MIDTERMS: L3 - GRAM-NEG COCCI Flashcards
(94 cards)
1
Q
Two major pathogens (Neisseria) of the human person
A
- N. gonorrhoeae
2. N. meningitidis
2
Q
MOTF
- Most strains of Gonococci contains plasmids
- Plasmids of Gonococci - develop resistance to antibiotics
- Gonococci - limited treatment compare to meningococci
- Gonococci also contains capsules making them more pathogenic and virulent
A
1,2,3 - TRUE
4 - FALSE
Gonococci don’t have capsules - only plasmids (still pathogenic and virulent)
3
Q
MOTF
- N. meningitidis - do not contain plastmids
- N. meningitidis - encapsulated bacteria
A
BOTH TRUE
4
Q
MOTF
- N. cinerea, N. lactamica, N. sicca, N. mucosa, N. polysaccharea, N. subflava, N.flavescens, N. elongate- examples normal flora of humans
- They are found in upper RT in the nasopharynx
A
BOTH TRUE
5
Q
A normal flora of the
oral cavities, upper respiratory tract of
animals like cats and dogs
A
N. animaloris
6
Q
Formerly Neisseria catarrhalis/Branhamella
A
Moraxella catarrhalis
- not part of Neisseriaceae
- Resembles Neisseria biochemically and
morphologically
7
Q
MOTF
- Neisseria are gram-positive diplococci
- Non-motile, non-spore-forming
- Individual cocci are like kidney-shaped or lancet-shaped or bullet-shaped
A
1 - false
2,3 -true
1 - Neisseria - gram-negative diplococci
8
Q
T OR F
- Neisseria elongata are rod-shaped bacilli
- They are catalase negative
A
True
ALL NEISSERIA ARE CATALASE POS EXCEPT FOR N. elongata
9
Q
MOTF
- Neisseria - aerobic, and cytochrome oxidase positive (+)
- Most oxidize carbohydrates with acid and gas
A
1 true 2 false
2 - NO GAS
10
Q
MOTF
- In gram stain, neisseria can be seen intracellularly
- Flat sides are adjacent
A
BOTH TRUE
11
Q
MOTF
Culture characteristics (In enriched media, 48 hours)
1. Gonococci - small grayish white convex, shiny colonies - transparent or opaque, with pigments and hemolytic
2. Meningococci - medium, smooth, round, moist, gray to white; encapsulate strains mucoid, non pigmented and non hemolytic
A
1 - false
2- true
1 - non pigmented and non hemolytic
12
Q
MOTF
Pathogenic neisseria
1. Very fastidious - requires requires 5% SBAP/CAP
2. Meningococci are more fastidious than gonococci
A
1 - true
2 - false
Gonococci are more fastidious than meningococci
13
Q
Enriched culture media (especially CAP) can supply fastidious components such as:
A
iron, hemin (Factor X), coenzyme 1 (NAD (Nicotinamide adenine dinucleotide)/ Factor B)
14
Q
MOTF 1. N. meningitidis - requirement for cultivation is the use of 5% SBAP (can also use CAP) 2. N. gonococci - also grow on SBAP and CAP 3. More nutritious media - SBAP (cooked)
A
1 - true
2,3 - false
2 - only grow in CAP
3 - CAP more nutritious
15
Q
MOTF
- Upon collection, transport, and cultivation, they must not be subjected to low temperatures because it will kill these 2 organisms
- Gonococci needs cysteine
A
BOTH TRUE
NOTE: THEY ARE COLD-SENSITIVE
16
Q
MOTF
- N. flavescens, N. animaloris, N. subflava, N. lactamica, N. mucosa, N. polysaccharea - colonies may be yellow/contain yellow pigmentantion
- N. animaloris - has a distinct smell (popcorn-like)
A
BOTH TRUE
17
Q
MOTF
- N. sicca - Opaque, brittle, wrinkled colonies, non-pigmented
- N. cinerea - Small, grayish white, slightly granular
- Moraxella catarrhalis - Large, nonpigmented or pinkish gray opaque colonies; friable, hockey puck consistency
A
ALL TRUE
18
Q
MOTF
- Hockey puck consistency helps distinguish Moraxella from Neisseria
- Hockey puck consistency - move colonies across surface without disintegrating it
A
BOTH TRUE
19
Q
MOTF 1. M. catarrhalis - Grows on BAP at 22C and on NA at 35C 2. They can reduce nitrate to nitrite - due to their enzymes 3. Can also utilize carbohyrates
A
1,2 - true
3 - false
3 - cannot utilize carbohydrates (Inert)
20
Q
M. catarrhalis contains enzyme that Allows hydrolyse or digest substrate tributyrin, this is called:
A
Butyrate esterase
