Europe-wide expansion and eradication of multidrug-resistant Neisseria gonorrhoeae lineages: a genomic surveillance study

Centre for Genomic Pathogen Surveillance and the Euro-GASP study group: Sonja Pleininger, Alexander Indra, Irith De Baetselier, Wim Vanden Berghe, Blaženka Hunjak, Tatjana Nemeth Blažić, Panayiota Maikanti-Charalambous, Despo Pieridou, Hana Zákoucká, Helena Žemličková, Steen Hoffmann, Susan Cowan, Lasse Jessen Schwartz, Rita Peetso, Jevgenia Epstein, Jelena Viktorova, Ndeindo Ndeikoundam, Beatrice Bercot, Cécile Bébéar, Florence Lot, Susanne Buder, Klaus Jansen, Vivi Miriagou, Georgios Rigakos, Vasilios Raftopoulos, Eszter Balla, Mária Dudás, Lena Rós Ásmundsdóttir, Guðrún Sigmundsdóttir, Guðrún Svanborg Hauksdóttir, Thorolfur Gudnason, Aoife Colgan, Brendan Crowley, Sinéad Saab, Paola Stefanelli, Anna Carannante, Patrizia Parodi, Gatis Pakarna, Raina Nikiforova, Antra Bormane, Elina Dimina, Monique Perrin, Tamir Abdelrahman, Joël Mossong, Jean-Claude Schmit, Friedrich Mühlschlegel, Christopher Barbara, Francesca Mifsud, Alje Van Dam, Birgit Van Benthem, Maartje Visser, Ineke Linde, Hilde Kløvstad, Dominique Caugant, Beata Młynarczyk-Bonikowska, Jacinta Azevedo, Maria-José Borrego, Marina Lurdes Ramos Nascimento, Peter Pavlik, Irena Klavs, Andreja Murnik, Samo Jeverica, Tanja Kustec, Julio Vázquez Moreno, Asuncion Diaz, Raquel Abad, Inga Velicko, Magnus Unemo, Helen Fifer, Jill Shepherd, Lynsey PattersonBackground: Genomic surveillance using quality-assured whole-genome sequencing (WGS) together with epidemiological and antimicrobial resistance (AMR) data is essential to characterise the circulating Neisseria gonorrhoeae lineages and their association to patient groups (defined by demographic and epidemiological factors). In 2013, the European gonococcal population was characterised genomically for the first time. We describe the European gonococcal population in 2018 and identify emerging or vanishing lineages associated with AMR and epidemiological characteristics of patients, to elucidate recent changes in AMR and gonorrhoea epidemiology in Europe. Methods: We did WGS on 2375 gonococcal isolates from 2018 (mainly Sept 1-Nov 30) in 26 EU and EEA countries. Molecular typing and AMR determinants were extracted from quality-checked genomic data. Association analyses identified links between genomic lineages, AMR, and epidemiological data. Findings: Azithromycin-resistant N gonorrhoeae (8·0% [191/2375] in 2018) is rising in Europe due to the introduction or emergence and subsequent expansion of a novel N gonorrhoeae multi-antigen sequence typing (NG-MAST) genogroup, G12302 (132 [5·6%] of 2375; N gonorrhoeae sequence typing for antimicrobial resistance [NG-STAR] clonal complex [CC]168/63), carrying a mosaic mtrR promoter and mtrD sequence and found in 24 countries in 2018. CC63 was associated with pharyngeal infections in men who have sex with men. Susceptibility to ceftriaxone and cefixime is increasing, as the resistance-associated lineage, NG-MAST G1407 (51 [2·1%] of 2375), is progressively vanishing since 2009-10. Interpretation: Enhanced gonococcal AMR surveillance is imperative worldwide. WGS, linked to epidemiological and AMR data, is essential to elucidate the dynamics in gonorrhoea epidemiology and gonococcal populations as well as to predict AMR. When feasible, WGS should supplement the national and international AMR surveillance programmes to elucidate AMR changes over time. In the EU and EEA, increasing low-level azithromycin resistance could threaten the recommended ceftriaxone-azithromycin dual therapy, and an evidence-based clinical azithromycin resistance breakpoint is needed. Nevertheless, increasing ceftriaxone susceptibility, declining cefixime resistance, and absence of known resistance mutations for new treatments (zoliflodacin, gepotidacin) are promising.This study was supported by the European Centre for Disease Prevention and Control, the Centre for Genomic Pathogen Surveillance, the Li Ka Shing Foundation (Big Data Institute, University of Oxford), the Wellcome Genome Campus, the Foundation for Medical Research at Örebro University Hospital, and grants from Wellcome (098051 and 099202). LSB was funded by Conselleria de Sanitat Universal i Salut Pública, Generalitat Valenciana (Plan GenT CDEI-06/20-B), Valencia, Spain, and Ministry of Science, Innovation and Universities (PID2020–120113RA-I00), Spain, at the time of analysing and writing this manuscript.info:eu-repo/semantics/publishedVersio

Dermatologic symptoms associated with gastrointestinal neoplasia

Gastrointestinal tumors are among the most common neoplastic causes of death worldwide. Presence of characteristic skin lesions can allow faster diagnosis and therapy and this way can increase the probability of a cure. In the paper we present the most important paraneoplastic syndromes that can coexist with gastrointestinal malignancy including colon, gastric, esophagus and pancreatic cancers. We take into account genetic syndromes such as Cowden syndrome, familial atypical multiple mole melanoma syndrome (FAMMM) (melanoma/pancreatic cancer), Clarke Howel-Evans, Peutz-Jeghers, Muir-Torre, Gardner syndromes and acquired syndromes such as acantosis nigricans maligna, tripe palms, Leser-Trelat, Bazex, hypertrichosis languinosa, erythema gyratum repens , carcinoid and glucagonoma syndrome. We also include cutaneous metastases and coexistence of neoplasia in some cases of dermatomyositis

