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Genomic Characterization of Emerging Bacterial Uropathogen Neisseria meningitidis, Which Was Misidentified as

Kimberley V Sukhum1,2, Sophonie Jean2,3, Meghan Wallace2

  • 1The Edison Family Center for Genome Sciences and Systems Biology, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA.

Journal of Clinical Microbiology
|November 12, 2020
PubMed

Insights

Certain Neisseria meningitidis strains cause urethritis, leading to misidentification as Neisseria gonorrhoeae by some diagnostic tests. This highlights the need for accurate identification of these emerging urogenital pathogens.

Area of Science:

  • Microbiology
  • Infectious Diseases
  • Genomics

Background:

  • Neisseria meningitidis and Neisseria gonorrhoeae are pathogenic bacteria causing human infections.
  • While N. meningitidis typically causes meningitis and bacteremia, a urogenital strain is emerging as a cause of urethritis.
  • Accurate identification of these bacteria is crucial, especially with the rise of N. meningitidis in urogenital infections.

Purpose of the Study:

  • To assess the accuracy of identification tools for N. meningitidis and N. gonorrhoeae in urogenital isolates.
  • To evaluate the phylogenetic relationship and antimicrobial susceptibility of urogenital N. meningitidis.
  • To determine the potential for misidentification of urogenital N. meningitidis as N. gonorrhoeae.

Main Methods:

  • Characterization of consecutive N. meningitidis urogenital isolates and random N. gonorrhoeae isolates using routine identification systems.
  • Antimicrobial susceptibility testing and whole-genome sequencing (WGS) were performed.
  • Identification methods included MALDI-TOF MS, multilocus sequence typing, 16S rRNA gene sequencing, average nucleotide identity, Aptima Combo 2 CT/NG, and Xpert CT/NG NAAT.

Main Results:

  • MALDI-TOF MS, multilocus sequence typing, 16S rRNA gene sequencing, and average nucleotide identity accurately identified 95% of isolates.
  • The Aptima Combo 2 CT/NG test misidentified 30% of N. meningitidis isolates as N. gonorrhoeae; the Xpert CT/NG NAAT showed no misidentifications.
  • Phylogenetic analyses confirmed urogenital N. meningitidis isolates are distinct from N. gonorrhoeae and respiratory N. meningitidis.
  • Urogenital N. meningitidis isolates were predominantly azithromycin resistant, unlike azithromycin-susceptible N. gonorrhoeae.

Conclusions:

  • Urogenital N. meningitidis can be misidentified as N. gonorrhoeae by certain diagnostic assays, potentially impacting public health surveillance for gonorrhea.
  • Accurate diagnostic tools are essential for distinguishing between these two Neisseria species in urogenital samples.
  • Further research is needed to understand the clinical implications of urogenital N. meningitidis infections.
Keywords:
Neisseriaantibiotic resistanceurethritiswhole-genome sequencing

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