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Chapter 20: The Neisseriae

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The inhabitants of a group of small villages in rural sub-Saharan Africa experienced an epidemic of meningitis. Ten percent of the people died, most of them younger than the age of 15 years. The microorganism that most likely caused this epidemic was

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(A) Streptococcus agalactiae (group B)

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(B) Escherichia coli K1 (capsular type 1)

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(C) Haemophilus influenzae serotype b

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(D) Neisseria meningitidis serogroup A

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(E) West Nile virus

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A 9-year-old boy presented to the clinic with a urethral discharge for the past 24 hours. Neisseria gonorrhoeae was cultured from the specimen and found to be β-lactamase positive and resistant to high levels (≥32 μg/mL) of tetracycline. Which of the following statements about these antimicrobial resistance factors is correct?

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(A) β-lactamase production and high-level resistance to tetracycline are both mediated by genes on plasmids.

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(B) Whereas β-lactamase production is mediated by a gene on the bacterial chromosome, high-level tetracycline resistance is mediated by a gene on a plasmid.

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(C) Whereas β-lactamase production is mediated by a gene on a plasmid, high-level tetracycline resistance is mediated by a gene on the bacterial chromosome.

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(D) β-lactamase production and high-level resistance to tetracycline are both mediated by genes on the bacterial chromosome.

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A 6-year-old boy develops a fever and headache. He is taken to the emergency department, where he is noted to have a stiff neck, suggesting meningeal irritation. A lumbar puncture is done, and culture of the cerebrospinal fluid grows Neisseria meningitidis serogroup B. Which of the following should be considered for his family (household) members?

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(A) No prophylaxis or other steps are necessary.

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(B) They should be given Neisseria meningitidis pilin vaccine.

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(C) They should be given Neisseria meningitidis serogroup B polysaccharide capsule vaccine.

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(D) They should be given rifampin prophylaxis.

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(E) They should be given sulfonamide prophylaxis.

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An 18-year-old woman who reports unprotected sex with a new partner 2 weeks previously develops fever and left lower quadrant abdominal pain with onset in association with her menstrual period. On pelvic examination in the emergency department, she has bilateral tenderness when the uterus is palpated. A mass 2–3 cm in diameter is felt on the left, suggestive of tubo-ovarian abscess. Subsequently, Neisseria gonorrhoeae is cultured from ...

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