Chapter 1.8 Neisseria

Question 1

What is the only pathogenic gram-negative cocci?

Answer 1

Neisseria

Question 2

What is the shape of Neisseria?

Answer 2

Diplococci and each coccus is shaped like a kidney bean with their concave sides facing each other

Question 3

What are the 2 species of Neisseria that cause disease in humans?

Answer 3

Neisseria meningitidis and Neisseria gonorrhoeae

Question 4

What type of meningitis is associated with Neisseria meningitidis?

Answer 4

Central nervous system irritation-meningitis (meningocococcus)

Question 5

What dose Neisseria gonorrhoeae cause?

Answer 5

Sexually transmitted disease (STD) gonorrhea

Question 6

What disease other then meningitis does Neisseria meningitidis cause?

Answer 6

Life threatening sepsis (meningococemia)

Question 7

What are the virulence factors of Neisseria meningitidis?

Answer 7

Polysaccharide capsule, endotoxin (LPS), IgA1 protease, iron extraction from transferrin

Question 8

What is the function of endotoxin (LPS) in Neisseria meningitidis?

Answer 8

Cause blood vessel destruction (hemorrhage) to look like petechiae and sepsis

Question 9

What makes someone a carrier of Neiserria meningitidis?

Answer 9

When the Neisseria becomes part of the normal flora of the nasopharynx and they are asymptomatic

Question 10

What are the high risk groups for Neisseria meningitidis?

Answer 10

Infants from 6 months to 2 years and army recruits

Question 11

Why are infants from 6 mo. - 2 years susceptible to meningococcal infections?

Answer 11

Up until then they were protected by mothers antibodies and haven’t made their own yet

Question 12

Why are army recruits susceptible to invasive meningococcal invasion from Neisseria?

Answer 12

Since they are in such close quarters, each army recruit an be a carrier of a certain strain of meningococcus that the other army recruit’ immune system has never encountered

Question 13

How does Neisseria meningitidis spread?

Answer 13

Via respiratory secretions and lives asymptomatic ally in the nasopharynx

Question 14

What is the classic clue to an invasive meningococcal infection?

Answer 14

Appearance of petechial rash from release of endotoxin and vascular necrosis of skin

Question 15

What is meningooccemia?

Answer 15

Intravascular invasion of Neisseria meningitidis in the bloodstream

Question 16

What is the clinical presentation of meningococcemia?

Answer 16

Spiking fevers, chills, arthralgia, muscle pains, and petechial rash

Question 17

What is arthralgia?

Answer 17

Joint pain

Question 18

What is fulminant meningococcemia?

Answer 18

septic shock from bilateral hemorrhage into the adrenal glands that causes adrenal insufficency
*also called Waterhouse-Friderichsen syndrome

Question 19

What is the clinical presentation of fulminant meningococcemia?

Answer 19

Abrupt onset of hypotension and tachycardia
Rapidly enlarging petechial skin lesion
DIC and coma may occur
Death occurs in 6-8 hours

Question 20

What is the most common form of meningocococcal disease?

Answer 20

Meningitis in infants

Question 21

What is the clinical presentation of an infant with meningitis?

Answer 21

Nonspecific findings of infection- fever, visiting, irritability, and lethargy
Anterior Fontainebleau may be present

Question 22

What is the clinical presentation of a slightly older child with meningitis?

Answer 22

Stiff neck and positive Kernig’s and Brudzinski’s sign

Question 23

What tests are done to diagnose meningitis?

Answer 23

Gram stain

Culture from blood, CSF, or petechial scraping

Question 24

What agar does Neisseria grow best?

Answer 24

Chocolate agar- blood agar that has been heated

Question 25

What is the classic medium for culturing Neisseria?

Answer 25

Thayer-Martin VCN media- chocolate agar with antibiotics *Neisseria is the only bacteria that can grow in this V- vancomycin C- colistin N- nystatin

Question 26

What an kill all gram-positive organisms?

Answer 26

Vancomycin

Question 27

What can kill all gram-negative organisms except Neisseria?

Answer 27

Colistin (polymyxin)

Question 28

What can eliminate fungi?

Answer 28

Nystatin

Question 29

How to culturally differentiate between the 2 Neisseria strains?

Answer 29

Neisseria meningitidis can produce acid from metabolism while Neisseria gonorrhoeae cannot

Question 30

What is another name for Neisseria gonorrhoeae?

Answer 30

Gonococcus

Question 31

What is the first sexually transmitted disease? What is the second?

