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Neisseria elongata is part of the commensal microbiota of the oropharynx. Although it is not considered pathogenic to humans, N. elongata has been implicated in several cases of infective endocarditis (IE). Here, we report a case of IE caused by N. elongata subsp. nitroreducens (Nel_M001) and compare its genome with 17 N. elongata genomes available in GenBank. We also evaluated resistance and virulence profiles with Comprehensive Antibiotic Resistance and Virulence Finder databases. The results showed a wide diversity among N. elongata isolates. Based on the pangenome cumulative curve, we demonstrate that N. elongata has an open pangenome. We found several different resistance genes, mainly associated with antibiotic efflux pumps. A wide range of virulence genes was observed, predominantly pilus formation genes. Nel_M001 was the only isolate to present two copies of some pilus genes and not present nspA gene. Together, our results provide insights into how this commensal microorganism can cause IE and may assist further biological investigations on nonpathogenic Neisseria spp. Case reporting and pangenome analyses are critical for enhancing our understanding of IE pathogenesis, as well as for alerting physicians and microbiologists to enable rapid identification and treatment to avoid unfavorable outcomes., We report a case of a 71‐year‐old male with infective endocarditis caused by Neisseria elongata. This microorganism was isolated from blood culture, and its whole genome was sequenced. We also performed a comparative genomic analysis with seventeen N. elongata genomes available in GenBank to explore virulence and resistance in N. elongata, as well as its pangenome.

To (i) describe the nationwide antimicrobial susceptibility ofTwelve representative sentinel sites cultured NG isolates from men with urethral discharge. Susceptibility to eight antimicrobials was examined using agar dilution method, according to WHO standards. The consenting participants were invited to provide epidemiological data.In total, 633 NG isolates (one isolate per participant) were analysed, and 449 (70.9%) questionnaires were answered. Heterosexual (68.2%) and homosexual (23.1%) sexual orientations were common, and most prevalent types of unprotected sexual intercourse were vaginal insertive (69.9%), oral giving (56.6%) and anal insertive (47.4%). The levels ofCompared with 2015-16, ciprofloxacin resistance has remained high and azithromycin and cefixime resistance rates have increased in Brazil. Resistance remained lacking to ceftriaxone, gentamicin and spectinomycin, which all are gonorrhoea treatment options. The increasing azithromycin resistance in Brazil and internationally may threaten the future use of azithromycin in dual regimens for treatment of gonorrhoea. Consequently, continued and enhanced quality-assured surveillance of gonococcal AMR, and ideally also treatment failures and including WGS, is imperative in Brazil and worldwide.

Neisseria gonorrhoeae is a major concern of public health due to its extraordinary capacity to develop and acquire resistance to different antimicrobials used to treat gonorrhoea. Limited treatment options and uncontrolled transmission have raised the need to assess the antimicrobial susceptibility profile of the isolates and to establish affordable alternatives for laboratory diagnosis.This study aimed to (i) determine the susceptibility profile of 336 clinical isolates of N. gonorrhoeae to ceftriaxone, azithromycin, ciprofloxacin, spectinomycin and gentamicin by the gold standard agar dilution method; (ii) assess the agreement among agar dilution and disc diffusion results for ciprofloxacin, azithromycin, ceftriaxone, spectinomycin and gentamicin.All isolates were susceptible to ceftriaxone and spectinomycin. The levels of resistance to azithromycin and ciprofloxacin were 3.9% and 35.1%, respectively. Intermediate susceptibility to gentamicin was observed in 19.4% of isolates. There was 100% agreement between methods for spectinomycin and ceftriaxone, 99.7% for ciprofloxacin, and 85.7% for azithromycin. For gentamicin, there was 86.3% agreement between agar dilution and disc diffusion, resulting in intermediate susceptible by one method and susceptible by the other method, defined as minor errors. The discordance among agar dilution and disc diffusion results is acceptable for ciprofloxacin, ceftriaxone and spectinomycin as per CLSI M23-Ed4.Spectinomycin and gentamicin can be considered in some cases as options for the treatment of gonorrhoea in Brazil. Disc diffusion can be an alternative method in routine testing with comparable accuracy to agar dilution.

