• No results found

Prevalence and persistence of Neisseria cinerea and other Neisseria spp in adults

N/A
N/A
Protected

Academic year: 2020

Share "Prevalence and persistence of Neisseria cinerea and other Neisseria spp in adults"

Copied!
5
0
0

Loading.... (view fulltext now)

Full text

(1)

JOURNAL OFCLINICAL MICROBIOLOGY, May1988, p. 896-900 Vol.26, No. 5 0095-1137/88/050896-05$02.00/0

Prevalence and Persistence of

Neisseria cinerea

and

Other

Neisseria spp.

in

Adults

JOAN S. KNAPPl2t* AND EDWARD W. HOOK1112t

NeisseriaReference

Laboratory'

andDepartment

of

Medicine,2

University

of Washington, Seattle, Washington

98195

Received26May1987/Accepted 26 January 1988

Neisseria cinerea is a commensal Neisseria sp. which was first described in 1906 but was subsequently misclassified as a subtype of Branhamella catarrhalis. N. cinerea resembles Neisseria gonorrhoeae in both cultural and biochemical characteristicsand, thus, may also have beenmisidentified as N.gonorrhoeae. Of 202 patients whose oropharynges were colonized by Neisseria spp., N. cinerea was isolated in 57(28.2%)patients, including 25 (30.1%) of 83 women, 22 (23.9%) of 92 heterosexual men,and10(37.0%)of 27homosexualmen inSeattle, Wash., in 1983 to 1984.N. cinereawasisolated fromthe urethra ofonlyone(1.1%) patient. The oropharynges of many individualswerecolonizedpersistentlybystrainsof N. cinerea and other Neisseria spp.

Neisseria cinerea was first described in 1906 (23), but strains of this species were subsequently misidentified as Branhamella (Neisseria) catarrhalis (14, 15, 26) because nitrate reduction was

nfot

used as a differential test forthe classification of Neisseria spp. until 1961 (3). Although isolates

resembling

N. cinerea werereferredtoasNeisseria pseudocatarrhalis in 1934 (F. M. Huntoon, Abstr. Annu. Meet. Am. Soc. Bacteriol., 1934, M50,p.

108),

this

species

was not recognized again until 1962 (8) and was not de-scribed in the United States until 1984

(18).

We have been interested inN. cinereabecausealthough strainsarecolistin sensitive(18),they have recently been isolated onselective media for

pathogenic

Neisseria spp. and resembleNeisseria gonorrhoeaeinboth culturalandbiochemicalcharacteristics (13, 18). Strains ofN. cinerea may be misidentified as N. gonorrhoeaewhen many tests available forthe

rapid

identi-fication ofgonococciareused(10-13,

18-20),

with

resulting

serious socialand medicolegal consequences (13).

We undertook a study in two parts to determine the prevalence ofN. cinereaintheoropharynxand

genital

sites andto determine the

ability

ofN. cinerea to

persist

in the

oropharynx

with otherNeisseria spp.

MATERIALS AND METHODS

Strains. Inthe firstpart ofthe study, we determined the prevalence ofN. cinereain 209unselected patients attending the Seattle-King County Sexually Transmitted Diseases ClinicatHarborviewMedical Center betweenOctober1982 andFebruary1983.Cervical andpharyngeal specimens from women and urethral and pharyngeal specimens from men wereinoculatedon a new medium,LBVT.SNR, which was selective forcommensal Neisseria spp. (described below).

Oropharyngeal

specimens from the first 109 patients were plated only on LBVT.SNR medium, but oropharyngeal specimens from the next 100 patients were also plated on

*Correspondingauthor.

tPresent address: Sexually Transmitted Diseases Laboratory Program, Center for Infectious Diseases,Centers for Disease Con-trol, Atlanta, GA30333.

tPresent address: Divisionof Infectious Diseases, Johns

Hop-kinsHospital, Baltimore, MD21205.

modifiedThayer-Martin mediumto ensuremaximum recov-ery of Neisseria meningitidis, which was recovered at a lower frequency than expected from homosexual men among the first 109 patients. Allurogenital specimens were also inoculated onThayer-Martin medium.

