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Bacte LEC > Neisseria > Flashcards

Neisseria Flashcards

1
Q

Neisseria

Aerobic, non-motile, non spore forming, gram negative diplococci with adjacent ends flattened that resemble tiny (2), except: (3) which are rod shaped.

A

“coffee beans” or “kidney beans”

N . weaveri
N .elongata
N. bacilliformis

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2
Q

All are catalase positive and cytochrome
oxidase positive, except:

A

N. elongata subspecies nitroreducens
N. bacilliformis

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3
Q

T or F

Neisseria

Capnophilic (3-10% CO2) and humidophiles

A

True

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4
Q

Neisseria

• Optimal temperature:
• Natural habitat:

A

between 35C and 37C (32C-36C)

Mucus membranes of the RT and urogenital tracts

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5
Q

Primary pathogens:

A

N.gonorrhoea & N.meningitidis

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6
Q

Neisseria gonorrheae (______)
and Neisseria meninigitidis
(_____) are highly fastidious:

Require_____ for growth
• Require_____ media for growth

A

gonococci

meningococci

iron

enriched

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7
Q

: grows on enriched CAP supplemented with

cysteine
X (hemin)
V (NAD or Coenzyme 1) factors

A

N.gonorrheae

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8
Q
  • derived from: LYSED RBCS
  • can derived from RBCs, but abundantly produced by some bacteria (Staphylococcus aureus) and can be obtained from yeast, yeast extracts and potato extracts
A

X factor

V factor

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9
Q

require SBA as the minimal growth
standard.

A

Neisseria meninigitidis (and Moraxella cattarhalis)

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10
Q

Neisseria

Note: Both organisms are highly sensitive to______ and must be protected from____!

They must be_____ immediately on their respective primary isolation media.

A

temperature changes

cold

inoculated

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11
Q

Remember!!
Enriched CAP for…

Remember!! Sheep Blood Agar (BAP) for…

A

Neisseria gonorrhea

Neisseria meningitidis

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12
Q

NEISSERIA
Virulence Factors

A

Receptors for human transferrin

Polysaccharide Capsule-

Pili

IgA protease

Cell membrane proteins

LOS (Lipooligosaccharide)

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13
Q

-competes human hosts for IRON

A

Receptors for human transferrin

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14
Q
  • (N.meningitides only) -

resists phagocytosis

A

Polysaccharide Capsule

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15
Q
  • for attachment to host’s mucus membranes;

also for conjugation and transfer of genetic materials such as genes that code for antimicrobial resistance.

A

Pili

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16
Q

-cleaves IgA antibodies in mucus membranes

A

IgA protease

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17
Q

Cell membrane proteins

A

Por (protein I)
Opa (Protein II)
Reduction modified protein (Protein III)

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18
Q
  • channel for passage of nutrients and waste products

Coded by…

PorB expressed only by_______
- protective against host’s inflammatory response and complement mediated killing

A

Por (protein I)

PorA and PorB genes

N.gonorrheae

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19
Q
  • facilitate adherence of organisms to phagocytic and epithelial cells
  • blocks host IgG
A

Opa (protein II)

Reduction modified protein (protein III)

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20
Q
  • contain the endotoxin portion of the organism
A

LOS (Lipooligosaccharide)

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21
Q

____ is anchored in the outer membrane.
The____ portion of the LOS contains the____.

During periods of rapid growth, Neisseria gonorrhea releases outer memorane fragments called “____”
which contain LOS.

A

LOS; Lipid; endotoxin

blebs

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22
Q

In large amounts,_____ can stimulate macrophages to produce increased amounts “pro-inflammatory” cytokines

A

endotoxins

• Tumor necrosis factor
• Interleukin 1
• Chemokines
• And other inflammatory mediator

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23
Q

Effects of endotoxin

A

• Prolonged inflammation and fever
• Prolonged vasodilation (vascular permeability)
• Capillary leakage (hemorrhage) - manifested by purpura and petechial rash.
• Hypotension
• Tachycardia - increased heartbeat
• Septic shock - abrupt cessation of the functions of vital organs due to decrease oxygen delivery
• Intravascular coagulation

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24
Q

is a “double-edged” sword. It is beneficial when it is able to achieve its primary purpose in the immune response.

But when it goes south, such as due to endotoxin stimulation, the heightened inflammatory response could be
damaging to the host.

A

Inflammation

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25
Q

Causative agent of____ - acute pyogenic infection of the non-ciliated columnar and transitional epithelium.

A

gonorrhoea

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26
Q

Gonorrheae aka

A

Flow of seed
Clap/ clapier

Also confused with syphilis

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27
Q

Also known
aร:

  • urethral discharge mistaken for
    semen.

