Gonococcal Bacteremia Research Articles

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A Case of Bacteremia by Neisseria gonorrhoeae Coincident with Massive Hemorrhage of Esophageal Varices

A 42-yr-old man with hepatitis B virus associated liver cirrhosis was admitted to the emergency room because of multiple seizures, a history of chills and myalgia over the previous 2 weeks, and 3 days of melena. He was febrile with a temperature of 38.0℃. There were no symptoms and signs related to the genitourinary system, skin, or joints. Three sets of blood cultures were obtained and oxidase-positive, gram-negative diplococci were detected after 25.9-26.9 hr of incubation in all aerobic vials. The organism was positive for catalase and oxidase, and was identified as Neisseria gonorrhoeae, using a Vitek Neisseria-Haemophilus Identification card (bioMérieux Vitek, Inc., USA). Further, 16S rRNA sequencing of this isolate revealed a 99.9% homology with the published sequence of N. gonorrhoeae strain NCTC 83785 (GenBank Accession No. NR_026079.1). Acute bleeding by variceal rupture seems to be a likely route of introduction of N. gonorrhoeae from the mucosa into the blood. To the best of our knowledge, this is the first case of gonococcal bacteremia in Korea.

Disseminated Gonococcal Infection in Pregnancy Presenting as Meningitis and Dermatitis

In 2003, the reported gonorrhea rate among women was 118.8 per 100,000 women. Most gonococcal infections in pregnant women are asymptomatic or produce a mildly symptomatic genital infection. Disseminated infections can occur when gonococcal bacteremia produces extragenital symptoms, most commonly arthritis. A patient presented in the third trimester of pregnancy with fever, body aches, neck soreness, and skin lesions. There was no arthritis. Cultures performed during evaluation confirmed extragenital Neisseria gonorrhoeae. A high index of suspicion is necessary to diagnose disseminated gonococcal infection and prevent disease sequelae.

Comparison of isolates of Neisseria gonorrhoeae causing meningitis and report of gonococcal meningitis in a patient with C8 deficiency

We studied a previously healthy 20-year-old woman who presented with gonococcal meningitis. The gonococcal isolate, HT-1, was prototrophic by auxotyping, was protein I serovar IB-1, and agglutinated with wheat germ lectin. This isolate differed from the proline-requiring, serovar IA-1 and IB-4, wheat germ-agglutination-negative gonococcal isolates recovered from three patients during a recent outbreak of gonococcal meningitis in Philadelphia. HT-1 was killed by normal pooled human sera (greater than or equal to 98% at 30 min) but not effectively killed by the convalescent-phase sera of the patient (greater than 30% survival at 30 min). Similar results were obtained when mucosal and cerebrospinal fluid isolates from a Philadelphia patient were exposed to these sera, but mucosal and blood isolates from another Philadelphia case showed increased resistance to killing by normal pooled human sera. Further characterization revealed multiple differences in outer membrane and cellular proteins and lipopolysaccharide between case isolates. Absence of the L8 lipopolysaccharide epitope was noted for all isolates. Sera of our patient were found to have low total hemolytic complement (CH100 = 21 U/ml; normal = 55 to 100 U/ml) due to deficiency of C8 (C8 less than 1,000 CH50 U/ml; normal = greater than or equal to 16,000 CH50 U/ml). This is the first reported case of gonococcal meningitis occurring in a patient with a terminal-complement deficiency. Gonococcal meningitis is a rare complication of gonococcal bacteremia. Both defects in host defenses (e.g., terminal-complement deficiency) and organisms with unusual virulence appear to contribute to the pathogenesis of this complication of gonococcal bacteremia.

Common Epitopes of Pilin of Neisseria meningitidis

We assessed distribution, immunogenicity, and accessibility of common epitopes of meningococcal pilins. When used as probes in western immunoblots, antisera to gonococcal pili; gonococcal pilin fragment CNBR-2; peptide sequences 41-50, 48-60, and 69-84 of gonococcal pilin; and monoclonal antibody 2-1-Fc recognized meningococcal pilins of different isolates. Meningococcal pilins could be separated into distinct groups based on reactivity with these probes. Common epitopes were conserved on meningococcal pilins isolated during laboratory passage and during infection of human nasopharyngeal organ cultures. Antibodies to common epitopes of pilin were, however, rarely detected in convalescent sera from patients with meningococcal or gonococcal bacteremia. Except for an epitope involving peptide sequence 48-60, immunoelectron microscopy indicated that common epitopes of pilin were not readily accessible on pili assembled on meningococci. Our antisera also did not block attachment of piliated meningococci to human buccal epithelial cells.

Natural immunity to murine gonococcal bacteremia: roles of complement, leucocytes, and sex

The roles of the serum bactericidal system, inflammatory cells, and sex in resisting gonococcal infection were studied in a murine model of gonococcal bacteremia. The role of serum killing in defense was investigated with complement component 5 deficient (C5-deficient) (B1O.D2/OSN) and normal (B1O.D2/NSN) mice. No significant differences were found between LD50's with either murine serum-sensitive or serum-resistant gonococci in those two mouse strains. However, in vitro experiments revealed a heat-stable factor in mouse serum which killed gonococci. Thus it appeared that the C5-deficient mouse is not a good model for the study of the role of C-mediated killing in resistance to gonococcal infection. Mice with Chediak-Higashi disease were used to study the role of phagocytes and natural killer cells. The difference in LD50's between affected mice (C57B1/6J beige J) and controls (C57B1/6J) was significant. The CBA/N mice, which have a B-cell maturation defect, were no more resistant to infection than control mice, which was taken as further evidence that B cells were less important than other leucocytes in innate immunity to gonococcal infection. Finally, male mice were significantly more resistant than female mice to gonococcal bacteremia. Thus, in this study the two most important determinants of resistance to gonococcal infection were inflammatory cells and sex.

