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Gram (-) Bacteria (Labs (Urease (+) Klebsiella H. pylori Proteaus…
Gram (-) Bacteria
Labs
Urease (+)
Klebsiella
H. pylori
Proteaus mirabilis
Lactose Fermentation
E. Coli
Klebsiella
Serratia (Slow)
Enterobacter
Oxidase (+)
N. meningitidis
Campylobacter Jejuni
Pseudomonas
Vibrio cholerae
Vibrio parahaemolyticus
Vibrio vulnificus
Legionella
Pasteurella multocida
Growth on Chocolate Agar
N. gonorrhea
N. meningitis
H. Influenzae
Growth on Thayer Martin
N. gonorrhea
N. meningitis
Motile
Salmonella
Serratia
Enterobacter
H. Pylori
Maltose Fermentation
N. meningitidis
Bloody Diarrhea
Shigella
EHEC
Y. Enterocolitica
Campylobacter
HUS
Shigella
EHEC
Type 3 Secretion system
Shigella
Salmonella Enteritis
Yersinia Pestis
H2S Production
Salmonella Typhi
Salmonella Enteritis
Proteus Mirabilis
Watery Diarrhea
V. cholerae
Oxidase (+)
All Curved Rod Gram (-)
H. pylori
Vibrio cholerae
Campylobacter jejuni
Pseudomonas
Pasteurella multocida
Obligate Aerobe
Pseudomonas
Mycobacterium
Ear Infections
Otitis Externa - Pseudomonas
Otitis Media - H. influenzae
Intracellular
Neisseria gonorrhoeae
Salmonella typhi
Francisella tularensis
Yersinia pestis
Legionella
Vaccine
H Influ vaccine
only covers the type that can cause Meningitis (Type B)
N. Meningitis vaccine
covers all types
except
the variant that causes meningitis
Low ID50
Shigella (10 cells)
Campy (500 cells)
E. histolytica (1-10 organisms)
Giardia (1-10 organisms)
Gram (-) Curved Rods
Oxidase (+)
H. pylori
Campylobacter
Vibrio cholera
Neisseria species
Pseudomonas
Grows in 42 Degrees C
Spiral Shaped (curved) Rod
Campylobacter jejuni
Special
Curved Rod
Invades the epithelium
Undercooked poultry is common reservoir
Puppies from kennels are likely to harbor campy
Bloody diarrhea
Reactive Arthritis
Guillan Barré with
Ascending Paralysis
(botulism is a descending paralysis(
Virulence Factors
Enters enterocytes within endocytic vacuoles and causes cytotoxic injury
Cytolethal Distending Toxin (cytotoxic damage)
Lipooligosaccharide (cytotoxic dame)
Diseases
Watery diarrhea
that can be bloody
Bacteremia
Reactive Arthritis (Reiter's)
Seronegative Spondyloarthritis
Guillan Barré
- autoimmune demyelination of peripheral nerves -->
ascending paralysis
Lab Identifiers
Oxidase (+)
Curved Rod
Stool
Inflammation (leukocytes, erythrocytes)
No ova or parasites
Gorws in Alkaline Media
Comma Shaped Rod
Vibrio
Special
Comma-shaped
Strains
Vibrio parahaemolyticus
Special
Contaminate seafood - especially
oysters
Vibrio vulnificus
Special
Contaminate seafood - especially
oysters
Vibrio cholerae
Special
Enterotoxin is made
in
the intestine, not pre-forme
Profuse WATERY diarrhea
No leukocytes or Erythrocytes in stool, only flecks of mucus are seen due to goblet cell activation
Acid-labile requiring large load
Cholera toxin increases cAMP at gut leading to water accumulation
Lab Identifiers
Oxidase (+)
Acid Label
Grows on Alkaline media
Management
Oral Rehydration therapy with electrolytes
Virulence Factors
Uses fimbriae to attach to ganglioside receptors in the intestinal wall
Cholera Toxin
binds to adenylate cyclase (Gs-protein) and increases cAMP increasing water in the intestinal lumen
Diseases
Diffuse Watery Diarrhea acquired by water
10 - 20 L/day
Rice water diarrhea
More common in patients with Achlorhydria
Produce Urease
Helical Rod
Helicobacter pylori
Special
Cause 95% of
Duodenal Ulcers
Cause 50% of
Adenocarcinoma
of Stomach
Untreated can lead to
MALToma
(remediable upon removal)
Use Triple Therapy Protocol
Less Special
Often found at the pylorus at the antrum of the stomach
Creates alkaline environment via urease in order to survive
Management
Triple Therapy
Proton Pump Inhibitor
stop increased acid production by H. pylori
Amoxicillin
Macrolide
eg. Clarithromycin
Virulence Factors
Motile via flagella. Moves by
spinning
Urease production creates alkaline environment necessary for survival. Ureas breaks down urea into NH3+ and CO2. NH3+ helps raise stomach pH.
