Multi-locus sequence analysis reveals profound genetic diversity among isolates of the human pathogen Bartonella bacilliformis.

Gemma L Chaloner,Richard J Birtles,Palmira Ventosilla Palmira Ventosilla,Mathieu Picardeau

doi:10.1371/journal.pntd.0001248

Abstract

Bartonella bacilliformis is the aetiological agent of human bartonellosis, a potentially life threatening infection of significant public health concern in the Andean region of South America. Human bartonellosis has long been recognised in the region but a recent upsurge in the number of cases of the disease and an apparent expansion of its geographical distribution have re-emphasized its contemporary medical importance. Here, we describe the development of a multi-locus sequence typing (MLST) scheme for B. bacilliformis and its application to an archive of 43 isolates collected from patients across Peru. MLST identified eight sequence types among these isolates and the delineation of these was generally congruent with those of the previously described typing scheme. Phylogenetic analysis based on concatenated sequence data derived from MLST loci revealed that seven of the eight sequence types were closely related to one another; however, one sequence type, ST8, exhibited profound evolutionary divergence from the others. The extent of this divergence was akin to that observed between other members of the Bartonella genus, suggesting that ST8 strains may be better considered as members of a novel Bartonella genospecies.

Highlights

IntroductionBartonellosis, or Carrion’s disease, caused by the bacterium
Bartonellosis, or Carrion’s disease, caused by the bacteriumBartonella bacilliformis, has long been recognised in the Andean region of South America, in the high valleys lining the western side of the cordillera in central Peru [1]
Oroya fever is characterised by fever, headache, pallor and myalgia, which progresses to a severe haemolytic anaemia

Summary

Introduction

Bartonellosis, or Carrion’s disease, caused by the bacterium. Bartonella bacilliformis, has long been recognised in the Andean region of South America, in the high valleys lining the western side of the cordillera in central Peru [1]. Bartonellosis may present in two markedly different clinical manifestations. Oroya fever is characterised by fever, headache, pallor and myalgia, which progresses to a severe haemolytic anaemia. Mortality rates as high as 88% have been described in untreated patients with this manifestation. Infection may provoke ‘‘verruga peruana’’ characterised by angiogenic skin lesions akin to bacillary angiomatosis caused by Bartonella henselae and Bartonella quintana. The appearance of lesions may be dramatic, verruga peruana tends to be self-limiting and not lifethreatening. The natural cycles of Bartonella species are characterised by mammalian reservoirs and arthropod vectors, and for

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