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DEN 7102 Micro & Immuno Concepts > Exam 3 Gram Negative Cocci > Flashcards

Exam 3 Gram Negative Cocci Flashcards

1
Q

Neisseria is classified as a ___ ____ ____

A

gram negative diplococci

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2
Q

Are Neisseria aerobic or anaerobic?

A

Aerobic

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3
Q

Neisseria produces ______ which distinguishes it from oral Streptococci

A

cytochrome c oxidase (oxidase positive)

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4
Q

What medium is used to grow Neisseria

A

Thayer Martin

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5
Q

Positive oxidase test result

A

Indicator chemical turns blue when oxidized

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6
Q

Thayer Martin medium is best on ____ agar with _____

A

chocolate agar; increased CO2

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7
Q

True or false: many different species can survive on Thayer Martin medium

A

False - selective medium Neisseria only, other bacteria die from antibiotics that are present

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8
Q

Neisseria main virulence factors

A
  • adhesion factors (pili)
  • endotoxin (lipooligosaccharide)
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9
Q

The endotoxin of ____ is extremely potent

A

N. meningitidis

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10
Q

The endotoxin of _____ has low potency

A

N. gonorrhoeae

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11
Q

N. meningitidis has pili that are specific for:

A

epithelial cells of the oropharynx and meninges

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12
Q

Neisseria has ____ in its cell wall

A

LOS (lipooligosaccharide)

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13
Q

N. gonorrhoeae has pili specific for:

A

Mucosal cells

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14
Q

_____ is extracellular

A

N. meningitidis (spinal tap shows diplococci outside of cells)

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15
Q

_____ is intracellular

A

N. gonorrhoeae

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16
Q

N. meningitidis transmission

A

person to person by respiratory droplets

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17
Q

N. gonorrhoeae transmission

A
  • sexual
  • perinatal
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18
Q

True or false: N. meningitidis has a higher mortality than N. gonorrhoeae if untreated

A

True (85% if untreated)

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19
Q

IgG and IgM antibodies against ______ are protective

A

N. meningitidis capsular antigens

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20
Q

The pili of N. gonorrhoeae are _____ but highly _____, which leads to evasion of host immunity

A

immunogenic; polymorphic

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21
Q

Those with C5-C9 complement deficiencies are predisposed to:

A

Bacterial and Neisseria species infections

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22
Q

How does C5-C9 complement fight bacteria?

A
  • form transmembrane channel in bacteria
  • bacteria burst and die
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23
Q

N. meningitidis is part of ______. 5-15% are carriers in the ____

A

normal flora; nasopharynx

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24
Q

Where does N. meningitidis have high transmission rates?

A
  • day care centers
  • dorms
  • barracks
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25
Q

What is the most common cause of acute meningitis?

A

N. meningitidis

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26
Q

N. meningitidis causes acute meningitis in:

A
  • babies and children
  • adolescents
  • young adults
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27
Q

Most invasive disease of N. meningitidis is caused by what serogroups?

A

A, B, C, Y, W-135

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28
Q

Meningococcal disease incidence is highest in what age group?

A

Babies and children

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29
Q

N. meningitidis pathogenesis

Leading to meningitis

A
  1. adhere to and colonize the nasopharynx
  2. invade epithelium and then blood
  3. hematogenous spread causes endotoxemia
  4. toxins produces leads to meningitis
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30
Q

Meningococcal disease incidence has been decreasing recently due to:

A

Vaccine

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31
Q

True or false: N. meningitidis always results in meningitis

A

False - can also cause meningococcemia, pneumonia, arthritis, otitis media

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32
Q

Without treatment for N. meningitidis, fatality nears ___. With treatment, it nears _____ and up to ____ in meningococcemia

A

100%; 9-12%; 40%

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33
Q

Clinical findings of N. meningitidis

A
  • acute bacterial meningitis
  • CSF profile
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34
Q

What is the bacterial CSF profile?

A

WBC - 0-60,000
Cell type - neutrophils
Glucose - very low
Profile - high

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35
Q

What does the gram stain look like for N. meningitidis?