Diseases
Duodenal Ulcers
(95% of them) due to damage that incurs increased acid production
less somatostatin production OR
increased production of Gastrin
Adenocarcinoma of Stomach
(1/2 linked to H. pylori)
Lymphoma of Mucous Associated Lymphoid Tissue
(MALToma) - often will go away if source of inflammation is removed
Lab Identifiers
Urease (+)
Urea Breath Test
- used to diagnose - swallow urea labeled with radioactive carbon. The only way for this carbon to be removed is for urea to be acted upon by urease liberated the carbon from urea in the production of NH3+ and CO2. If reactive carbon leaves in the CO2 then the person has a urease (+) organism in their stomach.
Biopsy during Endoscopy
--> check for urease via
rapid test
Oxidase (+)
Zoonotic Gram (-) Bacilli
Coccobacilli
Brucella
("Bruce Farms")
Special
Tetracycline and Rifampin for Primary infection
Cows, sheep, goat, pigs are reservoir
Facultative intracellular organism
Sread in macrophages and spreads throughout reticuloendothelial system
Splenomegaly
Hepatomegaly
Undulating Fever
Management
Tetracyclines
eg. Doxycycline
Rifampin Adjunctive Therapy
Diseases
Fever, Chills and Anorexia
Undulating fever
Systemic Spread causes enlargement of Spleen, Liver, and Lymph nodes
Osteomyelitis
Virulence Factors
Farm Animal Reservoir
Cows
Sheep
Goats
Pigs
Veterinarian, rancher, slaughter house workers
Recent consumption of unpasteurized milk/cheese products
Faculitative Intracellular
Prevent Phagolysosome fusion
Francisella tularensis
(Francis the Rabbit)
Special
Intracellular
Coccobacilli
or
Rod
Caseating Granulomas at Reticuloendothelial Organs (lymph Nodes)
Associated with Rabbits
Black Eschar at site of Bite
Dermacentor Tick on rabbits
Virulence Factors
Aerosol transmission
Facultative Intracellular
Management
Aminoglycosides - Streptomycin
Diseases
Nonspecifics : fever, fatigue
Painful Ulcer at site of Ticket Bite
tender skin lesion at the site of the bite that is well demarcated with a black base (**ulceroglandular tularemia)
bacteria can enter blood via ulcer
infect macrophages
multiplies at reticuloendothelial system
Regional Lymphadenopathy
Pasteurella multiocida
(Pasteur's Lab)
Special
Respiratory tract of small mammals like cats and dogs
Bipolar Staining (like Yersinia)
Virulence Factors
Capsule
Lab Identifiers
Catalase (+)
Oxidase (+)
Good Growth on 5% Sheep blood agar
Bipolar Staining
(like Yersinia) sdf
Management
Penicillin & Beta-lactamase inhibitor
amoxicillin & clavulonic acid
Diseases
Cellulitis within 24 hours
Necrotizing Fascitis
Osteomyelitis
Can spread systemically in patients with liver disease
Bartonella henselae
(Bart the Leopard)
Special
Axillary Lymhadenopathy is very common
Warthin-Starry stain to visualize
Involvement of Regional Lymph Nodes
Lab Identifiers
Warthin-Starry Stain
Management
Cat Scratch
Doxycycline
Azithromycin for more complicated disease
Cat Scratch & Bacillary Angiomatosis
Macrolide for Bacillary Angiomatosis or Catch
Diseases
Cat Scratch Disease
Inoculation lesions evolves from vesicular to erythematous to papular
Fever
Can involve regional lymph nodes especially at axilla
Immunocompromised Patients
Bacillary Angiomatosis
fever
chills
red raised vascular lesions all over skin
similar in presentation to Kaposi Sarcoma
Coxiella burnetti
Special
Virulence Factors
Transmitted via respiratory droplets from air contaminated by animal poop.
