Neisseria meningitidis

Features

Epi

Neisseria gonorrhea

-serogrps (polysacch. capsule)= A, B, C, X, Y, W-135

-serotypes (proteins in OM)
-ONLY contagious bacterial meningitis (meningococcal meningitis)
- Winter, Spring
-US= serogrp B
-Meningitis belt: Central Africa (serogroup A)

-Women asymptomatic carriers

-Adolescents: 1/3 of all cases
-Sexual Contact: Women 50% chance, Men 20%

-Nasopharynx colonization (w/o harm)

Virulence
Factors

Capsule

Polysaccharide; anti-phagocytic

LPS

Vascular damage Vascular HYPOtension

OM Vesicles

Tissue damage; Invade meninges

(4) Pili
Extracellular
Protease

Attachment, Colonization of pharynx

Risk
Factors

LOS

-Terminal Complement Deficiencies: C5,6,7,8

-Previous colonization protective immunity

1.

3.

Upper Resp infection: fever, weak, myalgia, nausea,

vomit, headache
Petechial Rash: small splotches on trunk, lower ext
spreads RAPIDLY become Ecchymotic
Hypotension, DIC

1.
2.

Abrupt: Fever, headache, altered mental status

Meningeal Signs: Nuchal rigidity (cant flex neck)

2.

TNF-a cytokine release inflamm

(3) Pili

Attachment

Pathogenesis

-attach to nonciliated cells (of fallopian tube)

-causes ciliary stasis in ciliated cells=decreased ability
to flush bacteria=ciliated cells sloughed
-nonciliated cells (microvilli) engulf
bacteriaphagocytic vacuoles release at basement
membraneblood entry

Men

-Urethra-restricted
-Symptoms: Burn, Dysuria, Purulent Discharge
-Complications: Epididymitis, Prostatis, Anorectal

Meningitis +/meningococcemia

Pharyngitis
Women

-Kids: fever and vomiting only

Bacteremia

Diagnosis

Anti-phagocytic

Cleave IgA evade immune system

Meningococcemia

Clinical

Capsule

-Transient (resolves quickly)

- +/- skin lesions or meningeal signs

Disseminated

Pneumonia

Rare

Purulent
Conjunctivitis

Choc Agar of CSF

Non-pigmented (transparent), non-hemolytic, mucoid

colonies

NAAT

Gram Stain of
CSF

Gram diplococci (intracellular)

Culture Blood

-Cervix
-Symptoms: Abdom pain, Dysuria, Discharge
-Complications: Ascend to Fallopian Tubes
Abscess, Pelvic Inflamm Disease, Bartholinitis
-Rare that it gets into the blood
-Symptoms: fever, migratory arthralgias, suppurative
arthritis, pustular rash
-Newborns: Ophthalamia Neonatorum
NA Amplification Test of urine

Gram Stain (of

discharge)
Agar (if
disseminated)
Probes

Thayer Martin: Cultures wont grow other bacteria

Chocolate: OK for sterile sites (non-genital)
Ag or Nuc Acid; Rapid; tell GC from Chlamydia

Ceftriaxone

No penicillin

Gram - diplococci (intracellular)

Cephalosporins, 3rd Gen

Treat and
Prevent

Neisseria

Chloramphenicol

Developing countries or those allergic to

cephalosporins

Chemoprophylaxis
(Rifampin, Ciprofloxin, or
Ceftriaxone)

-CLOSE CONTACTS ONLY

-Just need 1 dose

-against serogroups A, C, Y, W-135

-Military, Travelers, Genetic Complement def,
Tetravalent Vaccine
asplenics
-Routine (age 10-12)
Gram -, diplococci (intracellular)
-Obligate aerobe
-Nonmotile

Dosage
Azithromycin,
Doxycycline

-Complicated require prolonged therapy

Treat presumptively for chlamydia

-Chocolate Agar: Non-pigmented, non-hemolytic, mucoid colonies

-serogrps (polysacch. capsule)
-serotypes (proteins in OM)

Moraxella catarrhalis
Micro - Diagnosis

Epi

Gram - diplococci
-Blood or Chocolate
Agar

-Upper Resp Tract

-Older, risk
-COPD, risk

Pathogenesis
-Contagious spread

Clinical
-Lower Rest Tract Infection (smokers)
-Otitis Media: 10-15%
-Bacterial Sinusitis
-Pneumonia (Elderly)

Treat
--lactamases NO penicillin
- Macrolides
-Fluoroquinolones
-Amoxicillin+Clavulanic acid