GRAM NEGATIVE COCCI

Neisseriaceae

JOSE R. VILLARINO, RMT

 Genus Neisseria
 Gram negative cocci in pairs “coffee-bean
shaped” with the adjacent sides flattened
Except N. elongata
 Non-sporing, non-motile
 Obligate aerobes but prefer increased CO2
 Capnophilic – need 3-10% CO2 for growth
 Pathogenic species are very fastidious
 Oxidase positive and Catalase positive
except N.elongata
 Medically important species
 Neisseria gonorrheae – “ gonococcus” causes
gonorrhea
 Neisseria meningitidis – “meningococcus”
causes meningococcemia and meningitis
 Neisseria gonorrheae
 Agent of gonorrhea, an acute pyogenic
infection mainly of the mucous
membranes of the endocervix and male
urethra.
 In males, acute urethritis associated with
dysuria and urethral discharge
 In females, may result to PID (pelvic
inflamatory disease) such as scarred
fallopian tubes, ectopic pregnancy and
eventual sterility
 Other related conditions:
 Disseminated gonococcal infections like
septicemia ( hemorrhagic skin eruptions),
endocarditis & gonococcal arthritis
 “opthalmia neonatorum” or gonococcal
conjunctivitis among neonates
 Oropharyngeal and rectal infections seen
among homosexual/heterosexual males
and females
 Neisseria meningitidis
 Cause of bacterial meningitis and
septicemia
 Carried by some asymptomatic individuals
as normal flora in the nasopharynx which
may serve as reservoir of infection.
 Acute meningococcemia which may lead
to DIC (disseminated intravascular
coagulation) or hemorrhage into adrenal
glands resulting to Waterhouse-
Friderichsen syndrome.
 N. meningitidis
 Chronic meningococcemia which may
eventually lead to meningitis as a result of
the organism is able to cross the blood-
brain barrier and enters into the CNS.
Signs include headache, stiff neck, nausea
and vomiting, delirium and rigid spine.
 Petechial rash (tiny hemorrhages on the
skin) is a common sign.
 Virulence Factors
 Neisseria gonorrheae – pili initiate
infection by attachment to susceptible cell
in the mucous membrane and inhibits
phagocytosis.
 Neisseria meningitidis – presence of the
polysaccharide capsule resisting
phagocytosis is regarded as principal
virulence factor. The pili also help in
attachment to host cells.
 Specimen Collection
 Female patients = endocervical specimen
and Urethral swabs for male patients
 Anorectal, oropharynegal and conjunctival
specimens used in particular cases
 Blood or synovial fluid for culture (DGIs)
 Use of dacron, rayon or cotton swabs
treated with charcoal are preferred to use
with immediate inoculation onto the CM
 Laboratory Diagnosis
 Gram staining of appropriate specimen
 Culture using Chocolate agar, Thayer
Martin Medium
 Oxidase test ( presumptive identification )
 Carbohydrate fermentation ( specie id )
 Serologic tests
Smear – urethral discharge
Smear – centrifuged CSF
 Sugar Fermentation
 Neisseria gonorrheae – glucose only
 Neisseria meningitidis – glucose & maltose

Penicillin resistant Neisseria gonorrheae –

produces the enzyme penicillinase or beta-
lactamase.
Alternative tx: Spectinomycin or Ceftriaxone