Abstract
Mycobacterium avium complex (MAC) species constitute most mycobacteria infections in persons with cystic fibrosis (CF) in the United States, but little is known about their genomic diversity or transmission. During 2016–2020, we performed whole-genome sequencing on 364 MAC isolates from 186 persons with CF from 42 cystic fibrosis care centers (CFCCs) across 23 states. We compared isolate genomes to identify instances of shared strains between persons with CF. Among persons with multiple isolates sequenced, 15/56 (27%) had >1 MAC strain type. Genomic comparisons revealed 18 clusters of highly similar isolates; 8 of these clusters had patients who shared CFCCs, which included 27/186 (15%) persons with CF. We provide genomic evidence of highly similar MAC strains shared among patients at the same CFCCs. Polyclonal infections and high genetic similarity between MAC isolates are consistent with multiple modes of acquisition for persons with CF to acquire MAC infections.
Highlights
Mycobacterium avium complex (MAC) species constitute most mycobacteria infections in persons with cystic fibrosis (CF) in the United States, but little is known about their genomic diversity or transmission
Isolates were analyzed from a total of 42 cystic fibrosis care centers (CFCCs) and 22 states (Figure 2)
Most (132/186 [71%]) persons with samples analyzed were from 41 CFCCs in 21 states, and the remainder received care at 1 CFCC
Summary
Mycobacterium avium complex (MAC) species constitute most mycobacteria infections in persons with cystic fibrosis (CF) in the United States, but little is known about their genomic diversity or transmission. We provide genomic evidence of highly similar MAC strains shared among patients at the same CFCCs. Polyclonal infections and high genetic similarity between MAC isolates are consistent with multiple modes of acquisition for persons with CF to acquire MAC infections. Whole-genome sequencing (WGS) to analyze the genetic diversity of MAC is aimed at identifying MAC infections that cluster by high bacterial genomic sequence similarity, in susceptible populations such as persons with CF. Unclustered isolates are unrelated and are not implicated in transmission, but clustering between MAC isolates suggests that they are derived from the same source (i.e., shared water, surfaces, or person-to-person transmission). To this end, we analyzed the WGS of NTM isolates
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