Exam 3 Gram Negative Cocci Flashcards
(104 cards)
1
Q
Neisseria is classified as a ___ ____ ____
A
gram negative diplococci
2
Q
Are Neisseria aerobic or anaerobic?
A
Aerobic
3
Q
Neisseria produces ______ which distinguishes it from oral Streptococci
A
cytochrome c oxidase (oxidase positive)
4
Q
What medium is used to grow Neisseria
A
Thayer Martin
5
Q
Positive oxidase test result
A
Indicator chemical turns blue when oxidized
6
Q
Thayer Martin medium is best on ____ agar with _____
A
chocolate agar; increased CO2
7
Q
True or false: many different species can survive on Thayer Martin medium
A
False - selective medium Neisseria only, other bacteria die from antibiotics that are present
8
Q
Neisseria main virulence factors
A
- adhesion factors (pili)
- endotoxin (lipooligosaccharide)
9
Q
The endotoxin of ____ is extremely potent
A
N. meningitidis
10
Q
The endotoxin of _____ has low potency
A
N. gonorrhoeae
11
Q
N. meningitidis has pili that are specific for:
A
epithelial cells of the oropharynx and meninges
12
Q
Neisseria has ____ in its cell wall
A
LOS (lipooligosaccharide)
13
Q
N. gonorrhoeae has pili specific for:
A
Mucosal cells
14
Q
_____ is extracellular
A
N. meningitidis (spinal tap shows diplococci outside of cells)
15
Q
_____ is intracellular
A
N. gonorrhoeae
16
Q
N. meningitidis transmission
A
person to person by respiratory droplets
17
Q
N. gonorrhoeae transmission
A
- sexual
- perinatal
18
Q
True or false: N. meningitidis has a higher mortality than N. gonorrhoeae if untreated
A
True (85% if untreated)
19
Q
IgG and IgM antibodies against ______ are protective
A
N. meningitidis capsular antigens
20
Q
The pili of N. gonorrhoeae are _____ but highly _____, which leads to evasion of host immunity
A
immunogenic; polymorphic
21
Q
Those with C5-C9 complement deficiencies are predisposed to:
A
Bacterial and Neisseria species infections
22
Q
How does C5-C9 complement fight bacteria?
A
- form transmembrane channel in bacteria
- bacteria burst and die
23
Q
N. meningitidis is part of ______. 5-15% are carriers in the ____
A
normal flora; nasopharynx
24
Q
Where does N. meningitidis have high transmission rates?
A
- day care centers
- dorms
- barracks
25
What is the most common cause of acute meningitis?
N. meningitidis
26
N. meningitidis causes acute meningitis in:
- babies and children
- adolescents
- young adults
27
Most invasive disease of N. meningitidis is caused by what serogroups?
A, B, C, Y, W-135
28
Meningococcal disease incidence is highest in what age group?
Babies and children
29
N. meningitidis pathogenesis
| Leading to meningitis
1. adhere to and colonize the nasopharynx
2. invade epithelium and then blood
3. hematogenous spread causes endotoxemia
4. toxins produces leads to meningitis
30
Meningococcal disease incidence has been decreasing recently due to:
Vaccine
31
True or false: N. meningitidis always results in meningitis
False - can also cause meningococcemia, pneumonia, arthritis, otitis media
32
Without treatment for N. meningitidis, fatality nears ___. With treatment, it nears _____ and up to ____ in meningococcemia
100%; 9-12%; 40%
33
Clinical findings of N. meningitidis
- acute bacterial meningitis
- CSF profile
34
What is the bacterial CSF profile?
WBC - 0-60,000
Cell type - neutrophils
Glucose - very low
Profile - high
35
What does the gram stain look like for N. meningitidis?
Gram negative diplococci in blood or CSF
36
____ is responsible for many severe systemic effects of N. meningitidis
Endotoxin (LPS)
37
N. meningitidis infection can lead to:
- hemorrhagic skin lesions (petechiae, may coalesce)
- **septic shock**
- **disseminated intravascular coagulopathy (DIC)**
- **Waterhouse-Friderichsen syndrome**
- multi-organ failure/death
38
What is Waterhouse-Friderichsen syndrome?
Hemorrhagic destruction of the adrenals, which regulate metabolism, immune system, blood pressure
39
Petechiae
Infection causes blood clots to develop in small blood vessels
40
Petechiae can coalesce into:
Hemorrhagic bullae (blood blister)
41
Septic shock can lead to _____
| N. meningitidis
Hypotension/**shock** (systemic vasodilation)
| toxins damage small blood vessels + leak fluid into surrounding tissues
42
N. meningitidis infection causes ____ to develop in small blood vessels, which leads to activation of ____ ultimately leading to ____
Blood clots; clotting system (systemic inflammation); disseminated intravascular coagulation (DIC)
43
No. 1 cause of death in intensive care units (ICU)
Septic shock
44
Disseminated Intravascular coagulation (DIC) - how does it lead to death?
1. infection **causes blood clots** to develop in small blood vessels
2. clots **deplete platelets** and clotting factors, leading to bleeding in blood vessels
3. leaky blood vessels **reduce blood to tissue** (ischemic)
4. **damage** to organs
45
Meningococcal disease timeline - symptoms such as confusion, delirium, loss of consciousness, or seizures can occur at:
24 hours after onset
46
N. meningitidis DOC
Penicillin (when organism is identified)
47
N. meningitidis treatment before organism is identified
Vancomycin and cephalosporin
48
True or false: those who have contacted someone with N. meningitidis infection does not need any treatment
False, they need antibiotic prophylaxis - rifampin and ciprofloxacin
49
There are ____ vaccines available for N. meningitidis, which are:
2; MenACWY and MenB
50
Which N. meningitidis vaccine provides better protection?
