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Gonorrhea is a sexually transmitted disease caused by Neisseria gonorrhoeae. Gonorrhea infection varies greatly in the community, especially in sexually active women. Infection cases in women are often asymptomatic, that can causes complication can easily occur. The aims of this study are to identify and determine sensitivity of Neisseria gonorrhoeae bacteria against cefixime antibiotics. This study was using a descriptive method and used 30 samples. Neisseria gonorrhoeae was isolatd from the vaginal swab sample of Commercial Sex Workers at Puskesmas II Denpasar Selatan. The cultured bacteria on Thayer Martin media were then identified by gram staining, oxidase test, and catalase test. Neisseria gonorrhoeae sensitivity test against cefixime was performed by disc diffusion method. The results of identification showed that 6 (20 %) of 30 samples were Neisseria gonorrhoeae bacteria with cell characteristics in the form of diplococcus, gram-negative, oxidase and catalase positive. The results of the sensitivity test showed that all isolats of Neisseria gonorrhoeae were resistant to cefixime

Gonorrhea, one of the sexually transmitted disease caused by a gram negative diplococcus bacteria Neisseria gonorrhoeae. Rho protein is indispensable for bacterial viability due to its versatile fu...

The Gram-negative diplococcus Neisseria macacae is a commensal bacterium of the mucosal surfaces in humans. A 52-year-old woman receiving continuous ambulatory peritoneal dialysis was admitted because of abdominal pain and turbid peritoneal fluid. N. macacae was isolated from peritoneal fluid culture and showed susceptibility to ceftriaxone. Despite appropriate antibiotics, the peritonitis was refractory, leading to the removal of the peritoneal dialysis catheter. We herein report the first case of peritoneal dialysis peritonitis caused by Neisseria macacae and review previous case reports of N. macacae infection in humans.

Today the problem of pathogenesis and rational treatment of purulent-inflammatory odontogenic diseases of the maxillofacial area is quite relevant in the field of medical and SOCIAL problems. In recent years, the number of patients with odontogenic inflammatory does not catch an illness, while the number of complications increases. In case of the development of purulent inflammation the complex of interrelated morphological, biochemical, immunological and other changes is observded. The basis in the complex treatment of phlegmon of the maxillofacial area and neck of any localization is active surgical treatment. General therapy for odontogenic inflammatory diseases of the maxillofacial area primarily provides control of infection and intoxication, aimed at normalization of the impaired functions of organs and systems. The purpose of this research was to increase the effectiveness of comprehensive treatment of patients with odontogenic phlegmon of the maxillofacial localization by the use of cryopreserved placental cells. In most cases, the cause of inflammatory processes of maxillofacial localization was untreated periodontal teeth, retained teeth and negligent behavior of patients. That is why the majority of authors believe that the "cause" tooth should be urgently removed, but the solution depends on the individual features of the patient and in some cases may be postponed until the relief of the inflammatory process [3,4]. The combination of local and general factors is necessary to avoid further development of abscesses and phlegmons of the maxillofacial area and neck. The local factors are aerobic and anaerobic infection (staphylococcus, streptococcus, enterococcus, diplococcus, intestinal, gram-positive and gram-negative rods, but less often - mycoplasmas, the simplest of the family Trichomonas, spirochetes, and fungi of the genus Candida). The concentration of causal microflora, general and local nonspecific and specific protective factors of the body, the state of various organs and systems of the body, as well as anatomical and topographic features of the tissues of the maxillofacial area play a significant role in the development and course of purulent-inflammatory processes of the head and neck. All of the above determines the nature of the inflammatory reaction: normergic, hyperergic, hypoergic, anergic. Currently, placental cryoextract preparations are widely used in various fields of medicine, in particular, in urology, gynecology and general surgery. So, maxillofacial surgeons can be interested in their use in the treatment of patients with inflammatory purulent diseases of the maxillofacial localization. That is why carrying out a detailed analysis of native and foreign literature, we have concluded that it is necessary to continue study and scientifically substantiate the issue of optimizing conservative treatment of patients with odontogenic phlegmons with the use of biologically active substances. In further studies it is planned to investigate the impact on the mechanism of purulent wound healing by cryopreserved placenta and to create a morphological and biochemical evidence base for the effectiveness of the proposed treatment.

Septic Arthritis is a medical emergency with a significant mortality and morbidity. Infection usually occurs via haematogenous seeding of microorganisms or via injury, such as trauma or surgery. The aim of management is to minimise the risk of irreversible joint damage and to preserve function. Septic arthritis is usually bacterial in origin, most commonly Staphylococcus aureus, but Mycobacteria or fungi can also be responsible. Neisseria meningitidis is an aerobic Gram-Negative Diplococcus that normally inhabits the naso and oropharynx and has the potential to cause meningitis, septicaemia, septic arthritis and endocarditis. We present the case of a 63 year old lady admitted with bilateral knee pain and swelling, lower limb rash and a fever who was initially managed as a Reactive Arthritis but subsequent Polymerase Chain Reaction (PCR) molecular analysis revealed capsular group B N. meningitidis in bilateral knee aspirates. We discuss the diagnostic challenges in differentiating Septic Arthritis from inflammatory arthritis, and the role of PCR molecular analysis in that process.

Resumen Neisseria gonorrhoeae es un diplococo gramnegativo, no móvil, esporulado, aerobio o anaerobio facultativo, catalasa y oxidasa positivas. Las infecciones de transmisión sexual causadas por este microorganismo son un problema de salud pública definido como tal desde el siglo XIX, representando una gran amenaza para la salud humana debido a la su alta prevalencia y multirresistencia a antimicrobianos. En las últimas décadas han aumentado los reportes de cepas resistentes a penicilina, fluoroquinolonas, sulfonamidas, tetraciclina, macrólidos, y más recientemente a cefalosporinas y azitromicina. Tal panorama ha generado preocupación a nivel mundial, debido al aumento de casos de gonorrea asociados a cepas multirresistentes. En Chile se desarrolló desde el 2010 hasta el 2018 el Programa de Vigilancia de N. gonorrhoeae a nivel nacional con el objeto de caracterizar esta infección en las regiones y registrar la resistencia a los antimicrobianos. Esta revisión presenta un análisis sistemático bibliográfico, actualizado, de los principales aspectos de este microorganismo, su respuesta a antimicrobianos, y entrega pautas de diagnóstico y tratamiento, a la espera de avanzar en la comprensión del mecanismo molecular y las interacciones metabólicas e inmunológicas que determinan la infección, con miras a diseñar una vacuna efectiva.

