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Journal of Clinical Microbiology, April 2007, p. 1378, Vol. 45, No. 4
0095-1137/07/$08.00+0     doi:10.1128/JCM.02495-06
Copyright © 2007, American Society for Microbiology. All Rights Reserved.

LETTER TO THE EDITOR

Emergence of Non-Ceftriaxone-Susceptible Neisseria meningitidis in India


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LETTER
 
V. Manchanda and P. Bhalla reported eight serogroup A Neisseria meningitidis non-ceftriaxone-susceptible isolates in India showing MICs ranging from 0.25 to 8 µg/ml (5). This is of great concern, as ceftriaxone is used for treatment of bacterial meningitis. In the meningitis belt of Africa, where outbreaks are caused mostly by serogroup A meningococci, ceftriaxone is scheduled to be an alternative to oily chloramphenicol for treatment of patients. As five of eight isolates are also resistant to chloramphenicol, I hope that such strains never reach Africa: it would be a catastrophe. Increasing numbers of N. meningitidis strains with decreased susceptibility to penicillin G (MICs of >0.064 µg/ml to ≤1 µg/ml) have been reported in recent years from many countries, due to the presence of mosaic structures in the penA gene (3); these isolates are susceptible to ceftriaxone. Only a few isolates of N. meningitidis resistant to penicillin via plasmid-encoded ß-lactamase production have been found in Spain, Canada, and South Africa (2, 4, 7). The two isolates from Spain showed good susceptibility to ceftriaxone (1). As this is the first time that non-ceftriaxone-susceptible meningococci have been identified showing such high MICs, in my opinion, Gram staining and latex agglutination are not sufficient for their characterization. The authors should give us the results of culture of these strains on Trypticase soy agar, chocolate agar, and chocolate plus antibiotics (vancomycin, nystatin, and colistin); utilization of glucose, maltose, lactose, and sucrose; oxidase, catalase, and tributyrin tests; reduction of nitrate; and the presence or not of gamma glutamyl transferase (6) and ß-lactamase. For determination of serogroup on culture, I think that serum is better than latex. At least to show the clonality of these strains, it is important to characterize them using typing, subtyping, and multilocus sequence typing.

I hope that the authors will give these data in their response. If they don't have reagents to achieve the characterization of these strains and to identify the mechanisms of resistance, I propose the authors send such isolates to Dr. P. Nicolas, Head of the Meningococcus Unit, WHO Collaborating Center for Reference and Research on Meningococci, IMTSSA, BP 46, 13998 Marseille Armees, France.


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REFERENCES
 
    1
  1. Bäckman, A., P. Orvelid, J. A. Vazquez, O. Sköld, and P. Olcén. 2000. Complete sequence of a ß-lactamase-encoding plasmid in Neisseria meningitidis. Antimicrob. Agents Chemother. 44:210-212.[Abstract/Free Full Text]
    2. 2
  2. Botha, P. 1988. Penicillin-resistant Neisseria meningitidis in southern Africa. Lancet i:54.
    3. 3
  3. Bowler, L. D., Q.-Y. Zhang, J.-Y. Riou, and B. G. Spratt. 1994. Interspecies recombination between the penA genes of Neisseria meningitidis and commensal Neisseria species during the emergence of penicillin resistance in N. meningitidis: natural events and laboratory simulation. J. Bacteriol. 176:333-337.[Abstract/Free Full Text]
    4. 4
  4. Dillon, J. R., M. Pauze, and K.-H. Yeung. 1983. Spread of penicillinase-producing and transfer plasmids from the gonococcus to Neisseria meningitidis. Lancet i:779-781.
    5. 5
  5. Manchanda, V., and P. Bhalla. 2006. Emergence of non-ceftriaxone-susceptible Neisseria meningitidis in India. J. Clin. Microbiol. 44:4290-4291. (Letter.)[Free Full Text]
    6. 6
  6. Riou, J.-Y., and M. Guibourdenche. 1992. Laboratory methods Neisseria and Branhamella, p. 150-166. Institut Pasteur, Paris, France.
    7. 7
  7. Vazquez, J. A., A. M. Enriquez, L. De La Fuente, S. Berron, and M. Baquero. 1996. Isolation of a strain of beta-lactamase-producing Neisseria meningitidis in Spain. Eur. J. Clin. Microbiol. Infect. Dis. 15:181-182.[CrossRef][Medline]
P. Nicolas
Meningococcus Unit
WHO Collaborating Center for Reference and Research on Meningococci
IMTSSA
Marseille 13998, France

Phone: 33 4 91 15 01 15, Fax: 33 4 91 59 44 77, E-mail: nicolasp{at}imtssa.fr


Authors' Reply


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LETTER 
 
Please note that the mechanisms of resistance of the isolates (e.g., ß-lactamase production) are currently under study, and the data once ready will be submitted for publication. As far as the identity of the strains is concerned, all isolates have been identified from three different latex kits (all three different brands) as mentioned in the paper. Furthermore, identification based on serum-based antisera as suggested by Dr. Nicolas is not possible in our laboratory at this point because of the high costs involved. We have offered to provide our strains to Dr. Nicolas.

Vikas Manchanda*
P. Bhalla
Maulana Azad Medical College and Associated Chacha Nehru Children's Hospital
Geeta Colony
Delhi 110031, India

* Phone: 91-11-27472222
Fax: 91-11-26899362
E-mail: manchandavikas{at}hotmail.com

Journal of Clinical Microbiology, April 2007, p. 1378, Vol. 45, No. 4
0095-1137/07/$08.00+0     doi:10.1128/JCM.02495-06
Copyright © 2007, American Society for Microbiology. All Rights Reserved.



This article has been cited by other articles:

  • Hedberg, S. T., Fredlund, H., Nicolas, P., Caugant, D. A., Olcen, P., Unemo, M. (2009). Antibiotic Susceptibility and Characteristics of Neisseria meningitidis Isolates from the African Meningitis Belt, 2000 to 2006: Phenotypic and Genotypic Perspectives. Antimicrob. Agents Chemother. 53: 1561-1566 [Abstract] [Full Text]  

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