scholarly journals Genetic Diversity of Clinical and Environmental Vibrio parahaemolyticus Strains from the Pacific Northwest

2012 ◽  
Vol 78 (24) ◽  
pp. 8631-8638 ◽  
Author(s):  
Rohinee Paranjpye ◽  
Owen S. Hamel ◽  
Asta Stojanovski ◽  
Martin Liermann
Keyword(s):  
Pacific Northwest ◽  
Vibrio Parahaemolyticus ◽  
The United States ◽  
Assessment Tools ◽  
Clinical Isolates ◽  
Environmental Isolates ◽  
Content Type ◽  
The Pacific ◽  
Geographical Regions ◽  
Thermostable Direct Hemolysin

ABSTRACTSince 1997, cases ofVibrio parahaemolyticus-related gastroenteritis from the consumption of raw oysters harvested in Washington State have been higher than historical levels. These cases have shown little or no correlation with concentrations of potentially pathogenicV. parahaemolyticus(positive for the thermostable direct hemolysin gene,tdh) in oysters, although significant concentrations oftdh+V. parahaemolyticusstrains were isolated from shellfish-growing areas in the Pacific Northwest (PNW). We compared clinical and environmental strains isolated from the PNW to those from other geographic regions within the United States and Asia for the presence of virulence-associated genes, including the thermostable direct hemolysin (tdh), the thermostable-related hemolysin (trh), urease (ureR), the pandemic group specific markersorf8andtoxRS, and genes encoding both type 3 secretion systems (T3SS1 and T3SS2). The majority of clinical strains from the PNW were positive fortdh,trh, andureRgenes, while a significant proportion of environmental isolates weretdh+buttrhnegative. Hierarchical clustering grouped the majority of these clinical isolates into a cluster distinct from that including the pandemic strain RIMD2210633, clinical isolates from other geographical regions, andtdh+,trh-negative environmental isolates from the PNW. We detected T3SS2-related genes (T3SS2β) in environmental strains that weretdhandtrhnegative. The presence of significant concentrations oftdh+,trh-negative environmental strains in the PNW that have not been responsible for illness and T3SS2β intdh- andtrh-negative strains emphasizes the diversity in this species and the need to identify additional virulence markers for this bacterium to improve risk assessment tools for the detection of this pathogen.

Effect of Intertidal Exposure on Vibrio parahaemolyticus Levels in Pacific Northwest Oysters

2004 ◽  
Vol 67 (10) ◽  
pp. 2178-2182 ◽  
Author(s):  
J. L. NORDSTROM ◽  
C. A. KAYSNER ◽  
G. M. BLACKSTONE ◽  
M. C. L. VICKERY ◽  
J. C. BOWERS ◽  
...  
Keyword(s):  
Pacific Northwest ◽  
Vibrio Parahaemolyticus ◽  
Marine Mammals ◽  
The United States ◽  
Fecal Matter ◽  
Hood Canal ◽  
The Pacific ◽  
Thermostable Direct Hemolysin ◽  
The Relationship ◽  
Maximum Exposure

Interest in Vibrio parahaemolyticus (Vp) increased in the United States following Vp-associated gastroenteritis outbreaks in 1997 and 1998 involving the West Coast and other areas. The present study evaluated multiple aspects of Vp ecology in the Pacific Northwest with three objectives: (i) to determine the effect of low-tide exposure on Vp levels in oysters, (ii) to determine the relationship between total and pathogenic Vp, and (iii) to examine sediments and aquatic fauna as reservoirs for pathogenic Vp. Samples were collected from intertidal reefs along Hood Canal, Wash., in August 2001. Fecal matter from marine mammals and aquatic birds as well as intestinal contents from bottom-dwelling fish were tested. Total and pathogenic Vp levels in all the samples were enumerated with colony hybridization procedures using DNA probes that targeted the thermolabile direct hemolysin (tlh) and thermostable direct hemolysin (tdh) genes, respectively. The mean Vp densities in oysters were four to eight times greater at maximum exposure than at the corresponding first exposure. While tdh-positive Vp counts were generally ≤10 CFU/g at first exposure, counts as high as 160 CFU/g were found at maximum exposure. Vp concentrations in sediments were not significantly different from those in oysters at maximum exposure. Pathogenic (tdh positive) Vp was detected in 9 of 42 (21%) oyster samples at maximum exposure, in 5 of 19 (26%) sediment samples, but in 0 of 9 excreta samples. These results demonstrate that summer conditions permit the multiplication of Vp in oysters exposed by a receding tide.

