Macrolide treatment failure in a case of secondary syphilis: a novel A2059G mutation in the 23S rRNA gene of Treponema pallidum subsp. pallidum.
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 Escherichia coli 23S rRNA gene. The occurrence of this novel 23S rDNA mutation was examined among 7 rabbit-propagated syphilitic strains of Treponema pallidum 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.
Department of Biology, Faculty of Medicine, Masaryk University, Building A6, Kamenice 5, 625 00 Brno, Czech Republic.
Petra
P
Matějková
Department of Medical Microbiology, Faculty of Medicine, Masaryk University, Pekařská 53, 656 91 Brno, Czech Republic.
Magdalena
M
Flasarová
National Reference Laboratory for Diagnostics of Syphilis, National Institute of Public Health, Šrobárova 48, 100 42 Prague 10, Czech Republic.
Hana
H
Zákoucká
National Reference Laboratory for Diagnostics of Syphilis, National Institute of Public Health, Šrobárova 48, 100 42 Prague 10, Czech Republic.
Milan
M
Bořek
Department of Dermatovenerology, Faculty Hospital Královské Vinohrady, Šrobárova 50, 100 34 Prague 10, Czech Republic.
Soňa
S
Křemenová
Department of Dermatovenerology, Faculty Hospital Královské Vinohrady, Šrobárova 50, 100 34 Prague 10, Czech Republic.
Petr
P
Arenberger
Department of Medical Microbiology, Faculty of Medicine, Masaryk University, Pekařská 53, 656 91 Brno, Czech Republic.
Vladana
V
Woznicová
Genome Sequencing Center, Washington University School of Medicine, 4444 Forest Park Avenue, St Louis, MO 63108, USA.
George M
GM
Weinstock
Department of Biology, Faculty of Medicine, Masaryk University, Building A6, Kamenice 5, 625 00 Brno, Czech Republic.
David
D
Šmajs
D000293:Adolescent; D000328:Adult; D000818:Animals; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D018153:Czech Republic / Q000453:epidemiology; D004269:DNA, Bacterial / Q000032:analysis / Q000302:isolation & purification; D024881:Drug Resistance, Bacterial / Q000235:genetics*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D018942:Macrolides / Q000494:pharmacology / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009154:Mutation; D015995:Prevalence; D012338:RNA, Ribosomal, 23S / Q000235:genetics*; D011817:Rabbits; D017422:Sequence Analysis, DNA; D015572:Spiramycin / Q000494:pharmacology / Q000627:therapeutic use; D013587:Syphilis / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D017211:Treatment Failure; D014210:Treponema pallidum / Q000187:drug effects* / Q000235:genetics; D055815:Young Adult
D000900:Anti-Bacterial Agents; D004269:DNA, Bacterial; D018942:Macrolides; D012338:RNA, Ribosomal, 23S; D015572:Spiramycin