A

Gram negative diplococci in blood or CSF

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36
Q

____ is responsible for many severe systemic effects of N. meningitidis

A

Endotoxin (LPS)

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37
Q

N. meningitidis infection can lead to:

A
  • hemorrhagic skin lesions (petechiae, may coalesce)
  • septic shock
  • disseminated intravascular coagulopathy (DIC)
  • Waterhouse-Friderichsen syndrome
  • multi-organ failure/death
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38
Q

What is Waterhouse-Friderichsen syndrome?

A

Hemorrhagic destruction of the adrenals, which regulate metabolism, immune system, blood pressure

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39
Q

Petechiae

A

Infection causes blood clots to develop in small blood vessels

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40
Q

Petechiae can coalesce into:

A

Hemorrhagic bullae (blood blister)

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41
Q

Septic shock can lead to _____

N. meningitidis

A

Hypotension/shock (systemic vasodilation)

toxins damage small blood vessels + leak fluid into surrounding tissues

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42
Q

N. meningitidis infection causes ____ to develop in small blood vessels, which leads to activation of ____ ultimately leading to ____

A

Blood clots; clotting system (systemic inflammation); disseminated intravascular coagulation (DIC)

43
Q

No. 1 cause of death in intensive care units (ICU)

A

Septic shock

44
Q

Disseminated Intravascular coagulation (DIC) - how does it lead to death?

A
  1. infection causes blood clots to develop in small blood vessels
  2. clots deplete platelets and clotting factors, leading to bleeding in blood vessels
  3. leaky blood vessels reduce blood to tissue (ischemic)
  4. damage to organs
45
Q

Meningococcal disease timeline - symptoms such as confusion, delirium, loss of consciousness, or seizures can occur at:

A

24 hours after onset

46
Q

N. meningitidis DOC

A

Penicillin (when organism is identified)

47
Q

N. meningitidis treatment before organism is identified

A

Vancomycin and cephalosporin

48
Q

True or false: those who have contacted someone with N. meningitidis infection does not need any treatment

A

False, they need antibiotic prophylaxis - rifampin and ciprofloxacin

49
Q

There are ____ vaccines available for N. meningitidis, which are:

A

2; MenACWY and MenB

50
Q

Which N. meningitidis vaccine provides better protection?

A

MenACWY

51
Q

MenACWY vaccine is also called:

A

Meningococcal C & Y vaccine

52
Q

MenACWY is a ____ ____ vaccine

A

quadrivalent conjugate vaccine

53
Q

MenACWY prevents meningococcal disease caused by serogroups:

A

A, C, Y, W-135

54
Q

When is the MenACWY vaccine given?

A
  • routine childhood vaccination starting at 2 months
  • adolescents age 11-12
  • booster age 16
55
Q

Who is at increased risk of invasive meningococcal disease?

A

- college freshmen living in a dormitory
- complement component deficiency
- HIV
- asplenia
- taking eculizumab (Soliris)
- military recruits
- meningococcal outbreaks
- microbiologists if routinely exposed
- travelers

56
Q

When was MenB approved in the US?

A

2014

57
Q

MenB is recommended for age ____

A

age 16-23 (prefer age 16-18)

58
Q

True or false: MenB provides long term protection against most serogroup B strains

A

False - short term protection

59
Q

Currently, MenB is being administered to:

A

Increased-risk groups for now

Broader age recommendations being discussed

60
Q

Unlike N. meningitidis, N. gonorrhoeae does not contain:

A

Capsule or hemolysin

61
Q

____ help N. gonorrhoeae invade epithelial cells

A

OPA proteins

62
Q

Second most commonly reported STD in the US

A

Gonorrhea

63
Q

Most common reported STD in the US

A

Chlamydia

64
Q

____ as many new infections of gonorrhea are estimated to occur each year as are reported

A

Twice

65
Q

What race/ethnicity has the most reported cases of gonorrhea?

A

Black/African American (similar pattern in other STDs)

66
Q

Which group of sex/sex partners have the highest reports of gonorrhea cases?

A

Men who have sex with men (MSM)

67
Q

What is the difference between STI and STD?

