Transcript Neiserria
1 Neisseria Filename: Neisseri.ppt 4/13/2015 2 Organisms Neisseria meningitidis: meninges (base of the brain) Neisseria gonorrhoeae: primary infection sex organs Branhamella, formerly Neisseria catarrhalis, cocci Moraxella: coccobacilli Kingella: coccobacilli Acinetobacter: coccobacilli 4/13/2015 3 4/13/2015 4 N. meningitidis gram negative cocci, capsules, oxidase positive Ontario averages 10 cases per year; 60 in 1994 4/13/2015 5 N. meningitidis in CSF 4/13/2015 6 N menigitiditis Excess outer membrane with endotoxin in released into extracellular space of actively growing cells 4/13/2015 7 Pathogenesis colonize the nasopharynx by pili invasion not prevented by phagocytosis - capsule toxic effects lipopolysaccharide endotoxin bacteria transmitted via the blood - after a mild pharyngitis 4/13/2015 8 Meningitis Infection chills, fever, malaise, headache lasts 1-2 days can be a transient bacteremia with fever Intracranial pressure headache, vomiting, fever rarely papilledema (edema of the optic disk) possible nuchal rigidity 4/13/2015 9 Differential diagnosis: S. pneumoniae E. coli Hemophilius influenzae N.meningitidis 4/13/2015 10 Age Suscepitbility to Meningiococcus 4/13/2015 11 Age differences Infants rarely signs of meningeal irritation, irritability, refuse food, vomiting, no fever if age less than 2 months, hypothermia Older children and adults fever, altered mental states, severe headache, nausea, vomiting and photophobia acute bacterial meningitis 4/13/2015 12 Meningococcal Disease in USA 4/13/2015 13 Antigenic determinants: serogroup: polysaccharide capsule serotype: outer membrane protein immunotype: lipopolysaccharide 4/13/2015 14 Acute Bacterial Meningitis Neurological signs convulsion, coma, cervical rigidity, thoracolumbar rigidity, hamstring spasm, exaggerated reflexes petechiae (minute hemorrhagic spots in the skin) purpura (hemorrhages into the skin), most common in areas subject to pressure - i.e. axilliary folds, beltline & back 4/13/2015 15 Fulminant Meningococcemia Waterhouse-Frederickson Syndrome high mortality sudden onset patient dies within 24 hours no typical signs of meningitis 4/13/2015 16 Waterhouse-Frederickson Syndrome Symptoms high fever, chills and myalgias (muscular pain) weakness, nausea, vomiting and headache within a few hours, apprehension, restlessness and delirium skin lesions pulmonary insufficiency overwhelmingly disseminated intravascular coagulation with shock - destruction of the adrenal glands 4/13/2015 17 Possible secondary effects from Fulminant Meningococcemia pneumonia arthritis urethritis petechial skin lesions 4/13/2015 18 Gonorrhea 4/13/2015 19 Neisseria gonorrhoeae 1379 cases in Ontario 1994 6 cases Windsor-Essex in same period adherence by pili to mucosal cells invasion of cells capsule: prevents phagocytosis protein I: major surface antigen Lipopolysaccharide: endotoxin IgA Protease: destroys immunoglobulin IgA 4/13/2015 20 N. gonorrhoeae Structure 4/13/2015 21 N. gonorrhoeae pili Attaches to host cells by means of pili Closer attachment of bacteria to host cells is mediated by PII PII is a membrane protein which mediates microcolony formation PI is an outer membrane porin that may form pores in host cell membranes PI could impair the ability of phagocytes to kill the bacteria 4/13/2015 22 4/13/2015 23 Gonorrhea in USA 4/13/2015 24 Incidence of Gonorrhea by Gender in USA 4/13/2015 25 4/13/2015 26 Incidence of B lactamase producing N gonorrhaeae in USA Beta lactamase: hydrolyzes the Betalactam ring in penicillin 4/13/2015 27 4/13/2015 28 Salpinitis 4/13/2015 29 4/13/2015 30 4/13/2015 31 4/13/2015 32 4/13/2015 33 Gonorrhea: Males Men: urethra, purulent discharge, dysuria 27 days after infection (incubation period). Complications: epidydimitis, prostatitis, periurethral abscesses 4/13/2015 34 Gonorrhea: Females Women: frequently asymptomatic. When symptomatic: cervix, vaginal discharge, dysuria, abdominal pain, Ascending genital infection, salpingitis, tubo-ovarian abscess, pelvic inflammatory disease (PID) 4/13/2015 35 Disseminated infections Septicemia, infections of skin and joints in 1-3 % of women more common in women due to untreated symptomatic infections 4/13/2015 36 Clinical: fever, migratory arthralgias, suppurative arthritis in the wrists, knees and ankles, pustular rash on the extremities Ophthalmia neonatorum - purulent conjunctivitis, acquired at delivery 4/13/2015 37 Lab Diagnosis gram stain culture 4/13/2015 38 Gm Stain N. gonorrhoeae Urethral discharge 4/13/2015 39 Treatment: penicillin resistant strains plasmid encoded resistance 4/13/2015 40 The End 4/13/2015 41 N. gonorrhoeae pili ...cont. The gene from il E exhibits phase variation Pil+ to Pil- In addition there are 106 variations in the antigens on the surface There are many reasons why a vaccine cannot be effective 4/13/2015 Although there are many highly conserved 42 Epidemiology of ??? Disease/bacterial factors Transmission Who is at risk Geography/ season Incidence Modes of control 4/13/2015 43 Short Answers Construct a table of the virulence factors associated with ??? and the biological activity of each Use a series of no more than four diagrams to describe the mechanism of ??? activity Describe the clinical manifestions ??? Construct a table listing the common ??? species and the associated human diseases. 4/13/2015 44 Neisseria gonorrhoeae structure X protein I cell wall structure Y 4/13/2015