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Ahead of Print -Evidence for Elizabethkingia anophelis Transmission from Mother to Infant, Hong Kong - Volume 21, Number 2—February 2015 - Emerging Infectious Disease journal - CDC

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Ahead of Print -Evidence for Elizabethkingia anophelis Transmission from Mother to Infant, Hong Kong - Volume 21, Number 2—February 2015 - Emerging Infectious Disease journal - CDC



CDC. Centers for Disease Control and Prevention. CDC 24/7: Saving Lives. Protecting People.

Volume 21, Number 2—February 2015

Research

Evidence for Elizabethkingia anophelis Transmission from Mother to Infant, Hong Kong

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Susanna K.P. Lau1, Alan K.L. Wu1, Jade L.L. Teng1, Herman Tse1, Shirly O.T. Curreem, Stephen K.W. Tsui, Yi Huang, Jonathan H.K. Chen, Rodney A. Lee, Kwok-Yung Yuen, and Patrick C.Y. WooComments to Author 
Author affiliations: The University of Hong Kong, Hong Kong (S.K.P. Lau, J.L.L. Teng, H. Tse, S.O.T. Curreem, Y. Huang, J.H.K. Chen, K.-Y. Yuen, P.C.Y. Woo); State Key Laboratory of Emerging Infectious Diseases, Research Centre of Infection and Immunology, Carol Yu Centre for Infection, Hong Kong (S.K.P. Lau, H. Tse, K.Y. Yuen, P.C.Y. Woo); Pamela Youde Nethersole Eastern Hospital, Hong Kong (A.K.L. Wu, R.A. Lee); School of Biomedical Sciences, The Chinese University of Hong Kong, Hong Kong (S.K.W. Tsui)

Abstract

Elizabethkingia anophelis, recently discovered from mosquito gut, is an emerging bacterium associated with neonatal meningitis and nosocomial outbreaks. However, its transmission route remains unknown. We use rapid genome sequencing to investigate 3 cases of E. anophelis sepsis involving 2 neonates who had meningitis and 1 neonate’s mother who had chorioamnionitis. Comparative genomics revealed evidence for perinatal vertical transmission from a mother to her neonate; the 2 isolates from these patients, HKU37 and HKU38, shared essentially identical genome sequences. In contrast, the strain from another neonate (HKU36) was genetically divergent, showing only 78.6% genome sequence identity to HKU37 and HKU38, thus excluding a clonal outbreak. Comparison to genomes from mosquito strains revealed potential metabolic adaptations in E. anophelis under different environments. Maternal infection, not mosquitoes, is most likely the source of neonatal E. anophelis infections. Our findings highlight the power of genome sequencing in gaining rapid insights on transmission and pathogenesis of emerging pathogens.
Microbial genome sequencing can enhance diagnosis and control of infectious diseases (1,2). Its ultimate molecular resolution is superior to other phenotypic and genotypic tests and enables not only rapid microbial identification but also characterization of transmission events. The technique has been applied in large-scale infectious disease outbreaks such as those caused by Escherichia coli O104:H4, Staphylococcus aureus,Streptococcus pyogenes, Enterococcus faecium, Pseudomonas aeruginosa, Vibrio cholerae, and mycobacteria (3–14). However, the routine application of this method in diagnostic microbiology and infection control, especially for less well-defined, emerging pathogens, is yet to be explored.
Elizabethkingia anophelis is a recently discovered bacterium isolated from the midgut of the Anopheles gambiaemosquito in 2011 (15). The genus Elizabethkingia also includes E. meningoseptica (previously namedChryseobacterium/Flavobacterium meningosepticum) and E. miricola (16). E. meningoseptica causes neonatal sepsis and infections in immunocompromised persons. E. anophelis has also recently been reported to cause neonatal meningitis in the Central African Republic, and a nosocomial outbreak was reported in an intensive care unit in Singapore (17–19). However, the role of mosquitoes or other sources in the transmission of E. anophelisremains unclear.
In 2012, we encountered 3 cases of Elizabethkingia sepsis associated with meningitis in 2 neonates and chorioamnionitis in a neonate’s mother in a hospital in Hong Kong. Three strains of Elizabethkingia-like, gram-negative bacilli sharing similar phenotypic characteristics were isolated from the 3 patients, but confident identification results were not obtained by matrix-assisted laser desorption ionization/time-of-flight (MALDI-TOF) mass spectrometry and 16S rRNA gene sequencing. Moreover, clinical and microbiological data did not provide adequate clues about the possible transmission route. We therefore attempted to use draft genome sequencing to rapidly dissect transmission pathways and confirm the identity of the species.
Thumbnail of Clinical course of illness in 3 patients infected with Elizabethkingia anophelis in whom sepsis developed and the mother of patient 1, who had culture-negative postpartum fever, Hong Kong, 2012. Locations where patients were treated at the hospital and times when they were home are noted.CSF, cerebrospinal fluid; leaking, leaking of amniotic fluid (membrane rupture).
Figure 1. Clinical course of illness in 3 patients infected with Elizabethkingia anophelisin whom sepsis developed and the mother of patient 1, who had culture-negative postpartum fever, Hong Kong, 2012. Locations where...
Dr. Lau is a clinical professor in the Department of Microbiology at The University of Hong Kong. Her research focuses on microbial genomics for studying emerging infectious diseases.

Acknowledgments

We thank Cheung-Hing Foo for technical support in bacterial identification and members of the Centre for Genomic Sciences, The University of Hong Kong, for their technical support in genome sequencing.
This work was supported by Health and Medical Research Fund, Food and Health Bureau, The Government of the Hong Kong Special Administrative Region; Strategic Research Theme Fund, Committee for Research and Conference Grant, and University Development Fund, The University of Hong Kong; the Shaw Foundation; donation from Ms. Eunice Lam; and Consultancy Service for Enhancing Laboratory Surveillance of Emerging Infectious Disease for the HKSAR Department of Health.

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Technical Appendix

Suggested citation for this article: Lau SKP, Wu AKL, Teng JLL, Tse H, Curreem SOT, Tsui SKW, et al. Evidence for Elizabethkingia anophelis transmission from mother to infant, Hong Kong. Emerg Infect Dis [Internet]. 2015 Feb [date cited]. http://dx.doi.org/10.3201/eid2102.140623
DOI: 10.3201/eid2102.140623
1These authors contributed equally to this article.


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