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Mycobacterium tuberculosis (M.tb), the pathogen responsible for tuberculosis (TB) poses as the major cause of death among infectious diseases. The knowledge about the molecular diversity of M.tb enables the implementation of more effective surveillance and control measures and, nowadays, Whole Genome Sequencing (WGS) holds the potential to produce high-resolution epidemiological data in a high-throughput manner. Florianópolis, the state capital of Santa Catarina (SC) in south Brazil, shows a high TB incidence (46.0/100,000). Here we carried out a WGS-based evaluation of the M.tb strain diversity, drug-resistance and ongoing transmission in the capital metropolitan region. Resistance to isoniazid, rifampicin, streptomycin was identified respectively in 4.0% (n = 6), 2.0% (n = 3) and 1.3% (n = 2) of the 151 studied strains by WGS. Besides, resistance to pyrazinamide and ethambutol was detected in 0.7% (n = 1) and reistance to ethionamide and fluoroquinolone (FQ) in 1.3% (n = 2), while a single (0.7%) multidrug-resistant (MDR) strain was identified. SNP-based typing classified all isolates into M.tb Lineage 4, with high proportion of sublineages LAM (60.3%), T (16.4%) and Haarlem (7.9%). The average core-genome distance between isolates was 420.3 SNPs, with 43.7% of all isolates grouped across 22 genomic clusters thereby showing the presence of important ongoing TB transmission events. Most clusters were geographically distributed across the study setting which highlights the need for an urgent interruption of these large transmission chains. The data conveyed by this study shows the presence of important and uncontrolled TB transmission in the metropolitan area and provides precise data to support TB control measures in this region.

Background Neisseria gonorrhoeae (NG) has an extraordinary ability to develop resistance to all antimicrobials used for its treatment. This study analysed molecular determinants of antimicrobial resistance and NG-MAST of 153 NG isolates collected at Florianopolis metropolitan area during 2008–2016. Methods Minimal Inhibitory Concentration (MIC) was determined by agar dilution and the molecular epidemiology was evaluated by NG-MAST. Results Resistance was observed to penicillin (PEN) (26.1%), tetracycline (TET) (41.2%), ciprofloxacin (CIP) (52.3%) and azithromycin (AZT) (5.2%). All isolates were susceptible to cefixime (CFX) and ceftriaxone (CRO). However, 8.5% of isolates had MIC=0.125 mg/L for CFX, one log below the resistance cut-off point (EUCAST). β-lactamase production was detected in 12.4% of isolates and one of them carried the blaTEM-135 allele. The American or Dutch tetM gene were carried by 5.2% of the isolates. Mutations in the QRDR were observed in 87.5% of isolates resistant to CIP. NG-MAST showed 64 different sequence types (STs), including 19 novel STs. ST225, ST2992, ST1582, ST338, ST1407, ST2202 and ST6827 were most prevalent. G225 genogroup was associated with resistance to CIP (p Conclusion This study showed high rates of resistance to PEN, TET and CIP associated with persistence and dissemination of gonococcal strains resistant to CIP and plasmid resistance to PEN and TET. Despite the high resistance profile to CIP, the treatment recommended to the south region of Brazil was the association of CIP-AZT until 2017, when the national recommendation changed it to CRO-AZT. Disclosure No significant relationships.

Introduction Policies promoting access to syphilis diagnosis have led to the widespread use of rapid tests (RT) in health facilities of different complexities throughout Brazil. To monitor the quality of the testing procedures, the Ministry of Health introduced the National Program of External Quality Assessment for RT (EQA-RT). This involves healthcare professionals registering on an online platform to receive a panel with four dried tube specimens with unknown reactivity for syphilis. The respondents test the samples as if it they were from their own patients and submit the results online for subsequent analysis. Methods We analysed reports from eight EQA-RT rounds conducted in 2014–2016. The quality of the professionals´ performance was assessed by examining the degree of concordance between the results from the panel samples that were expected and those actually reported. A certificate of approval is issued in the event of 70% accuracy. Any professional receiving less than 70% approval rating is sent a report suggesting possible causes and solutions for issues that might have been responsible to prevent the quality of testing. Results The average number of participants per round was 843 (545 in 2014, 909 in 2015 and 1.075 in 2016) distributed in 347 mainly primary healthcare units. It was interesting to note that many higher complexity services, despite registering in the program, failed to report the results (e.g. a 55% abstention rate in one of the rounds). Regarding the performance on EQA-RT, an average of 93% of respondents were approved per round, with 88% achieving 100% accuracy. The most common failures identified so far have been incorrect pipetted sample volumes and result reading times Conclusion The majority of healthcare professionals currently participating in Brazil´s EQA-RT program are maintaining a high level of RT quality. While the number of participants doubled in 2014–2016, there is still a need for education work to encourage more adherence to the Program aimed at ensuring the reliability and credibility of the TR results.

