Gonococcemia

Last updated
Gonococcemia
Other namesDisseminated gonococcal infection [1]
NeisseriaGonorrhoeae.jpg
Neisseria gonorrhoeae
Specialty Infectious diseases   OOjs UI icon edit-ltr-progressive.svg
Symptoms Fever, multijoint pain, hemorrhagic pustules
Complications Rarely leads to meningitis and endocarditis
CausesNeisseria gonorrhoeae infection
Risk factors unprotected sex, female sex
Diagnostic method Nucleic Acid Amplification Techniques (NAAT)
TreatmentCephalosporins or Fluoroquinolones

Gonococcemia (also known as "Disseminated gonococcal infection" [1] ) is a rare complication of mucosal Neisseria gonorrhoeae infection, or Gonorrhea, that occurs when the bacteria invade the bloodstream. [2] It is characterized by fever, tender hemorrhagic pustules on the extremities or the trunk, migratory polyarthritis, and tenosynovitis. [3] It also rarely leads to endocarditis and meningitis. [4] This condition occurs in 0.5-3% of individuals with gonorrhea, and it usually presents 2–3 weeks after acquiring the infection. [5] Risk factors include female sex, sexual promiscuity, and infection with resistant strains of Neisseria gonorrhoeae. This condition is treated with cephalosporin and fluoroquinolone antibiotics. [4]

Contents

Gonococcemia hemorrhagic pustule Gonococcal lesion on the skin PHIL 2038 lores.jpg
Gonococcemia hemorrhagic pustule

Epidemiology

Neisseria gonorrhoeae is a gram negative diplococcus (also referred to as "Gonococcus") and a pathogenic bacteria. [2] In 2019, there were 616,392 reported cases of gonorrhea in the United States, with an overall increased rate 5.7% from 2018 to 2019. [6] Among those approximately 600,000 cases, it is estimated that 0.5-3% of gonorrheal infections result in gonococcemia. This condition is more common in women, affecting approximately 2.3-3% of women with gonorrhea and 0.4-0.7% of men. [4] This discrepancy is explained by increased incidence of silent gonorrheal infections in females and an increased rate of transmission to females that have sexual intercourse with infected males. [5] Gonococcemia also occurs more frequently in pregnant women, those with recent menstruation, and those with IUDs. [5]

Risk Factors

Symptoms

Treatment

Treatment typically consists of cephalosporin and fluoroquinolone antibiotics. [4] Gonococcemia is typically treated with intravenous or intramuscular cephalosporin antibiotics. [5] Approximately 10-30% of gonorrheal infections present with a co-infection of chlamydia, so it is common to add a one-time dose of oral azithromycin or doxycycline for coverage of Chlamydia trachomatis . [5] Bacterial resistance to antibiotics is increasingly common in Neisseria gonorrhoeae, so it is often advised to check susceptibility of the bacterial culture and then adjust the antibiotic therapy as needed. [4]

Pathogenesis

Neisseria gonorrhoeae is transmitted during sexual contact with an infected individual. The bacteria invade the non-ciliated columnar epithelium of the urogenital tract, oral mucosa, or anal mucosa following exposure. [2] Invasion of the host cells is made possible due to virulence factors such as Pili, LOS, Opa, and others. [2] Similarly, these virulence factors can be used for avoiding the host immune system, which may explain prolonged infection, bacterial resistance, and gonococcemia. [3]

Neisseria gonorrhoeae Wild type Neisseria gonorrhoeae (29347475808).jpg
Neisseria gonorrhoeae

See also

Related Research Articles

Gram-negative bacteria Group of bacteria that do not retain the Gram stain used in bacterial differentiation

Gram-negative bacteria are bacteria that do not retain the crystal violet stain used in the Gram staining method of bacterial differentiation. They are characterized by their cell envelopes, which are composed of a thin peptidoglycan cell wall sandwiched between an inner cytoplasmic cell membrane and a bacterial outer membrane.

Pelvic inflammatory disease Infection of uterus, fallopian tubes, ovaries or the inner surface of pelvis

Pelvic inflammatory disease, also known as pelvic inflammatory disorder (PID), is an infection of the upper part of the female reproductive system, namely the uterus, fallopian tubes, and ovaries, and inside of the pelvis. Often, there may be no symptoms. Signs and symptoms, when present, may include lower abdominal pain, vaginal discharge, fever, burning with urination, pain with sex, bleeding after sex, or irregular menstruation. Untreated PID can result in long-term complications including infertility, ectopic pregnancy, chronic pelvic pain, and cancer.

