SPECIMEN
In Acute Gonorrhea In chronic gonorrhea
• Endocervical culture - 80 - 90% sensitivity • Morning drop secretion
• Urethral discharge - 50% sensitivity • Exudate after prostatic massage • High vaginal swab are not satisfactory • Centrifuged deposits of urine when no • Rectal wall swab - if there is history of rectal sex urethral discharge
Microscopy : Fluorescent antibody technique
Transport Media : Stuart’s or Amies media processing is to occur within.
For longer holding period culture media with self CO2 generating system (such as JEMBEC or Gono- pak systems) may be used.
Culture Media : Acute → Chocolate agar or Muller - Hinton agar. Chronic → Selective media like Thayer Martin medium.
Serology : Done in chronic case or with metastatic lesion Eg CFT, Precipitation, passive agglutination, Immunofluorescence, RIA.
Chemiluminescent DNA Probe : in high risk patient undergoing screening for STD's.
Blood Culture (Eg. of synovial fluid) : in suspected cases of disseminated infection.
• Preferred method for diagnosis of gonococcal infection in children is a standardized culture, from urethera and cervix. However cervical specimen are not recommended in prepubertial girls unless necessary.
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BACTERIOLOGY
“Gram —ve Cocci”6. Ans. is d i.e. Group B Ref. Ghai 6/e, p 197 - 198
“No vaccine is available for protection against group B meningococci.”
• Conjugate vaccines are prepared by conjugating protein carrier with polysaccharide capsule. • Conjugate vaccine are available for :
a. Hemophilus influenza B.
b. Menigococcal serotypes A, C, Y and W - 135. c. Streptococcal pneumoniae (pneumococcus).
7. Ans. is c i.e. M protein Ref. Harrison 17/e, p 915; Ananthnarayan 7/e, p 226 M protein is the virulence factor of strept. pyogenes not of gonococci.
Virulence factors of neisseria gonorrhoea 1. Outer Membrane Proteins
• Pilli • Opacity associated protein (Protein II) • Porin (Protein I and III) • Lipoprotein H. 8
• IgA1 protease • Transferrin and lactoferrin binding protein
2. Lipooligosaccharide (endotoxin)
8. Ans. is a i.e. Gram positive cocci Ref. Harrison 17/e, p 916
Gonococcal Infection In Males
• MC Clinical manifestation – Acute urethritis.
• Major symptoms – Urethral discharge and dysuria usually without urinary frequency or urgency.
• Other features – Epididymitis (uncommon) – Prostatitis (rare)
– Edema of penis and Balanitis.
– Urethral stricture and Periurethral abscess or fistulae (=Watercan perineum)
– Inflammation or abscess of Cowper's gland. – Seminal vesiculitis
• DOC – 3rd generation cephalosporin - cefixime and ceftriaxone
Remember : • All cocci are gram positive except GMC i.e N. gonorrhoea, N. meningococci, N. catarrhalis. • All important bacilli are gram negative except ABC, CML i.e. Actinomycetes, Bacillus,
SECTION
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B
9. Ans. is a and c i.e. It is the most common cause of meningitis in children; and In children less than 2 years the vaccine is not effective
Ref. Park 18/e, p 138; 19/e, p 140; Forfar & Arneil's, p 1338
• MC cause of neonatal meningitis : E. coli
• MC cause of meningitis in age group 1 month to 20 year is N. meningitidis.
• MC cause of meningitis > 20 years : Strep pneumoniae. ... Harrison 17/e, p 2621 • Sulphonamides once the mainstay, are not used now due to widespread resistance. ... AA 7/e, p 225
• MC serotype is not given in Park or any other book so as the rule first written is the most common so group A is MC not group B.
• Vaccine (not available for group B) is contraindicated in pregnancy and ineffective in children < 2years.
10. Ans. is b i.e. Testis Ref. Ananthnarayan 7/e, p 227
Spread of infection in males
Acute urethritis Chronic urethritis
↓ ↓
Prostate, seminal vesicles Urethral stricture + periurethral infection
epididymis ↓
Abscess + multiple sinuses (= Water can perineum)
11. Ans. is c and d i.e. Most patients present with symptoms of dysuria; and Single dose of ciprofloxacin is effective in treatment Ref. Harrison 17/e, p 916; Ananthnarayan 7/e, p 227
Gonococcal infection in Females
– Initial infection involves urethra and cervix uteri. – Cervicitis is MC manifestation.
– Vaginal mucosa is resistant due to stratified squamous epithelium but can involve in anestrogenic women (prepubertal, post menopausal).
– Infection spreads to endometrium, fallopian tube, bartholin gland, peritoneum with perihepatic inflammation
(Fitz-Hugh-Curtis syndrome).
– Clinical disease (as a rule) is less severe in women. – Proctitis occur in both sexes.
