Abstract
An atypically large outbreak of Elizabethkingia anophelis infections occurred in Wisconsin. Here we show that it was caused by a single strain with thirteen characteristic genomic regions. Strikingly, the outbreak isolates show an accelerated evolutionary rate and an atypical mutational spectrum. Six phylogenetic sub-clusters with distinctive temporal and geographic dynamics are revealed, and their last common ancestor existed approximately one year before the first recognized human infection. Unlike other E. anophelis, the outbreak strain had a disrupted DNA repair mutY gene caused by insertion of an integrative and conjugative element. This genomic change probably contributed to the high evolutionary rate of the outbreak strain and may have increased its adaptability, as many mutations in protein-coding genes occurred during the outbreak. This unique discovery of an outbreak caused by a naturally occurring mutator bacterial pathogen provides a dramatic example of the potential impact of pathogen evolutionary dynamics on infectious disease epidemiology.
Highlights
An atypically large outbreak of Elizabethkingia anophelis infections occurred in Wisconsin
We found that the outbreak strain represents a novel phylogenetic sublineage of E. anophelis and has unique genomic regions
Eight clinical strains initially identified as E. meningoseptica were members of the E. anophelis species
Summary
An atypically large outbreak of Elizabethkingia anophelis infections occurred in Wisconsin. An outbreak of 66 laboratory-confirmed infections caused by the bacterial pathogen Elizabethkingia anophelis occurred in 2015–2016 in the USA states of Wisconsin (63 patients), Illinois (2 patients) and Michigan (1 patient). A joint investigation by the Wisconsin Division of Public Health, Wisconsin State Laboratory of Hygiene and the Centers for Disease Control and Prevention (CDC) assessed many potential sources of the outbreak, including health-care products, personal care products, food, tap water and person-to-person transmission. We found that the outbreak strain represents a novel phylogenetic sublineage of E. anophelis and has unique genomic regions It displayed exceptional evolutionary dynamism during the outbreak, likely caused by the insertion of the mobile integrative and conjugative element (ICEEa1) into the mutY DNA repair gene
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