Neisseria - negative
21
Q
Old colonies especially after 48 hours using CAP, the appearance of colonies illustrates:
A
Wagon wheels
22
Q
Incubation condition of Neisseria:
A
- 35-37C for 48-72 hours
2. Humid, CO2 enriched (3%-5% min. requirement)
23
Q
MOTF
- Gonococcus and meningococcus - used of enriched/selective media
- Selective media - CAP base plus antimicrobials
A
BOTH TRUE
24
Q
Thayer-martin antibiotics:
A
Vancomycin, colistin, nystatin
25
Modified-Thayer Martin (MTM) antibiotics:
Vancomycin, colistin, nystatin and trimethoprim
26
Martin-Lewis antibiotics:
vancomycin, colistin, anisomycin, trimethoprim
| Increased concentration of Vancomycin
27
GC-Lec and New York City antibiotics:
GC lec - vancomycin, colistin, amphotericin, trimethoprim, lincomycin (inhibits gram pos)
New York City (NYC) - vancomycin, colistin, amphotericin, trimethoprim
DIFFERENCE: NYC has no lincomycin
28
Incorporated to inhibit the growth of gram positive (+) organisms
vancomycin, 3 μg/mL
29
Inhibit the growth of gram negative (-) organism aside from Neisseria
colistin, 7.5 μg/mL
30
Act as antifungal
amphotericin B, 1 μg/mL (nystatin, anisomycin)
31
Inhibit the swarming growth of Proteus which can be an impedance to the growing Neisseria
trimethoprim, 3 μg/mL
32
Positive Growth on MTM, ML, NYC
N. gonorrhoeae, N. meningitidis, N. lactamica (NF)
33
Reagent used in oxidase test:
tetra-methyl-
| p-phenylenediamine dihydrochloride (TMPPD)
34
Positive result in Oxidase test:
Purple color
35
T OR F
CHROMOGENIC ENZYME SUBSTRATE TEST - Used to differentiate between the medically significant
organisms and those that grow on the selective culture
medium
True
36
CHROMOGENIC ENZYME SUBSTRATE TEST - detect 3 enzymes, which are:
1.Beta-galactosidase 2.Gamma-glutamyl aminopeptidase 3.Hydroxyprolyl aminopeptidase
CLUE: BEGA, GAGA, HA
37
MOTF
In CHROMOGENIC ENZYME SUBSTRATE TEST:
1. N. lactamica - Beta-galactosidase
2. Gonococcus - Gamma-glutamyl aminopeptidase
3. Meningococcus - Hydroxyprolyl aminopeptidase
4. M. catarrhalis - does not have these enzymes
1,4 - true
2,3 - false
2. Gonococcus - Hydroxyprolyl aminopeptidase
3. Meningococcus - Gamma-glutamyl aminopeptidase
38
T or F
N. elongata, a NF that is also positive
(+) for Hydroxyprolyl aminopeptidase
FALSE
| N. cinerea - also positive for Hydroxyprolyl aminopeptidase
39
Indicator for CARBOHYDRATE UTILIZATION PATTERN - Cystine Trypticase Agar (CTA) Sugars:
PHENOL RED
YELLOW - acidic
ALKALINE - red
If there is sugar - acid release > turns into YELLOW
40
Enumerate the carbohydrate utilization pattern for glucose, maltose, lactose and sucrose:
GC - G + , M L S -
MC - G M +, L S -
N. Lactima - G M L +, S -
M. catarrhalis - ALL neg, DNAse pos
41
MOTF
1. N. Polysaccharea will resemble N. meningitidis
2. Both has G M + and L S F -
BOTH TRUE
42
To differentiate N. Polysaccharea and N. meningitidis, what are the ways:
1. Meningitidis will grow on selective media
| 2. Allow your polysaccharea to grow on 1% - 5% sucrose agar - produce polysaccharides
43
MOTF
1. N. cinerea and N. gonorrhoeae - share same characteristics: Enzyme - Hydroxyprolyl Aminopeptidase
2. And
Oxidation pattern - glucose +
BOTH TRUE
44
MOTF
1. Culture using mha - N. cinerea can grow and N. gonorrhoeae cannot grow
2. MTM - N. cinerea cannot grow and N. gonorrhoeae can grow
3. Colistin sensitivity testing - kill N. cinerea and cannot inhibit N. gonorrhoeae
ALL TRUE
45
MOTF
Disadvantages of CTA test
1. Not sensitive to acid production of some organisms
2. Cannot check the oxidative strains of Neisseria
Both true
46
MOTF
Newer test systems
1. Use light concentration of inoculum in a small volume of buffered low-peptone substrate with the appropriate carbohydrate
2. Results available within 4 hrs
1 false
2 true
1 - use heavy
Examples: Rim-Neisseria test, Neisseria Kwik Test, Gonobio Test
47
MOTF
1. Neisseria - Inhibited by Fatty Acids & salts
