**General Features of Neisseria:
Gram (-) diplococci (KIDNEY BEAN SHAPE). Aerobic. FREE LIVING. NO CAPSULE
**Appearance of Neisseria:
Kidney bean
**Test results for Neisseria:
Gram (-) kidney bean shaped in neutrophils. Oxidase (+) Catalase (+)
**How to differentiate between N. Gonorrhoeae and N. Meningitidis:
N. Meningitidis FERMENTS MALTOSE. N. Gonorrhoeae does NOT. Meningitidis HAS A CAPSULE.
**Virulence Factors of N. Gonorrhoeae (6):
Pilin. Porin. Opacity Protein. LOS. IgA Protease. Beta-lactamase
Which virulence factors of N. Gonorrhoeae undergo antigenic variation to avoid immune response (4):
Pilin. Porin. Opacity Protein. LOS
Biologic Effect of Pilin in N. Gonorrhoeae:
Attachment, anti-phagocytic
Biologic effect of Porin in N. Gonorrhoeae
Promotes intracellular survival
Biologic effect of Opacity Protein in N. Gonorrhoeae
Attachment to eukaryotic cells
Biologic Effect of LOS in N. Gonorrhoeae
ENDOTOXIN.
LOS Variation:
Can change its appearance to escape immune response.
N. Gonorrhoeae infection is most common in:
African Americans. people 15-24. SE US
**Higher risk of disseminated N. Gonorrhoeae disease in:
patients with deficiencies in the latter part of the complement system (C5-C9=MAC)
Pathogenesis of N. Gonorrhoeae:
Attachment (Pili, PorB, Opa) > penetrate into cell and multiply > pass through cells to sub epithelial space where infection is ESTABLISHED LOS stimulates inflammation > SYMPTOMS.
**Symptoms of N. Gonorrhoeae infection:
Mucopurulent discharge and dysuria. 95% of infected men will have symptoms. 50% of women will not.
Leading cause of Purulent Arthritis in Adults:
Disseminated infection of N. Gonorrhoeae
**Presentation of Disseminated N. Gonorrhoeae:
Septicemia Infection of skin + joints= Swelling and redness in wrists, knees and ankles. Rash over extremities
N. Gonorrhoeae disease beyond UG:
Purulent Conjunctivitis (Opthalmia Neonatorum) Anorectal gonorrhea. Pharyngitis
Opthalmia Neonatorum:
Purulent ocular infection particularly common in newborns during vaginal delivery. Caused by N. Gonorrhoeae.
**Diagnosis of N. Gonorrhoeae:
Direct smear of discharge: Gram (-), bean shaped diplococci IN NEUTROPHILS Can also use NAAT from urine/discharge, also.
Treatment of N. Gonorrhoeae:
Ceftriaxone PLUS doxycycline or azithromycin to treat chlamydia (presumed with gonorrhea)