Robustness in population-structure and demographic-inference results derived from the Aedes aegypti genotyping chip and whole-genome sequencing data.

The mosquito Aedes aegypti is the primary vector of many human arboviruses such as dengue, yellow fever, chikungunya, and Zika, which affect millions of people worldwide. Population genetic studies on this mosquito have been important in understanding its invasion pathways and success as a vector of human disease. The Axiom aegypti1 SNP chip was developed from a sample of geographically diverse A. aegypti populations to facilitate genomic studies on this species. We evaluate the utility of the Axiom aegypti1 SNP chip for population genetics and compare it with a low-depth shotgun sequencing approach using mosquitoes from the native (Africa) and invasive ranges (outside Africa). These analyses indicate that results from the SNP chip are highly reproducible and have a higher sensitivity to capture alternative alleles than a low-coverage whole-genome sequencing approach. Although the SNP chip suffers from ascertainment bias, results from population structure, ancestry, demographic, and phylogenetic analyses using the SNP chip were congruent with those derived from low-coverage whole-genome sequencing, and consistent with previous reports on Africa and outside Africa populations using microsatellites. More importantly, we identified a subset of SNPs that can be reliably used to generate merged databases, opening the door to combined analyses. We conclude that the Axiom aegypti1 SNP chip is a convenient, more accurate, low-cost alternative to low-depth whole-genome sequencing for population genetic studies of A. aegypti that do not rely on full allelic frequency spectra. Whole-genome sequencing and SNP chip data can be easily merged, extending the usefulness of both approaches.

Pathology of an iridescent virus in immature Culex pipiens L. (Diptera, Culicidae).

Iridovirus in Culex pipiens was reported for the first time in 2012. Later studies of horizontal transmission were performed, in which an interaction with the parasite Strelkovimermis spiculatus acting as viral vector was recognized. In the present study, we observed aspects of the pathology produced by an invertebrate iridescent virus in laboratory infected immature Cx. pipiens as well as in infected immature Cx. pipiens in the field. In the laboratory infected larvae, the infection and mortality were asynchronous. Signs of infection in larvae exposed to the virus were observed between the second and the fourth days post-exposure in 99% of the cases, while the highest daily record of visible infected larvae (52%) was observed on the third day post exposure. Moreover, 79% of confirmed virus infected larvae died in the first 10 days after exposure. The Median Lethal Time was eight days. Several tissues were found to be infected and the common sites of replication were the fat body, epidermis and epithelial derivatives, such as the imaginal discs and the tracheal epithelium. Moreover, infection in the salivary glands, gastric ceca and posterior gut have not been previously documented on other mosquito iridescent viruses.

First report on knockdown resistance mutations in wild populations of Aedes aegypti from Argentina determined by a novel multiplex high-resolution melting polymerase chain reaction method.

BACKGROUND: The mosquito Aedes aegypti is an urban vector of dengue and other arboviruses. During epidemics of these viruses, pyrethroid insecticides are used for the control of adult mosquitoes. The worldwide resistance of Ae. aegypti to these insecticides is a cause of failure of vector control campaigns. The primary target of pyrethroids is the voltage-gated sodium channel. Point mutations in the gene coding for this channel, called knockdown resistance (kdr) mutations, are associated with pyrethroid resistance. Two kdr mutations, V1016I and F1534C, have increased in frequency in natural populations of Ae. aegypti in the Americas during the last decade. Their association with pyrethroid resistance has been largely demonstrated in field populations throughout the Americas, and in in vitro assays. Diagnostics for kdr polymorphism allow early detection of the spread of insecticide resistance, which is critical for timely decisions on vector management. Given the importance of resistance management, high-throughput methods for kdr genotyping are valuable tools as they can be used for resistance monitoring programs. These methods should be cost-effective, to allow regional-scale surveys. Despite the extensive presence of Ae. aegypti and incidence of dengue in Argentina, the presence, abundance, and distribution of kdr mutations in populations of this mosquito have yet to be reported for the country. METHODS: Aedes aegypti samples were collected as immature stages or adults from Buenos Aires Metropolitan Area and northern localities of Tartagal (Salta Province) and Calilegua (Jujuy Province). Immature stages were maintained in the laboratory until they developed into adults. A high-resolution melting assay, based on an analysis of melting temperatures, was developed for the simultaneous genotyping of V1016I and F1534C kdr mutations. We used this method to infer the presence and frequencies of kdr alleles in 11 wild populations from Argentina. RESULTS: We demonstrated the presence of kdr mutations in Ae. aegypti in Argentina in regions where this species is under different selection pressures due to the use of pyrethroids. The populations under analysis are located in geographically distant regions of the species' distribution in Argentina: the northern provinces of Salta and Jujuy and the Buenos Aires Metropolitan Area. Higher frequencies of resistant-associated alleles were detected in the northern region. We report a multiplex high-throughput assay based on a high-resolution melting polymerase chain reaction method for the simultaneous genotyping of V1016I and F1534C kdr mutations. This assay was shown to be cost-effective, and thus provides an interesting molecular tool for kdr genotyping in A. aegypti control campaigns. CONCLUSIONS: We report, to the best of our knowledge for the first time, the presence of kdr mutations in populations of Ae. aegypti from geographically distant locations of Argentina that differ with respect to their epidemiological situation and history of mosquito control. We have developed a high-throughput method for the genotyping of kdr mutations in Ae. aegypti from the Americas. Given its affordability and short running time, this method can be used in control campaigns to monitor the presence and spread of kdr alleles. The information provided here is relevant for the rational design of control strategies in the context of integrated vector management.

