Neisseria Gonorrhoeae

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Neisseria gonorrhoeae

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DOC = Ceftriaxone (Doxycycline usually added b/c often co-infected w/ Chlamydia)

Gram (-), oxidase positive, capnophile, no capsule, infects humans exclusively

Virulence Factors:
1.) Pili - Initial attachment. Can turn pili off (phase variation) or change pili (antigenic variation)
2.) Opacity proteins (Opa) - Tight adherence to specific tissue, invasion into host cells. Antigenic variation by changing # of short repeats found in DNA (frame-shift mutation)
3.) PorB - Type A & B. Type A in disseminated strains b/c blocks factor H of complement for resistance in serum. Can translocated into host membrane. No antigenic variation
4.)Transferrin receptor - made of TbpA and TbpB. Utilizes human transferrin for iron source. No antigenic variation
5.)LOS - Endotoxin that causes most damage (antigenic variation). Sialic acid from host binds and induces molecular mimicry in LOS.
6.) Peptidoglycan fragments - contribute to inflammatory response)
7.) IgA1 protease - cleaves IgA

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Antibiotic resistance to Neisseria ghonorrhoeae

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1.) PPNG - Penicillin-resistance plasma that produces beta-lactamase
2.) TRNG - plasmid that causes Tetracycline resistance
3.) penA - altered penicillin binding protein
4.) penB - reduced permeability of porin
5.) gyrA - DNA gyrase less sensitive to Quinolone (QRNG)
6.) mtr - efflux pump

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Pelvic inflammatory disease (PID)

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Often in women infected w/ ghonorrhea

Ascending infection of urogenital tract (endometritis, salpingitis, ovarian abscess, etc.)

Often other organisms like Chlamydia contribute

Present w/ lower abdominal pain following menses by a few days

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Other diseases caused by Neisseria gonorrhoeae

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1.) Anorectal infection
2.) Pharyngeal infection after oral sex
3.) Conjuctivitis - in adults after self-inoculation w/ genital infection (severe)
4.) Fitz-Hugh-Curtis syndrome - hepatic disease caused by spread from fallopian tube to liver
5.) Disseminated gonococcal infection (DGI) - Most common cause of septic arthritis in young adults
6.) Opthalmia neonatorum - conjunctivitis in neonates that can lead to blindness caused by passing through birth canal (neonates now given protective antimicrobial eye drops)

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2 morphologic forms of Chlamydiae in its life-cycle

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EB - bind phagosome , but don't divide. Once inside, reorganizes to RB

RB - Undergoes binary fission. Once they divide they turn back into EB and are released by the cell

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Chlamydiae trachomatis

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DOC = Tetracycline, Doxycycline

Gram (-), obligate intracellular organism, no typical peptidoglycan (MOMP and CRPs provide strength instead)

Often detected via immunofluorescence, but cell culture is most specific

Trachoma biovar:
1.) Trachoma - inflammation and follicle formation that involves entire conjunctiva, scarring of cornea, inflammation interferes w/ tear flow. Transmitted by eye droplets
2.) Chlamydia - caused by serovars D-K. Asymptomatic in women. Can cause PID, sterility, ectopic pregnancy. Symptomatic in men (urethral discharge and dysuria)
3.) Inclusion Conjunctivitis - caused by serovars of genital infection (D-K). Can be in adults or picked up in infants during birth. Purulent discharge from eyes, corneal scarring.

LGV Biovar:
1.) Lymphogranuloma venereum - primary lesion at site of infection, then inflammation and swelling of associated lymph nodes (can rupture) (L serobars)
2.) Ocular lymphogranuloma venereum - same thing, but in eye.

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Chlamydiae psittaci

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DOC = Tetracycline or erythromycin

Infection by inhaling dried bird feces (no person-to-person spread)

Infects lungs and causes pneumonia w/ nonproductive cough

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Chlamydiae pneumoniae

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DOC = Tetricycline and erythromycin

Causes "walking pneumonia"

Transmitted by respiratory droplets