Intracellular and extracellular diplococci in the smear

Diplococci in the smear can be pathologies, regardless of the localization of the process, and their identification indicates illness or carrier, even if there are no symptoms. These bacteria can be pathogens of various pathologies - meningitis, pneumonia, gonococcal genital process, and depending on this tactics of diagnosis and treatment are different.

Morphology of Diplococci

Diplococci are parasites belonging to the family Lactobacteriaceae. Diplococci are characterized by the structure of a circular cell, in which two cells are joined together by a pair. Such doubled cells are always together, but sometimes they can be in the form of a small chain. Distinguishing the degree of coloration in the study, parasites can be Gram-positive and Gram-negative. Gram negative - this is the term used in connection with these bacteria, which means that the violet dye is not conserved (during the Gram staining process) by these organisms in the thickness of the cell. Those bacteria that retain this dye are known as Gram-positive. Examples of gram-negative diplococci are Neisseria spp., Moraxella catarrhalis and Acinetobacter spp. Examples of gram-positive diplococci are Streptococcus pneumoniae and Enterococcus spp.

These parasites threaten the development of serious infections of internal organs. Having them in a normal body flora is not a normal indicator.

What causes diplococci? Since under normal conditions these bacteria should not be, they appear only due to human infection. Therefore, the norm of diplococci in the smear is when they are not there at all. When they are, the person is infected, even if there are no clinical manifestations yet.

Pathogens in the body can be at different stages in different forms - outside the cell and inside the cell. The extracellular phase does not have pathogenic action and cellular structure, but is harmful to humans, because the cell is a parasitic pathogenic organism. This form has a very dense membrane, which helps it to adapt in external conditions. It can be damaged only with the active use of disinfectants or laser radiation.

Causes of the diplococci in the smear

The causes of the appearance of diplococci in a smear are contact with an infected person who is sick or in contact with the carrier of the infection, but does not have any symptoms. Therefore, pathologies are considered dangerous, because they are easily spread between people. Diplococci in a smear from the nose can be sown in many people, but they can never have pneumonia or meningitis. Such people are called carriers or potential sources of infection.

But not all people suffer from such diseases, which are caused by diplococci. Risk factors are a decrease in the activity of the immune system, the presence of suppressive drugs, the presence of concomitant infections or immunodeficiencies. Therefore, children and elderly people are more prone to developing diseases when in contact with diplococci.

[1], [2], [3], [4], [5]

Pathogenesis

How is it transmitted? All depends on the specific type of pathogen infection. In the environment there are different types of such pathogens, but the most terrible are characterized by a potential risk in the development of serious, life-threatening inflammatory reactions. Being in the body, they will not do much harm, but can become a factor of infectious damage to the brain (or cortex), in the lungs (affect the entire respiratory system) and harm the sexual and urinary systems. Accordingly, dicococci are transmitted either by air or by contact.

Moraxella Catarrhalis is a diplococcus, widely distributed among humans. It is not mobile in nature and causes various types of bacterial infections of the respiratory system, central nervous system, middle ear and joints of the body. These bacteria are placed in the Moraxellaceae family, in the order of Pseudomonadales. Speaking specifically about diseases, bronchitis, sinusitis, otitis and laryngitis, there are few conditions caused by these microbes. This microorganism is also associated with the disease of bronchopneumonia. Heavy smokers and elderly patients should be especially aware of such problems caused by Moraxella catarrhalis. Beta-lactamase, produced by this organism, makes it resistant to penicillin. These bacteria are also resistant to tetracycline, trimethoprim sulfamethoxazole and trimethoprim. Some strains produce a protein that imparts resistance to the complement, preventing the formation of a membrane attack complex. M catarrhalis also expresses specific proteins for iron absorption, which act as receptor for transferrin and lactoferrin. M catarrhalis has been shown to have increased cell adhesion and pro-inflammatory responses in cold shock (26 C for 3 hours). Physiologically, this can occur with prolonged exposure to cold air temperatures, which leads to cold symptoms.

