Lec4
Fami
l
y
Nei
sseri
aceae
ﻣ
ﺤ
ﻤ
ﺪ
ﺃ
ﻧ
ﺴ
ﺎ
. ﻡ
ﺩ
Obj
ect
i
ves
1-Toi
dent
i
fyt
hechar
act
er
i
st
i
csof
Nei
sseri
ameni
ngi
t
i
di
s
2-I
dent
i
fyt
hel
abor
at
or
ydi
agnosi
sof
Nei
sseri
ameni
ngi
t
i
di
s
3-Knowt
hecl
i
ni
caldi
seasescausedby
Nei
sseri
ameni
ngi
t
i
di
s
4-Li
stt
hei
mpor
t
antvi
r
ul
encechar
act
er
i
st
i
csof
Nei
sseri
ameni
ngi
t
i
di
s
5-Di
f
fer
ent
i
at
ebet
ween
Nei
sseri
agonorrhoeaandNei
sseri
ameni
ngi
ti
di
si
nt
he
l
abor
at
or
y
Nei
sseri
ameni
ngi
ti
di
s
NM l
i
keot
herNei
sser
i
aar
egr
am negat
i
veki
dneyshaped,butchar
act
er
i
zed
bybei
ngcapsul
at
edandfer
mentgl
ucoseandmal
t
ose.I
tcanbefoundi
n3-
5%of
asympt
omat
i
c peopl
e. I
t can cause endemi
c and epi
demi
c meni
ngi
t
i
s,
meni
ngeococcemi
aandpneumoni
a.
Morphol
ogy
Meni
ngococciar
egram-
negat
i
veovalorspher
i
calcocci(
0.
6–0.
8μm i
n
si
ze)
,t
ypi
cal
l
yar
r
angedi
npai
r
s,wi
t
ht
headj
acentsi
desfl
at
t
enedorconcave
opposi
ngedgesandt
hel
ongaxespar
al
l
el
.
They ar
e t
ypi
cal
l
y seen i
n l
ar
ge number
s i
nsi
de pol
ymor
phonucl
ear
l
eukocyt
es.Mostf
r
eshi
sol
at
esar
ecapsul
at
ed.Theyar
enon-
spor
i
ngandnon-
mot
i
l
e.
Cul
t
uralCharact
eri
st
i
cs
Meni
ngococcinotgr
ow on or
di
nar
y medi
a.Gr
owt
h occur
s on medi
a
enr
i
chedwi
t
hbl
ood,ser
um orascet
i
cfl
ui
d.Theyar
est
r
i
ctaer
obes.Theopt
i
mum
t
emper
at
ur
eforgr
owt
hi
s35–36°C.Gr
owt
hi
sf
aci
l
i
t
at
edby5–10%CO2andhi
gh
humi
di
t
y.
Bl
ood agar
,chocol
at
e agarand Muel
l
er
–Hi
nt
on agarar
e t
he medi
a
commonl
yused f
orcul
t
ur
i
ng meni
ngococci
.Modi
fi
ed Thayer–Mar
t
i
n (
wi
t
h
vancomyci
n,col
i
st
i
nandnyst
at
i
n)i
sausef
ulsel
ect
i
vemedi
um.
Onbl
oodagaraf
t
er24hour
si
ncubat
i
on,col
oni
esar
e1–2mm i
ndi
amet
er
,
r
ound,convex,gr
ay,t
r
ansl
ucentandnonhemol
yt
i
c.
Bi
ochemi
calReact
i
ons
1.Theyar
ecat
al
aseandoxi
daseposi
t
i
ve.
2.Sugarfer
ment
at
i
on:Meni
ngococcif
er
mentgl
ucoseandmal
t
osewi
t
ht
he
pr
oduct
i
onofaci
dbutnogas.
Vi
r
ul
encefact
or
s:
1.
Capsul
arpol
ysacchar
i
de:i
sani
mpor
t
antvi
r
ul
encefact
orbecausei
t
i
nhi
bi
tphagocyt
osi
sandenhancesor
gani
sm sur
vi
valdur
i
ngbl
oodst
r
eam and
CNSi
nvasi
on.Al
sot
hecapsul
ei
sant
i
geni
candcl
assi
f
yNM i
nt
o13ser
ogr
oups
mosti
mpor
t
antar
eA,B,C,YandW-
135whi
char
eassoci
at
edwi
t
hepi
demi
cs.
2.
Pi
l
i
:pi
l
imedi
at
e at
t
achmentofmo t
o t
he epi
t
hel
i
all
i
ni
ng oft
he
nasophar
ynx.
3.
Out
ermembraneprot
ei
ns
1)Por
AandPor
Bmeni
ngococcalpor
i
npr
ot
ei
n.
2)Opa and Opcpr
ot
ei
n:I
tfaci
l
i
t
at
eadher
encet
o di
ffer
entcel
l
s.Opc
funct
i
oni
nmucosaladher
enceandi
nvasi
onofendot
hel
i
alcel
l
s.
