Neisseria

CLASSIFICATION
Kingdom: Bacteria
Phylum: Proteobacteriacea
Class: Betaproteobacteria
Order: Neisseriales
Family: Neisseriaceae
Genus: Neisseria
Species: gonorrhoeae
meningitidis
lactamica,etc
INTRODUCTION & HISTORY:

Discovered Neisseria
gonorrhoeae (1879)

Albert stain

Mycobacterium
Albert Ludwig Sigesmund
leprae
Neisser
CHARACTERISTICS:
Gram
negative/
cocci

Oxidase
positive characteristics Aerobes

cocc
diplo
i
CONTAINS TWO IMPORTANT PATHOGENS

 Nesseria meningitidis

 Nesseria gonorrhoeae
IMPORTANT DIFFERENCE BETWEEN
N.gonorrhoeae & N. meningitidis

I have got a I have got an

polysaccharide antibiotic resistant
capsule plasmid

N. gonrrhoeae N.
meningitidis
 NEISSERIA MENINGITIDIS
Described and isolated by weichselbaum from spinal
fluid of patient,1887
Gram negative

oval/spherical cocci

0.6 to 0.8 µm in size

Arranged in pairs (adjacent sides flattened)

Bean shaped

Encapsulated

Shape of Neisseria meningitidis

CULTURAL CHARACTERISTICS
Media used:
 non selective media:
 Blood agar
 Chocolate agar
 Mueller-Hinton starch casein hydrolysate agar
 Selective media
 Modified Thayer-Martin Agar

 Colony characteristics
 Color: Bluish grey
 Shape: Round
 Size: About 1mm
 Surface: Smooth
 Elevation: Convex
 Opacity: Transluscent
 Consistency: Butyrous
 Neisseria meningitidis
Neisseria meningitidis growing on sheep
growing on chocolate blood agar
agar
BIOCHEMICAL TESTS
• Oxidase positive

• Catalase positive

• Ferments glucose and maltose with acid production

• Doesn’t ferment lactose, sucrose and fructose

• Nitrate negative

• Colistin resistant

• Gamma-glutamyl aminopeptidase positive

• DNAase Positive
SEROGROUPS AND SEROTYPES

on the basis of specificity of capsular

polysaccharide antigens
divided into 13 serogroups .
These are A,B,C,D,X,Y,Z,W -135,29-E,H,I,K and
L.

Serogroups A,B,C,X,Y,W 135 : most commonly

associated with meningococcal disease
Group A: epidemics
Group C: localised outbreaks
Group B: both epidemics and outbreaks
CONTD…

 Serotypes:
 Based on the outermembrane protein
serogroups further divided into serotypes

 About 20 serotypes have been identified

VIRULENCE FACTORS

 Fimbrae (common pili)-

 Lipooligosaccharide:

 Capsule

 Cell membrane proteins

 IgA protease-
 EPIDEMIOLOGY
human nasopharynx
urogenital tract
Natural
habitat and anal canal
reservoir

Nasopharyngeal carriers 5-10% adults asymptomatic

carriers

Modes of infection Direct contact or respiratory droplets from

the nose and throat of infected people

Prevelence of meningitis is highest in meningitis belt of Africa

(frequent epidemics occurred there)
In 1996,largest 150000 cases 15000 deaths reported
PATHOGENESIS (STEPS)

Inhalation of contaminated droplets

Adherence of organism to nasopharyngeal mucosa

Local invasion and spread from nasopharynx to meninges through blood stream (directly along perineural
sheath of olfactory nerve,cribriform plate to subarachnoid space)

In meninges, organsims are internalised into phagocytic cells

They replicate and migrate to subepithelial spaces

Incubation period : 3-4 days

CLINICAL FEATURES

 Febrile illness : Mild and self limiting

 Pyogenic meningitis : High fever, stiff neck,
Kernig’s sign, severe headache, vomiting,
photophobia, chills
 Meningococcemia : acute fever with chills,
malaise, prostation, Waterhouse-
frederichsen syndrome, DIC
 Other Syndrome : Pneumonia, arthritis,
urethritis, respiratory tract infection
Hemorrhage in the adrenal
glands in Waterhouse-
Fridericksen syndrome

