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Emergence of a novel urogenital-tropic Neisseria meningitidis
Jose A Bazan1,2, David S Stephens3, Abigail Norris Turner1
1The Ohio State University College of Medicine.
Purpose Of Review:
Neisseria meningitidis (Nm) is primarily associated with asymptomatic nasopharyngeal carriage and invasive meningococcal disease (sepsis and meningitis), but like N. gonorrhoea (Ng), Nm can colonize urogenital and rectal mucosal surfaces and cause disease. First noted in 2015, but with origins in 2011, male urethritis clusters caused by a novel Nm clade were reported in the USA (the US_NmUC). This review describes research developments that characterize this urogenital-tropic Nm.
Recent Findings:
The US_NmUC evolved from encapsulated Nm serogroup C strains. Loss of capsule expression, lipooligosaccharide (LOS) sialylation, genetic acquisition of gonococcal alleles (including the gonococcal anaerobic growth aniA/norB cassette), antimicrobial peptide heteroresistance and high surface expression of a unique factor-H-binding protein, can contribute to the urethra-tropic phenotype. Loss-of-function mutations in mtrC are overrepresented in clade isolates. Similar to Ng, repeat US_NmUC urethritis episodes can occur. The US_NmUC is now circulating in the UK and Southeast Asia. Genomic sequencing has defined the clade and rapid diagnostic tests are being developed for surveillance.
Summary:
The US_NmUC emerged as a cause of urethritis due to acquisition of gonococcal genetic determinants and phenotypic traits that facilitate urogenital tract infection. The epidemiology and pathogenesis of this urogenital-tropic pathogen continues to be defined.
Insights
A novel Neisseria meningitidis (Nm) clade, the US_NmUC, has emerged causing male urethritis. This pathogen acquired gonococcal traits enabling urogenital tract colonization and infection.
Area of Science:
- Microbiology
- Infectious Diseases
- Genomics
Background:
- Neisseria meningitidis (Nm) typically causes nasopharyngeal carriage and invasive diseases like meningitis.
- However, Nm, similar to Neisseria gonorrhoeae (Ng), can infect urogenital and rectal mucosal surfaces.
- Clusters of male urethritis linked to a novel Nm clade (US_NmUC) were first identified in the USA around 2015.
Purpose of the Study:
- To review research characterizing the urogenital-tropic Neisseria meningitidis clade (US_NmUC).
- To understand the genetic and phenotypic adaptations enabling this pathogen's urogenital tropism.
Main Methods:
- Genomic sequencing to define the US_NmUC clade.
- Analysis of genetic determinants and phenotypic traits contributing to urogenital colonization.
- Surveillance data review for epidemiological insights.
Main Results:
- The US_NmUC evolved from encapsulated serogroup C Nm strains.
- Key adaptations include loss of capsule, LOS sialylation, acquisition of gonococcal genes (e.g., aniA/norB), antimicrobial peptide heteroresistance, and high factor-H-binding protein expression.
- Loss-of-function mutations in mtrC are common, and repeat urethritis episodes occur, similar to Ng.
Conclusions:
- The US_NmUC emerged due to acquiring gonococcal genetic determinants and traits facilitating urogenital infection.
- This urogenital-tropic pathogen is now circulating globally, necessitating ongoing epidemiological and pathogenetic definition.
- Development of rapid diagnostic tests is underway for surveillance.
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