<i>Notes from the Field</i>: Increase in<i>Neisseria meningitidis–</i>Associated Urethritis Among Men at Two Sentinel Clinics — Columbus, Ohio, and Oakland County, Michigan, 2015

Bazan, José A.; Peterson, Amy; Kirkcaldy, Robert D.; Briere, Elizabeth; Maierhofer, Courtney; Turner, Abigail Norris; Licon, Denisse B.; Parker, Nicole; Dennison, Amanda; Ervin, Melissa; Johnson, Laura A.; Weberman, Barbara; Hackert, Pamela; Wang, Xin; Kretz, Cécilia B.; Abrams, A. Jeanine; Trees, David L.; Rı́o, Carlos del; Stephens, David S.; Tzeng, Yih-Ling; DiOrio, Mary; Roberts, Mysheika Williams

doi:10.15585/mmwr.mm6521a5

Cited by 52 publications

(67 citation statements)

References 7 publications

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“…Our data indicate that a new nonencapsulated meningococcal clade of cc11 lineage 11.2/ET-15 (IS1301 containing), fine-type P1.5-1, 10-8, F3-6, 2-2, which is monophylogenic within cc11 (Fig. S1), is causing unprecedented clusters of urethritis in the United States (14). In addition to the large cluster observed in Columbus, Ohio, other sexually transmitted infection clinics in Oakland County, Michigan, Indianapolis, Atlanta, and other cities have also reported increased cases of cc11 Nm causing urethritis.…”

Section: Discussionmentioning

confidence: 83%

“…1A). This explained the nongroupable phenotype of US_NmUC isolates (14) and their corresponding susceptibility to killing by normal human serum in serum bactericidal assays. WGS of all 56 isolates confirmed the absence of cssA/B/C genes and the presence of IS1301, suggesting that this modification can serve as a unique genetic marker for this US Nm urethritis clade.…”

Section: Resultsmentioning

confidence: 91%

“…Smaller urethritis clusters, caused by Nm with the same genotype, have also been observed in Oakland County, Michigan (14), and later in multiple other US sites. In this study, we define genotypic properties of an emerging clade, termed the US Nm urethritis clade (US_NmUC), through whole-genome sequencing (WGS) analyses Significance Neisseria meningitidis (Nm) remains a leading cause of meningitis and rapidly fatal sepsis in otherwise healthy individuals.…”

mentioning

confidence: 75%

“…In addition to the large cluster observed in Columbus, Ohio, other sexually transmitted infection clinics in Oakland County, Michigan, Indianapolis, Atlanta, and other cities have also reported increased cases of cc11 Nm causing urethritis. Since 2015, this clade was the exclusive cause of a significant portion (∼20%) of symptomatic urethral infections (with urethral Gram-negative intracellular diplococci and growth of oxidase-positive Gram-negative diplococci) in Columbus (14). In Indianapolis, rates of discordant nongonococcal urethritis were 2.8, 1.4, and 6.9% in 2013, 2014, and 2015, respectively, indicating a significant increase in meningococcal urethritis (31).…”

Section: Discussionmentioning

confidence: 99%

“…Since January 2015 in the sexual health clinic of Columbus, Ohio, a significant portion (3-36%/month) of initially presumed Ng-symptomatic urethral infections, primarily among heterosexual men, have been determined to be meningococcal urethritis (now >100 cases) caused by nongroupable cc11 Nm (14). Smaller urethritis clusters, caused by Nm with the same genotype, have also been observed in Oakland County, Michigan (14), and later in multiple other US sites.…”

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confidence: 99%

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Emergence of a new Neisseria meningitidis clonal complex 11 lineage 11.2 clade as an effective urogenital pathogen

Tzeng

Bazan

Turner

et al. 2017

Proc. Natl. Acad. Sci. U.S.A.

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124

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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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Section: Discussionmentioning

confidence: 83%

Section: Resultsmentioning

confidence: 91%

mentioning

confidence: 75%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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