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N. Meningitidis Case Study

A 19-year-old male presented with symptoms of bacterial meningitis including a rash, fever, neck stiffness, confusion and vomiting. Laboratory testing of a cerebrospinal fluid sample found gram-negative diplococci consistent with Neisseria meningitidis. Further tests including carbohydrate utilization and serogrouping were conducted to identify and characterize the causative agent. N. meningitidis was identified as the likely cause of the patient's meningitis.

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Kevin Rodriguez
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256 views24 pages

N. Meningitidis Case Study

A 19-year-old male presented with symptoms of bacterial meningitis including a rash, fever, neck stiffness, confusion and vomiting. Laboratory testing of a cerebrospinal fluid sample found gram-negative diplococci consistent with Neisseria meningitidis. Further tests including carbohydrate utilization and serogrouping were conducted to identify and characterize the causative agent. N. meningitidis was identified as the likely cause of the patient's meningitis.

Uploaded by

Kevin Rodriguez
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MICROBIOLOGY

Case Analysis:
Neisseria meningitidis
GROUP 3
Leader: MANARANG, Loryssa Joie
Members:

PAMINTUAN, Kiara
RODRIGUEZ, Kevin
YUTUC, Jonnel

MT 3E

SUMMARY OF CASE
ANGELES UNIVERSITY FOUNDATION
MEDICAL CENTER

PATIENT'S RECORDS (Room 003)


Patient:
Age:
Date:
Time:

Tommy Cruise
19 years old
6-Aug-15
1:01AM

S/S:

Reddish skin rashes, 39 degrees Celsius fever,


stiff neck, confusion, headaches, vomiting and
photosensitivty

Spx:
Physician:

Cerebrospinal Fluid (Spinal Tapping)


Dr. Micro Bio

ANSWERS TO QUESTIONS
1. What are the significant results?
CHOCOLATE AGAR PLATE

Figure 1 Encapsulated strains, small, tan, mucoid


colonies

ANSWERS TO QUESTIONS
BLOOD AGAR PLATE

Figure 2 Encapsulated strains, bluish-gray colonies, small, tan

ANSWERS TO QUESTIONS
GRAM STAINING

Figure 3 Gram (-) PMN

ANSWERS TO QUESTIONS
CARBOHYDRATE UTILIZATION

Figure 4 CFT. (From L-R) Maltose, Glucose, Lactose, Sucrose

GLUCOSE

MALTOSE

SUCROSE

MALTOSE

Positive Result - Yellow color on broth --> Organic Acid


Negative Result - no color change (red)

ANSWERS TO QUESTIONS
2. Principle of the Tests
GRAM STAINING

ANSWERS TO QUESTIONS

GRAM STAINING
The principle of Gram Staining
makes use of the differences in
cell wall composition of Gram
positive and Gram negative
bacteria

ANSWERS TO QUESTIONS

CARBOHYDRATE UTILIZATION
TEST
The principle of this test is to
show the ability of certain
bacteria to ferment an array of
sugars (glucose, sucrose,
lactose).

ANSWERS TO QUESTIONS

3. Causative Agent
The causative agent
identified is most like to be
Neisseria meningitidis

ANSWERS TO QUESTIONS
4. What are the signs and symptoms?

ANSWERS TO QUESTIONS
The signs and symptoms observed in
the patient are:
skin rash
39 degrees Celsius fever
stiff neck
confusion
vomiting
photosensitivity

ANSWERS TO QUESTIONS
5. Disease of the patient
Bacterial meningitis
a serious infection of the thin lining that
surrounds the brain and spinal cord.
Neisseria meningitidis is a potential
cause of the disease
N. meningitidis infects humans only, there
is no animal reservoir

ANSWERS TO QUESTIONS
6. Other laboratory tests
Oxidase Test (Kovacs Oxidase
Test)

ANSWERS TO QUESTIONS
Oxidase test is a presumptive exam
which separates pathogenic to nonpathogenic Neisseria species.
The oxidase test determines the
presence of cytochrome oxidase.

