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Kim WJ, Higashi D, Goytia M, Rendón MA, Pilligua-Lucas M, Bronnimann M, McLean JA, Duncan J, Trees D, Jerse AE, So M. Commensal Neisseria Kill Neisseria gonorrhoeae through a DNA-Dependent Mechanism. Cell Host Microbe 2019; 26:228-239.e8. [PMID: 31378677 DOI: 10.1016/j.chom.2019.07.003] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 04/25/2019] [Accepted: 07/11/2019] [Indexed: 12/13/2022]
Abstract
The mucosa is colonized with commensal Neisseria. Some of these niches are sites of infection for the STD pathogen Neisseria gonorrhoeae (Ngo). Given the antagonistic behavior of commensal bacteria toward their pathogenic relatives, we hypothesized that commensal Neisseria may negatively affect Ngo colonization. Here, we report that commensal species of Neisseria kill Ngo through a mechanism based on genetic competence and DNA methylation state. Specifically, commensal-triggered killing occurs when the pathogen takes up commensal DNA containing a methylation pattern that it does not recognize. Indeed, any DNA will kill Ngo if it can enter the cell, is differentially methylated, and has homology to the pathogen genome. Consistent with these findings, commensal Neisseria elongata accelerates Ngo clearance from the mouse in a DNA-uptake-dependent manner. Collectively, we propose that commensal Neisseria antagonizes Ngo infection through a DNA-mediated mechanism and that DNA is a potential microbicide against this highly drug-resistant pathogen.
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Affiliation(s)
- Won Jong Kim
- Department of Immunobiology and the BIO5 Institute, University of Arizona, Tucson, AZ 85721, USA
| | - Dustin Higashi
- Department of Immunobiology and the BIO5 Institute, University of Arizona, Tucson, AZ 85721, USA
| | - Maira Goytia
- Department of Biology, Spelman College, Atlanta, GA 30314, USA
| | - Maria A Rendón
- Department of Immunobiology and the BIO5 Institute, University of Arizona, Tucson, AZ 85721, USA
| | - Michelle Pilligua-Lucas
- Department of Microbiology and Immunology, Uniformed Services University, Bethesda, MD 20814, USA
| | - Matthew Bronnimann
- Department of Immunobiology and the BIO5 Institute, University of Arizona, Tucson, AZ 85721, USA
| | - Jeanine A McLean
- Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | - Joseph Duncan
- Department of Medicine, University of North Carolina, Chapel Hill, NC 27599, USA
| | - David Trees
- Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | - Ann E Jerse
- Department of Microbiology and Immunology, Uniformed Services University, Bethesda, MD 20814, USA
| | - Magdalene So
- Department of Immunobiology and the BIO5 Institute, University of Arizona, Tucson, AZ 85721, USA.
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Liu H, Taylor TH, Pettus K, Johnson S, Papp JR, Trees D. Comparing the disk-diffusion and agar dilution tests for Neisseria gonorrhoeae antimicrobial susceptibility testing. Antimicrob Resist Infect Control 2016; 5:46. [PMID: 27904747 PMCID: PMC5122013 DOI: 10.1186/s13756-016-0148-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 11/03/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We assessed the validity of testing for antimicrobial susceptibility of clinical and mutant Neisseria gonorrhoeae (GC) isolates by disk diffusion in comparison to agar dilution, and Etest® (bioMerieux, France), respectively, for three third generation extended spectrum cephalosporins (ESC): ceftriaxone (CRO), cefixime (CFX), and cefpodoxime (CPD). METHODS One hundred and five clinical isolates and ten laboratory-mutants were tested following Clinical Laboratory Standard Institute (CLSI) and manufacturer's standards for each of the three methods. The measured diameters by the disk diffusion method were tested for correlation with the MIC values by agar dilution. In addition, comparisons with the Etest® were made. Categorical results for concordance, based on standard CLSI cutoffs, between the disk diffusion and the other two methods, respectively, were tested using the Chi-square statistics. Reproducibility was tested for CFX across a 6-month interval by repeated disk tests. RESULTS Across all 115 specimens, the disk diffusion tests produced good categorical agreements, exhibiting concordance of 93.1%, 92.1%, and 90.4% with agar dilution and 93.0%, 92.1%, and 90.4% with Etest®, for CRO, CFX, and CPD, respectively. Pearson correlations between disk-diffusion diameters and agar dilution MIC's were -0.59, -0.67, and -0.81 for CRO, CFX, and CPD, respectively. The correlations between disk diffusion and Etest® were -0.58, -0.73, and -0.49. Pearson correlation between the CFX disk readings over a 6-month interval was 91%. CONCLUSIONS Disk diffusion tests remain to be a useful, reliable and fast screening method for qualitative antimicrobial susceptibility testing for ceftriaxone, cefixime, and cefpodoxime.