MenACWY
51
MenACWY vaccine is also called:
Meningococcal C & Y vaccine
52
MenACWY is a ____ ____ vaccine
quadrivalent conjugate vaccine
53
MenACWY prevents meningococcal disease caused by serogroups:
A, C, Y, W-135
54
When is the MenACWY vaccine given?
- **routine childhood vaccination** starting at 2 months
- **adolescents** age 11-12
- booster age 16
55
Who is at increased risk of invasive meningococcal disease?
**- college freshmen living in a dormitory**
**- complement component deficiency**
- HIV
- asplenia
- taking eculizumab (Soliris)
- military recruits
- meningococcal outbreaks
- microbiologists if routinely exposed
- travelers
56
When was MenB approved in the US?
2014
57
MenB is recommended for age ____
age 16-23 (prefer age 16-18)
58
True or false: MenB provides long term protection against most serogroup B strains
False - short term protection
59
Currently, MenB is being administered to:
Increased-risk groups for now
| Broader age recommendations being discussed
60
Unlike N. meningitidis, N. gonorrhoeae does not contain:
Capsule or hemolysin
61
____ help N. gonorrhoeae invade epithelial cells
OPA proteins
62
Second most commonly reported STD in the US
Gonorrhea
63
Most common reported STD in the US
Chlamydia
64
____ as many new infections of gonorrhea are estimated to occur each year as are reported
Twice
65
What race/ethnicity has the most reported cases of gonorrhea?
Black/African American (similar pattern in other STDs)
66
Which group of sex/sex partners have the highest reports of gonorrhea cases?
Men who have sex with men (MSM)
67
What is the difference between STI and STD?
- STI = sexually transmitted infection
- infection doesn't necessarily mean you are experiencing symptoms (disease = symptoms)
68
There has been a _____ increase/decrease in cases of gonorrhea since 2017
28% increase
69
Gonorrhea transmission routes
- sexual (genital, oral, rectal)
- perinatal (mother to infant)
70
Gonorrhea is associated with increased transmission of and susceptibility to
HIV infection
71
Men with gonorrhea can experience:
- urethritis
- epididymitis
72
Women with gonorrhea can experience:
- urethritis
- cervicitis
- pelvic inflamatory disease
73
True or false: most females with gonorrhea are asymptomatic
True
74
Male urethritis symptoms
- purulent discharge
- very painful
75
Males with urethritis usually seek immediate ____
Medical attention (very painful/pus)
76
Epididymitis symptoms
Unilateral testicular pain and swelling
77
Epididymitis is usually associated with
Urethritis
78
Most common local complication of gonorrhea in males
Epididymitis
79
____ of women with cervicitis are asymptomatic
50%
80
Cervicitis symptoms
- purulent discharge
- usually painless
81
Cervicitis is highly _____
Infectious
82
If a woman with cervicitis is feeling pain, the pain can often be confused with:
Period pain
83
Most common cause of infertility
Pelvic inflammatory disease (PID)
84
Pelvic inflammatory disease entails infection of:
- uterus
- fallopian tubes
85
Pelvic inflammatory disease can lead to:
- infertility
- ectopic pregnancy
- abscess formation
- chronic pelvic pain
86
Oral gonorrhea can lead to:
- pharyngeal gonorrhea
- gingival gonorrhea
87
True or false: you can contract conjunctivitis from gonorrhea
True (fluids are very infectious)
88
N. gonorrhoeae can disseminate and cause ____ _____
Gonococcemia lesions
89
Gonococcemia can manifest as _____ if they reach the joints
Gonoccal arthritis
90
Types of gonoccal arthritis
- monoarthritis (one joint at a time)
- oligoarthritis (a few joints at a time)
91
How do gonoccocal infections occur in babies?
**perinatal** infection via conjunctiva, pharynx, respiratory tract
92
Ophthalmia neonatorum
Eye infection in a newborn caused by chlamydia, gonorrhea, or other genital/rectal bacteria
93
Ophthalmia neonatorum can lead to:
Blindness
94
Gonococcal infection in older children is a sign of:
Possible evidence of sexual abuse
95
If you notice gonococcal infection in older children, what do you have to do?
- collect evidence and laboratory documentation
- required to report to social services/law enforcement (all 50 states)
96
How is N. gonorrhoeae diagnosed?
- Gram stain of discharge and cells
- immunofluorescence
- culture (Thayer Martin medium)
97
Microscopy is sufficient to diagnose gonorrhea in ___. Sensitivity test also needs to be used to diagnose _____
males with purulent discharge; all females
98
True or false: microscopy/gram stain can be used to diagnose pharyngeal gonorrhea
False - other Neisseria species can colonize pharynx so can lead to **false positive**
99
True or false: Neisseria gonorrhea shows antibiotic resistance
True - half of infections resistant to at least one antibiotic
100
DOC for N. gonorrhoeae
Ceftriaxone IM and a tetracycline
| also effective for assumed coexisting Chlamydia infection
101
N. gonorrhea confers antibiotic resistance via:
- plasmid
- chromosome
102
N. gonorrhea is becoming increasingly resistant to:
Cephalosporins
103
Why is a tetracycline also used in treatment of gonorrhea?
Reduces ceftriaxone resistance risks
104
Opthalmia neonatorum prophylaxis
- erythromycin (Ilotycin)
- tetracycline ophthalmic ointment