scholarly journals Molecular, Serological, and Virulence Characteristics of Vibrio parahaemolyticus Isolated from Environmental, Food, and Clinical Sources in North America and Asia

2003 ◽  
Vol 69 (7) ◽  
pp. 3999-4005 ◽  
Author(s):  
Angelo DePaola ◽  
Jodie Ulaszek ◽  
Charles A. Kaysner ◽  
Bradley J. Tenge ◽  
Jessica L. Nordstrom ◽  
...  
Keyword(s):  
United States ◽  
New York ◽  
Vibrio Parahaemolyticus ◽  
Gulf Coast ◽  
Atlantic Coast ◽  
The United States ◽  
Clinical Isolates ◽  
Food Sources ◽  
Environmental Isolates ◽  
The Pacific

ABSTRACT Potential virulence attributes, serotypes, and ribotypes were determined for 178 pathogenic Vibrio parahaemolyticus isolates from clinical, environmental, and food sources on the Pacific, Atlantic, and Gulf Coasts of the United States and from clinical sources in Asia. The food and environmental isolates were generally from oysters, and they were defined as being pathogenic by using DNA probes to detect the presence of the thermostable direct hemolysin (tdh) gene. The clinical isolates from the United States were generally associated with oyster consumption, and most were obtained from outbreaks in Washington, Texas, and New York. Multiplex PCR was used to confirm the species identification and the presence of tdh and to test for the tdh-related hemolysin trh. Most of the environmental, food, and clinical isolates from the United States were positive for tdh, trh, and urease production. Outbreak-associated isolates from Texas, New York, and Asia were predominantly serotype O3:K6 and possessed only tdh. A total of 27 serotypes and 28 ribogroups were identified among the isolates, but the patterns of strain distribution differed between the serotypes and ribogroups. All but one of the O3:K6 isolates from Texas were in a different ribogroup from the O3:K6 isolates from New York or Asia. The O3:K6 serotype was not detected in any of the environmental and food isolates from the United States, and none of the food or environmental isolates belonged to any of the three ribogroups that contained all of the O3:K6 and related clinical isolates. The combination of serotyping and ribotyping showed that the Pacific Coast V. parahaemolyticus population appeared to be distinct from that of either the Atlantic Coast or Gulf Coast. The fact that certain serotypes and ribotypes contained both clinical and environmental isolates while many others contained only environmental isolates implies that certain serotypes or ribotypes are more relevant for human disease.

scholarly journals Genomic Variation and Evolution of Vibrio parahaemolyticus ST36 over the Course of a Transcontinental Epidemic Expansion

mBio ◽  
2017 ◽  
Vol 8 (6) ◽  
Author(s):  
Jaime Martinez-Urtaza ◽  
Ronny van Aerle ◽  
Michel Abanto ◽  
Julie Haendiges ◽  
Robert A. Myers ◽  
...  
Keyword(s):  
United States ◽  
Pacific Northwest ◽  
Vibrio Parahaemolyticus ◽  
Evolutionary Process ◽  
The United States ◽  
Sequence Type ◽  
Evolutionary Divergence ◽  
Human Pathogens ◽  
The Pacific ◽  
Northeast Coast