Original paper Plasmid-mediated resistance to tetracyclines among Neisseria gonorrhoeae strains isolated in Poland between 2012 and 2013

A b s t r a c t Introduction: One of two main mechanisms of resistance in tetracycline-resistant Neisseria gonorrhoeae (TRNG) is associated with the presence of TetM protein responsible for actively blocking of the tetracycline target site in the 30S ribosomal subunit. This mechanism is encoded by conjugative plasmids. The second mechanism is chromosomal in nature and due to mutations in specific genes. Aim: To determine the incidence and type of tetM determinants in TRNG strains isolated from patients presenting with gonorrhea infection to the Dermatology and Venereology Clinic in Warsaw in 2012-2013. Material and methods: Tetracycline and doxycycline susceptibility was determined by E-Tests. The presence and type of the tetM gene were determined by polymerase chain reaction. Results: Tetracycline resistance was detected in 50.8% of the evaluated strains. The TRNG strains containing the tetM plasmid constituted 13.8% of all the evaluated strains. Dutch type tetM constituted 12.3% and American type tetM 1.5% of all the evaluated strains. In the remaining TRNG strains, resistance to tetracyclines was presumably chromosome-encoded. The minimal inhibitory concentration (MIC) of tetracycline ranged from 0.25 to 32.0 mg/l, MIC 50 = 2.0 mg/l, MIC 90 = 32.0 mg/l. The MIC of doxycycline ranged from 0.25 to 32.0 mg/l, MIC 50 = 4.0 mg/l, MIC 90 = 16.0 mg/l. Conclusions: Unlike most of European countries, in 2012-2013 in Poland, the Dutch type tetM was found to be much more common than the American type. Minimal inhibitory concentration values of tetracycline and doxycycline were similar, with doxycycline exhibiting a somewhat lower effectiveness in vitro than tetracycline towards chromosome-mediated tetracycline resistant strains of N. gonorrhoeae

SERS-based sensor for the detection of sexually transmitted pathogens in the male swab specimens: A new approach for gonorrhea diagnosis

https://kent-islandora.s3.us-east-2.amazonaws.com/node/14387/83893-thumbnail.jpgSexually transmitted diseases (STDs) refer to infections and syndromes passed through sexual contact and caused by bacteria, viruses, and fungi. It was estimated that each year around 376 million people struggle with bacterial STDs. There are several methods that enable diagnosis of STDs, but each of them has some limitations e.g.: Gram staining is characterized by its low detection rate while microbial culture requires time-consuming incubation and specific conditions for bacterial growth. Even the most recommended tests - nucleic acid amplification tests (NAATs) are very expensive and not every laboratory can afford it. For the above-described reasons, there is still a need to establish rapid, reliable and sensitive method for STDs diagnosis. More recently, a lot of studies have been done presenting the great potential of the application of SERS (Surface-enhanced Raman Spectroscopy) in diverse fields including medicine and biology. SERS is a kind of fingerprint technique based on the inelastic scattering of incident light by molecules adsorbed on the roughened metal surface (SERS-active substrate). The phenomenon of the SERS technique originates mainly from two main mechanisms: electromagnetic (EM) and chemical. In this study, we present that SERS-based sensor and chemometric analysis can be performed successfully in direct as well as indirect manner for STD diagnosis. The indirect (confirmatory) approach is based on the identification of unknown pathogenic strain in clinical sample by comparison its spectral image to others spectral image of different bacteria. While the direct one guarantees ultrafast diagnosis (up to 15 min) by classifying SERS spectra of clinical sample to the correct group by means of supervised technique (SIMCA, PLS1-DA). The undoubted advantage of this approach is that it does not involve advance preparation of sample and any chemical reagents while maintaining ultrahigh sensitivity. Hence, both of these methods can compete with many currently used techniques. This research may have a great impact in biomedical application since, the integration of SERS-based sensor with a small, portable Raman spectrometer could lead to the development of a handheld point-of-care device, which would enable the diagnosis of STD in extremely short time.</p

Syphilis in patients of the Department of Dermatology and Venereology at Medical University of Warsaw in 2015 – epidemiological and clinical characteristics, and coexistence of other sexually transmitted diseases

Introduction . Syphilis is a sexually transmitted disease that can be asymptomatic or associated with various symptoms including systemic manifestations. A total of 1,253 cases of syphilis were registered in Poland in 2015. Syphilis frequently coexists with HIV infection and other sexually transmitted diseases. Objective . Epidemiological and clinical characteristics of the population of patients treated for syphilis in the Department of Dermatology and Venereology, Medical University of Warsaw, and to evaluate the coexistence of other sexually transmitted diseases with special reference to HIV infection. Material and methods . The retrospective study involved an analysis of information included in medical files of 411 consecutive patients treated for syphilis in the Department of Dermatology and Venereology, Medical University of Warsaw, in 2015. Results . As many as 92% of the analyzed patients treated for syphilis were males, and 72.5% were men who have sex with men. Eighty-one percent of the subjects were between 21 and 40 years of age. Out of 325 patients with known HIV test results, 26.5% were HIV-positive. Evaluation of coexistence of other sexually transmitted diseases was difficult because of incomplete data, however gonorrhoea (7.8%) and hepatitis C virus infection (2.7%) were diagnosed more often in the studied group of patients with syphilis than in the general population. Hepatitis C virus infection was found in 6% of individuals co-infected with syphilis and HIV. Conclusion . The results confirm the need to screen patients with syphilis for HIV infection, and HIV-positive patients for syphilis