Conjunctivitis Caused by Neisseria gonorrhoeae Isolates with Reduced Cephalosporin Susceptibility and Multidrug Resistance

Abstract

bWe report two cases of conjunctivitis caused by Neisseria gonorrhoeae with reduced cephalosporin susceptibility. Patients showed no response to cefmenoxime eye drops and intravenous ceftriaxone administration. The patients' condition improved after the addition of oral minocycline. The isolates contained the mosaic penA for reduction of ␤-lactam susceptibility. CASE REPORTSC ase 1. A 31-year-old man visited a private clinic and presented with conjunctival injection and discharge in his right eye. A diagnosis of acute conjunctivitis was made, and he was treated with a combination of 1.5% levofloxacin (LVFX) and 0.1% betamethasone eye drops 4 times per day. However, his symptoms had worsened 2 days later, and he was referred to our hospital. Slitlamp biomicroscopy revealed severe purulent discharge, conjunctival injection, and eyelid edema in the right eye (Fig. 1A). However, he did not have conjunctival papillae or follicles or corneal epithelial damage. Direct microscopy and bacterial culture of the discharge were performed. Direct microscopy demonstrated the presence of Gram-negative diplococci, and the culture reports confirmed the presence of Neisseria gonorrhoeae. The patient did not have other gonococcal infection, such as pharyngitis or urethritis. We considered conjunctivitis caused by N. gonorrhoeae and began treatment with topical 0.5% cefmenoxime (CMX) every hour and intravenous administration of ceftriaxone (CTRX) (1 g/day) for 3 days. Although the amount of discharge was slightly decreased 1 week after initiating the therapy, conjunctival injection was still active (Fig. 1B). We added oral minocycline (MINO; 200 mg/day) for 2 weeks after obtaining drug susceptibility testing results, and the conjunctivitis resolved within 7 days (Fig. 1C).Case 2. A 28-year-old woman visited a local hospital and presented with conjunctival injection and discharge in the right eye. She was treated with a combination of 1.5% LVFX and 0.1% fluorometholone eye drops 4 times per day. However, the amount of discharge increased, and she was referred to our hospital. Slitlamp biomicroscopy revealed severe purulent discharge and eyelid edema. The patient's condition was similar to the condition shown in Fig. 1A. Microbiological tests revealed the presence of Neisseria gonorrhoeae. She did not have other gonococcal infection. We started treatment with topical 0.5% CMX every hour and intravenous administration of CTRX (1 g/day) for 3 days. As conjunctival infection was still active 3 days later, oral MINO (200 mg/day) was administered for 1 week. Conjunctival inflammation subsided within 5 days after the addition of MINO.Antimicrobial susceptibility testing.

Gonococcal Conjunctivitis Despite Successful Treatment of Male Urethritis Syndrome

“…In contrast to several recently reported cases of progressive ocular infection due to N. gonorrhoeae strains with reduced cephalosporin susceptibility or resistance, the strain isolated from the conjunctiva of our patient was fully susceptible to cephalosporins. 1,2 Ocular gonorrhoea, as is the case in this patient, generally presents with eyelid swelling, conjunctival chemosis and hyperacute purulent discharge. If left untreated, the infection will progress from the conjunctiva into the cornea resulting in peripheral corneal ulceration that may rapidly progress to corneal perforation.…”

Conjunctivitis Caused by a Strain of <i>Neisseria gonorrhoeae</i> That Was Less Susceptible to Ceftriaxone

“…To treat N. gonorrhoeae infections, we should perform culture and susceptibility testing for each case. In a case report from Ehime Prefecture in Japan, two patients with conjunctivitis caused by a strain of N. gonorrhoeae that displayed decreased susceptibility to cephalosporin were reportedly treated with minocycline ( 15 ).…”