ABSTRACT Vibrio parahaemolyticus is the leading cause of seafood-related infections with illnesses undergoing a geographic expansion. In this process of expansion, the most fundamental change has been the transition from infections caused by local strains to the surge of pandemic clonal types. Pandemic clone sequence type 3 (ST3) was the only example of transcontinental spreading until 2012, when ST36 was detected outside the region where it is endemic in the U.S. Pacific Northwest causing infections along the U.S. northeast coast and Spain. Here, we used genome-wide analyses to reconstruct the evolutionary history of the V. parahaemolyticus ST36 clone over the course of its geographic expansion during the previous 25 years. The origin of this lineage was estimated to be in ~1985. By 1995, a new variant emerged in the region and quickly replaced the old clone, which has not been detected since 2000. The new Pacific Northwest (PNW) lineage was responsible for the first cases associated with this clone outside the Pacific Northwest region. After several introductions into the northeast coast, the new PNW clone differentiated into a highly dynamic group that continues to cause illness on the northeast coast of the United States. Surprisingly, the strains detected in Europe in 2012 diverged from this ancestral group around 2000 and have conserved genetic features present only in the old PNW lineage. Recombination was identified as the major driver of diversification, with some preliminary observations suggesting a trend toward a more specialized lifestyle, which may represent a critical element in the expansion of epidemics under scenarios of coastal warming. IMPORTANCE Vibrio parahaemolyticus and Vibrio cholerae represent the only two instances of pandemic expansions of human pathogens originating in the marine environment. However, while the current pandemic of V. cholerae emerged more than 50 years ago, the global expansion of V. parahaemolyticus is a recent phenomenon. These modern expansions provide an exceptional opportunity to study the evolutionary process of these pathogens at first hand and gain an understanding of the mechanisms shaping the epidemic dynamics of these diseases, in particular, the emergence, dispersal, and successful introduction in new regions facilitating global spreading of infections. In this study, we used genomic analysis to examine the evolutionary divergence that has occurred over the course of the most recent transcontinental expansion of a pathogenic Vibrio, the spreading of the V. parahaemolyticus sequence type 36 clone from the region where it is endemic on the Pacific coast of North America to the east coast of the United States and finally to the west coast of Europe. IMPORTANCE Vibrio parahaemolyticus and Vibrio cholerae represent the only two instances of pandemic expansions of human pathogens originating in the marine environment. However, while the current pandemic of V. cholerae emerged more than 50 years ago, the global expansion of V. parahaemolyticus is a recent phenomenon. These modern expansions provide an exceptional opportunity to study the evolutionary process of these pathogens at first hand and gain an understanding of the mechanisms shaping the epidemic dynamics of these diseases, in particular, the emergence, dispersal, and successful introduction in new regions facilitating global spreading of infections. In this study, we used genomic analysis to examine the evolutionary divergence that has occurred over the course of the most recent transcontinental expansion of a pathogenic Vibrio, the spreading of the V. parahaemolyticus sequence type 36 clone from the region where it is endemic on the Pacific coast of North America to the east coast of the United States and finally to the west coast of Europe.

scholarly journals Population Structure of Clinical and Environmental Vibrio parahaemolyticus from the Pacific Northwest Coast of the United States

PLoS ONE ◽  
2013 ◽  
Vol 8 (2) ◽  
pp. e55726 ◽  
Author(s):  
Jeffrey W. Turner ◽  
Rohinee N. Paranjpye ◽  
Eric D. Landis ◽  
Stanley V. Biryukov ◽  
Narjol González-Escalona ◽  
...  
Keyword(s):  
United States ◽  
Population Structure ◽  
Pacific Northwest ◽  
Vibrio Parahaemolyticus ◽  
The United States ◽  
Northwest Coast ◽  
Pacific Northwest Coast ◽  
The Pacific

scholarly journals Cryptococcus deuterogattiiVGIIa Infection Associated with Travel to the Pacific Northwest Outbreak Region in an Anti-Granulocyte-Macrophage Colony-Stimulating Factor Autoantibody-Positive Patient in the United States

mBio ◽  
2019 ◽  
Vol 10 (1) ◽  
Author(s):  
Shelly Applen Clancey ◽  
Emily J. Ciccone ◽  
Marco A. Coelho ◽  
Joie Davis ◽  
Li Ding ◽  
...  
Keyword(s):  
United States ◽  
Pacific Northwest ◽  
The United States ◽  
Colony Stimulating Factor ◽  
Content Type ◽  
Gm Csf ◽  
The Pacific ◽  
Macrophage Colony Stimulating Factor ◽  
Macrophage Colony ◽  
Stimulating Factor