Meningococcal disease is favoured by defieciency of the

terminal complement components (C5-C9)
PROPHYLAXIS

a. Chemoprophylaxis :
 Rifampicin
 Minocycline
 Ciprofloxacin

b. Vaccination:
 A vaccine containing capsular polysaccharide of
serotypes A and C : for infants below 2 years
 A quadrivalent vaacine constituted by
polysaccharides of serotypes A,C,Y and W-135 :
for children and adults
 conjugate vaccine:
polysaccharide antigen is conjugated to diptheria
toxoid
LABORATORY DIAGNOSIS

1. Specimen:
 CSF

 Blood

2. Examination of CSF:
 Increased Pressure
 Turbid

 Thecollected CSF is divided into 3 portions (for

microscopy, for biochemical tests and for culture)
 Microscopy:
 Gram stained smear of CSF deposit commonly shows
Gram negative intracellular diplococci.
 White cell count increases to several thousand per cubic
mm with 90-99% PMNs.

 Biochemical tests:

 Glucose is markedly diminished

 CSF protein is markedly raised CSF:

 Culture:
 Inoculated into chocloate agar
 Incubated at 37c in 5-10% Carbondioxide and high humidity
 After 24 hours bacterial colonies appear
 The organism is tested for biochemical and agglutination reaction
CSF IN DIFFERENT
MENINGITIS CSF in TB
meningitis:

Clear or slightly turbid

10-500 cells,mainly
Normal CSF: CSF in bacterial lymphocytes( polys early)
meningitis: AFB in Z-N stain
Clear , Turbid Grow in LJ medium
colorless 500-20,000 Moderately raised
0-5 cells,few protein
lymphocytes lymphocytes Sugar reduced
Sterile Bacteria in Gram
150-450 mg /l stain CSF in viral meningitis
protein Markedly raised Clear or slightly turbid
2.8-3.9mmol/l protein 10-500 cells mainly
glucose Reduced or lymphocytes
absent glucose Stool culture, or
serology +ve
Normal or slightly raised
protein
Normal glucose
3.Blood culture:
 Blood
culture is positive in over 40% cases of
meningiococcal meningitis
4.Other Cultures:
 Nasopharyngeal swab
 Skin lesions
 Joint fluid
 Tracheal aspirate
 Urethral discharge
 Serology
 Petechial lesions
d) Detection of antigen:
 For Detection of Meningiococcal DNA
 Polymerase Chain Reaction (PCR)
 For detection of soluble polysaccharide antigen
 Counter current immunoelectrophoresis (CIEP)
 Latex agglutination test
Neisseria gonorrhoeae (Gonococcus)

 N. gonorrhoeae causes the sexually

transmitted disease gonorrhoea.

 first described by Neisser in 1879 in

gonorrheal pus.

 resembles meningococci very closely in many

properties.
MORPHOLOGY:

Gram negative

oval/spherical cocci

usually found with in the polymorphs

Arranged in pairs (adjacent sides concave)

Kidney shaped

possess pili on their surface

CULTURE & CULTURAL CHARACTERISTICS:

 fastidious organisms do not grow on ordinary culture

media.

 aerobic but may grow anaerobically also

 The optimum temperature for growth is 35-36°C &

optimum pH is 7.2-7.6.

 It is essential to provide 5-10% CO2.

Media used:

a) Non selective media: Chocolate agar,

Mueller-Hinton agar
Modified New York City
medium

b) Selective media: Thayer Martin medium

with antibiotics (Vancomycin, Colistin &
Nystatin)
Colony morphology: Colonies are
small
round
translucent
convex or slightly umbonate
finely granular surface
lobate margins.
Biochemical reactions:

1) Oxidase test: Positive

2) Ferments only glucose

but not maltose.
PATHOGENICITY:

Source of infection:
1. Asymptomatic carriers
2. Patients

Mode of infection:
1. Venereal infection (sexual contact)
2. Nonvenereal infection
Antigenic structure & virulence factors:

1. Pili

2. Lipooligosaccharide: Endotoxic.

3. Outer membrane proteins: 3 types

a) Protein I (por)- it is a porin & helps in adherence.
b) Protein II (opa)- helps in adherence.
c) Protein III (rmp)- it is associated with protein I.