Urethritis is the inflammation of the urethra. The most common symptoms include painful or difficult urination and urethral discharge. It is a commonly treatable condition usually caused by infection with bacteria. This bacterial infection is often sexually transmitted, but not in every instance; it can be idiopathic, for example. Some incidence of urethritis can appear asymptomatic as well.

Conjunctivitis Inflammation of the eye

Conjunctivitis, also known as pink eye, is inflammation of the outermost layer of the white part of the eye and the inner surface of the eyelid. It makes the eye appear pink or reddish. Pain, burning, scratchiness, or itchiness may occur. The affected eye may have increased tears or be "stuck shut" in the morning. Swelling of the white part of the eye may also occur. Itching is more common in cases due to allergies. Conjunctivitis can affect one or both eyes.

<i>Neisseria gonorrhoeae</i> Species of bacterium

Neisseria gonorrhoeae, also known as gonococcus (singular), or gonococci (plural), is a species of Gram-negative diplococci bacteria isolated by Albert Neisser in 1879. It causes the sexually transmitted genitourinary infection gonorrhea as well as other forms of gonococcal disease including disseminated gonococcemia, septic arthritis, and gonococcal ophthalmia neonatorum.

<i>Neisseria</i> Genus of bacteria

Neisseria is a large genus of bacteria that colonize the mucosal surfaces of many animals. Of the 11 species that colonize humans, only two are pathogens, N. meningitidis and N. gonorrhoeae. Most gonococcal infections are asymptomatic and self-resolving, and epidemic strains of the meningococcus may be carried in >95% of a population where systemic disease occurs at <1% prevalence.

Nongonococcal urethritis (NGU) is an inflammation of the urethra that is not caused by gonorrheal infection.

Epididymitis Medical condition

Epididymitis is a medical condition characterized by inflammation of the epididymis, a curved structure at the back of the testicle. Onset of pain is typically over a day or two. The pain may improve with raising the testicle. Other symptoms may include swelling of the testicle, burning with urination, or frequent urination. Inflammation of the testicle is commonly also present.

Ceftriaxone Chemical compound

Ceftriaxone, sold under the brand name Rocephin, is a third-generation cephalosporin antibiotic used for the treatment of a number of bacterial infections. These include middle ear infections, endocarditis, meningitis, pneumonia, bone and joint infections, intra-abdominal infections, skin infections, urinary tract infections, gonorrhea, and pelvic inflammatory disease. It is also sometimes used before surgery and following a bite wound to try to prevent infection. Ceftriaxone can be given by injection into a vein or into a muscle.

<i>Neisseria meningitidis</i> Species of bacterium that can cause meningitis

Neisseria meningitidis, often referred to as meningococcus, is a Gram-negative bacterium that can cause meningitis and other forms of meningococcal disease such as meningococcemia, a life-threatening sepsis. The bacterium is referred to as a coccus because it is round, and more specifically a diplococcus because of its tendency to form pairs.

Cefotaxime

Cefotaxime is an antibiotic used to treat a number of bacterial infections in human, other animals and plant tissue culture. Specifically in human it is used to treat joint infections, pelvic inflammatory disease, meningitis, pneumonia, urinary tract infections, sepsis, gonorrhea, and cellulitis. It is given either by injection into a vein or muscle.

Endometritis Medical condition

Endometritis is inflammation of the inner lining of the uterus (endometrium). Symptoms may include fever, lower abdominal pain, and abnormal vaginal bleeding or discharge. It is the most common cause of infection after childbirth. It is also part of spectrum of diseases that make up pelvic inflammatory disease.

Salpingitis Medical condition

Salpingitis is an infection and inflammation in the Fallopian tubes. It is often used synonymously with pelvic inflammatory disease (PID), although PID lacks an precise definition and can refer to several diseases of the female upper genital tract, such as endometritis, oophoritis, myometritis, parametritis and infection in the pelvic peritoneum. In contrast, salpingitis only refers to infection and inflammation in the fallopian tubes.

