Lodi Lorenzo, Rubino Chiara, Ricci Silvia, Indolfi Giuseppe, Giovannini Mattia, Consales Guglielmo, Magazzini Simone, Lai Franco, Vasarri Pierluigi, Conti Antonella, Brunelli Tamara, Moriondo Maria, Azzari Chiara
Post-graduate School of Pediatrics, University of Florence, Florence, Italy.
Department of Health Sciences, University of Florence and Meyer Children's University Hospital, Florence, Italy.
J Chemother. 2020 Apr;32(2):98-102. doi: 10.1080/1120009X.2020.1723967. Epub 2020 Feb 10.
We present the first Italian reported case of an invasive meningococcal disease with rifampicin-resistance (Rif-R)secondary to chemoprophylaxis. The case is entered in a cluster of two IMDs registered in Tuscany, Italy, in November 2019 caused by two non-differentiable group-C belonging to ST-11 clonal-complex. The contact case, differently from the index, harbored H552Y mutation on gene which is known to confer Rif-R putting a high-cost fee on bacterial fitness. The extremely mild clinical presentation in the contact can constitute an demonstration of the virulence attenuation observed for H552Ymutants. Clinicians should be aware of the possibility of secondary cases with induced Rif-R and keep a high level of suspicion on contacts who received rifampicin-chemoprophylaxis. Molecular characterization of Rif-R should be performed routinely directly on biological samples and not only on isolates, in order to rapidly detect rare cases of resistance and consequently modify chemoprophylaxis for contacts.
我们报告了意大利首例因化学预防继发的耐利福平（Rif-R）侵袭性脑膜炎球菌病病例。该病例属于2019年11月在意大利托斯卡纳登记的两例侵袭性脑膜炎球菌病聚集性病例之一，由两个无法区分的C群菌株引起，它们属于ST-11克隆复合体。与索引病例不同，接触病例在基因上存在H552Y突变，已知该突变会导致耐利福平，这对细菌适应性造成了高成本代价。接触病例极其轻微的临床表现可证明观察到的H552Y突变体的毒力减弱。临床医生应意识到继发耐利福平病例的可能性，并对接受利福平化学预防的接触者保持高度怀疑。应常规直接对生物样本而非仅对分离株进行耐利福平的分子特征分析，以便快速检测罕见的耐药病例，从而修改对接触者的化学预防措施。