Categorization by Score of Mosquito Species (Diptera: Culicidae) Related to Yellow Fever Epizootics in Argentina.

The mosquito-borne yellow fever virus (YFV) is the cause of a zoonotic disease, with both sylvatic and urban cycles. Some mosquito species have been associated directly with transmission of the virus in South America, although the importance given to each species varies depending on the bibliography, geographical location, or year of publication. For Argentina, few publications have assessed the involvement of mosquito species, especially those included in the sylvatic cycle. Therefore, the goal of our paper was to gather all the information available in South America and categorize all mosquito species potentially involved in the YFV transmission cycle in Argentina according to incriminating vector criteria. Based on three main characteristics ('Hosts', 'Mosquito vector', and 'YF outbreak'), we generated scales of importance by species, one exclusively for Argentina and another for all of South America, Sabethes albiprivus Theobald, 1903 was the most important species in Argentina; whereas the most important species in South America were Haemagogus janthinomys Dyar 1921, Hg. leucocelaenus Dyar and Shannon, 1924, and Sa. chloropterus Von Humboldt, 1819. Our review highlights the lack of research that evaluates the importance of these species for YFV transmission in Argentina, while serving as a starting point to establish priorities for research on the bionomics and vector status of these species.

Rapid and Efficient Detection by PCR of Culicoides insignis (Diptera: Ceratopogonidae), the Main Vector of Bluetongue Virus (BTV) in the Neotropical Region.

Bluetongue virus (BTV) causes a viral, non-contagious disease that mainly affects sheep, cattle, and wild and farmed ruminants causing damage to these animals and significant economic losses. Culicoides insignis Lutz, the major BTV vector in South America, is one of the most abundant species in Argentina and commonly associated with cattle farms. The morphological identification of Culicoides spp. is routinely carried out with the aid of morphological keys, which mainly refer to the wing patterns, sensillae of palpi, and antennal flagella. Molecular tools applied to taxonomy provide a rapid and efficient method of identification of vector species. An easy protocol for the extraction of total DNA from single midges is herein described, and a forward primer for rapid and reliably test detection by polymerase chain reaction of C. insignis is developed.

Activity of N-Acetylcysteine Alone and in Combination with Colistin against Pseudomonas aeruginosa Biofilms and Transcriptomic Response to N-Acetylcysteine Exposure.

