Neisseria

Dr. Ng Woei Kean

Ph.D. (Molecular Medicine)
 Classification
• Neisseria is one of the four genera under the
family Neisseriaceae.
Neisseriaceae
Neisseria
Moraxella
Kingella
Acinetobacter
• There are 8 species under Neisseria, only N.
gonorrhea (gonococcus) and N.
meningitidis (meningococcus) are known
primary human pathogens.
• Other species of Neisseria are nonpathogenic or
commensal flora in human host and may be
opportunistic pathogen.
• Other species of Neisseria are extracellular to
polymorphonuclear (PMN) cells.
 General Characteristics
• Neisseria are gram negative cocci and arranged
in pairs.
• They are oxidase positive.
• Grows better in increased CO2 concentration.
• They are found intracellular to PMN.
• Moraxella, Acinetobacter and Veillonela
resembles Neisseria morphologically.
Neisseria gonorrhoeae present in a Gram stain of a patient with
gonococcal urethritis. The N. gonorrhoeae are the intracellular
gram- negative diplococci within the cytoplasm of the
polymorphonuclear (PMN) cell.
 Characteristics of N.
meningitidis and N. gonorrhea
• Obligate human pathogen.
• Does not grow at 22°C compared to other
neisseria.
• They are highly autolytic.
• They need enriched media to grow.
• They are pilated when isolated.
• Transformation occurs in pilated form.
How to differentiate N meningitidis from N gonorrhea?
Sugar utilization - Pattern of acid production from sugars e.g.
glucose, maltose, sucrose and lactose identify Neisseria and related
species.
 Diseases Caused by
Meningococcus
• Asymptomatic carrier rate is 5-10% in nasopharynx
• Meningococcemia
• Meningitis
• Waterhouse-Friderichsen syndrome
• Rarely pneumonia
Host factors which predisposes meningococcal diseases
1. Absence of bactericidal antibodies
2. Production of blocking Antibodies
3. C6, C7 & C8 deficiency
4. Deficiency of Mannose Binding Protein (MBP)
 Diseases Caused by
Gonococcus
• Men: urethritis, epididymitis.
• Women: cervicitis (ascending infection of uterine
cavity, fallopian tubes leading to complications).
• Pharyngitis
• Conjunctivitis in neonates
• Disseminated gonococcal infection:
arthritis, endocarditis, meningitis - 1%
Host factors which predisposes gonococcal diseases
1. Production of blocking Antibodies - production of IgG
blocking Antibodies blocking anti-LOS IgM (LOS-
lipooligosaccharide)
2. C6, C7 & C8 deficiency
 Virulence Factors
Capsule
N. meningitidis N. gonorrhea
• Capsule is acidic • Unknown
polysaccharides.
• Most capsule composed of
sialic acid.
• There are 13 sero groups
based on capsule: A, B, C, H,
I, K, L, M, Y, X, Z, E-29 & W-
135.
• It is anti-phagocyte and anti-
complement, confers serum
resistance.
 Major surface proteins - Pili
N. meningitidis N. gonorrhea
• Pili promotes attachment • Pili mediates attachment
to epithelial cells, to columnar epithelial
endothelial cells and cell
RBC • Necessary for DNA
• Necessary for DNA uptake
uptake • Anti-phagocytic
• Undergo antigenic
variation
 Major surface proteins - Porins
N. meningitidis
• Class 1, 2,3 - Used for
serotyping.
• Class 4 - Target for blocking
IgA that protects
meningococcus from IgG
and complement-mediated
killing.
• Class 5 OMP: promotes
adherence to host cell and
WBC.
N. gonorrhea
• Por A and PorB (formerly
PIA and PIB - used for
Serotyping and for entry of
nutrient.
• Rmp (reduction modifiable
protein) antigen for
production of IgG that block
killing by IgM and
complements.
• Opacity protein Or Opa (PII):
Promotes adherence to
mucosa and PMN. 6-8
different antigenic types;
confers opaque colony.
Major Surface Structure - Lipooligosaccharide (LOS)
N. meningitidis N. gonorrhea
• 13 serotypes. • Six antigenically distinct
• Causes cytokine release, serotypes.
septic shock and DIC • LOS damages cells.
(disseminated • It exhibits antigenic
intravascular coagulation variation.
syndrome). • Target of IgM.
• Sialylation of LOS and
become serum resistant
by inactivation of
complements and
preventing deposition of
C3b

• Both produces IgA proteases and contain Iron binding

protein
Virulence factors of meningococcus
 Mechanism of Invasion of
Epithelial Cells
• Neisseria adheres to mucous secreting non-
ciliated cells by pili and Opa proteins.
• LOS and PDG causes ciliostasis.
• Endocytosis is directed by porins.
• Endocytosed bacteria is egested into basement
membrane leading to inflammation.
• Ciliated and non-ciliated cells are destroyed.
• Organisms resist killing by antibodies and
complements.
• Attachment to endothelial cells and
dissemination through blood.
 Diagnosis of Meningococcus
Specimens to isolate N. meningitidis depends on
the stage or type of infection:

• Nasopharynx is cultured to determine carrier

state.
• Blood during meningo-coccemia.
• Skin lesions from petechial rash if present.
• Cerebrospinal fluid (CSF) for meningitis.
• Synovial fluid in cases of suspected septic
arthritis.
Types of test
• Gram stain
• Culture
• Bacterial antigen detection in CSF

* CSF should be centrifuged at 1500 X g for 15

minutes. The supernatant fluid removed and used
for direct detection of soluble antigens. The
sediment should be cultured on chocolate agar
and thioglycollate broth.
 Diagnosis of Gonococcus
• Swabs for N. gonorrhea should be collected and
transported in Amies modifies transport media

Types of test
• Gram stain
• Culture: in Thayer-Martin selective media.
• Molecular methods: The non-amplified DNA
probe assay is used for direct detection of
gonococcal ribosomal RNA (rRNA) in genital
and conjuctival specimens.