de Oliveira Vítor Falcão, Coracini Tonacio Adriana, Marchi Ana Paula, Farrel Côrtes Marina, Luiza Bazzo Maria, Takeshigue Lemos Gabriela, Bortolotto Bampi Jose Victor, Patricia Sanchez Espinoza Evelyn, Luiz Tarsia Duarte Edson, Cristina Ruedas Martins Roberta, Alves Dos Santos Sânia, Vieira Perdigão Neto Lauro, Ramalho da Costa-Lourenço Ana Paula, Regina Bonelli Raquel, Rita Elmore Maria, Rossi Flavia, Hughes Gwenda, Figueiredo Costa Silvia
Departamento de Moléstias Infecciosas e Parasitárias, Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Arnaldo, 255, CEP: 01246-903, São Paulo, Brazil.
Laboratório de Investigação Médica, Bacteriologia e Resistência Antimicrobiana, Instituto de Medicina Tropical da FMUSP (LIM 49), Av. Dr. Enéas Carvalho de Aguiar, 470, CEP: 05403-000, São Paulo, Brazil.
Microbes Infect. 2023 Jan-Feb;25(1-2):105037. doi: 10.1016/j.micinf.2022.105037. Epub 2022 Aug 6.
In this study, we describe a case report of gonococcal arthritis in a Systemic Lupus Erythematosus patient. Although several mechanisms favor disseminated gonococcal infection (DGI) in patients immunosuppressed by SLE, this association is rarely reported in literature. We performed whole genome sequencing (WGS) of the etiologic agent involved and molecular analysis using a global collection of Neisseria gonorrhoeae strains. Ours is the only sample derived from synovial fluid identified in this collection, the others being from the usual anatomical sites. Antimicrobial susceptibility was determined by disk diffusion and Etest, and WGS was conducted to determine multilocus sequence typing profiles, group isolates based on core genome single nucleotide polymorphisms (SNP), and identify virulence genes and antimicrobial resistance determinants. The N. gonorrhoeae samples in the global collection were highly heterogeneous. The SNP tree had a total 19,532 SNPs in 320 samples. Our sample displayed resistance to ciprofloxacin (MIC = 2 μg/mL) and tetracycline (zone diameter = 0 mm) belonged to ST 1588 and was not closely related to any isolate in the global collection of N. gonorrhoeae strains. The isolate had genetic features related to beta-lactam, tetracycline and quinolone resistance. Seventy-one virulence genes were identified in our sample, belonging to the following classes: adherence, efflux pump, immune modulator, invasion, iron uptake, protease and stress adaptation. Moreover, no virulence genes for immune evasion and toxin were identified.
在本研究中，我们描述了一例系统性红斑狼疮患者发生淋菌性关节炎的病例报告。尽管有多种机制促使系统性红斑狼疮免疫抑制患者发生播散性淋球菌感染（DGI），但这种关联在文献中鲜有报道。我们对所涉及的病原体进行了全基因组测序（WGS），并使用淋病奈瑟菌菌株的全球集合进行分子分析。我们的样本是该集合中唯一来自滑液的样本，其他样本来自常见的解剖部位。通过纸片扩散法和Etest测定抗菌药物敏感性，并进行WGS以确定多位点序列分型谱，基于核心基因组单核苷酸多态性（SNP）对分离株进行分组，并鉴定毒力基因和抗菌药物耐药决定因素。全球集合中的淋病奈瑟菌样本高度异质。SNP树在320个样本中共有19,532个SNP。我们的样本对环丙沙星（MIC = 2 μg/mL）和四环素（抑菌圈直径 = 0 mm）耐药，属于ST 1588，与全球淋病奈瑟菌菌株集合中的任何分离株均无密切关系。该分离株具有与β-内酰胺、四环素和喹诺酮耐药相关的遗传特征。在我们的样本中鉴定出71个毒力基因，属于以下类别：黏附、外排泵、免疫调节剂、侵袭、铁摄取、蛋白酶和应激适应。此外，未鉴定出免疫逃避和毒素的毒力基因。
