1887

Abstract

Mucormycoses are invasive infections by species and other Mucorales. Over 10 months, four solid organ transplant (SOT) recipients at our centre developed mucormycosis due to (=2), (=1) or (=1), at a median 31.5 days (range: 13–34) post-admission. We performed whole genome sequencing (WGS) on 72 Mucorales isolates (45 . , 19 . , six . , two species) from these patients, from five patients with community-acquired mucormycosis, and from hospital and regional environments. Isolates were compared by core protein phylogeny and global genomic features, including genome size, guanine–cytosine percentages, shared protein families and paralogue expansions. Patient isolates fell into six core phylogenetic lineages (clades). Phylogenetic and genomic similarities of isolates recovered 7 months apart from two SOT recipients in adjoining hospitals suggested a potential common source exposure. However, isolates from other patients and environmental sites had unique genomes. Many isolates that were indistinguishable by core phylogeny were distinct by one or more global genomic comparisons. Certain clades were recovered throughout the study period, whereas others were found at particular time points. In conclusion, mucormycosis cases could not be genetically linked to a definitive environmental source. Comprehensive genomic analyses eliminated false associations between Mucorales isolates that would have been assigned using core phylogenetic or less extensive genomic comparisons. The genomic diversity of Mucorales mandates that multiple isolates from individual patients and environmental sites undergo WGS during epidemiological investigations. However, exhaustive surveillance of fungal populations in a hospital and surrounding community is probably infeasible.

Funding
This study was supported by the:
  • Medical Center, University of Pittsburgh
    • Principle Award Recipient: M. Hong Nguyen
  • National Science Foundation (Award OCE-1259994)
    • Principle Award Recipient: Christopher L. Dupont
  • National Science Foundation (Award IOS-1354423)
    • Principle Award Recipient: Christopher L. Dupont
  • This is an open-access article distributed under the terms of the Creative Commons Attribution License.
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2020-11-27
2021-10-21
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