title: Mutation patterns in gyrA and parC genes of ciprofloxacin resistant isolates of Neisseria gonorrhoeae from India.
abstract: OBJECTIVE
  To analyse mutations in the gyrA and parC genes leading to possible increase in ciprofloxacin resistance (high MIC values for ciprofloxacin) in clinical isolates of Neisseria gonorrhoeae in Delhi, India.
  
  
  METHODS
  MIC of ciprofloxacin for 63 clinical isolates of N gonorrhoeae were examined by the Etest method. Subsequently, gyrA and parC genes of these isolates were amplified and sequenced for possible mutations.
  
  
  RESULTS
  Out of the 63 clinical isolates tested, only five (8%) isolates were found to be susceptible to ciprofloxacin (MIC <0.06 micro g/ml). DNA sequence analysis of the gyrA and the parC genes of all these isolates (n = 63) revealed that all isolates which were not susceptible to ciprofloxacin (n=58) had mutation(s) in gyrA and parC genes. 12 isolates (19%) exhibited high resistance with an MIC for ciprofloxacin of 32 micro g/ml. Two out of these 12 isolates (UD62 and UD63), harboured triple mutations (Ser-91 to Phe, Asp-95 to Asn and Val-120 to Leu) in the gyrA gene. The third mutation of Val-120 to Leu, lies downstream of the quinolone resistance determining region (QRDR) of the gyrA and has not been described before in gonococcus. In addition, both these isolates had a Phe-100 to Tyr substitution in the parC, a hitherto unknown mutation.
  
  
  CONCLUSIONS
  Emergence of ciprofloxacin resistance with high levels of MIC values (up to 32 micro g/ml) in India is alarming. Double and triple mutations in gyrA alone or together in gyrA and parC could be responsible for such a high resistance.
authors.affiliation: Dr BR Ambedkar Center for Biomedical Research, University of Delhi, India.
authors.forename: U
authors.initials: U
authors.lastname: Chaudhry
authors.forename: K
authors.initials: K
authors.lastname: Ray
authors.forename: M
authors.initials: M
authors.lastname: Bala
authors.forename: D
authors.initials: D
authors.lastname: Saluja
mesh_terms: D000890:Anti-Infective Agents / Q000627:therapeutic use*; D002939:Ciprofloxacin / Q000627:therapeutic use*; D027081:DNA Gyrase / Q000235:genetics; D027101:DNA Topoisomerase IV / Q000235:genetics; D024881:Drug Resistance, Bacterial / Q000235:genetics*; D005798:Genes, Bacterial / Q000235:genetics*; D006069:Gonorrhea / Q000235:genetics*; D006801:Humans; D008297:Male; D009154:Mutation / Q000235:genetics*; D009344:Neisseria gonorrhoeae / Q000187:drug effects / Q000235:genetics*; D014526:Urethritis / Q000235:genetics / Q000382:microbiology
chemical_list: D000890:Anti-Infective Agents; D002939:Ciprofloxacin; D027101:DNA Topoisomerase IV; D027081:DNA Gyrase