Answer 31

1. Chlamydia | 2. Gonorrhoeae

Question 32

What are the virulence factors of Neisseria gonorrhoeae?

Answer 32

Pili, protein II

Question 33

What is the function of pili in Neisseria gonorrhoeae?

Answer 33

Protect bacteria from antibodies Adhere to host cell allowing disease to occur Prevent phagocytosis

Question 34

How does Neisseria gonorrhoeae occur in men?

Answer 34

Men who have unprotected sex with an infected person

Question 35

What is the mechanism of Neisseria gonorrhoeae in men?

Answer 35

Neisseria penetrates mucous membrane or urethra, causing inflammation (urethritis)

Question 36

What is the clinical presentation of a man with Neisseria gonorrhoeae?

Answer 36

Painful urination | Purulent urethral dish argue (pus from tip of penis)

Question 37

How is Neisseria gonorrhoeae occur in women?

Answer 37

Sexual transmission from infected person

Question 38

What is the clinical presentation of a woman with Neisseria gonorrhoeae?

Answer 38

``` Painful burning on urination Purulent discharge from urethra Dyspareunia- pain with intercourse Lower abdominal discomfort *more likely asymptomatic ```

Question 39

What is the clinical presentation of the cervix in a woman with Neisseria gonorrhoeae?

Answer 39

Reddened and friable with purulent exudate

Question 40

What can a gonococcal infection of the cervix progress to?

Answer 40

Pelvic inflammatory disease (PID)

Question 41

What is pelvic inflammatory disease?

Answer 41

Infection of the uterus (endometritis) , Fallopian tubes (salpingitis), and or/ovaries (oophoritis)

Question 42

What is the clinical presentation of a woman with PID?

Answer 42

Fever, lower abdominal pain, abnormal menstrual bleeding, and cervical motion tenderness

Question 43

What is the significance of an intrauterine device (IUD) in gonococcal infection?

Answer 43

Increases the risk of a cervical gonococcal infection that can progress to PID

Question 44

What are the complications of PID from gonorrhoeae?

Answer 44

Sterility- increased risk from scarring of Fallopian tubes preventing sperm from reaching egg Ectopic pregnancy- increased risk from scarring of fallopian tube and inflammation Abscesses- can develop in Fallopian tube, ovaries, or peritoneum Peritonitis- bacterial spread from ovaries and Fallopian tube and infect peritoneal fluid Peri-hepatitis- infection of the capsule around the liver

Question 45

What is the patient presentation of peri-hepatitis caused from Neisseria gonorrhoeae?

Answer 45

Right upper quadrant pain and tenderness | *also called Fitz-Hugh-Curtis syndrome

Question 46

What are 2 gonococcal diseases that can occur in both men and women?

Answer 46

Gonococcal bacteremia and septic arthritis

Question 47

What causes gonococcal bacteremia?

Answer 47

When Neisseria gonorrhoeae invades the bloodstream

Question 48

What is the clinical presentation of gonococcal bacteremia?

Answer 48

Fever, joint pains, skin lesions

Question 49

What is the clinical presentation of septic arthritis from Neisseria gonorrhoeae?

Answer 49

Acute onset of fever Pain and swelling of 1 or 2 joints Progressive destruction of joint

Question 50

What tests are done for septic arthritis from Neisseria gonorrhoeae?

Answer 50

Synovial fluid exam- high WBCs | Gram stain and culture of synovial fluid- gram-negative diplococci within the WBCs

Question 51

What is the most common kind of septic arthritis in young, sexually active individuals?

Answer 51

Gonococcal arthritis

Question 52

How is Neisseria gonorrhoeae transmitted in infants?

Answer 52

From pregnant woman to her child during deliver

Question 53

What is the clinical presentation of an infant who got Neisseria gonorrhoeae from delivery?

Answer 53

Ophthalmia neonatorum- eye infection that occurs on 1st or 2nd day of life Damages cornea- causing blindness

Question 54

What is the best way to diagnose Neiserria gonorrhoeae?

Answer 54

Gram stain and culture on Thyer-Martin VCN medium | Gram stain will show diplococci within WBCs

Question 55

What disease can be caused by branhamella catarrhalis?

Answer 55

Otitis media, sinusitis, bronchitis, and pneumonia

Question 56

What are the characteristics of branhamella catarrhalis?

Answer 56

Formerly called Neisseria catarrhalis | Is part of the normal respiratory flora