In the second phase of the study, oropharyngeal speci-mens werecollected weekly, for 15weeks, from 16 volun-teers in our laboratories to determine whether N. cinerea persisted in the oropharynx or whether it colonized the oropharynxtransientlyand thus would be isolatedrarely.All specimenswereinoculateddirectlyonLBVT.SNRmedium and modified Thayer-Martin medium. All volunteers gave verbalinformed consent before specimencollection.

LBVT.SNR medium for theselective isolation of commensal Neisseriaspp. The medium base, LB medium,contained1% Bacto-Tryptone (Difco Laboratories), 0.5% yeast extract (Difco), 0.5% sodium chloride, and 1.5% Bacto-Agar (Difco).Theingredientsweredissolved,5.0 mlof neutralred indicator (0.3% [wt/vol]) per liter was added, and the me-diumwassterilizedby autoclaving for15minat121°C.After coolingto56°C, sucrose wasadded to the base medium to a final concentration of 1% (wt/vol), and vancomycin and trimethoprimwereeach addedto afinal concentrationof3.0

Ftg/ml.

The

complete

medium, designated

LBVT.SNR,

was

used to isolate strains of commensal Neisseria spp. and B. catarrhalis and to test for polysaccharide production from sucrose. Known strainsofcommensalNeisseriaspp. and B. catarrhalis were used to evaluate the selective medium. Strains ofmost specieswerestockcultures inthe Neisseria Reference Laboratory and included strains of Neisseria

perflava

and Neisseria sicca provided by Ulrich Berger, Hygiene Institute, University of Heidelberg, Heidelberg, FederalRepublic of Germany.

Isolation of commensal Neisseriaspp. and B. catarrhalis on LBVT.SNR medium. Specimens were plated directly onto LVBT.SNRmedium, placed in acandle extinction jar, and incubatedat37°C. After 44 to 48 h ofincubation, at least one colony representative of eachmorphologictype was subcul-tured onto supplemented GC-base medium (GCK; 24). To ensure maximumrecovery ofisolates of N. cinerea and to detect concurrent colonizationby N. cinerea, N. meningiti-dis, andNeisseria lactamica, several translucent, pink col-onies characteristic ofthese specieswere isolated. A small

896

on April 11, 2020 by guest

http://jcm.asm.org/

(2)

TABLE 1. Colonial morphologic characteristicsofcommensalNeisseiria spp. and B.

(catarrHialis

grown on LBVT.SNRmedium selective at37°C for48 hinaCO.-enriched atmosphere

Color when stained Finalcolor"

Species Diam (mm) Color Elevation Surface Opacity

'th

stoine ofmedium

N. nu(zOsa, N. sic(-a, N.peflatah 1-2 Yellow-pink Convex Glistening Opaque Blue-black Pink

N.flav'a,N. subflav'a" 1-2 Orange Flat Matt Opaque Noreaction Orange

N.flavescenis 1 Orange Convex Glistening Opaque Blue-black Nochange

N. lacIatmi(a, N. nmeningitidis, 1-2 Pink Convex Glistening Translucent No reaction Nochange N. (inieie(a

B.

(altairrhablis

1-2 Pink Convex Matt Opaque Noreaction Nochange

Finalcolor of medium inoculated withapure culture of each species.

N.peiflava, N.subflavabiovar

pe:flava.

N.flaoa,N.subjiavabiovarflaoa.

" N.

subi

ava,N.

subfl/aa

biovar

subi

/aa.

section of the culture plate was then flooded with Lugol's

iodine to detect polysaccharide-negative colonies ofB.

ca-tarrhalisthat hadacolonial morphologicappearancesimilar

to that of the polysaccharide-producing Neisseria spp. on

this medium. In this way,itwaspossibletodetectstrains of the polysaccharide-positive N. polysaccharea (21) that also produce pink, translucent colonies on this medium. All

isolates of gram-negative, oxidase-positive diplococci were

identified by their pattern of acid production from

glucose,

maltose, sucrose, fructose, and lactose (17), reduction of

nitrate (17), and production ofpolysaccharide from sucrose on LBVT.SNR medium (18). Colistin disk susceptibility

tests were performedon strains resemblingN. cinerea (18).

Sucrose-positive, nitrate-negative isolates, Neisseria sieh-flavabiovarpeiflava (Neisseriapeiflava) andN. sicca,were

recorded as N. peiflava-N. sicca because these species

could not bedifferentiated biochemically.