A
  • STI = sexually transmitted infection
  • infection doesn’t necessarily mean you are experiencing symptoms (disease = symptoms)
68
Q

There has been a _____ increase/decrease in cases of gonorrhea since 2017

A

28% increase

69
Q

Gonorrhea transmission routes

A
  • sexual (genital, oral, rectal)
  • perinatal (mother to infant)
70
Q

Gonorrhea is associated with increased transmission of and susceptibility to

A

HIV infection

71
Q

Men with gonorrhea can experience:

A
  • urethritis
  • epididymitis
72
Q

Women with gonorrhea can experience:

A
  • urethritis
  • cervicitis
  • pelvic inflamatory disease
73
Q

True or false: most females with gonorrhea are asymptomatic

A

True

74
Q

Male urethritis symptoms

A
  • purulent discharge
  • very painful
75
Q

Males with urethritis usually seek immediate ____

A

Medical attention (very painful/pus)

76
Q

Epididymitis symptoms

A

Unilateral testicular pain and swelling

77
Q

Epididymitis is usually associated with

A

Urethritis

78
Q

Most common local complication of gonorrhea in males

A

Epididymitis

79
Q

____ of women with cervicitis are asymptomatic

A

50%

80
Q

Cervicitis symptoms

A
  • purulent discharge
  • usually painless
81
Q

Cervicitis is highly _____

A

Infectious

82
Q

If a woman with cervicitis is feeling pain, the pain can often be confused with:

A

Period pain

83
Q

Most common cause of infertility

A

Pelvic inflammatory disease (PID)

84
Q

Pelvic inflammatory disease entails infection of:

A
  • uterus
  • fallopian tubes
85
Q

Pelvic inflammatory disease can lead to:

A
  • infertility
  • ectopic pregnancy
  • abscess formation
  • chronic pelvic pain
86
Q

Oral gonorrhea can lead to:

A
  • pharyngeal gonorrhea
  • gingival gonorrhea
87
Q

True or false: you can contract conjunctivitis from gonorrhea

A

True (fluids are very infectious)

88
Q

N. gonorrhoeae can disseminate and cause ____ _____

A

Gonococcemia lesions

89
Q

Gonococcemia can manifest as _____ if they reach the joints

A

Gonoccal arthritis

90
Q

Types of gonoccal arthritis

A
  • monoarthritis (one joint at a time)
  • oligoarthritis (a few joints at a time)
91
Q

How do gonoccocal infections occur in babies?

A

perinatal infection via conjunctiva, pharynx, respiratory tract

92
Q

Ophthalmia neonatorum

A

Eye infection in a newborn caused by chlamydia, gonorrhea, or other genital/rectal bacteria

93
Q

Ophthalmia neonatorum can lead to:

A

Blindness

94
Q

Gonococcal infection in older children is a sign of:

A

Possible evidence of sexual abuse

95
Q

If you notice gonococcal infection in older children, what do you have to do?

A
  • collect evidence and laboratory documentation
  • required to report to social services/law enforcement (all 50 states)
96
Q

How is N. gonorrhoeae diagnosed?

A
  • Gram stain of discharge and cells
  • immunofluorescence
  • culture (Thayer Martin medium)
97
Q

Microscopy is sufficient to diagnose gonorrhea in ___. Sensitivity test also needs to be used to diagnose _____

A

males with purulent discharge; all females

98
Q

True or false: microscopy/gram stain can be used to diagnose pharyngeal gonorrhea

A

False - other Neisseria species can colonize pharynx so can lead to false positive

99
Q

True or false: Neisseria gonorrhea shows antibiotic resistance

A

True - half of infections resistant to at least one antibiotic

100
Q

DOC for N. gonorrhoeae

A

Ceftriaxone IM and a tetracycline

also effective for assumed coexisting Chlamydia infection

101
Q

N. gonorrhea confers antibiotic resistance via:

A
  • plasmid
  • chromosome
102
Q

N. gonorrhea is becoming increasingly resistant to:

A

Cephalosporins

103
Q

Why is a tetracycline also used in treatment of gonorrhea?

A

Reduces ceftriaxone resistance risks

104
Q

Opthalmia neonatorum prophylaxis

A
  • erythromycin (Ilotycin)
  • tetracycline ophthalmic ointment

DEN 7102 Micro & Immuno Concepts (26 decks)

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