Rene S. Hendriksen, Pimlapas Leekitcharoenphon, Oksana Lukjancenko, Chileshe Lukwesa-Musyani, Bushimbwa Tambatamba, John Mwaba, Annie Kalonda, Ruth Nakazwe, Geoffrey Kwenda, Jacob Dyring Jensen, Christina A. Svendsen, Karen K. Dittmann, Rolf S. Kaas, Lina M. Cavaco, Frank M. Aarestrup, Henrik Hasman and James C.L Mwansa
Retrospectively, we investigated the epidemiology of a massive Salmonella enterica serovar Typhi outbreak in Zambia during 2010 to 2012. Ninety-four isolates were susceptibility tested by MIC determinations. Whole genome sequence typing (WGST) of 33 isolates and bioinformatic analysis identified the MLST, haplotype, plasmid replicon, antimicrobial resistance genes, and the genetic relatedness by Single Nucleotide Polymorphism (SNP) analysis and genomic deletions. The outbreak affected 2,040 patients with a fatality rate of 0.5%. Most isolates (83.0%) were multi-drug resistant (MDR). The isolates belonged to MLST ST1 and a new variant of the haplotype; H58B. Most isolates contained a chromosomally translocated region containing seven antimicrobial resistance genes; catA1, blaTEM-1, dfrA7, sul1, sul 2, strA, and strB, fragments of incQ1plasmid replicon, class 1 integron, and the mer operon. The genomic analysis revealed an overall 415 SNPs difference and 35 deletions among 33 of the isolates whole genome sequenced. In comparison with other genomes of H58, the Zambian isolates separated from genomes from Central Africa and India with 34 and 52 SNPs, respectively. The phylogenetic analysis indicates that 32 isolates of the 33 sequenced belonged to a tight clonal group, distinct from other H58 genomes included in the study. The small numbers of SNPs identified within this group are consistent with short-term transmission that can be expected over a period of 2 years. The phylogenetic analysis and deletions suggest that a single MDR clone was responsible for the outbreak during which occasional other S. Typhi lineages including sensitive ones continued to co-circulate. The common view is that the emerging global S. Typhi haplotype; H58B, containing the MDR incHI1 plasmid is responsible for the majority of typhoid infections in Asia and sub-Saharan Africa; we found that a new variant of the haplotype harbouring a chromosomally translocated region containing the MDR islands of incHI1 plasmid emerged in Zambia. This could chance the perception of the term “classical MDR typhoid” currently being solely associated with the incHI1 plasmid. It might be more common than anticipated that S. Typhi haplotype; H58B harbour either the incHI1 plasmid and /or a chromosomally translocated MDR region.
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