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Takahashi H, Morita M, Yasuda M, Ohama Y, Kobori Y, Kojima M, Shimuta K, Akeda Y, Ohnishi M. Detection of Novel US Neisseria meningitidis Urethritis Clade Subtypes in Japan. Emerg Infect Dis 2023; 29:2210-2217. [PMID: 37877502 PMCID: PMC10617353 DOI: 10.3201/eid2911.231082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2023] Open
Abstract
Neisseria meningitidis causes invasive meningococcal diseases and has also been identified as a causative agent of sexually transmitted infections, including urethritis. Unencapsulated sequence type 11 meningococci containing the gonococcal aniA-norB locus and belonging to the United States N. meningitidis urethritis clade (US_NmUC) are causative agents of urethral infections in the United States, predominantly among men who have sex with men. We identified 2 subtypes of unencapsulated sequence type 11 meningococci in Japan that were phylogenetically close to US_NmUC, designated as the Japan N. meningitidis urethritis clade (J_NmUC). The subtypes were characterized by PCR, serologic testing, and whole-genome sequencing. Our study suggests that an ancestor of US_NmUC and J_NmUS urethritis-associated meningococci is disseminated worldwide. Global monitoring of urethritis-associated N. meningitidis isolates should be performed to further characterize microbiologic and epidemiologic characteristics of urethritis clade meningococci.
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2
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Buder S. [Urethritis-spectrum of pathogens, diagnostics and treatment]. DERMATOLOGIE (HEIDELBERG, GERMANY) 2023; 74:835-850. [PMID: 37847382 DOI: 10.1007/s00105-023-05230-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/06/2023] [Indexed: 10/18/2023]
Abstract
A broad spectrum of bacteria, fungi, protozoa and viruses can cause urethritis. In particular, N. gonorrhoeae, C. trachomatis, M. genitalium and T. vaginalis are the focus of diagnostic considerations as classic pathogens associated with sexually transmitted infections (STI). A step-by-step procedure is needed to make a definitive diagnosis. Microscopy with a staining preparation provides an initial differentiation between gonoccocal and non-gonococcal urethritis in symptomatic men as a point-of-care (POC) test. Nucleic acid amplification technology (NAAT) is used for specific and sensitive pathogen detection and, as a multiplex diagnostic test, offers the possibility of detecting several organisms from the same sample. In addition, compared to culture, no vital organisms are required, which allows the collection and use of more diverse and less invasive biological samples (e.g. first stream urine in men or vaginal swabs). Susceptibility testing by culture remains essential for N. gonorrhoeae as resistance is emerging. The treatment of urethritis depends on the suspected or proven pathogen according to the current guidelines. Treatment failure can be caused by many factors (coinfection, lack of therapy adherence, reinfection or resistance of the pathogen) and requires a repeated diagnostic and therapeutic procedure and differentiated approach.
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Affiliation(s)
- Susanne Buder
- Klinik für Dermatologie und Venerologie, Vivantes Klinikum Berlin Neukölln, Rudower Str. 48, 12351, Berlin, Deutschland.
- Konsiliarlabor für Gonokokken, Robert Koch-Institut, Seestr. 10, 13353, Berlin, Deutschland.
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3
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Rodriguez EI, Tzeng YL, Stephens DS. Continuing genomic evolution of the Neisseria meningitidis cc11.2 urethritis clade, NmUC: a narrative review. Microb Genom 2023; 9:001113. [PMID: 37850987 PMCID: PMC10634446 DOI: 10.1099/mgen.0.001113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 09/26/2023] [Indexed: 10/19/2023] Open
Abstract
Neisseria meningitidis (Nm) is a bacterial pathogen responsible for invasive meningococcal disease. Though typically colonizing the nasopharynx, multiple outbreaks of meningococcal urethritis were first reported in 2015-2016; outbreaks originally presumed to be caused by Neisseria gonorrhoeae (Ng). Genomic analysis revealed that the Nm isolates causing these outbreaks were a distinct clade, and had integrated gonococcal DNA at multiple genomic sites, including the gonococcal denitrification apparatus aniA-norB, a partial gonococcal operon of five genes containing ispD, and the acetylglutamate kinase gene argB with the adjacent gonococcal locus NGO0843. The urethritis isolates had also deleted the group C capsule biosynthesis genes cssA/B/C and csc, resulting in loss of capsule. Collectively, these isolates form the N. meningitidis urethritis clade (NmUC). Genomic analysis of recent (2016-2022) NmUC isolates revealed that the genomic features have been maintained in the clade, implying that they are important for NmUC's status as a urogenital pathogen. Furthermore, the analysis revealed the emergence of a sub-clade, designated NmUC-B, phylogenetically separated from the earlier NmUC-A. This sub-clade has integrated additional gonococcal alleles into the genome, including alleles associated with antimicrobial resistance. NmUC continues to adapt to a urethral niche and evolve as a urogenital pathogen.
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Affiliation(s)
- Emilio I. Rodriguez
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Yih-Ling Tzeng
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - David S. Stephens
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
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4
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Nguyen HT, Phan TV, Tran HP, Vu TTP, Pham NTU, Nguyen TTT, Bui HM, Duong BH, Luu TNA, Pham NN, Nguyen PD, Le TN, Le TQ, Vo DTT, Phan LT, Van Khuu N, Pham QD, Nguyen TV. Outbreak of Sexually Transmitted Nongroupable Neisseria meningitidis-Associated Urethritis, Vietnam. Emerg Infect Dis 2023; 29:2130-2134. [PMID: 37735771 PMCID: PMC10521605 DOI: 10.3201/eid2910.221596] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/23/2023] Open
Abstract
We report on an outbreak of nongroupable Neisseria meningitidis-associated urethritis, primarily among men who have sex with men in southern Vietnam. Nearly 50% of N. meningitidis isolates were resistant to ciprofloxacin. This emerging pathogen should be considered in the differential diagnosis and management of urethritis.
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Tzeng YL, Sannigrahi S, Berman Z, Bourne E, Edwards JL, Bazan JA, Turner AN, Moir JWB, Stephens DS. Acquisition of Gonococcal AniA-NorB Pathway by the Neisseria meningitidis Urethritis Clade Confers Denitrifying and Microaerobic Respiration Advantages for Urogenital Adaptation. Infect Immun 2023; 91:e0007923. [PMID: 37092998 PMCID: PMC10187123 DOI: 10.1128/iai.00079-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 03/28/2023] [Indexed: 04/25/2023] Open
Abstract
Neisseria meningitidis historically has been an infrequent and sporadic cause of urethritis and other urogenital infections. However, a nonencapsulated meningococcal clade belonging to the hyperinvasive clonal complex 11.2 lineage has recently emerged and caused clusters of urethritis cases in the United States and other countries. One of the genetic signatures of the emerging N. meningitidis urethritis clade (NmUC) is a chromosomal gene conversion event resulting in the acquisition of the Neisseria gonorrhoeae denitrification apparatus-the N. gonorrhoeae alleles encoding the nitrite reductase AniA, the nitric oxide (NO) reductase NorB, and the intergenic promoter region. The biological importance of the N. gonorrhoeae AniA-NorB for adaptation of the NmUC to a new environmental niche is investigated herein. We found that oxygen consumption, nitrite utilization, and NO production were significantly altered by the conversion event, resulting in different denitrifying aerobic and microaerobic growth of the clade. Further, transcription of aniA and norB in NmUC isolates differed from canonical N. meningitidis, and important polymorphisms within the intergenic region, which influenced aniA promoter activity of the NmUC, were identified. The contributions of three known meningococcal regulators (NsrR, FNR, and NarQP) in controlling the denitrification pathway and endogenous NO metabolism were distinct. Overall, transcription of aniA was dampened relative to canonical N. meningitidis, and this correlated with the lower NO accumulation in the clade. Denitrification and microaerobic respiration were bolstered, and protection against host-derived NO was likely enhanced. The acquisition of the N. gonorrhoeae denitrification pathway by the NmUC supports the clade's adaptation and survival in a microaerobic urogenital environment.
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Affiliation(s)
- Yih-Ling Tzeng
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Soma Sannigrahi
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Zachary Berman
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Emily Bourne
- Department of Biology, University of York, Heslington, York, United Kingdom
| | - Jennifer L. Edwards
- Department of Pediatrics, The Research Institute at Nationwide Children’s Hospital and The Ohio State University, Columbus, Ohio, USA
| | - Jose A. Bazan
- Division of Infectious Diseases, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, Ohio, USA
- Sexual Health Clinic, Columbus Public Health, Columbus, Ohio, USA
| | - Abigail Norris Turner
- Division of Infectious Diseases, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - James W. B. Moir
- Department of Biology, University of York, Heslington, York, United Kingdom
| | - David S. Stephens
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, Georgia, USA
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6
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Walker E, van Niekerk S, Hanning K, Kelton W, Hicks J. Mechanisms of host manipulation by Neisseria gonorrhoeae. Front Microbiol 2023; 14:1119834. [PMID: 36819065 PMCID: PMC9935845 DOI: 10.3389/fmicb.2023.1119834] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 01/18/2023] [Indexed: 02/05/2023] Open
Abstract
Neisseria gonorrhoeae (also known as gonococcus) has been causing gonorrhoea in humans since ancient Egyptian times. Today, global gonorrhoea infections are rising at an alarming rate, in concert with an increasing number of antimicrobial-resistant strains. The gonococcus has concurrently evolved several intricate mechanisms that promote pathogenesis by evading both host immunity and defeating common therapeutic interventions. Central to these adaptations is the ability of the gonococcus to manipulate various host microenvironments upon infection. For example, the gonococcus can survive within neutrophils through direct regulation of both the oxidative burst response and maturation of the phagosome; a concerning trait given the important role neutrophils have in defending against invading pathogens. Hence, a detailed understanding of how N. gonorrhoeae exploits the human host to establish and maintain infection is crucial for combating this pathogen. This review summarizes the mechanisms behind host manipulation, with a central focus on the exploitation of host epithelial cell signaling to promote colonization and invasion of the epithelial lining, the modulation of the host immune response to evade both innate and adaptive defenses, and the manipulation of host cell death pathways to both assist colonization and combat antimicrobial activities of innate immune cells. Collectively, these pathways act in concert to enable N. gonorrhoeae to colonize and invade a wide array of host tissues, both establishing and disseminating gonococcal infection.
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Affiliation(s)
- Emma Walker
- Te Huataki Waiora, School of Health, University of Waikato, Hamilton, New Zealand
| | - Stacy van Niekerk
- Te Huataki Waiora, School of Health, University of Waikato, Hamilton, New Zealand
| | - Kyrin Hanning
- Te Huataki Waiora, School of Health, University of Waikato, Hamilton, New Zealand
| | - William Kelton
- Te Huataki Waiora, School of Health, University of Waikato, Hamilton, New Zealand,Te Aka Mātuatua School of Science, University of Waikato, Hamilton, New Zealand
| | - Joanna Hicks
- Te Huataki Waiora, School of Health, University of Waikato, Hamilton, New Zealand,*Correspondence: Joanna Hicks,
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Bazan JA, Tzeng YL, Bischof KM, Satola SW, Stephens DS, Edwards JL, Carter A, Snyder B, Turner AN. Antibiotic Susceptibility Profile for the US Neisseria meningitidis Urethritis Clade. Open Forum Infect Dis 2023; 10:ofac661. [PMID: 36655188 PMCID: PMC9835751 DOI: 10.1093/ofid/ofac661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2022] [Indexed: 12/14/2022] Open
Abstract
The US Neisseria meningitidis urethritis clade (US_NmUC) harbors gonococcal deoxyribonucleic acid alleles and causes gonorrhea-like urogenital tract disease. A large convenience sample of US_NmUC isolates (N = 122) collected between January 2015 and December 2019 in Columbus, Ohio demonstrated uniform susceptibility to antibiotics recommended for gonorrhea treatment and meningococcal chemoprophylaxis.
