Neisse Ria

Neisseria
Dr. Mohamed Sakr, MD

Medical Microbiology and Immunology
Neisseria
Neisseria species are Gram-negative diplococci flattened along the adjoining side
resemble coffee beans or kidney shape when viewed microscopically. All the medically
significant species of Neisseria are positive for both catalase and oxidase.
The organism is usually found

intracellularly in
polymorphonuclear leukocytes
Neisseria
N. Gonorrohea N. Meningitidis Commensal

Glucose + Glucose + Glucose --
Maltose -- Maltose + Maltose --
Sucrose -- Sucrose -- Sucrose +
Neisseria gonorrhea
 Gonorrhea is a sexually transmitted disease. The pathogens
penetrate into the urogenital mucosa, causing a local purulent
infection.
 Fastidious, Grow best in moist atmosphere supplemented with
CO2
 Produce acid from glucose, but not from other sugars
Virulence factors
• Pili: essential for adhesion to mucosal surfaces and inhibit
neutrophil killing.
• The outer membrane is composed of phospholipids and other
outer membrane proteins. These proteins facilitate adhesion and
promote invasion.
• Lipo-oligosaccharides have endotoxin activity.
• Ig A1 protease.
Clinical picture
 Gonorrhea in men: Urethritis, Epididymitis, prostatitis and may
lead to infertility. Most infections among men are acute and
symptomatic with purulent discharge & dysuria (painful urination)
after 2-5 day incubation period.
 Gonorrhea in women: Cervicitis; Vaginitis; Pelvic Inflammatory

Disease (Can cause scarring of fallopian tubes leading to infertility
or ectopic pregnancy) and Disseminated Gonococcal Infection
(DGI) may also cause arthritis or even endocarditis.
 Gonococci reaching the conjunctival membrane may cause a

purulent conjunctivitis, seen mainly in newborn children
)Ophthalmia neonatorum(.
 Gonococci can also infect the rectal or pharyngeal mucosa.

Laboratory diagnosis
Specimens
Pus and secretions are taken from the urethra (morning drop in male), cervix,
rectum, conjunctiva, throat, or synovial fluid for culture and smear.
Smears
Gram-stained smears of urethral or endocervical exudates reveal many diplococci
within pus. It is diagnostic in case of acute male gonorrhea.
Cultures
Immediately after collection, pus or mucus is streaked on chocolate agar or
enriched selective medium like modified Thayer-Martin medium and incubated
in an atmosphere containing 5% CO2(candle jar) at 36ºc. to avoid overgrowth by
contaminants, the selective medium contains antimicrobial drugs like vancomycin,
colistin, amphotericin. 48 hours after culture, the organisms can be quickly
identified by both morphology and biochemical characteristics.
Treatment
Ceftriaxone, cefixime or fluoroquinolone
Chemoprophylaxis of newborns against opthalmia neonatorum with
1% silver nitrate, 1% tetracycline, or 0.5% erythromycin eye
ointments.
Treatment of newborns with opthalmia neonatorum with ceftriaxone
Neisseria meningitides
(Meningiococcus)
Case Carrier
Epidemic Cerebrospinal meningitis

Neisseria meningitidis
• Morphology: Encapsulated small,

gram-negative diplococci, typically
arranged in pairs, with the adjacent sides
flattened.
• Second most common cause (behind
S. pneumoniae) of community-
acquired meningitis in previously
healthy adults.
Virulence factors:
• Pili-mediated, receptor-specific
colonization of nasopharynx
• Antiphagocytic polysaccharide
capsule allows systemic spread in
absence of specific immunity
• Lipooligosaccharide
• IgA proteases
Classification:
Meningococci are capsulated, unlike other Neisseria. Based on their

capsular polysaccharide antigens, meningococci are classified into at
least 13 serogroups, of which Groups A, B and C are most important.
Group A is usually associated with epidemics.
 Serogroups: A, B, C, Y, W135 account for about 90% of all infections.

Pathogenesis and clinical picture
The nasopharynx is the primary site for Meningococci.

