Neisseriaceae and Moraxella catarrhalis

Question 1

A sexually transmitted infection (STI) in both men and women

Answer 1

Gonorrhea

Question 2

invasion of the mucous membranes of the genital tract, rectum and the throat causing inflammation

Answer 2

Gonorrhea

Question 3

Genital gonorrhea In males:

- Primary site of infection is the

Answer 3

urethra

Question 4

Genital gonorrhea In males:

Incubation period ranges from [?] days or longer, with an average of 2 to 7 days.

Answer 4

1 to 14

Question 5

Symptoms of [?] occur in 90-95% of infected males

Answer 5

urethritis

Question 6

(burning sensation during urination)

Answer 6

dysuria

Question 7

(yellow, creamy pus)

Answer 7

purulent urethral discharge

Question 8

Genital gonorrhea In females:

- Primary site of infection is the

Answer 8

endocervix, with concomitant urethral infection

Question 9

Genital gonorrhea In females:

Incubation period ranges from [?] days

Answer 9

8 to 10

Question 10

Symptoms of [?] occur in 10-20% of infected females

Answer 10

endocervicitis

Question 11

Symptoms of endocervicitis

Answer 11

‣ purulent cervicovaginal discharge
‣ dysuria
‣ menorrhagia (intermenstrual bleeding)
‣ dyspareunia (painful vaginal intercourse)

Question 12

In untreated cases, ascending infection may occur and can result in [?] that is manifested as salpingitis (infection of the Fallopian tubes), endometritis, and tubo-ovarian abscess.

Answer 12

pelvic inflammatory disease (PID)

Question 13

is a risk factor for ectopic pregnancy, infertility, chronic pelvic pain, and Fitz–Hugh–Curtis syndrome

Answer 13

Salpingitis

Question 14

an infection and inflammation of liver capsule and “violin string” adhesions of peritoneum to liver.

Answer 14

perihepatitis

Question 15

When gonorrhea is present in a child after the newborn period and before puberty, this infection may be a sign of

Answer 15

sexual abuse.

Question 16

In prepubertal girls, gonorrhea manifests as a [?] with a vaginal discharge, rather than a cervicitis.

Answer 16

vaginitis

Question 17

The epithelium of the prepubertal vagina is composed of [?], which are the cell types that N. gonorrhoeae preferentially infects.

With the onset of puberty, these cells are replaced by a[?] that is not susceptible to gonococcal infection.

Answer 17

columnar epithelial cells

stratified squamous epithelium

Question 18

Seen in MSM (men having sex with men)

Answer 18

Oropharyngeal gonococcal infection

Question 19

women who acquire the infection by engaging in orogenital sexual contact with an infected partner

Answer 19

Oropharyngeal gonococcal infection

Question 20

Over 90% are asymptomatic

Answer 20

Oropharyngeal gonococcal infection

Question 21

Patients with oropharyngeal gonococcal infection often have gonococcal infection at

Answer 21

genital and/or rectal sites

Question 22

Seen primarily in MSM who practice unprotected [?] anal intercourse; among MSM, gonococcal infection of the rectum may be the only infected anatomic site.

Answer 22

receptive

Question 23

Women may also acquire rectal infections by [?] anal intercourse, but most rectal infections in women are due to [?] contamination with infected cervicovaginal secretions.

Answer 23

receptive

perianal

Question 24

Are often asymptomatic, but some individuals may experience symptoms ranging from [?] to with anorectal pain and itching, a mucopurulent discharge, bleeding, tenesmus, and constipation 5 to 7 days following infection.

Answer 24

mild pruritis

acute proctitis

Question 25

Painful, purulent conjunctivitis

Answer 25

Ocular gonococcal infection

Question 26

Occurs in adults who become infected by self-inoculation of the eyes from genital secretions

Answer 26

Ocular gonococcal infection

Question 27

An infection of the eye in newborns

Answer 27

Gonococcal ophthalmia neonatorum

Question 28

Acquired during passage through the birth canal of an infected mother

Answer 28

Gonococcal ophthalmia neonatorum

Question 29

Initial purulent conjunctivitis occurs 2-5 days after birth, rapidly progresses and, if untreated, results in blindness

Answer 29

Gonococcal ophthalmia neonatorum

Question 30

Results from the spread of gonococci into the bloodstream

Answer 30

Disseminated Gonococcal Infection (DGI)

Question 31

Characterized by low-grade fever, painful, hemorrhagic skin lesions (initially appear as papules that evolve into necrotic pustules) on the hands, forearms, feet, and legs; tenosynovitis and suppurative arthritis, usually of the knees, ankles, and wrists.