2. Produce autolytic enzymes (25oC, ↑ pH)
3. Needs rapid and prompt processing
All true
48
MOTF
1. Pili - also called fimbriae
2. Provide resistance to phagocytosis
3. Main function of the gonococcal pili is it facilitates the
attachment of gonococci to host cells
4. Different strains of Neisseria gonorrhoeae produce pili
that are antigenically different from each other
ALL TRUE
49
MOTF
1. Opa (protein II) - adhesion within colonies making them intact and attachment to host cell receptors
2. Opa protein - colonies can form opaque
3. Opa - no antigenic variation, same all throughout
1,2 - true
| 3 - false
50
MOTF
1. Lipooligosaccharide or LOS - One of the major virulence factor of Gonococci
2. Gonococcal LPS (lipopolysaccharide) without long O-antigen side chains - thus, only LOS
Both true
51
MOTF
1. LOS - molecular mimicry of human glycosphingolipids. It structurally resembles human glycosphingolipids thus, causing immune invasion
2. LOS - Released in membrane blebs (Outer membrane fragments contain LOS)
Both true
OTHER FUNCTIONS:
1. suppression of leukotriene B4 synthesis - inhibits PMN activation
LB4 - calls for migration of PMNS (pmns - kill organisms)
2. activates alternative complement pathway → inflammation
3. activates TNF → inflammation
52
Protein responsible for the formation of pores in the cell walls of our bacterium
Por protein (Protein I)
Importance:
1. allows passage of nutrients
2. facilitate the excretion of waste materials
53
Prevent phagosome-lysosome fusion
Por protein (Protein I) - no formation of phagolysosome
NOTE: the reason why N. gonorrhoeae can be seen inside your PMNS
54
Reduction-modifiable protein; associates with Por in the formation of pores in the surface
Rmp (protein III)
55
T OR F
| Ferric-binding protein or Fbp allows N. gonorrhoeae to scavenge for little amounts of iron and continue to live
True
56
Splits/inactivates the major mucosal IgA1
IgA1 protease
NOTE: In the secretions, the dominant antibody is IgA
57
MOTF
Uncomplicated GC infection: IN MEN
1. URETHRITIS - inflammation of urethra
2. URETHRITIS - can lead to prostatis and epididymitis
3. PHARYNGITIS - point of entry is throat
4. Proctitis - entry is rectal portion
ALL TRUE
58
Painful sexual intercourse - called
Dyspareunia
59
PELVIC INFLAMMATORY DISEASE (PID)
Endometritis - organism enter endometrium
Salpingitis - spread further in fallopian tube
Oophoritis - organism reached ovaries
NOTE: THESE 3 ARE PRESENT IT WILL RESULT TO PID
60
Infection of peritoneum (cavity where most internal organs such as intestines are located)
Peritonitis
61
Inflammation of the capsule covering the liver
Peri-hepatitis
| Coming as form of complication PID = called Fitz-Hugh-Curtis syndrome
62
Infection of newborn baby upon passing through the infected birth canal
Gonococcal Ophthalmia neonatorum
63
Gonococcal Ophthalmia neonatorum treatment/antibiotics used:
Erythromycin - 0.5%
Tetracycline - 1%
AgNO3eye drops - used before, now stopped due to eye irritation
64
Gonococcal Bacteremia (Septicemia)
Gonococcus is present in the blood
65
Inflammation of synovium covering your tendons
TENOSYNOVITIS
66
Difference between papules and pustules
Pustules - contains pus
| Papules - does not contains pus
67
Triad of Disseminated Gonococcal Infection (DGI:
1. PAPULES and PUSTULES
2. TENOSYNOVITIS
3. SEPTIC ARTHRITIS
68
MOTF
1. The type of specimen depends on the manifestation of the patient
2. Male common sample - endocervical discharge
3. Direct gram stain - diagnostic for female gonococcal infection
1 true
2,3 - false
2 - Male - urethral discharge
3 - DGS - diagnostic for male, not diagnostic for female
MALE - 90% sensitivity, 95% specificity
FEMALE - 50% sensitivity, 95% specificity
69
MOTF
1. DGI (joint and blood culture) - Use a special system because the SPS that we use in blood culture bottles can inhibit the growth of N. gonorrhoeae
