Transmission of Antimicrobial Resistant Yersinia pestis During a Pneumonic Plague Outbreak
Open Access
- 9 July 2021
- journal article
- research article
- Published by Oxford University Press (OUP) in Clinical Infectious Diseases
- Vol. 74 (4), 695-702
- https://doi.org/10.1093/cid/ciab606
Abstract
Pneumonic plague (PP), caused by Yersinia pestis, is the most feared clinical form of plague due to its rapid lethality and potential to cause outbreaks. PP outbreaks are now rare due to antimicrobial therapy. A PP outbreak in Madagascar involving transmission of a Y. pestis strain resistant to streptomycin, the current recommended first-line treatment in Madagascar, was retrospectively characterized using epidemiology, clinical diagnostics, molecular characterization, and animal studies. The outbreak occurred in February 2013 in the Faratsiho district of Madagascar and involved 22 cases, including three untreated fatalities. The 19 other cases participated in funeral practices for the fatal cases and fully recovered after combination antimicrobial therapy: intramuscular streptomycin followed by oral co-trimoxazole. The Y. pestis strain that circulated during this outbreak is resistant to streptomycin resulting from a spontaneous point mutation in the 30S ribosomal protein S12 (rpsL) gene. This same mutation causes streptomycin resistance in two unrelated Y. pestis strains, one isolated from a fatal PP case in a different region of Madagascar in 1987 and another isolated from a fatal PP case in China in 1996, documenting this mutation has occurred independently at least three times in Y. pestis. Laboratory experiments revealed this mutation has no detectable impact on fitness or virulence, and revertants to wild-type are rare in other species containing it, suggesting Y. pestis strains containing it could persist in the environment. Unique AMR strains of Y. pestis continue to arise in Madagascar and can be transmitted during PP outbreaks.Funding Information
- Institut Pasteur de Madagascar
This publication has 34 references indexed in Scilit:
- Lack of Antimicrobial Resistance in Yersinia pestis Isolates from 17 Countries in the Americas, Africa, and AsiaAntimicrobial Agents and Chemotherapy, 2012
- Mutations in rpsL that confer streptomycin resistance show pleiotropic effects on virulence and the production of a carbapenem antibiotic in Erwinia carotovoraMicrobiology, 2010
- Antibiotic resistance and its cost: is it possible to reverse resistance?Nature Reviews Microbiology, 2010
- Epidemiological trends for human plague in Madagascar during the second half of the 20th century: a survey of 20 900 notified casesTropical Medicine & International Health, 2006
- Pneumonic Plague Cluster, Uganda, 2004Emerging Infectious Diseases, 2006
- From the recent lessons of the Malagasy foci towards a global understanding of the factors involved in plague reemergenceVeterinary Research, 2005
- Susceptibility of Yersinia pestis to novel and conventional antimicrobial agentsJournal of Antimicrobial Chemotherapy, 2003
- Genome sequence of Yersinia pestis, the causative agent of plagueNature, 2001
- Transferable Plasmid-Mediated Resistance to Streptomycin in Clinical Isolate of Yersinia pestisEmerging Infectious Diseases, 2001
- Multidrug Resistance inYersinia pestisMediated by a Transferable PlasmidThe New England Journal of Medicine, 1997