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Affiliation(s)
- Hsi Liu
- Division of STD Prevention, NCHHSTP, Atlanta, USA
| | - Thomas H Taylor
- Division of Laboratory Systems, CSELS, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30333 USA
| | - Kevin Pettus
- Division of STD Prevention, NCHHSTP, Atlanta, USA
| | | | - John R Papp
- Division of STD Prevention, NCHHSTP, Atlanta, USA
| | - David Trees
- Division of STD Prevention, NCHHSTP, Atlanta, USA
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Grad YH, Harris SR, Kirkcaldy RD, Green AG, Marks DS, Bentley SD, Trees D, Lipsitch M. Genomic Epidemiology of Gonococcal Resistance to Extended-Spectrum Cephalosporins, Macrolides, and Fluoroquinolones in the United States, 2000-2013. J Infect Dis 2016; 214:1579-1587. [PMID: 27638945 PMCID: PMC5091375 DOI: 10.1093/infdis/jiw420] [Citation(s) in RCA: 138] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 08/31/2016] [Indexed: 12/31/2022] Open
Abstract
Background. Treatment of Neisseria gonorrhoeae infection is empirical and based on population-wide susceptibilities. Increasing antimicrobial resistance underscores the potential importance of rapid diagnostic tests, including sequence-based tests, to guide therapy. However, the usefulness of sequence-based diagnostic tests depends on the prevalence and dynamics of the resistance mechanisms. Methods. We define the prevalence and dynamics of resistance markers to extended-spectrum cephalosporins, macrolides, and fluoroquinolones in 1102 resistant and susceptible clinical N. gonorrhoeae isolates collected from 2000 to 2013 via the Centers for Disease Control and Prevention's Gonococcal Isolate Surveillance Project. Results. Reduced extended-spectrum cephalosporin susceptibility is predominantly clonal and associated with the mosaic penA XXXIV allele and derivatives (sensitivity 98% for cefixime and 91% for ceftriaxone), but alternative resistance mechanisms have sporadically emerged. Reduced azithromycin susceptibility has arisen through multiple mechanisms and shows limited clonal spread; the basis for resistance in 36% of isolates with reduced azithromycin susceptibility is unclear. Quinolone-resistant N. gonorrhoeae has arisen multiple times, with extensive clonal spread. Conclusions. Quinolone-resistant N. gonorrhoeae and reduced cefixime susceptibility appear amenable to development of sequence-based diagnostic tests, whereas the undefined mechanisms of resistance to ceftriaxone and azithromycin underscore the importance of phenotypic surveillance. The identification of multidrug-resistant isolates highlights the need for additional measures to respond to the threat of untreatable gonorrhea.