Cilj: Cilj rada bio je detaljno prikazati metode mikrobiološke dijagnostike Neisseria gonorrhoeae i metode uzorkovanja za dijagnosticiranje gonoreje, ukazati na moguće načine prevencije od infekcija gonorejom te ispitati učestalost testiranja na bakteriju N. gonorrhoeae u Splitsko-dalmatinskoj županiji i učestalost pozitivnih rezultata. Materijali i metode: U ovom radu korišteni su materijali i podaci Nastavnog zavoda za javno zdravstvo Splitsko-dalmatinske županije. Neisseria gonorrhoeae su gram negativni diplokoki koji ne stvaraju spore. Za dijagnostiku gonoreje, koristi se test amplifikacije nukleinskih kiselina. Međutim, pozitivni rezultati moraju se potvrditi drugom metodom. Dijagnoza se može postaviti i izravnom mikroskopijom, najčešće iz brisa uretre ili endocerviksa, bojenih po Metilenu ili po Gramu gdje se vide intracelularni diplokoki u polimorfonuklearnim leukocitima. Također, radi se kultivacija gonokoka iz uzorka i antibiogram pomoću kojeg se mogu dobiti podaci o osjetljivosti gonokoka. Rezultati: Kroz petogodišnje razdbolje od 1.1.2016. do 31.12.2020. u Nastavnom zavodu za javno zdravstvo Splitsko-dalmatinske županije zaprimljeno je ukupno 136 uzoraka testiranih metodom aerobne kultivacije na bakteriju N. gonorrhoeae. Od toga je 127 bilo negativno, dok je u 9 (6,6 %) uzoraka dokazana bakterija N. gonorrhoeae od kojih su svi bili muškarci. Metodom PCR na bakteriju N. gonorrhoeae testirano je 187 uzoraka od kojih su 172 uzorka bila negativna, a u 15 (8 %) uzoraka se dokazala bakterija N. gonorrhoeae. Pozitivnih muškaraca je bilo 12 (8,8 %), 1 pozitivna žena (4,2 %), te 2 pozitivna rezultata kod prvog mlaza urina. Zaključak: Gonoreja je spolno prenosiva bolest koja se najčešće javlja kao asimptomatska bolest, a kada se pojave simptomi, to su gnojni isjedak iz spolovila, bol u donjem djelu trbuha, bol tijekom odnosa, krvarenje nakon odnosa, sterilitet itd. Sve veći problem je razvoj smanjene osjetljivosti na lijekove gdje je pronađena rezistencija na peniciline, tetracikline i kinolone. Potrebno je liječiti oba partnera, jer ako se ne liječe istodobno, bolest će se ponovno aktivirati. Objectives: The aim of the study is to describe in detail the methods of microbiological diagnosis of Neisseria gonorrhoeae and sampling methods for diagnosing gonorrhea, to indicate possible ways to prevent gonorrhea infections and to examine the frequency of testing for N. gonorrhoeae in Split-Dalmatia County and the frequency of positive results. Material and methods: In this study, the materials and data of the Teaching Institute for Public Health of the Split-Dalmatia County were used. Neisseria gonorrhoeae are gram-negative diplococci that do not form spores. A nucleic acid amplification test is used to diagnose gonorrhea. However, positive results must be confirmed by another method. The diagnosis can also be made by direct microscopy, most often from urethral or endocervical smears, stained by Methylene or Gram, where intracellular diplococci are seen in polymorphonuclear leukocytes. Also, gonococcal cultivation is performed from a sample and an antibiogram can be used to obtain gonococcal susceptibility data. Results: Through a five-year period from 1.1.2016. to 31.12.2020. a total of 136 samples tested by the method of aerobic cultivation for the bacterium N. gonorrhoeae were received at the Teaching Institute for Public Health of the Split-Dalmatia County. Of these, 127 were negative, while N. gonorrhoeae was detected in 9 (6.6%) samples, all of which were male. The PCR method on N. gonorrhoeae tested 187 samples, of which 172 were negative and N. gonorrhoeae was detected in 15 (8%) samples. There were 12 positive men (8.8%), 1 positive woman (4.2%), and 2 positive results in the first urine stream. Conclusion: Gonorrhea is a sexually transmitted disease that most often occurs as an asymptomatic disease, and when symptoms appear, it is a purulent discharge from the genitals, lower abdominal pain, pain during intercourse, postpartum hemorrhage, sterility, etc. An increasing problem is the development of reduced sensitivity to drugs where resistance to penicillins, tetracyclines and quinolones has been found. Both partners need to be treated because if they are not treated at the same time, the disease will reactivate.

Rising levels of antibiotic resistance in uncomplicated N gonorrhoeae infection have led to changes in recommended treatment and suggestions for new management paradigms. It is, however, unclear how these new approaches to treatment should be reflected in managing gonococcal pelvic inflammatory disease (PID). Gonorrhoea remains an important but relatively uncommon cause of PID for which treatment is often commenced prior to identification of the causative organisms. Those at highest risk (severe symptoms, partner with gonorrhoea, gram negative diplococci on microscopy) should have therapy which includes cover for N gonorrhoeae. Newer agents, such as lefamulin, gepotidacin and zoliflodacin have not been evaluated in women with pelvic infections but frequently have a wide spectrum of activity covering not just gonorrhoea but many of the other bacteria associated with PID, and achieve good tissue levels in the upper genital tract. However, optimal dosing regimens for PID to achieve clearance of infection but minimise the risk of developing future resistance need to be determined.

Neisseria meningitidis is a gram negativediplococcus and is one of the common causes of community-acquiredmeningitis inour country. In meningococcal meningitis, taking infection control measures andchemoprophyla is are important for the prevention of transmission. In thisarticle, a 20-year-old military personel who developed meningitis due to Neisseria meningitidis serogroup B waspresented and the infection control measures taken for the military unit andthose with close contact with the patient were reviewed., Neisseriameningitidis gram negatif diplokok olup ülkemizdetoplum kaynaklı menenjitin yaygın etkenlerinden biridir. Meningokok menenjitinde infeksiyonkontrol önlemlerinin alınması vekemoprofilaksi bulaşın önlenmesi açısından önemlidir. Bu yazıda, Neisseriameningitidis serogrup B’ye bağlı olarak menenjit gelişen, 20 yaşındaki birasker sunularak askeri birlik ve hastanın yakın temaslılarına yönelik alınan infeksiyonkontrol önlemleri gözden geçirilmiştir.

