Neisseriaceae: Gram-Negative Cocci
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Questions and Answers

What is the characteristic shape of Neisseriaceae cocci?

  • Flattened on adjacent sides, like coffee beans (correct)
  • Multicellular filaments
  • Rod-shaped
  • Spherical

    • What is the oxygen requirement of Neisseriaceae?

  • Facultatively anaerobic
  • Aerobic (correct)
  • Microaerophilic
  • Anaerobic

    • Which Neisseria species is a commensal?

  • Neisseria lactamica (correct)
  • Simonsiella spp.
  • Neisseria meningitidis
  • Neisseria gonorrhoea

    • What is the morphology of Simonsiella?

    <p>Multicellular filaments</p> Signup and view all the answers

    Which genus of Neisseriaceae contains rare pathogens?

    <p>Eikenella</p> Signup and view all the answers

    What is the habitat of Neisseriaceae?

    <p>Mucous membranes of warm-blooded animals</p> Signup and view all the answers

    What is the Gram staining characteristic of Neisseriaceae?

    <p>Gram-negative</p> Signup and view all the answers

    How many genera does the family Neisseriaceae contain?

    <p>5</p> Signup and view all the answers

    What is the characteristic of Neisseria meningitidis that enables it to grow?

    <p>Requiring 5-10% CO2 for growth</p> Signup and view all the answers

    What is the mode of transmission of Neisseria meningitidis?

    <p>Direct contact and droplet spread</p> Signup and view all the answers

    What is the result of proliferation and horizontal gene exchange during carriage of Neisseria meningitidis?

    <p>Many phenotypes</p> Signup and view all the answers

    What is the primary site of infection for Neisseria gonorrhoeae?

    <p>Urogenital epithelia</p> Signup and view all the answers

    What is the characteristic of Neisseria meningitidis that makes it an accidental human pathogen?

    <p>It is a commensal of the human upper respiratory tract</p> Signup and view all the answers

    What is the outcome of Neisseria meningitidis carriage in most cases?

    <p>No disease</p> Signup and view all the answers

    What is the percentage of CO2 required for the growth of Neisseria meningitidis?

    <p>5-10%</p> Signup and view all the answers

    What is the characteristic of Neisseria meningitidis that distinguishes it from Neisseria gonorrhoeae?

    <p>Lifestyle</p> Signup and view all the answers

    What was the outcome of introducing MenAfriVac in Africa?

    <p>Virtual elimination of serogroup A meningitis and epidemics</p> Signup and view all the answers

    What is a major virulence factor of Neisseria gonorrhoea?

    <p>Type IV pili</p> Signup and view all the answers

    How many suspected cases of meningitis were reported each year from 2015 to 2017?

    <p>More than 25,000</p> Signup and view all the answers

    What is Neisseria gonorrhoea typically transmitted through?

    <p>Unprotected vaginal, oral, or anal sex</p> Signup and view all the answers

    What is a symptom of Neisseria gonorrhoea infection in men?

    <p>Burning when peeing</p> Signup and view all the answers

    What is a characteristic of Neisseria gonorrhoea?

    <p>It is non-capsulated</p> Signup and view all the answers

    How many serogroup A carriers were identified before vaccination?

    <p>32</p> Signup and view all the answers

    Who discovered Neisseria gonorrhoea?

    <p>Albert Neisser</p> Signup and view all the answers

    What is the primary method of diagnosis for Meningococcal disease?

    <p>PCR</p> Signup and view all the answers

    What is the reason for preferring benzyl penicillin or amoxicillin over other antibiotics for Meningococcal disease treatment?

    <p>Drug resistance is rare with these antibiotics</p> Signup and view all the answers

    What is the significance of administering steroids before the first dose of antibiotics in Meningococcal disease treatment?

    <p>To prevent the Herxheimer reaction</p> Signup and view all the answers

    What is the current approach to Gonococcal disease treatment due to the development of antibiotic resistance?

    <p>Using dual treatments with ceftriaxone and azithromycin</p> Signup and view all the answers

    What is the purpose of vasoactive treatments in Meningococcal disease?

    <p>To treat shock</p> Signup and view all the answers

    What is the method of diagnosis for Gonococcal disease?