Statistical analysis. Statistical analyseswereperformed by using achi-square test.

RESULTS

Growth of commensalNeisseria spp. and B. catarrhalison

LBVT.SNR medium. Five strains each ofN. lactamnica, N. cinerea, N. sicca, Neisseria mnucosa, N. subflava biovars

subflat'a (N. subflava), flava (Neisseriaflav'a), and petflav'a (N. perflava), and B. catarrhalis and one strain each of

Neisseriaflavescens and Neisseria polysaccharea

repeat-edly grew well on LBVT.SNR medium both alone and in

combination witheachother. Some strains of N. ineningiti-disdidnotgrowaswellon LBVT.SNRmedium asonGCK

medium. LBVT.SNRmedium didnot supportgrowth of N. gonorrhoeae strains. The colonial morphologic characteris-tics ofNeisseria spp. and B. catarrhalis after growth on

LBVT.SNR medium at 37°C for 48 h in a CO,-enriched atmosphere aresummarized in Table 1. All strainsproduced

colonies 1 to2mm indiameter. Although many,but notall, N. sicca coloniesproduce wrinkled, adherent colonies,few colonies of this type werefoundin the isolatesstudied, and

we presumed that most of the N.perflava-N. sicca isolates

were N. peiflava. We isolated a few strains ofN. muicosa

that produced wrinkled, adherent colonies similar to those

described for N. sicca.

Strains of different Neisseriaspp. ormultiplestrainsofN.

perflava-N. sicca were isolated from the oropharynges of

individuals.The colonialmorphologyofisolates and

produc-tion ofpolysaccharide were useful for initial differentiation

between strains and species on the isolation medium. The

final color of the culture medium was not useful for differ-entiating betweenspecies because the color of the indicator reflected the proportion of sucrose-positive and N.

flava

colonies present. If N.flai'a was present, thefinal color of themediumwasorange.If N.flai'a wasnotpresent,the final color of the medium was pink because of acid

production

from sucrose by the N. peiflfava-N. sicca and N. lifllO5s(

strains.

Isolation of commensal Neisseria spp. from clinical speci-mens. Gram-negative, oxidase-positive diplococci were

iso-lated from the oropharynges of 202 (96.6%) of 209persons,

including83 women,92 heterosexualmen, and 27

homosex-ualmen. Of these patients, onlyone woman hadpharyngeal

gonorrhea. Thefrequencyofisolation of Neisseria spp. and

B. catarrhalis from the 202 patients is shown in Table 2. Colonies representative of different colonial morphologic

types of N. peiflav'a-N. sicca isolated from individuals

TABLE 2. Frequencyofisolation of Neisseriia spp. and B.

eu(z-r-rHalis from the oropharynges of 202 adults attending the

Seattle-King CountySexually Transmitted DiseasesClinic, Harborview MedicalCenter, 1982to1983

No.(7c) ofindividuals colonized

Species Men Women

Heterosexual Homosexual (t =83)'

(n =92)` (n =27)`

N.peiflava"-N. si(-(-a' 89(97) 26(96) 79(95) N. inc(osa 21 (23) 6(22) 23(28)

N. flava" 26(28) 9(33) 18(22)

N. (inetrea 25 (27) 10(37) 22(27)

N. mneningitidis 4 (7) 4(29) 0

N. lactani(ca 1(1) 0 1(1)

B. (caarrhcalis 4(4) 1(4) 4 (5)

`Thesedenominatorsarefor al species,with theexceptionof N.

menin-gitidis.Thedenominators for N. nefingitiddisare54,14. and 30, respectively.

N.pefflara.N.subflavabiovarpet/aflrva.

N. siccastrainscannotbedistinguishedfromN.sub/ara biovarpe:fl/ava

onthe basis of biochemicaltests; onthe basis of colonialmorphology, very

few isolateswereN.sicca.

