Clinically important Neisseria

• Epididymitis is an inflammation of the coiled tube, called the epididymis, at the back of the testicle
• Salpingitis is inflammation of the fallopian tubes, caused by infection
• A 23-year-old college student with drowsiness, rash, hypotension, high temperature, neck stiffness, and photophobia is likely suffering from Meningococcal meningitis with sepsis
• Neisseria species like N. gonorrhoeae and N. meningitidis are pathogenic, while others like N. subflava, N. mucosa, N. lactamica are commensals
• Gram stain of Neisseria Spp shows pink (Gram-negative), round cocci in pairs (diplococci), typically intracellular in clinical infection specimens
• Pathogenic Neisseria species are fastidious in their growth requirements, requiring prompt transport of specimens to the lab and the use of enriched culture media like chocolate agar
• N. meningitidis has an average asymptomatic carriage rate of 5-10%, with the highest in 15-20 year-olds, and can lead to invasive infection with an incubation period of 1-10 days
• Invasive Meningococcal Disease risk factors include environmental factors like living conditions and travel, as well as patient factors like underlying conditions and viral infections
• Inhalation of droplets containing Neisseria leads to colonization of the nasopharynx, with the capsule helping the organism avoid host immunity and causing pathogenesis through toxin production
• Clinical presentation of invasive meningococcal disease includes meningitis symptoms like headache, fever, stiff neck, and photophobia, as well as sepsis with a characteristic rash
• Laboratory diagnosis of meningococcal disease involves collecting appropriate samples like blood and CSF, performing Gram stains, blood cultures, PCR tests, and susceptibility tests
• Management of invasive meningococcal disease includes antibiotics, fluid replacement, correction of coagulation abnormalities, critical care, and notifying public health for contact tracing and prophylactic measures
• Prevention of meningococcal disease involves population-level vaccination with conjugate vaccines targeting different serogroups like MenC, MenB, and MenAfriVac
• Serogroup B conjugate vaccine (MenB) has been in use since 2000
• Prevention for at-risk groups includes antibiotic chemoprophylaxis and vaccination against all serogroups (MenACWY + MenB)
• For a 23-year-old with suspected meningococcal disease, paramedics should administer IV Ceftriaxone
• On arrival to the hospital, the patient should be prescribed IV Ceftriaxone
• Investigations to send to the microbiology lab for suspected meningococcal disease include blood cultures and a lumbar puncture for cerebrospinal fluid analysis
• For a patient with >1000 WCC/microL in urine but no growth on culture, the likely diagnosis is N. gonorrhoea
• Gonorrhoea is the second most common sexually transmitted bacterial infection, causing infection of mucous membranes
• Gonorrhoea may be asymptomatic, especially in females, and reinfection is common due to lack of protective immunity
• Complications of gonorrhoea include pelvic inflammatory disease (PID), disseminated infection, and risks during pregnancy and neonatal infection
• Laboratory diagnosis of gonorrhoea involves culture-based methods and nucleic acid amplification tests
• Treatment for confirmed gonorrhoea with PCR includes a single dose of intramuscular Ceftriaxone
• Management of gonococcal infection includes test of cure using NAAT/PCR two weeks later and public health notification and partner notification
• Prevention of gonorrhoea involves education, condom use, and testing all sexually transmitted infections in those presenting with one STI