    <p>Nucleic acid amplification tests</p> Signup and view all the answers

    What is the significance of the latency period in the diagnosis of Meningococcal disease?

    <p>It is too long, making culture impractical</p> Signup and view all the answers

    What is the current trend in antibiotic resistance for Gonococcal disease?

    <p>Rapid development of resistance to all antibiotics</p> Signup and view all the answers

    What is the primary route of transmission for gonorrhoea from mother to baby?

    <p>Horizontal transmission during birth</p> Signup and view all the answers

    Which age group is most affected by gonorrhoea?

    <p>20-24 years</p> Signup and view all the answers

    What is the global incidence of gonorrhoea each year?

    <p>&gt;78 million cases</p> Signup and view all the answers

    What is the consequence of increasing antibiotic resistance in gonorrhoea?

    <p>Gonorrhoea may become untreatable</p> Signup and view all the answers

    What is the recommended treatment for gonorrhoea in the context of antibiotic resistance?

    <p>Dual antimicrobial therapy with azithromycin and ceftriaxone</p> Signup and view all the answers

    What is the primary reason for the development of azithromycin resistance in the UK?

    <p>Sub-therapeutic dosing in Asia and the UK</p> Signup and view all the answers

    What is the complication of gonorrhoeal conjunctivitis in newborns?

    <p>Rapid corneal perforation</p> Signup and view all the answers

    What is the impact of gonorrhoea on the transmission of HIV?

    <p>Gonorrhoea increases the transmission of HIV</p> Signup and view all the answers

    Neisseria gonorrhoea was discovered in 1859 by Albert Neisser

    <p>False</p> Signup and view all the answers

    MenAfriVac is effective against serogroup B meningococcal disease

    <p>False</p> Signup and view all the answers

    Neisseria gonorrhoea is typically transmitted through unprotected handshakes

    <p>False</p> Signup and view all the answers

    The introduction of MenAfriVac in Africa led to an increase in serogroup A meningitis cases

    <p>False</p> Signup and view all the answers

    Neisseria gonorrhoea is capsulated

    <p>False</p> Signup and view all the answers

    More than 50,000 suspected cases of meningitis were reported each year from 2015 to 2017

    <p>False</p> Signup and view all the answers

    Type IV pili is not a major virulence factor of Neisseria gonorrhoea

    <p>False</p> Signup and view all the answers

    Only one serogroup A carrier was identified before vaccination

    <p>False</p> Signup and view all the answers

    Gonorrhoea mainly affects people in their 30s.

    <p>False</p> Signup and view all the answers

    The dual antimicrobial therapy for gonorrhoea consists of Azithromycin and Amoxicillin.

    <p>False</p> Signup and view all the answers

    Azithromycin resistance in the UK is mainly due to over-dosing.

    <p>False</p> Signup and view all the answers

    Gonorrhoea is typically transmitted through casual contact.

    <p>False</p> Signup and view all the answers

    The global incidence of gonorrhoea is less than 50 million cases each year.

    <p>False</p> Signup and view all the answers

    Gonorrhoea increases the transmission of Hepatitis.

    <p>False</p> Signup and view all the answers

    Neisseria meningitidis can cause pharyngitis and conjunctivitis in neonates.

    <p>True</p> Signup and view all the answers

    Gonorrhoeal conjunctivitis in newborns may result in blindness.

    <p>True</p> Signup and view all the answers

    Neisseria gonorrhoeae is a commensal of the human upper respiratory tract.

    <p>False</p> Signup and view all the answers

    The primary route of transmission for gonorrhoea from mother to baby is through breastfeeding.

    <p>False</p> Signup and view all the answers

    The human nasopharynx is the sole ecological niche for Neisseria gonorrhoeae.

    <p>False</p> Signup and view all the answers

    Neisseria meningitidis requires 10-20% CO2 for growth.

    <p>False</p> Signup and view all the answers

    Neisseria meningitidis is a primary pathogen of the human upper respiratory tract.

    <p>False</p> Signup and view all the answers

    Neisseria gonorrhoeae is a major cause of infertility in both men and women.

    <p>True</p> Signup and view all the answers

    Neisseria meningitidis can cause disease in the absence of carriage.

