Lec3
The
Nei
sseri
aceae
ﻣ
ﺤ
ﻤ
ﺪ
ﺃ
ﻧ
ﺴ
ﺎ
. ﻡ
ﺩ
Obj
ect
i
ves
Att
heendoft
hi
sl
ect
ur
et
hest
udentwi
l
lbeabl
et
o:
1-Knowt
het
ypesofNei
sser
i
aspeci
es
2-I
dent
i
f
yt
hechar
act
er
i
st
i
csof
Nei
sseri
agonorrhoea
3-
Knowt
hepat
hogenesi
sandcl
i
ni
cali
nfect
i
onscausedby
Nei
sseri
a
gonorrhoea
4-Knowt
hevi
r
ul
encef
act
or
sof
Nei
sseri
agonorrhoea
5-I
dent
i
f
yt
hel
abor
at
or
ymet
hodsusedi
nt
hedi
agnosi
sof
Nei
sseri
a
gonorrhoea
The
Nei
sseri
aceae
Fami
l
y:Nei
sser
i
aceae
Or
der
:Nei
sser
i
al
es
Phyl
um:Pr
ot
eobact
er
i
a
Gener
a:
Nei
sseri
a,Ki
ngel
l
a,Ei
kenel
l
a
and32ot
hergener
a.
Genus
Nei
sseri
a
Mor
phol
ogy
Genus Nei
sser
i
a ar
e gr
am negat
i
ve cocci
,0.
8 μm i
n di
amet
er
,
fr
equent
l
yoccuri
npai
r
scal
l
eddi
pl
ococciwi
t
hadj
acentf
l
atsi
degi
vet
he
coff
eebeanorki
dneyshapeappear
anceandt
hel
ongaxespar
al
l
el
.I
ti
snon
–mot
i
l
e,nonspor
ef
or
mi
ng,cat
al
aseposi
t
i
veandoxi
daseposi
t
i
ve,capnophi
l
i
c
andi
tr
equi
r
eshumi
dat
mospher
e.
Speci
esofgenusNei
sser
i
a
Non pat
hogeni
c
nei
sser
i
a ar
e nor
mali
nhabi
t
ant
s oft
he human
r
espi
r
at
or
yt
r
act
,r
ar
el
ycausedi
sease,andoccurext
r
a-
cel
l
ul
ar
l
y.Theyar
e
oppor
t
uni
st
i
cpat
hogens.Theygr
owonor
di
nar
ymedi
um (
nut
r
i
entagar
)
Exampl
e:
N.fl
avescens,N.subfl
ava,N.si
cca,N.mucosa,N.l
actami
ca
and
N.pol
ysaccharea,N.ci
nerea.
Pat
hogeni
cSpeci
es
1. N.gonorrhoeae
(
al
socal
l
edgonococcus(
GC)
)i
sal
wayspat
hogeni
c
notanor
malf
l
or
a.
2.
N.meni
ngi
t
i
di
s
(
al
so cal
l
ed meni
ngococcus)canbepr
esentas
commensaloft
heURTofcar
r
i
er
s.
Theyar
epr
i
mar
yhumanpat
hogensandar
ei
nt
r
acel
l
ul
ar
.
Bot
har
efast
i
di
ousr
equi
r
esi
r
onf
orgr
owt
handmet
abol
i
sm.
Nei
sseri
agonorrhoeae
N.gonorrhoeae
causesgonor
r
hea.Humansar
et
heonl
yhostfort
hi
sM.
O.
I
tcausesacut
epyogeni
ci
nf
ect
i
onsoft
henon-
ci
l
i
at
edcol
umnarepi
t
hel
i
um.
Thepr
i
mar
yi
nf
ect
i
onoccur
si
nt
hemucusmembr
aneofur
et
hr
a,endocer
vi
x,
analcanal
,phar
ynx,and conj
unct
i
va.Gonor
r
hea i
ssecond t
o
Chl
amydi
a
t
rachomati
s
asacauseofsexual
l
yt
r
ansmi
t
t
edbact
er
i
ali
nf
ect
i
onandi
t
’
sa
r
epor
t
abl
edi
sease.
Mor
phol
ogy
I
nsmear
sf
r
om t
heur
et
hr
aldi
schar
gei
nacut
egonor
r
hea,t
heor
gani
sm
appear
sasa
Di
pl
ococcus
wi
t
ht
headj
acentsi
desconcavet
ypi
cal
l
yki
dney-
shaped.I
ti
s f
ound pr
edomi
nant
l
y wi
t
hi
n t
he pol
ymor
phs,some cel
l
s
cont
ai
ni
ngasmanyasahundr
edcocci
.
