Gram-negative Cocci Gram-negative bacilli Miklos Fuzi Neisseria Pyogenic Cocci GRAM - Aerobic: Oxidase + Neisseria N. gonorrhoeae N. meningitidis others (N. sicca, N. subflava, N. flavescens and apathogenic spp.) Moraxella M. catarrhalis Anaerobic: Veillonella spp. Veillonellae vietsciences.free.fr N. gonorrhoeae and N. meningitidis Morphology Gram-negative Diplococci www.waterscan.co.yu/images Gram-negative Diplococci path.upmc.edu N. gonorrhoeae and N. meningitidis Oxidase + Culture: Special demands Nutrient rich medium (Chocolate agar and 5-10% CO2) Resistance: Sensitive bacteria: Dry, Heat, Disinfectants, Antibiotics path.upmc.edu http://www.mfi.ku.dk/ppaulev/chapter33/images/33-3.jpg N. gonorrhoeae = Gonococcus Antigens and Virulence factors: Pili/Fimbriae (Antigenic variations!) IgA-Proteases! outer membrane proteins (OMP) (Antigenic variations!) LOS (Mimicry!- sialiation in serum prevents immune response) Cell-wall Peptidoglycan (Toxic) Inhibits apoptosis in macrophages (prevention of immune response) N. gonorrhoeae = Gonococcus N. gonorrhoeae = Gonococcus Pili textbookofbacteriology.net N. gonorrhoeae = Gonococcus Gonococcus-Lymphocyte Interaction neisseria.org/images/ng-lym2.jpg N. gonorrhoeae = Gonococcus Source of infection Sick humans Transmission - Direct (sexual) Contact Clinical findings Gonorrhea = Tripper Ophthalmoblenorrhea neonatorum NO IMMUNITY! (Antigenic variations!) Pathogenesis Medmicro Gonorrhea – acute Urethritis www.stdservices.on.net www.boltonlgb.co.uk Gonorrhea – acute Urethritis Gonorrhea – acute Cervicitis www.boltonlgb.co.uk Gonorrhea – acute Cervicitis Gonorrhea – acute Conjuctivitis Blenorrhea neonatorum www.mc3.edu Corneal ulcers due to gonococcus are very destructive and have a tendency to perforate the cornea. www.slackbooks.com Gonorrhea – Chronic and disseminated Form Endometritis, Salpingitis, Prostatitis purulent Arthritis , Vasculitis Important! anorectal GO and Pharyngitis („alternative Genitals”) Fig. 8.33 Gonococcal arthritis. Dactylitis secondary to gonococcal bacteriaemia. By courtesy of Dr. S.E. Thompson Fig. 8.33 Gonococcal septic arthritis. Arthritis due to N. gonorrhoeae in a 24-year-old woman, showing marked erythema and swelling of the right ankle and leg. By courtesy of Dr. T.F. Sellers Jr. Gonorrhea – Diagnosis – acute Disease Microscopic www2.mf.uni-lj.si, www.uni-ulm.de , Direct detection – phagocytosed diplococci pathmicro.med.sc.edu Gram staining Methylenblue staining, Direct Immunofluorescent (DIF) GO – Gram staining – presumptive Diagnosis only! GO – Gram staining – only presumptive Diagnosis! www.med.uni-giessen.de Gonorrhea – Diagnosis Culture : „bedside” Thayer-Martin medium and chocolate agar, 5% CO2 Identification: ox+, glu+, mal- Antigen detection (direct): Latex-agglutination Detection of bact. DNA: PCR www2.mf.uni-lj.si, www.uni-ulm.de , pathmicro.med.sc.edu Gonorrhea Therapy: 3. Generation Cephalosporin (Ceftriaxone) or Spectinomycin (Aminoglycoside) Prophylaxis: GO - Exposition (safe sex) - Source of infection: find and treat! - Early Diagnosis and treatment www.tiscali.co.uk Ophthalmia neonatorum: Application of 1% silver-nitrate in conjunctival sack NO VACCINE! (Antigenic