Chronic colonization by Pseudomonas aeruginosa is critical in cystic fibrosis (CF) and other chronic lung diseases, contributing to disease progression. Biofilm growth and a propensity to evolve multidrug resistance phenotypes drastically limit the available therapeutic options. In this perspective, there has been growing interest in evaluating combination therapies, especially for drugs that can be administered by nebulization, which allows high drug concentrations to be reached at the site of infections while limiting systemic toxicity. Here, we investigated the potential antibiofilm activity of N-acetylcysteine (NAC) alone and in combination with colistin against a panel of P. aeruginosa strains (most of which are from CF patients) and the transcriptomic response of a P. aeruginosa CF strain to NAC exposure. NAC alone (8,000 mg/L) showed a limited and strain-dependent antibiofilm activity. Nonetheless, a relevant antibiofilm synergism of NAC-colistin combinations (NAC at 8,000 mg/L plus colistin at 2 to 32 mg/L) was observed with all strains. Synergism was also confirmed with the artificial sputum medium model. RNA sequencing of NAC-exposed planktonic cultures revealed that NAC (8,000 mg/L) mainly induced (i) a Zn2+ starvation response (known to induce attenuation of P. aeruginosa virulence), (ii) downregulation of genes of the denitrification apparatus, and (iii) downregulation of flagellar biosynthesis pathway. NAC-mediated inhibition of P. aeruginosa denitrification pathway and flagellum-mediated motility were confirmed experimentally. These findings suggested that NAC-colistin combinations might contribute to the management of biofilm-associated P. aeruginosa lung infections. NAC might also have a role in reducing P. aeruginosa virulence, which could be relevant in the very early stages of lung colonization. IMPORTANCE Pseudomonas aeruginosa biofilm-related chronic lung colonization contributes to cystic fibrosis (CF) disease progression. Colistin is often a last-resort antibiotic for the treatment of such P. aeruginosa infections, and it has been increasingly used in CF, especially by nebulization. N-acetylcysteine (NAC) is a mucolytic agent with antioxidant activity, commonly administered with antibiotics for the treatment of lower respiratory tract infections. Here, we show that NAC potentiated colistin activity against in vitro biofilms models of P. aeruginosa strains, with both drugs tested at the high concentrations achievable after nebulization. In addition, we report the first transcriptomic data on the P. aeruginosa response to NAC exposure.

Relevant increase of CTX-M-producing Escherichia coli carriage in school-aged children from rural areas of the Bolivian Chaco in a three-year period.

OBJECTIVES: The aim of this study was to perform two cross-sectional surveys on the fecal carriage of CTX-M-producing Enterobacterales in school-aged children from rural areas of the Bolivian Chaco (2016 vs 2019). METHODS: A total of 757 fecal samples were collected from school-aged children living in nine indigenous communities (n=337, 2016; n=420, 2019). After a first passage onto MacConkey agar (MCA), samples were plated onto MCA plus cefotaxime 2 µg/mL (MCA-CTX), and a loopful of the bacterial growth was used as a template for the detection of group 1, 2, 8/25, and 9 blaCTX-M variants by multiplex reverse transcriptase polymerase chain reaction . Positive samples were tested again for detecting, identifying, and characterizing CTX-M-positive isolates. RESULTS: Growth onto MCA-CTX was obtained with 208 samples (27.5%; 62/337, 2016; 146/420, 2019), of which 201 (96.6%) were positive for blaCTX-M genes. Overall, a relevant increase of fecal carriage of CTX-M-producing Enterobacterales was observed in the study period: 17,5% (59/337) in 2016 compared with 33,8% (142/420) in 2019, p<0.01. Nonetheless, the relative group distribution of CTX-M groups remained stable, with group 1 being the prevalent, followed by group 9 and group 8/25. Group 2 was not detected. CONCLUSIONS: The present study demonstrated an alarming spread of CTX-M enzymes in rural areas of the Bolivian Chaco, where antibiotics consumption is limited. Further studies are encouraged to better understand the dissemination dynamics of such relevant resistance determinants.

Activity of fosfomycin/colistin combinations against planktonic and biofilm Gram-negative pathogens.

OBJECTIVES: To investigate the in vitro activity of fosfomycin, colistin and combinations thereof against planktonic and biofilm cultures of Gram-negative pathogens, mostly showing MDR phenotypes, at concentrations achievable via inhalation of aerosolized drugs. METHODS: Activity against planktonic cultures was tested by the chequerboard assay with 130 strains, including 52 Pseudomonas aeruginosa, 47 Klebsiella pneumoniae, 19 Escherichia coli, 7 Stenotrophomonas maltophilia and 5 Acinetobacter baumannii. Activity against biofilm cultures was tested by biofilm chequerboard and quantitative antibiofilm assays with a subset of 20 strains. In addition, 10 of these strains were tested in mutant prevention concentration (MPC) assays. RESULTS: Against planktonic cultures, synergism between fosfomycin and colistin was detected with a minority (10%) of strains (eight K. pneumoniae and five P. aeruginosa), while antagonism was never observed. Synergism between fosfomycin and colistin against biofilms was observed with the majority of tested strains (16/20 in biofilm chequerboard assays, and 18/20 in the quantitative antibiofilm assays), including representatives of each species and regardless of their resistance genotype or phenotype. Furthermore, combination of fosfomycin and colistin was found to significantly reduce the MPC of individual drugs. CONCLUSIONS: Fosfomycin and colistin in combination, at concentrations achievable via inhalation of nebulized drugs, showed notable synergy against MDR Gram-negative pathogens grown in biofilm, and were able to reduce the emergence of fosfomycin- and colistin-resistant subpopulations.