Cul
t
ur
alChar
act
er
i
st
i
cs
Theyar
eaer
obi
c.Gr
owt
hoccur
sbestatpH7.
0-
7.
4atat
emper
at
ur
eof
35–36°Candr
equi
r
es5–10%CO2.
Theygr
owwel
lonchocol
at
eagarandMuel
l
er
–Hi
nt
onagar
.
Thesel
ect
i
vemedi
um i
st
heThayer
–Mar
t
i
nmedi
um (chocol
at
eagar
cont
ai
ni
ng vancomyci
n, col
i
st
i
n and nyst
at
i
n) whi
ch i
nhi
bi
t
s most
cont
ami
nant
s,i
ncl
udi
ngnonpat
hogeni
c
Nei
sseri
a
.
Col
oni
esar
esmal
l
,r
ound,t
r
ansl
ucent
,convexorsl
i
ght
l
yumbonat
e,wi
t
h
fi
nel
ygr
anul
arsur
f
aceandl
obat
emar
gi
nsaf
t
eri
ncubat
i
onf
or24hour
s.They
ar
esoftandeasi
l
yemul
si
f
i
abl
e.
Typesofgonococci
:gonococcidi
vi
dedi
nt
of
i
vet
ypes(
T1–T5)ont
he
basi
sofcol
oni
alappear
ance,aut
o-
aggl
ut
i
nabi
l
i
t
yandvi
r
ul
ence.
Types1and2f
or
m smal
lbr
owncol
oni
esandhavenumer
ousf
i
mbr
i
ae
(
pi
l
i
at
edt
ypesP1andP2)
.Theyar
eaut
o-
aggl
ut
i
nabl
eandvi
r
ul
entandal
so
knownasP+andP++
TypesT3andT5ar
enon-
pi
l
i
at
ed(
P–)
,f
or
m smoot
hsuspensi
onsandar
e
avi
r
ul
ent
.Theyar
eknownasP–.
Bi
ochemi
calReact
i
ons
1- Oxi
daseposi
t
i
ve
2- Fer
mentonl
ygl
ucose
Ant
i
geni
cst
r
uct
ur
eandVi
r
ul
encefact
or
s:
Gonococcus(
GC)i
sant
i
geni
cal
l
yhet
er
ogenousandt
hi
sant
i
geni
c
var
i
at
i
onal
l
owst
heMOt
oevadet
hei
mmunesyst
em.Sur
f
acest
r
uct
ur
es
i
ncl
ude:
1.
Li
pool
i
gosacchar
i
de (
LOS)or(
endot
oxi
n)
:i
s a maj
ori
n vi
vo
vi
r
ul
encef
act
ort
hatmedi
at
esdamaget
obodyt
i
ssues.
2.
Pi
l
i
:Pi
l
iar
e hai
r
-
l
i
ke appendages t
hatext
end up t
o sever
al
mi
cr
omet
er
sf
r
om t
hegonococcalsur
f
ace.Theyactasvi
r
ul
encef
act
or
sbya-
pr
omot
i
ngat
t
achmentt
ohostcel
l
s,b-
i
nhi
bi
t
i
ngphagocyt
osi
sandc-
hel
psi
n
t
heexchangeoft
hegenet
i
cmat
er
i
al
sbet
weent
hecel
l
s.d-mot
i
l
i
t
y.Pi
l
i
under
goant
i
geni
candphasevar
i
at
i
on.
3.
Out
ermembr
anepr
ot
ei
ns:
a. Pr
ot
ei
nI(Por
B):t
hemaj
orout
ermembr
anepor
i
npr
ot
ei
nf
or
m
channel
sf
ornut
r
i
ent
st
opassi
nt
oandwast
epr
oductt
oexi
tt
hecel
li
tal
so
pr
ot
ect
sagai
nsthosti
nfl
ammat
or
yr
esponse.
b. Pr
ot
ei
nI
I(
Opaforopaci
t
y)agr
oupofpr
ot
ei
nt
hatf
aci
l
i
t
at
ebact
er
i
al
adher
encet
oeachot
herandt
oeukar
yot
i
ccel
l
s.
c. Pr
ot
ei
n I
I
I(r
educt
i
on modi
fi
ed pr
ot
ei
n [
RMP]
)bl
ocks t
he host
ser
um bact
er
i
ci
di
al(
I
gG)act
i
onagai
nstt
heor
gani
sm.
4.