The review presents a modern strategy to improve the means of vaccine prevention of streptococcal infections aimed at finding and developing new vaccines for immunization of people belonging to risk groups. It should be noted that pneumococci (S. pneumoniae) are members of gram-positive bacteria (diplococci) and become the main cause of various nosological forms of human infectious diseases (such as pneumonia, otitis media, sinusitis, bacteremia and meningitis). Existing pneumococcal vaccines (conjugate and polysaccharide) have some important limitations, for example, serotype dependence, loss of effectiveness due to a change in the serotype landscape, insufficient protective effect from non-invasive forms of pneumococcal infections and high production costs associated with the development of these products. The main part of the review presents the most important research papers that used modern proteomic technologies in the study of the S. pneumoniae proteomic profile. These works allow us to evaluate at the molecular level the importance of bacterial proteins as candidates for creating new combination vaccines that can effectively protect against the full range of pneumococcal serotypes circulating in the human population. So, in particular, the data are provided on the new methodology for the analysis of the proteome of extracellular S. pneumoniae bacterial microvesicles to identify immunoreactive protein antigens, potential candidates for inclusion into vaccines. As a result of these studies, 15 immunoreactive proteins were discovered, 7 of which are cytosolic and 8 proteins are bound to the cell surface (MalX, ABC transporter or substrate binding transport protein, AmiA, AliA, LytC, IgA1 protease, PspA and the putative precursor of β-galactosidase). These are possible candidates for developing combination vaccines. Additionally, the review presents data on the role of significant virulence factors of the protein nature of S. pneumoniae strains in nasopharyngeal colonization, increased infectivity, as well as on overcoming reactions of the host's immune response.

The presence of microbial communities in the digestive tract affects the physiological functions of digestion. The purpose of this study is to determine the bacterial community in the digestive tract of lobsters, especially pearl lobsters. This research is descriptive explorative. Samples were taken from the lobster digestive tract which was divided into 3, namely the cardiac, pylorus and intestinal sections and each part was counted for the total bacteria using the TPC (Total Plate Count) method. Then isolated from the Sea Water Complex media and partially characterized. The results showed that the total number of bacterial cells in cardiac, piloric and intestinal cells were 41.91 x 108 cfu.ml-1, 18.26 x 108 cfu.ml-1 and 14.10 x 108 cfu.ml-1 respectively. The number of bacterial isolates obtained from the lobster pearl digestive tract were 51 isolates with details of 18 cardiac isolates, 16 isolates in piloric, and 17 isolates in the intestine. Phenotypic isolates obtained from lobster digestive tract bacteria consisted of monococcus 37.25%, diplococcus 27.45%, streptococcus 29.41%, staphylococcus 1.96%, and long baccil 3.92%, while gram positive 62.65 % and gram negative at 37.25%

Neisseria meningitidisis a gram-negative bacterium that often asymptomatically colonizes the human nasopharyngeal tract. These bacteria cross the epithelial barrier can cause life-threatening sepsis and/or meningitis. Antimicrobial peptides are one of the first lines of defense against invading bacterial pathogens. Human beta-defensin 2 (hBD2) is an antimicrobial peptide with broad antibacterial activity, although its mechanism of action is poorly understood. Here, we investigated the effect of hBD2 onN. meningitidis. We showed that hBD2 binds to and kills actively growing meningococcal cells. The lethal effect was evident after 2 h incubation with the peptide, which suggests a slow killing mechanism. Further, the membrane integrity was not changed during hBD2 treatment. Incubation with lethal doses of hBD2 decreased the presence of diplococci; the number and size of bacterial microcolonies/aggregates remained constant, indicating that planktonic bacteria may be more susceptible to the peptide. Meningococcal DNA bound hBD2 in mobility shift assays and inhibited the lethal effect of hBD2 in a dose-dependent manner both in suspension and biofilms, supporting the interaction between hBD2 and DNA. Taken together, the ability of meningococcal DNA to bind hBD2 opens the possibility that extracellular DNA due to bacterial lysis may be a means ofN. meningitidisto evade immune defenses.

Streptococcus pneumoniae, also known as pneumococcus, is a Gram-positive diplococcus and a major human pathogen. This bacterium is a leading cause of bacterial pneumonia, otitis media, meningitis, and septicemia, and is a major cause of morbidity and mortality worldwide. To date, studies on S. pneumoniae have mainly focused on the role of its virulence factors including toxins, cell surface proteins, and capsules. However, accumulating evidence indicates that in addition to these studies, knowledge of host factors and host-pathogen interactions is essential for understanding the pathogenesis of pneumococcal diseases. Recent studies have demonstrated that neutrophil accumulation, which is generally considered to play a critical role in host defense during bacterial infections, can significantly contribute to lung injury and immune subversion, leading to pneumococcal invasion of the bloodstream. Here, we review bacterial and host factors, focusing on the role of neutrophils and their elastase, which contribute to the progression of pneumococcal pneumonia.

The black-footed ferret (Mustela nigripes) is an endangered mustelid native to North America. Gastroenteritis is a documented cause of morbidity and mortality in managed individuals, particularly by infectious agents. Fecal cytology is an inexpensive and rapid test that can help guide clinical management strategies for animals with enteritis; however, normal parameters have not been established in black-footed ferrets. The objective of this study was to characterize fecal cytological findings of 50 fecal samples from 18 black-footed ferrets that received two different diet types (ground meat versus whole prey) and that were visibly judged to be normal or abnormal. This study also tested for the presence of Clostridium perfringens enterotoxin by enzyme-linked immunosorbent assay in all abnormal and a subset of normal fecal samples. Significantly higher spore-forming bacteria and yeast prevalence were present in normal feces from individuals following the meat-based compared with the whole-prey diet. Samples from individuals with abnormal feces had significantly more spore-forming bacteria than normal feces, regardless of diet. Normal feces had higher diplococci and spore-forming bacteria compared with domestic canine and feline standards. A single abnormal fecal sample was positive for enterotoxin and originated from the only animal requiring treatment. Results indicate that low numbers of spore-forming bacteria can be found in fecal samples from clinically normal black-footed ferrets. Fecal cytology shows significantly increased spore-formers in clinically abnormal ferrets and in clinically normal ferrets following a ground meat-based diet.

The Gram-negative diplococcus Neisseria meningitidis, also called meningococcus, exclusively infects humans and can cause meningitis, a severe disease that can lead to the death of the afflicted individuals. To cause meningitis, the bacteria have to enter the central nervous system (CNS) by crossing one of the barriers protecting the CNS from entry by pathogens. These barriers are represented by the blood–brain barrier separating the blood from the brain parenchyma and the blood–cerebrospinal fluid (CSF) barriers at the choroid plexus and the meninges. During the course of meningococcal disease resulting in meningitis, the bacteria undergo several interactions with host cells, including the pharyngeal epithelium and the cells constituting the barriers between the blood and the CSF. These interactions are required to initiate signal transduction pathways that are involved during the crossing of the meningococci into the blood stream and CNS entry, as well as in the host cell response to infection. In this review we summarize the interactions and pathways involved in these processes, whose understanding could help to better understand the pathogenesis of meningococcal meningitis.

Objective Moraxella catarrhalis is a non-motile Gram-negative diplococcus bacterium that contributed to several human infections including conjunctivitis. This study aimed to reveal the prevalence of M. catarrhalis in patients who suffered from conjunctivitis in Ahvaz city, southwest of Iran. Results Out of 100 conjunctiva swab specimens, M. catarrhalis was isolated only from one (1%) conjunctivitis cases using the culture method. This strain was isolated from a 34 years old female patient. Also, the results of the polymerase chain reaction (PCR) were in agreement with the culture method, and the specimen that showed positive culture was also positive for specific gene of M. catarrhalis. The remaining 99 specimens did not show positive results with any of the culture and PCR methods.

