印度泰米尔纳德邦的神经类鼻疽病暴发：基于基因组学见解的传播调查
Neuromelioidosis outbreak in Tamil Nadu, India: an investigation of transmission with genomic insights.
作者信息
Miraclin Thirugnanakumar Angel, Rajkumar Prabu, Gunasekaran Karthik, Mannam Pavithra, Ponnaiah Manickam, Chethrapilly Purushothaman Girish Kumar, Velmurugan Aravind, Raj Neeravi Ayyan, Jacob Jobin John, Cruz Solomon D, Singh Bhagteshwar, Appaswamy Thirumal Prabhakar, Jasper Anitha, Mohan Malu, Shanmugasundaram Devika, Abraham Ananth, Thangarajan Senthil, Panicker Tony, Nair Bijesh, Selvakumar Aravintharaj, Moorthy Ranjith K, Joseph Baylis Vivek, Prabhu Krishna, Reddy Sirasanambati Devarajulu, Nair Shalini, Umapathy Murali, Pitchamuthu Kishore, Murugesan Balusamy, Sathyendra Sowmya, Hansdak Samuel George, Paul Hema, Isaiah Rajesh, Paul P Abhilash Kundavaram, Nair Aditya V, Mathew Vivek, Sivadasan Ajith, Thomas Maya Mary, Aaron Sanjith, Jude Prakash John Antony, Chacko Geeta, Rupali Priscilla, Solomon Tom, Anavarathan Somasundaram, Thirumalaichiry Sivaprakasam Selvavinayagam, Veeraraghavan Balaji, Murhekar Manoj
机构信息
Department of Neurological Sciences (Division of Neurology), Christian Medical College, Vellore, Tamil Nadu, India.
Indian Council of Medical Research - National Institute of Epidemiology, Chennai, Tamil Nadu, India.
出版信息
Lancet Reg Health Southeast Asia. 2025 May 21;37:100602. doi: 10.1016/j.lansea.2025.100602. eCollection 2025 Jun.
BACKGROUND
In May 2023, we investigated a cluster of neuromelioidosis notified from Tamil Nadu state in southern India to describe case characteristics and identify the infection source.
METHODS
We searched for probable cases presenting with fever and brainstem syndrome, supported by radiological findings suggestive of neuromelioidosis. Cases were confirmed by isolation of from tissue, blood, or cerebrospinal fluid (CSF), or by PCR. The cases were described by time (epidemic curve), place (spot map), and person (clinical characteristics). Infection sources and virulence markers were identified by genome sequencing of the clinical and environmental isolates. Whole genome sequencing data were analysed to investigate the expression of -like gene, and a phylogenetic tree was constructed to study sequence similarity to the global isolates.
FINDINGS
We identified 21 probable cases between July 2022 and April 2023 (median age = 33 years; 11 females; five confirmed) across four districts in Northern Tamil Nadu. Seventeen cases were from a single district and 10 reported prior dental treatment at a clinic. Cases with dental exposure had higher fatality (8/10 vs. 1/11) and shorter time to death (median 17 days vs. 1 death at day 56) than sporadic cases. The gene, which is associated with neurotropism, was identified in all three clonal isolates (two from the cases and one from the environmental isolate from the in-use saline bottle). Whole genome sequencing identified the ST1553 strain as being associated with the current outbreak. Genetic analysis of 209 isolates available in the public database with metadata revealed that ST1553, the strain responsible for the outbreak, clustered with isolates from India and Australia that expressed the .
INTERPRETATION
We confirmed a large cluster of neuromelioidosis from South India, likely representing sporadic cases from environmental sources and cases linked to an iatrogenic source at a dental clinic. Rapid and high case fatality among dental cases supports the direct trans-neural spread of to the brainstem following inoculation via contaminated saline. Expression of
FUNDING
None.
背景
2023年5月，我们对印度南部泰米尔纳德邦报告的一组神经类鼻疽病例进行了调查，以描述病例特征并确定感染源。
方法
我们搜索了出现发热和脑干综合征且有提示神经类鼻疽的影像学表现的可能病例。通过从组织、血液或脑脊液（CSF）中分离出 ，或通过聚合酶链反应（PCR）来确诊病例。通过时间（流行曲线）、地点（点状地图）和人物（临床特征）来描述病例。通过对临床和环境分离株进行基因组测序来确定感染源和毒力标记。分析全基因组测序数据以研究类 基因的表达，并构建系统发育树以研究与全球分离株的序列相似性。
结果
我们在2022年7月至2023年4月期间在北泰米尔纳德邦的四个区确定了21例可能病例（中位年龄 = 33岁；11名女性；5例确诊）。17例来自单个区，10例报告曾在一家诊所接受过牙科治疗。有牙科接触史的病例比散发病例的病死率更高（8/10对1/11），死亡时间更短（中位17天对1例在第56天死亡）。在所有三个克隆分离株中均鉴定出与嗜神经性相关的 基因（两个来自病例，一个来自在用盐水瓶的环境分离株）。全基因组测序确定ST1553菌株与当前疫情有关。对公共数据库中209个带有元数据分离株的遗传分析表明，导致此次疫情的ST1553菌株与来自印度和澳大利亚且表达 的分离株聚集在一起。
解读
我们证实了来自印度南部的一大组神经类鼻疽病例，可能代表来自环境源的散发病例以及与一家牙科诊所医源性来源相关的病例。牙科病例中快速且高的病死率支持了通过受污染盐水接种后 直接经神经传播至脑干。 的表达
资助
无。
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