variants!) N. meningitidis = Meningococcus scanning EM textbookofbacteriology.net N. meningitidis = Meningococcus Antigens and Virulence factors: Capsule – Polysaccharide, antiphagocytic Multiple serotypes (A, B, C, W135, Y!) Capsule change Pili/Fimbriae IgA-Proteases! Outer Membrane Proteins (OMP) LOS (Mimicry, sialisation: Serum resistant, very toxic) Meningococcus zdsys.chgb.org.cn N. meningitidis = Meningococcus Source of infection human – carriers (sick, healthy) Transmission, Portal of entry - Direct, drop-infection - Nose, throat Clinical finding Pharyngitis Meningitis cerebrospinalis epidemica Sepsis = Waterhouse-Friderichsen Syndrome Fig. 10.56 Acute meningococcaemia. Note the variable size of the lesions and their peripheral distribution. Some of the lesions are obviously purpuric, others macular or papular. Fig. 10.60 Acute meningococcaemia. Petechia on bulbar conjunctiva. Fig. 10.62 Acute meningococcaemia. Gangrene of the extremities following a near-fatal illness with hypotension. Fig. 10.63 Acute meningococcaemia. Gangrene of both legs in a black man with acute meningococcal infection. Bilateral below knee amputations were later required. The characteristic skin rash of meningococcal septicaemia, caused by Neisseria meningitidis . (Courtesy of Wellcome Trust Photographic Library) srs.dl.ac.uk ufl. © Urban © Urban & Fischer 2003 – A Roche LexikonMedizin, 5. Waterhouse- Friderichsen Syndrome: schwere nekrotisierende Hautläsionen bei Meningokokkensepsis mit Verbrauchskoagulopathie (R. E. Rieger, Univ.-Kinderklinik Marburg). www.gesundheit.de The patient with Waterhouse-Friderichsen syndrome has sepsis with DIC and marked purpura. medlib.med.utah.edu pathy.fujita-hu.ac.jp Purulent meningitis with hemorrhage in the frontal lobe (gross findings). Acute hemorrhage in bilateral adrenals caused acute adrenal insufficiency (Waterhouse-Friderichsen syndrome). pathy.fujita-hu.ac.jp Meningitis Diagnosis Samples, specimen: Liquor (cerebrospinal fluid) ! – Lumbar punction Blood carriers: throat Meningitis Diagnosis Detection Microscopic examination (Liquor, blood culture) Culture Liquor, Blood, Throat Direct detection of antigen (Liquor) – Latex-agglutination Direct detection of bact. DNA Real-time PCR from blood, CSF Diagnosis N. meningitidis Culture: Bloodagar, Chocolate agar Identification: glu+, mal+ MIC (E-test) Meningococcus meningitis Therapy: Penicillin and/or Ceftriaxone; cefotaxime NO Beta-lactamase production Prophylaxis: Active Immunisation Vaccine for: - Risk groups - Traveler (Meningitis belt!) Chemoprophylaxis: Ciprofloxacin; rifampicin (Contacts) Meningitis belt Neisseria meningitidis - B Europe! NO VACCINE! Rifampicin only www.versapharm.com Haemophilus GRAM-NEGATIVE COCCOBACILLI Genus Species Haemophilus H. influenzae H. parainfluenzae H. aegyptius H. ducreyi Bordetella B. pertussis B. parapertussis P: Pathogen Haemophilus influenzae Morphology: Gram - Coccobacillus, ca. 1 µm Cultivation: Growth factors ! (chocolate, X= Haem, V= NAD, Satellite-phenomenon; Satellitism www.waterscan.co.yu/images phil.cdc.gov Blood agar plate culture showing Haemophilus influenzae satelliting around Staphylococcus aureus. Haemophilus influenzae