Disseminated gonococcal infection in an elderly Japanese man.

Published on Jan 1, 2013in Internal Medicine1.005
· DOI :10.2169/INTERNALMEDICINE.52.1033
Hideharu Hagiya13
Estimated H-index: 13
(Okayama University),
Nobuhiko Onishi1
Estimated H-index: 1
(Okayama University)
+ 5 AuthorsFumio Otsuka35
Estimated H-index: 35
(Okayama University)
: We herein present the case of a 69-year-old Japanese man who had unprotected sexual contact with a local commercial sex worker in an East Asian country and was diagnosed as having disseminated gonococcal infection (DGI). The organism was confirmed to be Neisseria gonorrhoeae based on 16S rRNA sequencing and positive results for the cppB gene. This case indicates that a diagnosis of DGI should also be considered in elderly individuals. DGI potentially causes many complications, and the pathogen has recently been reported to be resistant to various antibiotics. Physicians must therefore pay more attention to the possible occurrence of DGI in various clinical settings.
#1Robert D. Kirkcaldy (CDC: Centers for Disease Control and Prevention)H-Index: 26
#2Akbar A. Zaidi (CDC: Centers for Disease Control and Prevention)H-Index: 32
Last. Hillard Weinstock (CDC: Centers for Disease Control and Prevention)H-Index: 51
view all 10 authors...
Background: Gonorrhea treatment has been complicated by antimicrobial resistance in Neisseria gonorrhoeae. Gonococcal fluoroquinolone resistance emerged more rapidly among men who have sex with men (MSM) than men who have sex exclusively with women (MSW). Objective: To determine whether N. gonorrhoeae urethral isolates from MSM were more likely than isolates from MSW to exhibit resistance to or elevated minimum inhibitory concentrations (MICs) of antimicrobials used to treat gonorrhea. Design: 6...
74 CitationsSource
: In a nationwide antimicrobial susceptibility survey of 494 Nesseria gonorrhoeae isolates collected from February 2008 to December 2009 in 3 regions of Japan, 112 (22.7%) were collected from western Japan (Kinki, Chugoku, Shikoku, and Kyushu), 277 (56.1%) from mid-eastern Japan (Kanto), and 105 (21.1%) from eastern Japan (Tokai, Hokuriku, Koushinetsu, Tohoku, and Hokkaido). Resistance to ciprofloxacin (CPFX) was 72.8%, to penicillin G (PCG) 19.8%, and to tetracycline (TC) 18.2%. Intermediate re...
7 CitationsSource
#1Dahae Won (UOU: University of Ulsan)H-Index: 2
#2Dongheui An (UOU: University of Ulsan)H-Index: 6
Last. Young Sang Lee (UOU: University of Ulsan)H-Index: 5
view all 4 authors...
A 42-yr-old man with hepatitis B virus associated liver cirrhosis was admitted to the emergency room because of multiple seizures, a history of chills and myalgia over the previous 2 weeks, and 3 days of melena. He was febrile with a temperature of 38.0℃. There were no symptoms and signs related to the genitourinary system, skin, or joints. Three sets of blood cultures were obtained and oxidase-positive, gram-negative diplococci were detected after 25.9-26.9 hr of incubation in all aerobic vials...
8 CitationsSource
#1Ai Suzaki (Nihon University)H-Index: 7
#2Kentaro Hayashi (Nihon University)H-Index: 2
Last. Satoshi Hayakawa (Nihon University)H-Index: 27
view all 5 authors...
Disseminated gonococcal infection (DGI) is quite a rare condition, especially in the Japanese population; only 10 cases have been reported in case notes and minutes. We describe a man in which Neisseria gonorrhoeae was suspected to have infected the patient through his pharynx. He developed chills, fever, tonsillitis, papules, tenosynovitis and migratory polyarthralgia without genitourinary symptoms. After conducting a literature review, we suggest that being male is a possible risk factor and t...
28 CitationsSource
#1Michelle J Cole (HPA: Health Protection Agency)H-Index: 29
Last. Catherine A IsonH-Index: 53
view all 6 authors...
Objective To perform a European sentinel surveillance study for antimicrobial resistance (AMR) in Neisseria gonorrhoeae as part of the European Surveillance of Sexually Transmitted Infections Programme. Methods From 2006 to 2008 17 countries participated in the AMR surveillance programme. The susceptibility of a total of 3528 consecutive isolates was tested using the agar dilution breakpoint technique or Etests for ciprofloxacin, penicillin, tetracycline, azithromycin, spectinomycin and ceftriax...
86 CitationsSource
#1Pennan M. Barry (UCSF: University of California, San Francisco)H-Index: 17
#2Jeffrey D. KlausnerH-Index: 81
Gonorrhea remains an important clinical and public health problem throughout the world. Gonococcal infections have historically been diagnosed by Gram stain and culture but are increasingly diagnosed through nucleic acid tests, thereby eliminating the opportunity for antimicrobial susceptibility testing. Gonococcal infections are typically treated with single-dose therapy with an agent found to cure > 95% of cases. Unfortunately, the gonococcus has repeatedly developed resistance to antimicrobia...