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Affiliation(s)
- Jose A Bazan
- Division of Infectious Diseases, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, Ohio, USA
- Sexual Health Clinic, Columbus Public Health, Columbus, Ohio, USA
| | - Yih-Ling Tzeng
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Katarina M Bischof
- Division of Epidemiology, The Ohio State University College of Public Health, Columbus, Ohio, USA
| | - Sarah W Satola
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - David S Stephens
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Jennifer L Edwards
- Department of Pediatrics, The Research Institute at Nationwide Children's Hospital and The Ohio State University, Columbus, Ohio, USA
| | - Alexandria Carter
- Division of Infectious Diseases, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Brandon Snyder
- Division of Infectious Diseases, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Abigail Norris Turner
- Division of Infectious Diseases, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, Ohio, USA
- Division of Epidemiology, The Ohio State University College of Public Health, Columbus, Ohio, USA
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8
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Meningococcal Urethritis: Old and New. J Clin Microbiol 2022; 60:e0057522. [PMID: 35969045 PMCID: PMC9667755 DOI: 10.1128/jcm.00575-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Neisseria meningitidis is a common commensal bacterium found in the respiratory tract, but it can also cause severe, invasive disease. Vaccines have been employed which have been successful in helping to prevent invasive disease caused by encapsulated N. meningitidis from the A, C, W, Y, and B serogroups. Currently, nonencapsulated N. meningitidis groups are more common commensals in the population than in the prevaccine era. One emerging nonencapsulated group of bacteria is the U.S. N. meningitidis urethritis clade (US_NmUC), which can cause meningococcal urethritis in men. US_NmUC has unique genotypic and phenotypic features that may increase its fitness in the male urethra. It is diagnostically challenging to identify and distinguish meningococcal urethritis from Neisseria gonorrhoeae, as the clinical presentation and microbiological findings are overlapping. In this review, the history of meningococcal urethritis, emergence of US_NmUC, laboratory diagnosis, and clinical treatment are all explored.
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Oliver SE, Retchless AC, Blain AE, McNamara LA, Ahrabifard S, Farley M, Weiss D, Zaremski E, Wang X, Hariri S. Risk Factors for Invasive Meningococcal Disease Belonging to a Novel Urethritis Clade of Neisseria meningitidis-United States, 2013-2017. Open Forum Infect Dis 2022; 9:ofac035. [PMID: 35350171 PMCID: PMC8944325 DOI: 10.1093/ofid/ofac035] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 01/24/2022] [Indexed: 10/19/2023] Open
Abstract
We describe cases of invasive meningococcal disease caused by nongroupable Neisseria meningitidis belonging to a novel phylogenetic clade associated with urethritis. Seven cases were identified, comprising 0.6% of sequenced invasive meningococcal disease isolates from 2013 to 2017. Five patients had a known or likely immunocompromising condition, including 2 with a complement deficiency.
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Affiliation(s)
- Sara E Oliver
- Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Adam C Retchless
- Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Amy E Blain
- Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Lucy A McNamara
- Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Monica Farley
- Emory University School of Medicine, VA Medical Center, Atlanta, Georgia, USA
| | - Don Weiss
- New York City Department of Health and Mental Hygiene, Queens, New York, USA
| | | | - Xin Wang
- Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Susan Hariri
- Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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10
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Alderson MR, Arkwright PD, Bai X, Black S, Borrow R, Caugant DA, Dinleyici EC, Harrison LH, Lucidarme J, McNamara LA, Meiring S, Sáfadi MAP, Shao Z, Stephens DS, Taha MK, Vazquez J, Zhu B, Collaborators G. Surveillance and control of meningococcal disease in the COVID-19 era: A Global Meningococcal Initiative review. J Infect 2021; 84:289-296. [PMID: 34838594 PMCID: PMC8611823 DOI: 10.1016/j.jinf.2021.11.016] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 11/17/2021] [Accepted: 11/22/2021] [Indexed: 12/03/2022]
Abstract
This review article incorporates information from the 4th Global Meningococcal Initiative summit meeting. Since the introduction of stringent COVID-19 infection control and lockdown measures globally in 2020, there has been an impact on IMD prevalence, surveillance, and vaccination compliance. Incidence rates and associated mortality fell across various regions during 2020. A reduction in vaccine uptake during 2020 remains a concern globally. In addition, several Neisseria meningitidis clonal complexes, particularly CC4821 and CC11, continue to exhibit resistance to antibiotics, with resistance to ciprofloxacin or beta-lactams mainly linked to modifications of gyrA or penA alleles, respectively. Beta-lactamase acquisition was also reported through horizontal gene transfer (blaROB-1) involving other bacterial species. Despite the challenges over the past year, progress has also been made on meningococcal vaccine development, with several pentavalent (serogroups ABCWY and ACWYX) vaccines currently being studied in late-stage clinical trial programmes.
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Affiliation(s)
| | - Peter D Arkwright
- Lydia Becker Institute of Immunology & Inflammation, University of Manchester, Manchester, UK
| | - Xilian Bai
- Meningococcal Reference Unit, Public Health England, Manchester Royal Infirmary, Manchester, UK
| | - Steve Black
- Center for Global Health, Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - Ray Borrow
- Meningococcal Reference Unit, Public Health England, Manchester Royal Infirmary, Manchester, UK.
| | - Dominique A Caugant
- Division for Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Ener Cagri Dinleyici
- Eskisehir Osmangazi University Faculty of Medicine, Department of Pediatrics, Eskisehir, Turkey
| | - Lee H Harrison
- Center for Genomic Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jay Lucidarme
- Meningococcal Reference Unit, Public Health England, Manchester Royal Infirmary, Manchester, UK
| | - Lucy A McNamara
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, CDC, USA
| | - Susan Meiring
- Division of Public Health Surveillance and Response, National Institute for Communicable Diseases, a division of the National Health Laboratory Service, Johannesburg, South Africa
| | - Marco A P Sáfadi
- Department of Pediatrics, Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil
| | - Zhujun Shao
- State Key Laboratory of Infectious Disease Prevention and Control, National Institute for Communicable disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China. Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, People's Republic of China
| | - David S Stephens
- Robert W Woodruff Health Sciences Center, Emory University, Atlanta, Georgia, USA
| | - Muhamed-Kheir Taha
- Institut Pasteur, National Reference Centre for Meningococci and Haemophilus influenzae, Paris, France
| | - Julio Vazquez
- National Centre of Microbiology, Institute of Health Carlos III, Madrid, Spain
| | - Bingqing Zhu
- State Key Laboratory of Infectious Disease Prevention and Control, National Institute for Communicable disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China. Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, People's Republic of China
| | - Gmi Collaborators
- GMI Collaborators: Sotharith Bory, Suzana Bukovski, Josefina Carlos, Chien-Shun Chiou, Davor Culic, Trang Dai, Snezana Delic, Medeia Eloshvili, Tímea Erdos, Jelena Galajeva, Prakash Ghimire, Linda Glennie, Setyo Handryastuti, Jung Yeon Heo, Amy Jennison, Hajime Kamiya, Pavla Křížová,Tonnii Sia Loong Loong, Helen Marshall, Konstantin Mironov, Zuridin Nurmatov, Nina Dwi Putri, Senjuti Saha, James Sim, Anna Skoczyńska, Vinny Smith, Usa Thisyakorn, Thanh Phan Van, Lyazzat Yeraliyeva, Saber Yezli
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Abstract
PURPOSE OF REVIEW Neisseria meningitidis (Nm) is primarily associated with asymptomatic nasopharyngeal carriage and invasive meningococcal disease (sepsis and meningitis), but like N. gonorrhoea (Ng), Nm can colonize urogenital and rectal mucosal surfaces and cause disease. First noted in 2015, but with origins in 2011, male urethritis clusters caused by a novel Nm clade were reported in the USA (the US_NmUC). This review describes research developments that characterize this urogenital-tropic Nm. RECENT FINDINGS The US_NmUC evolved from encapsulated Nm serogroup C strains. Loss of capsule expression, lipooligosaccharide (LOS) sialylation, genetic acquisition of gonococcal alleles (including the gonococcal anaerobic growth aniA/norB cassette), antimicrobial peptide heteroresistance and high surface expression of a unique factor-H-binding protein, can contribute to the urethra-tropic phenotype. Loss-of-function mutations in mtrC are overrepresented in clade isolates. Similar to Ng, repeat US_NmUC urethritis episodes can occur. The US_NmUC is now circulating in the UK and Southeast Asia. Genomic sequencing has defined the clade and rapid diagnostic tests are being developed for surveillance. SUMMARY The US_NmUC emerged as a cause of urethritis due to acquisition of gonococcal genetic determinants and phenotypic traits that facilitate urogenital tract infection. The epidemiology and pathogenesis of this urogenital-tropic pathogen continues to be defined.
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Workowski KA, Bachmann LH, Chan PA, Johnston CM, Muzny CA, Park I, Reno H, Zenilman JM, Bolan GA. Sexually Transmitted Infections Treatment Guidelines, 2021. MMWR Recomm Rep 2021; 70:1-187. [PMID: 34292926 PMCID: PMC8344968 DOI: 10.15585/mmwr.rr7004a1] [Citation(s) in RCA: 713] [Impact Index Per Article: 237.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
These guidelines for the treatment of persons who have or are at risk for
sexually transmitted infections (STIs) were updated by CDC after consultation
with professionals knowledgeable in the field of STIs who met in Atlanta,
Georgia, June 11–14, 2019. The information in this report updates the
2015 guidelines. These guidelines discuss 1) updated recommendations for
treatment of Neisseria gonorrhoeae, Chlamydia trachomatis,
and Trichomonas vaginalis; 2) addition of
metronidazole to the recommended treatment regimen for pelvic inflammatory
disease; 3) alternative treatment options for bacterial vaginosis; 4) management
of Mycoplasma genitalium; 5) human papillomavirus vaccine
recommendations and counseling messages; 6) expanded risk factors for syphilis
testing among pregnant women; 7) one-time testing for hepatitis C infection; 8)
evaluation of men who have sex with men after sexual assault; and 9) two-step
testing for serologic diagnosis of genital herpes simplex virus. Physicians and
other health care providers can use these guidelines to assist in prevention and
treatment of STIs.
