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Large scale genomic analysis shows no evidence for repeated pathogen adaptation during the invasive phase of bacterial meningitis in humans

By John Lees, Philip HC Kremer, Ana S Manso, Nicholas J Croucher, Bart Ferwerda, Mercedes Valls SerĂ³n, Marco R Oggioni, Julian Parkhill, Matthjis C Brouwer, Arie van der Ende, Diederik van de Beek, Stephen D Bentley

Posted 17 Aug 2016
bioRxiv DOI: 10.1101/070045 (published DOI: 10.1099/mgen.0.000103)

Recent studies have provided evidence for rapid pathogen genome variation, some of which could potentially affect the course of disease. We have previously detected such variation by comparing isolates infecting the blood and cerebrospinal fluid (CSF) of a single patient during a case of bacterial meningitis. To determine whether the observed variation repeatedly occurs in cases of disease, we performed whole genome sequencing of paired isolates from blood and CSF of 938 meningitis patients. We also applied the same techniques to 54 paired isolates from the nasopharynx and CSF. Using a combination of reference-free variant calling approaches we show that no genetic adaptation occurs in the invasive phase of bacterial meningitis for four major pathogen species: Streptococcus pneumoniae, Neisseria meningitidis, Listeria monocytogenes and Haemophilus influenzae. From nasopharynx to CSF , no adaptation was seen in S. pneumoniae, but in N. meningitidis mutations potentially mediating adaptation to the invasive niche were occasionally observed in the dca gene. This study therefore shows that the bacteria capable of causing meningitis are already able to do this upon entering the blood, and no further sequence change is necessary to cross the blood-brain barrier. The variation discovered from nasopharyngeal isolates suggest that larger studies comparing carriage and invasion may help determine the likely mechanisms of invasiveness.

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