Unit 5, Week 1 (Pt. 2)

- Gonococcus
- Neisseria gonorrhoeae, a Gram-negative diplococcus

- Incubation period of 2-5 days, frequently asymptomatic
- Men have urethritis
- Women may have painful urination, vaginal discharge
- In adults transmitted horizontally
- Transmitted vertically to newborns (birth)
- Causes issue in conjunctiva/eyes in newborns

Pili attach to receptors on mucosal cells (urethra, uterine cervix, mouth, pharynx, rectum, or conjunctiva)

- Adhesins > active invasion
- Bacterial polysaccharide and peptidoglycan released cause inflammatory response

- Avoids adaptive immunity
- Antigenic variation

- Several types of Opa proteins
- Several types of pili
- Block antibody production

- One of the most severe types of conjunctivitis in newborns
- Complications can lead to loss of vision
- Prevented by prophylactic antibiotic ointment applied to eyes of newborns

Direct horizontal

Indirect horizontal

Indirect horizontal

- Capsules
- Peptidoglycan and arabinoglycan layer
- Mycolic acid layer or mycomembrane

Additional sugars being outermost layer

- Will have active damage to lung tissue
- Progression to cavitary TB

Have M tuberculosis DNA detected in tissues by in situ PCR, not damaging

- Has difficult time actually killing and destroying bacteria
- No problem with recognition, but immune system has a harder time clearing bacteria
- When it can't kill it, will try to wall it off into tubercle to enclose bacteria so it won't spread (some bacteria are able to break through)

Expanding AIDS epidemic, increasing prevalence of drug-resistant strains

- Acid-fast bacillus
- Slow growth (generation time = 12 hrs)
- Resistant to drying, disinfectants and low/high pH

2-12 weeka

- Fever
- Weight loss (not hungry, not comfortable eating)
- Cough with bloodied septum
- Chest pain
- Chills

Asymptomatic, not contagious

Symptomatic, can transmit bacteria

- Renewed growth after latent period
- Can be caused by stress, immunosuppression, other infections in the area

Macrophages

Recruit other WBCs

- Forms with bacteria, macrophages, and other immune cells
- Means the body is keeping bacteria latent, enough to prevent active coughing and other symptoms

1. M. tuberculosis-containing aerosols are inhaled; bacilli may bypass goblet cells and move to the lungs
2. Macrophage recognition and bacterial engulfment trigger innate immune signaling pathways, which leads to recruitment of other immune cells to the infection site
3. Immune cells organize in spherical structure, surrounded by fibrinogen and collagen (granuloma)
4. Bacteria can survive inside the granuloma in a latent state (asymptomatic)
5. Due to environmental genetic factors, the granuloma disintegrates, allowing the bacilli to spread and form more lesions (this is active TB and can be transmitted to others)

Walled off tubercules

- Purified protein derivative
- Injection of bacterial protein
- Not testing for live bacteria, testing for antibody reaction or memory

- Body recognizes that protein as familiar
- Can be an indicator of latent formation
- Could have been infected at some point in the past then cleared the infection
- If you had a TB vaccine, you would have a positive test

Combination therapy
- Isoniazid
- Rifampin
- Rifapentin

Inhibit mycolic acid synthesis

Inhibit RNA polymerase

Inhibits RNA polymerase

- M tuberculosis exhibits spontaneous chromosomal mutations
- Slow growth

- Administering only one drug
- Improperly administered drug