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13
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Carriage of Neisseria meningitidis in Men Who Have Sex With Men Presenting to Public Sexual Health Clinics, New York City. Sex Transm Dis 2021; 47:541-548. [PMID: 32520884 DOI: 10.1097/olq.0000000000001205] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND We conducted a Neisseria meningitidis (Nm) carriage study among men who have sex with men (MSM) to explore possible sexual transmission. METHODS We paired information on patient characteristics with oropharyngeal, rectal, and urethral Nm culture results to assess associations with Nm carriage among 706 MSM at New York City sexual health clinics. The Nm isolates were characterized by whole genome sequencing. RESULTS Twenty-three percent (163 of 706) of MSM were Nm carriers. Oropharyngeal carriage was 22.6% (159 of 703), rectal 0.9% (6 of 695), and urethral 0.4% (3 of 696). Oropharyngeal carriage was associated with the following recent (past 30 days) exposures: 3 or more men kissed (adjusted relative risk [aRR], 1.38; 95% confidence interval [CI], 1.03-1.86), performing oral sex (aRR, 1.81; 95% CI, 1.04-3.18), and antibiotic use (aRR, 0.33; 95% CI, 0.19-0.57). Sixteen clonal complexes were identified; 27% belonged to invasive lineages. CONCLUSIONS Our findings suggest that oral sex and the number of recent kissing partners contribute to Nm carriage in MSM.
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14
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Tzeng YL, Stephens DS. A Narrative Review of the W, X, Y, E, and NG of Meningococcal Disease: Emerging Capsular Groups, Pathotypes, and Global Control. Microorganisms 2021; 9:microorganisms9030519. [PMID: 33802567 PMCID: PMC7999845 DOI: 10.3390/microorganisms9030519] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 02/25/2021] [Accepted: 02/26/2021] [Indexed: 12/21/2022] Open
Abstract
Neisseria meningitidis, carried in the human nasopharynx asymptomatically by ~10% of the population, remains a leading cause of meningitis and rapidly fatal sepsis, usually in otherwise healthy individuals. The epidemiology of invasive meningococcal disease (IMD) varies substantially by geography and over time and is now influenced by meningococcal vaccines and in 2020–2021 by COVID-19 pandemic containment measures. While 12 capsular groups, defined by capsular polysaccharide structures, can be expressed by N. meningitidis, groups A, B, and C historically caused most IMD. However, the use of mono-, bi-, and quadrivalent-polysaccharide-conjugate vaccines, the introduction of protein-based vaccines for group B, natural disease fluctuations, new drugs (e.g., eculizumab) that increase meningococcal susceptibility, changing transmission dynamics and meningococcal evolution are impacting the incidence of the capsular groups causing IMD. While the ability to spread and cause illness vary considerably, capsular groups W, X, and Y now cause significant IMD. In addition, group E and nongroupable meningococci have appeared as a cause of invasive disease, and a nongroupable N. meningitidis pathotype of the hypervirulent clonal complex 11 is causing sexually transmitted urethritis cases and outbreaks. Carriage and IMD of the previously “minor” N. meningitidis are reviewed and the need for polyvalent meningococcal vaccines emphasized.
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Affiliation(s)
- Yih-Ling Tzeng
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA 30322, USA;
| | - David S. Stephens
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA 30322, USA;
- Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, GA 30322, USA
- Correspondence: ; Tel.: +404-727-8357
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15
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Microscale communication between bacterial pathogens and the host epithelium. Genes Immun 2021; 22:247-254. [PMID: 34588625 PMCID: PMC8497271 DOI: 10.1038/s41435-021-00149-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 08/18/2021] [Accepted: 08/23/2021] [Indexed: 02/01/2023]
Abstract
Pathogenic bacteria have evolved a variety of highly selective adhesins allowing these microbes to engage specific surface determinants of their eukaryotic host cells. Receptor clustering induced by the multivalent microorganisms will not only anchor the bacteria to the tissue, but will inevitably trigger host cell signaling. It has become clear, that these bacteria-initiated signaling events can be seen as a form of localized communication with host epithelial cells. Such a microscale communication can have immediate consequences in the form of changes in host cell membrane morphology or cytoskeletal organization, but can also lead to transcriptional responses and medium- and long-term alterations in cellular physiology. In this review, we will discuss several examples of this form of microscale communication between bacterial pathogens and mammalian host cells and try to delineate their downstream ramifications in the infection process. Furthermore, we will highlight recent findings that specialized pathogenic bacteria utilize the adhesin-based interaction to diffuse the short-range messenger molecule nitric oxide into the host tissue. While anti-adhesive strategies to disrupt the initial bacterial attachment have not yet translated into medical applications, the ability to interfere with the microscale communication emanating on the host side provides an unconventional approach for preventing infectious diseases.
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16
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Unemo M, Ross J, Serwin AB, Gomberg M, Cusini M, Jensen JS. Background review for the '2020 European guideline for the diagnosis and treatment of gonorrhoea in adults'. Int J STD AIDS 2020; 32:108-126. [PMID: 33323071 DOI: 10.1177/0956462420948739] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Gonorrhoea is a major public health concern globally. Increasing incidence and sporadic ceftriaxone-resistant cases, including treatment failures, are growing concerns. The 2020 European gonorrhoea guideline provides up-to-date evidence-based guidance regarding the diagnosis and treatment of gonorrhoea. The updates and recommendations emphasize significantly increasing gonorrhoea incidence; broad indications for increased testing with validated and quality-assured nucleic acid amplification tests (NAATs) and culture; dual antimicrobial therapy including high-dose ceftriaxone and azithromycin (ceftriaxone 1 g plus azithromycin 2 g) OR ceftriaxone 1 g monotherapy (ONLY in well-controlled settings, see guideline for details) for uncomplicated gonorrhoea when the antimicrobial susceptibility is unknown; recommendation of test of cure (TOC) in all gonorrhoea cases to ensure eradication of infection and identify resistance; and enhanced surveillance of treatment failures when recommended treatment regimens have been used. Improvements in access to appropriate testing, test performance, diagnostics, antimicrobial susceptibility surveillance and treatment, and follow-up of gonorrhoea patients are essential in controlling gonorrhoea and to mitigate the emergence and/or spread of ceftriaxone resistance and multidrug-resistant and extensively drug-resistant gonorrhoea. This review provides the detailed background, evidence base and discussions, for the 2020 European guideline for the diagnosis and treatment of gonorrhoea in adults (Unemo M, et al. Int J STD AIDS. 2020).
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Affiliation(s)
- M Unemo
- WHO Collaborating Centre for Gonorrhoea and other STIs, National Reference Laboratory for STIs, Department of Laboratory Medicine, Microbiology, Örebro University Hospital and Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Jdc Ross
- University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
| | - A B Serwin
- Department of Dermatology and Venereology, Medical University of Białystok, Białystok, Poland
| | - M Gomberg
- Moscow Scientific and Practical Center of Dermatovenereology and Cosmetology, Moscow, Russia
| | - M Cusini
- Department of Dermatology, Fondazione IRCCS Ca' Granda Ospedale Policlinico, Milano, Italy
| | - J S Jensen
- Infection Preparedness, Research Unit for Reproductive Tract Microbiology, Statens Serum Institut, Copenhagen, Denmark
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17
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Abstract
In 2015, we identified a non-groupable clade of Neisseria meningitidis that causes urethritis in men (the US_NmUC). Because repeat infection is common with Neisseria gonorrhoeae, we examined whether reinfection also occurs with the US_NmUC. We provide evidence that men are susceptible to repeat episodes of urethritis from the US_NmUC.
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18
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Tongtoyai J, Tatakham N, Cherdtrakulkiat T, Sirivongrangson P, Hickey A. Neisseria Meningitidis Urethritis in a Thai Male. JOURNAL OF HEALTH SCIENCE AND MEDICAL RESEARCH (JHSMR) 2020; 39:251-255. [PMID: 33898941 DOI: 10.31584/jhsmr.2020773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Although Neisseria meningitidis (N. meningitidis) urogenital infections have been reported widely, meningococcal urethritis has not been reported previously in Thailand. A 42-year-old Thai male presented at a sexual health clinic with dysuria and urethral discharge following oral and insertive anal intercourse. N. meningitidis, serogroup C was cultured from a urethral discharge specimen and the patient was treated successfully with standard treatment for gonococcal urethritis. This case reflects a growing trend of reports describing meningococcal urethritis, likely resulting from sexual contact.
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Affiliation(s)
- Jaray Tongtoyai
- Division of HIV/AIDS Prevention, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia 30333, The United Stated Of America.,Thailand Ministry of Public Health - U.S. Centers for Disease Control and Prevention Collaboration, Mueang, Nonthaburi 11000, Thailand
| | - Nongkran Tatakham
- Division of HIV/AIDS Prevention, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia 30333, The United Stated Of America.,Thailand Ministry of Public Health - U.S. Centers for Disease Control and Prevention Collaboration, Mueang, Nonthaburi 11000, Thailand
| | - Thitima Cherdtrakulkiat
- Division of HIV/AIDS Prevention, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia 30333, The United Stated Of America.,Thailand Ministry of Public Health - U.S. Centers for Disease Control and Prevention Collaboration, Mueang, Nonthaburi 11000, Thailand
| | - Pachara Sirivongrangson
- Department of Disease Control, Thailand Ministry of Public Health, Mueang, Nonthaburi 11000, Thailand
| | - Andrew Hickey
- Division of HIV/AIDS Prevention, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia 30333, The United Stated Of America.,Thailand Ministry of Public Health - U.S. Centers for Disease Control and Prevention Collaboration, Mueang, Nonthaburi 11000, Thailand
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19
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Neisseria meningitidis Urethritis Outbreak Isolates Express a Novel Factor H Binding Protein Variant That Is a Potential Target of Group B-Directed Meningococcal (MenB) Vaccines. Infect Immun 2020; 88:IAI.00462-20. [PMID: 32958529 DOI: 10.1128/iai.00462-20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 09/17/2020] [Indexed: 12/12/2022] Open
Abstract
Factor H binding protein (FHbp) is an important Neisseria meningitidis virulence factor that binds a negative regulator of the alternative complement pathway, human factor H (FH). Binding of FH increases meningococcal resistance to complement-mediated killing. FHbp also is reported to prevent interaction of the antimicrobial peptide (AMP) LL-37 with the meningococcal surface and meningococcal killing. FHbp is a target of two licensed group B-directed meningococcal (MenB) vaccines. We found a new FHbp variant, peptide allele identification no. 896 (ID 896), was highly expressed by an emerging meningococcal pathotype, the nonencapsulated urethritis clade (US_NmUC). This clade has been responsible for outbreaks of urethritis in multiple U.S. cities since 2015, other mucosal infections, and cases of invasive meningococcal disease. FHbp ID 896 is a member of the variant group 1 (subfamily B), bound protective anti-FHbp monoclonal antibodies, bound high levels of human FH, and enhanced the resistance of the clade to complement-mediated killing in low levels of human complement likely present at human mucosal surfaces. Interestingly, expression of FHbp ID 896 resulted in augmented killing of the clade by LL-37. FHbp ID 896 of the clade was recognized by antibodies elicited by FHbp in MenB vaccines.