Neisseria Meningitidis is one of the most important gram-negative diplococci, and is responsible for the occurrence of meningitis. The mortality rates caused by her infection are high. Younger children (less than 5 years old) are at greater risk of infection caused by these bacteria. These microbes attack only humans, since they can receive iron from humans (from sources of lactoferrin and transferrin).

The outer membrane of this microbe contains lipo-oligosaccharide and in chemical form it acts as an endotoxin, which is responsible for septic shock and fever. In some cases, lipo-oligosaccharide also causes the destruction of erythrocytes and leads to hemorrhage. The sputum of the affected person can be checked in the laboratory to confirm the presence of this bacterium.

Neisseria Gonorrhoeae is the cause of gonorrhea, a sexually transmitted infection. This bacterium moves through convulsive movement with the help of locomotor organs, called saws. In laboratories, a bacterium can grow on a chocolate agar. In the case of gonorrhea, local manifestations of the inflammatory process that occur when the cells of the organ epithelium are damaged and the formation of leukocytes can be observed. All this is accompanied by characteristic manifestations, up to the development of complications. This is not just an infection that is caused by this microbe, but other health problems caused by this diplococcus are troublesome. Symptoms caused by his infection include pharyngitis, conjunctivitis, urethritis, orchitis and prostatitis. It was found that Neisseria gonorrhoeae is resistant to antibiotics from the penicillin group.

[6], [7], [8], [9]

Symptoms of the diplococci in the smear

Symptoms that cause diplococci when a person is infected depend on the disease that they cause, that is, the type of pathogen.

Moraxella catarrhalis is a gram-negative, aerobic diplococcus. Various clinical manifestations of this infection depend on the site of infection and the underlying conditions. It is believed that the transmission is due to direct contact with contaminated secretion of saliva and droplets of air. The preferred place of localization of diplococcus determines where the inflammatory process will develop. If bacteria enter the cavity of the middle ear, then otitis develops, and if they fall on the lungs, pneumonia.

The first signs of otitis media caused by such a diplococcus include otoalgia (severe pain in the ear), fever and hearing loss. Otitis is a very common disease, especially in children. Approximately 70% of children experience at least 1 episode of otitis during childhood. Symptoms develop sharply, and against the background of increased body temperature, pain in the ear increases, the child is restless and inflammation can be up to the perforation of the tympanic membrane.

In a patient with sinusitis, a clinical history usually includes headache, pain in the maxillary or frontal region, fever and cough. Young children have constant discharge from the nose (lasting more than 2 weeks) and coughing, especially at night.

Symptoms of an infection of the lower respiratory tract caused by this diplococcus may include: coughing, high sputum, headache, dyspnea. Being the causative agent of the infection of the upper respiratory tract, Moraxella Catarrhalis infections cause symptoms similar to those of common infections such as pneumonia, ear infections and sinusitis. It should be noted that symptoms persisting for more than 10 days, most often can be caused by infections of Moraxella Catarrhalis and require antibiotic therapy.

Diplococci in a smear in a child when diagnosing sputum or secretions from the ear can confirm the diagnosis with an accurate definition of the pathogen. Moraxella Catarrhalis is not diagnosed individually in the usual way, but as a common bacterial infection. If conventional antibiotics do not work, the doctor will conduct some special tests to find out which antibiotic will be most effective in treating or reducing symptoms in Moraxella Catarrhalis infections. Polymorphic diplococci in a smear of a sputum can be defined at a pneumonia, in such cases the originator can be not one pathogen of kind Moraxella, but also other factors, such as a pneumococcus. Some diagnostic tests for Moraxella Catarrhalis may include, in addition to sputum culture, the determination of antibodies in serum to the causative agent Moraxella Catarrhalis.

Kokki and diplococcus in a smear of sputum or secretions from the ear can become evidence of streptococci, which require complex treatment.

Meningitis - inflammation that occurs in the membranes of the brain, can become a factor in its swelling in the future. In addition to this, pathological processes can be in other organs, with the spread of the pathogen by blood. Symptoms can be very visible and obvious, and asymptomatic in the first stages. Meningococcal disease can refer to any disease that occurs when Neisseria meningitidis penetrates the blood or spinal cord and brain. Meningococcal infection is an infection that spreads in close contact with an infected person. Rapid medical attention is extremely important if meningococcal disease is suspected.