3)I
r
onbi
ndi
ngpr
ot
ei
nsameasGC.
4.
LOSsameasGC.
5.
I
gApr
ot
easesameasGC.
6.
Pl
asmi
ds:ar
euncommoni
nNM.Howeverbet
al
act
amasesencodi
ng
pl
asmi
dsfr
omGCcanbet
r
ansfer
r
edt
oNM.
Cl
i
ni
cali
nfect
i
ons
NM i
shi
ghl
ycont
agi
oust
r
ansmi
t
t
edbyr
espi
r
at
or
ysecr
et
i
ons.Humans
ar
et
heonl
ynat
ur
alhost
sforwhom meni
ngococciar
epat
hogeni
c.Ther
ear
e
t
hr
eest
agesofmeni
ngeococcali
nfect
i
ons
Fi
rst Stage—Nasopharyngeal I
nfecti
on The organi
sms appear i
n
nasophar
ynx l
eadi
ng t
o nasophar
yngeal i
nfect
i
on, whi
ch i
s usual
l
y
asympt
omat
i
c.
SecondStage—Meni
ngococcalSepti
cemi
aI
nasmal
lper
cent
ageofcases,
t
hemeni
ngococcient
ert
hebl
oodst
r
eam f
r
om t
hepost
er
i
ornasophar
ynx.Thi
s
st
agei
scal
l
edmeni
ngococcemi
a.Thepat
i
entdevel
opsfever
,mal
ai
seand
pet
echi
alski
nl
esi
ons.
Theor
gani
smsmayal
socausel
esi
onsi
nt
hej
oi
nt
sandl
ungsandr
ar
el
y
causemassi
vebi
l
at
er
alhemor
r
hagesi
nt
headr
enal
s(
Wat
erhouse–Fr
i
deri
chsen
syndr
ome)
.I
ti
sanover
whel
mi
ngandusual
l
yf
at
alcondi
t
i
on,char
act
er
i
zedby
shock,di
ssemi
nat
edi
nt
ravascul
arcoagul
at
i
on(DI
C)andmul
t
i
syst
em fai
l
ure.
Meni
ngococcaldi
seasei
sfavor
edbydef
i
ci
encyoft
het
er
mi
nalcompl
ement
component
s(
C5–C9)al
soi
naspl
eni
cpat
i
ent
s.
Thi
rdStage—Meni
ngi
ti
s
I
nt
het
hi
r
dst
ageofmeni
ngococcali
nf
ect
i
on,t
heor
gani
smscancr
osst
he
bl
ood–br
ai
nbar
r
i
erandi
nf
ectt
hemeni
nges.I
nmeni
ngi
t
i
s,t
hemeni
ngesar
e
acut
el
y i
nf
l
amed,wi
t
h t
hr
ombosi
s of bl
ood vessel
s and exudat
i
on of
pol
ymor
phonucl
earl
eukocyt
es,sot
hatt
hesur
f
aceoft
hebr
ai
ni
scover
edwi
t
ha
t
hi
ckpur
ul
entexudat
e.Casefat
al
i
t
yi
svar
i
abl
ebuti
nunt
r
eat
edcasesmaybeas
hi
ghas80%.Sur
vi
vor
smayhavesequel
aesuchasbl
i
ndnessanddeafness.
Ful
mi
nant meni
ngococcemi
a i
s mor
e sever
e,wi
t
h hi
gh f
ever and
hemor
r
hagi
cr
ash.Ther
emaybei
nt
er
st
i
t
i
almyocardi
t
i
s,art
hri
t
i
s,and ski
n
l
esi
ons.
Lab.Di
agnosi
s:
1.Speci
mensi
ncl
udeCSF,bl
ood,nasophar
yngealswab,aspi
r
at
esfr
om
ski
nl
esi
onsorpus.
2.Gram st
ai
n of cyt
ocent
r
i
fuged CSF (
i
nt
r
acel
l
ul
ar gr
am negat
i
ve
di
pl
ococci
)
.
3.Cul
t
ureonsel
ect
i
veandnon-
sel
ect
i
vemedi
a(
SBAorCHOC)
.i
ncubat
ed
at37°C,humi
di
t
yand5%CO
2
(
candl
ej
ar
)
.Amodi
f
i
edThayer
-
Mar
t
i
nmedi
umwi
t
h
ant
i
bi
ot
i
cs(
vancomyci
n,col
i
st
i
n,amphot
er
i
ci
n)favor
st
hegr
owt
hof
Nei
sseri
ae,
i
nhi
bi
t
smanyot
herbact
er
i
a.
4.Bi
ochemi
calt
est
s:
Oxi
dase,cat
al
aseandCHO ut
i
l
i
zat
i
on(
gl
ucoseand
mal
t
ose)
.