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20
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Unemo M, Ross J, Serwin AB, Gomberg M, Cusini M, Jensen JS. 2020 European guideline for the diagnosis and treatment of gonorrhoea in adults. Int J STD AIDS 2020:956462420949126. [PMID: 33121366 DOI: 10.1177/0956462420949126] [Citation(s) in RCA: 82] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Gonorrhoea is a major public health concern globally. Increasing incidence and sporadic ceftriaxone-resistant cases, including treatment failures, are growing concerns. The 2020 European gonorrhoea guideline provides up-to-date evidence-based guidance regarding the diagnosis and treatment of gonorrhoea. The updates and recommendations emphasize significantly increasing gonorrhoea incidence; broad indications for increased testing with validated and quality-assured nucleic acid amplification tests and culture; dual antimicrobial therapy including high-dose ceftriaxone and azithromycin (ceftriaxone 1 g plus azithromycin 2 g) OR ceftriaxone 1 g monotherapy (ONLY in well-controlled settings, see guideline for details) for uncomplicated gonorrhoea when the antimicrobial susceptibility is unknown; recommendation of test of cure (TOC) in all gonorrhoea cases to ensure eradication of infection and identify resistance; and enhanced surveillance of treatment failures when recommended treatment regimens have been used. Improvements in access to appropriate testing, test performance, diagnostics, antimicrobial susceptibility surveillance and treatment, and follow-up of gonorrhoea patients are essential in controlling gonorrhoea and to mitigate the emergence and/or spread of ceftriaxone resistance and multidrug-resistant and extensively drug-resistant gonorrhoea. For detailed background, evidence base and discussions, see the background review for the present 2020 European guideline for the diagnosis and treatment of gonorrhoea in adults (Unemo M, et al. Int J STD AIDS. 2020).
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Affiliation(s)
- M Unemo
- WHO Collaborating Centre for Gonorrhoea and other STIs, National Reference Laboratory for STIs, Department of Laboratory Medicine, Microbiology, Örebro University Hospital and Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Jdc Ross
- University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
| | - A B Serwin
- Department of Dermatology and Venereology, Medical University of Białystok, Białystok, Poland
| | - M Gomberg
- Moscow Scientific and Practical Center of Dermatovenereology and Cosmetology, Moscow, Russia
| | - M Cusini
- Department of Dermatology, Fondazione IRCCS Ca' Granda Ospedale Policlinico, Milano, Italy
| | - J S Jensen
- Infection Preparedness, Research Unit for Reproductive Tract Microbiology, Statens Serum Institut, Copenhagen, Denmark
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21
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Ma KC, Mortimer TD, Hicks AL, Wheeler NE, Sánchez-Busó L, Golparian D, Taiaroa G, Rubin DHF, Wang Y, Williamson DA, Unemo M, Harris SR, Grad YH. Adaptation to the cervical environment is associated with increased antibiotic susceptibility in Neisseria gonorrhoeae. Nat Commun 2020; 11:4126. [PMID: 32807804 PMCID: PMC7431566 DOI: 10.1038/s41467-020-17980-1] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Accepted: 07/24/2020] [Indexed: 01/01/2023] Open
Abstract
Neisseria gonorrhoeae is an urgent public health threat due to rapidly increasing incidence and antibiotic resistance. In contrast with the trend of increasing resistance, clinical isolates that have reverted to susceptibility regularly appear, prompting questions about which pressures compete with antibiotics to shape gonococcal evolution. Here, we used genome-wide association to identify loss-of-function (LOF) mutations in the efflux pump mtrCDE operon as a mechanism of increased antibiotic susceptibility and demonstrate that these mutations are overrepresented in cervical relative to urethral isolates. This enrichment holds true for LOF mutations in another efflux pump, farAB, and in urogenitally-adapted versus typical N. meningitidis, providing evidence for a model in which expression of these pumps in the female urogenital tract incurs a fitness cost for pathogenic Neisseria. Overall, our findings highlight the impact of integrating microbial population genomics with host metadata and demonstrate how host environmental pressures can lead to increased antibiotic susceptibility.
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Affiliation(s)
- Kevin C Ma
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Tatum D Mortimer
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Allison L Hicks
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Nicole E Wheeler
- Centre for Genomic Pathogen Surveillance, Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, Cambridgeshire, UK
| | - Leonor Sánchez-Busó
- Centre for Genomic Pathogen Surveillance, Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, Cambridgeshire, UK
| | - Daniel Golparian
- WHO Collaborating Centre for Gonorrhoea and other STIs, Swedish Reference Laboratory for STIs, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - George Taiaroa
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - Daniel H F Rubin
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Yi Wang
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Deborah A Williamson
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - Magnus Unemo
- WHO Collaborating Centre for Gonorrhoea and other STIs, Swedish Reference Laboratory for STIs, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Simon R Harris
- Microbiotica Ltd, Biodata Innovation Centre, Wellcome Genome Campus, Hinxton, Cambridgeshire, UK
| | - Yonatan H Grad
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
- Division of Infectious Diseases, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
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22
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Aye AMM, Bai X, Borrow R, Bory S, Carlos J, Caugant DA, Chiou CS, Dai VTT, Dinleyici EC, Ghimire P, Handryastuti S, Heo JY, Jennison A, Kamiya H, Tonnii Sia L, Lucidarme J, Marshall H, Putri ND, Saha S, Shao Z, Sim JHC, Smith V, Taha MK, Van Thanh P, Thisyakorn U, Tshering K, Vázquez J, Veeraraghavan B, Yezli S, Zhu B. Meningococcal disease surveillance in the Asia-Pacific region (2020): The global meningococcal initiative. J Infect 2020; 81:698-711. [PMID: 32730999 DOI: 10.1016/j.jinf.2020.07.025] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 07/17/2020] [Accepted: 07/24/2020] [Indexed: 12/20/2022]
Abstract
The degree of surveillance data and control strategies for invasive meningococcal disease (IMD) varies across the Asia-Pacific region. IMD cases are often reported throughout the region, but the disease is not notifiable in some countries, including Myanmar, Bangladesh and Malaysia. Although there remains a paucity of data from many countries, specific nations have introduced additional surveillance measures. The incidence of IMD is low and similar across the represented countries (<0.2 cases per 100,000 persons per year), with the predominant serogroups of Neisseria meningitidis being B, W and Y, although serogroups A and X are present in some areas. Resistance to ciprofloxacin is also of concern, with the close monitoring of antibiotic-resistant clonal complexes (e.g., cc4821) being a priority. Meningococcal vaccination is only included in a few National Immunization Programs, but is recommended for high-risk groups, including travellers (such as pilgrims) and people with complement deficiencies or human immunodeficiency virus (HIV). Both polysaccharide and conjugate vaccines form part of recommendations. However, cost and misconceptions remain limiting factors in vaccine uptake, despite conjugate vaccines preventing the acquisition of carriage.
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Affiliation(s)
| | - Xilian Bai
- Meningococcal Reference Unit, Public Health England, Manchester Royal Infirmary, Manchester M13 9WZ, UK.
| | - Ray Borrow
- Meningococcal Reference Unit, Public Health England, Manchester Royal Infirmary, Manchester M13 9WZ, UK.
| | | | - Josefina Carlos
- University of the East Ramon Magsaysay Memorial Medical Center, Quezon City, Philippines
| | | | | | - Vo Thi Trang Dai
- Department of Microbiology and Immunology, Pasteur Institute of Ho Chi Minh City, Ho Chi Minh City, Viet Nam
| | | | | | | | - Jung Yeon Heo
- Department of Infectious Diseases, Ajou University School of Medicine, Suwon, South Korea.
| | | | - Hajime Kamiya
- National Institute of Infectious Diseases, Tokyo, Japan
| | | | - Jay Lucidarme
- Meningococcal Reference Unit, Public Health England, Manchester Royal Infirmary, Manchester M13 9WZ, UK.
| | - Helen Marshall
- Robinson Research Institute and department of Paediatrics, Adelaide Medical School, The University of Adelaide, Adelaide, Australia.
| | - Nina Dwi Putri
- Dr Cipto Mangunkusumo National Central Hospital, Jakarta, Indonesia
| | - Senjuti Saha
- Child Health Research Foundation, Mohammadpur, Dhaka1207, Bangladesh.
| | - Zhujun Shao
- National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
| | | | - Vinny Smith
- Meningitis Research Foundation, Bristol, UK.
| | | | - Phan Van Thanh
- Department of Microbiology and Immunology, Pasteur Institute of Ho Chi Minh City, Ho Chi Minh City, Viet Nam
| | - Usa Thisyakorn
- Tropical Medicine Cluster, Chulalongkorn University, Bangkok, Thailand
| | - Kinley Tshering
- Jigme Dorji Wangchuck National Referral Hospital, Thimpu, Bhutan
| | - Julio Vázquez
- National Reference Laboratory for Meningococci, Institute of Health Carlos III, Spain.
| | | | - Saber Yezli
- Global Center for Mass Gatherings Medicine, Saudi Arabia
| | - Bingqing Zhu
- National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
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23
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Ladhani SN, Lucidarme J, Parikh SR, Campbell H, Borrow R, Ramsay ME. Meningococcal disease and sexual transmission: urogenital and anorectal infections and invasive disease due to Neisseria meningitidis. Lancet 2020; 395:1865-1877. [PMID: 32534649 DOI: 10.1016/s0140-6736(20)30913-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 03/15/2020] [Accepted: 04/09/2020] [Indexed: 01/08/2023]
Abstract
Neisseria meningitidis is an obligate human commensal bacterium that frequently colonises the upper respiratory tract. Person-to-person transmission occurs via direct contact or through dispersion of respiratory droplets from a carrier of the bacteria, and can lead to invasive meningococcal disease. Rare sporadic cases of meningococcal urogenital and anorectal infections, including urethritis, proctitis, and cervicitis, have been reported, typically following orogenital contact with an oropharyngeal meningococcal carrier. The resulting infections were clinically indistinguishable from infections caused by Neisseria gonorrhoeae. Over the past two decades, there have also been multiple outbreaks across North America and Europe of invasive meningococcal disease among men who have sex with men (MSM). The responsible meningococci belong to a highly virulent and predominantly serogroup C lineage, including strains that are able to express nitrite reductase and grow in anaerobic environments, such as the urogenital and anorectal tracts. More recently, a distinct clade within this lineage has expanded to cause urethritis predominantly among men who have sex with women. Evolutionary events giving rise to this clade included the loss of the ability to express a capsule, and acquisition of several gonococcal alleles, including one allele encoding a highly efficient gonococcal nitrite reductase. Members of the clade continue to acquire gonococcal alleles, including one allele associated with decreased antibiotic susceptibility. This evolution has implications for the clinical and public health management of those who are infected and their close contacts, in terms of both antibiotic treatment, and prevention through vaccination.