When a person develops meningococcal meningitis, bacteria infect the protective membranes that cover the brain and spinal cord and cause swelling. Symptoms of meningococcal disease may vary depending on the type of disease that develops. The first signs of pathology can be characteristic of any inflammation, they are: fever, headache, neck tension. Often there are additional symptoms, such as nausea, vomiting, photophobia (the eyes are more sensitive to light), altered mental status (confusion). Newborns and children may not have or can be difficult to notice the classic symptoms of fever, headache and neck strain. Instead, infants can be slow or inactive, irritable, they may have vomiting. In small children, doctors can also look at the child's reflexes for signs of meningitis.

When meningococcal septicemia develops, bacteria enter the bloodstream and multiply, damaging the walls of blood vessels. This causes bleeding in the skin and organs. Symptoms may include: fever, fatigue, vomiting, cold hands and feet, severe pain or pain in the muscles, joints, chest or abdomen. At later stages, a dark purple rash appears.

Meningococcal disease is very serious and can be fatal for several hours. Early diagnosis and treatment is very important. Meningococcal disease can be difficult to diagnose because signs and symptoms are often similar to those of other diseases. If the doctor suspects meningococcal disease, the diagnosis is to examine blood samples or cerebrospinal fluid (fluid near the spinal cord). Then the doctors check the samples to see if there is an infection. Gram-negative diplococci in the smear are a direct confirmation of the diagnosis. If the bacteria Neisseria meningitidis are in the samples, the lab technicians can grow (cultivate) the bacteria. Growing bacteria in the laboratory allows doctors to recognize the specific type of bacteria that cause infection. Knowing this helps doctors decide which antibiotic will work best.

Gonorrhea is a pathology of the reproductive system, which develops due to the defeat of diplococcus. In women, the main signs of such damage include different degrees of excretion. The most common symptom of gonorrhea is vaginal discharge due to the development of endocervicitis when the bacterium multiplies in the cervical region. Typically, a small amount of discharge, purulent, but many patients have minimal symptoms or symptoms of gonococcal cervicitis. Other symptoms may occur as a discharge of urination, intermenstrual bleeding, dyspareunia (painful sexual intercourse), mild pain in the lower abdomen. If the infection progresses to pelvic inflammatory disease, the symptoms may include increased vaginal discharge, fever, chills, nausea and vomiting (less common).

In men, the main symptoms of infection with this diplococcus include the development of urethritis. The main manifestation of gonococcal infection in men is a characteristic feeling of heat during urination; In a few days, there are abundant, green discharge, sometimes colored with blood.

Also, men and women can have classic manifestations of disseminated gonococcal infection - this is an arthritis-dermatitis syndrome. Pain in joints or tendons is the most common complaint at an early stage of infection. The second stage is characterized by septic arthritis. The knee is the most common site of purulent gonococcal arthritis.

In newborns who have bilateral conjunctivitis (ophthalmia newborn) often develops from a mother with gonococcal infection. Symptoms of gonococcal conjunctivitis include the following: eye pain, redness, purulent discharge.

Extracellular gram-positive diplococci in a smear in women with a planned gynecological examination can confirm the diagnosis, since only gonococci have such a structure with such a localization. If leukocytes and diplococci are detected in the smear, this indicates active endocervicit, which requires treatment.

In men, asymptomatic gonorrhea is more common, so they can confirm the diagnosis if polymorphic diplococci are detected in the smear in men. When detecting bacteria, both partners are necessarily examined. Tests that are used to determine systemic gonococcal infection are a polymerase chain reaction (PCR, as well as amplification of nucleic acid) to identify genes unique to N. Gonorrhoeae. These PCR-based tests require a urine sample, a urethral smear or a vaginal smear. Culture (cultivation of bacterial colonies to isolate and identify them) and a gram-spot (staining bacterial cell walls to reveal morphology) can also be used to detect the presence of N. Gonorrhoeae in all samples except urine. All people who are positive for gonorrhea should be tested for other sexually transmitted diseases, such as chlamydia, syphilis and human immunodeficiency virus.

