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

Vítor Falcão de Oliveira; Adriana Coracini Tonacio; Ana Paula Marchi; Marina Farrel Côrtes; Maria Luiza Bazzo; Gabriela Takeshigue Lemos; Jose Victor Bortolotto Bampi; Evelyn Patricia Sanchez Espinoza; Edson Luiz Tarsia Duarte; Roberta Cristina Ruedas Martins; +8 more... Sânia Alves Dos Santos; Lauro Vieira Perdigão Neto; Ana Paula Ramalho da Costa-Lourenço; Raquel Regina Bonelli; Maria Rita Elmore; Flavia Rossi; Gwenda Hughes ORCID logo; Silvia Figueiredo Costa; (2022) Neisseria gonorrhoeae arthritis in a patient with systemic lupus: resistance and virulence profiles. Microbes and infection, 25 (1-2). 105037-. ISSN 1286-4579 DOI: 10.1016/j.micinf.2022.105037
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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.

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