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Affiliation(s)
- Shamez N Ladhani
- Immunisation and Countermeasures Division, Public Health England, London, UK; Paediatric Infectious Diseases Research Group (PIDRG), St George's University of London, London, UK.
| | - Jay Lucidarme
- Meningococcal Reference Unit, Public Health England, Manchester Royal Infirmary, Manchester, UK
| | - Sydel R Parikh
- Immunisation and Countermeasures Division, Public Health England, London, UK
| | - Helen Campbell
- Immunisation and Countermeasures Division, Public Health England, London, UK
| | - Ray Borrow
- Meningococcal Reference Unit, Public Health England, Manchester Royal Infirmary, Manchester, UK
| | - Mary E Ramsay
- Immunisation and Countermeasures Division, Public Health England, London, UK
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24
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Muenzner P, Hauck CR. Neisseria gonorrhoeae Blocks Epithelial Exfoliation by Nitric-Oxide-Mediated Metabolic Cross Talk to Promote Colonization in Mice. Cell Host Microbe 2020; 27:793-808.e5. [PMID: 32289262 DOI: 10.1016/j.chom.2020.03.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 12/19/2019] [Accepted: 03/17/2020] [Indexed: 12/18/2022]
Abstract
Several pathogens suppress exfoliation, a key defense of epithelia against microbial colonization. Common among these pathogens, exemplified by Neisseria gonorrhoeae, is their ability to bind carcinoembryonic antigen-related cell adhesion molecules (CEACAMs). Gonococcal CEACAM engagement triggers the expression of CD105, which is necessary to block epithelial exfoliation, whereas homotypic CEACAM-CEACAM interactions or antibody-mediated CEACAM clustering does not lead to CD105 expression. Here, we show that CEACAM-associated bacteria release nitric oxide (NO) during anaerobic respiration, and membrane-permeable NO initiates a eukaryotic signaling pathway involving soluble guanylate cyclase (sGC), protein kinase G, and the transcription factor CREB to upregulate CD105 expression. A murine vaginal infection model with N. gonorrhoeae reveals this metabolic cross communication allows bacterial suppression of epithelial exfoliation to facilitate mucosal colonization. Disrupting NO-initiated responses in host cells re-establishes epithelial exfoliation and inhibits mouse genital tract colonization by N. gonorrhoeae, suggesting a host-directed approach to prevent bacterial infections.
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Affiliation(s)
- Petra Muenzner
- Lehrstuhl Für Zellbiologie, Fachbereich Biologie, Universität Konstanz, 78457 Konstanz, Germany
| | - Christof R Hauck
- Lehrstuhl Für Zellbiologie, Fachbereich Biologie, Universität Konstanz, 78457 Konstanz, Germany; Konstanz Research School Chemical Biology, Universität Konstanz, 78457 Konstanz, Germany.
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25
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Development of a SimpleProbe real-Time PCR Assay for rapid detection and identification of the US novel urethrotropic clade of Neisseria meningitidis ST-11 (US_NmUC). PLoS One 2020; 15:e0228467. [PMID: 32040516 PMCID: PMC7010270 DOI: 10.1371/journal.pone.0228467] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 01/15/2020] [Indexed: 11/25/2022] Open
Abstract
Urethritis, or inflammation of the urethra, is one of the most common reasons men seek clinical care. Sexually transmitted pathogens including Neisseria gonorrhoeae are responsible for over half of the symptomatic urethritis cases in U.S. men. Recently, clinics in Indianapolis, Columbus, Atlanta, and other U.S. cities began to note increasing numbers of men presenting with urethritis and Gram-negative intracellular diplococci in their urethral smears who test negative for N. gonorrhoeae. Many of these discordant cases, which have periodically reached highs of more than 25% of presumed gonococcal cases in some sexually transmitted infection clinics in the U.S. Midwest, are infected with strains in a novel urethrotropic clade of Neisseria meningitidis ST-11 (US_NmUC). However, no cultivation-independent tests are available for the US_NmUC strains, and prior studies relied on microbial culture and genome sequencing to identify them. Here, we describe a PCR test that can identify the US_NmUC strains and distinguish them from commensal and invasive N. meningitidis strains as well as N. gonorrhoeae. Our SimpleProbe®-based real-time PCR assay targets a conserved nucleotide substitution in a horizontally acquired region of US_NmUC strain genomes. We applied the assay to 241 urine specimens whose microbial compositions had previously been determined by deep shotgun metagenomic sequencing. The assay detected the single US_NmUC positive case in this cohort, with no false positives. Overall, our simple and readily adaptable assay could facilitate investigation of the pathogenesis and epidemiology of the US_NmUC clade.
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26
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Bai X, Borrow R, Bukovski S, Caugant DA, Culic D, Delic S, Dinleyici EC, Eloshvili M, Erdősi T, Galajeva J, Křížová P, Lucidarme J, Mironov K, Nurmatov Z, Pana M, Rahimov E, Savrasova L, Skoczyńska A, Smith V, Taha MK, Titov L, Vázquez J, Yeraliyeva L. Prevention and control of meningococcal disease: Updates from the Global Meningococcal Initiative in Eastern Europe. J Infect 2019; 79:528-541. [PMID: 31682877 DOI: 10.1016/j.jinf.2019.10.018] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 10/23/2019] [Accepted: 10/26/2019] [Indexed: 12/20/2022]
Abstract
The Global Meningococcal Initiative (GMI) aims to prevent invasive meningococcal disease (IMD) worldwide through education, research and cooperation. In March 2019, a GMI meeting was held with a multidisciplinary group of experts and representatives from countries within Eastern Europe. Across the countries represented, IMD surveillance is largely in place, with incidence declining in recent decades and now generally at <1 case per 100,000 persons per year. Predominating serogroups are B and C, followed by A, and cases attributable to serogroups W, X and Y are emerging. Available vaccines differ between countries, are generally not included in immunization programs and provided to high-risk groups only. Available vaccines include both conjugate and polysaccharide vaccines; however, current data and GMI recommendations advocate the use of conjugate vaccines, where possible, due to the ability to interrupt the acquisition of carriage. Ongoing carriage studies are expected to inform vaccine effectiveness and immunization schedules. Additionally, IMD prevention and control should be guided by monitoring outbreak progression and the emergence and international spread of strains and antibiotic resistance through use of genomic analyses and implementation of World Health Organization initiatives. Protection of high-risk groups (such as those with complement deficiencies, laboratory workers, migrants and refugees) is recommended.
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Affiliation(s)
- Xilian Bai
- Meningococcal Reference Unit, Public Health England, Manchester Royal Infirmary, Manchester M13 9WZ, UK.
| | - Ray Borrow
- Meningococcal Reference Unit, Public Health England, Manchester Royal Infirmary, Manchester M13 9WZ, UK.
| | - Suzana Bukovski
- University Hospital for Infectious Diseases, Zagreb, Croatia.
| | | | - Davor Culic
- Institute for Public Health, Sombor, Serbia.
| | | | | | - Medeia Eloshvili
- National Center for Disease Control & Public Health, Tbilisi, Georgia.
| | - Tímea Erdősi
- National Public Health Center, Budapest, Hungary.
| | | | - Pavla Křížová
- National Institute of Public Health, Prague, Czechia.
| | - Jay Lucidarme
- Meningococcal Reference Unit, Public Health England, Manchester Royal Infirmary, Manchester M13 9WZ, UK.
| | | | - Zuridin Nurmatov
- Scientific and Production Association "Preventive Medicine", Bishkek, Kyrgyzstan.
| | - Marina Pana
- Cantacuzino National Medico Military Institute for Research Development, Bucharest, Romania
| | | | - Larisa Savrasova
- The Centre for Disease Prevention and Control of Latvia, Riga, Latvia.
| | - Anna Skoczyńska
- National Reference Centre for Bacterial Meningitis, National Medicines Institute, Warsaw, Poland.
| | - Vinny Smith
- Meningitis Research Foundation, Bristol, UK.
| | - Muhamed-Kheir Taha
- National Reference Centre for Meningococci, Institute Pasteur, Paris, France.
| | - Leonid Titov
- Republican Research & Practical Center for Epidemiology & Microbiology, Minsk, Belarus.
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Proceedings of the 2017 International Forum on Gonococcal Infections and Resistance in Shenzhen, China. Sex Transm Dis 2019; 45:e75-e79. [PMID: 29664765 DOI: 10.1097/olq.0000000000000859] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The 2017 International Forum on Gonococcal Infections and Resistance (2017 IFGIR) was held at Shenzhen, China from September 17, 2017, to September 19, 2017. The key objectives of the conference were to review and analyze the epidemiological profiles of gonococcal infections and antimicrobial resistance (AMR) at global, regional, and national levels; to share and discuss findings from ongoing and completed research studies; and to identify research needs to respond to the spread of gonococcal infections and AMR. The following contents were presented at the conference: global estimates of infections with Neisseria gonorrhoeae; global, regional and country status of gonococcal AMR; molecular techniques for predicting gonococcal AMR and the use of these technologies to enhance gonococcal AMR surveillance and clinical management; and updates on therapeutic approaches to gonococcal AMR.
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Jannic A, Mammeri H, Larcher L, Descamps V, Tosini W, Phung B, Yazdanpanah Y, Bouscarat F. Orogenital Transmission of Neisseria meningitidis Causing Acute Urethritis in Men Who Have Sex with Men. Emerg Infect Dis 2019; 25:175-176. [PMID: 30561300 PMCID: PMC6302579 DOI: 10.3201/eid2501.171102] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Neisseria meningitidis sequence type 11 is an emerging cause of urethritis. We demonstrate by using whole-genome sequencing orogenital transmission of a N. meningitidis sequence type 11 isolate causing urethritis in a monogamous couple of men who have sex with men. These results suggest dissemination of this clonal complex among low-risk patients.
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Ambrosio L, Neri A, Fazio C, Rossolini GM, Vacca P, Riccobono E, Voller F, Miglietta A, Stefanelli P. Genomic analysis of Neisseria meningitidis carriage isolates during an outbreak of serogroup C clonal complex 11, Tuscany, Italy. PLoS One 2019; 14:e0217500. [PMID: 31136624 PMCID: PMC6538176 DOI: 10.1371/journal.pone.0217500] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 05/13/2019] [Indexed: 11/19/2022] Open
Abstract
Background In 2015–2016, a cross-sectional carriage survey was performed in Tuscany Region, Italy, during an outbreak of invasive meningococcal disease due to Neisseria meningitidis serogroup C clonal complex 11 (MenC:cc11). This study aims to evaluate the genomic profile of meningococcal carriage isolates collected during the survey. Methods Whole-genome sequencing (WGS) was performed using Illumina MiSeq on 85 cultivated meningococcal carriage isolates received at the Dept. of Infectious Disease, National Institute of Health (Istituto Superiore di Sanità, ISS), as National Reference Laboratory (NRL) for Invasive Meningococcal Disease (IMD). De novo assembled genomes were scanned by the BIGSdb platform to assign: the genotypic profiles, the cgMLST, the vaccine antigen variants and allele types of antimicrobial resistance associated genes, together with denitrification pathway loci. Results Capsule null and non-groupable meningococci accounted for 52.9% and 10.6%, respectively. Among the remaining carriage isolates, serogroup B was the predominant (71.0%). Serogroup C meningococci were culture negative and unavailable for WGS. Overall, 64 genotypic profiles were identified and, based on cgMLST, isolates clustered according to clonal complexes. Eight isolates (9.4%) harbored at least one gene encoding a 4CMenB vaccine antigen. Mutated penA alleles were found in more than 82%. Finally, complete aniA and norB coding sequences were detected among 71.8% of carriage isolates. Conclusions Meningococcal carriage isolates collected during the MenC:cc11 outbreak were characterized by an extensive genetic diversity. The lack of outbreak-related isolates among carriage might be attributable to the high transmissibility with low duration of colonization of MenC:cc11 meningococci.