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Affiliation(s)
- Yonatan H Grad
- Department of Immunology and Infectious Diseases.,Division of Infectious Diseases, Brigham and Women's Hospital and Harvard Medical School
| | | | | | - Anna G Green
- Department of Systems Biology, Harvard Medical School, Boston, Massachusetts
| | - Debora S Marks
- Department of Systems Biology, Harvard Medical School, Boston, Massachusetts
| | - Stephen D Bentley
- Wellcome Trust Sanger Institute, Hinxton.,Department of Medicine, University of Cambridge and Addenbrookes Hospital, Cambridge, United Kingdom
| | - David Trees
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Marc Lipsitch
- Department of Immunology and Infectious Diseases.,Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard T. H. Chan School of Public Health
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Harrison OB, Clemence M, Dillard JP, Tang CM, Trees D, Grad YH, Maiden MCJ. Genomic analyses of Neisseria gonorrhoeae reveal an association of the gonococcal genetic island with antimicrobial resistance. J Infect 2016; 73:578-587. [PMID: 27575582 PMCID: PMC5127880 DOI: 10.1016/j.jinf.2016.08.010] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 08/18/2016] [Accepted: 08/20/2016] [Indexed: 02/03/2023]
Abstract
OBJECTIVES Antimicrobial resistance (AMR) threatens our ability to treat the sexually transmitted bacterial infection gonorrhoea. The increasing availability of whole genome sequence (WGS) data from Neisseria gonorrhoeae isolates, however, provides us with an opportunity in which WGS can be mined for AMR determinants. METHODS Chromosomal and plasmid genes implicated in AMR were catalogued on the PubMLST Neisseria database (http://pubmlst.org/neisseria). AMR genotypes were identified in WGS from 289 gonococci for which MICs against several antimicrobial compounds had been determined. Whole genome comparisons were undertaken using whole genome MLST (wgMLST). RESULTS Clusters of isolates with distinct AMR genotypes were apparent following wgMLST analysis consistent with the occurrence of genome wide genetic variation. This included the presence of the gonococcal genetic island (GGI), a type 4 secretion system shown to increase recombination and for which possession was significantly associated with AMR to multiple antimicrobials. CONCLUSIONS Evolution of the gonococcal genome occurs in response to antimicrobial selective pressure resulting in the formation of distinct N. gonorrhoeae populations evidenced by the wgMLST clusters seen here. Genomic islands offer selective advantages to host bacteria and possession of the GGI may, not only facilitate the spread of AMR in gonococcal populations, but may also confer fitness advantages.
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Affiliation(s)
| | | | - Joseph P Dillard
- Department of Medical Microbiology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
| | - Christoph M Tang
- Sir William Dunn School of Pathology, University of Oxford, Oxford, UK
| | - David Trees
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Yonatan H Grad
- Harvard TH Chan School of Public Health, Boston, MA, USA; Division of Infectious Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Trees D. S11.3 Use of whole genome sequencing to determine the probability of antimicrobial resistance in neisseria gonorrhoeae. Br J Vener Dis 2015. [DOI: 10.1136/sextrans-2015-052270.59] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Carroll S, Kirkcaldy R, Fox J, Kubin G, Trees D. Decreased susceptibility to ceftriaxone in Neisseria gonorrhoeae in the absence of a mosaic penicillin-binding protein 2 (PenA) allele. Int J Infect Dis 2014. [DOI: 10.1016/j.ijid.2014.03.639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Grad YH, Kirkcaldy RD, Trees D, Dordel J, Harris SR, Goldstein E, Weinstock H, Parkhill J, Hanage WP, Bentley S, Lipsitch M. Genomic epidemiology of Neisseria gonorrhoeae with reduced susceptibility to cefixime in the USA: a retrospective observational study. Lancet Infect Dis 2014; 14:220-6. [PMID: 24462211 PMCID: PMC4030102 DOI: 10.1016/s1473-3099(13)70693-5] [Citation(s) in RCA: 153] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Background The emergence of Neisseria gonorrhoeae with decreased susceptibility to extended spectrum cephalosporins raises the prospect of untreatable gonorrhoea. In the absence of new treatments, efforts to slow the increasing incidence of resistant gonococcus require insight into the factors that contribute to its emergence and spread. We assessed the relatedness between isolates in the USA and reconstructed likely spread of lineages through different sexual networks. Methods We sequenced the genomes of 236 isolates of N gonorrhoeae collected by the Centers for Disease Control and Prevention's Gonococcal Isolate Surveillance Project (GISP) from sentinel public sexually transmitted disease clinics in the USA, including 118 (97%) of the isolates from 2009–10 in GISP with reduced susceptibility to cefixime (cefRS) and 118 cefixime-susceptible isolates from GISP matched as closely as possible by location, collection date, and sexual orientation. We assessed the association between antimicrobial resistance genotype and phenotype and correlated phylogenetic clustering with location and sexual orientation. Findings Mosaic penA XXXIV had a high positive predictive value for cefRS. We found that two of the 118 cefRS isolates lacked a mosaic penA allele, and rechecking showed that these two were susceptible to cefixime. Of the 116 remaining cefRS isolates, 114 (98%) fell into two distinct lineages that have independently acquired mosaic penA allele XXXIV. A major lineage of cefRS strains spread eastward, predominantly through a sexual network of men who have sex with men. Eight of nine inferred transitions between sexual networks were introductions from men who have sex with men into the heterosexual population. Interpretation Genomic methods might aid efforts to slow the spread of antibiotic-resistant N gonorrhoeae through augmentation of gonococcal outbreak surveillance and identification of populations that could benefit from increased screening for aymptomatic infections. Funding American Sexually Transmitted Disease Association, Wellcome Trust, National Institute of General Medical Sciences, and National Institute of Allergy and Infectious Diseases, National Institutes of Health.