Neisseria gonorrhoeae is a global pathogen with significant morbidity. This bacterium is one of the common causes of sexually transmitted diseases; however, ocular gonococcal infection is rare. The gonococcal ocular infection can lead to ulcerative keratitis and/or corneal perforation. We report a case of endophthalmitis resulting from gonococcal keratoconjunctivitis. Sexual transmission could not be proven in this patient., Highlights • Neisseria gonorrhoeae is a global pathogen with significant morbidity. • Ocular gonococcal infection is rare. • A rare case of endophthalmitis secondary to gonococcal keratoconjunctivitis was described.

Patient: Male, 34-year-old Final Diagnosis: Conjunctivitis • Keratitis • Neisseria sicca Symptoms: Eye pain and redness • eyelid swelling • pus discharge Medication: — Clinical Procedure: — Specialty: Ophthalmology Objective: Rare disease Background: Neisseria-associated conjunctivitis is a rare cause of bacterial conjunctivitis in adults, with Neisseria gonorrhoeae as the primarily identified infectious strain. Here, we present a rare case of bacterial conjunctivitis due to Neisseria sicca in a 34-year-old immunocompetent man with no prior medical or ocular history. Case Report: A 34-year-old man with no significant past medical or ocular history presented with a 3-day history of left peri-orbital edema, ocular pain, and copious purulent discharge. Bacterial conjunctivitis was suspected due to the rapidity of onset and purulence. Peripheral corneal thinning was identified. Preliminary culture results showed gram-negative diplococci, and the patient was treated for gonococcal infection. Final cultures identified Neisseria sicca, a rarely pathogenic strain of Neisseria species. Conclusions: This is the second reported case of Neisseria sicca-associated conjunctivitis, and the first reported case to have corneal involvement. Neisseria sicca, while typically non-pathogenic, may manifest as conjunctivitis in immuno-competent hosts with a low-risk sexual history.

Neisseria meningitidis, a gram-negative diplococcus, is typically an asymptomatic coloniser of the oropharynx and nasopharynx. Passage of N. meningitidis into the bloodstream can cause invasive meningococcal disease (IMD), a potentially life-threatening illness with rapid onset that generally presents as meningitis, septicemia or both. Serogroup W IMD has been increasing in prevalence in recent years, and observations suggest that it may present with atypical signs and symptoms. Herein, a literature search was performed to identify trends in atypical serogroup W IMD presentation in order to review those that are most prevalent. Findings indicate that the most prevalent atypical presentations of serogroup W IMD include acute gastrointestinal (GI) symptoms, septic arthritis and bacteremic pneumonia or severe upper respiratory tract infection, notably epiglottitis. Atypical clinical presentation is associated with higher case fatality rates and can lead to misdiagnoses. Such risks highlight the need for clinicians to consider IMD in their differential diagnoses of patients with acute GI symptoms, septic arthritis or bacteremic pneumonia, primarily in regions where serogroup W is prevalent.

Otitis media (OM) is a prevalent pediatric infection characterized by painful inflammation of the middle ear. The Gram-negative diplococcus Moraxella catarrhalis is a commensal of the nasopharynx and one of three leading causative agents of OM. The most recent work on this multifaceted disease indicates that biofilms and polymicrobial infections play a pivotal role in recurrent and chronic OM, which are difficult to eradicate using standard antibiotic protocols. Although there have been significant advances in OM research, the actual bacterial and viral interactions leading to pathogenesis remain largely uncharacterized. However, colonization and persistence in the nasopharynx is clearly an essential first step. In this study, we assessed the role M. catarrhalis plays in the co-colonization and persistence of the other major otopathogens, Streptococcus pneumoniae and non-typeable Haemophilus influenzae (NTHi). We characterized both monomicrobial and polymicrobial biofilms using an in vitro nasopharyngeal colonization model. Biofilm assays were designed to mimic the nasopharynx and bacterial persistence was quantified over time. NTHi showed a steady and significant decline in viability over 20-48 h when this organism was in a dual species biofilm with S. pneumoniae. However, when M. catarrhalis was present in the polymicrobial biofilm NTHi survived for 48 h at 107 CFU per mL. In addition, an isogenic M. catarrhalis catalase-deficient mutant was also fully capable of protecting NTHi from the bactericidal activity of S. pneumoniae in a polymicrobial biofilm. Our results show that M. catarrhalis promotes a favorable environment for stable polymicrobial biofilms by enhancing the survival of NTHi in the presence of S. pneumoniae. These data suggest that colonization with M. catarrhalis promotes stable co-colonization with other otopathogens.

Background Found as a commensal in the upper respiratory tract, Gram-negative diplococcus Moraxella catarrhalis did not hold much importance as an infectious agent for long. The emergence of the first antibiotic-resistant strain of M. catarrhalis was noted in 1977 in Sweden. This has gradually spread worldwide over the years to more than 95% of the strains showing resistance to penicillin now. Penicillin resistance is mediated by the production of beta-lactamases encoded by bro-1 and bro-2 genes that code for beta-lactamases BRO-1 and BRO-2, respectively. The purpose of this study was to explore the trends of antibiotic resistance, the presence of bro genes, and clinical correlation of these findings with the rise in M. catarrhalis was noted in 1977 in Sweden. This has gradually spread worldwide over the years to more than 95% of the strains showing resistance to penicillin now. Penicillin resistance is mediated by the production of beta-lactamases encoded by bro-1 and bro-2 genes that code for beta-lactamases BRO-1 and BRO-2, respectively. The purpose of this study was to explore the trends of antibiotic resistance, the presence of bro genes, and clinical correlation of these findings with the rise in. Methods Strains of M. catarrhalis was noted in 1977 in Sweden. This has gradually spread worldwide over the years to more than 95% of the strains showing resistance to penicillin now. Penicillin resistance is mediated by the production of beta-lactamases encoded by bro-1 and bro-2 genes that code for beta-lactamases BRO-1 and BRO-2, respectively. The purpose of this study was to explore the trends of antibiotic resistance, the presence of bro genes, and clinical correlation of these findings with the rise in. Results Fourteen strains of M. catarrhalis was noted in 1977 in Sweden. This has gradually spread worldwide over the years to more than 95% of the strains showing resistance to penicillin now. Penicillin resistance is mediated by the production of beta-lactamases encoded by bro-1 and bro-2 genes that code for beta-lactamases BRO-1 and BRO-2, respectively. The purpose of this study was to explore the trends of antibiotic resistance, the presence of bro genes, and clinical correlation of these findings with the rise in. Conclusion The increase in antibiotic resistance and beta-lactamase production in M. catarrhalis is a cause of concern. The emerging resistance pattern emphasises the need for an appropriate antibiotic stewardship program in clinical practice. Importance should be given to the monitoring of the trends of antibiotic susceptibility and their usage to prevent the emergence of outbreaks with resistant strains and treatment failures.M. catarrhalis was noted in 1977 in Sweden. This has gradually spread worldwide over the years to more than 95% of the strains showing resistance to penicillin now. Penicillin resistance is mediated by the production of beta-lactamases encoded by bro-1 and bro-2 genes that code for beta-lactamases BRO-1 and BRO-2, respectively. The purpose of this study was to explore the trends of antibiotic resistance, the presence of bro genes, and clinical correlation of these findings with the rise in.