Diplococci during pregnancy talk about gonorrhea, so you need to treat the pathology with the approved antibiotics, since there is a risk of infection of the fetus if the woman falls ill before giving birth.

[10], [11], [12], [13], [14], [15]

Complications and consequences

The consequences of a transmitted infection caused by diplococci can be very serious and depend on the type of pathogen and timely treatment. Complications of the respiratory tract infection can be in the form of spreading the infection to other organs. Complications of M catarrhalis infection may include the following: bacterial sepsis, meningitis, mastoiditis, hearing loss, pleural effusion formation, infectious shock.

Even with antibiotic treatment, 10 to 15 of 100 people infected with meningococcal disease have a lethal outcome. The consequences of meningitis can be such as deafness, problems with the nervous system or brain damage.

The consequences of an untreated gonococcal infection can be a problem in the conception of a child.

[16], [17], [18], [19], [20], [21], [22]

Treatment of the diplococci in the smear

Treatment of Moraxella Catarrhalis infections requires good home care. There are special ways in which you can improve the treatment process by home care methods, in the case of this infection.

Fever is one of the symptoms of Moraxella Catarrhalis infection. If you suffer from fever above 38 degrees, you need to take medications such as ibuprofen or paracetamol.

It is often necessary to ventilate the room, as Moraxella Catarrhalis is easily transmitted through respiratory secretions; it is important to be careful and keep the room clean. Sinus infections and cough are alleviated with the help of moist air.

It should be remembered that smoking in the house can transmit or increase the chance of contracting Moraxella Catarrhalis in the room if the smoker suffers from this. It is important for each house to wash your hands properly and stay away from infection.

Proper nutrition is very important for the treatment of Moraxella Catarrhalis infection. Eat fresh foods and drink plenty of fluids.

Drug treatment usually involves the treatment of certain symptoms observed with Moraxella Catarrhalis infection. However, the general course of treatment of Moraxella Catarrhalis includes treatment with antibiotics. This pathogen requires newer and stronger antibiotics, since this strain has a high level of resistance to antibiotics. The most effective antibiotics prescribed by doctors for the treatment of Moraxella Catarrhalis include the following:

1. Cephalosporins (including Zinacef, Ceftriaxone).
2. Amoxicillin-clavulanate (penicillin preparations).
3. Azithromycin (Macrolide preparations).
4. Erythromycin (Macrolide preparations).
5. Clarithromycin (Macrolide preparations).
6. Trimethoprim-sulfamethoxazole.
7. Fluoroquinolones (Ciprofloxacin, Levofloxacin).

Since at the onset of the disease meningitis caused by N meningitidis can not be distinguished from other types of meningitis, empirical antibiotic treatment with effective penetration into the central nervous system is used. In anticipation of the final identification of the causative organism, immunocompetent adults suspected of having a meningococcal infection receive cephalosporin of the third generation and dexamethasone. A 7-day course of intravenous ceftriaxone or penicillin is adequate for uncomplicated meningococcal meningitis.

After establishing an accurate diagnosis of meningococcal meningitis, appropriate changes can be made. Currently, the third generation cephalosporin (Ceftriaxone or Cefotaxime) is the drug of choice for the treatment of meningococcal meningitis and septicemia. Penicillin G, ampicillin, chloramphenicol, fluoroquinolone and aztreonam are alternative therapies. The use of dexamethasone in the treatment of bacterial meningitis in adults remains controversial. It can be used in children, especially in people with meningitis caused by Haemophilus influenzae. In adults with suspected bacterial meningitis, especially in cases of high risk, additional use of dexamethasone may be beneficial.

