ABSTRACT
INTRODUCTION: The increase in sexually transmitted infections (STI) caused by Neisseria gonorrhoeae (NG) worldwide, together with the decrease in antibiotic susceptibility, forced us to understand the epidemiology of gonococcal infection. METHODS: The GONOvig project analyzed, comparatively following CLSI and EUCAST criteria, the antibiotic susceptibility of 227 NG strains collected in thirteen representative hospitals of the Valencia Community (CV) between 2013 and 2018. Additionally, molecular typing of 175 strains using the NG multi-antigen sequence typing technique (NG-MAST) was performed. RESULTS: High rates of resistance to tetracycline (38.2% by CLSI and 50.9% by EUCAST) and ciprofloxacin (49.1% CLSI and 54% EUCAST), and low percentages of resistance to spectinomycin (0%), cefixime (0.5% CLSI but 5.9% EUCAST), and ceftriaxone (1.5% CLSI and 2.4% EUCAST) were detected. Azithromycin resistance was 6% (both CLSI and EUCAST). Molecular analysis revealed the presence of 86 different sequence types (ST), highlighting ST2992 (7.4%), ST3378 (6.9%), ST2400 (4.6%) and ST13288 (6.9%), which was associated with resistance to cefixime (P=.031). The main genogroups (G) were G1407 (13.1%), G2992 (10.3%), G2400 (6.3%) and G387 (3.4%). G1407 and G2400 were associated with resistance to ciprofloxacin (P<.03). CONCLUSION: Low resistance to ceftriaxone, a worrying resistance to azithromycin and a wide variety of circulating sequence types have been detected, some of which show correlation with certain resistance profiles.
Subject(s)
Gonorrhea , Neisseria gonorrhoeae , Humans , Neisseria gonorrhoeae/genetics , Cefixime/pharmacology , Ceftriaxone/pharmacology , Azithromycin , Spain/epidemiology , Microbial Sensitivity Tests , Anti-Bacterial Agents/pharmacology , Gonorrhea/epidemiology , Ciprofloxacin/pharmacology , GenotypeABSTRACT
Introducción: El aumento de las infecciones de transmisión sexual (ITS) producidas por Neisseria gonorrhoeae (NG) a nivel mundial, junto con la disminución de la susceptibilidad antibiótica, obliga a profundizar en la epidemiología de la infección gonocócica (IG). Métodos: El proyecto GONOvig analizó, comparativamente siguiendo criterios CLSI y EUCAST, la sensibilidad antibiótica de 227 cepas de NG recogidas en trece hospitales representativos de la Comunidad Valenciana (CV) entre los años 2013 y 2018. Adicionalmente, se pudo realizar la tipificación molecular de 175 cepas mediante la técnica NG multi-antigen sequence typing (NG-MAST). Resultados: Se detectaron elevadas tasas de resistencia a tetraciclina (38,2% por CLSI y 50,9% por EUCAST) y ciprofloxacino (49,1% CLSI y 54% EUCAST), y bajos porcentajes de resistencia a espectinomicina (0%), cefixima (0,5% CLSI pero 5,9% EUCAST) y ceftriaxona (1,5% CLSI y 2,4% EUCAST). La resistencia a azitromicina fue de 6% (tanto CLSI como EUCAST). El análisis molecular reveló la presencia de 86 secuenciotipos (ST) distintos, destacando el ST2992 (7,4%), ST3378 (6,9%), ST2400 (4,6%) y ST13288 (6,9%) el cual presentaba asociación con resistencia a cefixima (p = 0,031). Los genogrupos (G) mayoritarios fueron el G1407 (13,1%), G2992 (10,3%), G2400 (6,3%) y G387 (3,4%); G1407 y G2400 mostraron asociación con resistencia a ciprofloxacino (p < 0,03). Conclusión: Se ha detectado una baja resistencia a ceftriaxona, una preocupante resistencia a azitromicina y una gran variedad de ST circulantes, algunos de los cuales presentan correlación con determinados perfiles de resistencia.(AU)
Introduction: The increase in sexually transmitted infections (STI) caused by Neisseria gonorrhoeae (NG) worldwide, together with the decrease in antibiotic susceptibility, forced us to understand the epidemiology of gonococcal infection. Methods: The GONOvig project analyzed, comparatively following CLSI and EUCAST criteria, the antibiotic susceptibility of 227 NG strains collected in thirteen representative hospitals of the Valencia Community (CV) between 2013 and 2018. Additionally, molecular typing of 175 strains using the NG multi-antigen sequence typing technique (NG-MAST) was performed. Results: High rates of resistance to tetracycline (38.2% by CLSI and 50.9% by EUCAST) and ciprofloxacin (49.1% CLSI and 54% EUCAST), and low percentages of resistance to spectinomycin (0%), cefixime (0.5% CLSI but 5.9% EUCAST), and ceftriaxone (1.5% CLSI and 2.4% EUCAST) were detected. Azithromycin resistance was 6% (both CLSI and EUCAST). Molecular analysis revealed the presence of 86 different sequence types (ST), highlighting ST2992 (7.4%), ST3378 (6.9%), ST2400 (4.6%) and ST13288 (6.9%), which was associated with resistance to cefixime (p = 0.031). The main genogroups (G) were G1407 (13.1%), G2992 (10.3%), G2400 (6.3%) and G387 (3.4%). G1407 and G2400 were associated with resistance to ciprofloxacin (p < 0.03). Conclusión: Low resistance to ceftriaxone, a worrying resistance to azithromycin and a wide variety of circulating sequence types have been detected, some of which show correlation with certain resistance profiles.(AU)
