1/104. Genotypic evolution in a quinolone-resistant neisseria gonorrhoeae isolate from a patient with clinical failure of levofloxacin treatment.Recently, a reduction in the antimicrobial susceptibility of clinical isolates of neisseria gonorrhoeae to newer fluoroquinolones including levofloxacin in vitro has been recognized in japan. We examined the quinolone resistance mechanisms in N. gonorrhoeae isolates from a patient with clinical failure of levofloxacin treatment. Man with gonococcal urethritis was treated with oral 100 mg levofloxacin 3 times daily for 7 days. However, clinical failure of the treatment was observed. The minimum inhibitory concentration of levofloxacin for the posttreatment isolate (4.0 microg/ml) was 4-fold higher than that for the pretreatment isolate (1.0 microg/ml). To analyze quinolone resistance mechanisms in the set of isolates, we performed dna sequencing of the quinolone resistance-determining regions within the gyrA and parC genes. Moreover, we assayed the intracellular levofloxacin and norfloxacin accumulation level in these isolates. The pretreatment isolate contained three substitutions compared to susceptible wild-type isolate, including serine to phenylalanine at position 91 and aspartic acid to asparagine at position 95 in the GyrA protein, and serine to proline at position 88 in the ParC protein. The posttreatment isolate had four substitutions, including the same three substitutions and an additional glutamic acid to glutamine substitution at position 91 in ParC. There was no significant difference in the level of accumulation of levofloxacin and norfloxacin between the pretreatment and posttreatment isolates. Our results indicate that levofloxacin selects a mutant having an additional alteration within the gene cording for the ParC protein during treatment, which may have enhanced quinolone resistance in the organism.- - - - - - - - - - ranking = 1keywords = gonorrhoeae (Clic here for more details about this article) |
2/104. neisseria gonorrhoeae resistant to ciprofloxacin: first report in cuba.BACKGROUND AND OBJECTIVES: The Cuban Ministry of public health plans to implement the syndromic approach to sexually transmitted diseases in persons with urethral or vaginal syndrome in cuba using 500 mg ciprofloxacin as therapy. Although the emergence of clinical isolates of neisseria gonorrhoeae with decreased susceptibility to ciprofloxacin have been sporadically detected in cuba, there has been no report of isolates that exhibited significant resistance to this drug. This is the first report of the isolation of a N gonorrhoeae strain resistant to ciprofloxacin in cuba. STUDY DESIGN: Case report. CONCLUSIONS: This case emphasizes the need for awareness regarding the potential emergence of a clinically significant resistance of N gonorrhoeae in cuba. There is a need for continued antimicrobial susceptibility surveillance of Cuban isolates to ciprofloxacin and other fluoroquinolones.- - - - - - - - - - ranking = 1.1666666666667keywords = gonorrhoeae (Clic here for more details about this article) |
3/104. Emergence of cephem- and aztreonam-high-resistant neisseria gonorrhoeae that does not produce beta-lactamase.Regarding neisseria gonorrhoeae, the National Committee for Clinical Laboratory Standards (NCCLS) has not defined the breakpoint minimum inhibitory concentration (MIC) for expanded spectrum cephems such as cefpodoxime and ceftizoxime, because of the absence of resistant strains to these antibiotics. To date, in gonococcal urethritis, after treatment with third generation cephems and aztreonam, clinical failures caused by resistant N. gonorrhoeae strains have not been reported. However, we experienced two clinical failures in patients with gonococcal urethritis treated with cefdinir and aztreonam. N. gonorrhoeae isolates from these two patients showed high-level MICs to these agents. The MIC of cefdinir was 1 microg/ml for both strains and that of aztreonam was 8 microg/ml for both strains, while the MICs of other beta-lactams were also higher than the NCCLS value, except for ceftriaxone, for which the MIC was 0.125 microg/ml for both strains. Moreover, the MICs of fluoroquinolones, tetracyclines, and erythromycin against these two isolates were higher than the NCCLS susceptibility value. These isolates were susceptible to spectinomycin. In N. gonorrhoeae, the emergence of these beta-lactam-resistant isolates is of serious concern. However, a more serious problem is that these isolates were already resistant to non-beta-lactam antimicrobials. In japan, ceftriaxone has not been permitted for clinical use against gonococcal infections. Therefore, in japan, patients with gonococcal urethritis caused by these resistant N. gonorrhoeae strains should be treated with cefodizime or spectinomycin.- - - - - - - - - - ranking = 1.5keywords = gonorrhoeae (Clic here for more details about this article) |
4/104. Recognition of an asymptomatic male carrier of neisseria gonorrhoeae in singapore - a case report.neisseria gonorrhoeae was isolated from centrifuged urine deposit of an asymptomatic male. The case history and significance of this asymptomatic infection are described.- - - - - - - - - - ranking = 0.83333333333333keywords = gonorrhoeae (Clic here for more details about this article) |
