Al-Dorri (2020): Isolation of N sicca from genital tract Dec, 2020 Vol. 23 Issue 24 Isolation of Neisseria sicca from genital tract Alaa Zanzal Ra'ad Al-Dorri1* 1. Department of Medical Microbiology, Tikrit University/ College of Medicine (TUCOM), Iraq. *Corresponding author:[email protected] (Al-Dorri) Abstract In the last few decades some researchers has focused on N. meningitidis and N. gonorrhoeae in attempts to understand the pathogenesis of the diseases produced by these organisms. Although little attention has been paid to the other neisseria species since they are considered harmless organisms of little clinical importance although they can cause infections. In this paper, pathological features and the clinical of high vaginal and cervical infections caused by Neisseria sicca are described, which are normal inhabitants of the human respiratory tract as in oropharynx and can act as opportunistic pathogens when present in other sites such as female genital tract. We note they usually infect married women at a young age group who were multipara and active sexual women. N.sicca was resistant to most antibiotics that were used while the doxycycline was the most effective antibiotic against N.sicca. Keywords: Neisseria sicca,genital tract infection, pharyngeal carriage, colonization, antimicrobial resistance How to cite this article: Al-Dorri AZR (2020): Isolation of Neisseria sicca from genital tract, Ann Trop Med & Public Health; 23(S24): SP232417. DOI:http://doi.org/10.36295/ASRO.2020.232417 Introduction: Neisseria is considered as a genus of b-Proteobacteria, which are absolute symbionts in human mucosal surfaces. 8 species of Neisseria have been reported and they normally colonize the mucosal surfaces of humans [1, 2]. Although some studies have described eleven other species that colonizes humans, only two are pathogens, N.gonorrhoeae and N.meningitidis oftentimes cause infections [3]. Neisseria meningitides cause septicemia and meningitis, whilst Neisseria gonorrhoeae causes transmitted sexual disease. For of their importance to public global health, the former researches completed have focused fundamentally on the two pathogens, leading to the identification of large factor virulence that is substantial for humans in infection. Neisseria species are Gram-negative bacteria, diplococci resemble coffee beans, sometimes appear as tetrads, and they grow at 37°C when viewed microscopically. Neisseria is positive for both catalase and oxidase [3]. Several Neisseria could be diagnosed via fermentation of sugars from which they will products acid. For like, N.gonorrheae products acid from only glucose, but N.meningitidis produces acid from maltose and glucose [3]. New reports show that commensal Neisseria as well has the genes associated with virulence.N. meningitidisand N. gonorrhoeae cause important diseases distributed world-wide, the dominance of which is subordinate on the availability and widespread utilizer of gonococcal vaccines and meningococcal. The nature of the organism’s heterogeneity, variability, poor immunogenicity onto components surface should be affected the development of Neisseria vaccines [4, 5, 6]. Therefore, the study focused each on a fixed number of genes virulence or only one commensal genome. The total virulence gene content of the Neisseria genus is unknown. Neisseria sicca differs from other commensal Neisseria because it causes disease in healthy individuals [6]. One of the protective Annals of Tropical Medicine & Public Health http://doi.org/10.36295/ASRO.2020.232417 Al-Dorri (2020): Isolation of N sicca from genital tract Dec, 2020 Vol. 23 Issue 24 mechanisms of N. meningitidis is the presence of a polysaccharide capsule that surrounds the outer membrane of the bacterium and protects the bacteria against immune defense mechanisms, while N. gonorrhea does not possess such capsule. Both commensal and pathogenic Neisseria have lipooligosaccharide (LOS) consisting of a core polysaccharide and lipid A instead of lipopolysaccharide (LPS) and play an important role in the pathogenesis of pathogenic species. Commensal Neisseria also has LOS but can express additional structures not found in the pathogenic strains.N. sicca was responsible for a fatal case of endocarditis in healthy adult males, this isolate from commensal species represents an increase in virulence of this organism to invade the host and survive in the blood [7]. LOS acts as an endotoxin against antibiotics, and it is a high stimulator to the human immune system [8]. Regarding the cultural features of N. sicca are Gram-negative diplococcus bacteria, while colonies appear as dry, wrinkled, adherent colonies but smooth colonies may form catalase positive. Most N. sicca strains are not pigmented while others strains can