Ann Lab Med.  2012 Sep;32(5):366-369. 10.3343/alm.2012.32.5.366.

Quinolone-resistant Shigella flexneri Isolated in a Patient Who Travelled to India

Affiliations
  • 1Department of Medicine, Graduate School, Kyung Hee University, Seoul, Korea.
  • 2Department of Biomedical Science, Kyung Hee University Graduate School, Seoul, Korea. leehejo@khmc.or.kr
  • 3Department of Laboratory Medicine, School of Medicine, Kyung Hee University, Seoul, Korea.
  • 4Department of Molecular Biology, Seoul Medical Science Institute/Seoul Clinical Laboratories, Seoul, Korea.
  • 5Division of Enteric Bacterial Infections, Center for Infectious Disease, National Institute of Health, Seoul, Korea.

Abstract

We report a recent case in which ciprofloxacin-resistant Shigella flexneri was isolated from a 23-yr-old female patient with a history of travel to India. Prior to her admission to our internal medicine department, she experienced symptoms of high fever and generalized weakness from continuous watery diarrhea that developed midway during the trip. S. flexneri was isolated from the stool culture. Despite initial treatment with ciprofloxacin, the stool cultures continued to show S. flexneri growth. In the susceptibility test for antibiotics of the quinolone family, the isolate showed resistance to ciprofloxacin (minimum inhibitory concentration [MIC], 8 microg/mL), norfloxacin (MIC, 32 microg/mL), ofloxacin (MIC, 8 microg/mL), nalidixic acid (MIC, 256 microg/mL), and intermediate resistance to levofloxacin (MIC, 4 microg/mL). In molecular studies for quinolone resistance related genes, plasmid borne-quinolone resistance genes such as qnrA, qnrB, qnrS, aac(6')-Ib-cr, qepA, and oqxAB were not detected. Two mutations were observed in gyrA (248C-->T, 259G-->A) and 1 mutation in parC (239G-->T). The molecular characteristics of the isolated S. flexneri showed that the isolate was more similar to the strains isolated from the dysentery outbreak in India than those isolated from Korea.

Keyword

Quinolone resistance; Shigella flexneri; Ciprofloxacin resistance

MeSH Terms

Anti-Bacterial Agents/pharmacology
Bacterial Proteins/genetics/metabolism
Drug Resistance, Bacterial/drug effects
Dysentery, Bacillary/microbiology
Feces/microbiology
Female
Humans
India
Mutation
Quinolones/*pharmacology
Shigella flexneri/drug effects/*isolation & purification/metabolism
Travel
Young Adult

Figure

  • Fig. 1 Expression of the efflux pump genes in response to ciprofloxacin with reference to the expression levels in the control strain. Expression of tolC, mdfA, and ydhE was measured by real-time PCR in the absence and presence of ciprofloxacin. Each value represents the average of 5 culture replicates, each of which was evaluated twice. Relative gene expression levels were calculated as 2-ΔΔCT, where ΔΔCT=ΔCT (sample) - ΔCT (control) [11]. CIP-: absence of ciprofloxacin; CIP+: presence of ciprofloxacin.


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