5/104. Gonococcal ophthalmia treated with ciprofloxacin.neisseria gonorrhoeae infection in the eye and its treatment with ciprofloxacin is presented.- - - - - - - - - - ranking = 0.16666666666667keywords = gonorrhoeae (Clic here for more details about this article) |
6/104. Simultaneous scabies and gonococcal infection.A case is presented of an unusual complication arising in a man with scabies and gonococcal urethritis: the secondary infection of excoriated genital lesions by neisseria gonorrhoeae. This occurred after he had occluded his genitals with a plastic wrap.- - - - - - - - - - ranking = 0.16666666666667keywords = gonorrhoeae (Clic here for more details about this article) |
7/104. Disseminated gonococcemia.A 26-year-old woman presented with a high-grade fever and chills of 2 days' duration. She complained of associated joint pain, especially in the wrists and knees. One day before admission, tender skin lesions began to develop on the fingers, and subsequently spread to the more proximal extremities. The patient recalled having a sore throat and a nonproductive cough before the onset of the fever and eruption. The past medical history was significant for gardnerella vaginitis and several urinary tract infections. The patient was taking oral contraceptive pills; her most recent menstruation was 3 weeks before admission. She reported having sexual intercourse with her boyfriend 2 weeks before admission. The patient's temperature was 40 degrees C. Dermatologic examination revealed a 6-mm, hemorrhagic pustule on an ill-defined pink base, overlying the volar aspect of the left second proximal interphalangeal joint (Fig. 1a). Scattered on the upper and lower extremities were occasional round, ill-defined pink macules with central pinpoint vesiculation (Fig. 1b). A skin biopsy of the digit revealed a dense neutrophilic infiltrate with leukocytoclasis and marked fibrin deposition in the superficial and deep dermal vessels (Fig. 2a). Gram stains demonstrated the presence of Gram-negative diplococci (Fig. 2b). Laboratory findings included leukocytosis (leukocyte count of 20 x 109/L, with 81% neutrophils). Analysis of an endocervical specimen by polymerase chain reaction was positive for neisseria gonorrhoeae and negative for chlamydia trachomatis. Throat and blood cultures grew N. gonorrhoeae. Specimen cultures obtained by skin biopsy yielded no growth. Results of serologic analysis for human immunodeficiency virus, hepatitis, syphilis, and pregnancy were negative. Beginning on admission, intravenous ceftriaxone, 2 g, was administered every 24 h for 6 days, followed by oral cefixime, 400 mg twice daily for 4 days. Oral azithromycin, 1 g, was administered to treat possible coinfection with C. trachomatis. By treatment day 4, the patient was afebrile, with the resolution of leukocytosis and symptomatic improvement of arthralgias.- - - - - - - - - - ranking = 0.33333333333333keywords = gonorrhoeae (Clic here for more details about this article) |
8/104. Perianal abscess due to neisseria gonorrhoeae: an unusual case in the post-antibiotic era.Described here is the case of a 21-year-old homosexual male patient who presented with perianal abscess without urethritis that was caused by infection with neisseria gonorrhoeae. Incision and drainage of the abscess and oral penicillin therapy resulted in full healing, without the development of an anal fistula. The spectrum of gonococcal abscesses and the relevant aspects of their management are discussed.- - - - - - - - - - ranking = 0.83333333333333keywords = gonorrhoeae (Clic here for more details about this article) |
9/104. Fulminant endocarditis due to infection with penicillinase-producing neisseria gonorrhoeae.endocarditis is a rare but potentially lethal manifestation of gonococcal infection. We report the case of a patient with fulminant endocarditis secondary to infection with penicillinase-producing neisseria gonorrhoeae (PPNG). The patient had rapid deterioration from extensive destruction of the aortic valve with abscess and fistula formation. Lifesaving emergency surgery was performed. To our knowledge this is the first reported case of gonococcal endocarditis secondary to infection with a penicillinase-producing organism.- - - - - - - - - - ranking = 0.83333333333333keywords = gonorrhoeae (Clic here for more details about this article) |
10/104. low back pain due to neisseria prostatitis: report of three cases.After a short term of employment in a new job, 3 young heroin addicts became disabled from low back pain due to neisseria gonorrhea prostatitis. Each returned to work after a few weeks of antibiotic therapy without symptoms following proper diagnosis. These patients demonstrate the importance of a careful history and thorough examination of the patient with low back pain including a rectal examination of the prostate gland.- - - - - - - - - - ranking = 0.039108950201604keywords = neisseria (Clic here for more details about this article) |
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