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A genomic epidemiology investigation of yaws re-emergence and bacterial drug resistance selection
Sheila A Lukehart
Oriol Mitja
Marc Noguera-Julian
Charmie Godornes
Maria Casadella
Camila Gonzalez-Beiras
Mariona Parera
Marc Corbacho-Monne
Roger Paredes
Fernando Gonzalez-Candelas
Nicholas R Thomson
Mathew A Beale
Michael Marks
Novel Coronavirus
Acceso Abierto
Atribución
10.1101/2019.12.31.19016220
Background: In a longitudinal study assessing the WHO strategy for yaws eradication using mass azithromycin treatment, we observed resurgence of yaws cases with dominance of a single JG8 sequence type and emergence of azithromycin-resistant Treponema pallidum. Here, we analyse genomic changes in the bacterial population using samples collected during the study. Methods: We performed whole bacterial genome sequencing directly on DNA extracted from 37 lesion swabs collected from patients on Lihir Island, Papua New Guinea, between 2013 and 2016. We produced phylogenies and correlated these with temporo-spatial information to investigate the source of new cases and the emergence of five macrolide-resistant cases. We used deep amplicon sequencing of surveillance samples to assess the presence of minority macrolide resistance populations. Findings: We recovered 20 whole Treponema genomes, and phylogenetic analysis showed that the re-emerging JG8 sequence type was composed of three bacterial sub-lineages characterised by distinct temporo-spatial patterns. Of five patients with resistant Treponema, all epidemiologically linked, we recovered genomes from three and found no variants. Deep sequencing showed that pre-treatment, the index patient harboured fixed macrolide-sensitive Treponema, while the post-treatment sample harboured a fixed resistant genotype, as did three of four contact cases. We also found no evidence of pre-existing minority Treponema drug-resistance variants in the general population. Interpretation: In this study, re-emergence of yaws cases was polyphyletic, indicating multiple epidemiological sources. However, given the genomic and epidemiological linkage of resistant cases and the rarity of resistance alleles in the general population, it is likely that azithromycin resistance evolved only once in this study, followed by onward dissemination. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This work was funded by Wellcome (Grant #206194) and the Provintial Deputation of Barcelona (Grant #1940000465). The funders played no role in study design, sample collection, analysis or reporting. ### Author Declarations All relevant ethical guidelines have been followed; any necessary IRB and/or ethics committee approvals have been obtained and details of the IRB/oversight body are included in the manuscript. Yes All necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes Raw sequencing reads from WGS were deposited at the European Nucleotide Archive (ENA) under BioProject PRJEB34799. Raw sequencing reads from deep amplicon sequencing were deposited at the Short Read Archive (SRA) under BioProject PRJNA575636. All accessions used in this project are listed in Supplementary Data 1 and Supplementary Data 2 along with the appropriate sample identifier. [https://figshare.com/articles/A_genomic_epidemiology_investigation_of_yaws_re-emergence_and_bacterial_drug_resistance_selection/11418012][1] [1]: https://figshare.com/articles/A_genomic_epidemiology_investigation_of_yaws_re-emergence_and_bacterial_drug_resistance_selection/11418012
Cold Spring Harbor Laboratory Press
2020
Preimpreso
https://www.medrxiv.org/content/10.1101/2019.12.31.19016220v1
Inglés
VIRUS RESPIRATORIOS
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