I
ronr
epr
essi
bl
epr
ot
ei
ns:t
hesear
epr
oducedundercondi
t
i
onof
i
r
onst
ar
vat
i
onoranaer
obi
osi
s.
5.
I
gA1pr
ot
easeswhi
chhydr
ol
yzet
heI
gA1butnotI
gA2att
hehi
nge
r
egi
on.
6.
Pl
asmi
d:pl
asmi
d bor
n vi
r
ul
ence of
N.gonorrhoeae
i
s mai
nl
y
associ
at
edwi
t
hant
i
mi
cr
obi
alr
esi
st
ance.
7.
β-
l
act
amasewhi
chdegr
adespeni
ci
l
l
i
n.
Cl
i
ni
cali
nfect
i
ons:
Thedi
seasei
sacqui
r
edbysexualcont
act
.Thei
ncubat
i
onper
i
odi
s2–8
days.Gonococcali
nf
ect
i
onsar
emost
l
yasympt
omat
i
candundi
agnosed;t
hi
s
l
eadst
ospr
eadoft
hei
nf
ect
i
on.
1. I
nmenacut
eur
et
hr
i
t
i
susual
l
ywi
t
hpur
ul
entdi
schar
geanddysur
i
a.
Asympt
omat
i
c i
nf
ect
i
on i
s uncommon (
3-
5%)
.Compl
i
cat
i
on i
s ascendi
ng
i
nf
ect
i
oni
ncl
udi
ngpr
ost
at
i
t
i
sandepi
di
dymi
t
i
s.Chr
oni
cur
et
hr
i
t
i
smayl
eadt
o
st
r
i
ct
ur
ef
or
mat
i
on.
2. I
nwomen50%ofcasesar
easympt
omat
i
c.Theendocer
vi
xi
smost
commonsi
t
eofi
nf
ect
i
on.Thei
nf
ect
i
onmayext
endt
ot
heendomet
r
i
um and
f
al
l
opi
ant
ubest
ogi
ver
i
set
oacut
esal
pi
ngi
t
i
s
,
whi
chmaybefol
l
owedby
pel
vi
ci
nfl
ammat
or
ydi
seaseandahi
ghpr
obabi
l
i
t
yofst
er
i
l
i
t
y.Per
i
t
oneal
spr
ead occasi
onal
l
yoccur
sand maypr
oducea per
i
hepat
i
ci
nfl
ammat
i
on
(
Fi
t
z–Hugh–Cur
t
i
ssyndr
ome)wher
et
hei
nfect
i
onspr
eadt
ot
hel
i
vercapsul
e
(
Vi
ol
i
nst
ri
ngadhesi
on)
.
Pr
oct
i
t
i
soccur
si
nbot
hsexes.
Conj
unct
i
vi
t
i
smayoccurusual
l
ybyaut
oi
nocul
at
i
onwi
t
hf
i
nger
s.
3. Opht
hal
mi
aneonat
or
um:i
sanon-
vener
eali
nf
ect
i
oni
nt
henewbor
n,
i
nwhi
cht
heeyesar
ecoat
edwi
t
hgonococciast
hebabypassesdownt
he
bi
r
t
hcanal
.Asever
epur
ul
enteyedi
schar
gewi
t
hper
i
-
or
bi
t
aledemaoccur
s
wi
t
hi
nafewdaysofbi
r
t
h.I
funt
r
eat
ed,l
eadsr
api
dl
yt
obl
i
ndness.
4.
Di
ssemi
nat
edgonococcaldi
sease:Bl
oodi
nvasi
onmayoccurfr
om
t
hepr
i
mar
ysi
t
eofi
nf
ect
i
onandmayl
eadt
omet
ast
at
i
cl
esi
onssuchas
ar
t
hr
i
t
i
s,ul
cer
at
i
veendocar
di
t
i
sandr
ar
el
ymeni
ngi
t
i
s.
Di
agnosi
s:
Gonococcus
i
saver
ydel
i
cat
eor
gani
sm,r
eadi
l
yki
l
l
edbydr
yi
ng.
1. Speci
mens:pusandsecr
et
i
onsar
et
akenfr
om:
I
nmal
e:fr
om t
hepur
ul
entdi
schar
georur
et
hr
alswabi
nser
t
ed2-
3cm i
nt
o
t
heur
et
hr
aandr
ot
at
edsl
owl
y.
I
nfemal
es:endocer
vi
calswab(
ahi
ghvagi
nalswabi
snotsui
t
abl
e)
Rect
alswabs:i
nser
t
ed4-
5cmi
nt
heanalcanal
Conj
unct
i
va,t
hr
oat
,orsynovi
alfl
ui
df
orcul
t
ur
eandsmear
.
