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Comparative Study
. 2010 Jan;48(1):184-91.
doi: 10.1128/JCM.01011-09. Epub 2009 Nov 4.

An unusual pneumococcal sequence type is the predominant cause of serotype 3 invasive disease in South Africa

Kedibone M Mothibeli  1 , Mignon du Plessis, Anne von Gottberg, Linda de Gouveia, Peter Adrian, Shabir A Madhi, Keith P Klugman; Group for Enteric, Respiratory and Meningeal Disease Surveillance in South Africa (GERMS-SA)
Collaborators, Affiliations
Comparative Study

An unusual pneumococcal sequence type is the predominant cause of serotype 3 invasive disease in South Africa

Kedibone M Mothibeli et al. J Clin Microbiol. 2010 Jan.

Abstract

We reviewed pneumococcal serotype 3 cases reported from 2000 through 2005 to a laboratory-based surveillance system for invasive pneumococcal disease in South Africa. The prevalence of serotype 3 invasive isolates was compared to their prevalence in carriage isolates to determine the odds of invasiveness due to serotype 3 among South African children. Three groups of serotype 3 strains were characterized by pulsed-field gel electrophoresis (PFGE) or Box element PCR (BOX-PCR), randomly selected invasive isolates from one province, isolates from a carriage study involving children in the same province, and antimicrobial-resistant invasive isolates collected nationally. Examples of the PFGE types identified were further characterized by multilocus sequence typing. In total, 15,980 viable isolates causing invasive disease were submitted, of which 661 (4%) were serotype 3, mostly from adults (85% [489/575]). Fewer serotype 3 isolates were nonsusceptible to antimicrobial agents tested (40/661 [6%]) than non-serotype 3 isolates (8,480/15,319 [55%]) (P < 0.001). Compared to non-serotype 3 cases, there was no association with HIV coinfection (2,212/2,569 [86%] versus 72/78 [92%]; P = 0.1) or increased case fatality ratio (1,190/4,211 [28%] versus 54/154 [35%]; P = 0.7). Serotype 3 in children had a low but statistically insignificant invasive disease potential (odds ratio [OR] of 0.15; 95% confidence interval [CI] of 0.01 to 1.06). Strains were grouped into 3 PFGE clusters, with the largest, cluster A, representing 54% (84/155), including 14 isolates confirmed as sequence type 458 (ST458). It was confirmed that 3 isolates from cluster B, which represented only 12% (18/155) of the isolates, were the serotype 3 global strain, ST180. We have therefore identified ST458 as predominating in South Africa, but with an invasive potential similar to that of the predominant global clone ST180.

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Figures

FIG. 1.
FIG. 1.
Annual age-specific incidence rates of non-serotype 3 invasive pneumococcal disease (n = 3,347) and serotype 3 disease (n = 118) in South Africa in 2005.
FIG. 2.
FIG. 2.
Schematic dendrogram showing pulsed-field gel electrophoresis (PFGE) clusters of 118 isolates randomly selected from serotype 3 isolates causing invasive pneumococcal disease in Gauteng Province, South Africa, in 2000 to 2005; 25 national antibiotic-resistant serotype 3 strains (2000 to 2005); a 1987 multidrug-resistant serotype 3 isolate (isolate C4023, which is located second from the bottom on the dendrogram); and 11 nasopharyngeal isolates from Gauteng Province in 2007 to 2008 (shown in boxes). Province abbreviations: GA, Gauteng; KZN, KwaZulu-Natal; NW, North-West; MP, Mpumalang. Antibiotic abbreviations used in the Antibiogram column: P, penicillin G; R, rifampin; M, trimethoprim-sulfamethoxazole; T, tetracycline; E, erythromycin: L, clindamycin.
FIG. 2.
FIG. 2.
Schematic dendrogram showing pulsed-field gel electrophoresis (PFGE) clusters of 118 isolates randomly selected from serotype 3 isolates causing invasive pneumococcal disease in Gauteng Province, South Africa, in 2000 to 2005; 25 national antibiotic-resistant serotype 3 strains (2000 to 2005); a 1987 multidrug-resistant serotype 3 isolate (isolate C4023, which is located second from the bottom on the dendrogram); and 11 nasopharyngeal isolates from Gauteng Province in 2007 to 2008 (shown in boxes). Province abbreviations: GA, Gauteng; KZN, KwaZulu-Natal; NW, North-West; MP, Mpumalang. Antibiotic abbreviations used in the Antibiogram column: P, penicillin G; R, rifampin; M, trimethoprim-sulfamethoxazole; T, tetracycline; E, erythromycin: L, clindamycin.
FIG. 2.
FIG. 2.
Schematic dendrogram showing pulsed-field gel electrophoresis (PFGE) clusters of 118 isolates randomly selected from serotype 3 isolates causing invasive pneumococcal disease in Gauteng Province, South Africa, in 2000 to 2005; 25 national antibiotic-resistant serotype 3 strains (2000 to 2005); a 1987 multidrug-resistant serotype 3 isolate (isolate C4023, which is located second from the bottom on the dendrogram); and 11 nasopharyngeal isolates from Gauteng Province in 2007 to 2008 (shown in boxes). Province abbreviations: GA, Gauteng; KZN, KwaZulu-Natal; NW, North-West; MP, Mpumalang. Antibiotic abbreviations used in the Antibiogram column: P, penicillin G; R, rifampin; M, trimethoprim-sulfamethoxazole; T, tetracycline; E, erythromycin: L, clindamycin.
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