Asunto(s)
Antibacterianos/uso terapéutico , Azitromicina/uso terapéutico , Ceftriaxona/uso terapéutico , Farmacorresistencia Bacteriana/genética , Gonorrea/tratamiento farmacológico , Gonorrea/genética , Neisseria gonorrhoeae/efectos de los fármacos , Neisseria gonorrhoeae/genética , Humanos , Pruebas de Sensibilidad MicrobianaRESUMEN
We report a treatment failure to azithromycin 2.0 g caused by a urethral Neisseria gonorrhoeae isolate with high-level azithromycin resistance in California. This report describes the epidemiological case investigation and phenotypic and genetic characterization of the treatment failure isolate.
Asunto(s)
Antibacterianos/administración & dosificación , Azitromicina/farmacología , Ceftriaxona/administración & dosificación , Gonorrea/tratamiento farmacológico , Neisseria gonorrhoeae/efectos de los fármacos , Uretritis/tratamiento farmacológico , Adulto , California/epidemiología , Trazado de Contacto , Farmacorresistencia Bacteriana , Femenino , Gonorrea/genética , Gonorrea/microbiología , Humanos , Masculino , Pruebas de Sensibilidad Microbiana , Neisseria gonorrhoeae/genética , Vigilancia de la Población , Insuficiencia del Tratamiento , Estados Unidos/epidemiología , Uretritis/etiología , Uretritis/genéticaRESUMEN
AIM: To analyse mutations in the gyrA and parC genes leading to possible increase in ciprofloxacin resistance (high MIC values for ciprofloxacin) in clinical isolates of Neisseria gonorrhoeae in Delhi, India. METHOD: MIC of ciprofloxacin for 63 clinical isolates of N gonorrhoeae were examined by the Etest method. Subsequently, gyrA and parC genes of these isolates were amplified and sequenced for possible mutations. RESULTS: Out of the 63 clinical isolates tested, only five (8%) isolates were found to be susceptible to ciprofloxacin (MIC <0.06 micro g/ml). DNA sequence analysis of the gyrA and the parC genes of all these isolates (n = 63) revealed that all isolates which were not susceptible to ciprofloxacin (n=58) had mutation(s) in gyrA and parC genes. 12 isolates (19%) exhibited high resistance with an MIC for ciprofloxacin of 32 micro g/ml. Two out of these 12 isolates (UD62 and UD63), harboured triple mutations (Ser-91 to Phe, Asp-95 to Asn and Val-120 to Leu) in the gyrA gene. The third mutation of Val-120 to Leu, lies downstream of the quinolone resistance determining region (QRDR) of the gyrA and has not been described before in gonococcus. In addition, both these isolates had a Phe-100 to Tyr substitution in the parC, a hitherto unknown mutation. CONCLUSIONS: Emergence of ciprofloxacin resistance with high levels of MIC values (up to 32 micro g/ml) in India is alarming. Double and triple mutations in gyrA alone or together in gyrA and parC could be responsible for such a high resistance.
Asunto(s)
Antiinfecciosos/uso terapéutico , Ciprofloxacina/uso terapéutico , Farmacorresistencia Bacteriana/genética , Genes Bacterianos/genética , Gonorrea/genética , Mutación/genética , Neisseria gonorrhoeae/genética , Girasa de ADN/genética , Topoisomerasa de ADN IV/genética , Humanos , Masculino , Neisseria gonorrhoeae/efectos de los fármacos , Uretritis/genética , Uretritis/microbiologíaRESUMEN
Forty three strains of Neisseria gonorrhoeae with decreased sensitivity to quinolone antibiotics were detected amongst 2141 Australian isolates of gonococci examined in the years 1984 to 1990. The strains examined belonged to 23 different auxotype/serovar classes, were generally more resistant to other antibiotics and, in the majority of cases, were isolated from travellers entering or returning to Australia from SE Asia. Quinolone-sensitive wild-type gonococci became less sensitive to these agents in vitro at a relatively high frequency when grown in the presence of quinolone concentrations at or around the MIC (Mean Inhibitory Concentration) of the antibiotic. Further increments in the levels of quinolone resistance of the already less-sensitive gonococci were also produced by this means, but high-level resistance to these agents was not observed. This suggests that mechanisms other than alterations in the DNA-gyrase of the organisms were responsible for the changes seen. Although spread of quinolone resistance in gonococci in Australia is unlikely to be rapid, if these antibiotics are used in therapy, treatment regimens with higher rather than lower dosages of quinolone antibiotics should be employed.
Asunto(s)
Antibacterianos/uso terapéutico , Farmacorresistencia Microbiana/genética , Gonorrea/tratamiento farmacológico , Neisseria gonorrhoeae/aislamiento & purificación , Quinolonas/uso terapéutico , Australia/epidemiología , Ciprofloxacina/uso terapéutico , Relación Dosis-Respuesta a Droga , Variación Genética/genética , Gonorrea/epidemiología , Gonorrea/genética , Humanos , Neisseria gonorrhoeae/efectos de los fármacos , Neisseria gonorrhoeae/genéticaRESUMEN
The family constellations and epidemiologic circumstances of three prepubertal girls with vulvovaginitis due to Neisseria gonorrhoeae are reported. In each instance, an infected asymptomatic man, himself a contact to a woman with pelvic inflammatory disease, could be implicated as the potential source of infection. In one instance, asymptomatic infection in a child was uncovered through epidemiologic investigation. Prepubertal gonococcal vaginitis is important not only as a potential indicator of child abuse, but also as a possible link to important transmitters of gonococcal infection. The need for meticulous epidemiologic investigation of these cases is stressed.