2. Can still use sps - concentration of SPS mus tnot exceed 0.25%
3. Incorporate gelatin - neutralize SPS
1,3 - true
2- false
2- not exceed 0.025%
SPS - Sodium polyanethole sulfonate
70
Specific swabs used in acquiring sample for N. gonorrhoeae
Dacron and Rayon swabs
71
MOTF
1. Cotton contains Fatty acids and it is toxic to N.
gonorrhoaea
2. Cotton swabs can be used but with the addition of charcoal - neutralize fatty acids
3. Calcium alginate can inhibit the growth of
gonorrhoaea
ALL TRUE
72
Culture Media Transport Systems:
JEMBEC, Gono-Pak, and Transgrow
JEMBEC - John E. Martin Biological Environmental Chamber
Incorporated in these 3 systems is the use of selective culture medium and have their CO2 generator
73
MOTF
1. Colonies (T1, T2) - piliated GC; typical small colonies on selective subculture
2. Colonies ( T3, T4, T5) - nonpiliated GC: larger colonies on nonselective subculture
BOTH TRUE
74
Colonies - piliated GC and transparent
P+, Opa-
75
MOTF
1. Gonococcus - catalase and oxidase positive
2. CTA SUGAR - GLUCOSE ONLY
BOTH TRUE
76
Non culture tests for N. gonorrhoeae:
1. Antigen detection (Gonozyme) - GONOZYME TEST
2. Direct specimen nucleic acid probe (Nucleic Acid Amplification Test - NAAT)
3. Nucleic acid amplification (Ligase Chain Reaction - LCR)
77
CDC Recommended Treatment for Uncomplicated Gonorrhea:
Ceftriaxone (most potent), Cefixime,
Ciprofloxacin, Ofloxacin, and Levofloxacin
+
1g Azithromycin (or 100 mg Doxycycline 2x / 7 days) - for chlamydia
78
Concomitant infection of gonorrhea:
Co-infection (chlamydia)
79
Uncomplicated Gonococcal infections of the Cervix, Urethra, and Rectum (treatment)
Recommended regimen
○ Ceftriaxone 250 mg IM (mode of delivery:
intramuscular) in a single dose PLUS
Azithromycin 1g orally in a single dos
80
Treatment of Arthritis and Arthritis - Dermatitis Syndrome
Recommend regimen
○ Ceftriaxone 1 g IM or IV every 24 hours PLUS
Azithromycin 1 g orally in a single dose
81
Treatment of Gonococcal Meningitis and Endocarditis
Recommended regimen
○ Ceftriaxone 1-2 g IV every 12-24 hours PLUS
Azithromycin 1 g orally in a single dose
82
MOTF
1. Neisseria meningitidis has 13 serogroups: immunologic specificity of capsular polysaccharides
2. Common serogroups associated with infection, diseases, and outbreaks are A, B, C, X, Y, and W-135
Both true
Western hemisphere - B, C, W-135 and Y
Southern Finland and Sau Paulo, Brazil - B and C
New zealand - B
Africa - A
Epidemic cases - A and C
83
MOTF
1. Virulence factors of meningococci share the same
function and effects as Gonococci
2. Type IV pili - interact with GIT endothelial cells
3. Pili, Opa, LOS, and to a lesser extent, Opc, undergo
antigenic variation
1,3 true
2 - false
2 - brain endothelial cells
84
MOTF
1. OMP Class 1,2,3 - porins for intracellular survival
2. Class 1 - Por A and Class 2,3 - Por B
3. Class 4 (OPA) - attachment and invasion
4. Class 5 (RMP) - Blocks host serum bactericidal IgG action
1,2 true
3,4 false
Class 5 (OPA) - attachment and invasion
Class 4 (RMP) - Blocks host serum bactericidal IgG action
85
MOTF
1. Humans are the only natural host for whom meningococci are pathogenic
2. When meningococci enters nasopharynx, it could be a full blown pathogen or transient microbiota
BOTH TRUE
86
What facilitates the bloodstream invasion of N. meningitidis?
1. Lack of bactericidal Abs
2. Deficient in C5-C8
3. Chronic irritation or damage to the RT mucosa
87
Hallmark of MGC infections
rashes on arms, legs, and trunk
88
1. Fulminant Type of Meningococcemia
2. Symptoms due to endotoxin activity (LOS)
3. Characterized by disseminated intravascular coagulation
(DIC)
Waterhouse-Friderichsen syndrome
89
MOTF Waterhouse-Friderichsen syndrome
1. Hemorrhage of adrenal glands happens
2. Gangrene of skin and soft tissues
3. Abnormal formation of blood clots in blood vessels
ALL TRUE
90
MOTF
1. Meningitis - cause severe cerebral hyperemia
2. Permanent hearing loss/mental retardation in 11-19% of recovered Pxs
Both true
91
Supine position, flex leg at the hip and knee, extend further leg
NO MENINGITIS - can flex further
WITH MENINGITIS - pain in harmstring muscle
Kernig's sign
92
Elevate head and neck
NO MENINGITIS - no pain
WITH MENINGITIS - flex head and neck, he/she will suffer pain, reflex of knees
Brudzinski's sign
93
Drug of choice for treatment of N. meningiditis
PENICILLIN G (IV; drug of choice)
94
Prophylaxis used:
Prophylaxis: rifampin (most commonly used),
| ciprofloxacin (for adults), or ceftriaxone (for children)
