In Canada, N. gonorrhoeae isolates with decreased susceptibilities to third-generation cephalosporins have increased over the years. The alterations in penA, mtrR, and porB1b (penB alteration) are important determinants identified in these isolates. The most common STs identified among these Canadian isolates have also been reported worldwide.
A toxigenic Corynebacterium diphtheriae biovar mitis sequence type 136 (ST136) strain was recovered from a toe infection of an unvaccinated patient recently returned from India. The isolate was resistant to clindamycin, erythromycin (ermX positive), tetracycline, and trimethoprim-sulfamethoxazole, intermediate to ceftriaxone and cefotaxime, and had high MICs for telithromycin and chloramphenicol but was sensitive to other drugs. CASE REPORTA 38-year-old male was seen by a family physician in a city located in a western Canadian province for an evaluation of an abscess on his left second toe which started 3 days prior while the patient was visiting family and friends in India. The patient had no history of traumatic injury, denied contact with sick persons, and had an unknown vaccination history. A swab of the left second toe was sent within hours to a private laboratory for bacterial culture and drug sensitivity testing. The patient was prescribed 500 mg of cephalexin three times a day for 10 days, and he recovered uneventfully. Patient consent to describe this case was obtained for the purpose of this study.The direct Gram stain of the specimen revealed Gram-positive cocci and Gram-positive bacilli. After ϳ48 h of incubation under facultatively anaerobic conditions at 35°C on 5% sheep blood agar, the culture grew colonies which were identified as group A streptococci and Staphylococcus aureus. In addition, the culture also grew creamy, opaque, slightly raised nonhemolytic colonies; Gram smear of the isolate revealed Grampositive bacilli with club-shaped ends and occasional V forms. This strain was urease negative and facultatively anaerobic. Colonies were black with dark halos on Tinsdale medium (17). The isolate was referred to the BC Center for Disease Control Laboratory for confirmation and identification as Corynebacterium diphtheriae. This strain fermented glucose and maltose but not lactose, mannitol, glycogen, or xylose. When studied by conventional methods, this strain reduced nitrate to nitrite and was catalase positive. Black colonies typical for C. diphtheriae grew on freshly prepared cystine-tellurite blood agar (17). Albert's staining (18a) was performed after 24 h of growth on Loeffler's medium (PML Microbiologicals, bioMérieux), where typical blue-black metachromatic granules against a green cytoplasm were observed, consistent with C. diphtheriae (6). The strain was forwarded to the Canadian National Microbiology Laboratory (NML) for further characterization and toxigenicity testing (NML identifier 090066).Growth in brain heart infusion broth was not enhanced by the addition of ϳ1% (vol/vol) sterile Tween 80, a feature that, if present, is suggestive of C. diphtheriae biovar intermedius (9). Using conventional carbohydrate broth sugars (2), the strain was corroborated as being positive for catalase, reduction of nitrate, and fermentation of glucose, fructose, galactose, maltose, mannose, and ribose but not glycerol, glycogen, lactose, mannitol, raffinose, sucrose, trehalose, or xylose. Oxidase wa...
Conclusions Although this study shows a low prevalence of NG infection among young pregnant women in Brazil, they presented STI risk factors that justify include STI counselling for this population.
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