Neisseria Meningitidis Urethritis: A Case Report Highlighting Clinical Similarities to and Epidemiological Differences From Gonococcal Urethritis

Katz, Alan R.; Chasnoff, Rachelle; Komeya, Alan Y; Lee, Maria Veneranda C.

doi:10.1097/olq.0b013e3181ffa7dc

Cited by 16 publications

(8 citation statements)

References 21 publications

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“…Urethral N. meningitidis infection can be asymptomatic or symptomatic mimicking a gonococcal urethritis with the characteristic purulent penile discharge (Katz et al, 2011). The same treatment is recommended for both N. meningitidis and N. gonorrhoeae infections (Hook & Handsfield, 2008) Both methylene blue/gentian violet stain and Gram stain can be used for direct microscopic gonococcal diagnostics (Taylor et al, 2011), but the specificity for N. gonorrhoeae is not 100 %, as other Neisseria species may have an identical microscopic appearance.…”

Section: Discussionmentioning

confidence: 99%

A misleading urethral smear with polymorphonuclear leucocytes and intracellular diplococci; case report of urethritis caused by Neisseria meningitidis

Genders

Spitaels²,

Jansen

et al. 2013

Journal of Medical Microbiology

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The primary pathogens found in men with urethritis are Chlamydia trachomatis and Neisseria gonorrhoeae. Rapid diagnosis of N. gonorrhoeae infection can be made based on a Gram-or methylene blue-stained urethral smear. We describe a case of a man with purulent penile discharge, in which microscopic examination led to the presumptive diagnosis of gonorrhoea. A nucleic acid amplification test was negative for N. gonorrhoeae but positive for C. trachomatis. Culture showed Gram-negative diplococci which were identified as Neisseria meningitidis. N. meningitidis can be sporadically pathogenic in the genito-urinary tract and mimicks gonococcal urethritis, and appears identical by microscopy. When a gonococcal urethritis is suspected based on clinical signs and microscopic examination, but investigatory tests cannot confirm the diagnosis, a N. meningitidis infection should be considered.

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Section: Discussionmentioning

confidence: 99%

A misleading urethral smear with polymorphonuclear leucocytes and intracellular diplococci; case report of urethritis caused by Neisseria meningitidis

Genders

Spitaels²,

Jansen

et al. 2013

Journal of Medical Microbiology

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“…In several subsequent reports, the presence of N. meningitidis in the urethra was not associated with genital symptoms [78,83,84,95]. However, genital infections caused by meningococci may sometimes present similar clinical symptoms to classical gonorrhea, e.g., purulent penile discharge and urethritis, and cervicitis/vaginitis [29,30,[85][86][87]93,94] (Table 1).…”

Section: Meningococcal Genitourinary Tract Infectionsmentioning

confidence: 93%

“…The molecular bases for these qualities have yet to be wholly elucidated [4,27]. However, isolation of both gonococci and meningococci from sites other than their corresponding natural niches has been reported time and again [28][29][30][31][32]. In addition, infections with commensal Neisseria species behaving as opportunistic pathogens have been described, with the oldest reports dating to the beginning of the C20th (extensively reviewed in [33]).…”

Section: Introductionmentioning

confidence: 99%

Atypical, Yet Not Infrequent, Infections with Neisseria Species

Humbert

Christodoulides

2019

Pathogens

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Neisseria species are extremely well-adapted to their mammalian hosts and they display unique phenotypes that account for their ability to thrive within niche-specific conditions. The closely related species N. gonorrhoeae and N. meningitidis are the only two species of the genus recognized as strict human pathogens, causing the sexually transmitted disease gonorrhea and meningitis and sepsis, respectively. Gonococci colonize the mucosal epithelium of the male urethra and female endo/ectocervix, whereas meningococci colonize the mucosal epithelium of the human nasopharynx. The pathophysiological host responses to gonococcal and meningococcal infection are distinct. However, medical evidence dating back to the early 1900s demonstrates that these two species can cross-colonize anatomical niches, with patients often presenting with clinically-indistinguishable infections. The remaining Neisseria species are not commonly associated with disease and are considered as commensals within the normal microbiota of the human and animal nasopharynx. Nonetheless, clinical case reports suggest that they can behave as opportunistic pathogens. In this review, we describe the diversity of the genus Neisseria in the clinical context and raise the attention of microbiologists and clinicians for more cautious approaches in the diagnosis and treatment of the many pathologies these species may cause.

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“…Those two species historically were thought to be isolated populations (18). However, N. meningitidis is quite frequently described as the causative agent of urogenital infections (19)(20)(21)(22)(23)(24), and there are numerous examples of N. meningitidis and Neisseria gonorrhoeae being coisolated either from the pharynx (25)(26)(27) or from urogenital sites (28)(29)(30)(31). Consequently, Hodge et al discovered a Neisseria strain that phenotypically resembles N. meningitidis but reacts with serological tests intended for gonococcal confirmation (32).…”

mentioning

confidence: 99%

Description of an Unusual Neisseria meningitidis Isolate Containing and Expressing Neisseria gonorrhoeae-Specific 16S rRNA Gene Sequences

Walcher¹,

Skvoretz²,

Montgomery-Fullerton³

et al. 2013

J Clin Microbiol

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An apparently rare Neisseria meningitidis isolate containing one copy of a Neisseria gonorrhoeae 16S rRNA gene is described herein. This isolate was identified as N. meningitidis by biochemical identification methods but generated a positive signal with Gen-Probe Aptima assays for the detection of Neisseria gonorrhoeae. Direct 16S rRNA gene sequencing of the purified isolate revealed mixed bases in signature regions that allow for discrimination between N. meningitidis and N. gonorrhoeae. The mixed bases were resolved by sequencing individually PCR-amplified single copies of the genomic 16S rRNA gene. A total of 121 discrete sequences were obtained; 92 (76%) were N. meningitidis sequences, and 29 (24%) were N. gonorrhoeae sequences. Based on the ratio of species-specific sequences, the N. meningitidis strain seems to have replaced one of its four intrinsic 16S rRNA genes with the gonococcal gene. Fluorescence in situ hybridization (FISH) probes specific for meningococcal and gonococcal rRNA were used to demonstrate the expression of the rRNA genes. Interestingly, the clinical isolate described here expresses both N. meningitidis and N. gonorrhoeae 16S rRNA genes, as shown by positive FISH signals with both probes. This explains why the probes for N. gonorrhoeae in the Gen-Probe Aptima assays cross-react with this N. meningitidis isolate. The N. meningitidis isolate described must have obtained N. gonorrhoeae-specific DNA through interspecies recombination.

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Neisseria Meningitidis Urethritis: A Case Report Highlighting Clinical Similarities to and Epidemiological Differences From Gonococcal Urethritis

Cited by 16 publications

References 21 publications

A misleading urethral smear with polymorphonuclear leucocytes and intracellular diplococci; case report of urethritis caused by Neisseria meningitidis

A misleading urethral smear with polymorphonuclear leucocytes and intracellular diplococci; case report of urethritis caused by Neisseria meningitidis

Atypical, Yet Not Infrequent, Infections with Neisseria Species

Description of an Unusual Neisseria meningitidis Isolate Containing and Expressing Neisseria gonorrhoeae-Specific 16S rRNA Gene Sequences

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