Bertille de Barbeyrac

Whole-genome analysis of diverse Chlamydia trachomatis strains identifies phylogenetic relationships masked by current clinical typing

Chlamydia trachomatis is responsible for both trachoma and sexually transmitted infections, causing substantial morbidity and economic cost globally. Despite this, our knowledge of its population and evolutionary genetics is limited. Here we present a detailed phylogeny based on whole-genome sequencing of representative strains of C. trachomatis from both trachoma and lymphogranuloma venereum (LGV) biovars from temporally and geographically diverse sources. Our analysis shows that predicting phylogenetic structure using ompA, which is traditionally used to classify Chlamydia, is misleading because extensive recombination in this region masks any true relationships present. We show that in many instances, ompA is a chimera that can be exchanged in part or as a whole both within and between biovars. We also provide evidence for exchange of, and recombination within, the cryptic plasmid, which is another key diagnostic target. We used our phylogenetic framework to show how genetic exchange has manifested itself in ocular, urogenital and LGV C. trachomatis strains, including the epidemic LGV serotype L2b.

Propionibacterium acnes isolated from synovial tissue and fluid in a patient with oligoarthritis associated with acne and pustulosis

This report describes the case of a patient with a 14-month course of severe oligoarthritis associated with acne. Pure cultures of Propionibacterium acnes were isolated from synovial tissue and synovial fluid specimens collected from the same joint after a 4-month interval. After 2 months of treatment with roxithromycin 300 mg/day, rifampicin 1,200 mg/day, and a nonsteroidal antiinflammatory drug (NSAID), followed by 4 months of treatment with azithromycin 1 gm/week and an NSAID, the synovitis persisted. Cultures of skin lesions and synovial fluid at this time were negative. Although P acnes has previously been isolated from bone specimens obtained from patients with osteitis associated with acne, this is the first report of the isolation of this microorganism from the synovial tissue of a patient with arthritis associated with acne. Our findings raise the question of the role of P acnes in the pathogenesis of arthritis associated with acne.

Chlamydial infections in duck farms associated with human cases of psittacosis in France.

Five severe cases of psittacosis in individuals associated with duck farms were notified in France between January and March 2006. Diagnostic examination included serology and/or molecular detection by PCR from respiratory samples. As a consequence, we investigated all duck flocks (n=11) that were housed in the three farms where human infections occurred. While serology by complement fixation test was negative for all samples, cloacal and/or tracheal chlamydial excretion was detected by PCR in all three units. Notably, one duck flock was tested strongly positive in 2 of the 3 affected farms, and Chlamydophila (C.) psittaci strains were isolated from cloacal and/or tracheal swab samples from both farms. Human samples and duck isolates exhibited the same PCR-RFLP restriction pattern, which appeared to be an intermediate between genotypes A and B. Analysis of ompA gene sequences and comparison to those of the type strains showed that the isolates could not be strictly assigned to any of the generally accepted genotypes of C. psittaci. Further analysis by MLVA of the PCR-positive human samples revealed two distinct patterns, which were related to previously isolated C. psittaci duck strains.

Rectal lymphogranuloma venereum, France.

