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  • 1. NEISSERIAN.meningitidisN.GonorrheaDeepa Babin
  • 2. Family Neisseriaceae• Genera include Neisseria, Branhamella, Moraxella• Gram-negative diplococci• Residents of mucous membranes of warm blooded animals• 2 primary human pathogens: – Neisseria gonorrhoeae – Neisseria meningitidis 2
  • 3. Neisseria Gonorrhoeae:• Gram-negative, bean-shaped, diplococci• Nonmotile and Non sporing• Capsulated,Pili• Strict parasites, do not survive long outside of the host• Aerobic or microaerophilic• Oxidative metabolism• Produce catalase and cytochrome oxidase• Pathogenic species require enriched complex media and CO2 3
  • 4. Neisseria Gonorrhoeae: Gonococcus• Causes gonorrhea (flow of seeds) an STDMorphology- Gram negative diplococci with adjacent side concave or pear shaped,seen intracellularly 4
  • 5. Epidemiology and Pathology• Strictly a human infection• In top 5 STDs• Infectious dose 100-1,000• Does not survive more than 1-2 hours on fomites• Virulence factors: – Fimbriae, Pili,other surface molecules for attachment; slows phagocytosis – IgA protease – cleaves secretory IgA 5
  • 6. Pathogenicity• Acquire thru sexual contact• Adhesion on urethra or mucosal surface(Pili)• Cocci penetrate thru intercellular spaces and reach the subepithelial connective tissue• IP- 2-8 DAYS
  • 7. GonorrheaInfection is asymptomatic in 10% of males and 50% of females• Males –Extends along urethra-prostate- seminal vesicle-epididymis causes urethritis, yellowish discharge, scarring, and infertility• WATERCAN PERINEUM(Multiple discharging sinus) 7
  • 8. Gonorrheal damage to the male reproductive tract 8
  • 9. • Females – vaginitis, urethritis, salpingitis (PID) mixed anaerobic abdominal infection, common cause of sterility and ectopic tubal pregnancies
  • 10. Ascending gonorrhea in women 10
  • 11. Extragenital infections – Gonorrhea in Newborns• Infected as they pass through birth canal• Ophthalmia neonatorum• Eye inflammation, blindness• Prevented by prophylaxis immediately after birth• Extragenital infections – anal, pharygeal, conjunctivitis, septicemia, arthritis 11
  • 12. Lab Diagnosis and Control• Gram stain – Gram-negative intracellular (neutrophils) diplococci from urethral, vaginal, cervical, or eye exudate – presumptive identification• Culture-Chocolate agar,Muller Hinton agar,Thayer Martin Medium• Treatment-Ceftriazone +Doxycyline(Erythromycin)• Combined therapies indicated• Recurrent infections can occur• Reportable infectious disease 12
  • 13. Gram stain of urethral pus 13
  • 14. Non specific urethritis• Gonococci cannot be demonstrated in this condition• Some time associated with Reiters syndrome(urethritis, conjunctvitis ,arthritis)• L forms of Gonococci not detectable• Others-Chlamydia trchomatis, Ureaplasma urealyticum, Mycoplasma hominis, Herpes virus, Cytomegalovirus,Gardinella vaginalis, Acinetobacter,Candida,Trichomonas vaginalis
  • 15. Neisseria Meningitidis: MeningococcusMorphlogy-Gram negative diplococci with adjacent side flattened ,intracellularVirulence factors: – Capsule – Adhesive fimbriae – IgA protease – Endotoxin• 12 strains; serotypes A, B, C cause most cases 15
  • 16. Epidemiology• Prevalent cause of cerebrospinal meningitis and meningococcal septicemia and sporadic or epidemic• Human reservoir – nasopharynx, 3-30% of adult population; higher in institutional settings• High risk individuals are those living in close quarters, children 6 months-3 years, children and young adults 10-20 years 16
  • 17. Pathogenesis• Infection is acquired through droplet spread via the carriers• Incubation period is 3 days• It spread along the perineural sheath of olfactory nerve thru cribriform plate to subarachnoid space• When bacteria enter bloodstream, cross the blood-brain barrier, permeate the meninges, and grow in the cerebrospinal fluid• Very rapid onset; neurological symptoms; endotoxin causes hemorrhage and shock; can be fatal
  • 18. Dissemination of the meningococcus from a nasopharyngeal infection 18
  • 19. CLINICAL FEATURES• Acute fever with petechial rash• Few develop meningococcemia(Waterhouse- Friderichsen syndrome) characterised by shock, disseminated intravascular coagulation and multisystem failure
  • 20. One clinical sign of meningococcemia 20
  • 21. Lab diagnosis• Specimens-CSF, blood, or nasopharyngeal sample• CSF COLLECTION-Lumbar puncture• THREE PORTIONS OF CSF• Microscopy-Gram staining- Gram negative diplococci, intracellular and extracellular• Culture- Chocolate agar, Blood agar, Newyork city medium• Oxidase test-positive• Rapid tests for capsular polysaccharide 21
  • 22. Treatment and Prevention• IV penicillin G, Cefotaxime ,Ceftriaxone• Prophylactic treatment of family members, medical personnel, or children in close contact with patient• Primary vaccine contains specific purified capsular antigens 24
  • 23. Other causes of meningitisBacterial causes:Three primary pathogens:N. meningitidis, H influenzae, S.pneumoniaeN.menningitidis all agesHI 2m-5yS.pneumoniae all ages but more common in adult with underlying illnesses.
  • 24. Other causative bacteria (Continue)E.coli & other coliformsListeriaStrept.group BSalmonella spp.Favobacteria..All common in neonates
  • 25. Other causative bacteria (ContinueAfter surgery or traumaS.aureusS.pneumoniaeAFB chronic meningitisSpirochaetes
  • 26. Other CausesViral :enterovirus, Paramyxovirus, Herpes viruses, adenoviruses, arboviruses.Fungi: yeasts (Candida,cryptococcus spp.) Aspergillus spp ,Mucor
  • 27. Normal CSF: BACTERIAL MENINGITIS CSF Clear , colorless 0-5 lymphocytes Turbid Sterile 500-20,000 cells mainly polys,few 150-450 mg /l protein lymphocytes 2.8-3.9mmol/l glucose Bacteria in Gram stain Markedly raised protein Reduced or absent glucoseCSF in TB meningitisClear or slightly turbid10-500 cells,mainly CSF in VIRAL meningitislymphocytes polys early) Clear or slightly turbidAFB in Z-N stain 10-500 cells mainly lymphocytesGrow in LJ medium Stool culture, or serology +veModerately raised protein Normal or slightly raised proteinSugar reduced Normal glucose