Large Cluster of Neisseria meningitidis Urethritis in Columbus, Ohio, 2015

Bazan, José A.; Turner, Abigail Norris; Kirkcaldy, Robert D.; Retchless, Adam C.; Kretz, Cécilia B.; Briere, Elizabeth; Tzeng, Yih-Ling; Stephens, David S.; Maierhofer, Courtney; Rı́o, Carlos del; Abrams, A. Jeanine; Trees, David L.; Ervin, Melissa; Licon, Denisse B.; Fields, Karen S.; Roberts, Mysheika Williams; Dennison, Amanda; Wang, Xin

doi:10.1093/cid/cix215

Cited by 51 publications

(70 citation statements)

References 37 publications

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“…The standard pigeonholing of these species—while a convenient shorthand—belies the clinical observations that not all the Gram negative diplococci that cause “gonorrhea‐like” symptoms are N. gonorrhoeae . Meningococcus and Neisseria lactamica have been isolated in urethritis cases, and a recent outbreak of meningococcal urethritis renewed interest in the question of whether adaptation to the urogenital niche may happen periodically . N. gonorrhoeae is not as diverse as other Neisseria (Fig.…”

Section: Neisseria Gonorrhoeae: Clinical Manifestations and Originsmentioning

confidence: 99%

Applications of genomics to slow the spread of multidrug‐resistant Neisseria gonorrhoeae

Mortimer

Grad

2018

Annals of the New York Academy of Sciences

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Infections with Neisseria gonorrhoeae, a sexually transmitted pathogen that causes urethritis, cervicitis, and more severe complications, are increasing. Gonorrhea is typically treated with antibiotics; however, N. gonorrhoeae has rapidly acquired resistance to many antibiotic classes, and lineages with reduced susceptibility to the currently recommended therapies are emerging worldwide. In this review, we discuss the contributions of whole genome sequencing (WGS) to our understanding of resistant N. gonorrhoeae. Genomics has illuminated the evolutionary origins and population structure of N. gonorrhoeae and the magnitude of horizontal gene transfer within and between Neisseria species. WGS can be used to predict the susceptibility of N. gonorrhoeae based on known resistance determinants, track the spread of these determinants throughout the N. gonorrhoeae population, and identify novel loci contributing to resistance. WGS has also allowed more detailed epidemiological analysis of transmission of N. gonorrhoeae between individuals and populations than previously used typing methods. Ongoing N. gonorrhoeae genomics will complement other laboratory techniques to understand the biology and evolution of the pathogen, improve diagnostics and treatment in the clinic, and inform public health policies to limit the impact of antibiotic resistance.

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Section: Neisseria Gonorrhoeae: Clinical Manifestations and Originsmentioning

confidence: 99%

Applications of genomics to slow the spread of multidrug‐resistant Neisseria gonorrhoeae

Mortimer

Grad

2018

Annals of the New York Academy of Sciences

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“…In one study, 75 Nm urethritis cases detected between January and November of 2015 in Columbus OH, represented 20% of all men who presented during that time with urethral GNID and growth of oxidase‐positive Gram‐negative diplococci (Bazan et al ., ). Similar Nm‐associated urethritis clusters have now been observed in multiple US cities (Bazan et al ., ; ; Toh et al ., ; Retchless et al ., ). These urethritis‐associated Nm isolates are members of a novel nongroupable US Nm urethritis clade (US_NmUC) in the cc11/ET‐15 hyperinvasive lineage (Tzeng et al ., ).…”

Section: Introductionmentioning

confidence: 97%

“…However, there have been sporadic case reports in which Nm was isolated from patients with urethritis, cervicitis, vaginitis, proctitis, pelvic inflammatory disease and postpartum endometritis dating back to the 1940s (Givan et al ., ; Conde‐Glez and Calderon, ; Maini et al ., ). Recently, sustained sexually transmitted meningococcal urethritis outbreaks have been reported (Bazan et al ., ; ; Toh et al ., ; Tzeng et al ., ; Retchless et al ., ). In one study, 75 Nm urethritis cases detected between January and November of 2015 in Columbus OH, represented 20% of all men who presented during that time with urethral GNID and growth of oxidase‐positive Gram‐negative diplococci (Bazan et al ., ).…”

Section: Introductionmentioning

confidence: 99%

“…Recently, sustained sexually transmitted meningococcal urethritis outbreaks have been reported (Bazan et al ., ; ; Toh et al ., ; Tzeng et al ., ; Retchless et al ., ). In one study, 75 Nm urethritis cases detected between January and November of 2015 in Columbus OH, represented 20% of all men who presented during that time with urethral GNID and growth of oxidase‐positive Gram‐negative diplococci (Bazan et al ., ). Similar Nm‐associated urethritis clusters have now been observed in multiple US cities (Bazan et al ., ; ; Toh et al ., ; Retchless et al ., ).…”

Section: Introductionmentioning

confidence: 99%

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Heteroresistance to the model antimicrobial peptide polymyxin B in the emerging Neisseria meningitidis lineage 11.2 urethritis clade: mutations in the pilMNOPQ operon

Tzeng

Berman

Toh

et al. 2018

Molecular Microbiology

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Summary Clusters of Neisseria meningitidis (Nm) urethritis among primarily heterosexual males in multiple United States cities have been attributed to a unique non-encapsulated meningococcal clade (the U.S. 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, N. gonorrhoeae. The US_NmUC isolates were found to be highly resistant to the model AMP, polymyxin B (PmB, MICs 64–256 μg/ml). The isolates also demonstrated stable subpopulations of heteroresistant colonies that showed near total resistant to PmB (MICs 384–1024 μg/ml) and colistin (MIC 256 μg/ml) 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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“…In these cases, nongroupable NM (multi‐gene deletion at the capsule synthesis locus) were isolated. Surprisingly, MSM were not affected by these isolates, but rather by a hypervirulent serogroup C (ST‐11 clonal complex) responsible for several outbreaks of IMD in New York, Los Angeles, Chicago, Southern California, France, Berlin, etc . Taha et al .…”

mentioning

confidence: 99%

Neisseria meningitidis urethritis: synthesis of published data

Maatouk

2018

Int J Dermatology

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Large Cluster of Neisseria meningitidis Urethritis in Columbus, Ohio, 2015

Abstract: 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.

Cited by 51 publications

References 37 publications

Applications of genomics to slow the spread of multidrug‐resistant Neisseria gonorrhoeae

Applications of genomics to slow the spread of multidrug‐resistant Neisseria gonorrhoeae

Heteroresistance to the model antimicrobial peptide polymyxin B in the emerging Neisseria meningitidis lineage 11.2 urethritis clade: mutations in the pilMNOPQ operon

Neisseria meningitidis urethritis: synthesis of published data

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