Posts filed under ‘Infecciones de transmision sexual’

The Brief Case: Disseminated Neisseria gonorrhoeae in an 18-Year-Old Female

Journal of Clinical Microbiology April 2018 V.56  N.4

Julianne E. Burns and Erin H. Graf

CASE

An 18-year-old previously healthy female presented to a Philadelphia, PA, pediatric emergency department in February for further evaluation of polyarticular arthritis. Two weeks prior, she had presented to an outside hospital with body aches and onset of acute pain in the left arm and leg. The etiology was thought to be cervical radiculopathy, and she was discharged on naproxen and prednisone. She returned to the outside hospital 5 days later without improvement and now with pain and swelling in her left knee, right thumb, right wrist, and bilateral ankles. She had a markedly elevated erythrocyte sedimentation rate (ESR) of 80 mm/h (reference range, 0 to 20 mm/h) and C-reactive protein (CRP) of 76.6 mg/dl (reference range, 0 to 0.9 mg/dl). A workup for autoimmune disease included negative results for antinuclear antibody, rheumatoid factor, and anticyclic citrullinated peptide. Serologic testing for Lyme disease was also negative……

PDF

http://jcm.asm.org/content/56/4/e00932-17.full.pdf+html

 

 

Closing the Brief Case: Disseminated Neisseria gonorrhoeae in an 18-Year-Old Female

SELF ASSESSMENT QUESTIONS

Which of the following specimens is recommended and FDA cleared for nucleic acid amplification testing (NAAT) in suspected cases of disseminated Neisseria gonorrhoeae?

a-Whole blood

b-Urine

c-Synovial fluid

d.Serum

PDF

http://jcm.asm.org/content/56/4/e00933-17.full.pdf+html

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March 27, 2018 at 8:21 am

Impact of Rapid Susceptibility Testing and Antibiotic Selection Strategy on the Emergence and Spread of Antibiotic Resistance in Gonorrhea

The Journal of Infectious Diseases November 27, 2017 V.216 N.9  P.1141–1149  

Ashleigh R Tuite; Thomas L Gift; Harrell W Chesson; Katherine Hsu; Joshua A Salomon …

Background

Increasing antibiotic resistance limits treatment options for gonorrhea. We examined the impact of a hypothetical point-of-care (POC) test reporting antibiotic susceptibility profiles on slowing resistance spread.

Methods

A mathematical model describing gonorrhea transmission incorporated resistance emergence probabilities and fitness costs associated with resistance based on characteristics of ciprofloxacin (A), azithromycin (B), and ceftriaxone (C). We evaluated time to 1% and 5% prevalence of resistant strains among all isolates with the following: (1) empiric treatment (B and C), and treatment guided by POC tests determining susceptibility to (2) A only and (3) all 3 antibiotics.

Results

Continued empiric treatment without POC testing was projected to result in >5% of isolates being resistant to both B and C within 15 years. Use of either POC test in 10% of identified cases delayed this by 5 years. The 3 antibiotic POC test delayed the time to reach 1% prevalence of triply-resistant strains by 6 years, whereas the A-only test resulted in no delay. Results were less sensitive to assumptions about fitness costs and test characteristics with increasing test uptake.

Conclusions

Rapid diagnostics reporting antibiotic susceptibility may extend the usefulness of existing antibiotics for gonorrhea treatment, but ongoing monitoring of resistance patterns will be critical.

abstract

https://academic.oup.com/jid/article/216/9/1141/4100269

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January 31, 2018 at 11:18 pm

Genomic epidemiology and antimicrobial resistance of Neisseria gonorrhoeae in New Zealand

Journal of Antimicrobial Chemotherapy February 2018 V.73 N.2 P.353–364  

Robyn S Lee; Torsten Seemann; Helen Heffernan; Jason C Kwong; Anders Gonçalves da Silva …

Background

Antimicrobial-resistant Neisseria gonorrhoeae is a major threat to public health. No studies to date have examined the genomic epidemiology of gonorrhoea in the Western Pacific Region, where the incidence of gonorrhoea is particularly high.