Answer 31

Disseminated Gonococcal Infection (DGI)

Question 32

Complications include permanent joint damage, endocarditis, and rarely, meningitis.

Answer 32

Disseminated Gonococcal Infection (DGI)

Question 33

Neisseria gonorrhoeae Enhance attachment of gonococci to host cells and resistance to phagocytosis

Answer 33

Pili

Question 34

Neisseria gonorrhoeae Undergo antigenic variation; a single strain can make many antigenically distinct forms

Answer 34

Pili

Question 35

Neisseria gonorrhoeae Associated with porins; Undergo antigenic variation

Answer 35

Protein I (Por proteins)

Question 36

Neisseria gonorrhoeae Prevents intracellular killing of gonococci within neutrophils by preventing phagosome–lysosome fusion

Answer 36

Protein I (Por proteins)

Question 37

Neisseria gonorrhoeae Responsible for variable resistance of gonococci to killing by normal human serum

Answer 37

Protein I (Por proteins)

Question 38

Neisseria gonorrhoeae A portion is in the gonococcal outer membrane, and the rest is exposed on the cell surface

Answer 38

Protein II (Opa proteins)

Question 39

Neisseria gonorrhoeae adhesion of gonococci within colonies and attachment of gonococci to host cell receptors

Answer 39

Protein II (Opa proteins)

