February 27, 2019
Case Study Cont.
• Blood agar results: gamma hemolysis
• Gram stain: gram positive coccus
o Leads us to believe we have staph infection
• Coagulase test: negative
• STI panel: blood and urine analysis, gram stain; test for 9-11 STIs at same time
• Can we diagnosis now? No, results do not match
• Discharge gram stain: eukaryotic nuclei, intracellular cocci that are gram negative
o Suggests Neisseria gonorrhea
• Why did we get gram positive cocci on gram stain?
o Contamination and not clean edge (skin has staph cocci)
o Gc will not grow on blood agar, must grow on chocolate agar
• Now onto the sore throat.....
o Throat swab and conduct rapid strept test
▪ Strept test: negative
o Culture other swab: alpha hemolysis on blood agar
▪ Can rule out strept
o Concurrent Gc infection.... might also have pharyngeal infection
o Chocolate agar: growth that show signs of gonorrhae
• Genetic analysis last step to see if same strain of Gc or differing
• Antibiotic disc sensitivity test as well
• Exposed to gonorrhea by sexual contact
• Once in urogenital tract, attaches and invades non-ciliated epithelial cells
o Microvilli and ciliated are not the same!
• Ciliated cells “flush out” invasive bacteria, these are mucosal cells that produce mucus to
rid the body of bacteria
• Gc Responses:
o Sends membrane vesicles to the mitochondria, contain poring B - leads to
destruction of those epithelial cells
o Can also pass thru epithelial cells and be taken up by macrophage or neutrophils
▪ Macrophages – phagocytosed, some kill bacteria and produce cytokines
(tumor necrosis factor alpha – act on same epithelial cells but ALL
epithelial cells including ciliated, triggers apoptosis)
o Release of peptidoglycan / lipoligossachride – recycled in cells, receptor
o Neutrophils – migrate out of blood due to pathogen signaling and release
cytokines due to damage of mast cells (or any cells), HELP Gc
▪ Help Gc by...