A Snapshot of the Genetic Diversity of Salmonella Enteritidis Population Involved in Human Infections in Romania Taken in the European Epidemiological Context.

In the absence of consistent national molecular typing data to enhance the surveillance of Salmonella Enteritidis, it was considered useful to collect baseline information on the genetic diversity and antibiotic susceptibility of strains isolated in Romania between January 2016 and April 2020 and compare them to strains described in major international outbreaks of the same period. A collection of 245 clinical isolates were genotyped by a standardised multiple-locus variable-number of tandem repeats analysis (MLVA) 5-loci protocol and screened for antimicrobial resistance against 15 compounds. Twenty strains were further subjected to whole genome sequencing (WGS) and compared to epidemiologically relevant high-throughput sequencing data available in European databases. Twenty-seven MLVA genotypes were identified, of which three, commonly reported in Europe between 2016-2020, covered 72% of the collection. Antibiotic resistance was detected in 30% of the strains, with resistance to nalidixic acid and ciprofloxacin as the most common phenotype, and also associated with two prevalent MLVA clones. WGS-derived multilocus sequence typing (MLST) revealed a single sequence type (ST11) further resolved into 10 core-genome MLST complex types. The minimum spanning tree constructed from the cgMLST data clustered Romanian and international strains, which shared more than 95% of the core genes, revealing links with a contemporaneous multi-country outbreak. This study could be regarded as a forerunner to the advent of using this integrative approach in the public health practice at a national level and thus contribute to the concerted actions at a European level to stop outbreaks.

The seventh pandemic of cholera in Europe revisited by microbial genomics.

In 1970, the seventh pandemic of cholera (7 P) reached both Africa and Europe. Between 1970 and 2011, several European countries reported cholera outbreaks of a few to more than 2,000 cases. We report here a whole-genome analysis of 1,324 7 P V. cholerae El Tor (7 PET) isolates, including 172 from autochthonous sporadic or outbreak cholera cases occurring between 1970 and 2011 in Europe, providing insight into the spatial and temporal spread of this pathogen across Europe. In this work, we show that the 7 PET lineage was introduced at least eight times into two main regions: Eastern and Southern Europe. Greater recurrence of the disease was observed in Eastern Europe, where it persisted until 2011. It was introduced into this region from Southern Asia, often circulating regionally in the countries bordering the Black Sea, and in the Middle East before reaching Eastern Africa on several occasions. In Southern Europe, the disease was mostly seen in individual countries during the 1970s and was imported from North and West Africa, except in 1994, when cholera was imported into Albania and Italy from the Black Sea region. These results shed light on the geographic course of cholera during the seventh pandemic and highlight the role of humans in its global dissemination.

Usefulness of complex bacteriological and serological analysis in patients with spondyloarthritis.

Spondyloarthritis (SpA) is a group of associated chronic systemic inflammatory immune-mediated rheumatic diseases affecting axial and peripheral joints and entheses. The aim of the present study was to identify what parameters are useful to determine in order to better understand the correlation between the disease activity/severity and the microbiological results/immune status against intestinal and/or urogenital pathogens. Microorganisms known to trigger SpA, including Klebsiella spp., Yersinia spp., Salmonella spp., Campylobacter spp. and Chlamydia spp., were analyzed in various specimens (stool, urine, synovial fluid and serum) collected from 27 randomly selected SpA patients and 26 healthy controls using a combined direct and indirect approach relying on conventional culture technique and nucleic acid-based assays together with serological testing by ELISA. Although Escherichia coli derived from phylogroup A prevailed in the gut microflora of the patients and controls, differences were observed regarding the representatives of the other phylogroups with a higher prevalence of E.coli members of phylogenetic group B1 in the stool specimens of patients. Antibodies against the targeted species were detected in SpA patients and controls, and the serological profiles of the former were more diverse and complex. In conclusion, the detection of anti-bacterial antibodies combined with other specific laboratory investigations should be more extensively used to monitor SpA patients in association with their symptoms and in order to determine and administer more effective therapeutics.

Molecular Typing of Escherichia coli O157 Isolates from Romanian Human Cases.

Verocytotoxin-producing Escherichia coli (VTEC) of serogroup O157 are among the most important causes of severe cases of foodborne disease and outbreaks worldwide. As little is known about the characteristic of these strains in Romania, we aimed to provide reference information on the virulence gene content, phylogenetic background, and genetic diversity of 7 autochthonous O157 strains collected during 2016 and 2017 from epidemiologically non-related cases. These strains were typed by a combination of phenotypic and molecular methods routinely used by the national reference laboratory. Additionally, 4 of them were subjected to whole-genome sequencing (WGS), and public web-based tools were used to extract information on virulence gene profiles, multilocus sequence types (MLST), and single nucleotide polymorphism (SNP)-based phylogenetic relatedness. Molecular typing provided evidence of the circulation of a polyclonal population while distinguishing a cluster of non-sorbitol-fermenting, glucuronidase-negative, phylogenetic group E, MLST 1804 strains, representing lineage II and clade 7, which harbored vtx2c, eae-gamma, and ehxA genes. A good correlation between the routine typing methods and WGS data was observed. However, SNP-based genotyping provided a higher resolution in depicting the relationships between the O157:H7 strains than that provided by Pulse-field gel electrophoresis. This study should be a catalyst for improved laboratory-based surveillance of autochthonous VTEC.