"N.flava, N.subf/avabiovarflava.

on April 11, 2020 by guest

http://jcm.asm.org/

(3)

898 KNAPP AND HOOK

J.

gXgNo. (%)ofAdufts

E (

en

E 8 Colonized

2E222

i

Cà(N=202)

83 (41.1) 23 (11.4)

22 (11.0)

16 (8.0)

10 (5-0) 9 (4.5)

9 (4.5)

5 (2.5)

3

(1.5)

S S

~~~~~~~~3

(1-5)

2 (1.0)

u 2 (1.0)

1 5

(7.4)

FIG. 1. Frequency and colonizationpatternsof the oropharyn-geal neisserial flora from 202 adults in Seattle, Washington, from

1982 to 1983, by Neisseria spp. and Branhalmella caiarrhalis.

Shadedboxes represent the isolation of thecorresponding species

from thenumberofpatientsindicated.Thepatternsofcolonization

are arranged in order ofdecreasing frequency ofisolation. Some

patterns of colonization, indicated by the asterisk, were each

detected inonlyonepatient andincluded thefollowingisolates: 11

N.perflava,9N. mucosa,7 N.flava,6N.cinerea,5N.

mneningiti-dis,2N. lactamica, and6 B. catarrhalis.

remained morphologically distinct when subcultured onto

GCKmedium and were considered to be different strains. More than one colony form of N. perflava-N. sicca was isolatedfrom 155 (76.7%) of 202individuals. Kingella

deni-trificans was notisolated.

N. cinerea was isolated from the oropharynges of 25

(30.1%) of 83 women, 22 (23.9%) of 92 heterosexual men, and10(37.0%)of 27homosexual men. Althoughdifferences

werenotsignificant,N.cinereawasisolatedmorefrequently

fromhomosexualmenthan fromeitherheterosexualmen(P

= 0.32) or women(P = 0.29). N. meningitidiswas theonly

otherNeisseria sp. isolatedmorefrequentlyfrom

homosex-ual men. There was no difference in the frequency of

isolation of other Neisseria spp. according to gender or

sexualpreference. N. cinereawasisolated from theurethra

ofonlyone heterosexual man, and nootherNeisseria spp.

were isolated fromgenital specimens.

The frequency ofconcurrent colonization ofthe

oropha-rynges ofpatients byN. cinerea andotherNeisseriaspp. or

B. catarrhalis is shown in Fig. 1. N. cinerea was isolated

with mostotherspeciesonatleastoneoccasion. None ofthe

colistin-sensitive species were isolated on Thayer-Martin

medium in this study.

Two general patterns of neisserial oropharyngeal flora

wereobserved. Atotal of41%ofindividualswerecolonized

by

strains of N.

perflava-N.

sicca alone. Some individuals

werecolonized heavilybyasmanyasthreeorfourdifferent

strainsofN.

perflava-N.

sicca, and rarely by other species.

Other individuals were colonized by a variety of species,

each of which was isolated in low numbers. In general,

detection of N. cinerea in patients heavily colonized with

sucrose-positive Neisseria spp. was more difficult than in those who were not. There were no differences between homosexual men, heterosexual men, and women with

re-spect tothe patternsofcolonization

by

otherNeisseria spp. Persistence ofN. cinerea inadults. In the second

phase

of these studies, cultures were obtained from 16 volunteers weekly to determine whether N. cinerea persisted in the oropharynx; Neisseriaspp. wereisolated from 15

(93.8%)

of 16 volunteers. As observed in the first phase ofthe

study,

volunteers were either heavily colonized by N.

perflava-N.

sicca or were sparsely colonizedbyavariety ofspecies and the patternofcolonizationwasgenerally consistent foreach personthroughout the

study period.

N. cinereawasisolated from 10 (62.5%) of 16 volunteers

during

the

study

but was

notisolated in each week. N. cinereawasisolated inatleast 3 weeksfrom six (37.5%) individuals whowere

consistently

colonized sparselyby a variety ofspecies.

DISCUSSION

Inthis study, N. cinerea was a commoninhabitant ofthe oropharynges of adults butwas rarely isolated from

genital

sites. N. cinerea was isolated more frequently from homo-sexual menthan from heterosexual men orwomen, but the differencewas notsignificant.StrainsofN.cinereawerenot

presentinlargenumbersin anyspecimenand

concomitantly

colonized the oropharynx withother Neisseria spp.

Serially

cultured samples from volunteers

generally