ANSWERS TO QUESTIONS
Slide Agglutination Serogrouping
A test to identify the twelve (12)
serogroups, based on capsular
polysaccharides

ANSWERS TO QUESTIONS
4+

All of the cells agglutinate


and the cell suspension
appears clear

3+

75% of the cells agglutinate


and the cell suspension
remains slightly cloudy

2+

50% of the cells agglutinated


and the cell suspension
remains slightly cloudy

1+

Less than 25% of the cells


agglutinated and a fine
granular matter occurs

+/-

25% of the cells agglutinated


and the cell suspension
remains slightly cloudy

ANSWERS TO QUESTIONS
In determining the serogroup, the
following must be taken into
consideration:
A positive result is designated by a 3+ or 4+
(strong agglutination)within 1-2 minutes,
except for serogroup B, which is considered
positive with a rating of 2+ or greater.
A negative result is designated by a 0
(saline), +/-, 1+ or 2+ (weak agglutination).
The serogroup is determined when a
positive result occurs with only one of the
antisera and not with the saline.

ANSWERS TO QUESTIONS
If a serogroup is not determined, the isolate is
considered NG. The following result
combinationsare all reported as NG:
Agglutination in the saline,regardless of strong
reactions withother antisera,characterizes the
culture as autoagglutinating.
Agglutination with more than one serogroupspecific antisera in the absence of agglutination in
saline characterizes the culture as
polyagglutinating or cross-reactive.
No agglutination with any of the antisera or the
saline characterizes the strain as non-reactive.

PERTINENT INFORMATION
NEISSERIA MENINGITIDIS

PERTINENT INFORMATION
A gram negative, coffee-bean shaped
diplococci that may occur intracellularly
or extracellularly in PMN leukocytes
Fastidious organism, which grows best
at 35-37 degrees Celsius (with 10%
CO2).
Can grow in both Chocolate and Blood
Agar Plates
Gray and unpigmented on BAP
Colorless-to-grey, opaque colonies on a
CAP

PERTINENT INFORMATION
The human nasopharyngeal mucosa is
the only known reservoir of N.
meningitidis
N. meningitidis exploits host cell
signaling pathways in order to promote
its uptake by host cells
Does not have a type III or a type IV
secretion system

PERTINENT INFORMATION
IDENTIFICATION OF SPECIES

REFERENCES

BOOKS
Diagnostic Microbiology by Connie Mahon et al

Neisseria: Molecular Mechanisms of Pathogenesis by C.A. Genco

Case Studies in Infectious Disease: NeissseriaMeningitidisby Peter Lydyard et al

JOURNALS
Laboratory methods for the diagnosis of meningitis causedby Neisseria meningitidis, Streptococcus pneumoniae,
andHaemophilusinfluenzaBy WHO (World Health Organization)

Haemophilusinfluenzae, Neisseria meningitidis,Streptococcus pneumoniae,Neisseria gonorrhoeae, Salmonellaserotype Typhi,Shigella,


andVibrio cholerae: Manual for the Laboratory Identification andAntimicrobial Susceptibility Testing of Bacterial Pathogens of Public
Health Importancein the Developing WorldBy Mindy J. Perilla, MPH et al of WHO and CDC (Word Health Organization and Centers for
Disease Control and Prevention)

WEBSITES
www.who.int/csr/resources/publications/meningitis/whocdscsredc997.pdf

Meningococcal Fact Sheet by World Health Organization www.who.int/mediacentre/factsheets/fs141/en/

www.who.int/csr/resources/publications/drugresist/en/IAMRmanual.pdf

www.cdc.gov/meningitis/lab-manual/chpt07-id-characterization-nm.html

www.cdc.gov/meningococcal/about/causes-transmission.html

www.cdc.gov/meningitis/lab-manual/chpt07-id-characterization-nm.pdf

microbeonline.com/

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