    <p>False</p> Signup and view all the answers

    Neisseria meningitidis has a high morbidity and mortality rate during epidemic outbreaks.

    <p>True</p> Signup and view all the answers

    Polysaccharide capsule protects against host phagocytes and provides a barrier to the bloodstream.

    <p>False</p> Signup and view all the answers

    The 'glass test' is a reliable method for diagnosing meningococcal disease.

    <p>False</p> Signup and view all the answers

    Quadrivalent A, C, Y, W-135 polysaccharide vaccine is used for outbreak control in the meningo belt.

    <p>True</p> Signup and view all the answers

    Meningococcal disease can kill within 24 hours of onset.

    <p>False</p> Signup and view all the answers

    Conjugate C vaccine introduction in the UK increased cases of meningococcal disease.

    <p>False</p> Signup and view all the answers

    Multicomponent vaccines are effective against all virulent strains of N.meningitidis.

    <p>False</p> Signup and view all the answers

    Carriage of N.meningitidis offers complete immunity to meningococcal disease.

    <p>False</p> Signup and view all the answers

    Vomiting is a rare symptom of meningococcal meningitis.

    <p>False</p> Signup and view all the answers

    Cefixime is the first line treatment for Meningococcal disease.

    <p>False</p> Signup and view all the answers

    The primary site of infection for Neisseria meningitidis is the eyes.

    <p>False</p> Signup and view all the answers

    Vasoactive treatments are used to treat shock in Meningococcal disease.

    <p>True</p> Signup and view all the answers

    Steroids are preferably administered after the first dose of antibiotics in Meningococcal disease treatment.

    <p>False</p> Signup and view all the answers

    Gonococcal disease is typically diagnosed using latex agglutination.

    <p>False</p> Signup and view all the answers

    Dual treatments are no longer recommended for Gonococcal disease due to the development of antibiotic resistance.

    <p>False</p> Signup and view all the answers

    Neisseria meningitidis is typically transmitted through unprotected handshakes.

    <p>False</p> Signup and view all the answers

    The method of diagnosis for Meningococcal disease includes microscopy.

    <p>True</p> Signup and view all the answers

    Study Notes

    Neisseriaceae: Gram-Negative Cocci of Clinical Importance

    • The family Neisseriaceae consists of 5 genera: Neisseria, Kingella, Eikenella, Simonsiella, and Alysiella.
    • Neisseria genus includes pathogens like Neisseria meningitidis and Neisseria gonorrhoeae, and commensal like Neisseria lactamica.

    General Characteristics of Neisseriaceae

    • Gram-negative cocci, often diplococci with adjacent sides flattened.
    • Associated with mucous membranes of warm-blooded animals.
    • Twitching motility via Type IV pili.
    • Oxidase positive and capnophilic, requiring 5-10% CO2 for growth.
    • Acid from oxidation of carbohydrates, not from fermentation.

    Neisseria Meningitidis

    • Pathogen that causes meningitis and septicaemia.
    • Asymptomatic commensal of the human upper respiratory tract (URT).
    • High morbidity and mortality, with sporadic or epidemic outbreaks.
    • The human nasopharynx is the sole ecological niche.
    • Spreads via saliva – direct contact/droplet spread.
    • Proliferation/horizontal gene exchange, and genetic reassortment during carriage result in many phenotypes.

    Neisseria Gonorrhoeae

    • Pathogen that causes gonorrhoea, primarily infecting the urogenital epithelia.
    • Usually sexually transmitted, with rare cases of disseminated infection.
    • Non-capsulated, with a type IV pili major virulence factor.
    • Outer membrane: lipooligosaccharide (LOS) and surface protein OPA.
    • Discharge from the genitals, burning when peeing, and asymptomatic in women.
    • Transmitted from mother to baby during birth, causing conjunctivitis.

    Epidemiology of Gonorrhoea

    • Mainly affects people in their 20s, with an increasing incidence in the UK.
    • Over 78 million cases worldwide each year, with a lack of understanding of the complex transmission routes and reservoirs.