2.Aerosolized cattle/sheep amniotic fluid
Diseases
Q fever
Acute: nonspecific febrile illness with fever >10 days, fatigue, myalgias.
Severe headaches (retroorbital) with photophobia
Pneumonia
Increased Liver Enzmyes
Thrombocytopenia
Chronic
Infective carditis with valvular disease
Fatal if not treated
Tick Vector
Ehrlichiosis
Babesiosis
Francisella (coccobacilli)
Ehrlichiosis
Lone-Star Tick
Northeast (Pennsylvania)
Fever, headache, malaise, myalgia
Rash on trunk, legs, arms or face
Macular, maculopapular and/or petechial rash
Babesiosis
Ixodes Ticket
Northeastern or Upper Midwestern US
Fevers, chills, myalgias
GI Symtpoms
Dark urine
Hemolytic Anemica
Thrombocytopenia
elevated creatine and BUN
Enteric Gram (-) Bacilli
Lactose Fermenter
Fast Lactose Fermentation
Pink MacConkey
Indole Negative
Enterobacter (pterodactyl)
Special
Fast Lactose fermentation
nosocomial infection
multidrug resistance
Virulence Factors
Diseases
Nosocomial Pneuomonia
Nosocomial UTI
Management
Carbapenem in case of Multidrug resistance
Lab Identifiers
Fast lactose Fermenter
motile
Indole Positive
E. coli
Special
Number 1 Cause of UTIs
O157:H7 cas Shiga-Like Toxin
(+) Catalase and (+) Lactose Fermentation
Virulence Factors
Encapsulated
K1 Capsular antigen is the major virulence factor among E coli strains that cause neonatal meningitis
Catalase (+)
Fimbriae - allows for Urinary Tract Infections
Immunogenic Lipopolysaccharide in capsule
K antigen allow for Meningitis to occur
Diseases
UTIs
Meningitis in Neonates
with K capsule Antigen
Strains
No Sorbitol Fermentation (-)
EHEC
Special
Has
Shiga-Like
toxin
O157:H7 antigen is associated with outbreaks
Management
Virulence Factors
Shiga-Like Toxin
Inhibits Ribosome at 60s position
Diseases
Inflammatory/bloody diarrhea
Hemolytic Uremic Syndrome
Lab Identifiers
Fast-Lactose Fermentation
No Sorbitol Fermentation
Sorbitol Fermentation (+)
ETEC
Management
Virulence Factors
Produces two toxins:
Heat-
L
abile Toxin --> increased c
A
MP
Similar to Cholera toxin, activates Gs membrane G protein activating adenylate cyclase.