Question 40

Neisseria gonorrhoeae Undergo antigenic variation

Answer 40

``` Pili Protein I (Por proteins) Protein II (Opa proteins) Endotoxin ```

Question 41

Neisseria gonorrhoeae Structurally associates with Por in the outer membrane

Answer 41

Protein III (Reduction-modifiable Protein or Rmp)

Question 42

Neisseria gonorrhoeae antigenically conserved in all gonococci does not display antigenic variability

Answer 42

Protein III (Reduction-modifiable Protein or Rmp)

Question 43

Neisseria gonorrhoeae Diminishes the bactericidal effects of normal human serum

Answer 43

Protein III (Reduction-modifiable Protein or Rmp)

Question 44

Neisseria gonorrhoeae ``` gonococcal lipopolysaccharide (LPS) does not have an O polysaccharide side chain ```

Answer 44

lipooligosaccharide or LOS

Question 45

Neisseria gonorrhoeae Associated with toxicity in gonococcal infections; causes ciliary loss and mucosal cell death

Answer 45

Endotoxin

Question 46

Allows attachment to host mucosal surfaces by splitting and inactivating IgA1

Answer 46

IgA1 protease

Question 47

a major mucosal immunoglobulin of humans

Answer 47

IgA1

Question 48

Plasmid-mediated production responsible for penicillin resistance (PPNG = penicillin-producing N. gonorrhoeae)

Answer 48

β-lactamase

Question 49

• Results from the entry of meningococci from the nasopharynx into the blood stream probably by way of the cervical lymph node

Answer 49

Meningococcemia

Question 50

Abrupt onset with fever, chills, malaise, | prostration, and petechiae

Answer 50

Meningococcemia

Question 51

occurs in about 10% of patients with | meningococcemia

Answer 51

Purpura fulminans

Question 52

characterized by: - ecchymoses (larger form of petechiae) - disseminated intravascular coagulation (DIC) - shock - coma - Waterhouse-Friderichsen Syndrome - acute hemorrhage into the adrenal glands, resulting in death in 6-8 hours

Answer 52

Purpura fulminans

Question 53

Usually associated with epidemic meningitis; and the second most common cause of bacterial meningitis in adults

Answer 53

Meningococcal meningitis

Question 54

May occur simultaneously with meningococcemia

Answer 54

Meningococcal meningitis

Question 55

Symptoms usually begin with sudden onset of fever, with an intense headache, stiff neck, convulsion, vomiting and progresses to coma within a few hours

Answer 55

Meningococcal meningitis

Question 56

• The primary virulence factor of meningococci associated with blood stream invasion

Answer 56

Capsule

Question 57

Capsule consists of polysaccharide, which classifies meningococci into 13 serogroups :

Answer 57

A, B, C, D, H, I, K, L, W135, X, Y, Z, and 29E

Question 58

The most important serogroups associated with disease in humans are

Answer 58

A, B, C, X, Y, and W-135

Question 59

• Enables meningococci to resist the bactericidal activity of the complement and prevents destruction of the organism by phagocytes.

Answer 59

Capsule

Question 60

Protrudes through the organism’s capsule.

Answer 60

Pili

Question 61

Mediates initial attachment to surface proteins on non-ciliated cells in the nasopharyngeal epithelium of the host

Answer 61

Pili

Question 62

aggregates the meningococcal cells into microcolonies allowing attachment to epithelial microvilli and entry in to the bloodstream

Answer 62

Pili

Question 63

Endotoxin specifically referred as

Answer 63

meningococcal lipooligosaccharide (LOS).

Question 64

Responsible for many of the toxic effects found in meningococcal disease.

Answer 64

Endotoxin

Question 65

Neutralizes the protective action of the mucosal immunoglobulin

Answer 65

IgA1 Protease

Question 66

which in each dose consists of four purified bacterial capsular polysaccharides is said to be poorly immunogenic in children younger than age 18 months

Answer 66

Polysaccharide tetravalent vaccine

Question 67

contains capsular polysaccharide conjugated to diphtheria toxoid, and is licensed for use in persons 9 months to 55 years of age

Answer 67

Tetravalent conjugate vaccine

Question 68

With the availability of effective vaccines for meningococcal serogroups [?]. N. meningitidis has become the major cause of bacterial meningitis worldwide

Answer 68

A, C, Y, and W135, serogroup B

Question 69

Polysaccharide vaccines do NOT contain [?] because they are poorly immunogenic in both children and adults. It is attributed to resemblance of group B capsular material, comprised of a linear polymer of [?] to the polysialated form of the neural cell adhesion molecules found in fetal brain tissue.

Answer 69

group B polysaccharides ⍶2-8 N acetylneuraminic acid (sialic acid)

Question 70

Current efforts to develop group B vaccine have centered around the [?]. It is fairly new and not yet recommended as a routine vaccination for healthy people. CDC recommends routine serogroup B meningococcal vaccination for people 10 years or older at increased risk for meningococcal disease.

Answer 70

OMP (outer membrane proteins)

Question 71

is administered to individuals who had close contacts with primary case of meningitis or meningococcemia, ideally, within less than 24 hours after identification of the index case

Answer 71

Chemoprophylactic antimicrobial therapy

Question 72

PREVENTION AND CONTROL • avoiding multiple sexual partners • rapid eradication gonococci from infected individuals o instillation of silver nitrate solution to the conjunctiva of newborns

Answer 72

Neisseria gonorrhoeae

Question 73

``` o early diagnosis and treatment o case finding o education and screening of populations at high risk o use of mechanical prophylaxis  condoms o chemoprophylaxis  antibiotic resistance ```

Answer 73

• avoiding multiple sexual partners

Question 74

o instillation of silver nitrate solution to the conjunctiva of newborns

Answer 74

Crede’s Method

Question 75

Crede’s Method is replaced by

Answer 75

0.5% erythromycin or 1% tetracycline ointment at the site of infection

Question 76

HABITAT • NOT considered normal flora • mucous membranes of the genitourinary tract, rectum, throat, and the eye at time of infection • polymorphonuclear cells

Answer 76

Neisseria gonorrhoeae

Question 77

• human nasopharynx o pharyngitis – 10% of healthy individuals o carrier state may last for a few days to months

Answer 77

Neisseria meningitidis

Question 78

• direct contact through inhalation of respiratory secretions or droplets

Answer 78

Neisseria meningitidis

Question 79

• direct contact (sexually or perinatally)

Answer 79

Neisseria gonorrhoeae