To the Editor: Lymphogranuloma venereum (LGV), a sexually transmitted disease (STD) caused by Chlamydia trachomatis serovars L1, L2, or L3, is prevalent in tropical areas but occurs sporadically in the western world, where most cases are imported (1). LVG commonly causes inflammation and swelling of the inguinal lymph nodes, but it can also involve the rectum and cause acute proctitis, particularly among men who have sex with men. However, LGV serovars of C. trachomatis remain a rare cause of acute proctitis, which is most frequently caused by Neisseria gonorrhoeae or by non-LGV C. trachomatis (2). In 1981, in a group of 96 men who have sex with men with symptoms suggestive of proctitis in the United States, Quinn et al. found that 3 of 14 C. trachomatis infections were caused by LGV serovar L2 (3). In France, 2 cases of rectal LGV were reported in an STD clinic in Paris from 1981 to 1986 (4). In 2003, an outbreak of 15 rectal LGV cases was reported among men who have sex with men in Rotterdam; 13 were HIV-infected, and all reported unprotected sex in neighboring countries, including Belgium, France, and the United Kingdom (5). At the same time, a rise in C. trachomatis proctitis (diagnosed by using polymerase chain reaction [PCR]; [Cobas Amplicor Roche Diagnostic System, Meylan, France]) was detected in 3 laboratories in Paris and in the C. trachomatis national reference center located in Bordeaux. To identify the serovars of these C. trachomatis spp., all stored rectal specimens were analyzed by using a nested omp1 PCR-restriction fragment length polymorphism assay. The amplified DNA product was digested by restriction enzymes. Analysis of digested DNA was performed by electrophoresis. Patterns were compared visually with reference patterns (6). From January 1, 2003, to March 31, 2004, a total of 44 of 124 male rectal swabs were positive for C. trachomatis. Of those, 38 were identified as belonging to the L2 serotype, which confirms the diagnosis of rectal LGV. Epidemiologic information was retrospectively obtained by clinicians through review of medical records, telephone interview, or both. A complete history was available for 14 of the 38 cases. All 14 men reported unprotected anal sex with anonymous male sex partners in France, and none reported a stay in an LGV-endemic area. Their mean age was 40 years (31–50); 8 were HIV-infected, and 9 had another concomitant STD. The mean duration of symptoms before LGV diagnosis was 50 days (range 11–120 days). All 14 patients had symptoms of acute proctitis, including rectal pain, discharge, and tenesmus, and 3 (all HIV-infected) had fever. Deep, extended rectal ulcerations were reported in 8 patients, 3 of whom were HIV-infected and had lesions suggestive of rectal carcinoma. In 1 patient in whom a late diagnosis was made 4 months after the onset of symptoms, a rectal tumorlike stricture was observed. All 14 patients were treated with tetracycline for a mean duration of 16 days (range 10–60 days). An information campaign among microbiologists and clinicians and a sentinel LGV surveillance system were launched in April 2004. Subsequently, LGV was diagnosed in 65 additional male patients, some retrospectively. In total, rectal LGV was diagnosed in 103 patients from July 2002 to August 2004 (Figure). Figure Number of rectal lymphogranuloma venereum cases diagnosed in men in France, July 2002–August 2004. Prompt diagnosis and treatment is indeed paramount to prevention and control. Diagnosis may be further hampered because rectal LGV may mimic other conditions such as rectal carcinoma or Crohn disease. Treatment duration should be no shorter than 21 days, and follow-up examinations should be conducted until all signs and symptoms have resolved (7,8). If left untreated, rectal LGV could lead to serious complications such as rectal stricture (1). If recently exposed to infection, sexual contacts should receive prophylactic treatment to prevent reinfection and to eliminate a potential reservoir. The emergence of rectal LGV, characterized by deep mucosal ulcerations and frequently occurring in HIV-infected men who have sex with men, is a serious concern for the gay community in Europe.

Typing of lymphogranuloma venereum Chlamydia trachomatis strains

We analyzed by multilocus sequence typing 77 lymphogranuloma venereum Chlamydia trachomatis strains from men who have sex with men in Europe and the United States. Specimens from an outbreak in 2003 in Europe were monoclonal. In contrast, several strains were in the United States in the 1980s, including a variant from Europe.

CTX-M-producing Escherichia coli in a maternity ward: a likely community importation and evidence of mother-to-neonate transmission

OBJECTIVES To investigate the high prevalence of extended-spectrum beta-lactamase (ESBL)-producing strains of Escherichia coli (4%, 10/250 consecutive isolates) recovered during a 5 month period in the maternity ward of the University Hospital of Bordeaux, France. METHODS beta-Lactam resistance transfer was analysed by conjugation and transformation. ESBLs were characterized by isoelectric focusing, PCR amplification and sequencing. The relatedness of the strains was examined by PFGE and phylogenetic group determination. Plasmids were characterized by incompatibility group and restriction analysis. RESULTS Ten ESBL-producing E. coli were isolated from urinary or genital samples of eight mothers and from gastric fluids of two newborns of carrier mothers. The patients were hospitalized in five different units of the maternity ward. Transconjugants, obtained for 7 of the 10 strains, and wild-type strains exhibited various antibiotypes. Different CTX-M enzymes were characterized: CTX-M-1 (n = 4); CTX-M-14 (n = 3); CTX-M-32 (n = 2); and CTX-M-28 (n = 1). The strains recovered from two mothers and their respective babies were identical. All the other strains were epidemiologically unrelated. Furthermore, various plasmids were identified. Environmental samples from the common echographic and sampling rooms did not reveal the presence of ESBL-producing enterobacteria. CONCLUSIONS The data argue against the occurrence of a nosocomial outbreak and support the hypothesis of an importation of community-acquired ESBL-producing strains into the hospital through colonized/infected patients. At present, not only patients transferred from other hospitals or long-term care facilities are at risk of carrying ESBL-producing enterobacteria on hospital admission, but also community patients.

