Endocarditis infecciosa por Neisseria gonorroheae / Infectious endocarditis due to Neisseria gonorrhoeae

Resumen Se presenta un caso de endocarditis infecciosa por Neisseria gonorrhoeae, en un paciente masculino de 38 años, sin factores de riesgo cardiovascular ni otros antecedentes previos. La sospecha diagnóstica comienza por síndrome febril prolongado, astenia y pérdida de peso, confirmada con rescate de gonococo en los hemocultivos. Cumplió tratamiento antibiótico con ceftriaxona por 29 días. Evoluciona con insu ficiencia aórtica grave por lo cual se realiza cirugía de reemplazo valvular por prótesis mecánica bidisco exitosa, con una evolución favorable.

Abstract We report a case of infectious endocarditis due to Neisseria gonorrhoeae in a 38-year-old male patient with no cardiovascular risk factors or past medical history who presented with prolonged febrile illness, asthenia and weight loss. The blood cultures were positive for gonococcus. He received antibiotic treatment with ceftriaxone for 29 days. The patient developed severe aortic regurgitation and underwent surgical aortic valve replacement with a bileaflet mechanical prosthesis, with favorable outcome.

Neisseria gonorrhoeae: un patógeno díscolo: conceptos microbiológicos, resistencia a antimicrobianos y su vigilancia epidemiológica en Chile / Neisseria gonorrhoeae: a wayward pathogen: microbiological concepts, antimicrobial resistance and its epidemiological surveillance in Chile

Resumen Neisseria gonorrhoeae es un diplococo gramnegativo, no móvil, esporulado, aerobio o anaerobio facultativo, catalasa y oxidasa positivas. Las infecciones de transmisión sexual causadas por este microorganismo son un problema de salud pública definido como tal desde el siglo XIX, representando una gran amenaza para la salud humana debido a la su alta prevalencia y multirresistencia a antimicrobianos. En las últimas décadas han aumentado los reportes de cepas resistentes a penicilina, fluoroquinolonas, sulfonamidas, tetraciclina, macrólidos, y más recientemente a cefalosporinas y azitromicina. Tal panorama ha generado preocupación a nivel mundial, debido al aumento de casos de gonorrea asociados a cepas multirresistentes. En Chile se desarrolló desde el 2010 hasta el 2018 el Programa de Vigilancia de N. gonorrhoeae a nivel nacional con el objeto de caracterizar esta infección en las regiones y registrar la resistencia a los antimicrobianos. Esta revisión presenta un análisis sistemático bibliográfico, actualizado, de los principales aspectos de este microorganismo, su respuesta a antimicrobianos, y entrega pautas de diagnóstico y tratamiento, a la espera de avanzar en la comprensión del mecanismo molecular y las interacciones metabólicas e inmunológicas que determinan la infección, con miras a diseñar una vacuna efectiva.

Abstract Neisseria gonorrhoeae is a nonmotile, sporulated, aerobic or facultative anaerobic gram-negative diplococcus, catalase and oxidase positive. Sexually transmitted infections caused by this microorganism were established as public health problem since the 19th century, representing a great threat to human health due to its high prevalence and multi-resistance to antimicrobials. In recent decades, reports of strains resistant to penicillin, fluoroquinolones, sulfonamides, tetracycline, macrolides, and more recently to cephalosporins and azithromycin have increased. Such a panorama has generated concern worldwide, due to the increase in cases of gonorrhea associated with multi-resistant strains. In Chile, from 2010 to 2018, the National Surveillance Program for N. gonorrhoeae was developed in order to characterize this infection in the regions and record antimicrobial resistance. This review presents an updated, systematic bibliographic analysis of the main aspects of this microorganism, its response to antimicrobials, and provides diagnostic and treatment guidelines, while waiting to advance in the understanding of the molecular mechanism and the metabolic and immunological interactions that determine infection, with a view to designing an effective vaccine.

