Neisseriaceae

General Characteristics of Neisseria

The genus Neisseria comprises aerobic, gram-negative, kidney bean-shaped diplococci. These bacteria are cytochrome oxidase and catalase positive, and are capnophilic, preferring elevated CO2 concentrations for optimal growth. Their natural habitat is the mucous membranes of the respiratory and urogenital tracts.

• Gram-negative diplococci: Characteristic kidney bean shape, often found in pairs.

• Capnophilic: Require increased CO2 for growth.

• Habitat: Mucous membranes of respiratory and urogenital tracts.

• Virulence factors:

  • Capsule: Prevents phagocytosis.

  • Pili: Prevent phagocytosis and facilitate genetic exchange.

  • Cell wall proteins: Prevent phagocytosis.

  • Endotoxin: Prevents phagocytosis and mediates tissue damage.

  • IgA protease: Cleaves IgA antibodies on mucosal surfaces.

Principal human pathogens:

• Neisseria gonorrhoeae – Primary pathogen

• Neisseria meningitidis – Commensal inhabitant, but can cause disease

Nonpathogenic species: Neisseria subflava, Neisseria lactamica, Neisseria sicca – Usually part of normal flora, occasionally cause disease.

Neisseria gonorrhoeae

Pathogenesis and Clinical Manifestations

Neisseria gonorrhoeae is the causative agent of gonorrhea, an acute pyogenic infection of columnar epithelium. Humans are the only natural host. Gonococcal infections primarily affect the urethra, endocervix, anal canal, pharynx, and conjunctiva, and may disseminate from the primary site.

• Transmission: Primarily by sexual contact; asymptomatic carriers are the main reservoir.

• Incubation period: 2–7 days.

• Clinical features in men:

  • Acute urethritis with purulent discharge and dysuria.

  • Asymptomatic infection is rare (3–5%).

  • Complications: Prostatitis, epididymitis.

• Clinical features in women:

  • Endocervix is most common site; vaginal discharge and dysuria.

  • Up to 50% asymptomatic.

  • Symptoms: Dysuria, lower abdominal pain, vaginal bleeding.

  • Complications: Pelvic inflammatory disease (PID), sterility, ectopic pregnancy.

• Disseminated infection: Rare (<1%), causes purulent arthritis, septicemia, fever, rash.

• Other sites: Anorectal and oropharyngeal infections, often asymptomatic or nonspecific.

• Ophthalmia neonatorum: Gonococcal eye infection in newborns acquired during delivery; prevented by mandatory antimicrobial eye drops or silver nitrate.

Diagnosis:

• Gram-negative intracellular diplococci in male discharge correlates 95% with culture.

• Direct Gram stain in women correlates 50–70% with culture due to normal flora.

• Cultivation requires chocolate agar and 3–5% CO2.

Antimicrobial resistance:

• Penicillin resistance emerged in 1976 due to plasmid-mediated β-lactamase production.

• Ceftriaxone is currently recommended for therapy; effective against resistant strains.

Example: A male patient presents with purulent urethral discharge and dysuria. Gram stain reveals intracellular gram-negative diplococci, confirming presumptive diagnosis of gonorrhea.

Neisseria meningitidis

Pathogenesis and Clinical Manifestations

Neisseria meningitidis (meningococcus) is found in the nasopharynx and oropharynx of 3–30% of asymptomatic individuals. It is a major cause of endemic and epidemic meningitis, meningococcemia, and pneumonia. The only known reservoir is the human nasopharynx.

• Carrier rate: Varies with age, socioeconomic status, and other factors.

• Pathogenicity factors: Antiphagocytic polysaccharide capsule, pili, endotoxin.

• Transmission: Respiratory droplets from asymptomatic carriers, especially in close-contact populations (e.g., college dormitories).

• Clinical features:

  • Epidemic meningitis: Abrupt onset of frontal headache, stiff neck, fever.

  • Meningococcemia (sepsis): May occur with or without meningitis; 25% mortality rate even with treatment.

  • Petechial skin lesions, disseminated intravascular coagulation, septic shock, hemorrhage, and death in severe cases.

• Diagnosis: Gram-stained smears from cerebrospinal fluid show intracellular and extracellular gram-negative diplococci; encapsulated strains may have a halo.

• Cultivation: Requires chocolate agar and 3–5% CO2.

• Treatment: Penicillin is drug of choice; rifampin recommended for prophylaxis in close contacts.

Example: An adolescent in a college dormitory develops sudden headache and stiff neck. Lumbar puncture reveals gram-negative diplococci in CSF, confirming meningococcal meningitis.

Branhamella (Moraxella) catarrhalis

General Characteristics and Clinical Significance

Branhamella catarrhalis (now Moraxella catarrhalis) is a gram-negative diplococcus isolated only from humans. It is a normal commensal of the respiratory tract but has become an opportunistic pathogen.

• Associated infections: Pneumonia, sinusitis, otitis media, systemic disease.

• Clinical significance: Third most common cause of acute otitis media and sinusitis in children; also causes pneumonia in children and adults.

• Diagnosis: Presence of intracellular gram-negative diplococci in respiratory specimens may indicate infection.

Example: A child with acute otitis media is found to have Moraxella catarrhalis in middle ear fluid.

Table: Comparison of Neisseria Species

This table summarizes key features of pathogenic and commensal Neisseria species, as well as Moraxella catarrhalis.

Additional info: Table entries for nonpathogenic Neisseria species and Moraxella catarrhalis are inferred based on typical clinical microbiology knowledge.