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Affiliation(s)
- Luigina Ambrosio
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Arianna Neri
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Cecilia Fazio
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Gian Maria Rossolini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Clinical Microbiology and Virology Unit, Careggi University Hospital, Florence, Italy
| | - Paola Vacca
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Eleonora Riccobono
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Fabio Voller
- Regional Health Agency of Tuscany, Epidemiologic Observatory, Florence, Italy
| | - Alessandro Miglietta
- Regional Health Agency of Tuscany, Epidemiologic Observatory, Florence, Italy
- Units of Epidemiology and Preventive Medicine, Central Tuscany Health Authority, Florence, Italy
| | - Paola Stefanelli
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
- * E-mail:
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30
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Kretz CB, Bergeron G, Aldrich M, Bloch D, Del Rosso PE, Halse TA, Ostrowsky B, Liu Q, Gonzalez E, Omoregie E, Chicaiza L, Zayas G, Tha B, Liang A, Wang JC, Levi M, Hughes S, Musser KA, Weiss D, Rakeman JL. Neonatal Conjunctivitis Caused by Neisseria meningitidis US Urethritis Clade, New York, USA, August 2017. Emerg Infect Dis 2019; 25:972-975. [PMID: 31002061 PMCID: PMC6478211 DOI: 10.3201/eid2505.181631] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
We characterized a case of neonatal conjunctivitis in New York, USA, caused by Neisseria meningitidis by using whole-genome sequencing. The case was a rare occurrence, and the isolate obtained belonged to an emerging clade (N. meningitidis US nongroupable urethritis) associated with an increase in cases of urethritis since 2015.
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Affiliation(s)
| | | | - Margaret Aldrich
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (C.B. Kretz, G. Bergeron)
- New York City Department of Health and Mental Hygiene
- Queens, New York, USA (C.B. Kretz, G. Bergeron, M. Aldrich, D. Bloch, P.E. Del Rosso, Q. Liu, E. Gonzalez, E. Omoregie, L. Chicaiza, G. Zayas, B. Tha, A. Liang, J.C. Wang, S. Hughes, D. Weiss, J.L. Rakeman)
- Montefiore Medical Center, Bronx, New York, USA (M. Aldrich, B. Ostrowsky, M. Levi)
- New York State Department of Health, Albany, New York, USA (T.A. Halse, K.A. Musser)
| | - Danielle Bloch
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (C.B. Kretz, G. Bergeron)
- New York City Department of Health and Mental Hygiene
- Queens, New York, USA (C.B. Kretz, G. Bergeron, M. Aldrich, D. Bloch, P.E. Del Rosso, Q. Liu, E. Gonzalez, E. Omoregie, L. Chicaiza, G. Zayas, B. Tha, A. Liang, J.C. Wang, S. Hughes, D. Weiss, J.L. Rakeman)
- Montefiore Medical Center, Bronx, New York, USA (M. Aldrich, B. Ostrowsky, M. Levi)
- New York State Department of Health, Albany, New York, USA (T.A. Halse, K.A. Musser)
| | - Paula E. Del Rosso
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (C.B. Kretz, G. Bergeron)
- New York City Department of Health and Mental Hygiene
- Queens, New York, USA (C.B. Kretz, G. Bergeron, M. Aldrich, D. Bloch, P.E. Del Rosso, Q. Liu, E. Gonzalez, E. Omoregie, L. Chicaiza, G. Zayas, B. Tha, A. Liang, J.C. Wang, S. Hughes, D. Weiss, J.L. Rakeman)
- Montefiore Medical Center, Bronx, New York, USA (M. Aldrich, B. Ostrowsky, M. Levi)
- New York State Department of Health, Albany, New York, USA (T.A. Halse, K.A. Musser)
| | - Tanya A. Halse
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (C.B. Kretz, G. Bergeron)
- New York City Department of Health and Mental Hygiene
- Queens, New York, USA (C.B. Kretz, G. Bergeron, M. Aldrich, D. Bloch, P.E. Del Rosso, Q. Liu, E. Gonzalez, E. Omoregie, L. Chicaiza, G. Zayas, B. Tha, A. Liang, J.C. Wang, S. Hughes, D. Weiss, J.L. Rakeman)
- Montefiore Medical Center, Bronx, New York, USA (M. Aldrich, B. Ostrowsky, M. Levi)
- New York State Department of Health, Albany, New York, USA (T.A. Halse, K.A. Musser)
| | - Belinda Ostrowsky
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (C.B. Kretz, G. Bergeron)
- New York City Department of Health and Mental Hygiene
- Queens, New York, USA (C.B. Kretz, G. Bergeron, M. Aldrich, D. Bloch, P.E. Del Rosso, Q. Liu, E. Gonzalez, E. Omoregie, L. Chicaiza, G. Zayas, B. Tha, A. Liang, J.C. Wang, S. Hughes, D. Weiss, J.L. Rakeman)
- Montefiore Medical Center, Bronx, New York, USA (M. Aldrich, B. Ostrowsky, M. Levi)
- New York State Department of Health, Albany, New York, USA (T.A. Halse, K.A. Musser)
| | - Qinghuan Liu
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (C.B. Kretz, G. Bergeron)
- New York City Department of Health and Mental Hygiene
- Queens, New York, USA (C.B. Kretz, G. Bergeron, M. Aldrich, D. Bloch, P.E. Del Rosso, Q. Liu, E. Gonzalez, E. Omoregie, L. Chicaiza, G. Zayas, B. Tha, A. Liang, J.C. Wang, S. Hughes, D. Weiss, J.L. Rakeman)
- Montefiore Medical Center, Bronx, New York, USA (M. Aldrich, B. Ostrowsky, M. Levi)
- New York State Department of Health, Albany, New York, USA (T.A. Halse, K.A. Musser)
| | - Edimarlyn Gonzalez
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (C.B. Kretz, G. Bergeron)
- New York City Department of Health and Mental Hygiene
- Queens, New York, USA (C.B. Kretz, G. Bergeron, M. Aldrich, D. Bloch, P.E. Del Rosso, Q. Liu, E. Gonzalez, E. Omoregie, L. Chicaiza, G. Zayas, B. Tha, A. Liang, J.C. Wang, S. Hughes, D. Weiss, J.L. Rakeman)
- Montefiore Medical Center, Bronx, New York, USA (M. Aldrich, B. Ostrowsky, M. Levi)
- New York State Department of Health, Albany, New York, USA (T.A. Halse, K.A. Musser)
| | - Enoma Omoregie
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (C.B. Kretz, G. Bergeron)
- New York City Department of Health and Mental Hygiene
- Queens, New York, USA (C.B. Kretz, G. Bergeron, M. Aldrich, D. Bloch, P.E. Del Rosso, Q. Liu, E. Gonzalez, E. Omoregie, L. Chicaiza, G. Zayas, B. Tha, A. Liang, J.C. Wang, S. Hughes, D. Weiss, J.L. Rakeman)
- Montefiore Medical Center, Bronx, New York, USA (M. Aldrich, B. Ostrowsky, M. Levi)
- New York State Department of Health, Albany, New York, USA (T.A. Halse, K.A. Musser)
| | - Ludwin Chicaiza
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (C.B. Kretz, G. Bergeron)
- New York City Department of Health and Mental Hygiene
- Queens, New York, USA (C.B. Kretz, G. Bergeron, M. Aldrich, D. Bloch, P.E. Del Rosso, Q. Liu, E. Gonzalez, E. Omoregie, L. Chicaiza, G. Zayas, B. Tha, A. Liang, J.C. Wang, S. Hughes, D. Weiss, J.L. Rakeman)
- Montefiore Medical Center, Bronx, New York, USA (M. Aldrich, B. Ostrowsky, M. Levi)
- New York State Department of Health, Albany, New York, USA (T.A. Halse, K.A. Musser)
| | - Greicy Zayas
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (C.B. Kretz, G. Bergeron)
- New York City Department of Health and Mental Hygiene
- Queens, New York, USA (C.B. Kretz, G. Bergeron, M. Aldrich, D. Bloch, P.E. Del Rosso, Q. Liu, E. Gonzalez, E. Omoregie, L. Chicaiza, G. Zayas, B. Tha, A. Liang, J.C. Wang, S. Hughes, D. Weiss, J.L. Rakeman)
- Montefiore Medical Center, Bronx, New York, USA (M. Aldrich, B. Ostrowsky, M. Levi)
- New York State Department of Health, Albany, New York, USA (T.A. Halse, K.A. Musser)
| | - Bun Tha
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (C.B. Kretz, G. Bergeron)
- New York City Department of Health and Mental Hygiene
- Queens, New York, USA (C.B. Kretz, G. Bergeron, M. Aldrich, D. Bloch, P.E. Del Rosso, Q. Liu, E. Gonzalez, E. Omoregie, L. Chicaiza, G. Zayas, B. Tha, A. Liang, J.C. Wang, S. Hughes, D. Weiss, J.L. Rakeman)
- Montefiore Medical Center, Bronx, New York, USA (M. Aldrich, B. Ostrowsky, M. Levi)
- New York State Department of Health, Albany, New York, USA (T.A. Halse, K.A. Musser)
| | - Angela Liang
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (C.B. Kretz, G. Bergeron)
- New York City Department of Health and Mental Hygiene
- Queens, New York, USA (C.B. Kretz, G. Bergeron, M. Aldrich, D. Bloch, P.E. Del Rosso, Q. Liu, E. Gonzalez, E. Omoregie, L. Chicaiza, G. Zayas, B. Tha, A. Liang, J.C. Wang, S. Hughes, D. Weiss, J.L. Rakeman)
- Montefiore Medical Center, Bronx, New York, USA (M. Aldrich, B. Ostrowsky, M. Levi)
- New York State Department of Health, Albany, New York, USA (T.A. Halse, K.A. Musser)
| | - Jade C. Wang
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (C.B. Kretz, G. Bergeron)
- New York City Department of Health and Mental Hygiene
- Queens, New York, USA (C.B. Kretz, G. Bergeron, M. Aldrich, D. Bloch, P.E. Del Rosso, Q. Liu, E. Gonzalez, E. Omoregie, L. Chicaiza, G. Zayas, B. Tha, A. Liang, J.C. Wang, S. Hughes, D. Weiss, J.L. Rakeman)
- Montefiore Medical Center, Bronx, New York, USA (M. Aldrich, B. Ostrowsky, M. Levi)
- New York State Department of Health, Albany, New York, USA (T.A. Halse, K.A. Musser)
| | - Michael Levi
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (C.B. Kretz, G. Bergeron)
- New York City Department of Health and Mental Hygiene
- Queens, New York, USA (C.B. Kretz, G. Bergeron, M. Aldrich, D. Bloch, P.E. Del Rosso, Q. Liu, E. Gonzalez, E. Omoregie, L. Chicaiza, G. Zayas, B. Tha, A. Liang, J.C. Wang, S. Hughes, D. Weiss, J.L. Rakeman)
- Montefiore Medical Center, Bronx, New York, USA (M. Aldrich, B. Ostrowsky, M. Levi)
- New York State Department of Health, Albany, New York, USA (T.A. Halse, K.A. Musser)
| | - Scott Hughes
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (C.B. Kretz, G. Bergeron)
- New York City Department of Health and Mental Hygiene
- Queens, New York, USA (C.B. Kretz, G. Bergeron, M. Aldrich, D. Bloch, P.E. Del Rosso, Q. Liu, E. Gonzalez, E. Omoregie, L. Chicaiza, G. Zayas, B. Tha, A. Liang, J.C. Wang, S. Hughes, D. Weiss, J.L. Rakeman)
- Montefiore Medical Center, Bronx, New York, USA (M. Aldrich, B. Ostrowsky, M. Levi)
- New York State Department of Health, Albany, New York, USA (T.A. Halse, K.A. Musser)
| | - Kimberlee A. Musser
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (C.B. Kretz, G. Bergeron)
- New York City Department of Health and Mental Hygiene
- Queens, New York, USA (C.B. Kretz, G. Bergeron, M. Aldrich, D. Bloch, P.E. Del Rosso, Q. Liu, E. Gonzalez, E. Omoregie, L. Chicaiza, G. Zayas, B. Tha, A. Liang, J.C. Wang, S. Hughes, D. Weiss, J.L. Rakeman)
- Montefiore Medical Center, Bronx, New York, USA (M. Aldrich, B. Ostrowsky, M. Levi)
- New York State Department of Health, Albany, New York, USA (T.A. Halse, K.A. Musser)
| | - Don Weiss
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (C.B. Kretz, G. Bergeron)
- New York City Department of Health and Mental Hygiene
- Queens, New York, USA (C.B. Kretz, G. Bergeron, M. Aldrich, D. Bloch, P.E. Del Rosso, Q. Liu, E. Gonzalez, E. Omoregie, L. Chicaiza, G. Zayas, B. Tha, A. Liang, J.C. Wang, S. Hughes, D. Weiss, J.L. Rakeman)
- Montefiore Medical Center, Bronx, New York, USA (M. Aldrich, B. Ostrowsky, M. Levi)
- New York State Department of Health, Albany, New York, USA (T.A. Halse, K.A. Musser)
| | - Jennifer L. Rakeman
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (C.B. Kretz, G. Bergeron)