Molecular characterisation of human Shiga toxin-producing Escherichia coli O26 strains: results of an outbreak investigation, Romania, February to August 2016.

IntroductionAt the beginning of 2016, an increase in paediatric haemolytic uremic syndrome (HUS) cases was observed in Romania. The microbiological investigations allowed isolation of Shiga toxin-producing Escherichia coli (STEC) O26 as the causative agent from most cases. Methods: An enhanced national surveillance of HUS and severe diarrhoea was established across the country following the identification of the first cases and was carried out until August 2016. A total of 15 strains were isolated from 10 HUS and five diarrhoea cases. Strains were characterised by virulence markers (i.e. stx type/subtype, eae, ehxA genes), phylogroup, genetic relatedness and clonality using PCR-based assays, PFGE and multilocus sequence typing (MLST). The first six strains were further characterised by whole genome sequencing (WGS). Results: Five PCR-defined genotypes were distinguished. All strains from HUS cases harboured stx2a and eae, with or without stx1a, while strains from diarrhoea cases carried exclusively stx1a and eae genes. PFGE resolved strains into multiple pulsotypes, compatible with a certain geographic segregation of the cases, and strains were assigned to phylogroup B1 and sequence type (ST) 21. WGS confirmed the results of conventional molecular methods, brought evidence of O26:H11 serotype, and complemented the virulence profiles. Discussion/conclusion: This first description of STEC O26 strains from cases in Romania showed that the isolates belonged to a diverse population. The virulence content of most strains highlighted a high risk for severe outcome in infected patients. Improving the national surveillance strategy for STEC infections in Romania needs to be further considered.

ANTIMICROBIAL RESISTANCE AND GENETIC DIVERSITY OF SHIGELLA SONNEI ISOLATES FROM ROMANIA.

Although not endemic in the European Union and European Economic Area, shigellosis is included among the priority food- and waterborne diseases carefully surveyed by the European Centre for Disease Prevention and Control. From 2010 to 2012, 1018 cumulated confirmed shigellosis cases were reported to the European Surveillance System by Romania. This retrospective study aimed to provide insights into the antibiotic resistance and genetic diversity of a set of Shigella sonnei isolates recovered during that period. A total of 59 S. sonnei isolates were subjected to antimicrobial susceptibility testing (ampicillin, cefotaxim, chloramphenicol, streptomycin, gentamicin, kanamycin, tetracycline, sulphonamides compound, trimethoprim, trimethoprim-sulfamethoxazole, nalidixic acid, and ciprofloxacin), biotyping, and molecular characterization of resistance to third-generation cephalosporins, fluoroquinolones, and integron content. Pulsed-field gel electrophoresis (PFGE) was performed in order to assess the genetic relatedness of the isolates. Thirty-eight (64%) of the studied isolates displayed multidrug-resistant (MDR) phenotypes, the most common resistance profile comprising resistance to ampicillin, streptomycin, sulphonamides compound, trimethoprim, and trimethoprim-sulfamethoxazole. Resistance to cefotaxim was detected in a biotype g blaCTX-M-15 and a biotype e blaCMY-2-positive isolate, respectively. Resistance to ciprofloxacin and/or nalidixic acid was detected in three MDR isolates and was due to known mutations in gyrA gene leading to aminoacid substitutions (i.e. Ser83Leu, Asp87Tyr, Asp87Gly). Either class 1 or class 2 integrons were identified in 10 isolates. Comparisons of XbaI PFGE patterns of S. sonnei isolates revealed 9 clonal groups and 6 unique patterns. The genotyping results suggested that dissemination of clonal groups of S. sonnei may have persisted over the years in Romania.

Comparative study of pathogenicity tests for Shigella spp. and enteroinvasive Escherichia coli strains.

The purpose of this study was to optimize an in vitro pathogenicity model, as an alternative to Sereny test (on Guinea pigs). The study was performed on 13 Shigella spp. and 3 enteroinvasive Escherichia coli (EIEC) strains isolated in Romania between 2005 and 2007. The investigation implied the comparative evaluation between the Sereny test and Cravioto's adapted method for the assessment of the adherence and invasion capacity of the studied bacterial strains on HeLa cells, as well as the PCR detection of ipaH gene presence. The Sereny test was positive for all the strains tested. All strains adhered to the cellular layer, with a prevalent diffuse pattern for EIEC and an aggregative diffuse one for Shigella strains. The quantitative assessment of the invasion potential proved a high intracellular multiplication rate in 100% of the tested strains, with a progressive increase correlated with the incubation time. The present study has proven the existence of a good correlation between in vivo Sereny test and in vitro determination of the invasive capacity on eukaryotic HeLa cells, pleading for the utility of this test in identifying the invasive strains, taking into consideration the rigid regulations concerning the use of laboratory animals.