Methods

A population-level study of N. gonorrhoeae in New Zealand (October 2014 to May 2015). Comprehensive susceptibility testing and WGS data were obtained for 398 isolates. Relatedness was inferred using phylogenetic trees, and pairwise core SNPs. Mutations and genes known to be associated with resistance were identified, and correlated with phenotype.

Results

Eleven clusters were identified. In six of these clusters, >25% of isolates were from females, while in eight of them, >15% of isolates were from females. Drug resistance was common; 98%, 32% and 68% of isolates were non-susceptible to penicillin, ciprofloxacin and tetracycline, respectively. Elevated MICs to extended-spectrum cephalosporins (ESCs) were observed in 3.5% of isolates (cefixime MICs ≥ 0.12 mg/L, ceftriaxone MICs ≥ 0.06 mg/L). Only nine isolates had penA XXXIV genotypes, three of which had decreased susceptibility to ESCs (MIC = 0.12 mg/L). Azithromycin non-susceptibility was identified in 43 isolates (10.8%); two of these isolates had 23S mutations (C2611T, 4/4 alleles), while all had mutations in mtrR or its promoter.

Conclusions

The high proportion of females in clusters suggests transmission is not exclusively among MSM in New Zealand; re-assessment of risk factors for transmission may be warranted in this context. As elevated MICs of ESCs and/or azithromycin were found in closely related strains, targeted public health interventions to halt transmission are urgently needed.

abstract

https://academic.oup.com/jac/article/73/2/353/4647718

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January 28, 2018 at 7:40 pm

Ceftriaxone-Resistant Neisseria gonorrhoeae, Canada, 2017

Emerging Infectious Diseases February 2018 V.24 N.2

Brigitte Lefebvre, Irene Martin, Walter Demczuk, Lucie Deshaies, Stéphanie Michaud, Annie-Claude Labbé, Marie-Claude Beaudoin, and Jean Longtin

Author affiliations: Institut National de Santé Publique du Québec, Québec, Québec, Canada (B. Lefebvre, J. Longtin); Public Health Agency of Canada, Winnipeg, Manitoba, Canada (I. Martin, W. Demczuk); Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale, Québec (L. Deshaies); Direction de Santé Publique du Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale, Québec (S. Michaud); Université de Montréal, Québec (A.-C. Labbé); Centre de Recherche en Infectiologie, Université Laval, Québec (M.-C. Beaudoin, J. Longtin)

We identified a ceftriaxone-resistant Neisseria gonorrhoeae isolate in a patient in Canada.

This isolate carried the penA-60 allele, which differs substantially from its closest relative, mosaic penA XXVII (80% nucleotide identity).

Epidemiologic and genomic data suggest spread from Asia. Antimicrobial susceptibility surveillance helps prevent spread of highly resistant N. gonorrhoeae strains.

PDF

https://wwwnc.cdc.gov/eid/article/24/2/pdfs/17-1756.pdf

 

January 23, 2018 at 8:02 am

Use of Pristinamycin for Macrolide-Resistant Mycoplasma genitalium Infection

Emerging Infectious Diseases February 2018 V.24 N.2

Tim R.H., Jørgen S. Jensen, Christopher K. Fairley, Mieken Grant, Jennifer A. Danielewski, Jenny Su, Gerald L. Murray, Eric P.F. Chow, Karen Worthington, Suzanne M. Garland, Sepehr N. Tabrizi, and Catriona S. Bradshaw

Author affiliations: Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia (T.R.H. Read, C.K. Fairley, M. Grant, E.P.F. Chow, K. Worthington, C.S. Bradshaw); Monash University, Melbourne, Victoria, Australia (T.R.H. Read, C.K. Fairley, G.L. Murray, E.P.F. Chow, C.S. Bradshaw); Statens Serum Institut, Copenhagen, Denmark (J.S. Jensen); Murdoch Children’s Research Institute, Parkville, Victoria, Australia (J.A. Danielewski, J. Su, G.L. Murray, S.M. Garland, S.N. Tabrizi); Royal Women’s Hospital, Parkville (J.A. Danielewski, J. Su, G.L. Murray, S.M. Garland, S.N. Tabrizi); University of Melbourne, Parkville (S.M. Garland, S.N. Tabrizi, C.S. Bradshaw)

High levels of macrolide resistance and increasing fluoroquinolone resistance are found in Mycoplasma genitalium in many countries.