Neonatal conjunctivitis Medical condition

Neonatal conjunctivitis is a form of conjunctivitis which affects newborn babies following birth. It is typically due to neonatal bacterial infection, although can also be non-infectious. Infectious neonatal conjunctivitis is typically contracted during vaginal delivery from exposure to bacteria from the birth canal, most commonly Neisseria gonorrhoeae or Chlamydia trachomatis.

Cefodizime

Cefodizime is a 3rd generation cephalosporin antibiotic with broad spectrum activity against aerobic gram positive and gram negative bacteria. Clinically, it has been shown to be effective against upper and lower respiratory tract infections, urinary tract infections, and gonorrhea. Cefodizime is a bactericidal antibiotic that targets penicillin-binding proteins (PBPs) 1A/B, 2, and 3 resulting in the eventual death of the bacterial cell. In vivo experimental models of infection showed that bacterial clearance by this drug is at least as effective compared with other 3rd generation cephalosporins. It has similar adverse effect profile to other 3rd generation cephalosporins as well, mainly being limited to gastrointestinal or dermatological side effects.

Fleroxacin

Fleroxacin is a quinolone antibiotic. It is sold under the brand names Quinodis and Megalocin.

Gonorrhea Sexually transmitted infection

Gonorrhea, colloquially known as the clap, is a sexually transmitted infection (STI) caused by the bacterium Neisseria gonorrhoeae. Infection may involve the genitals, mouth, or rectum. Infected men may experience pain or burning with urination, discharge from the penis, or testicular pain. Infected women may experience burning with urination, vaginal discharge, vaginal bleeding between periods, or pelvic pain. Complications in women include pelvic inflammatory disease and in men include inflammation of the epididymis. Many of those infected, however, have no symptoms. If untreated, gonorrhea can spread to joints or heart valves.

A pneumococcal infection is an infection caused by the bacterium Streptococcus pneumoniae, which is also called the pneumococcus. S. pneumoniae is a common member of the bacterial flora colonizing the nose and throat of 5–10% of healthy adults and 20–40% of healthy children. However, it is also a cause of significant disease, being a leading cause of pneumonia, bacterial meningitis, and sepsis. The World Health Organization estimates that in 2005 pneumococcal infections were responsible for the death of 1.6 million children worldwide.

Antibiotic resistance in gonorrhea

Neisseria gonorrhoeae, the bacterium that causes the sexually transmitted infection gonorrhea, has developed antibiotic resistance to many antibiotics. The bacteria was first identified in 1879.

Neisseria cinerea is a commensal species grouped with the Gram-negative, oxidase-positive, and catalase-positive diplococci. It was first classified as Micrococcus cinereus by Alexander von Lingelsheim in 1906. Using DNA hybridization, N. cinerea exhibits 50% similarity to Neisseria gonorrhoeae.

References

  1. 1 2 Rapini, Ronald P.; Bolognia, Jean L.; Jorizzo, Joseph L. (2007). Dermatology: 2-Volume Set. St. Louis: Mosby. ISBN   978-1-4160-2999-1.[ page needed ]
  2. 1 2 3 4 Hill, Stuart A.; Masters, Thao L.; Wachter, Jenny (2016). "Gonorrhea - an evolving disease of the new millennium". Microbial Cell. 3 (9): 371–389. doi:10.15698/mic2016.09.524. ISSN   2311-2638. PMC   5354566 . PMID   28357376.
  3. 1 2 3 4 5 6 7 8 Shirtliff, Mark E.; Mader, Jon T. (October 2002). "Acute Septic Arthritis". Clinical Microbiology Reviews. 15 (4): 527–544. doi:10.1128/CMR.15.4.527-544.2002. ISSN   0893-8512. PMC   126863 . PMID   12364368.
  4. 1 2 3 4 5 Creighton, Sarah (2014-02-21). "Gonorrhoea". BMJ Clinical Evidence. 2014: 1604. ISSN   1752-8526. PMC   3931440 . PMID   24559849.
  5. 1 2 3 4 5 Beatrous, Surget V.; Grisoli, Stratton B.; Riahi, Ryan R.; Matherne, Ryan J.; Matherne, Ryan J. (2017). "Cutaneous manifestations of disseminated gonococcemia". Dermatology Online Journal. 23 (1). doi:10.5070/D3231033674. PMID   28329470.
  6. "National Overview - Sexually Transmitted Disease Surveillance, 2019". www.cdc.gov. 2021-04-19. Retrieved 2021-11-03.