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Journal of Clinical Microbiology, October 2008, p. 3208-3214, Vol. 46, No. 10
0095-1137/08/$08.00+0     doi:10.1128/JCM.00221-08
Copyright © 2008, American Society for Microbiology. All Rights Reserved.

Neisseria meningitidis Intermediately Resistant to Penicillin and Causing Invasive Disease in South Africa in 2001 to 2005

National Institute for Communicable Diseases (NICD) of the National Health Laboratory Service (NHLS),¹ School of Pathology,² School of Public Health, University of the Witwatersrand, Johannesburg, South Africa,³ Hubert Department of Global Health, Rollins School of Public Health, and Division of Infectious Diseases, School of Medicine, Emory University, Atlanta, Georgia⁴

Received 4 February 2008/ Returned for modification 15 April 2008/ Accepted 14 July 2008

Neisseria meningitidis strains (meningococci) with decreased susceptibility to penicillin (MICs, >0.06 µg/ml) have been reported in several parts of the world, but the prevalence of such isolates in Africa is poorly described. Data from an active national laboratory-based surveillance program from January 2001 through December 2005 were analyzed. A total of 1,897 cases of invasive meningococcal disease were reported, with an average annual incidence of 0.83/100,000 population. Of these cases, 1,381 (73%) had viable isolates available for further testing; 87 (6%) of these isolates tested intermediately resistant to penicillin (Penⁱ). Penⁱ meningococcal isolates were distributed throughout all provinces and age groups, and there was no association with outcome or human immunodeficiency virus infection. The prevalence of Penⁱ was lower in serogroup A (7/295; 2%) than in serogroup B (24/314; 8%), serogroup C (9/117; 8%), serogroup Y (22/248; 9%), or serogroup W135 (25/396; 6%) (P = 0.02). Pulsed-field gel electrophoresis grouped 63/82 Penⁱ isolates into nine clusters, mostly according to serogroup. The clustering of patterns from Penⁱ isolates was not different from that of penicillin-susceptible isolates. Twelve sequence types were identified among 18 isolates arbitrarily selected for multilocus sequence typing. DNA sequence analysis of the penA gene identified 26 different alleles among the Penⁱ isolates. Intermediate penicillin resistance is thus widespread among meningococcal serogroups, has been selected in a variety of lineages, and, to date, does not appear to be associated with increased mortality. This is the first report describing the prevalence and molecular epidemiology of Penⁱ meningococcal isolates from sub-Saharan Africa.

Published ahead of print on 23 July 2008.