Confused with syphilis - due to the lesions it produced that resemble the_____ in syphilis and both diseases
often come together in the same
individual.

A

Flow of seed

lesions

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28
Q

Also known as the “____” - derived from the French word “___” which means “____”.

Other theories also suggest that the “clap” refers to the throbbing pain caused by the infection, or it may refer to the early treatment of gonorrhea that involves smashing or clapping the penis with both hands at the same time to get rid of the of the pus or discharge.

A

clap

clapier

brothel

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29
Q

Primarily acquired by ___and occur primarily in the (5)

A

sexual contact

urethra
endocervix
anal canal pharynx
conjunctiva.

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30
Q

• Primary reservoir -
• Incubation period of

A

asymptomatic carriers!

2-7 days

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31
Q

• In men: _____ and ____
•____% of cases are asymptomatic
• Due to:____

In women: common site is the____ - symptoms (4)
____% of women are asymptomatic

A

Purulent discharge and dysuria
3-5%
AHU strain

endocervix
cervical discharge, dysuria, & lower abdominal pain
50%

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32
Q

Note: The AHU strains of _____require additional amino acid requirements such as Arginine, Hypoxanthine, and Uracil.

They are also often isolated disseminated N.gonorrhea infections often from women but also from asymptomatic men.

A

N. gonorrhea

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33
Q

In women:

Complicates to:____
-an infection of one or more of the upper reproductive organs, including the uterus, fallopian tubes and ovaries

A

PIV (pelvic inflammatory disease)

Sterility
Ectopic pregnancy
Perihepatitis (Fitz-Hugh-Curtis syndrome)

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34
Q

a chronic manifestation of pelvic inflammatory disease (PID)

An inflammation of the serous or peritoneal coating of the liver, without the involvement of the liver parenchyma

A

Perihepatitis (Fitz-Hugh-Curtis syndrome)

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35
Q

dissemination of N.gonorrhea into the blood causing septicemia and from the blood to distant sites of the body.

Mostly caused by AHU strain.

A

Disseminated Gonococcal Infection (DI)

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36
Q

Disseminated Gonococcal Infection (DI)= Clinical manifestations include:

A

Septic arthritis
Polyarthralgias
Pyogenic Flexor Tenosynovitis
Petechial/pustular skin lesions
Endocarditis
Meningitis

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37
Q
  • painful infection in the joint (though may be caused by a wide variety of bacteria, but in DGI, it is due to the disseminated infection caused by N.gonorrheae.
  • joint pain

-inflammation of the protective sheath (the synovial membrane) that surrounds your tendons

A

Septic arthritis

Polyarthralgias

Pyogenic Flexor Tenosynovitis

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38
Q
  • inflammation of the inner lining of the heart’s chambers and valves

inflammation of the fluid and membranes (meninges) surrounding your brain and spinal cord

A

Endocarditis

Meningitis

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39
Q

• Gonococcal eye infection in the
newborn
• Acquired during delivery through an
infected birth canal
• Can lead to blindness

A

Opthalmia neonatorum

40
Q

Opthalmia neonatorum

• Treated with:

A

• Crede’s prophylaxis ~ 1% silver nitrate
• Erythromycin drops (antimicrobial eye drops)

41
Q

Sources of Specimens:

A

genital sources (purulent discharge from the urethra in men & endocervix in women)

rectum
pharynx
joint fluid

42
Q

Spx collection in men:
when no apparent discharge, swab is inserted up to____ in the anterior urethra and slowly rotated to collect the discharge

_____specimens must be collected. WHY?

A

2cm

Two swabbed

First - direct microscopy
Second - inoculation on primary culture media

43
Q

• Swabs for rectal culture should be inserted_____ into the anal canal

A

4-5 cm

44
Q

•(2) - Inhibits N. gonorrheae-____ swabs are preferred.

A

Calcium alginate & cotton swabs

DACRON

45
Q

Neisseria

• Must be plated immediately to primary selective media due to extreme susceptibility to (2)

A

drying and temperature changes

46
Q

• Blood Specimens - collected to
diagnose____

• N.gonorrheae - inhibited by ____
(anticoagulant in Blood Culture System)

•____ is added to neutralize SPS

A

DGI - Disseminated Gonococcal Infection

SPS - Sodium Polyanetolsulfonate

Gelatin

47
Q

Commercial Transport Systems (3)

A

• Gono-Pak
• JEMBEC plates (James E. Martin
• Biological Environmental Chamber
Transgrow

48
Q

Commercial Transport Systems

Note: These contain____ media and a___ atmosphere to provide optimal conditions until the specimen reaches the laboratory.