Abiotic factors affecting the prevalence of Wolbachia (Rickettsiaceae) in immature Aedes albopictus (Skuse) (Culicidae).

Wolbachia is a genus of gram-negative endosymbiotic bacterium of maternal transmission, located mainly in the gonads of arthropods, including mosquitoes such as Aedes albopictus. The current distribution of Ae. albopictus in Argentina is restricted to the subtropical northeastern region of the country. Here, we studied the seasonal prevalence of Wolbachia detected in Ae. albopictus larvae and the relationship between the abiotic factors of the larval microhabitat and the infection status, in Eldorado city, Misiones province, subtropical region. The prevalence of Wolbachia infection found was 76.89% (n = 312). From the total samples examined, 52.80% (n = 214) showed double infection with the wAlbA/wAlbB strains, 23.84% (n = 97) infection only with wAlbB, and 0.25% (n = 1) only with wAlbA. The prevalence of double infection did not present statistically significant differences between the sites studied. For single infection, the lowest prevalence value of the wAlbB strain (13.33%) was found in the natural park, whereas the highest was found in the family dwellings and cemeteries. Tire repair shops showed an intermediate value. The wAlbA single infection was identified once. Our results also showed an association between temperature and slightly turbid waters with exposure to the sun in the larval habitats and the probability of infection by Wolbachia.

Redescription of immature stages of Culicoides paraensis (Goeldi) (Diptera: Ceratopogonidae), vector of the Oropouche virus.

Oropouche fever is an emerging zoonotic disease caused by Oropouche virus (OROV). It has two distinct transmission cycles, with the anthropophilic biting midge Culicoides paraensis (Goeldi) (Diptera: Ceratopogonidae) being the primary vector in the urban cycle. Species identification of Culicoides typically has been carried out on the basis of morphological characters, but molecular tools applied to taxonomy can provide rapid and efficient methods to the identification of vector species. The aim of this work was to obtain the first DNA barcode for C. paraensis collected in Argentina and redescribe the larvae and pupae of this species. Nested PCR amplification was applied in this study to increase the DNA amplification, because the material was preserved in alcohol 70% for a long period of time. The immature stages of C. paraensis are fully described from material collected in Misiones province, Argentina. Both stages are compared with their most similar congeners. This COI sequence complements the identification based on morphological characters and the values of genetic distance between the analysed species show that this sequence is useful to discriminate between species of the Culicoides genus.

Presence of Ascogregarina culicis and Ascogregarina sp. in natural sympatric populations of Aedes aegypti and Ae. albopictus (Diptera: Culicidae) in Argentina.

Aedes aegypti is the main vector of the four arboviruses in America which have the greatest impact on human health. The introduction of Aedes albopictus in South America and Argentina acquires importance given the possibility that this species may be a new vector of arboviruses in this region. For this reason, the studies of the biology of their parasites, such as Ascogregarina spp., should be important for the knowledge of the invasive behavior of these vectors. We reported the finding of Ascogregarina culicis in Aedes aegypti and Ascogregarina sp. in Ae. albopictus populations in subtropical Argentina. The prevalence of parasitism by A. culicis in Ae. aegypti and Ascogregrarina sp. in Ae. albopictus was 34.81% (n = 464) and 37.23% (n = 70), respectively, differing between the seasons and habitats. The infection intensity caused by A. culicis and Ascogregarina sp. varied between 1 to 250 and 1 to 327 trophozoites respectively. Ascogregarina culicis was found throughout the all sampling period of Ae. aegypti (June 2016-April 2018). However the presence of Ascogregarina sp. in the midgut of Ae. albopictus was not recorded throughout the whole sampling period despite the presence of the host.

Detection of Flaviviral-Like DNA Sequences in Aedes aegypti (Diptera: Culicidae) Collected From Argentina.

Diseases caused by flaviviruses are a major public health burden across the world. In the past decades, South America has suffered dengue epidemics, the re-emergence of yellow fever and St. Louis encephalitis viruses, and the introduction of West Nile and Zika viruses. Many insect-specific flaviviruses (ISFs) that cannot replicate in vertebrate cells have recently been described. In this study, we analyzed field-collected mosquito samples from six different ecoregions of Argentina to detect flaviviruses. We did not find any RNA belonging to pathogenic flaviviruses or ISFs in adults or immature stages. However, flaviviral-like DNA similar to flavivirus NS5 region was detected in 83-100% of Aedes aegypti (L.). Despite being previously described as an ancient element in the Ae. aegypti genome, the flaviviral-like DNA sequence was not detected in all Ae. aegypti samples and sequences obtained did not form a monophyletic group, possibly reflecting the genetic diversity of mosquito populations in Argentina.

