is not covered with a true CHON capsule

7. Neisseria gonorrhea Virulence factors Virulence factors 1.PILI- fresh clinical isolates – Control by Pil gene – Expression of pili is associated with virulence T1 T2 T3 T4 T5 – Antigenic variation of pili proteins and phase variation of pilin expression

8. Neisseria gonorrhea 2.Por proteins 2.Por proteins –Form pores or channels in the outer membrane – inhibits phagosome lysosomal fusion –Por A- express resistant to serum killing- disseminated disease –Por B –Antigenic variation –serotype classification

9. Neisseria gonorrhea 3.OPA-opacity protein –Mediates binding to epithelial cells –Opaque colonies –Adherence of bacteria to each other and to eukaryotic cell

10. Neisseria gonorrhea 4 RMP- reduction modifiable proteins -Stimulate antibodies that block serum bactericidal activity -Stimulate antibodies that block serum bactericidal activity 5. Transferrin binding protein Lactoferrin binding protein Lactoferrin binding protein Hemoglobin binding protein Hemoglobin binding protein 6. LOS-endotoxin activity 7. IgA proteases- degrades secretory IgA 8. Beta lactamase- hydrolyzes Beta lactam ring

11. Neisseria gonorrhea Epidemiology Epidemiology Transmitted by sexual contact Transmitted by sexual contact Women Women 50% risk developing disease after single exposure 50% risk developing disease after single exposure Men Men 20% risk developing disease after single exposure 20% risk developing disease after single exposure The risk of infection increases with more sexual partners

12. Neisseria gonorrhea Major resorvoir-asymptomatic infected person Asymptomatic carriage-common in women Half of infected women- have mild asymptomatic infection Men-symptomatic Asymptomatic infection- rectal and pharyngeal

13. Neisseria gonorrhea Clinical Diseases Men-urethritis-urethral d/c and dysuria Men-urethritis-urethral d/c and dysuria Complication is rare- epididymitis,prostatitis & periurethral abscesses Complication is rare- epididymitis,prostatitis & periurethral abscesses Women- Cervicitis- infect endocervical columnar epithelial cells. -d/c,dysuria, and abdominal pain -d/c,dysuria, and abdominal pain 10-20%- ascending infection can occur

14. Neisseria gonorrhea 1-3% of infected women-Disseminated infection, infection of skin and joints 1-3% of infected women-Disseminated infection, infection of skin and joints Clinical Manifestation of disseminated disease include fever, migratory arthralgias,suppurative arthritis in wrist,knees, ankles and a pustular rash on an erythematous base over the extremities Clinical Manifestation of disseminated disease include fever, migratory arthralgias,suppurative arthritis in wrist,knees, ankles and a pustular rash on an erythematous base over the extremities

15. Neisseria gonorrhea Other diseases: Other diseases: –Fitz-hugh-Curtis Syndrome –Opthalmia neonatorum –Anorectal gonorrhea –Pharyngitis –conjuctivitis

16. Neisseria gonorrhea Laboratory Diagnosis Laboratory Diagnosis 1.Gram stain- 90% sensitive and 98% specific- symptomatic cases 1.Gram stain- 90% sensitive and 98% specific- symptomatic cases 60% or less- asymptomatic cases 60% or less- asymptomatic cases -confirmed by culture -confirmed by culture useful in purulent arthritis useful in purulent arthritis 2.Genetic probes- sensitive, specific and rapid 2.Genetic probes- sensitive, specific and rapid 3.Serology- not recommended 3.Serology- not recommended

17. Neisseria gonorrhea Treatment, Prevention & Control Treatment, Prevention & Control Ceftriaxone, cefexime, ciprofloxacin or ofloxacine Ceftriaxone, cefexime, ciprofloxacin or ofloxacine doxycline or azithromycin doxycline or azithromycin 1% tetracycline, 0.5% erythromycin eye oitment 1% tetracycline, 0.5% erythromycin eye oitment

18. Neisseria Meningitidis Gram negative diplococci, coffee bean shaped Gram negative diplococci, coffee bean shaped Encapsulated Encapsulated Common colonizer of nasopharynx of healthy people Common colonizer of nasopharynx of healthy people Blood agar- transparent,non pigmented colonies Blood agar- transparent,non pigmented colonies With large capsule- mucoid With large capsule- mucoid

19. Neisseria Meningitidis 13 serogroups- antigenic differences on their capsule 13 serogroups- antigenic differences on their capsule serogroups- A,B,C,X,Y and W135 serogroups- A,B,C,X,Y and W135 Serotype classification- differences in the outer membrane proteins and oligosaccharide component of LOS Serotype classification- differences in the outer membrane proteins and oligosaccharide component of LOS –Epidemiologic classification

20. Neisseria Meningitidis 4 factors that determine outcome of infection 4 factors that determine outcome of infection 1. bacteria colonize the nasopharynx 2. Specific group and serotype-specific antibodies are present 3. Systemic spreads occurs w/o Ab mediated phagocytosis 4. Toxic effects are expressed

21. Neisseria Meningitidis Incidence of disease- greatest in children younger than 2 y/o Incidence of disease- greatest in children younger than 2 y/o Def in C5,C6,C7 or C8- increase risk Def in C5,C6,C7 or C8- increase risk Toxic effects- LOS endotoxin Toxic effects- LOS endotoxin Epidemiology Epidemiology -occurs worldwide -occurs worldwide -epidemics-common in developing countries -epidemics-common in developing countries

22. Neisseria Meningitidis Develop countries-serogroup B,C, or Y Develop countries-serogroup B,C, or Y Underdevelop countries- serogroup A Underdevelop countries- serogroup A Meningococcal pneumonia-serogroup Y and W135 Meningococcal pneumonia-serogroup Y and W135 MOT: respiratory droplets MOT: respiratory droplets Humans- natural carriers Humans- natural carriers –School aged children and young adults with high incidence in low socioeconomic group –Common during dry cold months of the year

23. Neisseria Meningitidis Clinical Disease Clinical Disease Meningitis Meningitis -start abruptly with HA,meningeal signs, and fever -start abruptly with HA,meningeal signs, and fever -neurologic sequelae is low-hearing defects and arthritis -neurologic sequelae is low-hearing defects and arthritis Meningococcemia Meningococcemia - septicemia with or w/o meningitis - septicemia with or w/o meningitis -thrombosis of small bld vessel and multiorgan involvement -thrombosis of small bld vessel and multiorgan involvement DIC with bilateral hge of the adrenals- Waterhouse- Friderichsen syndrome DIC with bilateral hge of the adrenals- Waterhouse- Friderichsen syndrome

24. Neisseria Meningitidis

26. –Pneumonia –Arthritis –Urethritis Laboratory Diagnosis Laboratory Diagnosis –Specimens-blood and CSF –Gram stain –Latex agglutination

27. Neisseria Meningitidis Treatment Treatment -Penicillin -Penicillin - rifampicin or Minocycline- prophylaxis - rifampicin or Minocycline- prophylaxis - Vaccine- polyvalent vaccine A,C,Y,W135 - Vaccine- polyvalent vaccine A,C,Y,W135