Neisseria

Moraxella catarrhalis
 Characteristics of Neisseria and
Moraxella catarrhalis
 Gram-negative diplococci with adjacent
sides flattened
 Frequently appear as intracellular gram-
negative diplococci within
polymorphonuclear neutrophils
 Cytochrome oxidase positive
 Neisseria gonorrhoeae fastidious showing
optimal growth on enriched chocolate agar
 Characteristics of Neisseria and
Moraxella catarrhalis
 Growth of Neisseria meningitidis and
Moraxella catarrhalis occurs on both sheep
blood and chocolate agar
 Neisseria gonorrhoeae, N. meningitidis,
and Moraxella catarrhalis capnophilic
(optimal growth with 3-7% CO2)
 Neisseria meningitidis and N. gonorrhoeae
closely related genetically and distantly to
saprophytic species of Neisseria
 Characteristics of Neisseria and
Moraxella catarrhalis
 Neisseria meningitidis encapsulated
(capsule the major virulence factor)
 Thirteen capsular polysaccharide
serogroups
 Invasive infection caused by organisms with
one of five capsular serogroups (A, B, C, Y,
and W135) with 90% of meningococcal
disease due to serogroups A, B, and C
 Characteristics of Neisseria and
Moraxella catarrhalis
 Moraxella rather than Branhamella accepted
taxonomically as the genus designation for
M. catarrhalis (family Moraxellaceae)
 Even though M. catarrhalis not a member of
the family Neisseriaceae, morphologic and
biochemical similarity to Neisseria allows
clinical laboratory identification of M.
catarrhalis with Neisseria species
 Pathogenic Species

 Neisseria gonorrhoeae
 Neisseria meningitidis

 Moraxella catarrhalis
 Saprophytic Species
Neisseria lactamica, N.
polysaccharea, N. cinera, N.
flavescens, N. subflava, N. sicca,
and N. mucosa
 Neisseria: Natural Habitats
 Neisseria gonorrhoeae an obligate pathogen
with invasive infection of anogenital,
oropharyngeal, and conjunctival mucous
membranes
 Neisseria meningitidis normally colonizes
oropharyneal and nasopharyngeal mucous
membranes of humans (carrier rate of 8-
20%)
 Neisseria: Natural Habitats
 Neisseria meningitidis rarely colonize
oropharyngeal and nasopharyngeal mucous
membranes of humans
 Saprophytic species are non-pathogenic
(non-invasive) and normally colonize the
oropharyngeal and nasopharyngeal mucous
membranes of humans
Moraxella catarrhalis: Natural Habitats
Present in the upper respiratory
tract of healthy individuals, more
commonly in children (50%) and
elderly adults (25%)
Neisseria gonorrhoeae: Modes of Infection
 Neisseria gonorrhoeae spread by sexual
contact, including genital, anogenital, and
orogenital. Spread from infected mother to
neonate as ocular infection during birth.
Non-sexual transmission not documented.
 Neisseria: Types of Infectious
Disease
 N. gonorrhoeae second most common cause
(after Chlamydia trachomatis) of sexually-
transmitted lower genital tract disease (acute
urethritis in men, endocervicitis in women)
 N. gonorrhoeae untreated can progress to
epididymitis, prostatitis, urethral stricture,
salpingitis, tubo-ovarian abscess, and pelvic
inflammatory disease
 Neisseria: Types of Infectious
Disease
 N. gonorrhoeae causes oral and anorectal
infections as a result of oral or anal intercourse
 N. gonorrhoeae disseminates with bacteremia
and/or septic arthritis if untreated
 Disseminated infection (bacteremia, pyogenic
arthritis) by N. meningitidis and N. gonorrhoeae
associated with deficiency in the terminal
components of complement (C5-C8)
Neisseria meningitidis: Modes of Infection
 Neisseria meningitidis transmitted by
inhalation of infectious air-born respiratory
droplets or direct contact with infectious
respiratory secretions.
 Neisseria: Modes of Infection
 Neisseria meningitidis can also be
transmitted by sexual contact, especially
orogenital or anogenital intercourse.
 Person-to-person transmission does not
occur with saprophytic Neisseria species
and infection (rare) is endogenous.
 Neisseria: Types of Infectious
Disease
 N. meningitidis causes a rapidly progressive
meningitis in school-aged children,
adolescents, and young adults with a
mortality of 7-13%
 N. meningitidis bacteremia (mortality of 19-
70%) a cause of Waterhouse-Friderichsen
syndrome with petechiae, purpura, adrenal
hemorrhage, dissemin-ated intravascular
coagulation, and shock
 Neisseria: Types of Infectious
Disease
Neisseria meningitidis associated
with sexual transmission and
gonococcal-like urethritis,
cervicitis, salpingitis, and proctitis
 Moraxella catarrhalis: Modes of
Infection
Oropharyngeal endogenous
strains spread into normally sterile
regions of the tracheo-
bronchial tree, the middle,
ear, and sinuses
 Moraxella catarrhalis: Types of
Infectious Disease
 Acute purulent exacerbation of chronic
bronchitis
 Causes 10-15% of episodes of otitis
media and sinusitis
 Rarely associated with systemic
infection (endocarditis, meningitits)
 Neisseria gonorrhoeae and Neisseria
meningitidis: Isolation
 Isolation often attempted from specimens with
abundant normal flora (genital, oral, anorectal)
(especially N. gonorrhoeae)
 Modified Thayer-Martin (MTM) agar an enriched
and selective medium for pathogenic N.
gonorrhoeae and N. meningitidis
 Nutritive base of MTM is chocolate agar
 Antibiotics present in MTM selective for the
growth of N. gonorrhoeae and N. meningitidis
 Modified Thayer-Martin Agar
 Colistin: Inhibits gram-negative flora (N.
gonorrhoeae and N. meningitidis resistant
to colistin, most saprophyic species of
Neisseria susceptible)
 Vancomycin: Inhibits gram-positive flora
 Nystatin: Inhibits yeast flora
 Trimethoprim: Inhibits swarming Proteus
 Patient-Side Inoculation of Selective
Media
 Optimal recovery of gonococci obtained when
species inoculated onto growth medium
immediately after collection
 JEMBEC plate: Inoculation of selective agar,
placement of a CO2-generating citric acid, and
plate covered for transport to laboratory
 Moisture in the covered JEMBEC plate sufficient
to generate CO2 from the citric acid/sodium
bicarbonate tablet
 Candle jar: Agar plates placed in a jar, a candle lit,
and jar sealed; candle extinguished at 3% CO2
atmosphere
 Neisseria gonorrhoeae: Identification
 white colonies on chocolate agar with
no discoloration of agar
 Acid from glucose but not maltose,
sucrose, fructose, or lactose
 Positive oxidase test