Heat-
S
table toxin --> increased c
G
MP
"e
L A
gua de
S
an
G
abriel"
Diseases
Traveler's Diarrhea (from Water)
Lab Identifiers
Fast-lactose fermentation
Sorbitol fermentation
Lab Identifiers
lactose Fermenter
Catalase (+)
Klebsiella
(Ankylosaurus)
Special
Thick Polysaccharide Cap
Fast Lactose Fermentation
Nosocomial infection
multidrug resistance
curant jelly sputum
"3 A Spiked Tail"
Alcoholics
Aspiration
Abscesses
Lab Identifiers
Fast lactose Fermenter
immotile
urease positive
Management
Carbapenem in case of Multidrug resistance
Virulence Factors
Polysaccharide Capsules
Diseases
Seen especially in Alcoholics, Aspiration, Abscesses
Nosocomial Pneuomonia
Cavitary lesions may look like TB
Nosocomial UTI
Bacteroides
Slow Lactose Fermentation
Serratia
(triceratops)
Special
Slow Lactose Fermentation
nosocomial infection
multidrug resistance
Produces Red Pigment
Management
Carbapenem in case of Multidrug resistance
Virulence Factors
Diseases
Nosocomial Pneuomonia
Nosocomial UTI
Lab Identifiers
Fast lactose Fermenter
motile
Citrobacter
Lab Identifiers
Management
Virulence Factors
Diseases
Non-lactose Fermenter
Oxidase (-)
H2S Production (+)
Black
on Hektoin
Salmonella
Special
H2S (+)
BLACK
Motile
(vs. Shigella)
Acid labile
(vs. Shigella)
Encapsulated
Facultative Intracellular by
in macrophages
Capsular Antigen Vi (anti-neutrophil and anti-macrophage)
Salmonella typhi
Capsular Antigen Vi
Diarrhea with leukocytes and a
monocytic predominance is typical for typhoid fever
Intracellular
Human to human transmission (oral fecal)
Chronic Carriers carry in gallbladder
cause of Osteomyelitis in
SICKLE CELL
patients
Diseases
Typhoid Fever
diarrhea looks like pea soup
Osteomyelitis in sickle cell patients
Rose-colored macules on abdomen (25%)
Management
Fluoroquinolone (Cipro)
Live
attenuated vaccine
Virulence Factors
Capsular Antigen Vi - inhibits neutrophil recruitment and phagocytosis. This limits the acute inflammatory response that helps contain the nontyphoidal species.
Inhibits macrophages from generating an oxidative burst to destroy bacteria --> unchecked intracellular replication and sissemination through the lymphatic adn reticuloendothelial system.
No capsular Antigen Vi
Salmonella enteritidis
Main source is undercooked chicken
Type III Secretion System
Inva
Diseases
1.1-5 days of gastroenteritis (water diarrhea, abdominal pain, and fever)
From Food poisoning from undercooked chicken
Virulence Factors
Type III Secretion System
protein that detects eukaryotic cells and helps increase infectivity
Invade enterocytes --> massive neutrophil-mediated inflammatory response in lamina propria/Peyer's patches --> control of infection
Proteus Mirabilis
Special
Uses urease to create Struvite stones in the kidney
Swarming motility via peritrichous flagella that are distributed evenly over the surface of the bacteria
Lab Identifiers
Urease (+)
H2S (+)
Swarming motility
Management
Sulfonamides
Virulence Factors
Swarming motility
Urease leads to Kidney Calculi - urease's production of ammonia creates alkaline environment increasing struvite stone precipitation
painful and cause damage
nidus for recurrent infections
Diseases
Cause UTIs
Ascending infections can lead to pyelonephritis and the formation of Staghorn Calculi in Kidney
No H2S Production (-)
Geen on Hektoin
Shigella
Special
Invades M cells at Peyer's Patches
Low Infectious Dose (ID50) required for Infection
H2S
Green
Immotile (vs. Salmonella)
Not Acid Labile
(vs. Salmonella)
can Cause HUS
60s Ribosome inhibition by Shiga Toxin
Lab Identifiers
Green on Hektoen (TSI) Agar
Salmonella vs Shigella
Management
Virulence Factors
Acid Labile
Survive in M cells by escaping phagolysosome
Uses host actin cytoskeleton to create a tail allowing it to move from one host to another (like actin "rockets" of Neisseria)
Shiga Toxin
- binds to 60s subunit of ribosomeinduces endothelial damage - especially at the kidney glomerulus