had consistent patterns of colonization by Neisseria spp. characterized either by heavy colonization with several strains of N. perflava-N. sicca or by sparse colonization with a

larger

numberofspecies.

Noprospective studies of the commensal neisserial flora of the oropharynx have been made since nitrate reduction wasintroduced as a differential test for the identification of Neisseria spp. (3), the redescription of N. cinerea (18) and N. mucosa (22),orthedescription ofN. lactamica(16). We isolated N. cinerea morefrequently thanprevious investiga-torsdid. Inprevious studies, specimenswere inoculatedon

nonselective media such asblood agar orasciticagar(9, 14, 15).Our own preliminary studies were made by usingsheep blood agar (data not shown).Cultureswereheavily contam-inated by normal flora; it was difficult both to isolate Neis-seria spp. that occurred in relatively small numbers in the oropharynx and to differentiate between Neisseria spp. on thebasis of their colonial morphology on sheep blood agar. Earlystudies of the neisserialflora of the oropharynx were also limited by the use of inappropriate serum-containing media to detect acid production from carbohydrates bythe oxidative Neisseria spp. (14, 15, 25, 26). Because oftheir inability to obtain consistent patterns of acid production from carbohydrates from many strains, even withprolonged incubation, Wilson and Smith (25) suggested that the "fer-mentation" tests did not provide a reliable method for distinguishing between Neisseria species and that N. catarrh-alis, N.flavus, N. cinereus, N. mucosus, and N. siccusbe combined into a single species, "Neisseria pharyngis." Berger subsequently showed that Neisseria spp. were oxi-dative and thus produced less acid than fermentative orga-nisms (1). By using a medium formulated to detect acid production fromNeisseria spp., he found that they produced less acid from the monosaccharides glucose and fructose, than from the disaccharides maltose and sucrose (4) and that, because strains of N. flava and N. subflava also produced ammonia from peptone (9), they would neutralize

J. CLIN. MICROBIOL.

on April 11, 2020 by guest

http://jcm.asm.org/

(4)

anyacid produced in media that had been used previously. Berger (5) also suggested that, although N. flava and N. subflava appeared to be variants of the one species, they were distinctly different from N.

perflava

and N. sicca. Serologic studies also supported these findings (7).

AlthoughB. catarrhalis subtypes, which almost certainly included N. cinerea, were isolated in early studies (14, 15, 26), the proportions of isolates belonging to each subtype were not determined. Thus, it is impossible to estimate the frequency ofoccurrence ofN. cinereafromthese studies.

Berger and Wulf (9) characterized the neisserial flora isolated on sheep blood agarfrom the oropharynges of202 individuals. Strains of N.

perflava-N.

sicca were isolated from 88% ofpatients, andon the basis ofserologic studies, it was estimated that 55% ofthese strains were N.

perflava

and45% were N. sicca, although many N. sicca strains did notproduce wrinkled colonies. Thefrequencies of isolation ofN.

perflava

and N. sicca werealmost certainly overesti-mated in these studies, however, because strains of N. mucosa were not differentiated. Strains ofN.flava and N. subflava were isolated from 4 and 11% of individuals, respectively. Asaccharolytic isolates

(B.

catarrhalis and N. cinerea) accounted for only 3% of strains. It is unclear whether the isolates represented one isolate from each patient or multiple isolates from fewer patients. Because none of the six asaccharolytic isolates reacted with B. catarrhalis-specificorN.flavescens-specificantiserum(9),it is likelythatthese isolateswere N. cinerea. No information is given about patterns of colonization ofthese

patients by

N. cinerea and other Neisseria spp.

Using a selective medium for B.

catarrhalis,