The swab containing the specimen should be rolled in a “___” pattern on the medium.

On receipt in the laboratory, the media can be cross-streaked with a loop to facilitate growth of isolated colonies.

A

selective; CO2

Z

49
Q

Smears are prepared from UROGENITAL SPECIMENS

A

Direct Microscopy Examination

50
Q

Direct Microscopy Examination

  • not recommended for gram stain due to the presence of commensal Neisseria

Significant finding: PRESENCE OF…

A

Nasopharyngeal specimens

GRAM NEGATIVE, INTRACELLULAR DIPLOCOCCI

51
Q

Virulent form
Avirulent form

A

Virulent form - INTRACELLULAR
Avirulent form - EXTRACELLULAR (lose their pili)

52
Q

N. gonorrheae

Culture and Incubation

• Does not grow well on_____ agar.

Medium of choice:_____
Incubation:_____

A

SHEEP BLOOD AGAR

ENRICHED CAP

35°C in a 3-5% CO2

53
Q

N. gonorrheae

Provision of sufficient humidity
•______evaporating from the media in a closed jar
• CO2 incubator with____
• Pan of water place at the bottom of the incubator

A

Moisture

humidifier

54
Q

N. gonorrheae

Culture and incubation

• Examined for growth for

A

7 days

55
Q

Inhibitor

Vancomycin - inhibits gram +
Colistin - Inhibits gram -
Nystatin - inhibits fungi

A

Thayer Martin

56
Q
  • inhibits gram positiVe
  • Inhibits gram negative
  • inhibits fungi
A

Vancomycin

Colistin

Nystatin

57
Q

Inhibits swarming if proteus

A

Trimethoprim lactate

58
Q

Nutrients of Thayer Martin/ Modified

A

Hemoglobin as source of
X-ractor; enriched with V factor, vitamins, amino acids, coenzymes, and dextrose

59
Q

Organisms that Grow in Thayer Martin

A

Neisseria gonorrhoea
Neisseria meningitidis

60
Q

Martin Lewis inhibitor

A

Vancomycin
Colistin
Trimetophrim Lactate

Anisomcyin - inhibits fungi

61
Q

Nutrients Present that Support Fastidious Neisseria gonorrheae

MARTIN LEWIS
______that provides X-factor,
nitrogenous nutrients in the form of_____,_____ to maintain pH,_____ that neutralize toxic fatty acids present in the mediu,______,_____,____,____,____,____, and other growth factors necessary for improvement and optimal growth of pathogenic Neisseria species.

A

Bovine hemoglobin

casein and meat peptone

phosphate buffer

cornstarch

V factor

vitamins, amino acids, coenzymes, dextrose, ferric ions

62
Q

New York City Agar INHIBITORS

A

Vancomycin
Colistin
Trimetophrim Lactate

Amphotericin B inhibits fungi

63
Q

Nystatin

Anisomycin

Amphotericin B

A

Thayer Martin

Martin Lewis

NYC Agar

64
Q

NYC Agar Nutrients

Peptone,_____ that neutralize toxic
metabolites producea by Nersseria,
Horse plasma, horse hemoglobin, dextrose, and yeast autolysate.

______provides essential electrolytes maintaining osmotic equilibrium thereby maintaining the integrity of cells.

A

cornstarch

Sodium chloride

65
Q

N. gonorrheae

Medium

A

Thayer Martin
Modified Thayer Martin
Martin Lewis
NYC Agar

66
Q

N. gonorrheae

Culture and Incubation
• Colonies are(3), and raised after ____hours of incubation

A

small, gray to tan, translucent

24-48 hrs

67
Q

N. gonorrheae

5 colony types

A

T1
T2
T3
T4
AHU colonies

68
Q

N. gonorrheae

: piliated, virulent colonies

• Smaller and raised, appear bright in
reflected light

A

T1 andT2

69
Q

N. gonorrheae

: non piliated, avirulent

• Larger, flatter colonies

A

T3-T5

70
Q

N. gonorrheae

: smaller colonies and grow slowly

A

• AHU colonies

71
Q

N. gonorrheae

•______ culture is recommended for workup since the organism can produce their own____ enzyme

A

Fresh culture

autolytic

72
Q

N. gonorrheae

Indirect Microscopy

• Gram stain of colonies obtained from
________

• Observe for:….