5.Lat
exaggl
ut
i
nat
i
ont
odet
ectgr
oupspeci
fi
csur
faceAgofNM.Theydo
notr
epl
acegr
am st
ai
norcul
t
ur
e.
6.Ser
ol
ogi
caldi
agnosi
sbyhaeaggl
ut
i
nat
i
ont
estorELI
SA
7.
PCR
Tr
eat
ment
:
TheDOCfort
r
eat
mentofNM meni
ngi
t
i
si
speni
ci
l
l
i
n,butr
i
fampi
ci
nor
sul
f
onami
de r
ecommended as pr
ophyl
axi
s f
orcl
ose cont
act
.Pat
i
entwi
t
h
meni
ngococcemi
ai
sbestt
r
eat
edwi
t
h3
r
d
gener
at
i
oncephal
ospor
i
ns.
Meni
ngococcalVacci
ne:
The new meni
ngococcalvacci
ne l
i
ke pr
evi
ous quar
i
val
entvacci
ne,
cont
ai
npol
ysacchar
i
deant
i
genst
oser
ogr
oupsA,C,Y,andW-
135conj
ugat
edt
o
di
pht
her
i
at
oxoi
dpr
ot
ei
n,t
hi
sconj
ugat
evacci
nei
sexpect
edt
opr
ovi
del
ongt
er
m
i
mmuni
t
ywhi
chi
sgr
oupspeci
fi
c.I
tcanbeadmi
ni
st
er
edt
ochi
l
dr
enol
dert
han2
year
s.Thevacci
necannotbeadmi
ni
st
er
edt
ochi
l
dr
eni
nyoungeragegr
oups
becauset
heydonotr
espondt
opol
ysacchar
i
deant
i
gens.Thi
svacci
nedoesnot
pr
ot
ectf
r
om i
nf
ect
i
onscausedbygr
oupB,becausegr
oupBpol
ysacchar
i
dei
s
ver
ypoori
mmunogeni
nhuman.
I
ti
sr
ecommendedt
obegi
vent
ost
udent
s11-
12year
sofage,t
hose
ent
er
i
ng hi
gh school
,mi
l
i
t
ar
yr
ecr
ui
t
s,aspl
eni
cpat
i
ent
s,t
r
avel
ert
o ar
eaof
epi
demi
cs,andLabper
sonnel
.
Meni
ngeococci
Gonococci
havepol
ysacchar
i
decapsul
es
donot
r
ar
el
yhavepl
asmi
ds
mostgonococcido
found i
n t
he upperr
espi
r
at
or
y
t
r
actandcausemeni
ngi
t
i
s
gonococci
cause
geni
t
al
i
nfect
i
ons
Ut
i
l
i
zesgl
ucoseandmal
t
ose
Ut
i
l
i
zesgl
ucoseonl
y
OtherNei
sseri
ae
Nei
sseri
al
act
ami
caveryrarel
ycausesdi
seasebuti
si
mpor
t
antbecausei
t
gr
owsi
nt
hesel
ect
i
vemedi
a(
eg,modi
fi
edThayer
-
Mar
t
i
nmedi
um)usedfor
cul
t
ur
esofgonococciandmeni
ngococcifr
om cl
i
ni
calspeci
mens.
Nl
act
ami
ca
canbecul
t
ur
edfr
om t
henasophar
ynxof3–40%ofper
sonsandmostoft
eni
s
f
oundi
nchi
l
dr
en.Unl
i
ket
heot
hernei
sser
i
ae,i
tf
er
ment
sl
act
ose.
Moraxel
l
a(Branhamel
l
a)Catarrhal
i
s
Morphol
ogy
Theyar
eovalgr
am-
negat
i
vecocci
.Theyar
enon-
capsul
at
edandnon-
mot
i
l
e.
Cul
turalCharacteri
sti
cs
Theyar
e aer
obes.Mostst
r
ai
ns gr
ow on nut
r
i
entagar
,bl
ood agaror
chocol
at
eagar
.
Bi
ochemi
calReacti
ons
∙
∙I
ti
soxi
daseposi
t
i
veandcat
al
aseposi
t
i
ve
∙
∙I
tdoesnotpr
oduceaci
df
r
om gl
ucose,mal
t
ose,sucr
ose,l
act
oseor
fr
uct
ose
∙
∙I
tr
educesni
t
r
at
et
oni
t
r
i
t
e.
Pathogenesi
s
Theyf
or
m par
toft
henor
malphar
yngealf
l
or
abutcancauser
espi
r
at
or
y
i
nf
ect
i
ons,i
ncl
udi
ngot
i
t
i
smedi
a,si
nusi
t
i
s,t
r
acheobr
onchi
t
i
sandpneumoni
a.
Mostst
r
ai
nsof
M catarrhal
i
sfrom cl
i
ni
cal
l
ysi
gni
fi
canti
nfect
i
onspr
oduceβ-
l
act
amase.
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.