1887

Abstract

We report an occurrence of treatment failure after oral spiramycin therapy in a man with secondary syphilis and a reported penicillin and tetracycline allergy. Molecular detection revealed treponemal DNA in the blood of the patient and sequencing of the 23S rDNA identified an A to G transition at the gene position corresponding to position 2059 in the 23S rRNA gene. The occurrence of this novel 23S rDNA mutation was examined among 7 rabbit-propagated syphilitic strains of and among 22 syphilis patient isolates from the Czech Republic. The prevalence of A2058G and A2059G mutations among clinical specimens was 18.2 and 18.2 %, respectively.

Loading

Article metrics loading...

/content/journal/jmm/10.1099/jmm.0.007542-0
2009-06-01
2019-09-18
Loading full text...

Full text loading...

/deliver/fulltext/jmm/58/6/832.html?itemId=/content/journal/jmm/10.1099/jmm.0.007542-0&mimeType=html&fmt=ahah

References

  1. CDC ( 2006; ). Sexually transmitted diseases treatment guidelines. MMWR Morb Mortal Wkly Rep 55, 1–94.
    [Google Scholar]
  2. Flasarova, M., Smajs, D., Matejkova, P., Woznicova, V., Heroldova-Dvorakova, M. & Votava, M. ( 2006; ). Molecular detection and subtyping of Treponema pallidum subsp. pallidum in clinical specimens. Epidemiol Mikrobiol Imunol 55, 105–111.
    [Google Scholar]
  3. Hook, E. W., III, Stephens, J. & Ennis, D. M. ( 1999; ). Azithromycin compared with penicillin G benzathine for treatment of incubating syphilis. Ann Intern Med 131, 434–437.[CrossRef]
    [Google Scholar]
  4. Hook, E. W., III, Martin, D. H., Stephens, J., Smith, B. S. & Smith, K. ( 2002; ). A randomized, comparative pilot study of azithromycin versus benzathine penicillin G for treatment of early syphilis. Sex Transm Dis 29, 486–490.[CrossRef]
    [Google Scholar]
  5. Idsoe, O., Guthe, T. & Willcox, R. R. ( 1972; ). Penicillin in the treatment of syphilis. The experience of three decades. Bull World Health Organ 47, 1–68.
    [Google Scholar]
  6. Katz, K. A. & Klausner, J. D. ( 2008; ). Azithromycin resistance in Treponema pallidum. Curr Opin Infect Dis 21, 83–91.[CrossRef]
    [Google Scholar]
  7. Kiddugavu, M. G., Kiwanuka, N., Wawer, M. J., Serwadda, D., Sewankambo, N. K., Wabwire-Mangen, F., Makumbi, F., Li, X., Reynolds, S. J. & other authors ( 2005; ). Effectiveness of syphilis treatment using azithromycin and/or benzathine penicillin in Rakai, Uganda. Sex Transm Dis 32, 1–6.[CrossRef]
    [Google Scholar]
  8. Liu, H., Rodes, B., Chen, C. Y. & Steiner, B. ( 2001; ). New tests for syphilis: rational design of a PCR method for detection of Treponema pallidum in clinical specimens using unique regions of the DNA polymerase I gene. J Clin Microbiol 39, 1941–1946.[CrossRef]
    [Google Scholar]
  9. Lukehart, S. A., Godornes, C., Molini, B. J., Sonnett, P., Hopkins, S., Mulcahy, F., Engelman, J., Mitchell, S. J., Rompalo, A. M. & other authors ( 2004; ). Macrolide resistance in Treponema pallidum in the United States and Ireland. N Engl J Med 351, 154–158.[CrossRef]
    [Google Scholar]
  10. Marra, C. M., Colina, A. P., Godornes, C., Tantalo, L. C., Puray, M., Centurion-Lara, A. & Lukehart, S. A. ( 2006; ). Antibiotic selection may contribute to increases in macrolide-resistant Treponema pallidum. J Infect Dis 194, 1771–1773.[CrossRef]
    [Google Scholar]
  11. Matejkova, P., Strouhal, M., Smajs, D., Norris, S. J., Palzkill, T., Petrosino, J. F., Sodergren, E., Norton, J. E., Singh, J. & other authors ( 2008; ). Complete genome sequence of Treponema pallidum ssp. pallidum strain SS14 determined with oligonucleotide arrays. BMC Microbiol 8, 76 [CrossRef]
    [Google Scholar]
  12. Mitchell, S. J., Engelman, J., Kent, C. K., Lukehart, S. A., Godornes, C. & Klausner, J. D. ( 2006; ). Azithromycin-resistant syphilis infection: San Francisco, California, 2000–2004. Clin Infect Dis 42, 337–345.[CrossRef]
    [Google Scholar]
  13. Morshed, M. G. & Jones, H. D. ( 2006; ). Treponema pallidum macrolide resistance in BC. CMAJ 174, 349 [CrossRef]
    [Google Scholar]
  14. Pandori, M. W., Gordones, C., Castro, L., Engelman, J., Siedner, M., Lukehart, S. & Klausner, J. ( 2007; ). Detection of azithromycin resistance in Treponema pallidum by real-time PCR. Antimicrob Agents Chemother 51, 3425–3430.[CrossRef]
    [Google Scholar]
  15. Pfister, P., Jenni, S., Poehlsgaard, J., Thomas, A., Douthwaite, S., Ban, N. & Bottger, E. C. ( 2004; ). The structural basis of macrolide-ribosome binding assessed using mutagenesis of 23S rRNA positions 2058 and 2059. J Mol Biol 342, 1569–1581.[CrossRef]
    [Google Scholar]
  16. Riedner, G., Rusizoka, M., Todd, J., Maboko, L., Hoelscher, M., Mmbando, D., Samky, E., Lyamuya, E., Mabey, D. & other authors ( 2005; ). Single-dose azithromycin versus penicillin G benzathine for the treatment of early syphilis. N Engl J Med 353, 1236–1244.[CrossRef]
    [Google Scholar]
  17. Stamm, L. V. & Bergen, H. L. ( 2000; ). A point mutation associated with bacterial macrolide resistance is present in both 23S rRNA genes of an erythromycin-resistant Treponema pallidum clinical isolate. Antimicrob Agents Chemother 44, 806–807.[CrossRef]
    [Google Scholar]
  18. Stamm, L. V., Stapleton, J. T. & Bassford, P. J., Jr ( 1988; ). In vitro assay to demonstrate high-level erythromycin resistance of a clinical isolate of Treponema pallidum. Antimicrob Agents Chemother 32, 164–169.[CrossRef]
    [Google Scholar]
  19. Vester, B. & Douthwaite, S. ( 2001; ). Macrolide resistance conferred by base substitutions in 23S rRNA. Antimicrob Agents Chemother 45, 1–12.[CrossRef]
    [Google Scholar]
  20. Woznicova, V., Smajs, D., Wechsler, D., Matejkova, P. & Flasarova, M. ( 2007; ). Detection of Treponema pallidum subsp. pallidum from skin lesions, serum, and cerebrospinal fluid in an infant with congenital syphilis after clindamycin treatment of the mother during pregnancy. J Clin Microbiol 45, 659–661.[CrossRef]
    [Google Scholar]
http://instance.metastore.ingenta.com/content/journal/jmm/10.1099/jmm.0.007542-0
Loading
/content/journal/jmm/10.1099/jmm.0.007542-0
Loading

Data & Media loading...

vol. , part 6, pp. 832 - 836

Primers used for amplification/sequencing of genetic material. [ PDF file] (78 KB)



PDF
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error