215 CitationsSource
#1P. Read (St Thomas' Hospital)H-Index: 1
#2R. AbbottH-Index: 1
Last. J. A. WhiteH-Index: 1
view all 5 authors...
Disseminated gonococcal infection (DGI) often presents a diagnostic challenge. Through the novel application of molecular technology, a case is presented that suggests how the diagnostic sensitivity for this systemic complication of gonococcal infection can be improved. In a typical case of DGI seen in a homosexual man in whom all mucosal and blood specimens were culture negative, nucleic acid amplification testing (NAAT) helped to confirm the diagnosis. Both throat and skin lesion specimens tes...
8 CitationsSource
#1John W. TapsallH-Index: 33
#2Edna A. LimniosH-Index: 5
Last. Denise Murphy (Queensland Health)H-Index: 15
view all 3 authors...
Objectives: To analyse trends in antimicrobial resistance (AMR) in Neisseria gonorrhoeae (GC) isolated in Australia between 1997 and 2006 and to identify factors influencing emergence and spread of AMR in GC. Methods: AMR data were generated in reference laboratories in each state and territory of Australia using the methods of the Australian Gonococcal Surveillance Programme from a comprehensive sample of GC. Trends in the proportion of strains resistant to penicillin, ciprofloxacin, spectinomy...
69 CitationsSource
#1Kimberly A. Workowski (CDC: Centers for Disease Control and Prevention)H-Index: 46
#2Stuart M. Berman (CDC: Centers for Disease Control and Prevention)H-Index: 49
An attendant console includes a memory section, an automatic operation data management section, a signal generation section, and an input/output signal processing section. The memory section stores automatic operation data representing whether call handling sequences are automatically operated. The automatic operation data management section sets the automatic operation data in the memory section in accordance with a keyboard operation performed by a console operator. The signal generation secti...
2,506 CitationsSource
#1Midori Tsuneishi (Okayama University)H-Index: 3
#2Tatsuo Yamamoto (Okayama University)H-Index: 30
Last. Tatsuo Watanabe (Okayama University)H-Index: 15
view all 6 authors...
Tonsilloliths are a potential cause of oral malodor. In this study, microbial profiles and composition of tonsilloliths were determined using culture-independent molecular methods and scanning electron microscopy. 16S ribosomal RNA bacterial genes (16S rDNAs) isolated from tonsilloliths of 6 individuals were amplified by PCR and cloned into Escherichia coli. Partial 16S rDNA sequences of approximately 600 bases of cloned inserts were used to determine species identity by comparison with sequence...
29 CitationsSource
Cited By4
#2Hideharu Hagiya (Osaka University)H-Index: 13
Last. Hiromi RakugiH-Index: 94
view all 14 authors...
Rationale Complement deficiency are known to be predisposed to disseminated gonococcal infection (DGI). We herein present a case of DGI involving a Japanese man who latently had a complement 7 deficiency with compound heterozygous variants. Patient concerns A previously healthy 51-year-old Japanese man complained of sudden-onset high fever. Physical examination revealed various skin lesions including red papules on his trunk and extremities, an impetigo-like pustule on left forearm, and tendinit...
#1Moni Roy (UIC: University of Illinois at Chicago)H-Index: 6
#2Sharjeel Ahmad (UIC: University of Illinois at Chicago)H-Index: 4
Last. Ashish Kumar Roy (OSF Saint Francis Medical Center)H-Index: 5
view all 3 authors...
Disseminated Neisseria gonorrhea (N. Gonorrhoeae) infection can present with polyarticular involvement. Acute vertebral discitis/osteomyelitis due to this organism infection has been rarely reported. We present a case of vertebral discitis and osteomyelitis due to N. gonorrhea in an immunocompetent host, treated successfully with a prolonged antibiotic course.
4 CitationsSource
#2Luciana L. TirelliH-Index: 1
Last. Margarita LarraldeH-Index: 14
view all 7 authors...
espanolLa gonorrea es una enfermedad de transmision sexual, que en la mayoria de los casos genera afectacion mucosa. En un bajo porcentaje, genera un cuadro que se conoce como infeccion gonococica diseminada. Su dificultad al momento del diagnostico se debe a la baja sensibilidad de los metodos complementarios y a su camaleonica presentacion clinica. Puede confundirse con distintas entidades, como sifilis, VIH, parvovirus B19 y enfermedades autoinflamatorias. Es importante tener en cuenta a la h...
#1Magnus Rehnström (Sahlgrenska University Hospital)H-Index: 1
#2Magnus UnemoH-Index: 73
Last. Petra TunbäckH-Index: 13
view all 3 authors...
3 CitationsSource