Introduction The threat of multidrug resistant Neisseria gonorrhoeae (NG) is a concern worldwide, especially in settings with emerging resistance to the extended spectrum cephalosporins. Since 2009 WHO recommendation to the countries to perform Antimicrobial Surveillance has been reinforced. Brazilian’s sexually transmitted infection guideline recommends dual therapy to treat gonococcal infection (ciprofloxacin plus azithromycin). However, regional studies performed in three Brazilian states demonstrated quinolone resistance. For these states it was recommended to replace the quinolones by third generation cephalosporin. The aim of this study was to perform a Brazilian national gonococcal antimicrobial surveillance. Methods The surveillance study included seven collection sites representing five geographic regions of Brazil. A total of 550 NG isolates from male urethral discharge was sent to the gonococcal national reference laboratory for analysis. The minimum inhibitory concentration (MIC) with the agar dilution method was performed for penicillin, tetracycline, ciprofloxacin, ceftriaxone, cefixime and azithromycin. Results The sensitivity profile of the NG isolates was performed in 131 isolates from the Southeast, 104 from the Northeast, 100 from the North, 68 from the Center-West and 147 from the South. In addition to penicillin and tetracycline, a high level of resistance for ciprofloxacin (47% to 78% of isolates) was observed in the isolates of all the regions. All the isolates were sensitive to ceftriaxone and cefixime, although one isolate was found with elevated MIC. Regarding azithromycin sensitivity, the majority of the isolates were sensitive, but the emergence of an intermediate (5% to 15%) or resistant (4% to 10%) profile needs to be monitored. Conclusion The national survey confirmed the high level of ciprofloxacin resistance already described worldwide. These results indicate the need to urgently change Brazilian recommendation for gonorrhoeae treatment and the importance of systematic gonococcal resistance surveillance.

Introduction: Neisseria gonorrhoeae (NG) was originally highly susceptible to antimicrobials. The ongoing selective pressure allied to the bacterium’s ability to develop and retain resistance factors has been indicating the possibility of NG to evolve into untreatable forms. Therefore, constant monitoring of antimicrobial resistance and updates of treatment guidelines are mandatory. The aim of this study was to evaluate the evolution of NG antimicrobial resistance in a historical series of isolates from Sao Paulo/Brazil. Methods A total of 173 NG isolates obtained between 2003 and 2016 from the STD/AIDS Reference and Training Centre of Sao Paulo were analysed. The bacterial species identification was confirmed by MALDI-TOF and the minimum inhibitory concentration (MIC) for penicillin (PEN), tetracycline (TET), ciprofloxacin (CIP), azithromycin (AZT), ceftriaxone (CRO) and cefixime (CFX) was determined by agar dilution. Results The isolates were divided into two periods, from 2003 to 2010 and 2011 to 2016. The susceptibility profile for PEN did not differ between the two periods, 77.8% of the isolates had intermediate (I) and 19% resistant (R) from 2003 to 2010, while 74.5% I and 25.5% R from 2011 to 2016. The susceptibility profile for TET showed a different behaviour with more intermediates in the second period (59.6% I and 31.9% R) compared to the first period (29.4% I and 60.3% R). For AZT, there was an increase in the number of resistant isolates over the years: 0.8% I and 1.6% R (2003 to 2010), and 10.6% I and 12.8% R (2011 to 2016). CIP was the drug that presented the major difference between the periods with 86.5% of isolates being sensitive, 1.6% I and 11.9% R in the first period and 46.8% R in the second period. The isolates were 100% sensitive to cefixime and ceftriaxone. Conclusion The study showed an increase in resistance to azithromycin and especially to ciprofloxacin. Ceftriaxone and cefixime isolates, both rarely used in clinic in Brazil, did not present resistance.

Introduction: Neisseria gonorrhoeae (NG), initially highly susceptible to many antimicrobials, was recently assigned as a superbug due to its ability to develop resistance to all antimicrobials introduced for treatment during the last years. This study aimed to determine the prevalence and trends of NG antimicrobial resistance (AMR) during 2008–2016 in Grande Florianopolis, Santa Catarina, Brazil. Methods A total of 152 gonococcal isolates from urogenital specimens were submitted to Santa Luzia Medical Laboratory, Florianopolis, Brazil. All isolates were identified to the species level using MALDI-TOF. The minimum inhibitory concentration (MIC) was determined using agar dilution method to penicillin, tetracycline, ciprofloxacin, ceftriaxone, cefixime and azithromycin. Quality control was performed using NG WHO reference strains and ATCC 49226. Results All isolates were sensitive to ceftriaxone (MIC 0.001–0.06 µg/ml) and cefixime (MIC: 0.0005–0.125 µg/ml). Resistance to penicilin, tetracycline, ciprofloxacin and azithromycin were 26.3%, 40.8%, 52.0% and 5.2% respectively. Conclusion The study showed increased resistance to penicillin, tetracycline, ciprofloxacin and azithromycin. No resistance to ceftriaxone and cefixime was detected. Due to the high level ciprofloxacin resistance, the dual therapy currently recommended in Brazil for gonococcal infections (ciprofloxacin plus azithromycin) is no more an effective treatment option in Grande Florianopolis. Thus, ceftriaxone constitute the treatment option for gonococcal infections, as well as in the states of Rio de Janeiro, Sao Paulo and Minas Gerais, where regional studies have already detected high level ciprofloxacin resistance. AMR testing needs to be frequently performed to ensure the treatment effectiveness.