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    A Genomic Approach to Resolving Relapse versus Reinfection among Four Cases of Buruli Ulcer

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    Author
    Eddyani, M; Vandelannoote, K; Meehan, CJ; Bhuju, S; Porter, JL; Aguiar, J; Seemann, T; Jarek, M; Singh, M; Portaels, F; ...
    Date
    2015-11-01
    Source Title
    PLoS Neglected Tropical Diseases
    Publisher
    PUBLIC LIBRARY SCIENCE
    University of Melbourne Author/s
    Seemann, Torsten; Porter, Jessica; Stinear, Timothy; Vandelannoote, Koen
    Affiliation
    Microbiology and Immunology
    Metadata
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    Document Type
    Journal Article
    Citations
    Eddyani, M., Vandelannoote, K., Meehan, C. J., Bhuju, S., Porter, J. L., Aguiar, J., Seemann, T., Jarek, M., Singh, M., Portaels, F., Stinear, T. P. & de Jong, B. C. (2015). A Genomic Approach to Resolving Relapse versus Reinfection among Four Cases of Buruli Ulcer. PLOS NEGLECTED TROPICAL DISEASES, 9 (11), https://doi.org/10.1371/journal.pntd.0004158.
    Access Status
    Open Access
    URI
    http://hdl.handle.net/11343/258268
    DOI
    10.1371/journal.pntd.0004158
    Abstract
    BACKGROUND: Increased availability of Next Generation Sequencing (NGS) techniques allows, for the first time, to distinguish relapses from reinfections in patients with multiple Buruli ulcer (BU) episodes. METHODOLOGY: We compared the number and location of single nucleotide polymorphisms (SNPs) identified by genomic screening between four pairs of Mycobacterium ulcerans isolates collected at the time of first diagnosis and at recurrence, derived from a collection of almost 5000 well characterized clinical samples from one BU treatment center in Benin. PRINCIPAL FINDINGS: The findings suggest that after surgical treatment-without antibiotics-the second episodes were due to relapse rather than reinfection. Since specific antibiotics were introduced for the treatment of BU, the one patient with a culture available from both disease episodes had M. ulcerans isolates with a genomic distance of 20 SNPs, suggesting the patient was most likely reinfected rather than having a relapse. CONCLUSIONS: To our knowledge, this study is the first to study recurrences in M. ulcerans using NGS, and to identify exogenous reinfection as causing a recurrence of BU. The occurrence of reinfection highlights the contribution of ongoing exposure to M. ulcerans to disease recurrence, and has implications for vaccine development.

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