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Neisseria
Filename: Neisseri.ppt
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Organisms
Neisseria meningitidis: meninges (base of the brain)
Neisseria gonorrhoeae: primary infection sex organs
Branhamella, formerly Neisseria catarrhalis, cocci
Moraxella: coccobacilli
Kingella: coccobacilli
Acinetobacter: coccobacilli
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N. meningitidis
gram negative cocci, capsules, oxidase positive
Ontario averages 10 cases per year;
60 in 1994
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N. meningitidis in CSF
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N menigitiditis
Excess outer membrane with endotoxin in
released into extracellular space of actively
growing cells
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Pathogenesis
colonize the nasopharynx by
pili
invasion not prevented by
phagocytosis - capsule
toxic effects lipopolysaccharide endotoxin
bacteria transmitted via the
blood - after a mild pharyngitis
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Meningitis
Infection
chills,
fever, malaise, headache
lasts 1-2 days
can be a transient bacteremia with fever
Intracranial pressure
headache,
vomiting, fever
rarely papilledema (edema of the optic disk)
possible nuchal rigidity
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Differential diagnosis:
S.
pneumoniae
E. coli
Hemophilius influenzae
N.meningitidis
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Age Suscepitbility
to
Meningiococcus
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Age differences
Infants
rarely
signs of meningeal irritation,
irritability, refuse food, vomiting, no fever
if age less than 2 months, hypothermia
Older children and adults
fever,
altered mental states, severe headache,
nausea, vomiting and photophobia
acute bacterial meningitis
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Meningococcal Disease in USA
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Antigenic determinants:
serogroup: polysaccharide capsule
serotype: outer membrane protein
immunotype: lipopolysaccharide
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Acute Bacterial Meningitis
Neurological signs
convulsion,
coma, cervical rigidity, thoracolumbar
rigidity, hamstring spasm, exaggerated reflexes
petechiae (minute hemorrhagic spots in the skin)
purpura (hemorrhages into the skin), most
common in areas subject to pressure - i.e.
axilliary folds, beltline & back
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Fulminant Meningococcemia
Waterhouse-Frederickson Syndrome
high mortality
sudden onset
patient dies within 24 hours
no typical signs of meningitis
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Waterhouse-Frederickson
Syndrome
Symptoms
high
fever, chills and myalgias (muscular pain)
weakness, nausea, vomiting and headache
within a few hours, apprehension, restlessness
and delirium
skin lesions
pulmonary insufficiency
overwhelmingly disseminated intravascular
coagulation with shock - destruction of the
adrenal glands
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Possible secondary effects from
Fulminant Meningococcemia
pneumonia
arthritis
urethritis
petechial skin lesions
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Gonorrhea
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Neisseria gonorrhoeae
1379 cases in Ontario 1994
6 cases Windsor-Essex in same period
adherence by pili to mucosal cells
invasion of cells
capsule: prevents phagocytosis
protein I: major surface antigen
Lipopolysaccharide: endotoxin
IgA Protease: destroys immunoglobulin IgA
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N. gonorrhoeae Structure
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N. gonorrhoeae pili
Attaches to host cells by means of pili
Closer attachment of bacteria to host cells is
mediated by PII
PII is a membrane protein which mediates
microcolony formation
PI is an outer membrane porin that may
form pores in host cell membranes
PI could impair the ability of phagocytes to
kill the bacteria
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Gonorrhea in USA
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Incidence of Gonorrhea by
Gender in USA
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Incidence of B lactamase
producing N gonorrhaeae in USA
Beta lactamase:
hydrolyzes the Betalactam ring in
penicillin
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Salpinitis
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Gonorrhea: Males
Men: urethra, purulent discharge, dysuria 27 days after infection (incubation period).
Complications: epidydimitis, prostatitis,
periurethral abscesses
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Gonorrhea: Females
Women: frequently asymptomatic. When
symptomatic: cervix, vaginal discharge,
dysuria, abdominal pain, Ascending genital
infection, salpingitis, tubo-ovarian abscess,
pelvic inflammatory disease (PID)
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Disseminated infections
Septicemia, infections of skin and joints in
1-3 % of women
more common in women due to untreated
symptomatic infections
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Clinical:
fever, migratory arthralgias, suppurative
arthritis in the wrists, knees and ankles,
pustular rash on the extremities
Ophthalmia neonatorum - purulent
conjunctivitis, acquired at delivery
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Lab Diagnosis
gram stain
culture
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Gm Stain N. gonorrhoeae
Urethral
discharge
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Treatment:
penicillin
resistant strains
plasmid encoded resistance
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The End
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N. gonorrhoeae pili ...cont.
The gene
from
il E exhibits phase variation
Pil+ to Pil-
In addition there are 106 variations in the
antigens on the surface
There are many reasons why a vaccine
cannot be effective
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Although there are many highly conserved
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Epidemiology of ???
Disease/bacterial factors
Transmission
Who is at risk
Geography/ season
Incidence
Modes of control
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Short Answers
Construct a table of the virulence factors
associated with ??? and the biological
activity of each
Use a series of no more than four diagrams
to describe the mechanism of ??? activity
Describe the clinical manifestions ???
Construct a table listing the common ???
species and the associated human diseases.
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Neisseria gonorrhoeae
structure X
protein I
cell wall
structure Y
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