be pigmented, for differentiation among N. subflava and N. sicca we can use the characteristic of lacking pigmentation. N.sicca produces acid from glucose, maltose, sucrose, and fructose but not for lactose [9]. For the past 70 years, antibiotics were used successfully for the treatment of the pathogenic Neisseria (N. gonorrhea and N. meningitides) infections. Although resistance to antibiotics is increasing. The mechanisms of antibiotic resistance in gonococci and meningococci should be elucidated in order todesign novel antimicrobials to avoid this problem [10]. Neisseria sicca/subflava are considered as one of normal flora are found in the greater tract respiratory and oral cavity of humans and rarely cause meningitis, endocarditis, urethritis, pneumonia, spondylitis, and bacteremia. There is little literature that explains the clinical features and management of iatrogenic meningitis caused by N. sicca/subflava[11, 12]. The human mucosal surfaces have variation in the Neisseria species which leads to the increase in the probability of genetic exchange between the bacteria [13, 14]. Because these infections are more associated with gonococci and meningococci, we should be careful during identification of all Neisseria recovered from blood, cerebrospinal fluid, and gynecologic specimens. The aim of this work: to investigate the pathological features and the clinical of high vaginal and cervical infections caused by Neisseria sicca are described, which are normal inhabitants of the human respiratory tract as in oropharynx and can act as opportunistic pathogens when present in other sites such as female genital tract. Methods and materials Study the population was composed of (215) married women, at aged among 15–49 years old, who attending the outpatient of gynecological and obstetric clinic in Tikrit Teaching Hospital and private clinics in Tikrit province. Most of the patients were suffering from colored vaginal discharge, itching or irritation, and sometimes bad odor, dysuria (pain during urination), and dyspareunia (pain during intercourse). All patients were interviewed and careful history taken from them by special questioners of parity, bad obstetric history, used contraceptive, drugs, level of education, resident, and husband occupation. The patients excluded from this study included presenting with diabetes mellitus (DM), received corticosteroids (CS) drug, malignancy, vaginal bleeding, and menstrual bleeding and received antimicrobial or antibiotic drugs less than one week. By using unlubricated sterile Cusco's speculum was inserted into vaginal women in the lithotomy position. The lateral, posterior vaginal fornix and cervix were swabbed with two sterile cotton-tipped applicators. One of the Annals of Tropical Medicine & Public Health http://doi.org/10.36295/ASRO.2020.232417 Al-Dorri (2020): Isolation of N sicca from genital tract Dec, 2020 Vol. 23 Issue 24 swabs was put in the tube with 1 – 2 ml of sterile Amies transport media and transported to the microbiological laboratory in TUCOM, were cultured and another swab for microscopic examination (wet mount and Gram stain). A pH strip placed in contact with the secretions on the speculum for measuring vaginal pH. Bacterial infection was clinically diagnosed when the vaginal pH > 4.5 this indicates dimensioned in normal Lactobacilli flora, while in candida vaginitis there is no elevated in pH. Gram stain usually used to determine the vaginal flora, clue cells, leukocyte counts, which were evaluated in five different fields. The vaginal discharge present on the swab directly transferred to the glass slide, the smear was fixing by heating, and then Gram staining was done. Swabs were inoculated directly on to selective media such as Columbia blood agar base (Himedia/India), with supplement FD 056 (Himedia/India) vial contains antibiotics (Nalidixic acid 15 mg, Gentamicin sulfate 2 mg and Amphotericin B 1 mg) each one vial added to cooled (45-50 OC) of 500 ml of sterilized this media along with 5% human blood mixed well. Plates were incubated anaerobically at 37 OC for 48 hours in candle jar to provide 5- 10% CO2 tension. Another swab streaked the Blood agar, Chocolate agar and MacConkey's agar, which were incubated at the microaerophilic atmosphere. Catalase and oxidase tests were positive, also the suspicious colonies investigated by further biochemical testing and usage of Api System (analytical profile index) for identification of bacteria including RapIDTM NH ONE System (remel) was used for diagnosis and identification of Neisseria sicca [15]. Disk diffusion method (Kirby Bauer test) The susceptibility of Neisseria sicca against various antibiotics was studied, using the Kirby-Bauer method. The used disk in this method was 5 mm in diameter and the