Antimicrobial Resistance of Neisseria gonorrhoeae Isolated from Out Patients Presenting with Urethral and Vaginal Discharges at Mbarara Regional Referral Hospital

Background: Gonococcus is one of the most common sexually transmitted diseases in developing countries and it has become a global health burden, hence a need for effective treatment. However, there is growing trend of antimicrobial resistant strains, in many parts of the world, to the previously effective antimicrobials thus creating serious health concerns.Setting: Mbarara Regional Referral Hospital -South-Western Uganda.Objectives:1) To determine the prevalence ofgonococcusamong out patients presenting with urethral and vaginal discharges at MRRH. 2) To determine the level of antimicrobial resistance ofgonococcusbased on phenotypic methods at MRRH.Design: The study was crosssectional and enrolled 189 participants presenting with urethral and vaginal discharges. The urethral and endo cervical swab samples collected were cultured on Chocolate media supplemented with 5%-10% carbondioxide in candle jar (inoculated plates were placed in a jar and a burning candle placed in the same jar, then closed, by the time the candle went off, that 5%-10% carbondioxide atmosphere would have been created). Isolates obtained were identified according to the laboratory standard operating procedures. Drug Sensitivity Test (DST) on confirmed Neisseria gonorrheaeisolates was performed using the Kirby Bauer technique. The colonies of the test organism were emulsified in peptone water and then inoculated on prepared sterile chocolate agarand the following discs were applied to it (Ceftriaxone discs (30μg), Erythromycin (15ug), Ciprofloxacin (10ug) and Penicillin (10IU). The plates were incubated at 37°C for 24-48 hours under 5% carbon dioxide atmospheres. The Zone of inhibition was seen around an antibiotic disc to which the organism was sensitive. Results: Out of the 189 participants whose urethral swabs and Endo cervical swabs were cultured, 89 were positive cultures (47%), out of which 25 (28%) were found to have gonococcal infection, 64 (72%) patients had other micro-organisms. The prevalence of NeisseriaGonorrhoeaewas 13%. In total, 4% of the isolates were resistant to Ceftriaxone, 28% to Ciprofloxacin, 68% to Erythromycin and 80% to Penicillin. A high percentage of resistance was observed against Penicillin (80%) and Erythromycin (68%).Conclusion: Adults aged 18 years and above who present at Mbarara Regional Referral Hospital with urethral or vaginal discharges are more likely to have a Neisseria gonorrhoeaewhich is resistant to Penicillin and Erythromycin

The Nongenomic Effects of Progesterone in Repressing iNOS Activation through P38MAPK Pathways in Gonococci-Infected Polymorphonuclear Leukocytes and the Clinical Significance / 华中科技大学学报（医学）（英德文版）

Progesterone has nongenomic effects on inducible nitric oxide synthase(iNOS),which is mediated by mitogen activated protein kinase(MAPK)pathways.This effect is supposed to have some potential association with asymptomatic gonococcal infections in women by immunological depression.In this study,polymorphonuclear leukocytes(PMNs)challenged by gonococci were used to study the nongenomic effects of progesterone.The activation of iNOS was assessed by measuring[3H]L-arginine converses to[3H]L-citruiline,and the activity of MAPK was detected by Western blot.It was found that the activity of iNOS and the yields of NO were enhanced significantly in gonococci-challenged PMNs compared with the controls(P<0.01).Progesterone could repress the activation of iNOS through P38MAPK pathway within PMNs(P<0.05),which could be blocked by SB203580(P<0.01),but not by actinomycin D(P>0.05).It was also found subsequently that in the serum specimens collected from gonococci-infected but asymptomatic women,the progesterone level was higher than that in women with severe symptoms(P<0.01).Moreover,the yield of NO had an inverse correlation with progester-one.With these results it suggested that the rapid nongenomic effects of progesterone may inhibit iNOS activation and NO yields mediated by P38MAPK pathways,which were supposed to be concerned with asymptomatic women infected with gonococci.

Cost-effectiveness Analysis of Five Therapeutic Schemes for Female's Urogenital Tract Infections of Gon-ococcus Combining Chlamydia / 中国药房

OBJECTIVE:To discuss the economic effectiveness of different therapeutic schemes for the same disease.METH_ODS:104 cases of female's urogenital tract infections of gonococcus combining chlamydia were randomly divided into five gro_ups,which were given ofloxacin(A),levofloxacin hydrochloride(B),clarithromycin(C),azithromycin(D)and ceftriaxone+erythromycin(E)respectively.Using pharmacoeconomic cost-effectiveness analysis method,the five schemes were compared.RES_ULTS:The costs of the five schemes were RMB 351,390,474,633 and 666 yuans,respectively.The ratios between cost and effectiveness were 5.7,4.5,5.5,7.6 and 8.3 in term of curative rate and 4.9,4.1,5.2,7.1 and 7.8 in term of effective rate respectively.CONCLUSION: B and C schemes are the best ones.