GRAM NEGATIVE BACTERIA • Meningococcemia

- dissemination of meningococci into the bloodstream

- multiorgan disease, petechial or purpuric rash
(purpura fulminans)

• Waterhouse-Friderichsen Syndrome
- most severe form of meningococcemia
- high fever, shock, widespread purpura,
thrombocytopenia, and adrenal insufficiency
★ bilateral hemorrhagic destruction of the adrenal
glands

TREATMENT
• penicillin G (no significant resistance)

PREVENTION
• meningococcal vaccine
• rifampin chemoprophylaxis to close contacts
GRAM GEACTIVE DIPLOCCI

NEISSERIA GONORRHEA

CHARACTERISTICS
• gram-negative "kidney-bean" diplococci
• insignificant capsule
• ferment glucose only
NEISSERIA MENINGITIS

CHARACTERISTICS
• gram-negative "kidney-bean" diplococci
• large polysaccharide capsule
• ferment maltose and glucose

HABITAT AND TRANSMISSION

• habitat is the human genital tract
• transmission by sexual contact or during passage through
the birth canal

SPECTRUM OF DISEASE: LOCALIZED

HABITAT AND TRANSMISSION • Ophthalmia Neonatorum
• habitat is the URT - purulent conjunctivitis in newborns
• transmission via respiratory droplets
• humans are the only natural hosts • Gonococcal Urethritis
• high carriage rate in close quarters - urethritis and epididymitis in men
- military recruits, dormitories, camps, travel (e.g.
epidemic related to traveling to Saudi Arabia for the Hajj • Pelvic Inflammatory Disease
pilgrimage) - most common cause of PID
- complications:
SPECTRUM OF DISEASE ➔ sterility
• Meningitis ➔ ectopic pregnancy
- most common cause among aged 2-18 yrs ➔ chronic pelvic pain
- fever, headache, stiff neck, and an increased level of ➔ dyspareunia
PMNs in spinal fluid ➔ Fitz-Hugh-Curtis syndrome (perihepatitis):
violin-string adhesions

• Septic Arthritis
- most common cause in sexually active adults
- arthritis, tenosynovitis, or pustules in the skin

DIAGNOSIS
Kernig Sign
• Nucleic acid amplification test (NAAT) – the gold standard
- Resistance to full extension of leg at knee when hip is
for the diagnosis of gonorrheal infections
flexed
TREATMENT
• Ceftriaxone + Doxycycline due to frequent co-infection with
Chlamydia trachomatis

PREVENTION
• barrier contraception (condoms)
• treat a sexual partner
Brudzinki Sign • erythromycin ointment or silver nitrate to prevent conjunctivitis
- Flexion of both hips and knees when neck is passively
flexed
 GRAM-NEGATIVE RODS - RESPIRATORY • Incubation Period
- 7-10 days

• Catarrhal phase
- 1-2 weeks
- rhinorrhea, malaise, fever, sneezing, anorexia
- Antibiotics most effective

• Paroxysmal phase
HAEMOPHILUS INFLUENZAE - 2-4 weeks
- ‘Whoop’ → burst of non-productive coughs
CHARACTERISTICS - Antibiotics ineffective during this stage
• small gram-negative (coccobacillary) rods
• requires factor X and V for growth (chocolate agar) • Convalescent stage
• satellite phenomenon around S. aureus colonies - hemolysis - 3-4 weeks (or longer)
by S. aureus liberates factor V needed by H. influenzae - Diminished paroxysmal cough
- Development of secondary complications (pneumonia,
seizure, encephalopathy)

TREATMENT
• Erythromycin

PREVENTION
• acellular vaccine in combination with diphtheria and tetanus
toxoids (DTaP)

GRAM-NEGATIVE RODS - GIT & GUT

HABITAT AND TRANSMISSION
• habitat is the upper respiratory tract
• transmission via respiratory droplets

PATHOGENESIS
• type b = 95% of invasive disease
• affects children from 6 months to 1 year
- decline in maternal IgG and immature immune system

SPECTRUM OF DISEASE
• sinusitis, otitis media, pneumonia
• meningitis
• epiglottitis
- most common cause
- cherry red epiglottis
- thumb sign
• COPD exacerbations ESCHERICHIA COLI

TREATMENT CHARACTERISTICS
• Ceftriaxone • facultative gram-negative rods
• lactose-fermenting colonies on EMB or MacConkey agar
PREVENTION • green sheen on EMB agar; metallic sheen
• HiB vaccine - given between 2 and 18 months of age