Berger (2) isolated "N.catarrhalis"from 15% ofpatients. Becausethis medium did notpermit differentiation between the "saccha-rolytic" Neisseria spp., there is no information on the coexistence ofNeisseria spp. in healthy adults. In a retro-spective study of these isolates, Berger and Paepcke (8) found that strains ofN. cinerea accounted for 93% of the asaccharolytic isolates obtained previously (2).

The useofa selective medium that also permitted differ-entiation between many commensal Neisseria spp. en-hancedthedetectionandisolation ofN. cinereainourstudy and also permitted an immediate appreciation ofthe com-plexity of the neisserial flora of the oropharynx. The fre-quency of isolation ofstrains ofN. cinerea, both in persons colonized heavily by strains ofN.

perflava-N.

sicca and in those persons colonized more

sparsely

by

a

variety

of

species,

may be a conservative estimate of the true preva-lence of this species. Strains of N. cinerea

generally

oc-curred in small numbers in all cultures from which the species was isolated. Strains ofN. cinerea may have been presentinthe persons

heavily

colonized

by

sucrose-positive

species

but may not have been observed because of over-growth. In those persons

sparsely

colonized

by

several

species,

it is

possible

that strains of N. cinerea werepresent in such lownumbers that

they

were not detected.

Thesedata

confirm

the

complexity

of the neisserial

flora

of the oropharynx and demonstrate that N. cinerea is a fre-quent inhabitant of the

oropharynx

in adults. The exact frequency of isolation ofN. cinereaisaffected

by

thetypeof neisserial flora ofthe

patient

from whom the

specimen

is collected. In a recent survey,N. cinerea was isolated from the oropharynges of27% of adults in DeKalb

County,

Ga. (datanot

shown).

Thus,

itdoes notappearthat N. cinerea will beisolatedonlyinlimited

geographic regions.

Although

strains ofN. cinerea wereisolated

infrequently

from

genital

specimens and were not isolated on

gonococcus-selective

medium

during

this

study,

the

possibility

that this

species

maybeisolatedmustbeconsidered when strains

resembling

the gonococcus are isolated from adults at low risk for

gonorrhea.

The

laboratory

identificationofN.

gonorrhoeae

from

patients

at low risk for

gonorrhea

must be

carefully

substantiated

by

using

tests

appropriate

for

differentiating

between N. cinerea and N.

gonorrhoeae.

LITERATURE CITED

1. Berger, U. 1960. Uber den Kohlenhydrat Stoffwechsel von

Neisseria undGemella. Zentralbl. Bakteriol. I. Abt. Orig. 180: 147-149.

2. Berger, U. 1961. Ein Elektivnahrboden fürNeisseria catarrh-alis. Zentralbl. Bakteriol. I. Abt. Orig. 183:135-138.

3. Berger, U. 1961. Reduktion von Nitrat und Nitrit durch

Neis-seria. Z. Hyg. 148:45-50.

4. Berger,U. 1961. ZurVariabilitat derZuckervergarungendurch

Neisserien.Arch. Hyg.(Berlin) 145:296-301.

5. Berger, U. 1962. Untersuchungen uber die Saurebildungdurch saccharolytische anspruchloseNeisserien. Arch. Hyg. (Berlin) 145:55-60.

6. Berger, U. 1963. DieanspruchlosenNeisserien. Ergeb. Mikro-biol. 36:7-167.

7. Berger,U.,and H. Brunhoeber.1961.

Neisseriaflava

(Bergeyet

al. 1923): Artoder Varietat?Z. Hyg. 148:39-44.

8. Berger, U., and E. Paepcke. 1962.

Untersuchungen

uber die asaccharolytischenNeisseriendes menschlichenNasopharynx. Z. Hyg. 148:269-281.

9. Berger,U.,and B.Wulf. 1961.

Untersuchungen

an

saprophytis-chen Neisserien. Z.Hyg. 147:257-268.

10. Boyce, J. M., and E. B. Mitchell, Jr. 1985. Difficulties in differentiatingNeisseria cinereafromNeisseria

gonorrhoeae

in rapidsystemsusedforidentifying

pathogenic

Neisseria

species.

J. Clin. Microbiol.22:731-734.

11. Boyce,J.M.,E. B.Mitchell, Jr.,J.S.Knapp,and T. M.Buttke.

1985. Production of `4C-labeled gas in BACTEC Neisseria

differentiation kits by Neisseria cinerea. J. Clin. Microbiol. 22:416-418.

12. Boyce, J.M.,M. R.Taylor,E. B.Mitchell, Jr.,andJ.S.Knapp.

1985.Nosocomialpneumoniacausedbya

glucose-metabolizing

strain ofNeisseria cinerea. J. Clin. Microbiol. 21:1-3. 13. Dossett, J.H.,P.C.Appelbaum, J.S.Knapp,andP. A. Totten.

