Abstract

Twenty-nine strains of Aggregatibacter actinomycetemcomitans cultured from blood stream infections in Denmark were characterised. Serotyping was unremarkable, with almost equal proportions of the three major types plus a single serotype e strain. Whole genome sequencing positioned the serotype e strain outside the species boundary; moreover, one of the serotype a strains was unrelated to other strains of the major serotypes and to deposited sequences in the public databases. We identified five additional strains of this type in our collections. The particularity of the group was corroborated by phylogenetic analysis of concatenated core genes present in all strains of the species, and by uneven distribution of accessory genes only present in a subset of strains. Currently, the most accurate depiction of A. actinomycetemcomitans is a division into three lineages that differ in genomic content and competence for transformation. The clinical relevance of the different lineages is not known, and even strains excluded from the species sensu stricto can cause serious human infections. Serotyping is insufficient for characterisation, and serotypes a and e are not confined to specific lineages.

Highlights

  • Aggregatibacter actinomycetemcomitans is a fastidious Gram-negative bacterium that inhabits the mucosal surfaces of humans and certain primates [1,2]

  • Twenty-nine blood stream isolates of A. actinomycetemcomitans were identified as part of an investigation of Danish HACEK bacteraemia cases [6]

  • Serotyping by PCR identified seven serotype a, 11 serotype b, 10 serotype c, and one serotype e strain—this distribution is similar to the observed prevalence among oral strains in Scandinavia ([16] and references therein)

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Summary

Introduction

Aggregatibacter actinomycetemcomitans is a fastidious Gram-negative bacterium that inhabits the mucosal surfaces of humans and certain primates [1,2]. A single serotype b clonal lineage is associated with a silent but aggressive orphan disease of adolescents that results in periodontitis and tooth loss [4]. A. actinomycetemcomitans is a member of the HACEK group of fastidious Gram-negative bacteria (Haemophilus, Aggregatibacter, Cardiobacterium, Eikenella and Kingella), a recognized but unusual cause. A recent population-based study of the incidence of HACEK bacteraemia in Denmark identified 147 cases corresponding to an annual incidence of 0.44 per 100,000 population [6]. A retrospective study from New Zealand with 87 cases of HACEK bacteraemia confirmed a strong association with infective endocarditis, the association with endocarditis ranged from 0 of 11 cases (Eikenella corrodens) to 18 of 18 cases (A. actinomycetemcomitans) [7]

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