Neisseria meningitidis is an etiological factor of invasive meningococcal disease (IMD). This Gram-negative diplococcus is transmitted from person to person via droplets or through a direct physical contact with secretions of infected patients or asymptomatic carriers. The latter account for 5-10% of the general population. The aim of the study was to estimate the actual N. meningitidis carriage rate in the military environment with identification of serogroups, genogroups, sequence types and clonal complexes of the isolates detected among Polish soldiers. The study was conducted during winter seasons of 2015 and 2016 and involved 883 professional soldiers from the Armoured Brigade in Świetoszow, Poland. The material for testing were nasopharyngeal swabs obtained from study participants. The samples were tested using standard microbiological methods (culture, incubation, microscopy, biochemical and automated identification). N. meningitidis isolates were subjected to slide agglutination test (identification of serogroups), the bacterial DNA was extracted and allowed to determine genogroups, clonal complexes and sequence types. 76 soldiers were found to be carriers of N. meningitidis , they accounted for 8.6% of the study group. The meningococcal isolates mostly belonged to serogroup B. Sequence types ST-11439, ST-136, ST-1136 and the clonal complex 41/44CC were found to be predominant. Clonal complexes responsible for IMD were detected in 15.8% of carriers and 1.4% of the whole study participants. Carriage rates of N. meningitidis among Polish soldiers were found to be similar to those reported in the general population. Neisseria meningitidis is an etiological factor of invasive meningococcal disease (IMD). This Gram-negative diplococcus is transmitted from person to person via droplets or through a direct physical contact with secretions of infected patients or asymptomatic carriers. The latter account for 5–10% of the general population. The aim of the study was to estimate the actual N. meningitidis carriage rate in the military environment with identification of serogroups, genogroups, sequence types and clonal complexes of the isolates detected among Polish soldiers. The study was conducted during winter seasons of 2015 and 2016 and involved 883 professional soldiers from the Armoured Brigade in Świetoszow, Poland. The material for testing were nasopharyngeal swabs obtained from study participants. The samples were tested using standard microbiological methods (culture, incubation, microscopy, biochemical and automated identification). N. meningitidis isolates were subjected to slide agglutination test (identification of serogroups), the bacterial DNA was extracted and allowed to determine genogroups, clonal complexes and sequence types. 76 soldiers were found to be carriers of N. meningitidis, they accounted for 8.6% of the study group. The meningococcal isolates mostly belonged to serogroup B. Sequence types ST-11439, ST-136, ST-1136 and the clonal complex 41/44CC were found to be predominant. Clonal complexes responsible for IMD were detected in 15.8% of carriers and 1.4% of the whole study participants. Carriage rates of N. meningitidis among Polish soldiers were found to be similar to those reported in the general population.

Using Deterministic Lateral Displacement devices optimized for sensitivity to particle length, we separatesubpopulations of bacteria depending on known properties that affect their capability to cau se disease(virulence). For the human bacterial pathogen Streptococcus pneumoniae, bacterial chain length and the presence of a capsule are known virulence factors contributing to its ability to cause severe disease.Separation of cultured pneumococci into subpopulations based on morphological type (single cocci,diplococci and chains) will enable more detailed studies of the role they play in virulence. Moreover, wepresent separation of mixed populations of almost genetically identical encapsulated and non-encapsulated pneumococcal strains in our device. Published version

Menigococcal infection is caused by Neisseria meningitidis, a Gram negative diplococci. Invasive meningococcal disease (IMD) is caused by 6 capsular groups. The spectrum of infection is broad, with meningitis and meningococcal sepsis associated with a case fatality of between 4 and 20%. The main burden of disease is felt in the under 1′s and this is where vaccination has been focused. Vaccination against MenC begun in 1999, with vaccines against Men ACWY and MenB added to the schedule in 2015. Over the last 1o years rates of IMD in the UK have fallen by over 50%. The impact of COVID-19 on cases has also been felt, with early data suggesting a significant drop in cases during the first wave in 2020. Despite the success of vaccination we need to remain vigilant. Clonal expansion of hypervirulent strains has been seen in epidemics and we have a significant proportion of the population who remain unvaccinated.

We report a case of bloodstream infection with the anaerobic bacterium Ruminococcus gnavus (R. gnavus), associated with intestinal perforation in a patient undergoing chemotherapy for multiple myeloma and cancer of the sigmoid colon. Gram staining of positive anaerobic blood cultures revealed both diplococci and short chains of gram-positive cocci. MALDI-TOF MS done directly on the blood culture bottle identified the bacterium as R. gnavus, and 16S rRNA gene sequencing confirmed the identification.

Urethritis, or inflammation of the urethra, is one of the most common reasons men seek clinical care. Sexually transmitted pathogens including Neisseria gonorrhoeae are responsible for over half of the symptomatic urethritis cases in U.S. men. Recently, clinics in Indianapolis, Columbus, Atlanta, and other U.S. cities began to note increasing numbers of men presenting with urethritis and Gram-negative intracellular diplococci in their urethral smears who test negative for N. gonorrhoeae. Many of these discordant cases, which have periodically reached highs of more than 25% of presumed gonococcal cases in some sexually transmitted infection clinics in the U.S. Midwest, are infected with strains in a novel urethrotropic clade of Neisseria meningitidis ST-11 (US_NmUC). However, no cultivation-independent tests are available for the US_NmUC strains, and prior studies relied on microbial culture and genome sequencing to identify them. Here, we describe a PCR test that can identify the US_NmUC strains and distinguish them from commensal and invasive N. meningitidis strains as well as N. gonorrhoeae. Our SimpleProbe®-based real-time PCR assay targets a conserved nucleotide substitution in a horizontally acquired region of US_NmUC strain genomes. We applied the assay to 241 urine specimens whose microbial compositions had previously been determined by deep shotgun metagenomic sequencing. The assay detected the single US_NmUC positive case in this cohort, with no false positives. Overall, our simple and readily adaptable assay could facilitate investigation of the pathogenesis and epidemiology of the US_NmUC clade.