ABSTRACTThe region encompassing the Pacific Northwest (PNW), Vancouver Island, Oregon, and Washington has been the location of an ongoingCryptococcus gattiioutbreak since the 1990s, and there is evidence that the outbreak is expanding along the West Coast into California. Here we report a clinical case of a 69-year-old, HIV-negative man from North Carolina who was diagnosed with a fungal brain mass by magnetic resonance imaging (MRI) and pathology. He had traveled to Seattle and Vancouver 3 years earlier and to Costa Rica 4 months prior to presentation. Phenotypic evidence showed that the fungal mass isolated from the patient’s brain representedC. gattii. In agreement with the phenotypic results, multilocus sequence typing (MLST) provided genotypic evidence that assigned the infecting organism within theC. gattiispecies complex and to theC. deuterogattiiVGIIa clade. Whole-genome sequencing revealed >99.99% identity with theC. deuterogattiireference strain R265, indicating that the infecting strain is derived from the highly clonal outbreak strains in the PNW. We conclude that the patient acquired theC. gattiiinfection during his travel to the region 3 years prior and that the infection was dormant for an extended period of time before causing disease. The patient tested positive for anti-granulocyte-macrophage colony-stimulating factor (GM-CSF) autoantibodies, supporting earlier reports that implicate these autoantibodies as a risk factor associated withC. gattiiinfection.IMPORTANCEMortality rates associated withC. gattiiinfections are estimated to be between 13% and 33%, depending on an individual’s predisposition, andC. gattiihas caused at least 39 deaths in the PNW region. There have been four other international travel cases reported in patients from Europe and Asia with travel history to the PNW, but this report describes the first North American traveler who acquiredC. deuterogattiiinfection presenting within the United States and the first case of aC. deuterogattiioutbreak infection associated with anti-GM-CSF autoantibodies. Early and accurate diagnoses are important for disease prevention and treatment and for control of infectious diseases. Continual reporting ofC. deuterogattiiinfections is necessary to raise awareness of the ongoing outbreak in the PNW and to alert travelers and physicians to the areas of endemicity with potential risks.

scholarly journals Association of Pandemic Vibrio parahaemolyticus O3:K6 Present in the Coastal Environment of Northwest Mexico with Cases of Recurrent Diarrhea between 2004 and 2010

2012 ◽  
Vol 78 (6) ◽  
pp. 1794-1803 ◽  
Author(s):  
Jorge Velazquez-Roman ◽  
Nidia León-Sicairos ◽  
Héctor Flores-Villaseñor ◽  
Santiago Villafaña-Rauda ◽  
Adrian Canizalez-Roman
Keyword(s):  
Vibrio Parahaemolyticus ◽  
Environmental Samples ◽  
Environmental Isolates ◽  
Content Type ◽  
Clinical Strains ◽  
Northwest Mexico ◽  
The North ◽  
The Pacific ◽  
Pandemic Strains ◽  
Northwestern Mexico

ABSTRACTIn 2004, more than 1,230 cases of gastroenteritis due to pandemic O3:K6 strains ofVibrio parahaemolyticuswere reported in southern Sinaloa, a state in Northwestern Mexico. Recurrent sporadic cases arose from 2004 to 2010, spreading from the south to the north. In the present study,Vibrio parahaemolyticuswas detected in both environmental samples and clinical cases along the Pacific coast of Sinaloa during 2004 to 2010. An evaluation was made of the serotypes, distribution of virulence genes, and presence of pandemic O3:K6 strains. A total of 144 strains were isolated from environmental samples (from sediment, seawater, and shrimp), and 154 clinical strains were isolated. A total of 10 O serogroups and 30 serovars were identified in the strains. Environmental strains (n= 144) belonged to 10 O serogroups and 28 serovars, while clinical strains (n= 154) belonged to 8 O serogroups and 14 serovars. Ten serovars were shared by both environmental and clinical strains. Among 144 environmental isolates, 4.1% (6/144) belonged to the pandemic clone, with 83.3% containing theorf8gene and with O3:K6 accounting for 67%. On the other hand, pathogenic strains (tdhand/ortrh) accounted for 52% (75/144) of the environmental isolates. Interestingly, among 154 clinical isolates, 80.5% (124/154) were pandemic strains, with O3:K6 (tdh,toxRSnew, andorf8) representing the predominant serovar (99.2%, 123/124). Overall, our results indicate that in spite of a high serodiversity and prevalence of pathogenicVibrio parahaemolyticusin the environment, the pandemic strain O3:K6 caused >79% of reported cases between 2004 and 2010 in Sinaloa, Mexico.

scholarly journals Ecology of Vibrio parahaemolyticus and Vibrio vulnificus in the Coastal and Estuarine Waters of Louisiana, Maryland, Mississippi, and Washington (United States)

