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Microbiology - Gram Negative > Neisseria > Flashcards

Neisseria Flashcards

1
Q

How to classify?

A

Gram negative intracellular diplococci

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2
Q

What are the virulence factors?

for both N.meningitidis and N.gonorrhoeae

A
  • Lipo-oligosaccharide (inflammation) in outer cell membrane (same as LPS endotoxin)
  • Outer membrane components (adhesion and antigenic variation) - Fimbriae/pili and Opa (surface proteins involved in binding)
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3
Q

What is the virulence factor?

for N.meningitidis

A

Capsule
(A, B, C, Y, W135)

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4
Q

What do conjugated vaccines for N.meningitidis contain?

A

Antigen from capsules A, C, Y, W135
-Polysaccharide (not so effective in infants)/Conjugated - polysaccharide + protein
Group B vaccine does not use capsular antigen but combination of other surface antigens - proteins

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5
Q

Who is the vaccine given to?

A

Splenectomy, haematological diseases, certain travellers (Hajj pilgrims, Meningitis belt), prophylaxis of close contacts (children, household members, selected healthcare workers) in local outbreaks

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6
Q

What is meningococcal disease?

A
  1. Meningococcaemia (Fulminant sepsis)
  2. Meningitis
  3. Both

Pneumonia,Urethritis,Pericarditis,Endocarditis,Conjunctivitis,Arthritis

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7
Q

Where does N.meningitidis colonise?

A

Nasopharyngeal carriage (10%)

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8
Q

How is N.meningitidis transmitted?

A

Respiratory droplets

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9
Q

What are the outbreaks of infection of N.meningitidis?

A
  • Institutions
  • Groups of people in close contact, students, Hajj pilgrims
  • Meningitis belt across Africa
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10
Q

Meningococcal disease has highest incidence in?

A

Young children

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11
Q

What can invasive meningococcal disease cause/present?

A

Initial macular rash but progress to haemorrhagic rash (petechia - purpura - ecchymoses)

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12
Q

What is the syndrome that N.meningitidis cause?

A

Waterhouse-Friderichsen syndrome
Haemorrhage into adrenal glands - haemorrhagic adrenalitis

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13
Q

How to diagnose meningococcal disease?

A

ALWAYS blood cultures
As indicated: CSF, throat swabs, other sites/joint fluid
Molecular diagnosis important as urgent antibiotics may render cultures negative

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14
Q

What is the treatment for meningococcal disease?

A
  • Ceftriaxone: preferred, clear nasopharyngeal carriage
  • Benzylpenicillin: narrow spectrum but multi-day dosing, resistance <1%, does not clear nasopharyngeal tissue
  • Surgery for devitalised tissue
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15
Q

What kind of infection is N.gonorrhoeae?

A

Sexually transmitted infection

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16
Q

What problems does N.gonorrhoeae have?

A

Antimicrobial resistance

17
Q

What does N.gonorrhoeae cause in male patients?

A

Urethritis with discharge, dysuria, local complications (epididymitis)

18
Q

Is male urethral discharge for N.gonorrhoeae usually diagnostic in gram stain?

A

Yes

19
Q

What does N.gonorrhoeae cause in female patients?

A
  • Endocervical infection (may develop vaginal discharge, dysuria, intermenstrual bleeding)
  • Salpingitis leads to infertility (pelvic inflammatory disease)
  • Fitz-Hugh-Curtis syndrome (perihepatitis part of PID)
20
Q

Many of female patients of N.gonorrhoeae are initially ___

A

asymptomatic

21
Q

Is Gram stain for N.gonorrhoeae useful in female patients?

A

No! Too much normal flora makes it difficult to interpret

22
Q

What does N.gonorrhoea cause in both males and females?

A
  • Throat infection (often asymptomatic)
  • Proctitis (rectal infection) from receptive anal sex
  • Conjunctivitis
  • Dissemianted gonococcal infection
  • Gonococcal arthritis
23
Q

What neonatal disease does N.gonorrhoeae cause?

A

Opthalmia neonatorum

Chlamydia trachomatis also

24
Q

How to diagnose N.gonorrhoea?

A
  • Nucleic acid test using urine samples, urethral swab/urine for males, endocervical/LVS for females, throat and rectal swabs
  • Gram stain only for clean sites (joint fluids, male urethra)
  • Culture using chocolate agar, CO2 enriched atmosphere and inoculate at bedside/send in transport media. Identify with mass spectroscopy
25
Q

What is the treatment for N.gonorrhoea?

A
  1. Ceftriaxone IM
  2. Ceftriaxone IM + Azithromycin PO
26
Q

What is the prophylaxis given?

A

Rimfapicin, ciprofloxacin, ceftriaxone

Microbiology - Gram Negative (25 decks)

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