Bl
oodcul
t
ur
ei
snecessar
yi
nsyst
emi
ci
l
l
ness
Theswabsshoul
dnotbecot
t
onswabsbecausemayi
nhi
bi
tt
hegr
owt
hof
t
heMO,soweuseDacr
onswabsandt
hesampl
eshoul
dbepl
at
edsoonor
kepti
nt
r
anspor
tmedi
um asAmi
est
r
anspor
tmedi
um andshoul
dbepl
at
ed
wi
t
hi
n6hour
satr
oomt
emper
at
ur
enoti
nt
hefr
i
dge.
2. Smear
s:gr
am st
ai
nofswabsr
evealmanydi
pl
ococcii
nsi
det
hepus
cel
l
s.St
ai
nedsmear
soft
heur
et
hr
alexudat
efr
om mencor
r
el
at
eswi
t
ht
he
cul
t
ur
ei
n 95%.St
ai
ned smear
sofendocer
vi
calexudat
escor
r
el
at
eswi
t
h
cul
t
ur
ei
n50-
70%.
3. Cul
t
ur
e:Avar
i
et
yofenr
i
chedcul
t
ur
emedi
ausedfori
sol
at
i
onofGC
i
ncl
ude
a. Modi
f
i
edThayerMar
t
i
n(
MTM)
b. GCLectmedi
a
c. NewYor
kCi
t
y(
NYC)medi
a.
Ant
i
bi
ot
i
csar
eaddedt
omaket
hemedi
amor
esel
ect
i
ve.Thecul
t
ur
ei
s
i
ncubat
edwi
t
h3-
7%CO2(
candl
ej
ar
)atmoi
st35-
37C°f
or24-
72hr
.
Col
oni
esar
econvex,gl
i
st
eni
ng,el
evat
ed,mucoi
dcol
oni
es1–5mm i
n
di
amet
er
,t
r
anspar
entoropaque,non-
pi
gment
ed,andnon-
hemol
yt
i
c.
I
dent
i
fi
cat
i
oni
smadebycul
t
ur
echar
act
er
i
st
i
csandcol
oni
esmor
phol
ogy,
oxi
daset
est(
posi
t
i
ve)andsugarut
i
l
i
zat
i
ont
est
.
MO
Gl
ucose Mal
t
ose Sucr
ose
N.gonorrohoeae
+
-
-
N.meni
ngi
t
i
des
+
+
-
N.mucosa
+
+
+
Moraxel
l
a
-
-
-
4. Geneti
c Probes:
Pr
obes speci
f
i
c f
ort
he nucl
ei
c aci
ds of
N.
gonorrhoeae
havebeendevel
oped f
ort
hedi
r
ectdet
ect
i
onofbact
er
i
ai
n
cl
i
ni
calspeci
mens.
5.
Serol
ogi
calDi
agnosi
s
Noser
ol
ogi
calt
esthasbeenfoundusef
ulf
or
r
out
i
nedi
agnost
i
cpur
poses.
Tr
eat
ment
Cur
r
ent
l
y,t
he Cent
er
s f
or Di
sease Cont
r
oland Pr
event
i
on (
CDC)
r
ecommendst
hatcef
t
r
i
axone,cef
i
xi
me,ci
pr
of
l
oxaci
n,orof
l
oxaci
nbeusedas
t
he i
ni
t
i
alt
her
apyforcasesofuncompl
i
cat
ed gonor
r
hea.Doxycycl
i
ne or
azi
t
hr
omyci
nshoul
dbeaddedf
ori
nf
ect
i
onscompl
i
cat
edbyduali
nf
ect
i
ons
wi
t
h
Chl
amydi
a
I
mmuni
t
y
Repeat
edgonococcali
nf
ect
i
onsar
ecommon.Pr
ot
ect
i
vei
mmuni
t
yt
or
e-
i
nf
ect
i
ondoesnotappeart
odevel
opaspar
toft
hedi
seasepr
ocess,because
oft
heant
i
geni
cvar
i
at
i
onofgonococci
.
References
1-Koneman'
scol
orat
l
asandt
ext
bookofdi
agnost
i
cmi
cr
obi
ol
ogy7
t
h
edi
t
i
on,
2017.
2-Bai
l
eyandScot
t
'
sDi
agnost
i
cMi
cr
obi
ol
ogy14
t
h
edi
t
i
on,2017.
3-Jawet
z,Mel
ni
ckandAdel
ber
g'
smedi
calmi
cr
obi
ol
ogy26
t
h
edi
t
i
on,2013.