Macrolide Treatment Failure in a Case of Secondary Syphilis: A Novel A2059G Mutation in the 23S rRNA Gene of Treponema Pallidum Subsp. Pallidum

J Med Microbiol. 2009 Jun;58(Pt 6):832-836. doi: 10.1099/jmm.0.007542-0.

Abstract

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.

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Animals
  • Anti-Bacterial Agents* / pharmacology
  • Anti-Bacterial Agents* / therapeutic use
  • Child
  • Child, Preschool
  • Czech Republic / epidemiology
  • DNA, Bacterial / analysis
  • DNA, Bacterial / isolation & purification
  • Drug Resistance, Bacterial / genetics*
  • Humans
  • Infant
  • Infant, Newborn
  • Macrolides / pharmacology
  • Macrolides / therapeutic use
  • Male
  • Middle Aged
  • Mutation*
  • Prevalence
  • RNA, Ribosomal, 23S / genetics*
  • Rabbits
  • Sequence Analysis, DNA
  • Spiramycin* / pharmacology
  • Spiramycin* / therapeutic use
  • Syphilis / drug therapy*
  • Syphilis / epidemiology
  • Syphilis / microbiology
  • Treatment Failure
  • Treponema pallidum / drug effects*
  • Treponema pallidum / genetics
  • Young Adult

Substances

  • Anti-Bacterial Agents
  • DNA, Bacterial
  • Macrolides
  • RNA, Ribosomal, 23S
  • Spiramycin