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This Concept Map, created with IHMC CmapTools, has information related to: Bacteriology 8 gram negative cocci, Neisseriaceae Neisseria gonorrhoeae epidemiology of disease 1. only in humans, sexl transmitted 2. 2nd most common STI in US 3. infx rates same in males/females, highr in AfAm, highr in SE US 4. peak incid 15-29yr 5. incid decreased but rate of decr slwd 6. 310k new infx in 2004 7. host promscty contrib to incid, Neisseriaceae Neisseria gonorrhoeae Dx Gm stain v good w/ purulence in men. exprt can make positive ID. others need culture on selective media, Neisseriaceae Neisseria gonorrhoeae symptoms cervix, urethra, rectum, pharynx, conjunctiva gen infx in men restricted to urethra purulent discharge, dysuria (95%) compl rare but may occur symptomatic females exp vag discharge, dysuria, abd pain. infx of endocervical columnar epi cells. ascendng gen. infx in 10-20% of women gonococcemia = gonococcal bacteremia -> disseminated infxns (1-3% women) fever, purulent and suppurated arthritis pustular rash on erythematous areas skin lesions, Neisseria meningitidis pathogenesis Por B protein interferes w/ degranltn of PMN's that'd kill endotoxic lipid A -------------------------------- cells approach by aspiration attach to mucosal epi pili receptrs on colmnr epi cross m barrier, enter blood polysacc caps protects against phagocytic destruction if not cleared, can enter CNS causing meningitis diffuse vascular damage attrb to LOS endotoxin. endothl damage vessl wall inflmm thrombosis disseminated intravascular coagulation (DIS - death is coming), other Neisseria species commenals, poss. opportunistic N. sicca N. mucosa, Other Gm neg cocci opportunistic pathogens Eikenella corrodens, Neisseriaceae Neisseria gonorrhoeae Tx 3rd gen ceph. or fluoroquinoline and Ab(doxycycline) but CDC recmm ceftriaxone instd of fluor. in some regions many others, common char of N. gonorrhoeae and N. meningitidis phys descrp aerobic diplococci adj sides flattened "coffee beans", Neisseria meningitidis epidemiology of disease infants - passive pro from maternal AB's incidence greatest in ɚyrs, after loss of maternal AB ------------------------------------- epidemics common in undevp countries pandemics uncmmn in devp countries diff serogroups help ID, Neisseria meningitidis Tx penicillin works (but not against elimnating carrier state) drug of choice if not, broad-spec ceph (ceftriaxone) or chloramphenicol, Other Gm neg cocci agar culture grows relatively easy on soft agar. N. gon/men. diff to grow, Neisseria meningitidis diseases meningococcemia sm petechial skin lesions on trunk & lowr extremities coalesce to hemorr lesions septicemia multi-organ & sm vessel thrombosis disseminated intravascular coagulation destruction of adrenal glands (Waterhouse-Friderichsen Syndrome) fulminant disease multi-system, chills, fever, malaise, headache milder, chronic septicemia low grade fever, arthritis, petechial skin lesions responds well to AB treatment acute bacterial meningitis headache, fever, meningeal signs: cervical and thoraco-lumbar rigidity hamstring spasm, exaggerated reflexes v. rapid onset mortality 100% (untreated), % treated pts other infxns: pneumonia, arthritis, urethritis meningococcal pneumonia usu preceded by resp tract infx symp: couch, chest pain, rales, fever, chills pharyngitis. prognosis good, Neisseria meningitidis Dx meningococcemia rash, petechiae (non-blanching) pink maculae meningitis detectd in CSF, periph blood culture (easier than gon.) handle w/ care ----------------------------- ID oxidase-pos, Gm neg diplocc on selective choc blood agar plate carb oxidation char commercial tests less acc than Gm, common char of N. gonorrhoeae and N. meningitidis char non-motile oxidase positive most produce catalase breaks down H2O2 acid produce by oxidation of carb N. gon. oxidize only glucose N. men. oxidize gluc & maltose, Neisseria meningitidis char phys identical to N. gon. Gm neg diplococci, non-motile, no spore common in nasopharynx of healthy people swift disease progressn to life-threatening growth on agar varies iron essential for growth 12 serogroups, Neisseriaceae Neisseria gonorrhoeae ID oxidase-pos Gm-neg diplococci growth on chocolate agar pattrn of carb oxidation PCR, Neisseria meningitidis mode of transmission meningococcal meningitis hi incid late wntr, early spring sporadic & in epidemics, Neisseria meningitidis Tx prophylactic treatment rifampin, ciprofloxacin, ceftriaxone, common char of N. gonorrhoeae and N. meningitidis phys descrp 2 beans at tbl 1 jittery w/ coffee 1 perverted bean both are neg cocc's, Neisseriaceae Neisseria gonorrhoeae pathogenesis obligate human pathogen acqd by sexual contact (95%) muc memb of men endocervix of women can spread to other tiss 2. attach, penetrate into cells estb infx in subepi space 3. proteins mediate attachment and penetration 4. gonococcal lipo-oligosaccharide (LOS). endotoxic, inflm respons -> release TNF-alpha -> causes sympts 5. IgG3 main response against infx. Ab's to proteins. LOS activate compl 6. hides and avoids destruction in phagocytic vesicles