Abstract
An epidemic of post-surgical wound infections, caused by a non-tuberculous mycobacterium, has been on-going in Brazil. It has been unclear whether one or multiple lineages are responsible and whether their wide geographical distribution across Brazil is due to spread from a single point source or is the result of human-mediated transmission. 188 isolates, collected from nine Brazilian states, were whole genome sequenced and analysed using phylogenetic and comparative genomic approaches. The isolates from Brazil formed a single clade, which was estimated to have emerged in 2003. We observed temporal and geographic structure within the lineage that enabled us to infer the movement of sub-lineages across Brazil. The genome size of the Brazilian lineage was reduced relative to most strains in the three subspecies of Mycobacterium abscessus and contained a novel plasmid, pMAB02, in addition to the previously described pMAB01 plasmid. One lineage, which emerged just prior to the initial outbreak, is responsible for the epidemic of post-surgical wound infections in Brazil. Phylogenetic analysis indicates that multiple transmission events led to its spread. The presence of a novel plasmid and the reduced genome size suggest that the lineage has undergone adaptation to the surgical niche.
Highlights
The Mycobacterium abscessus species complex (MABSC) consists of three subspecies, M. abscessus subspecies abscessus (M. a. abscessus), M. abscessus subspecies bolletii (M. a. bolletii) and M. abscessus subspecies massiliense (M. a. massiliense) [1, 2]
One lineage of M. a. massiliense is responsible for the epidemic of post-surgical wound infections in Brazil The Brazilian isolates formed a single clade, to the exclusion of all other isolates of M. abscessus, within the MABSC phylogeny, demonstrating that the epidemic was caused by a single lineage
Since 2004 there have been over 2000 cases of post-surgical wound infections caused by M. a. massiliense in Brazil, including several local outbreaks
Summary
The Mycobacterium abscessus species complex (MABSC) consists of three subspecies, M. abscessus subspecies abscessus (M. a. abscessus), M. abscessus subspecies bolletii (M. a. bolletii) and M. abscessus subspecies massiliense (M. a. massiliense) [1, 2]. Massiliense) [1, 2] Outbreaks of both skin and soft tissue and pulmonary infections caused by the MABSC are becoming more common, with outbreaks having been reported in the UK, USA, Taiwan and South Korea over the past two decades [3,4,5,6,7]. Brazil has seen the largest number, with over 2128 skin and soft tissue infections reported in 23 states since 2004, including large outbreaks in 15 states [8,9,10]. Molecular typing techniques have suggested that the outbreaks, which occurred in geographically distant locations in Brazil, were caused by a single lineage of M. a. Isolates sampled from post-surgical wound infections collected during the initial outbreak in Para (2004–2005) [7] and subsequent outbreaks in Goias (2005–2007) [11], Rio de Janeiro (2006–2007) [12], Parana (2007–2008) [13] and Rio Grande do Sul (2007–2011) [14] had identical rpoB sequences and pulse field gel electrophoresis (PFGE) patterns, several isolates were missing a 50 kb band believed to be a recently described plasmid, pMAB01, identified from an isolate belonging to this lineage [7, 9, 11, 15]
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