1. Cefotaxime is an antibiotic used to treat a diplococcal infection of any location. Dosage of the drug - 2 g 4 times a day, the method of application - in the form of intravenous infusion. The drug can be administered together with detoxification therapy. Side effects can be in the form of anaphylactic reactions and allergic skin rash. Precautions - if the patient has allergies to penicillins, use the drug only after the sample. 
2. Ceftriaxone 2 g is a broad-spectrum preparation, especially effective in the treatment of diplococcal infection. The dosage of the drug is 2 g per day for three or four doses. Method of use intravenous or intramuscular. Side effects can be allergic, and can also be headache, nausea.
3. Vancomycin is an antibiotic of the reserve group, which is used in persons with immunocompromised or elderly persons with a risk of concomitant severe infection. Dosage of the drug from 30 to 60 mg / kg per day. The method of administration can be intramuscular with a small dose or intravenous. Side effects - allergic disorders, visual impairment, dysbiosis.
4. Corticosteroids reduce the incidence of neurological complications in children and adults. When corticosteroids are used, they should be administered before or after the first dose of antibiotics. Dexamethasone is a hormonal drug that acts through anti-inflammatory activity. The dosage of the drug is 0, 15 mg / kg per administration with a possible repeat after 6 hours. Dosage in children is given within 4 days. The route of administration can be any - intramuscular, intravenous or rectal. Adverse reactions with short-term admission infrequent.

Depending on how serious the infection is, people with meningococcal disease may need other treatments, including: respiratory support, drugs to treat low blood pressure, care for wounds for parts of the body with damaged skin.

Than to treat a diplococcus in a smear at a genital lesion? Treatment of gonorrheal inflammation has its own characteristics. Because of the resistance to oral cephalosporins, only 1 regimen is recommended - this is a dual therapy with ceftriaxone and azithromycin to treat gonorrhea. Therapy with ceftriaxone and azithromycin should be administered together on the same day, preferably simultaneously and under direct supervision. The combination with azithromycin in comparison with doxycycline is preferred because of more convenient dosing, probably better patient compliance with the recommendations.

Uncomplicated urogenital, anorectal and pharyngeal gonococcal infection has the following treatment regimen: Ceftriaxone 250 mg intramuscularly single dose plus

Azithromycin 1 g once. Ceftriaxone is safe and effective in pregnant women.

With a common gonococcal infection, it is important to assess the presence of meningitis and endocarditis. It is recommended to conduct inpatient treatment in people who have purulent arthritis or who have other complications.

Recommendations for the treatment of gonococcal meningitis and endocarditis - use Ceftriaxone 1-2 g every 12-24 hours plus Azithromycin 1 g for 1 dose. A key consideration is testing for antimicrobial susceptibility and the patient's clinical response to empirical therapy.

Folk methods of treatment and homeopathy in such cases are not used, because this is a very serious infection that quickly leads to complications if we delay antibacterial therapy.

Surgical treatment is used very rarely, only when complications arise in the form of abscesses, which need to be dissected.

Prevention

Prevention of diplococcal infection may be specific only for meningococcus. If a person wants to prevent this disease, a vaccine against this pathogen is recommended. The prognosis for this infection is positive only in case of timely therapy, since in the absence of treatment, the lethality is high.

Prevention of gonococcal infections is based on education, mechanical or chemical prophylaxis and early diagnosis and treatment. Condoms offer partial protection, while effective antibiotics taken at therapeutic doses just before or shortly after exposure can mediate the infection. Preventive measures also include attention to notifying partners. Patients should be advised to notify their sexual partners of their effects and encourage them to seek medical help. If patients are unwilling or unable to notify their partners, then the assistance of state and local health departments may be sought.

Prevention in infants born to mothers with untreated gonococcal infection is preventive treatment with a single dose of Ceftriaxone (25-50 mg / kg not exceeding 125 mg). All newborns should undergo ophthalmic syndrome prophylaxis with an aqueous solution of silver nitrate (1%) once or ophthalmic ointment of erythromycin (0.5%) in both eyes once.

[23], [24], [25], [26], [27]

Diplococci are a composite concept of pathogens, which can cause different lesions according to their localization. The detection of bacteria requires treatment even without the presence of symptoms, because at some point they may appear.

[28], [29], [30], [31], [32], [33], [34], [35], [36], [37]