- New York City Department of Health and Mental Hygiene
- Queens, New York, USA (C.B. Kretz, G. Bergeron, M. Aldrich, D. Bloch, P.E. Del Rosso, Q. Liu, E. Gonzalez, E. Omoregie, L. Chicaiza, G. Zayas, B. Tha, A. Liang, J.C. Wang, S. Hughes, D. Weiss, J.L. Rakeman)
- Montefiore Medical Center, Bronx, New York, USA (M. Aldrich, B. Ostrowsky, M. Levi)
- New York State Department of Health, Albany, New York, USA (T.A. Halse, K.A. Musser)
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Tzeng YL, Berman Z, Toh E, Bazan JA, Turner AN, Retchless AC, Wang X, Nelson DE, Stephens DS. Heteroresistance to the model antimicrobial peptide polymyxin B in the emerging Neisseria meningitidis lineage 11.2 urethritis clade: mutations in the pilMNOPQ operon. Mol Microbiol 2018; 111:254-268. [PMID: 30338585 DOI: 10.1111/mmi.14153] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2018] [Indexed: 02/02/2023]
Abstract
Clusters of Neisseria meningitidis (Nm) urethritis among primarily heterosexual males in multiple US cities have been attributed to a unique non-encapsulated meningococcal clade (the US Nm urethritis clade, US_NmUC) within the hypervirulent clonal complex 11. Resistance to antimicrobial peptides (AMPs) is a key feature of urogenital pathogenesis of the closely related species, Neisseria gonorrhoeae. The US_NmUC isolates were found to be highly resistant to the model AMP, polymyxin B (PmB, MICs 64-256 µg ml-1 ). The isolates also demonstrated stable subpopulations of heteroresistant colonies that showed near total resistant to PmB (MICs 384-1024 µg ml-1 ) and colistin (MIC 256 µg ml-1 ) as well as enhanced LL-37 resistance. This is the first observation of heteroresistance in N. meningitidis. Consistent with previous findings, overall PmB resistance in US_NmUC isolates was due to active Mtr efflux and LptA-mediated lipid A modification. However, whole genome sequencing, variant analyses and directed mutagenesis revealed that the heteroresistance phenotypes and very high-level AMP resistance were the result of point mutations and IS1655 element movement in the pilMNOPQ operon, encoding the type IV pilin biogenesis apparatus. Cross-resistance to other classes of antibiotics was also observed in the heteroresistant colonies. High-level resistance to AMPs may contribute to the pathogenesis of US_NmUC.
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Affiliation(s)
- Yih-Ling Tzeng
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - Zachary Berman
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - Evelyn Toh
- Department of Microbiology and Immunology, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Jose A Bazan
- Division of Infectious Diseases, Department of Internal Medicine, Ohio State University College of Medicine, Columbus, OH, 43210, USA.,Sexual Health Clinic, Columbus Public Health, Columbus, OH, 43210, USA
| | - Abigail Norris Turner
- Division of Infectious Diseases, Department of Internal Medicine, Ohio State University College of Medicine, Columbus, OH, 43210, USA
| | - Adam C Retchless
- Meningitis and Vaccine Preventable Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA, 30333, USA
| | - Xin Wang
- Meningitis and Vaccine Preventable Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA, 30333, USA
| | - David E Nelson
- Department of Microbiology and Immunology, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - David S Stephens
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, 30322, USA.,Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, GA, 30322, USA
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32
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A Review of Global Epidemiology and Response to Meningococcal Disease Outbreaks among Men Who Have Sex with Men, 2001–2018. CURR EPIDEMIOL REP 2018. [DOI: 10.1007/s40471-018-0170-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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33
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Whaley MJ, Jenkins LT, Hu F, Chen A, Diarra S, Ouédraogo-Traoré R, Sacchi CT, Wang X. Triplex Real-Time PCR without DNA Extraction for the Monitoring of Meningococcal Disease. Diagnostics (Basel) 2018; 8:diagnostics8030058. [PMID: 30200184 PMCID: PMC6163423 DOI: 10.3390/diagnostics8030058] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 08/22/2018] [Accepted: 08/26/2018] [Indexed: 11/17/2022] Open
Abstract
Detection of Neisseria meningitidis has become less time- and resource-intensive with a monoplex direct real-time PCR (drt-PCR) to amplify genes from clinical specimens without DNA extraction. To further improve efficiency, we evaluated two triplex drt-PCR assays for the detection of meningococcal serogroups AWX and BCY. The sensitivity and specificity of the triplex assays were assessed using 228 cerebrospinal fluid (CSF) specimens from meningitis patients and compared to the monoplex for six serogroups. The lower limit of detection range for six serogroup-specific drt-PCR assays was 178–5264 CFU/mL by monoplex and 68–2221 CFU/mL by triplex. The triplex and monoplex showed 100% agreement for six serogroups and the triplex assays achieved similar sensitivity and specificity estimates as the monoplex drt-PCR assays. Our triplex method reduces the time and cost of processing CSF specimens by characterizing six serogroups with only two assays, which is particularly important for testing large numbers of specimens for N. meningitidis surveillance.
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Affiliation(s)
- Melissa J Whaley
- Centers for Disease Control and Prevention, Atlanta, GA 30329, USA.
| | - Laurel T Jenkins
- Centers for Disease Control and Prevention, Atlanta, GA 30329, USA.
| | - Fang Hu
- Centers for Disease Control and Prevention, Atlanta, GA 30329, USA.
| | - Alexander Chen
- Centers for Disease Control and Prevention, Atlanta, GA 30329, USA.
| | - Seydou Diarra
- Institut National de Recherche en Santé Publique, Bamako 00223, Mali.
| | | | | | - Xin Wang
- Centers for Disease Control and Prevention, Atlanta, GA 30329, USA.
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34
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Maatouk I. Neisseria meningitidis
urethritis: synthesis of published data. Int J Dermatol 2018; 57:e48-e49. [DOI: 10.1111/ijd.14060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 04/09/2018] [Accepted: 04/24/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Ismaël Maatouk
- Department of Dermatology; Keserwan Medical Center (KMC) affiliated with AUBMC; Beirut Lebanon
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35
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Dretler AW, Rouphael NG, Stephens DS. Progress toward the global control of Neisseria meningitidis: 21st century vaccines, current guidelines, and challenges for future vaccine development. Hum Vaccin Immunother 2018; 14:1146-1160. [PMID: 29543582 PMCID: PMC6067816 DOI: 10.1080/21645515.2018.1451810] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 02/21/2018] [Accepted: 03/09/2018] [Indexed: 12/21/2022] Open
Abstract
The control of meningitis, meningococcemia and other infections caused by Neisseria meningitidis is a significant global health challenge. Substantial progress has occurred in the last twenty years in meningococcal vaccine development and global implementation. Meningococcal protein-polysaccharide conjugate vaccines to serogroups A, C, W, and Y (modeled after the Haemophilus influenzae b conjugate vaccines) provide better duration of protection and immunologic memory, and overcome weak immune responses in infants and young children and hypo-responsive to repeated vaccine doses seen with polysaccharide vaccines. ACWY conjugate vaccines also interfere with transmission and reduce nasopharyngeal colonization, thus resulting in significant herd protection. Advances in serogroup B vaccine development have also occurred using conserved outer membrane proteins with or without OMV as vaccine targets. Challenges for meningococcal vaccine research remain including developing combination vaccines containing ACYW(X) and B, determining the ideal booster schedules for the conjugate and MenB vaccines, and addressing issues of waning effectiveness.
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Affiliation(s)
- A. W. Dretler
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - N. G. Rouphael
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - D. S. Stephens
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
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Retchless AC, Kretz CB, Chang HY, Bazan JA, Abrams AJ, Norris Turner A, Jenkins LT, Trees DL, Tzeng YL, Stephens DS, MacNeil JR, Wang X. Expansion of a urethritis-associated Neisseria meningitidis clade in the United States with concurrent acquisition of N. gonorrhoeae alleles. BMC Genomics 2018; 19:176. [PMID: 29499642 PMCID: PMC5834837 DOI: 10.1186/s12864-018-4560-x] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 02/20/2018] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Increased reports of Neisseria meningitidis urethritis in multiple U.S. cities during 2015 have been attributed to the emergence of a novel clade of nongroupable N. meningitidis within the ST-11 clonal complex, the "U.S. NmNG urethritis clade". Genetic recombination with N. gonorrhoeae has been proposed to enable efficient sexual transmission by this clade. To understand the evolutionary origin and diversification of the U.S. NmNG urethritis clade, whole-genome phylogenetic analysis was performed to identify its members among the N. meningitidis strain collection from the Centers for Disease Control and Prevention, including 209 urogenital and rectal N. meningitidis isolates submitted by U.S. public health departments in eleven states starting in 2015. RESULTS The earliest representatives of the U.S. NmNG urethritis clade were identified from cases of invasive disease that occurred in 2013. Among 209 urogenital and rectal isolates submitted from January 2015 to September 2016, the clade accounted for 189/198 male urogenital isolates, 3/4 female urogenital isolates, and 1/7 rectal isolates. In total, members of the clade were isolated in thirteen states between 2013 and 2016, which evolved from a common ancestor that likely existed during 2011. The ancestor contained N. gonorrhoeae-like alleles in three regions of its genome, two of which may facilitate nitrite-dependent anaerobic growth during colonization of urogenital sites. Additional gonococcal-like alleles were acquired as the clade diversified. Notably, one isolate contained a sequence associated with azithromycin resistance in N. gonorrhoeae, but no other gonococcal antimicrobial resistance determinants were detected. CONCLUSIONS Interspecies genetic recombination contributed to the early evolution and subsequent diversification of the U.S. NmNG urethritis clade. Ongoing acquisition of N. gonorrhoeae alleles by the U.S. NmNG urethritis clade may facilitate the expansion of its ecological niche while also increasing the frequency with which it causes urethritis.
