1. Neisseria gonorrhoeae and Neisseria meningitidis are two pathogenic species of Neisseria that cause gonorrhea and meningitis in humans. 2. N. gonorrhoeae causes the sexually transmitted infection gonorrhea, affecting the genital tract and sometimes other sites, while N. meningitidis most commonly causes meningitis and sepsis. 3. Both species are Gram-negative diplococci that can be identified via microscopy and cultured from clinical specimens. Definitive diagnosis and treatment helps control spread of these infections.

1. NEISSERIA
N.meningitidis
N.Gonorrhea
Deepa 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
STD
Morphology- 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. Gonorrhea
Infection 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:
Meningococcus
Morphlogy-Gram
negative diplococci
with adjacent side
flattened
,intracellular
Virulence 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
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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

24. 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
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25. 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.

26. Other causative bacteria (Continue)
E.coli & other coliforms
Listeria
Strept.group B
Salmonella spp.
Favobacteria..
All common in neonates

27. Other causative bacteria (Continue
After surgery or trauma
S.aureus
S.pneumoniae
AFB chronic meningitis
Spirochaetes

28. Other Causes
Viral :enterovirus, Paramyxovirus,
Herpes viruses, adenoviruses,
arboviruses.
Fungi: yeasts
(Candida,cryptococcus spp.)
Aspergillus spp ,Mucor

29. 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 glucose
CSF in TB meningitis
Clear or slightly turbid
10-500 cells,mainly CSF in VIRAL meningitis
lymphocytes 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