Type III Secretion System --> releases inflammatory cytokines and is better able to infect eukaryotic cells
Diseases
Inflammatory (bloody) Diarrhea
Leukocytosis
Starts as water diarrhea and progresses to fever, abdominal pain, dysentery, and tenesmus
Kids: Shigella dysenteriae --> Hemolytic Uremic Syndrome. Patient presents with signs of acute renal failure as they begin to improve
Hemolytic Uremic Syndrome
--> Shiga toxin damages endothelial --> platelet activation --> drop in platelets --> platelets aggregations lyse red blood cells as they pass --> shistocytes
Yersinia
Special - Enterocolitica
Intracellular
Gram Negative Rod
Invasive
Transmitted by Flea bites
In puppy poop
Cold temperature resistant
Bipolar staining (like Pasteurella)
Special - Pestis
Cause of Black death
Causes Buboes (painful swollen lymph nodes)
Lab Identifiers
No lactose fermentation
No H2S production
Bipolar Staining
Management
Aminoglycosides (Streptomycin) in combination with Tetracycline
Killed Vaccine can help prevent infection
Virulence Factors
Encapsulated
Endotoxin
Yersinia Associated Outer proteins (YOPS) which inhibit cytokine production and cause macrophage and neutrophil dysfunction
YOPs released via Type 3 Secretion System (like shigella, and Salmonella)
Diseases
Y. Enterocolitica
Bloody diarrhea transmitted via puppy feces or milk products so it commonly affects smaller children
Systemic Effects : fever, leukocytosis, abscesses especially in the abdomen
Can Mimic Appendicitis
- kid presents with RLQ pain and they mention puppies in the question, think Yersinia
Y. Pestis (Black Plaque)
Prairie Dogs are main reservoir (bacteria in the fleas)
Buboes - Swollen Tender Lymph nodes
In blood can cause: Organ Abscesses, DIC due to endotoxin which can cause necrosis of the digits, and cutaneous hemorrhage
Oxidase (+)
Pseudomonas
Special
Otitis Externa
Catalase (+)
Use Aminoglycosides and Fluoroquinolones for treatment
Gram (-) Nosocomial Pneumonia
blue-green pigment
Obligate Aerobe
Lab Identifiers
Oxidase (+)
Catalase (+)
Produces Blue-Green pigment
pyocyanin
pyoverdin
Produces Fruity grape like odor
Obligate Aerobe
Management
Pipercillin, Tazobactam
Anti Pseudomonal antibiotics
aminoclycosides
fluoroquinolone
Pipercillin
Tazobactam
Fluoroquinolones best for UTIs
Aminoglycosides with beta-lactam antibiotics
Virulence Factors
Encapsulated
Exotoxin A
EF-2 Ribosylation causing inhibition of protein synthesis and cell death (same as Diphtheria)
Diseases
Number one cause of Gram (-)
Nosocomial Pneumonia
Pulmonary infection in Cystic Fibrosis
patients
Number one cause of respiratory failure
CFTR mutation - unable to pump Cl- ions causing overly sticky mucous
Pseudomonal Osteomyelitis
IV drug users
Diabetics (more likely to have traumatic injuries (providing portal of entry) especially with Diabetic Neuropathy
Infections in Burn Victims
Often fatal
Unresponsive to antibiotics
Indwelling Catheter Infection (UTI)
Nosocomial transmission
Hot Tub Folliculitis
pruritic papular-pustular folliculitis due to the use of under chlorinated hot tub
Ecthyma gangrenosum
if Pseudomonas becomes systemic can cause sepsis and then it releases toxins that causes cutaneous necrosis - black spots
Otitis Externa
(Swimmer's Ear) - outer ear infection
Respiratory Gram (-) Bacilli
Coccobacilli
Bordatella pertussis
the 100 day cough
Special
Will cause lymphocytosis due to Lymphocyte chemokine receptor inhibition
2 months of Whooping Cough
Macrolide
Pertussis Toxin** ribosylates the G-protein G
Management
Macrolide for respiratory infection
Not effective for systemic infection
DTaP Vaccines - Acellular Vaccine with purified antigens of the Pertussis bacteria. Usually given with Tetanus and Diphtheria. (diphtheria, Tetanus, and Pertussis)
Contains
Pertactin
forms the basis of the acellular vaccine, it prevents B pertussis adherence to the ciliated upper respiratory epithelium.
