Strong, M. | Search bioRxiv

bioRxiv2019

In-host population dynamics of M. tuberculosis during treatment failure

BackgroundTuberculosis (TB) is a leading cause of death globally from an infectious agent. Understanding the population dynamics of TBs causative agent Mycobacterium tuberculosis (Mtb) in-host is vital for understanding the efficacy of antibiotic treatment. Here we use longitudinally collected clinical Mtb isolates that underwent Whole-Genome Sequencing (WGS) from the sputa of 307 subjects to investigate Mtb diversity during the course of active TB disease. Methods and findingsWe excluded cases suspected of reinfection or contamination to analyze data from 200 subjects, 167 of which met microbiological criteria for delayed culture conversion, treatment failure or relapse. Using technical and biological replicate samples, we defined an allele frequency threshold attributable to in-host evolution. Of the 167 subjects with unsuccessful treatment outcome, 27 (16%) developed new resistance mutations between sampling with 20/27 (74%) occurring in patients with pre-existing antibiotic resistance. Low abundance resistance variants at a purity of [≥]19% in the first isolate predicts fixation of these variants in the subsequent sample with 27.0% sensitivity and 95.8% specificity. We identify significant in-host variation in seven genes associated with antibiotic resistance and twenty other genes, including metabolic genes and genes known to modulate host innate immunity by interacting with TLR2. We confirm Rv0095c, Rv1944c, PPE18, PPE54 and PPE60 to be under positive selection by assessing phylogenetic convergence across a global and genetically diverse independent sample of 20,352 isolates. ConclusionsOur large sample provides a comprehensive picture of the mutational dynamics in-host during active TB disease. We demonstrate a framework to study temporal changes in Mtb population diversity using average depth WGS data. We show that minor variants can be used to inform antibiotic treatment regimens in patients with TB. Furthermore, we detect a signature of positive selection in-host, possibly stemming from innate immune pressure and informing our understanding of host-pathogen interactions.

genomics↗

bioRxiv2019

Population Genomics of Nontuberculous Mycobacteria Recovered from United States Cystic Fibrosis Patients

Nontuberculous mycobacteria (NTM) pose a threat to individuals with cystic fibrosis (CF) due to an increased prevalence of pulmonary infections, innate drug resistance of the bacteria, and potential transmission between CF patients. To explore the genetic diversity of NTM isolated from CF patients within the United States (US) and to identify potential transmission events, we sequenced and analyzed the genomes of 341 NTM isolates from 191 CF patients as part of a nationwide surveillance study. The most abundant species in the isolate cohort were Mycobacterium abscessus (59.5%), followed by species in the Mycobacterium avium complex (37.5%). Phylogenomic analyses of the three M. abscessus subspecies revealed that more than half of CF patients had isolates in one of four dominant clones, including two dominant clones of M. abscessus subspecies abscessus and two dominant clones of M. abscessus subspecies massiliense. M. avium isolates from US CF patients, however, do not have dominant clones and are phylogenetically diverse. Longitudinal NTM isolates were compared to determine genome-wide single nucleotide polymorphisms (SNPs) that occur within patients over time. This information was used to compare between and within-patient SNP distributions, to quantitatively define SNP thresholds suggestive of transmission, and calculate a posterior probability of recent transmission given the SNP distance between two isolates from different patients. Out of 114 patients with M. abscessus subspecies, ten clusters of highly similar isolates from 26 patients were identified. Among the 26 patients in the M. abscessus clusters, 12 attended the same CF care centers. No highly similar isolate clusters were observed in M. avium. Our study reveals the contrasting genomic diversity and epidemiology of two major NTM taxa and the potential for between-patient exposure and cross-transmission of these emerging pathogens.

microbiology↗