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INTRODUCTION

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The family Neisseriaceae includes the genera Neisseria, Kingella, Eikenella, Simonsiella, and Alysiella (see Chapter 16). The neisseriae are gram-negative cocci that usually occur in pairs (diplococci). Neisseria gonorrhoeae (gonococci) and Neisseria meningitidis (meningococci) are pathogenic for humans and typically are found associated with or inside polymorphonuclear cells. Some neisseriae are normal inhabitants of the human respiratory tract, rarely if ever cause disease, and occur extracellularly. Members of the group are listed in Table 20-1.

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TABLE 20-1Biochemical Reactions of the Neisseriae and Moraxella Catarrhalis
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Gonococci and meningococci are closely related, with 70% DNA homology, and are differentiated by a few laboratory tests and specific characteristics. Meningococci have polysaccharide capsules but gonococci do not, and meningococci rarely have plasmids but most gonococci do. Most importantly, the two species are differentiated by the usual clinical presentations of the diseases they cause: Meningococci typically are found in the upper respiratory tract and cause meningitis, but gonococci cause genital infections. However, the clinical spectra of the diseases caused by gonococci and meningococci do overlap.

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Morphology and Identification

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A. Typical Organisms
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The typical Neisseria is a gram-negative, nonmotile diplococcus, approximately 0.8 μm in diameter (Figures 20-1 and 20-2). Individual cocci are kidney bean shaped; when the organisms occur in pairs, the flat or concave sides are adjacent.

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FIGURE 20-1

Gram stain of a urethral exudate of a patient with gonorrhea. Nuclei of many polymorphonuclear cells are seen (large arrows). Intracellular gram-negative diplococci (Neisseria gonorrhoeae) in one polymorphonuclear cell are marked by the small arrow.

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FIGURE 20-2

Collage and drawing of Neisseria gonorrhoeae showing pili and the three layers of the cell envelop.

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B. Culture
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In 48 hours on enriched media (eg, modified Thayer-Martin, Martin-Lewis, GC-Lect, and New York City), gonococci and ...

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