4. IgA1 protease: Splits & inactivates IgA.

Antigenic structure & virulence factors
Mechanism of pathogenesis:

Gonococci adhere to epithelial cells of urethra or

other mucosal surface through pili

penetrate through the intercellular space

reach the sub epithelial connective tissue &

causes inflammation

Leads to clinical manifestations

Incubation period: 2-8 days.

Disease:
A) In men:

The disease starts as an acute urethritis with a

mucopurulent discharge

extends to the prostate, seminal

vesicles & epididymis

In some it may become chronic urethritis leading to

stricture formation

The infection may spread to the periurethral tissues,

causing abscesses & multiple discharging sinuses
(Watercan perineum)
B) In women:

The initial infection is urethritis & cervicitis but vaginitis

does not occur in adult female (vulvovaginitis can
occur in prepubertal girls)

The infection may extend to Bartholin’s glands,

endometrium & fallopian tubes causing
Pelvic Inflammatory Disease (PID)

Rarely peritonitis may develop with perihepatic

inflammation (Fitz-Hugh-Curtis syndrome)
C) In both the sexes:
Proctitis, pharyngitis,
conjunctivitis, bacteraemia which may lead to
metastatic infection such as arthritis,
endocarditis, meningitis, pyemia & skin rashes.

D) In neonates:
Opthalmia neonatorum (a
nonvenereal gonococcal conjunctivitis in the
newborn) results from direct infection during
passage through birth canal.
LABORATORY DIAGNOSIS:

Specimens collected:
A) In men:
a) Acute infection- Urethral discharge
b) Chronic infection-
i) Morning drop
ii) Discharge collected after prostatic massage
iii) Centrifuged deposit of urine
B) In women:
i) Urethral discharge
ii) Cervical swabs
C) In both the sexes: Blood, CSF, synovial fluid,
throat swab, rectal swab & material from skin
rashes.
Transport: If there is delay in processing than the
specimens should be sent in “ Stuart’s medium”.
Methods of examination:

A) Direct microscopy:

1. Gram staining:
Smear provides a
presumptive
evidence
of gonorrhea in men.
Gram negative
diplococci are found.
But it is unreliable
in women.
2. Immunofluorescence:
B) Culture:

Media used:

Colony morphology:

Gram’s smear:
Reveals Gram negative
cocci in pairs with
adjacent sides concave.

Biochemical reactions:
C) Serology:

 Complement fixation test,

 Precipitation,

 Passive agglutination,

 Immunofluorescence,

 Radioimmunoassay.(uses whole-cell
lysate,pilus protein and lipopolysaccharide
antigen)
TREATMENT:

 Previously Penicillin was drug of choice but

resistance developed rapidly.

 Penicillin resistant is due to production of

penicillinase enzyme & the strains are called
as penicillinase producing Neisseria
gonorrhoeae (PPNG).

 Now Ceftriaxone or Ciprofloxacin plus

Doxycycline or Erythromycin is useful.
EPIDEMIOLOGY:

 Gonorrhoea is an exclusively human disease.

 The only source of infection is a human

carrier or less often a patient.

 Asymptomatic carriage in women makes them

a reservoir to spread infection among their
male contact.

 Gonorrhoea is an venereal disease (STD).

PROPHYLAXIS:

 Early detection of cases,

 Tracing of contacts,

 Health education,

 General measures,

 Vaccination has no role in prophylaxis.

NONGONOCOCCAL (NONSPECIFIC) URETHRITIS
 Urethritis due to causative agents other than
gonococcus.
 Etiology:
a) Bacteria- Chlamydia trachomatis
Mycoplasma urealyticum
Ureaplasma urealyticum
b) Parasites- Trichomonas vaginalis
c) Viruses- Herpes simplex
Cytomegalovirus
d) Fungi- Candida
 NGU can be a part of Reiter’s syndrome- a clinical
condition characterized by urethritis, arthritis &
conjunctivitis.
COMMENSAL NEISSERIAE
N. lactamica

N.pharyngis

N. polysaccreae
Commensal
neisseriae
N. cinerea

N. flavescens

N. mucosa