1 Neisseria Filename Neisseri ppt 1162020 2 Organisms

1 Neisseria Filename: Neisseri. ppt 11/6/2020

2 Organisms Neisseria meningitidis: meninges (base of the brain) ä Neisseria gonorrhoeae: primary infection sex organs ä Branhamella, formerly Neisseria catarrhalis, cocci ä Moraxella: coccobacilli ä Kingella: coccobacilli ä Acinetobacter: coccobacilli ä 11/6/2020

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4 N. meningitidis gram negative cocci, capsules, oxidase positive ä Ontario averages 10 cases per year; ä 60 in 1994 ä 11/6/2020

5 N. meningitidis in CSF 11/6/2020

6 N menigitiditis ä Excess outer membrane with endotoxin in released into extracellular space of actively growing cells 11/6/2020

7 Pathogenesis ä colonize the nasopharynx by pili ä invasion not prevented by phagocytosis - capsule ä toxic effects lipopolysaccharide endotoxin ä bacteria transmitted via the blood - after a mild pharyngitis 11/6/2020

8 Meningitis ä Infection ä chills, fever, malaise, headache ä lasts 1 -2 days ä can be a transient bacteremia with fever ä Intracranial pressure ä headache, vomiting, fever ä rarely papilledema (edema of the optic disk) ä possible nuchal rigidity 11/6/2020

9 Differential diagnosis: ä S. pneumoniae ä E. coli ä Hemophilius influenzae ä N. meningitidis 11/6/2020

10 Age Suscepitbility to Meningiococcus 11/6/2020

11 Age differences ä Infants ä rarely signs of meningeal irritation, ä irritability, refuse food, vomiting, no fever ä if age less than 2 months, hypothermia ä Older children and adults ä fever, altered mental states, severe headache, nausea, vomiting and photophobia ä acute bacterial meningitis 11/6/2020

12 Meningococcal Disease in USA 11/6/2020

13 Antigenic determinants: serogroup: polysaccharide capsule ä serotype: outer membrane protein ä immunotype: lipopolysaccharide ä 11/6/2020

14 Acute Bacterial Meningitis Neurological signs ä convulsion, coma, cervical rigidity, thoracolumbar rigidity, hamstring spasm, exaggerated reflexes ä petechiae (minute hemorrhagic spots in the skin) ä purpura (hemorrhages into the skin), most common in areas subject to pressure - i. e. axilliary folds, beltline & back 11/6/2020

15 Fulminant Meningococcemia Waterhouse-Frederickson Syndrome high mortality sudden onset patient dies within 24 hours no typical signs of meningitis 11/6/2020

16 Waterhouse-Frederickson Syndrome Symptoms ä high fever, chills and myalgias (muscular pain) ä weakness, nausea, vomiting and headache ä within a few hours, apprehension, restlessness and delirium ä skin lesions ä pulmonary insufficiency ä overwhelmingly disseminated intravascular coagulation with shock - destruction of the adrenal glands 11/6/2020

17 Possible secondary effects from Fulminant Meningococcemia ä pneumonia ä arthritis ä urethritis ä petechial skin lesions 11/6/2020

18 Gonorrhea 11/6/2020

19 Neisseria gonorrhoeae ä 1379 cases in Ontario 1994 ä 6 cases Windsor-Essex in same period ä adherence by pili to mucosal cells ä invasion of cells ä capsule: prevents phagocytosis ä protein I: major surface antigen ä Lipopolysaccharide: endotoxin ä Ig. A Protease: destroys immunoglobulin Ig. A 11/6/2020

20 N. gonorrhoeae Structure 11/6/2020

21 N. gonorrhoeae pili ä Attaches to host cells by means of pili ä Closer attachment of bacteria to host cells is mediated by PII ä PII is a membrane protein which mediates microcolony formation ä PI is an outer membrane porin that may form pores in host cell membranes ä PI could impair the ability of phagocytes to kill the bacteria 11/6/2020

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23 Gonorrhea in USA 11/6/2020

24 Incidence of Gonorrhea by Gender in USA 11/6/2020

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26 Incidence of B lactamase producing N gonorrhaeae in USA ä Beta lactamase: hydrolyzes the Betalactam ring in penicillin 11/6/2020

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28 Salpinitis 11/6/2020

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33 Gonorrhea: Males ä Men: urethra, purulent discharge, dysuria 2 - 7 days after infection (incubation period). Complications: epidydimitis, prostatitis, periurethral abscesses 11/6/2020

34 Gonorrhea: Females ä Women: frequently asymptomatic. When symptomatic: cervix, vaginal discharge, dysuria, abdominal pain, Ascending genital infection, salpingitis, tubo-ovarian abscess, pelvic inflammatory disease (PID) 11/6/2020

35 Disseminated infections ä Septicemia, infections of skin and joints in 1 -3 % of women ä more common in women due to untreated symptomatic infections 11/6/2020

36 Clinical: ä fever, migratory arthralgias, suppurative arthritis in the wrists, knees and ankles, pustular rash on the extremities ä Ophthalmia neonatorum - purulent conjunctivitis, acquired at delivery 11/6/2020

37 Lab Diagnosis ä gram stain ä culture 11/6/2020

38 Gm Stain N. gonorrhoeae äUrethral discharge 11/6/2020

39 Treatment: ä penicillin ä resistant strains ä plasmid encoded resistance 11/6/2020

40 The End 11/6/2020

41 N. gonorrhoeae pili. . . cont. ä The gene from �il E exhibits phase variation Pil+ to Pil- ä In addition there are 106 variations in the antigens on the surface ä There are many reasons why a vaccine cannot be effective 11/6/2020 ä Although there are many highly conserved

42 Epidemiology of ? ? ? ä Disease/bacterial factors ä Transmission ä Who is at risk ä Geography/ season ä Incidence ä Modes of control 11/6/2020

43 Short Answers ä Construct a table of the virulence factors associated with ? ? ? and the biological activity of each ä Use a series of no more than four diagrams to describe the mechanism of ? ? ? activity ä Describe the clinical manifestions ? ? ? ä Construct a table listing the common ? ? ? species and the associated human diseases. 11/6/2020

44 Neisseria gonorrhoeae protein I structure X cell wall structure Y 11/6/2020