Database of Sabethes and Haemagogus (Diptera: Culicidae) in Argentina: Sylvatic Vectors of the Yellow Fever Virus.

Yellow fever is an endemic disease in America caused by an arbovirus that circulates in the sylvatic cycle between nonhuman primates and mosquitoes of the genera Sabethes Robineau-Desvoidy and Haemagogus Williston. The main goal of this work is to report the distribution patterns of these genera in Argentina through an updated database built from published records as well as from own sample collections. These genera are represented in Argentina by a total of 18 species distributed in 14 provinces and 10 ecoregions. The ecoregions with greatest biodiversity were Paranense Forest, Yungas, Campos and Malezales. This database will also allow generating distribution maps for these mosquito genera, and their respective species in Argentina, to establish areas with high probability of viral circulation that are an essential input for vector surveillance, as a tool for public health decision-makers.

Host range of Triatoma virus does not extend to Aedes aegypti and Apis mellifera.

Vector control is the most effective method to prevent transmission of Chagas disease. Control is mostly made through chemical insecticides although they have negative impact on wild pollinators, such as bees. Reducing pesticide use through biological alternatives could minimize the damage to these beneficial insects. Triatoma virus (TrV) is a pathogen able to kill triatomines and thus a valid candidate to be used as biological control agent. In this study we evaluate the capacity of TrV to infect an important beneficial insect (Apis mellifera) as well as a plague insect (Aedes aegypti). Results indicate that TrV does not infect the bees or mosquitoes tested in this study. The possible specificity of TrV for kissing bugs reinforces the possible use of TrV as a biological control agent for triatomines.

Vector competence of Aedes aegypti for different strains of Zika virus in Argentina.

The importance of Zika virus (ZIKV) has increased noticeably since the outbreak in the Americas in 2015, when the illness was associated with congenital disorders. Although there is evidence of sexual transmission of the virus, the mosquito Aedes aegypti is believed to be the main vector for transmission to humans. This species of mosquito has not only been found naturally infected with ZIKV, but also has been the subject of study in many vector competence assays that employ different strains of ZIKV around the world. In Argentina, the first case was reported in February 2016 and a total of 278 autochthonous cases have since been confirmed, however, ZIKV virus has not been isolated from any mosquito species yet in Argentina. In order to elucidate if Argentinian Ae. aegypti populations could be a possible vector of ZIKV, we conducted vector competence studies that involved a local strain of ZIKV from Chaco province, and a Venezuelan strain obtained from an imported case. For this purpose, Ae. aegypti adults from the temperate area of Argentina (Buenos Aires province) were fed with infected blood. Body, legs and saliva were harvested and tested by plaque titration on plates of Vero cells for ZIKV at 7, 11 and 14 days post infection (DPI) in order to calculate infection, transmission, and dissemination rates, respectively. Both strains were able to infect mosquitoes at all DPIs, whereas dissemination and transmission were observed at all DPIs for the Argentinian strain but only at 14 DPI for the Venezuelan strain. This study proves the ability of Ae. aegypti mosquitoes from Argentina to become infected with two different strains of ZIKV, both belonging to the Asian lineage, and that the virus can disseminate to the legs and salivary glands.

Differential Effects of Temperature and Mosquito Genetics Determine Transmissibility of Arboviruses by Aedes aegypti in Argentina.

Aedes aegypti (L.) (Diptera: Culicidae) have a global distribution and are the primary vector of a number of mosquito-borne viruses responsible for epidemics throughout the Americas. As in much of South America, the threat from pathogens including dengue virus (DENV; Flaviviridae, Flavivirus) and chikungunya virus (CHIKV; Togaviridae, Alphavirus) has increased in Argentina in recent years. The complexity of transmission cycles makes predicting the occurrence and intensity of arbovirus outbreaks difficult. To gain a better understanding of the risk of DENV and CHIKV in Argentina and the factors influencing this risk, we evaluated the role of population and temperature in the vector competence and vectorial capacity (VC) of Ae. aegypti from geographically and ecologically distinct locations. Our results demonstrate that intrinsic and extrinsic factors including mosquito population, viral species, and temperature significantly influence both vector competence and overall VC of Ae. aegypti in Argentina, yet also that the magnitude of these influences is highly variable. Specifically, results suggest that CHIKV competence is more dependent on mosquito genetics than is DENV competence, whereas temperature has a greater effect on DENV transmission. In addition, although there is an overall positive correlation between temperature and competence for both viruses, there are exceptions to this for individual virus-population combinations. Together, these data establish large variability in VC for these pathogens among distinct Ae. aegypti populations in Argentina and demonstrate that accurate assessment of arbovirus risk will require nuanced models that fully consider the complexity of interactions between virus, temperature, mosquito genetics, and hosts.

