Istituto Cantonale Batteriosierologico, Via Ospedale 6, 6904 Lugano, Switzerland1
Author for correspondence: Jean-Claude Piffaretti. Tel: +41 91 923 25 22. Fax: +41 91 922 09 93. e-mail: Jean-Claude.Piffaretti{at}ti.ch
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ABSTRACT |
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Keywords: Bacteroides fragilis, multilocus enzyme electrophoresis, cepA, cfiA, enterotoxin
Abbreviations: ET, electrophoretic type; ETBF, enterotoxin-producing Bacteroides fragilis; MLEE, multilocus enzyme electrophoresis (abbreviations for the enzymes studied by MLEE are defined in Methods)
The GenBank accession numbers for the sequences determined in this work are AF197508AF197534.
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INTRODUCTION |
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Previous studies have suggested a role of enterotoxin-producing Bacteroides fragilis (ETBF) in diarrhoeal disease of children (Sack et al., 1994 ; San Joaquin et al., 1995
). However, the high proportion of healthy carriers (Pantosti et al., 1994
, 1997a
) and the frequent association of ETBF with bacteraemia (Kato et al., 1996
), and thus not exclusively with diarrhoeal disease, make it difficult to define the enteric pathogenic importance of this micro-organism. Franco et al. (1997)
and Chung et al. (1999)
have shown that the metalloprotease enterotoxin encoded by the bft gene alters the morphology of intestinal epithelial cells and may thus contribute to the virulence of B. fragilis (Franco et al., 1997
). Recent studies have shown the existence of more than one allele of the bft gene [bft-1, bft-2 (Franco et al., 1997
), bft-3 (Kato et al., 2000
) and bft-Korea (Chung et al., 1999
)], and the localization of this gene on the fragilysin pathogenicity islet. However, although Scotto-DAbusco et al. (1998)
suggested a higher association of bft-2 with diarrhoea in children, little has been done to investigate a preferential correlation between one specific bft allele and a clinical manifestation.
DNADNA hybridization experiments have shown two DNA-homology groups of B. fragilis (I and II), with about 80 % of strains isolated in clinical studies assigned to homology group I (Johnson, 1978 ). Similarly, two genotypically distinct B. fragilis groups have been identified on the basis of ribotyping, restriction fragment length polymorphism (RFLP), PCR-generated fingerprinting, insertion sequence (IS) content and 16S rRNA sequence alignments (Moraes et al., 1999
; Kleivdal & Hofstad, 1995
; Podglajen et al., 1995
; Ruimy et al., 1996
; Smith & Callihan, 1992
). One group was characterized by the presence of the cfiA gene (encoding a metallo-ß-lactamase of Amblers class B) and the absence of the cepA gene (encoding a ß-lactamase of Amblers class A). Three specific insertion sequence elements, IS1186, IS942 and IS4351, providing the promoter region for the cfiA gene, were shown to be confined to this group (Podglajen et al., 1995
). The second group was characterized by the absence of the cfiA gene and of the associated insertion sequences, the frequent presence of the cepA gene, and a higher genetic heterogeneity (Podglajen et al., 1995
; Ruimy et al., 1996
). By including strains obtained from Johnson (1978)
in their 16S rRNA sequence comparison, Ruimy et al. (1996)
showed that the two groups described above could be related to the DNA homology groups II and I, respectively. Despite these findings, there is as yet no information dealing with the genetic relationship between invasive and noninvasive strains, human and animal strains and strains of different geographical origin.
Multilocus enzyme electrophoresis (MLEE) estimates the overall genetic relatedness among strains by indicating allele variation in a random sample of chromosomally encoded metabolic housekeeping enzymes (Selander et al., 1986 ). This technique has already been extensively used in our laboratory for the study of other bacterial species (Aeschbacher & Piffaretti, 1989
; Balmelli & Piffaretti, 1996
; