Question A: Gram-negative organisms like Neisseria harbor a form of endotoxin in the outer layer found around their cell wall. When these organisms are killed, the outer layer falls apart and releases the endotoxin components. This endotoxin is the virulence factor which can be responsible for the ‘turn for the worse’ seen after treatment as the endotoxin is released after the Neisseria is killed by antibiotics. It is important to remember that if too much treatment is given too fast, the release of the endotoxin could give way to serious complications for the patient.
Question B: The easiest way to deal with the patient’s family is to be truthful about the reason why the patient may appear to be doing poorly after treatment. You can explain about the release of the endotoxin, and explain that this change in health status is only temporary and will pass as the endotoxin is broken down by the patient’s body.
You should tell the family that the M protein is a component of the bacterial cell wall of some organisms including streptococci. This protein actually helps protect the bacteria from outside treatments such as antibiotics by making it difficult for the drugs to gain access to the bacterium. If there is a way to target and neutralize this bacterial defense, then many other treatment options become possible and the more options we have the better chance we have of dealing with the infection.