Virulence Factors
1a. Transmission via respiratory Droplets
1b. Pili - grab onto respiratory pills
Pertussis Toxin** ribosylates the G-protein Gi
Gi is normally an inhibitor of cAMP so its inhibition leads to increased cAMP
Disables chemokine receptors for Lymphocytes preventing them from entering lymphoid tissue causing lymphocytosis (similar to effect seen right after starting Glucocorticoids)
Adenylate Cyclase Toxin
- mimics adenylate cyclase and increases cAMP (similar to Edema Factor of B. anthracis) --> allows B pertussis to persist in alveolar macrophages by preventing effective phagocytosis
Tracheal toxin
- part of peptidoglycan wall and damages ciliated cells in respiratory epithelium
Diseases
1-2 Weeks of Nonspecific Symptoms
- catarrhal phase
conjunctivitis
lacrimation
malaise, mild fever, rhinorrhe
2 weeks
- 2 months of Whooping Cough -
Paroxysmal Phase
Children are so out of breath that their deep inspiration causes the characteristic whoop
Post-tussive emesis
Up to 3 months - gradual reduction of symptoms Convalescent
Lab Identifiers
Gram Negative Coccobacillus
Haemophilus influenzae
Special
Otitis Media
Polyribosylribitol Phosphate Capsule
Only Type B Encapsulated Strain can cause Meningitis
Cocco-bacilliary shape
Epiglottis - Thumb sign
Type B vaccine is conjugated to Diphtheria toxoid
Chocolate Agar
Lab Identifiers
Mixed spherical and rod shape
2. Growth on Chocolate Agar
contains Factor V (NAD)
contains Factor X (Hematin)
Thumb Sign on Imaging
Management
Vaccine to Type B Capsular Antigen
(Neisseria vaccine doesn't protect against N. meningitis whereas H. influenzae virus
only
protects against the meningitis causing Type B antigen)
PRP Polysaccharide of Haemophilus capsule conjugated to the Diphtheria toxoid increasing the immunogenicity of the polysaccharide to create IgG response
Vaccine given @ 2-18 months
Beta-lactam for respiratory infection
Systemic of Meningitis use
Ceftriaxone
Rifampin for prophylaxis
Virulence Factors
Aerosol transmission via respiratory droplets
Capsular form able to causes Meningitis
Polyribosylribitol Phosphate Capsule
allows it to invade tissue and survive in the blood stream
Diseases
Pneumonia
Epiglottis - inflamed epiglottis, inspiratory stridor, drooling
cherry red epiglottis
Otitis Media - inflamed, erythematous, bulging, immobile tympanic membrane due to the presence of infected fluid in the middle ear
Encapsulated Diseases
H. influenzae Meningitis - Type B strain
Patients without Spleen
Systemic H. influenzae - increased susceptibility without spleens removal of capsules
Legionella
(The silver ship: SS Cysteine)
Special
Intracellular
Atypical pneumonia - consolidation in one lobe
Use Silver Stain
Buffered Charcoal Yeast Extract for Growth
Cysteine & Iron needed for Growth
Presents with Hyponatremiam and diarrhea
High Fever (>104 F)
Hyponatremia
Lab Identifiers
Doesn't Gram stain well - use
Silver Stain
Buffered Charcoal Yeast Extract with cysteine and Iron are needed for growth
Hyponatremia
Rapid Urine Antigen Test - rapid diagnosis
Oxidase (+)
Management
1st Line Fluoroquinolones
2nd Line Macrolides
Diseases
Legionnaire Disease
Atypical Pneumonia
(same as with Chlamydia and Myoplasma)
Patchy infiltrate with consolidation in
one lobe
Hyponatremia (<130)
Patient with Pneumonia and Neurologic Symptoms
Patient with pneumonia,
diarrhea
, and hyponatremia
High Fever
More common in Smokers
Pontiac Fever
fever & malaise
Virulence Factors
Spreads via drinking water
Gram (-) Diplococci
Neisseria
Strains
Encapsulated
&
Maltose Fermentation (+)
Neisseria Meningitidis
Special
Bean Shaped
Has capsule
Spread via respiratory droplets
Encapsulated
Lipo-oligosaccharide cell protien
Ceftriaxone and Rifampin for contacts
Lab Identifiers
Maltose Fermentation (+)
Oxidase (+)
Growth on Chocolate agar
Growth on Thayer-Martin (VPR) Agar
Management
Vaccines with
A, C, and D
Polysaccharide capsule subtypes.