We isolated a gammaproteobacterial methanotrophic strain FWC3, from canal sediment from Western India. The strain oxidizes methane and can also grow on methanol. The draft genome of the same was sequenced which showed a size of ∼3.4 Mbp and 63% GC content. FWC3 is a coccoid, pale pink pigmented methanotroph and is seen in the form of diplococci, triplets, tetrads or small aggregates. After comparison of the complete 16S rRNA gene sequence, average amino-acid similarities and digital DNA-DNA hybridization values with that of the neighboring type species, we propose that the strain belongs to a novel genus and species, Ca. Methylolobus aquaticus FWC3Ts.

Background Neisseria gonorrhoeae is a gram negative diplococcus bacterium and the causative agent of the sexually transmitted disease Gonorrhea. It has been recently given the status of ‘superbug’ by World Health Organization because of the increasing antibiotic resistance and unavailability of a viable vaccine candidate targeted against this bacterium. Over the recent years, there have been increasing reports about the use of subtractive genomics to identify potential drug and vaccine targets. Methods Hence, present study utilizes the knowledge of Codon biasing, a tool to identify the essential genes in N. gonorrhoeae that could be novel therapeutic targets for drug or vaccine development. Through the screening of a total of 2350 genes, we could shortlist 29 ‘essential’ genes from the complete gene set. This selection process was done through calculating CAI scores for individual genes. Through the data-mining of BLAST2GO and InterProScan databases, we could predict the function of these 29 genes. Results All the selected 29 genes were involved in important cellular functions like DNA replication, energy synthesis and metabolites production. This study also shortlists the essential genes of N. gonorrhoeae that could be used to target Neisseria. We identified a molecule/drug which can be used as a target against essential protein DapD (succinyltransferase). Conclusion To conclude, through subtractive genomics, we could identify 29 genes that seem to be essential for the survival of the bacteria Neisseria gonorrhoeae. Identification of these genes can be helpful in understanding the pathogenesis of the bacteria as well. Moreover some of these genes are excellent drug targets as these are essential for the growth of bacteria. The selected molecule ZINC06311339 promises hope for treating this pathogen after having validated through experimental study. Disclosure No significant relationships.

The effective value of microbiological post-mortem examinations stands as fundamental in forensic cases involving microbiology. We ran these analyses on five victims, who suddenly died after showing persistent fever. The examinations were conducted between 48 hours and 10 days after death, and adrenal gland apoplexy was detected in all the cases. Microbiological examinations identified Neisseria meningitidis, which was accountable for Waterhouse–Friderichsen syndrome. Diplococci were isolated from three cadavers that underwent forensic dissection between 2 and 3 days after death. The remaining two cadavers showed polymicrobial contamination, and a polymerase chain reaction technique was necessary to identify the pathogen. We assumed that the microbial overlap could lead to diagnostic mistakes and conceal the identification of the lethal pathogen. Therefore, we suggest using molecular techniques for a postmortem interval (PMI) longer than 72 hours. Classical microbiological examination should be performed for PMI within 72 hours.

Background In order to increase the number of gonococcal isolates available for antimicrobial susceptibility surveillance, we expanded indications for GC culture in a municipal STD clinic in Seattle, Washington. We evaluated GC culture positivity by clinical criteria. Methods In 2017–2018, GC culture specimens were collected from STD clinic patients who met these criteria: (1) contact to GC, (2) GC NAAT+ not yet treated, or (3) symptomatic urethritis/cervicitis with intracellular diplococci on gram stain. Clinicians inoculated Modified Thayer-Martin agar plates at the bedside and incubated in a candle jar. Patient characteristics and indication for culture were abstracted from medical records; culture positivity was compared by indication, anatomic site, and patient group with Fisher’s exact test. Results Clinicians collected a total of 3,884 specimens, of which 1,107 (29%) were GC culture positive. Culture positivity among 74 endocervical, 1,611 pharyngeal, 1,154 rectal, and 1,045 urethral isolates was 30%, 17%, 29%, and 46%, respectively. Among contacts to GC, endocervical culture positivity was 6/26 (23%), pharyngeal 79/752 (11%), rectal 88/549 (16%), and urethral 71/445 (16%). Urethral culture positivity in male contacts without urethral discharge was low (6/221 [3%]). Pharyngeal culture positivity among GC contacts who were men who have sex with men was similar to heterosexual men (10% of 719 vs 12% of 17, p=0.68) but lower than pharyngeal positivity among women (43% of 14, p Conclusion Men with symptomatic urethritis had the highest GC culture yield (91%), followed by persons with recent GC NAAT+ (26–50%). Cultures in GC contacts had a modest yield (11%–23%). These criteria were appropriate for obtaining GC isolates for antimicrobial surveillance. Disclosure No significant relationships.

Streptococcus pneumoniae, a gram-positive diplococcus, is the most common cause of bacterial pneumonia. The diagnosis of pneumococcal pneumonia is usually confirmed by chest x-ray and gram stain. The most appropriate antibiotics for treatment pneumococcal infection are macrolides, beta-lactams, and quinolones. Two vaccines, PPSV23 and PCV13, are highly effective in preventing infection.

Summary Vancomycin-resistant Enterococcus (VRE) are highly antibiotic-resistant and readily transmissible pathogens that cause severe infections in hospitalized patients. We discovered that lithocholic acid (LCA), a secondary bile acid prevalent in the cecum and colon of mice and humans, impairs separation of growing VRE diplococci, causing the formation of long chains and increased biofilm formation. Divalent cations reversed this LCA-induced switch to chaining and biofilm formation. Experimental evolution in the presence of LCA yielded mutations in the essential two-component kinase yycG/walK and three-component response regulator liaR that locked VRE in diplococcal mode, impaired biofilm formation, and increased susceptibility to the antibiotic daptomycin. These mutant VRE strains were deficient in host colonization because of their inability to compete with intestinal microbiota. This morphotype switch presents a potential non-bactericidal therapeutic target that may help clear VRE from the intestines of dominated patients, as occurs frequently during hematopoietic stem cell transplantation.

Neisseria meningitidis is a Gram-negative diplococcus restricted to humans that causes severe septicemia and/or meningitidis. Initial adhesion to human endothelial cells is mediated through the interaction of type IV pili with the hetero-oligomeric complexes formed by the human receptors CD147 and the β2-adrenergic receptor. Interaction with this complex heterodimer activates a β-arrestin-biased signaling pathway leading to actin polymerization and accumulation of ezrin and ezrin-binding partners. These signaling events promote the formation of cell plasma membrane protrusions in endothelial cells, which are crucial for N. meningitidis colonies to resist shear stress and colonize blood vessels. Here we provide detailed protocols to evaluate the role of β-arrestins in actin and ezrin signaling downstream of G protein-coupled receptor activation.