Subject(s)
Humans , Male , Female , Neisseria gonorrhoeae/genetics , Sexually Transmitted Diseases , Drug Resistance, Microbial , Anti-Bacterial Agents , Microbiology , Communicable Diseases , Spain , Prospective StudiesABSTRACT
El linfoma es la forma más prevalente de neoplasia hematológica, clasificándose en dos grandes grupos, Hodgkin y no Hodgkin. El linfoma de células del manto (LCM) es un subtipo de linfoma no Hodgkin tipo B, de carácter agresivo y que tiene su origen en células de la zona periférica del centro germinal o en la zona del manto del folículo linfoide. El LCM es uno de los linfomas menos frecuentes, suponiendo cerca del 7% de los casos de linfoma no Hodgkin en los EE. UU. y Europa, con una incidencia aproximada de 4 a 8 casos por millón de personas y año. En torno a tres cuartas partes de los pacientes son varones caucasianos, reduciéndose a la mitad la frecuencia en la raza negra. La edad media en el diagnóstico es de 68 años, desarrollando adenopatías en el 75% de los casos y produciéndose diseminación extranodal en el 25% restante (bazo, médula ósea, sangre, tracto gastrointestinal, mama, pleura y anejos oculares). El laboratorio es un pilar clave en el diagnóstico de LCM establecido mediante el estudio histológico, inmunofenotípico y molecular. El 70% de los pacientes que se diagnostican presentan la enfermedad en un estadio avanzado. Ello conlleva frecuentemente la extensión gastrointestinal y a médula ósea. Aunque los linfomas afectan principalmente a ganglios linfáticos y tejidos linfoides, en algunos casos invaden la médula ósea y sangre periférica. Este proceso recibe el nombre de leucemización y ocurre en el 35% de los casos. Ante una cifra de leucocitos elevada en un paciente diagnosticado de LCM, el cometido del laboratorio será observar el frotis de sangre periférica en busca de linfocitos de aspecto centrocítico. on los tratamientos convencionales, la supervivencia media era de 3 años, cifra que ha aumentado hasta los 7 años para los pacientes que reciben los nuevos tratamientos. El pronóstico de LCM leucemizado es inferior al de las formas ganglionares sin expresión periférica (AU)
Lymphoma is the most prevalent kind of hematopoietic neoplasm, and it can be classified into two groups, Hodgkin and non-Hodgkin lymphoma. Mantle cell lymphoma (MCL) is one of the mature B cell non-Hodgkin lymphomas, with aggressive behavior and originates in peripheral zone cells of the germinal center or in the mantle zone of lymphoid. The mantle cell lymphoma is one of the less common lymphomas, and comprises about 7% of cases of non-Hodgkin lymphoma in the US and Europe, with an incidence of 4 to 8 cases per million persons per year. Around three-quarters of affected patients are Caucasian males, halving the rate in blacks. Median age at diagnosis is 68 years. Approximately 75% of patients initially present with lymphadenopathy and disease is the primary presentation in the remaining 25% (spleen, bone marrow, blood, gastrointestinal tract, breast, pleura and eye orbit). The Laboratory is a key pillar in the diagnosis of MCL established by histological, immunophenotypic and molecular study. Most patients with mantle cell lymphoma (70%) develope advanced stage disease at diagnosis, involving gastrointestinal tract and bone marrow. Although patients mainly present with lymphadenopathy and other lymphoid tissues participation, sometimes lymphoma invades the bone marrow and peripheral blood. This process is called leukemization and occurs in 35% of cases. Faced with a very high number of leukocytes in a patient already diagnosed with MCL, the role of the laboratory will be to observe the smear blood for lymphocyte centroblastic appearance. With conventional treatments median survival was 3 years, which has increased to 7 years with new treatments. Leukemized MCL prognosis is lower than in a ganglion forms without peripheral expression (AU)