1985. Proctitis associated withNeisseria cinerea misidentified

asNeisseriagonorrhoeaeinachild.J.Clin. Microbiol. 21:575-577.

14. Elser,W.J.,and F. M. Huntoon. 1909.Studieson

meningitis.

J.

Med.Res. 20:371-541.

15. Gordon, J. E. 1921. The

gram-negative

cocci in "colds" and influenza. VII. Influenzastudies.J. Infect. Dis. 29:462-494. 16. Hollis,D.G.,G. L.Wiggins,and R. E. Weaver. 1969.Neisseria

lactamicus sp.n.,a

lactose-fermenting

species

resembling

Neis-seriameningitidis. Appl. Microbiol. 17:71-77.

17. Knapp, J. S., and K. K. Holmes. 1983. Modified oxidation-fermentation medium for detection of acid

production

from

carbohydrates

by

Neisseria spp. andBranhamella catarrhalis. J. Clin. Microbiol. 18:56-62.

18. Knapp,J.S., P. A. Totten,M. H. Mulks,and B. H. Minshew.

1984. Characterization ofNeisseria cinerea, a

nonpathogenic

species

isolated on Martin-Lewis medium selectivefor

patho-genic

Neisseria spp. J.Clin. Microbiol. 19:63-67.

19. Minshew, B. H., J. L.

Beardsley,

and J. S.

Knapp.

1985.

Evaluation of GonoGen

coagglutination

testfor

serodiagnosis

of

Neisseria

gonorrhoeae:

identification of

problem

isolates by

auxotyping,

serotyping,

and with a fluorescent antibody

re-agent.

Diagn.

Microbiol. Infect. Dis. 3:41-46.

20. Morello, J. A., S. A.Lerner, and M. Bohnhoff. 1976. Charac-teristics of

atypical

Neisseria

gonorrhoeae

from disseminated and localizedinfections. Infect. Immun. 13:1510-1516. 21. Riou, J.-Y., and M.Guibourdenche. 1987. Neisseria

polysac-charea sp. nov. Int.J.

Syst.

Bacteriol. 37:163-165.

22. Véron,M.,P.Thibault,and L.Second.1961.Neisseriamucosa

(Diplococcus mucosus

Lingelsheim).

Il. Étude

antigénic

et

on April 11, 2020 by guest

http://jcm.asm.org/

(5)

900 KNAPP AND HOOK J. CLIN. MICROBIOL.

classification. Ann. Inst. Pasteur(Paris) 100:166-179.

23. Von Lingelsheim, W. 1906. Die bakteriologischen Arbeiten der

Kgl. Hygienischen Station zu Beuthen O. Schl. wahrend der

Genickstarreepidemie in Oberschlesien im Winter 1904/05.

Klin.Jahrb. 15:373-489.

24. White, L. A., and D. S. Kellogg, Jr. 1965. Neisseria

gonor-rhoeae identification in direct smears by a fluorescent

antibody-counterstain method.Apple. Microbiol. 13:171-174.

25. Wilson, G. S., and M. M. Smith. 1928. Observations on the gram-negative cocci of the nasopharynx, with a description of

Neisseriapharyvgis. J. Pathol. Bacteriol. 31:597-608.

26. Wilson, S. P. 1928. An investigation of certain gram-negative

cocci met within the nasopharynx, with special reference to

their classification. J. Pathol. Bacteriol. 31:477-492.

on April 11, 2020 by guest

http://jcm.asm.org/

References

Related documents

was associated with lower physical quality of life among earthquake and flood survivors in Iran and China, [26, 56] lower physical functioning in Iran, Rwanda, and Syrian refugees

The aim of the study was to assess the presence of pathogenic microbes on treatment tables in one outpatient teaching clinic and determine a simple behavioral model for

Twenty-five percent of our respondents listed unilateral hearing loss as an indication for BAHA im- plantation, and only 17% routinely offered this treatment to children with

Two sets of comparisons were made: first ANOVA was used to study the effects of different bread wheat varieties (Almansor and Pirana), durum wheat varieties (Celta, Hélvio

The Quarterly financial statistics Survey covers a sample of private enterprises operating in the formal non-agricultural business sector of the South African economy. It

12 For example, a software distributor that re- ceives most of its income from copyright royalties generated by its licensed software could be a personal holding

lustrates the time course in S-GOT in hepa- titis contacts with abnormal variability in S-GOT. It is worth emphasizing that, in spite of living in the same households with one or

To facilitate FTIR spectroscopy as quantitative analysis method of curcuminoid in ethanolic extract of turmeric, PLS was employed for making the correlation between actual