    Antibiotic Resistance in Gonorrhoea

    • Increased azithromycin resistance in the UK, leading to the possibility of untreatable gonorrhoea.
    • Dual antimicrobial therapy (Azithromycin and ceftriaxone) required.
    • Increased surveillance of strains and resistance necessary.

    Laboratory Diagnosis

    • Meningococcal disease: CSF and blood samples, microscopy, culture, PCR, and detection of soluble bacterial polysaccharides in CSF by latex agglutination.
    • Gonococcal disease: endocervical, cervical, anal, and eye swabs, and urines, with nucleic amplification tests (strand displacement amplification assay) and QRT PCR.

    Prevention and Control

    • Introduction of MenAfriVac (serogroup A meningococcal conjugate vaccine) for Africa has been a massive public health success.
    • Must introduce MenAfriVacR into the national childhood immunization program.
    • How long this protection will persist needs to be established.

    Meningococcal Disease and Prevention

    • Carriage of N. meningitidis in the nasopharynx is crucial in understanding the disease and prevention, with 10-35% of university students carrying the bacteria.
    • Pathogenesis of N. meningitidis involves invasive phenotypes expressing factors needed to invade the bloodstream, including lipooligosaccharide (LOS), type IV pili, surface proteins NadA and Opa, invasins, and iron-acquisition.
    • Meningococcal meningitis symptoms include vomiting, intense headache, confusion, drowsiness, fever, sensitivity to light, skin rash, and eventually, convulsions and stiff neck.
    • Meningitis is inflammation of the meninges, which can lead to fluid buildup in the brain ventricles, causing loss of consciousness or death if left untreated.
    • Vaccines are available to combat meningococcal disease, including quadrivalent A, C, Y, W-135 polysaccharide vaccines, which are effective in outbreak control.
    • Multicomponent vaccines exist but fall short of combating all virulent strains.

    N. meningitidis vs. N. gonorrhoeae

    • N. meningitidis is an asymptomatic commensal of the human upper respiratory tract, causing meningitis and septicaemia.
    • N. gonorrhoeae is usually transmitted sexually, infecting the urogenital epithelia, and can cause epididymitis, cervicitis, endometritis, and PID.
    • Both organisms have genetic and antigenic similarities but very different lifestyles.

    Carriage and Invasion of N. meningitidis

    • The human nasopharynx is the sole ecological niche for N. meningitidis.
    • Carriage of N. meningitidis allows for horizontal gene exchange and genetic reassortment, resulting in many phenotypes.
    • For genetically primed strains, invasion can occur, but most carriage is not associated with disease.

    Prevention and Control

    • Introduction of MenAfriVac (serogroup A meningococcal conjugate vaccine) has been a massive public health success in Africa, with virtual elimination of serogroup A meningitis and epidemics.
    • Vaccination has prevented serogroup A invasive meningococcal disease and carriage in Chad.
    • Surveillance of strains and resistance are required to monitor the effectiveness of vaccines.

    Gonorrhoea

    • Gonorrhoea mainly affects people in their 20s, with increasing incidence in the UK.
    • Transmission occurs via unprotected vaginal, oral, or anal sex.
    • Symptoms include discharge from the genitals, burning when peeing, and women are often asymptomatic.
    • Gonorrhoea can be transmitted from mother to baby during birth, causing conjunctivitis.

    Antibiotic Resistance in Gonorrhoea

    • Increased azithromycin resistance in the UK has led to the possibility of untreatable gonorrhoea.
    • Dual antimicrobial therapy (azithromycin and ceftriaxone) is recommended.
    • Sub-therapeutic dosing in Asia and the UK has contributed to antibiotic resistance.

    Laboratory Diagnosis

    • Meningococcal disease diagnosis involves CSF and blood samples, microscopy, culture, PCR, and detection of soluble bacterial polysaccharides in CSF.
    • Gonococcal disease diagnosis involves endocervical, cervical, anal, and eye swabs, and urines, as well as nucleic amplification tests and culture.

    Treatment

    • Meningococcal disease treatment involves IV antibiotics (benzyl penicillin or amoxicillin), and maintenance therapy for shock (fluids, etc.).
    • Gonococcal disease treatment involves dual therapy with ceftriaxone and azithromycin due to antibiotic resistance.

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