 Colistin resistance (growth on Modified

Thayer-Martin medium)
Laboratory Detection and Identification
of Neisseria gonorrhoeae
 Direct PCR detection for urogenital
specimens with culture confirmation when
PCR positive
 Culture isolation and biochemical
identification for urogential specimens with
gonorrhea refractory to treatment or sexual
abuse, and non-urogenital specimens
 Molecular strain typing for isolates of N.
gonorrhoeae in sexual abuse cases
 Neisseria meningitidis: Identification
 Gray colonies on chocolate agar with
green haze in agar immediately under
and adjacent to colonies
 Acid from glucose and maltose but not
sucrose, fructose, or lactose
 Colistin resistance (growth on modified
Thayer-Martin medium)
 Moraxella catarrhalis: Identification
 Pink coloration of colonies on chocolate
agar not apparent on blood agar
 No acid from glucose, maltose, sucrose,
fructose, or lactose (asaccharolytic)
 Produces DNase
 Possesses the enzyme butyrate esterase
 Selected Biochemical Reactions for
Identification of Neisseria and Moraxella
catarrhalis 1
Glu Mal Lac Suc DNa BE
N. gon + – – – – –
N. men + + – – – –
N. lac2 + + + – – –
M. cat – – – – + +
1Glu=glucose, Mal=maltose, Lac=lactose, Suc=sucrose,
DNa=DNase, BE=butyrate esterase (indoxyl butyrate
substrate), N. gon=N. gonorrhoeae, N. men=N.
meningitidis, N. lac=N. lactamica, M. cat=Moraxella
catarrhalis
2Colistin-resistant saprophytic species of Neisseria
 Prevention & Treatment
 Penicillin no longer drug of choice due to:
• Continuing rise in the MIC
• Plasmid-encoded beta-lactamase production
• Chromosomally-mediated resistance
 Uncomplicated: ceftriaxone, cefixime or fluoroquinolone
 Combined with doxycycline or azithromycin for dual infections
with Chlamydia
 Chemoprophylaxis of newborns against opthalmia
neonatorum with 1% silver nitrate, 1% tetracycline, or 0.5%
erythromycin eye ointments
 Treatment of newborns with opthalmia neonatorum with
ceftriaxone
 Measures to limit epidemic include education, aggressive
detection, and follow-up screening of sexual partners, use of
condoms or spermicides with nonoxynol 9
 Safe Laboratory Handling of Neisseria
meningitidis
 Use of biosafety cabinet for mechanical manipulation of
samples with risk of aerosolization or droplet formation
(grinding, centrifuging, blending)
 Use of a biosafety cabinet for manipulation of sterile site
isolates of N. meningitidis
 Informed decision by microbiology workers of vaccination
by quadrivalent meningococcal polysaccharide vaccine (A,
C, Y, W-135)
 Antimicrobial prophylaxis (rifampin, ciprofloxacin, or
ceftriaxone) for potential inhalational exposure
(aerosolization or droplet formation), percutaneous
exposure, or mucosal exposure to invasive N. meningitidis
isolate