Screening of Volunteer Students in Yaounde (Cameroon, Central Africa) for Chlamydia trachomatis Infection and Genotyping of Isolated C. trachomatis Strains

ABSTRACT The prevalence of Chlamydia trachomatis infection was 3.78% out of 1,277 volunteer students screened by direct fluorescence assay and Cobas Amplicor PCR. The infection was associated with the nonuse or inconsistent use of condoms in women (P = 0.026) and a previous sexually transmitted infection in men (P = 0.023). The most frequent genotypes determined by sequencing the omp1 genes of 25 clinical isolates were E (44%) and F (20%), and some strains harbored mutations, but E genotype strains did not.

Épidémiologie actuelle des infections sexuellement transmissibles bactériennes en France

Sexually transmitted infections (STIs) remains a major problem of public health in France. Voluntary networks of physicians (RésIST) and laboratories (Rénago, Rénachla, lymphogranuloma venereum: LGV network) produce indicators showing the evolution of the main bacterial STIs. In 2010, the main findings were the following. The number of gonococcal infections has increased throughout the decade 2000 to 2010. The decrease in susceptibility of gonococcal strains to first-line antibiotics (extended-spectrum cephalosporins) needs to keep great attention. The number of screening and diagnosis of chlamydial urogenital infections also continues to rise in both sexes, particularly due to increased screening among young people. The relatively stable number of cases of early syphilis and of rectal LGV needs to be confirmed over the coming years. Both of these STIs affect overwhelmingly homo/bisexual men. There is still a high level of HIV co-infection with LGV and syphilis, and to a lesser extent with gonorrhea. We observe that condom use is still inadequate, especially during oral sex.

Doxycycline failure in lymphogranuloma venereum

Lymphogranuloma venereum (LGV) cases are currently re-emerging in the homosexual community, particularly in HIV-seropositive patients. The standard treatment for this infection, which is caused by Chlamydia trachomatis L1, L2 and L3 serotypes, is a 3-week doxycycline regimen. The case is reported of a male patient presenting with LGV, who was rapidly cured with moxifloxacin treatment after failure of extended treatment with cyclines. This fluoroquinolone is known to be highly active in vitro on the LGV pathogenic agent. Thus it may be a useful alternative when doxycycline treatment results in failure.

Host preference and zoonotic potential of Chlamydia psittaci and C. gallinacea in poultry

Chlamydia psittaci and C. gallinacea are obligate intracellular bacteria infecting poultry. We conducted a survey in two poultry slaughterhouses that were processing either exclusively ducks (A) or various poultry species except ducks (B). Cloacal swabs were collected from all incoming poultry flocks in the course of a week, and blood samples and pharyngeal swabs were taken from workers. Swabs were examined using PCR and sera were analyzed with two immunoassays. PCR testing revealed the presence of C. psittaci in 9/38 duck flocks and the complete absence of C. gallinacea in these flocks (slaughterhouse A), whereas 16/33 Chlamydiaceae-positive poultry flocks handled in slaughterhouse B harbored C. gallinacea only. In an episode of psittacosis in slaughterhouse A, where one PCR-positive worker presented clinical signs, seroconversions were detected in 10 workers. In contrast, serological responses of slaughterhouse B workers to C. psittaci were generally low. This is in line with the almost complete absence of C. psittaci in handled flocks, where in additional sampling campaigns the agent was detected only once in the course of a year. Our study indicates that C. psittaci has a certain preference for ducks, whereas C. gallinacea was the predominant chlamydial agent in chickens and guinea fowl flocks.