Antigens and Virulence factors: Capsule – Polysaccharide Types: a, b, c, d, e, f (HiB!) IgA-Protease! Surface antigens: Outer Membrane Proteine (OMP) LPS Haemophilus influenzae Type b (Hib) www.soundmedicine.iu.edu Haemophilus influenzae Clinical findings: Meningitis , Sepsis Cellulitis Upper respiratory tract: Epiglottitis !, Nasopharyngitis, Sinusitis, Otitis media Lower respiratory tract: Bronchitis, Pneumonia, Haemophilus influenzae Sepsis An infant with severe vasculitis with disseminated intravascular coagulation (DIC) with gangrene of the hand secondary to Haemophilus influenzae type b septicemia - prior to the availability of the Hib vaccine. -Image provided by: Visual Red Book on CD-ROM- www.ecbt.org -(2000 Red Book: 25th Edition, Report of the Committee on Infectious Diseases) Haemophilus influenzae Periorbital cellulitis. © Neal Halsy, MD www.cispimmunize.org Haemophilus influenzae Clinical findings: Meningitis , Sepsis Cellulitis Upper respiratory tract: Epiglottitis! , Nasopharyngitis, Sinusitis, Otitis media Lower respiratory tract: Bronchitis, Pneumonia, HiB-epiglottitis Haemophilus influenzae Diagnosis: Samples, specimen LIQUOR! (CSF) Site of infection (Nose, throat, Sputum etc.) Detection: Microscopic, Culture, Capsule Ag detection (Latex-agglutination) Real-time PCR from blood, CSF Therapy: 1. Ampicillin + III. gen. Cephalosporins 2. Ampicillin + Aminoglycosides Prophylaxis: Active Immunisation - HiB Conjugate-Vaccine (Polysaccharide + Protein ) Lipopolysaccharid Extract - Vaccine ibs-isb.nrc-cnrc.gc.ca www.kmhk.kmu.edu.tw Haemophilus ducreyi Causing: Ulcus molle = Chancroid = = soft Chancre Haemophilus aegyptius Causing: Brasilian Purpuric Fever Haemophilus parainfluenzae Pharyngitis, Endocarditis, Conjunctivitis Ulcus molle Ulcus molle medinfo.ufl.edu Chancroid in female www.smu.edu Bordetella Bordetella pertussis Morphology: Gram-negative Coccobacillus, ca. 1 µm www.waterscan.co.yu/images Bordetella pertussis Culture: Special Medium Bordet – Gengou nobelprize.org www.szu.cz Bordetella pertussis Antigens and Virulence factors: Capsule Fimbriae, filamentous Haemagglutinin Outer Membrane Proteine (OMP) LPS Pertactin Extracellular Toxins: Pertussis Toxin Adenylate-cyclase Toxin Tracheal cytotoxin Dermatonecrotic Toxin FIGURE 31-2 Virulence factors of B pertussis . Medmicro Pertussis toxin www.med.sc.edu:85 Bordetella pertussis Pathogenesis, Infection: Source: sick – in prodromal and catarrhal Stadium Portal of entry: Respiratory tract Transmission: drop-infection → sensitive! 55°C; 30’ FIGURE 31-1 Pathogenesis of whooping cough. Medmicro www.my-pharm.ac.jp FIGURE 31-3 Binding of pertussis toxin to cell membranes. Medmicro FIGURE 31-4 Synergy between pertussis toxin and the filamentous hemagglutinin in binding to ciliated respiratory epithelial cells. Medmicro Bordetella pertussis Clinical finding: Whooping caugh / Pertussis (Peribronchial inflammation, Intersticiale Pneumonia) 4-Phases: Prodromal, Catarrhal, Paroxysmal, Convalescent Colonization of tracheal epithelial cells by B. pertussis web.umr.edu/~microbio Pertussis – paroxysmal Phase www.gesundes-kind.de , www.vaccineinformation.org www.med.sc.edu Pertussis - Diagnosis