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Affiliation(s)
- Adam C. Retchless
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA USA
| | - Cécilia B. Kretz
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA USA
- Present address: Division of Scientific Education and Professional Development, Center for Surveillance, Epidemiology and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, GA USA
| | - How-Yi Chang
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA USA
| | - Jose A. Bazan
- Division of Infectious Diseases, Department of Internal Medicine, Ohio State University College of Medicine, Columbus, OH USA
- Sexual Health Clinic, Columbus Public Health, Columbus, OH USA
| | - A. Jeanine Abrams
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA USA
| | - Abigail Norris Turner
- Division of Infectious Diseases, Department of Internal Medicine, Ohio State University College of Medicine, Columbus, OH USA
| | - Laurel T. Jenkins
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA USA
| | - David L. Trees
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA USA
| | - Yih-Ling Tzeng
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA USA
| | - David S. Stephens
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA USA
- Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, GA USA
| | - Jessica R. MacNeil
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA USA
| | - Xin Wang
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA USA
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Toh E, Gangaiah D, Batteiger BE, Williams JA, Arno JN, Tai A, Batteiger TA, Nelson DE. Neisseria meningitidis ST11 Complex Isolates Associated with Nongonococcal Urethritis, Indiana, USA, 2015-2016. Emerg Infect Dis 2018; 23:336-339. [PMID: 28098538 PMCID: PMC5324800 DOI: 10.3201/eid2302.161434] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
At a clinic in Indianapolis, Indiana, USA, we observed an increase in Neisseria gonorrhoeae–negative men with suspected gonococcal urethritis who had urethral cultures positive for N. meningitidis. We describe genomes of 2 of these N. meningitidis sequence type 11 complex urethritis isolates. Clinical evidence suggests these isolates may represent an emerging urethrotropic clade.
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Gutierrez-Fernandez J, Medina V, Hidalgo-Tenorio C, Abad R. Two Cases of Neisseria meningitidis Proctitis in HIV-Positive Men Who Have Sex with Men. Emerg Infect Dis 2018; 23:542-543. [PMID: 28221124 PMCID: PMC5382739 DOI: 10.3201/eid2303.161039] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
We report 2 cases from Spain of infectious proctitis caused by Neisseria meningitidis in HIV-positive men who have sex with men. Genetic characterization of the isolates showed that they are unusual strains not found in other more frequent meningococcal locations. This finding suggests an association between specific strains and anogenital tract colonization.
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Ma KC, Unemo M, Jeverica S, Kirkcaldy RD, Takahashi H, Ohnishi M, Grad YH. Genomic Characterization of Urethritis-Associated Neisseria meningitidis Shows that a Wide Range of N. meningitidis Strains Can Cause Urethritis. J Clin Microbiol 2017; 55:3374-3383. [PMID: 28904187 PMCID: PMC5703804 DOI: 10.1128/jcm.01018-17] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Accepted: 09/08/2017] [Indexed: 11/20/2022] Open
Abstract
Neisseria meningitidis, typically a resident of the oro- or nasopharynx and the causative agent of meningococcal meningitis and meningococcemia, is capable of invading and colonizing the urogenital tract. This can result in urethritis, akin to the syndrome caused by its sister species, N. gonorrhoeae, the etiologic agent of gonorrhea. Recently, meningococcal strains associated with outbreaks of urethritis were reported to share genetic characteristics with the gonococcus, raising the question of the extent to which these strains contain features that promote adaptation to the genitourinary niche, making them gonococcus-like and distinguishing them from other N. meningitidis strains. Here, we analyzed the genomes of 39 diverse N. meningitidis isolates associated with urethritis, collected independently over a decade and across three continents. In particular, we characterized the diversity of the nitrite reductase gene (aniA), the factor H-binding protein gene (fHbp), and the capsule biosynthetic locus, all of which are loci previously suggested to be associated with urogenital colonization. We observed notable diversity, including frameshift variants, in aniA and fHbp and the presence of intact, disrupted, and absent capsule biosynthetic genes, indicating that urogenital colonization and urethritis caused by N. meningitidis are possible across a range of meningococcal genotypes. Previously identified allelic patterns in urethritis-associated N. meningitidis strains may reflect genetic diversity in the underlying meningococcal population rather than novel adaptation to the urogenital tract.
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Affiliation(s)
- Kevin C Ma
- Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Magnus Unemo
- WHO Collaborating Centre for Gonorrhoea and Other Sexually Transmitted Infections, National Reference Laboratory for Sexually Transmitted Infections, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Samo Jeverica
- Institute for Microbiology and Immunology, Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Robert D Kirkcaldy
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, CDC, Atlanta, Georgia, USA
| | - Hideyuki Takahashi
- Department of Bacteriology I, National Institute of Infectious Diseases, Tokyo, Japan
| | - Makoto Ohnishi
- Department of Bacteriology I, National Institute of Infectious Diseases, Tokyo, Japan
| | - Yonatan H Grad
- Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
- Division of Infectious Diseases, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
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Bazan JA, Turner AN, Kirkcaldy RD, Retchless AC, Kretz CB, Briere E, Tzeng YL, Stephens DS, Maierhofer C, Del Rio C, Abrams AJ, Trees DL, Ervin M, Licon DB, Fields KS, Roberts MW, Dennison A, Wang X. Large Cluster of Neisseria meningitidis Urethritis in Columbus, Ohio, 2015. Clin Infect Dis 2017; 65:92-99. [PMID: 28481980 PMCID: PMC5848337 DOI: 10.1093/cid/cix215] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 03/07/2017] [Indexed: 11/13/2022] Open
Abstract
Background Neisseria meningitidis (Nm) is a Gram-negative diplococcus that normally colonizes the nasopharynx and rarely infects the urogenital tract. On Gram stain of urethral exudates, Nm can be misidentified as the more common sexually transmitted pathogen Neisseria gonorrhoeae. Methods In response to a large increase in cases of Nm urethritis identified among men presenting for screening at a sexually transmitted disease clinic in Columbus, Ohio, we investigated the epidemiologic characteristics of men with Nm urethritis and the molecular and phylogenetic characteristics of their Nm isolates. The study was conducted between 1 January and 18 November 2015. Results Seventy-five Nm urethritis cases were confirmed by biochemical and polymerase chain reaction testing. Men with Nm urethritis were a median age of 31 years (interquartile range [IQR] = 24-38) and had a median of 2 sex partners in the last 3 months (IQR = 1-3). Nm cases were predominantly black (81%) and heterosexual (99%). Most had urethral discharge (91%), reported oral sex with a female in the last 12 months (96%), and were treated with a ceftriaxone-based regimen (95%). A minority (15%) also had urethral chlamydia coinfection. All urethral Nm isolates were nongroupable, ST-11 clonal complex (cc11), ET-15, and clustered together phylogenetically. Urethral Nm isolates were similar by fine typing (PorA P1.5-1,10-8, PorB 2-2, FetA F3-6), except 2, which had different PorB types (2-78 and 2-52). Conclusions Between January and November 2015, 75 urethritis cases due to a distinct Nm clade occurred among primarily black, heterosexual men in Columbus, Ohio. Future urogenital Nm infection studies should focus on pathogenesis and modes of sexual transmission.
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Affiliation(s)
- Jose A Bazan
- Division of Infectious Diseases, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus
- Sexual Health Clinic, Columbus Public Health, Ohio
| | - Abigail Norris Turner
- Division of Infectious Diseases, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus
| | - Robert D Kirkcaldy
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention
| | - Adam C Retchless
- Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention
| | - Cecilia B Kretz
- Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention
| | - Elizabeth Briere
- Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention
| | - Yih-Ling Tzeng
- Division of Infectious Diseases, Departments of Medicine and
| | - David S Stephens
- Division of Infectious Diseases, Departments of Medicine and
- Microbiology and Immunology, Emory University School of Medicine, and
| | - Courtney Maierhofer
- Division of Infectious Diseases, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus
| | - Carlos Del Rio
- Division of Infectious Diseases, Departments of Medicine and
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia; and
| | - A Jeanine Abrams
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention
| | - David L Trees
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention
| | | | | | | | | | - Amanda Dennison
- STD & Hepatitis Prevention Program, Bureau of Infectious Diseases, Ohio Department of Health, Columbus
| | - Xin Wang
- Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention
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Kahler CM. Emergence of a Urogenital Pathotype of Neisseria meningitidis. Trends Microbiol 2017; 25:510-512. [PMID: 28545723 DOI: 10.1016/j.tim.2017.05.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 05/15/2017] [Indexed: 12/31/2022]
Abstract
Neisseria meningitidis is the causative agent of transmissible sepsis and meningitis in humans. A urogenital pathotype of N. meningitidis as the causative agent of transmissible urethritis in the USA has been recently characterised. This pathotype belongs to clonal complex 11 and has lost capsule production but gained anaerobic growth.
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Affiliation(s)
- Charlene M Kahler
- Marshall Center for Infectious Diseases Research and Training, School of Biomedical Sciences, University of Western Australia, Australia.
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Emergence of a new Neisseria meningitidis clonal complex 11 lineage 11.2 clade as an effective urogenital pathogen. Proc Natl Acad Sci U S A 2017; 114:4237-4242. [PMID: 28373547 DOI: 10.1073/pnas.1620971114] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Neisseria meningitidis (Nm) clonal complex 11 (cc11) lineage is a hypervirulent pathogen responsible for outbreaks of invasive meningococcal disease, including among men who have sex with men, and is increasingly associated with urogenital infections. Recently, clusters of Nm urethritis have emerged primarily among heterosexual males in the United States. We determined that nonencapsulated meningococcal isolates from an ongoing Nm urethritis outbreak among epidemiologically unrelated men in Columbus, Ohio, are linked to increased Nm urethritis cases in multiple US cities, including Atlanta and Indianapolis, and that they form a unique clade (the US Nm urethritis clade, US_NmUC). The isolates belonged to the cc11 lineage 11.2/ET-15 with fine type of PorA P1.5-1, 10-8; FetA F3-6; PorB 2-2 and express a unique FHbp allele. A common molecular fingerprint of US_NmUC isolates was an IS1301 element in the intergenic region separating the capsule ctr-css operons and adjacent deletion of cssA/B/C and a part of csc, encoding the serogroup C capsule polymerase. This resulted in the loss of encapsulation and intrinsic lipooligosaccharide sialylation that may promote adherence to mucosal surfaces. Furthermore, we detected an IS1301-mediated inversion of an ∼20-kb sequence near the cps locus. Surprisingly, these isolates had acquired by gene conversion the complete gonococcal denitrification norB-aniA gene cassette, and strains grow well anaerobically. The cc11 US_NmUC isolates causing urethritis clusters in the United States may have adapted to a urogenital environment by loss of capsule and gene conversion of the Neisseria gonorrheae norB-aniA cassette promoting anaerobic growth.
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