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Affiliation(s)
- Yonatan H Grad
- Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA; Division of Infectious Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | | | - David Trees
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | | - Edward Goldstein
- Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA
| | | | | | - William P Hanage
- Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA
| | - Stephen Bentley
- Wellcome Trust Sanger Institute, Hinxton, UK; Department of Medicine, University of Cambridge, Addenbrookes Hospital, Cambridge, UK
| | - Marc Lipsitch
- Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA; Department of Immunology and Infectious Diseases, Harvard School of Public Health, Boston, MA, USA
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Grad Y, Kirkcaldy R, Dordel J, Goldstein E, Trees D, Weinstock H, Parkhill J, Hanage WP, Bentley S, Lipsitch M. YI.4 Gonococcal Genomics Shows Impact of Recombination on Obscuring Phylogenetic Signal and Disseminating Resistance Loci. Br J Vener Dis 2013. [DOI: 10.1136/sextrans-2013-051184.0081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Grad YH, Kirkcaldy R, Trees D, Dordel J, Goldstein E, Weinstock H, Parkhill J, Hanage WP, Bentley S, Lipsitch M. O03.4 Genomic Epidemiology of Neisseria Gonorrhoeae with Reduced Susceptibility to Cefixime in the United States. Br J Vener Dis 2013. [DOI: 10.1136/sextrans-2013-051184.0098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Trees D, Pettus K, Johnson S. O21.2 Effect of Mutations in pilQon the Susceptibility of Neisseria Gonorrhoeaeto Cephalosporins. Br J Vener Dis 2013. [DOI: 10.1136/sextrans-2013-051184.0204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Trees D, Burroughs M, Harris S, Johnson S. P4-S1.05 Polymerase chain reaction-based typing of penA genes exhibiting elevated MIC values to cephalosporins in Isolates of Neisseria gonorrhoeae. Br J Vener Dis 2011. [DOI: 10.1136/sextrans-2011-050108.507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Mertz KJ, Trees D, Levine WC, Lewis JS, Litchfield B, Pettus KS, Morse SA, St Louis ME, Weiss JB, Schwebke J, Dickes J, Kee R, Reynolds J, Hutcheson D, Green D, Dyer I, Richwald GA, Novotny J, Weisfuse I, Goldberg M, O'Donnell JA, Knaup R. Etiology of genital ulcers and prevalence of human immunodeficiency virus coinfection in 10 US cities. The Genital Ulcer Disease Surveillance Group. J Infect Dis 1998; 178:1795-8. [PMID: 9815237 DOI: 10.1086/314502] [Citation(s) in RCA: 124] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
To determine the etiology of genital ulcers and to assess the prevalence of human immunodeficiency virus (HIV) infection in ulcer patients in 10 US cities, ulcer and serum specimens were collected from approximately 50 ulcer patients at a sexually transmitted disease clinic in each city. Ulcer specimens were tested using a multiplex polymerase chain reaction assay to detect Haemophilus ducreyi, Treponema pallidum, and herpes simplex virus (HSV); sera were tested for antibody to HIV. H. ducreyi was detected in ulcer specimens from patients in Memphis (20% of specimens) and Chicago (12%). T. pallidum was detected in ulcer specimens from every city except Los Angeles (median, 9% of specimens; range, 0%-46%). HSV was detected in >/=50% of specimens from all cities except Memphis (42%). HIV seroprevalence in ulcer patients was 6% (range by city, 0%-18%). These data suggest that chancroid is prevalent in some US cities and that persons with genital ulcers should be a focus of HIV prevention activities.
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Affiliation(s)
- K J Mertz
- Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA
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