Factors Related to Aedes aegypti (Diptera: Culicidae) Populations and Temperature Determine Differences on Life-History Traits With Regional Implications in Disease Transmission.

Aedes aegypti (L.) (Diptera: Culicidae) is a vector of many medically significant viruses in the Americas, including dengue virus, chikungunya virus, and Zika virus. Traits such as longevity, fecundity, and feeding behavior contribute to the ability of Ae. aegypti to serve as a vector of these pathogens. Both local environmental factors and population genetics could contribute to variability in these traits. We performed a comparative study of Ae. aegypti populations from four geographically and environmentally distinct collection sites in Argentina in which the cohorts from each population were held at temperature values simulating a daily cycle, with an average of 25°C in order to identify the influence of population on life-history traits. In addition, we performed the study of the same populations held at a daily temperature cycle similar to that of the surveyed areas. According to the results, Aguaray is the most outstanding population, showing features that are important to achieve high fitness. Whereas La Plata gathers features consistent with low fitness. Iguazu was outstanding in blood-feeding rate while Posadas's population showed intermediate values. Our results also demonstrate that climate change could differentially affect unique populations, and that these differences have implications for the capacity for Ae. aegypti to act as vectors for medically important arboviruses.

Biological characterization of Aedes albopictus (Diptera: Culicidae) in Argentina: implications for arbovirus transmission.

Aedes albopictus (Diptera: Culicidae) is an invasive mosquito, native to Asia, that has expanded its range worldwide. It is considered to be a public health threat as it is a competent vector of viruses of medical importance, including dengue, chikungunya, and Zika. Despite its medical importance there is almost no information on biologically important traits of Ae. albopictus in Argentina. We studied life cycle traits, demographic parameters and analyzed the competence of this mosquito as a virus vector. In addition, we determined the prevalence of Wolbachia strains in Ae. albopictus as a first approach to investigate the potential role of this bacteria in modulating vector competence for arboviruses. We observed low hatch rates of eggs, which led to a negative growth rate. We found that Ae. albopictus individuals were infected with Wolbachia in the F1 but while standard superinfection with wAlbA and wAlbB types was found in 66.7% of the females, 16.7% of the females and 62.5% of the males were single-infected with the wAlbB strain. Finally, despite high levels of infection and dissemination, particularly for chikungunya virus, Ae. albopictus from subtropical Argentina were found to be relatively inefficient vectors for transmission of both chikungunya and dengue viruses.

Targeted next generation sequencing in Italian patients with Usher syndrome: phenotype-genotype correlations.

We report results of DNA analysis with next generation sequencing (NGS) of 21 consecutive Italian patients from 17 unrelated families with clinical diagnosis of Usher syndrome (4 USH1 and 17 USH2) searching for mutations in 11 genes: MYO7A, CDH23, PCDH15, USH1C, USH1G, USH2A, ADGVR1, DFNB31, CLRN1, PDZD7, HARS. Likely causative mutations were found in all patients: 25 pathogenic variants, 18 previously reported and 7 novel, were identified in three genes (USH2A, MYO7A, ADGRV1). All USH1 presented biallelic MYO7A mutations, one USH2 exhibited ADGRV1 mutations, whereas 16 USH2 displayed USH2A mutations. USH1 patients experienced hearing problems very early in life, followed by visual impairment at 1, 4 and 6 years. Visual symptoms were noticed at age 20 in a patient with homozygous novel MYO7A missense mutation c.849G > A. USH2 patients' auditory symptoms, instead, arose between 11 months and 14 years, while visual impairment occurred later on. A homozygous c.5933_5940del;5950_5960dup in USH2A was detected in one patient with early deafness. One patient with homozygous deletion from exon 23 to 32 in USH2A suffered early visual symptoms. Therefore, the type of mutation in USH2A and MYO7A genes seems to affect the age at which both auditory and visual impairment occur in patients with USH.