Nisseria Gonorrhea PDF Template

Nisseria gonorrhea Year: Semester: Module: Objectives: By the end of this lecture, students will be able to: 1. Describe the composition of microbiota inhabiting the female and male reproductive system 2. Describe the morphology, and cultural characters, of...

Nisseria gonorrhea Year: Semester: Module: Objectives: By the end of this lecture, students will be able to: 1. Describe the composition of microbiota inhabiting the female and male reproductive system 2. Describe the morphology, and cultural characters, of Neisseria gonorrhoeae. 3. Enumerate antigenic structure and virulence factors of Neisseria gonorrhoeae. 4. Explain the pathogenesis of gonorrhea. 5. List diseases caused by Neisseria gonorrhoeae. 6. Explain the diagnostic laboratory tests of gonorrhea. 7. Discuss the prevention of gonorrhea. 8. Discuss the treatment of gonorrhea. Objective 1 Objective 2 Objective 3 Objective 4 Objective 5 Microbiota The aggregate of microorganisms that resides on or within any of a number of human tissues and biofluids, including the skin, mammary glands, placenta, seminal fluid, uterus, ovarian follicles, lung, saliva, oral mucosa, conjunctiva, biliary and gastrointestinal tracts. They include bacteria, fungiand viruses. Female genital system: lactobacilli Male genital system: Pseudomonas, Lactobacillus, or Prevotella Objective 1 Objective 2 Objective 3 Objective 4 Objective 5 Nisseriae Two members in the genus Nisseriae: N.gonorrhea & N. meningitidis. They can cause only disease in man, while other members occur as commensals in the oro-and naso-pharynx and vagina. Morphology: Gram –ve cocci arranged in pairs (diplococcic) (kidney shape appearance). In pathological specimen: they occur intracellular in pus cells as well as extra cellular. Objective 1 Objective 2 Objective 3 Objective 4 Objective 5 Cultural characters: They are aerobes & require enriched media containing heated blood (chocolate agar) or the selective media" MTM "Modified Thayer-Martin medium containing antibiotics that inhibit growth of other organisms present in the specimen. Incubation is at 35-37ºC at 5-10% CO2. Objective 1 Objective 2 Objective 3 Objective 4 Objective 5 Biochemical activities: Oxidase test: All species are oxidase +ve, as they possess the enzyme cytochrome C. Way of done: picking a portion of the colony & smearing it on a strip of the filter paper impregnated with the oxidase reagent, deep purple color develops. Objective 1 Objective 2 Objective 3 Objective 4 Objective 5 Acid production from sugar: Glucose Maltose Sucrose N. + + _ meningitidis N. + _ _ gonorrhea N.flavescens _ _ _ N. sicca + + + Objective 1 Objective 2 Objective 3&4 Objective 4 Objective 5 Neisseria gonorrheae : Gonococci: They cause gonorrhea(STD). Antigenic composition & virulence factors: 1- Pilli: It mediates the attachment to mucosal cells& anti-phagocytic. Non- piliated strains are avirulent. 100 serotypes are present, there is antigenic variation due to chromosomal rearrangement. Objective 1 Objective 2 Objective 3&4 Objective 4 Objective 5 Cont. 2- Lipoolysaccharides(LOS) : Responsible for endotoxic effects. 3- Outer membrane proteins(I,II& III) Play role in attachment. 4- Porin A: Present in some strains. It inactivates C3b & renders the strains resistant to killing by antibody & complement leading to disseminated infections. Objective 1 Objective 2 Objective 3&4 Objective 4 Objective 5 Cont. 5. IgA1 protease: It hydrolyzes secretory IgA1 and helps the attachment of the organism to the mucous membrane (colonization). Objective 1 Objective 2 Objective 5 Objective 4 Objective 5 Diseases caused by Gonococci: N. gonorrhoeae causes several clinical syndromes including urogenital, pharyngeal, and rectal infections in males and females and conjunctivitis in adults and neonates. If untreated, gonorrhea is a major cause of pelvic inflammatory disease (PID), tubal infertility, ectopic pregnancy, and chronic pelvic pain. Objective 1 Objective 2 Objective 5 Objective 4 Objective 5 Cont. (1) Genital infection in men Urethritis, Epididymitis The infection may become chronic with scanty discharge(morning drop). (2) Genital infection in women Approximately 50% of women infected with gonorrhea are asymptomatic. Cervicitis, Urethritis, salpingitis , PID(pelvic inflammatory disease); ectopic pregnancy & infertility(20%). No infection of the adult vagina due to acidity & presence of normal flora. (3) Anorectal & throat infection in heterosexual men & women. Objective 1 Objective 2 Objective 5 Objective 4 Objective 5 Cont. –Infections in children Perinatal: During childbirth, the neonatal conjunctiva, pharynx, respiratory tract, or anal canal may become infected. Conjunctivitis (ophthalmia neonatorum) is preventable by ocular prophylaxis in the newborn. Older children: –All cases of gonorrhea in children beyond the newborn period should be considered possible evidence of sexual abuse. –Vulvovaginitis (not cervicitis) is most common manifestation in prepubescent girls. Objective 1 Objective 2 Objective 5 Objective 4 Objective 5 Repeated gonococcal infection: Antigenic variation of pilli & outer membrane protein. Superficial nature of infection so IgG has little protective action. Secretory IgA1 is destroyed by IgA1 protease. Objective 1 Objective 2 Objective 3 Objective 6 Objective 5 Diagnosis: Discharge from urethra, cervix, rectum, conjuctiva, throat or synovial fluid. Colonies are identified by: (a) Morphology: gram –ve diplococci. (b) Biochemical reaction: oxidase +ve, acid production from glucose. (c) Detection of gonococcal antigen with ELISA. (d) Culture: on chocolate agar or MTM at 35-37ºC at 5-10% CO2. (e) Blood culture Objective 1 Objective 2 Objective 3 Objective 4 Objective 7&8 Treatment:  Penicillin G. Drug resistance to penicillin reported 1950.  Ceftriaxone in uncomplicated gonococcal infection.  Spectinomycin or ciprofloxacin.  Tetracycline or azithromycin if mixed infection with C. trachomatis.  Prevention:  Condom & treatment of patients.  Treatment of neonatal opthalmia by erythromycin, tetracycline (eye drop & eye ointment) after birth Objective 1 Objective 2 Objective 3 Objective 4 Objective 7&8 Nisseria  Quiz Time True or false 1. Nisseria is oxidase negative 2. Nisseria grow at 35-37ºC at 5-10% CO2