We evaluated pristinamycin for macrolide-resistant M. genitalium in a sexual health center in Australia.

Microbiologic cure was determined by M. genitalium–specific 16S PCR 14–90 days after treatment began. Of 114 persons treated with pristinamycin, infection was cured in 85 (75%).

This percentage did not change when pristinamycin was given at daily doses of 2 g or 4 g or at 3 g combined with 200 mg doxycycline.

In infections with higher pretreatment bacterial load, treatment was twice as likely to fail for each 1 log10 increase in bacterial load. Gastrointestinal side effects occurred in 7% of patients.

Pristinamycin at maximum oral dose, or combined with doxycycline, cured 75% of macrolide-resistant M. genitalium infections.

Pristinamycin is well-tolerated and remains an option where fluoroquinolones have failed or cannot be used.

PDF

https://wwwnc.cdc.gov/eid/article/24/2/pdfs/17-0902.pdf

 

January 23, 2018 at 8:01 am

Using Treponemal Assay Signal Strength Cutoff Ratios To Predict Syphilis Infection

Journal of Clinical Microbiology January 2018 V.56 N.1

Commentaries

Claire C. Bristow and Jeffrey D. Klausner

aDivision of Infectious Diseases & Global Public Health, Department of Medicine, University of California—San Diego, La Jolla, California, USA

bDepartment of Epidemiology, Fielding School of Public Health, University of California—Los Angeles, Los Angeles, California, USA

cDivision of Infectious Diseases, Department of Medicine, University of California—Los Angeles, Los Angeles, California, USA

Syphilis screening with the reverse algorithm, a treponemal test for screening followed by a nontreponemal test if reactive, is increasingly being used. That algorithm has several advantages, including use of an automated screening test, saving on laboratory time and costs, as well as detection of very early syphilis infection. However, under that algorithm, in situations where the treponemal result is positive and the nontreponemal result is nonreactive a second treponemal test must be performed, which may actually lead to inefficiencies in the laboratory. In this issue of the Journal of Clinical Microbiology, Y. F. Fakile et al. (J Clin Microbiol 56:e01165-17, 2017, https://doi.org/10.1128/JCM.01165-17) report the results of their study, which demonstrates the capability of signal strength ratio cutoffs for automated treponemal immunoassays to predict the outcome of repeat treponemal testing. Their findings suggest that anti-treponemal signal strength ratio values above a cutoff value can be used in lieu of repeat treponemal tests.

PDF

http://jcm.asm.org/content/56/1/e01555-17.full.pdf+html

January 5, 2018 at 8:17 am

Ceftriaxone-Resistant Neisseria gonorrhoeae, Canada, 2017.

Emerging Infectious Diseases February 15, 2018 Feb 15 V.24 N.2

Lefebvre B, Martin I, Demczuk W, Deshaies L, Michaud S, Labbé AC, Beaudoin MC, Longtin J.

Author affiliations: Institut National de Santé Publique du Québec, Québec, Québec, Canada (B. Lefebvre, J. Longtin); Public Health Agency of Canada, Winnipeg, Manitoba, Canada (I. Martin, W. Demczuk); Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale, Québec (L. Deshaies); Direction de Santé Publique du Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale, Québec (S. Michaud); Université de Montréal, Québec (A.-C. Labbé); Centre de Recherche en Infectiologie, Université Laval, Québec (M.-C. Beaudoin, J. Longtin)

Abstract

We identified a ceftriaxone-resistant Neisseria gonorrhoeae isolate in a patient in Canada. This isolate carried the penA-60 allele, which differs substantially from its closest relative, mosaic penA XXVII (80% nucleotide identity). Epidemiologic and genomic data suggest spread from Asia. Antimicrobial susceptibility surveillance helps prevent spread of highly resistant N. gonorrhoeae strains.

FULL TEXT

https://wwwnc.cdc.gov/eid/article/24/2/17-1756_article

December 5, 2017 at 7:10 am

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