2012 ◽  
Vol 78 (20) ◽  
pp. 7249-7257 ◽  
Author(s):  
Crystal N. Johnson ◽  
John C. Bowers ◽  
Kimberly J. Griffitt ◽  
Vanessa Molina ◽  
Rachel W. Clostio ◽  
...  
Keyword(s):  
United States ◽  
Organic Carbon ◽  
Dissolved Organic Carbon ◽  
Vibrio Parahaemolyticus ◽  
Vibrio Vulnificus ◽  
Environmental Parameters ◽  
The United States ◽  
Sea Surface ◽  
Content Type ◽  
Thermostable Direct Hemolysin

ABSTRACTVibrio parahaemolyticusandVibrio vulnificus, which are native to estuaries globally, are agents of seafood-borne or wound infections, both potentially fatal. Like all vibrios autochthonous to coastal regions, their abundance varies with changes in environmental parameters. Sea surface temperature (SST), sea surface height (SSH), and chlorophyll have been shown to be predictors of zooplankton and thus factors linked to vibrio populations. The contribution of salinity, conductivity, turbidity, and dissolved organic carbon to the incidence and distribution ofVibriospp. has also been reported. Here, a multicoastal, 21-month study was conducted to determine relationships between environmental parameters andV. parahaemolyticusandV. vulnificuspopulations in water, oysters, and sediment in three coastal areas of the United States. Because ecologically unique sites were included in the study, it was possible to analyze individual parameters over wide ranges. Molecular methods were used to detect genes for thermolabile hemolysin (tlh), thermostable direct hemolysin (tdh), andtdh-related hemolysin (trh) as indicators ofV. parahaemolyticusand the hemolysin genevvhAforV. vulnificus. SST and suspended particulate matter were found to be strong predictors of total and potentially pathogenicV. parahaemolyticusandV. vulnificus. Other predictors included chlorophylla, salinity, and dissolved organic carbon. For the ecologically unique sites included in the study, SST was confirmed as an effective predictor of annual variation in vibrio abundance, with other parameters explaining a portion of the variation not attributable to SST.

Evaluation of Nonisotopic DNA Hybridization Methods for Detection of the tdh Gene of Vibrio parahaemolyticus

2000 ◽  
Vol 63 (12) ◽  
pp. 1660-1664 ◽  
Author(s):  
SUSAN A. McCARTHY ◽  
ANGELO DEPAOLA ◽  
CHARLES A. KAYSNER ◽  
WALTER E. HILL ◽  
DAVID W. COOK
Keyword(s):  
New York ◽  
Alkaline Phosphatase ◽  
Pacific Northwest ◽  
Dna Hybridization ◽  
Vibrio Parahaemolyticus ◽  
Vibrio Species ◽  
Gene Probes ◽  
The Pacific ◽  
Thermostable Direct Hemolysin ◽  
Tdh Gene

Production of the thermostable direct hemolysin (TDH) by Vibrio parahaemolyticus is associated with pathogenicity of the organism and is encoded by the tdh gene. The timely resolution of seafood-associated outbreaks requires rapid and accurate detection of pathogenic V. parahaemolyticus. The specificity of alkaline phosphatase- and digoxigenin-labeled tdh gene probes was evaluated against 61 strains of V. parahaemolyticus (including isolates from recent outbreaks involving oysters from the Pacific Northwest, Texas, and New York), 85 strains of other vibrios, and 7 strains of non-vibrio species from clinical and environmental sources. The probes were specific for detection of the V. parahaemolyticus tdh gene.

scholarly journals Highly Recombinant VGII Cryptococcus gattii Population Develops Clonal Outbreak Clusters through both Sexual Macroevolution and Asexual Microevolution

mBio ◽  
2014 ◽  
Vol 5 (4) ◽  
Author(s):  
R. Blake Billmyre ◽  
Daniel Croll ◽  
Wenjun Li ◽  
Piotr Mieczkowski ◽  
Dee A. Carter ◽  
...  
Keyword(s):  
United States ◽  
Sexual Reproduction ◽  
Whole Genome Sequencing ◽  
Pacific Northwest ◽  
Genome Sequencing ◽  
The United States ◽  
Cryptococcus Gattii ◽  
Whole Genome ◽  
Content Type ◽  
The Pacific