 Humans only natural hosts.
 Person-to-person transmission by aerosolization of respiratory
tract secretions in crowded conditions.
Following dissemination of virulent organisms from the nasopharynx:
Meningitis, Septicemia (meningococcemia) with or without meningitis,
Meningoencephalitis, Pneumonia, Arthritis and Urethritis may occur.
Pathogenesis and clinical picture
 Onset of the meningitis is usually sudden, after an incubation period of

two to three days, with severe headache, fever, neck stiffness, Skin rash
and severe malaise. Severe hemorrhagic sepsis sometimes develops.
 Epidemic Cerebrospinal meningitis and meningococcal septicemia

are the two main types of meningococcal disease.
Cultural characteristics
Meningococci do not grow on ordinary media. Growth occurs on media enriched with blood,
serum or ascetic fluid.
They are strict aerobes. The optimum temperature for growth is 35-36oC. no growth takes place
below 30oC. Optimum pH is 7.4-7.6. Growth is facilitated by 5-10 % CO2. On solid media after
incubation for 24 hrs, the colonies are small translucent, round, convex, bluish grey, with a
smooth glistering surface and with entire edges. Blood agar, chocolate agar and are the media
commonly used for culturing meningococci.
Culture
Chocolate Agar inside Candle
Jar (5-10% CO2)
In meningococcal meningitis, the cocci are present in large numbers in
the spinal fluid and, in the early stage in the blood as well. Demonstration
of meningococci in the nasopharynx helps in the detection of carriers
(nasopharyngeal swab or west swab).
(a) Examination of CSF (taken by lumbar puncture).
The fluid will be under pressure and turbid, with a large number of pus
cells.
For bacteriological examination, the CSF is divided into :
One portion is centrifuged and Gram- stained smears are prepared from
the deposit, Meningococci will be seen mainly inside polymorphs.
Direct detection of meningococcal antigens in CSF by latex
agglutination testing.
The second portion of the CSF is inoculated in blood agar or chocolate

agar or modified Thayer-Martin medium plates and incubated at 35-36
°C under 5-10% CO2. Colonies appear after18-24 hrs which may be
identified by morphological and biochemical reactions.
• Transparent, non-pigmented nonhemolytic colonies.
• They are catalase and oxidase positive.
• Acid production from glucose and maltose but not from other sugars.
(b) Blood culture:
Meningococcemia and in early cases of meningitis, blood culture is often
positive. Cultures should be incubated for 4-7 days, with daily
subcultures.
(c) Nasopharyngeal swab (west swab):
This is useful for the detection of carriers.
(d) Petechial lesions:
Meningococci may sometimes be demonstrated in petechial
lesions by microscopy and culture.
(e) Molecular diagnosis:
Can be made by detection of meningococcal DNA sequence in
CSF or blood by PCR amplifications.
Treatment
• Intravenous penicillin G is the treatment of choice. or third-
generation cephalosporins, e.g., cefotaxime or ceftriaxone.
Chloramphenicol is also effective. Then shift according to
antimicrobial sensitivity testing.
Prevention:
• Chemoprophylaxis of close contacts with rifampin.
• Immunoprophylaxis: Polyvalent vaccine containing serogroups A,
C, Y, and W135 is effective in people older than 2 years of age for
immunoprophylaxis as an adjunct to chemoprophylaxis
• Infection control measures: use of masks for close contacts.
CSF in normal or meningitis

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Neisseria

Dr. Mohamed Sakr, MD

The organism is usually found

N. Gonorrohea N. Meningitidis Commensal

 Gonorrhea in women: Cervicitis; Vaginitis; Pelvic Inflammatory

 Gonococci reaching the conjunctival membrane may cause a

 Gonococci can also infect the rectal or pharyngeal mucosa.

Epidemic Cerebrospinal meningitis

• Morphology: Encapsulated small,

Meningococci are capsulated, unlike other Neisseria. Based on their

 Serogroups: A, B, C, Y, W135 account for about 90% of all infections.

The nasopharynx is the primary site for Meningococci.

 Onset of the meningitis is usually sudden, after an incubation period of

 Epidemic Cerebrospinal meningitis and meningococcal septicemia

The second portion of the CSF is inoculated in blood agar or chocolate

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