• (2) may occasionally grow - RODS

A

selective media

gram negative diplococci, “bean or kidney” shaped

Kingella and Acinetobacter

73
Q

Presumptive Biochemical Test for N. gonorrheae

A

Cytochrome Oxidase Test

74
Q

Oxidase Reagent/s:

A

• 1% dimethyl p-phenylenediamine dihydrochloride
• 1% tetramethyl dihydrochloride

75
Q

Cytochrome oxidase test

• Positive Result:
• Interpretation:

A

Purple color within 10-30 seconds

Presence of Neisseria species

76
Q

Cytochrome oxidase test

Alternative procedure:
• Oxidase reagent may be drop directly on the colony
• Positive result:

A

Colony turns deep purple to black

77
Q

Definitive Test

A

Carbohydrate Utilization Test using CTA Medium

78
Q

Carbohydrate Utilization Test using CTA Medium

Medium:
pH Indicator:
1% of individual CHO ( what is the sugar used for N. gonorrheae?)

A

Cystine Trypticase Agar

Phenol Red

Glucose

79
Q

Carbohydrate Utilization Test using CTA Medium

• Result:
• N. gonorrheae: Ferments GLUCOSE

A

Yellow color in the medium as a result of fermentation

80
Q

Other Tests for N. Gonorrheae

A

Chromogenic Substrates Methods of CHO utilization

Multitest Method

Beta lactamase test for Neisseria gonorrhea

81
Q

• Based on colour changes after bacterial enzymes hydrolyse the CHO
substrates

• Useful for identification of N.gonorrheae with aberrant CHO utilization

A

Chromogenic Substrates Methods of CHO utilization

82
Q

Multitest Method
• Multitest conventional chromogenic enzyme method
• Combine substrates of other biochemical tests
• Can also identify other genera such as…(2)

A

Haemophilus spp & Moraxella spp

83
Q

Beta-lactam drugs - contain beta lactam rings in their structure

Examples

A

penicillins
cephalosporins
penems
cephemscarbapenems
monobacatams

84
Q

binds to the penicillin-binding proteins (PBPs) of the peptidoglycan layer of both gram positive bacteria that result in the inhibition of cell wall synthesis.

This leads to bacterial lysis and death.

A

Beta-lactam ring

85
Q

Norma function of ____ (transpeptidase) - catalyze the polymerization of the peptidoglycan strands and cross linking between glycan chains.

____of beta-lactam drugs- bind to these enzymes (PBPs) inhibiting the polymerization and cross-linking of peptidoglycan layer.

This leads to loss of cell wall integrity, cell lysis, and death.

A

PBPs
Beta-lactam rings

86
Q

______produced by both gram + and gram - bacteria and it hydrolyses the beta lactam ring, making beta-lactam drugs ineffective.

______producing bacteria are resistant to penicillin and other beta-lactam drugs

A

Beta-lactamase (a.k.a penicillinase) enzyme-

Beta-lactamase

87
Q

Examples of bacteria that produce beta-lactamase (penicillinase) - NES

A

Neisseria, Escherichia coli, Staphylococci

88
Q

The_______ binds to the beta-lactam ring, preventing it from binding to the PBPs.

The beta-lactam ring is hydrolyzed by it, making them ineffective in inhibiting peptidoglycan synthesis.

A

Beta-lactamase enzyme

89
Q
  • determines the ability of the bacterial isolate to produce the Beta-lactamase enzyme chat hydrolyzes Beta-lactam rings, makine them resistant to penicillin and other beta lactam drugs.
A

The beta-lactamase test

90
Q
  • Detects beta-lactamase production from colonies…. Isolates containing these organisms should be routinely tested for B-lactamase activity
A

Cefinase test

Staphylococcus species,
Haemophilus influenzae,
Neisseria gonorrhoeae,
of and anaerobic bacteria

91
Q

Beta lactamase test

Reagent: - impregnated with chromogenic cephalosporin which is a beta-lactam ring-containing drug.

A

Cefinase disk

92
Q

Cefinase test

Procedure:
1. Moisten the cefinase disk with___
2. Using a sterile loop or needle, obtain a colony from the culture medium
3. Smear the colony on the moistened disk
4. Observed for color change:

A

1 drop of purified water

93
Q

Cefinase test

Result:
Colonies positive for beta-lactamase: color change of Cefinase disk from ___ to ____

• Colonies negative for beta-lactamase: color change does not occur on the disk.

A

yellow to red

94
Q

Previously susceptible to Penicillin
•- resistant to penicillin
• - N.gonorrhea acquire plasmids that code for beta-lactamase production.

A

Penicillinase-Producing Neisseria gonorrhoea (PPNG)

Plasmid mediated penicillin resistance

95
Q

• Plasmid mediated and chromosomally mediated resistance to:

A

tetracycline
spectinomycin
fluoroquinolones

Bacte LEC (29 decks)

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