BORDETELLA PERTUSSIS

CHARACTERISTICS
• small gram-negative rods

HABITAT AND TRANSMISSION

• habitat is human colon
• colonizes the vagina and urethra
• transmission
- ascending infection in UTI
HABITAT AND TRANSMISSION - during birth in neonatal meningitis
• habitat is the upper respiratory tract - fecal–oral route in diarrhea
• transmission via respiratory droplets
SPECTRUM OF DISEASE
SPECTRUM OF DISEASE • Urinary Tract Infection
• Pertussis or Tuspirina - most common cause of community-acquired UTI
- a paroxysmal pattern of hacking coughs, accompanied
by the production of copious amounts of mucus, that end • Neonatal Meningitis
with an inspiratory "whoop“ - 2nd most common cause
 HELICOBACTER PYLORI

CHARACTERISTICS
• curved gram-negative rods
• microaerophilic

TREATMENT
• ampicillin or sulfonamides for UTI
• 3° cephalosporins for meningitis and sepsis
• rehydration is effective in traveler's diarrhea

PREVENTION HABITAT AND TRANSMISSION

• limiting urinary catheterization • habitat is the human stomach
• switching IV lines promptly • transmission is by ingestion
• drinking boiled water
PATHOGENESIS
• damages goblet cells of the gastric mucosa
VIBRIO CHOLERAE • production of large amounts of ammonia by the organism's
urease
CHARACTERISTICS - ammonia also neutralizes stomach acid, allowing the
• comma-shaped gram-negative rods organism to survive
• motile • detected using the following tests:
• shooting star motility ➔ EGD with biopsy showing H. pylori
➔ urease breath test
➔ H. pylori stool antigen

SPECTRUM OF DISEASE
• Peptic Ulcer Disease
- recurrent pain in the upper abdomen, frequently
accompanied by bleeding into the gastrointestinal tract

• Disease Associations
- gastric carcinoma

ANTI-H. PYLORI ANTIBIOTICS

• Amoxicillin
HABITAT • Clarithromycin
• human colon only (V. cholerae) • Metronidazole
• Tetracycline
TRANSMISSION
• fecal–oral route (V. cholerae)
SALMONELLA TYPHI
SPECTRUM OF DISEASE
• Cholera CHARACTERISTICS
- watery diarrhea in large volumes (rice-water stools) • facultative gram-negative rods
- patients with severe hypovolemia may have sunken • non-lactose-fermenting
eyes, dry mouth, cold clammy skin, decreased skin • produces hydrogen sulfide (H2S)
turgor, or wrinkled hands and feet, aka • Widal test detects antibodies in patient's serum
‘washerwoman's hands’

TREATMENT
- fluid and electrolyte replacement
- tetracycline or azithromycin shortens duration

PREVENTION
• public health measures
- only improvements in sanitation can lead to effective
control of the disease
• short-term immunity using cholera vaccine HABITAT
• human colon only (S. typhi)
• enteric tract of humans and animals, e.g., chickens and
domestic livestock (S. enteritidis)

TRANSMISSION
• fecal–oral route
PATHOPHYSIOLOGY
• Typhoid Fever (S. typhi)
- due to Vi (virulence) capsular antigen
- organisms enter, multiply in Peyer patches
- predilection for invasion of the gallbladder, which can
result in the establishment of the chronic carrier state

SPECTRUM OF DISEASE
• Typhoid Fever
- incubation period 5 to 21 days

TREATMENT
• Ceftriaxone
• Philippines: amoxicillin, chloramphenicol, co-trimoxazole

PREVENTION
• public health measures
- e.g., sewage disposal, chlorination, hand washing, food
safety
• vaccines for S. typhi

SHIGELLA SPP.

CHARACTERISTICS
• non-lactose-fermenting, gram-negative rods
• do not produce H2S
• nonmotile

HABITAT
• human colon only

TRANSMISSION
• fecal–oral route

SHIGELLA TRANSMISSION
4 Fs: Food, Fingers, Feces, Flies

SPECTRUM OF DISEASE
• Dysentery
- incubation period: 1–4 days
- fever and abdominal cramps, followed by diarrhea,
initially watery then bloody
- diarrhea frequently resolves in 2 or 3 days

TREATMENT
• fluid and electrolyte replacement
• in severe cases, ciprofloxacin

PREVENTION
• public health measures, e.g., sewage disposal, chlorination,
hand washing, food safety