Neisseria gonorrhoeae arthritis in a patient with systemic lupus: resistance and virulence profiles

• Published in: Microbes and infection Vol. 25; no. 1-2; p. 105037
• Main Authors: 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
• Format: Journal Article
• Language: English
• Published: France Elsevier Masson SAS 01.01.2023
• Subjects: Anti-Bacterial Agents - pharmacology; Anti-Infective Agents; Arthritis; Drug Resistance, Bacterial - genetics; Gonococcal arthritis; Gonorrhea; Humans; Microbial Sensitivity Tests; Neisseria gonorrhoeae; Neisseria gonorrhoeae - genetics; Resistance; Tetracycline; Whole genome sequencing; Resistance; Neisseria gonorrhoeae; Whole genome sequencing; Gonococcal arthritis
• ISSN: 1286-4579; 1769-714X
• DOI: 10.1016/j.micinf.2022.105037

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.