Disseminated gonococcal infection in mice.

Gonococci do not readily cause disseminated infection in mice. To simulate some of the conditions leading to disseminated gonococcal infection in women, we suspended gonococci in mucin plus hemoglobin and studied the development of gonococcal bacteremia. The mucin-hemoglobin mixture was used because the menstruum appears to be involved in dissemination of gonococci from the genital tract during menstruation. Mice did not die after massive inocula of 10(9) gonococci given intraperitoneally in broth, but when gonococci were suspended in mucin (15%) alone, the 50% lethal dose was 10(8.4) and in 15% mucin plus 4% hemoglobin (M/H), the 50% lethal dose fell to 10(6.6). Sublethal doses produced local peritonitis and transient bacteremia. With larger inocula the local peritoneal infection progressed to fatal septicemia. Studies of the mechanism by which M/H lowered the 50% lethal dose showed that systemic clearance mechanisms were compromised, but not enough to account for the total decrease in the 50% lethal dose. If gonococci were given intravenously after intraperitoneal inoculation of M/H, sequestration of gonococci in the peritoneal cavity occurred, suggesting an effect on local peritoneal defenses. The effect on neutrophils appeared most significant, since numbers of neutrophils in the peritoneal fluid were decreased in the presence of M/H and neutrophils were destroyed by M/H in vitro. The serum bactericidal system was not affected. We conclude that M/H promotes gonococcal bacteremia by interference with phagocytosis and intracellular killing of gonococci. The model simulates the disseminated gonococcal infection cases in women which follow pelvic inflammatory disease in its progression from local peritonitis to transient or lethal bacteremia and in factors (mucin and hemoglobin) which enhance infection.

Evaluation of a gonococcal serologic test.

The fluorescent gonorrhea test--heated (FGT-H), an indirect immunofluorescent method for detecting the presence of antigonococcal antibodies in serum, was evaluated in 1,000 women referred to a private clinic for the termination of pregnancy, 202 women treated at a municipal venereal disease clinic, and six women hospitalized with gonococcal bacteremia. The test was positive for 17.7% of private outpatients, even though gonococci were cultured from only 1.1% of these women, and another 5.1% had histories of gonococcal infection. Positive test results were found for 68.3% of the women in the venereal disease clinic population, in which the prevalence of gonococcal infection was 36.1% and an additional 25.2% had had gonorrhea previously. The test was positive for all six patients with gonococcemia. The sensitivity of the test in the low-risk population was 72.7%, which was not significantly different from the sensitivity of 84% in the high-risk population. Specificity of the test was 83% in low-risk patients, but only 41% in high-risk patients. These findings indicate that a negative test is a highly reliable means for excluding gonorrhea in populations of low-risk women. The predictive value of a positive test is low, ranging from 4.5% in the low-risk group to 45% in the high-risk group.

Perihepatitis and Hepatitis as Complications of Experimental Endocarditis Due to Neisseria gonorrhoeae in the Rabbit

Seven strains of Neisseria gonorrhoeae (colony type 1 or 2) were tested for their ability to produce endocarditis in rabbits with transaortic valve catheters. The gonococci exhibited three auxotype patterns and a broad range of susceptibility to penicillin and to complement-mediated serum bactericidal activity. Only four strains produced endocarditis; infectivity appeared to be related to serum resistance. Neither arthritis nor skin lesions were observed in infected animals, but 40% had hepatitis, often with fibrinous perihepatitis. Hepatic lesions could be induced by the continuous infusion of gonococci without a transvalvular catheter. Suppurative hepatitis in the rabbit endocarditis model is of particular interest in light of the unusual hepatic involvement reported in association with gonococcal endocarditis in humans. Since perihepatitis also occurs as a complication of experimental gonococcal bacteremia, perhaps the Fitz-Hugh-Curtis (gonococcal perihepatitis) syndrome appearing in women occurs more often as a function of undiagnosed bacteremia than has heretofore been suspected.

GONOCOCCAL BACTEREMIA IN A WOMAN, WITH CURE BY SURGICAL INTERVENTION

In May, 1930, Wheeler and Cornell¹reported from the First Surgical Division of the New York Hospital a case of gonococcal bacteremia cured by operation. This probably represents the first case of its kind in surgical literature. Soon afterward, a patient presenting a similar condition was admitted to the Second Medical Division of the New York Hospital, and her case forms the basis of the present communication. A detailed description of the illness of this patient is herewith appended, because it is felt that the problem which presented itself is of considerable importance and that its solution opens up a new field in the therapy of this disease. <h3>REPORT OF CASE</h3> R. H., a woman, aged 26, was admitted to the medical service of the New York Hospital, June 26, 1929, with the chief complaint of fever and rash of four weeks' duration. Four weeks before, the patient came

GONOCOCCAL BACTEREMIA IN A WOMAN, WITH APPARENT CURE BY SURGICAL INTERVENTION

The case described in this article was one of intermittent gonococcal bacteremia in a woman, in which positive cultures were obtained from the genital organs (cervix, uterine cavity and tubes) without any evidence, either gross or microscopic, of a local acute inflammatory reaction. A thorough search of the literature failed to reveal a similar case treated surgically. In the majority of the cases in the literature, the bacteremia had followed an acute gonorrhea. The treatment of this case by surgical means apparently opens up a new field in the therapy of this disease. The history of the case in detail is as follows: REPORT OF CASE N. H., a woman, aged 19, single, born in the United States and employed as a bottle filler, was admitted to the New York Hospital, first medical division, 1 June 6, 1928. Her chief complaints were of pains in the left arm and left