We report a case of pneumococcal neonatal meningitis in an Italian girl, occurred 3 days after birth. CSF microscopic examination revealed the presence of Gram Positive diplococci, identified as S. pneumoniae after detection of pneumococcal capsular antigen. Tests for Group B Streptococcus on mother and child were both negative. The case was peculiar because in industrialized countries the most common agents responsible of neonatal meningitis are GBS, E. coli and Listeria monocytogenes, where pneumococcal meningitis in the neonatal period is quite uncommon: It is then necessary to consider that, in any case of early onset neonatal meningitis, S. pneumoniae is a possible yet uncommon causative agent, and that the microbiological profile of early onset neonatal meningitis in industrialized countries might change substantially because of migratory streams and the subsequent diffusion of emerging microorganisms, which are unusual at the present time.

Conserved protein antigens have been investigated as vaccine candidates against respiratory pathogens. We evaluated the natural development of antibodies against Streptococcus pneumoniae , Haemophilus influenzae , and Moraxella catarrhalis proteins during childhood. Serum samples were collected from 50 healthy children from their first months to age 13 years (median sampling interval, 6 months). We also analyzed serum samples from 24 adults. Serum IgG antibodies against eight pneumococcal proteins (Ply, CbpA, PspA 1 and 2, PcpA, PhtD, StkP-C, and PcsB-N), three H. influenzae proteins, and five M. catarrhalis proteins were measured using a multiplexed bead-based immunoassay. Antibody levels were analyzed using multilevel mixed-effects regression and Spearman's correlation. Antibody levels against pneumococcal proteins peaked at 3 to 5 years of age and then reached a plateau. Antibody levels against H. influenzae proteins peaked during the second year and then stabilized. Antibody levels against M. catarrhalis proteins peaked during the first year and then slowly decreased. Peak antibody levels during childhood were higher than those of adults. Correlations among pneumococcal antibody levels were highest among anti-CbpA, anti-PcpA, and anti-PhtD antibodies ( r = 0.71 to 0.75; P < 0.001). The children presented 854 symptomatic respiratory infections on 586 occasions. Symptomatic respiratory infections did not improve prediction of antibody levels in the regression model. The maturation of immune responses against the investigated pneumococcal proteins shares similarities, especially among CbpA, PcpA, and PhtD. Antibody production against H. influenzae and M. catarrhalis proteins starts early in life and reaches peak levels earlier than antibody production against the pneumococcal proteins. Basal antibody levels are not related to the occurrence of symptomatic respiratory infections.

Delafloxacin, an investigational anionic fluoroquinolone, is active against a broad range of Gram-positive and Gram-negative bacteria. In this study, 200 Streptococcus pneumoniae (plus 30 levofloxacin-resistant isolates), 200 Haemophilus influenzae , and 100 Moraxella catarrhalis isolates selected primarily from the United States (2014) were tested against delafloxacin and comparator agents. Delafloxacin was the most potent agent tested. MIC 50 and MIC 90 values against all S. pneumoniae isolates were 0.008 and 0.015 μg/ml. Delafloxacin susceptibility was not affected by β-lactamase status against H. influenzae and M. catarrhalis .

KEY POINTS A 23-year-old woman presented to a hemodialysis appointment with a one-day history of fever and rigours. Blood cultures grew Gram-negative diplococci, raising concern for Neisseria species bacteremia. The patient’s previous medical diagnoses included systemic lupus erythematosus with

A man in his 80s presented to the hospital with a 36-hour history of fever, myalgia, bilateral shoulder and right knee pain. Joint fluid aspirates from his shoulders and right knee isolated Gram-negative diplococci. After failing to grow on standard and selective media, Neisseria meningitidis was identified by 16s PCR and subsequently typed as serogroup C. He had no clinical features of meningitis or meningococcaemia. Blood cultures were negative and an EDTA blood sample was negative for meningococcal ctrA gene. Urine PCR was negative for Neisseria gonorrhoeae. He was treated successfully with two arthroscopic joint washouts of his right knee, aspirates of both shoulders, 40 days of intravenous ceftriaxone and intensive physiotherapy as both an inpatient and outpatient. In the literature, we have not found any previously documented cases of serogroup C meningococcus causing polyarticular primary septic arthritis in this age group or guidance on duration of antibiotic treatment. Literature on the impact of rehabilitation to baseline function was also found to be lacking. Although rare, primary meningococcal arthritis (PMA) should be considered as a differential diagnosis in cases of acute polyarticular septic arthritis. Polyarticular PMA in older adults may require prolonged rehabilitation before one might expect to return to premorbid function.

Neisseria gonorrhoeae is a gram negative diplococcus bacterium and the causative agent of the sexually transmitted disease Gonorrhea. It has been recently given the status of "superbug" by World Health Organization because of the increasing antibiotic resistance and unavailability of a viable vaccine candidate. Over recent years, there have been increasing reports about the use of subtractive genomics to identify potential drug and vaccine targets. Our study utilizes codon biasing, a tool to identify the essential genes, in N. gonorrhoeae that could be utilized as novel therapeutic targets for drug or vaccine development. Through the screening of 2350 total genes, we present a list of 29 such drug candidate genes based on codon adaptation. Through the data-mining with BLAST2GO and InterProScan databases, we could predict the function of these 29 genes. These genes are involved in pivotal cellular functions like DNA replication, energy synthesis and metabolites production. This study also shortlists the essential genes of N. gonorrhoeae that could be used to target Neisseria. We identified a molecule/drug which can be used to target essential protein DapD (succinyltransferase).

Sexually transmitted infections gained importance after the advent of human immunodeficiency virus infection in 1983. The global incidence of gonorrhea in 2008 was 106.1 million, in 2005 was 87.7 million, and in 1999 was 62 million. Laboratory diagnosis of gonorrhea is challenging due to poor facilities in smaller laboratories of developing countries. This along with nonsuspicion might lead to under-reporting of cases from such countries. We report two cases of gonococcal urethritis from a city in South India within a period of 1 year. Two young/middle-aged patients presented to the urology department with complaints of acute-onset painless urethral discharge. On suspicion of gonococcal urethritis, urethral pus was sent for Gram stain which revealed a plenty of polymorphonuclear neutrophils and a plenty of Gram-negative bean-shaped diplococci. The organism was isolated and identified as Neisseria gonorrhoeae. Contact tracing was not possible in both cases, so they were appropriately counseled and treated. Gonococcal urethritis could be under-reported in India. In the era of automation in microbiology and syndromic approach for diagnosis, simple techniques such as Gram stain and culture coupled with good clinical suspicion can clinch the diagnosis of gonococcal urethritis. Since there is a vast difference in antibiotics used for treating gonococcal and nongonococcal urethritis, it is important to diagnose the etiological agent at the earliest for targeted therapy.