No B vaccine
infections in the USA are mostly Type B strain
3rd Generation Lipophilic Cephalosporin : Ceftriaxone
Rifampin
for close contacts
Virulence Factors
Spread via respiratory droplets
Polysaccharide capsule that inhibits phagocytosis
Highly immunogenic Lipo-oligosaccharide membrane proteins
Diseases
Colonizes Nasopharynx first
Invades nasopharynx then spreads through blood
Immunogenic Lipo-oligosaccharide (LOS) are produced
Makes so much LOS that LOS blebs off leading to massive inflammatory response
Capillary permeability increases and leakage of fluid into the extravascular space
Hypovolemia results from massive inflammatory response
Massive inflammatory response leads to wide spread platelet and complement activation
Thrombocytopenia results and petechia appear
DIC has set in at this point and oozing and venipuncture sites would occur
ALSO
Waterhouse-Friederichsen syndrome secondary to the hypotension that causes adrenal infarct further worsening hypotension due to aldosterone insufficiency
Infection Secondary to C5-C9 complement deficiency
Infection secondary to Asplenia or Functional Asplenia
sickle cell disease
Nonecapsulated
&
No Maltose Fermentation (-)
Growth on Thayer Martin Agar
Neisseria Gonorrheae
Special
Intracellular
No Capsule
Polymorphonuclear lymphocyte invasion
Violin-String adhesions secondary to peritonitis
Dual therapy to cover for both Gonorrheae and Chlamydia : Ceftriaxone and Doxycycline
Virulence Factors
Facultative Intracellular --> Invades polymorphonuclear lymphocytes
Diseases
Men : urethritis --> orchitis, prostatitis
Women : ascent --> PID --> scarring -->risk of ectopic pregnancies/infertility
Both : White purulent discharge
PID --> Infection of peritoneum --> Fitz-Hugh-Curtis Syndrome --> liver (violin string adhesions)
Asymmetric polyartheritis usually at one knee --> purulent synovial fluid that does not gram stain
Congenital Gonoccal infection --> purulent conjunctivitis at first 5 days of life. (chlamydia presents later)
Management
Ceftriaxone
Always give with coverage for chlamydia
Macrolide : Azithromycin
Doxycycline
Lab Identifiers
Growth on Thayer-Martin (VPR) Agar
Growth on Chocolate agar Maltose + Fermentation (+)
Oxidase (+)
No Growth on Thayer Martin Agar
Moraxella
Lab Identifiers
Growth on Chocolate agar
Growth on
Thayer-Martin Agar
aka
VPN Agar
contains : vancomycin, colistin, and nystatin
Oxidase (+)
Virulence Factors
Complement required to kill Neisseria. C5-C9
Antigenic variations at the pilus
IgA protease - allows for survival on mucosal surfaces
Diseases
Neisseria infection secondary to complement deficiency (C5-C9) - no MAC