ABSTRACT An outbreak of the fungal pathogen Cryptococcus gattii began in the Pacific Northwest (PNW) in the late 1990s. This outbreak consists of three clonal subpopulations: VGIIa/major, VGIIb/minor, and VGIIc/novel. Both VGIIa and VGIIc are unique to the PNW and exhibit increased virulence. In this study, we sequenced the genomes of isolates from these three groups, as well as global isolates, and analyzed a total of 53 isolates. We found that VGIIa/b/c populations show evidence of clonal expansion in the PNW. Whole-genome sequencing provided evidence that VGIIb originated in Australia, while VGIIa may have originated in South America, and these were likely independently introduced. Additionally, the VGIIa outbreak lineage may have arisen from a less virulent clade that contained a mutation in the MSH2 ortholog, but this appears to have reverted in the VGIIa outbreak strains, suggesting that a transient mutator phenotype may have contributed to adaptation and evolution of virulence in the PNW outbreak. PNW outbreak isolates share genomic islands, both between the clonal lineages and with global isolates, indicative of sexual recombination. This suggests that VGII C. gattii has undergone sexual reproduction, either bisexual or unisexual, in multiple locales contributing to the production of novel, virulent subtypes. We also found that the genomes of two basal VGII isolates from HIV+ patients contain an introgression tract spanning three genes. Introgression substantially contributed to intra-VGII polymorphism and likely occurred through sexual reproduction with VGI. More broadly, these findings illustrate how both microevolution and sexual reproduction play central roles in the development of infectious outbreaks from avirulent or less virulent progenitors. IMPORTANCE Cryptococcus gattii is the causative agent responsible for ongoing infections in the Pacific Northwest of the United States and western Canada. The incidence of these infections increased dramatically in the 1990s and remains elevated. These infections are attributable to three clonal lineages of C. gattii, VGIIa, VGIIb, and VGIIc, with only VGIIa identified once previously in the Pacific Northwest prior to the start of the outbreak, albeit in a less virulent form. This study addresses the origin and emergence of this outbreak, using whole-genome sequencing and comparison of both outbreak and global isolates. We show that VGIIa arose mitotically from a less virulent clonal group, possibly via the action of a mutator phenotype, while VGIIb was likely introduced from Australia, and VGIIc appears to have emerged in the United States or in an undersampled locale via sexual reproduction. This work shows that multiple processes can contribute to the emergence of an outbreak.

scholarly journals Use of Whole-Genome Phylogeny and Comparisons for Development of a Multiplex PCR Assay To Identify Sequence Type 36 Vibrio parahaemolyticus

2015 ◽  
Vol 53 (6) ◽  
pp. 1864-1872 ◽  
Author(s):  
Cheryl A. Whistler ◽  
Jeffrey A. Hall ◽  
Feng Xu ◽  
Saba Ilyas ◽  
Puskar Siwakoti ◽  
...  
Keyword(s):  
Multiplex Pcr ◽  
Vibrio Parahaemolyticus ◽  
Sequence Type ◽  
Clinical Isolates ◽  
Whole Genome ◽  
Environmental Isolates ◽  
Content Type ◽  
Multiplex Pcr Assay ◽  
Antigenic Properties

Vibrio parahaemolyticussequence type 36 (ST36) strains that are native to the Pacific Ocean have recently caused multistate outbreaks of gastroenteritis linked to shellfish harvested from the Atlantic Ocean. Whole-genome comparisons of 295 genomes ofV. parahaemolyticus, including several traced to northeastern U.S. sources, were used to identify diagnostic loci, one putatively encoding an endonuclease (prp), and two others potentially conferring O-antigenic properties (cpsandflp). The combination of all three loci was present in only one clade of closely related strains of ST36, ST59, and one additional unknown sequence type. However, each locus was also identified outside this clade, withprpandflpoccurring in only two nonclade isolates andcpsin four. Based on the distribution of these loci in sequenced genomes,prpidentified clade strains with >99% accuracy, but the addition of one more locus increased accuracy to 100%. Oligonucleotide primers targetingprpandcpswere combined in a multiplex PCR method that defines species using thetlhlocus and determines the presence of both thetdhandtrhhemolysin-encoding genes, which are also present in ST36. Application of the methodin vitroto a collection of 94 clinical isolates collected over a 4-year period in three northeastern U.S. states and 87 environmental isolates revealed that theprpandcpsamplicons were detected only in clinical isolates identified as belonging to the ST36 clade and in no environmental isolates from the region. The assay should improve detection and surveillance, thereby reducing infections.

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