Gonococcal infection in males - Already described
Disseminated Gonococcal infection (DGI) or Arthritis. Occur in very few patient. DGI also cause skin
lesion, meningitis, endocarditis etc.
Treatment :– 3rd generation cephalosporin cefixime and ceftriaxone.
– Single dose ciprofloxacin, ofloxacin, Levofloxacin etc. also affective.
Remember : Incubation period of Gonococcal infection is 2-8 days.
12. Ans. is b i.e. Gram negative Diplococci in pus cells Ref. Ananthnarayan 7/e, p 223
Gram negative diplococci – Neisseria
UNIT
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BACTERIOLOGY
“Gram —ve Cocci”1. b) Maltose ... 2. b) Meningitis 3. None 4. None 5. b) Endotoxin
1. Differentiation of neisseria gonorrhoea and neisseria meningitidis is by : [AI 90]
a) Glucose fermentation b) Maltose Fermentation c) V.-P. reaction
d) Indol test
[Ref. Ananthnarayan 7/e, p 226]
2. Which is not a metastatic complication of gono- cocci : [JIPMER 91]
a) Endocarditis b) Meningitis c) Nephritis d) Arthritis
[Ref. Ananthnarayan 7/e, p 227]
3. Incubation period of gonorrhoea is :
a) Less than 24 hrs [JIPMER 92]
b) 1 to 2 days c) 2 to 15 days d) 12 to 25 days
[Ref. Ananthnarayan 7/e, p 226]
4. Gonococci in gram stained smears are seen in- side the : [Kerala 94]
a) Lymphocytes b) Neutrophils c) Mast cells d) Macrophages
[Ref. Ananthnarayan 7/e, p 225]
5. Skin lesion in meningococcal meningitis is due to:
a) Exotoxin [Kerala 94]
b) Endotoxin c) Allergic reaction
d) Direct vascular Damage
[Ref. Ananthnarayan 7/e, p 224]
Answer
6. Which f the following is most resistance to gono- coccal infection : [Kerala 94]
a) Prostate b) Epididymis c) Testis d) Urethra
[Ref. Robbins 7/e, p 1039]
7. Neisseria infection are associated with :
a) Deficiency of early complements [CUPGEE 95] b) Deficiency of late complements
c) There is not such association d) Any deficiency can be associated
[Ref. Ananthnarayan 7/e, p 224]
8. Gonococcus ferments : [AP 97]
a) Glucose b) Maltose c) Sucrose d) Fructose
[Ref. Ananthnarayan 7/e, p 226]
9. The diagnosis of gonorrohea is established by :
a) Comliment fixation tests [Orissa 98]
b) Pili agglutination tests c) Haem agglutination tests d) All of the above tests
[Ref. Ananthnarayan 7/e, p 228]
10. Meningococci differ from gonococci in that they :
a) Are intra-cellular [ICS 98]
b) Possess a capsule
c) Causes fermentation of glucose d) Are oxidase positive
[Ref. Ananthnarayan 7/e, p 222]
Chapter Review
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This section includes questions of VThis section includes questions of VThis section includes questions of Various Other PGMEES from 1990 – 2007.This section includes questions of VThis section includes questions of Various Other PGMEES from 1990 – 2007.arious Other PGMEES from 1990 – 2007.arious Other PGMEES from 1990 – 2007.arious Other PGMEES from 1990 – 2007.
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system easier and uncomplicated to save the precious time of PGMEE Aspirant.
system easier and uncomplicated to save the precious time of PGMEE Aspirant.system easier and uncomplicated to save the precious time of PGMEE Aspirant.
system easier and uncomplicated to save the precious time of PGMEE Aspirant.
system easier and uncomplicated to save the precious time of PGMEE Aspirant.
SECTION
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B
11. The following are gram-negative cocci except :
a) Pneumococci [Kar 01]
b) Meningococci c) Gonococci d) Veillonella
[Ref. Ananthnarayan 7/e, p 216]
12. The vaccine against N:meningitides contains :
a) Whole bacteria [ICS 00]
b) Capsular polysaccharide c) Somatic ‘0’ antigen
d) Lipo polysaccharide protein complex
[Ref. Ananthnarayan 7/e, p 225]
13. A pus culture on chocolate agar shows gram nega- tive cocci most likely organism is : [UP 04]
a) Haemophilis ducreyi b) Neisseria gonorrhoea c) Streptococcus pyogenes d) Streptococcus pneumoniae
[Ref. Ananthnarayan 7/e, p 225]
14. Water can perineum” is caused by : [UP 06]
a) E. coli
b) Enterococcus faecalis c) Neiserria-gonorrhoea d) Treponemia palladium
[Ref. Ananthnarayan 7/e, p 227]
11. a) Pneumococci 12. b) Capsular ...
13. b) Neisseria ... 14. c) Neiserria ...