Gonococcal infection is a current public health problem worldwide, being the second most prevalent bacterial sexually transmitted infection. The etiologic agent is Neisseria gonorrhoeae, a gram-negative diplococcus, and mainly causes urethritis in men. In women up to 50% of infections can be asymptomatic. N. gonorrhoeae has a great ability to develop antibiotic resistance, so the last remaining therapeutic option are extended spectrum cephalosporins. Many guides recommend dual therapy with ceftriaxone and azithromycin, but in recent years the resistance to azithromycin is also increasing, so that dual treatment is being questioned by scientific societies.

Moraxella catarrhalis is a gram-negative diplococcus bacterium primarily infecting the inner ear and respiratory tract. It is thought to be responsible for up to 20% of bacterial otitis media and 10% of infective exacerbations of COPD. Though previously described as part of the commensal nasal microbiome, it has gained traction recently as a pathogen and has been shown to attach to the cilia of the respiratory epithelium. We believe the interaction between M. catarrhalis and cilia might mimic some symptoms associated with Primary Ciliary Dyskinesia and assessed the impact of M. catarrhalis on PCD diagnosis. Firstly, we retrospectively analysed microbiology data collected from 526 nasal brushing samples from children referred for testing for Primary Ciliary Dyskinesia at the Royal Brompton Hospital between Jan 2015–2018. M. catarrhalis was isolated in 43/485 non-PCD (9%) samples and 1/41 (2%) PCD samples. No relationship was found between presence of M. catarrhalis and degree of ciliation or ciliary beat frequency. However, there was an increased incidence of ciliary dyskinesia due to ‘bulbous/swollen ciliary tips’ in individuals with M. catarrhalis growth when assessed by high-speed video microscopy. Following this, we hypothesised that M. catarrhalis attachment to cilia was responsible for the abnormalities observed at the ciliary tip. Three-dimensional high-resolution electron microscopy (electron tomography) revealed diplococci bacteria with surface proteins in direct contact with the membrane of the ciliary tips. To confirm the observed ciliary dyskinesia in the ex-vivo samples was due to M. catarrhalis attachment, air-liquid interface cultures of fully differentiated respiratory epithelium were infected with clinical strains of M. catarrhalisin vitro. 1 hour following infection, the cells were washed thoroughly and analysed by high-speed video microscopy and electron microscopy. M. catarrhalis was shown attached to ciliary tips and cilia in infected cultures demonstrated significant dyskinesia compared to uninfected control cell cultures. In summary, M. catarrhalis is isolated from nasal brushings in 10% of children referred for PCD diagnostic testing. M. catarrhalis attaches to the ciliary tip and causes secondary ciliary dyskinesia, possibly having implications for PCD diagnostic testing.

Balanitis is defined as inflammation of the glans penis, while balanoposthitis is an inflammation of the glans penis and prepuce. Balanitis/balanoposthitis due to Neisseria gonorrhoeae (N. gonorrhoeae) is rarely reported. A case of balanoposthitis in a man clinically manifested as circinate balanoposthitis was reported to show the possibility of gonococcal infection manifested as circinate balanoposthitis. Bacterial examination with Gram staining and polymerase chain reaction (PCR) examinations from the lesions denoted the appearance of intracellular and extracellular Gram negative diplococcus bacteria and positive for Chlamydia trachomatis (C. trachomatis). Serological examination showed the reactive results for syphilis. The patient received oral medications of 400 mg cefixime single dose and 1-gram azithromycin single dose, also 2.4 million international unit (IU) intramuscular per week for 3 weeks. The gonococcal infection as the cause of balanoposthitis should be put in the differential diagnosis and any possible examination should be done to establish the most plausible etiology.Key words: balanitis, balanoposthitis, gonococcal balanoposthitis, circinate balanoposthitis

Premature rupture of membranes occur if the membranes broke before spontan’s labour and after 1 hours there are no signs of labor. It can be caused by an infection of the membranes and amniotic fluid by various microorganisms or bacteria that entering by ascending cervical route and produce prostaglandins and make membranes become thin and weak. The purpose of this study was to determine the relationship of cervical diplococcus intracellular with premature rupture of membranes. This is an analytic correlation research with retrospective approach that use study documentation in Poly IMS of Malang Government’s Clinic.. The technique sampling on this research is total sampling with the number of samples are 18 respondens. Analyzing data using Fisher's Exact Test that obtained significance is 0.022 (less than 0.05) which means there is a relationship between cervical diplococcus intracellular with premature rupture of membrans. Keywords : Premature Rupture of Membranes, Intracellular Cervical Diplococcus

Vancomycin resistant Enterococcus (VRE) is a highly antibiotic-resistant and readily transmissible pathogen that causes severe infections in hospitalized patients. We discovered that lithocholic acid (LCA), a secondary bile acid prevalent in the cecum and colon of mice and humans, impaired separation of growing VRE diplococci causing the formation of long chains, increasing biofilm formation and enhancing VRE’s ability to colonize the host intestine. Divalent cations reversed the switch to chaining and biofilm formation. Experimental evolution in the presence of LCA yielded mutations in yycG/walK and liaR that locked VRE in diplococcal mode, impaired biofilm formation and increased susceptibility to Daptomycin. These strains were deficient in host colonization specifically by affecting VRE’s ability to compete with intestinal microbiota. This morphotype switch presents a non-bactericidal therapeutic target that may help to clear VRE from the intestines of dominated patients, as occurs frequently during hematopoietic stem cell transplantation.

Infection with Neisseria meningitidis, an aerobic encapsulated Gram-negative diplococcus, may be life-threatening or result in major long-term sequelae. In 2015, within the scope of a surveillance programme coordinated by the European Centre of Disease Prevention and Control (ECDC), the notification rate of invasive meningococcal disease was 0.6 cases per 100,000 population (lower and upper bound: 0.1–2.0) in the European Union/European Economic Area (EU/EEA) and 0.4 cases per 100,000 population in Germany [1]. Particularly high age-specific rates in the EU/EEA were found in infants under one year of age at 10.0 cases per 100,000 population and in children 1 to 4 years of age at 2.8 cases per 100,000 population [1]. The majority of cases with a known serogroup belonged to serogroup B (61%) [1]. Until 2012, no broadly effective serogroup B meningococcal vaccines were available as the capsular polysaccharide of meningococcal serogroup B is poorly immunogenic in humans [2,3]. This is why research has focused on proteins in the outer membrane of meningococci as potential antigens for candidate vaccines [2,3]. The multicomponent meningococcal serogroup B vaccine (4CMenB), Bexsero (GSK Vaccines S.r.l., Siena, Italy), contains four antigenic components: factor H binding protein, Neisseria adhesin A, Neisseria heparin-binding antigen and outer membrane vesicles from a New Zealand epidemic strain that produces Porin A, the immunodominant antigen that is present in the outer membrane vesicle component [4]. We aimed to evaluate and complement the safety profile of 4CMenB as described in the Summary of Product Characteristics. A special focus was placed on immune-mediated and severe neurological outcomes.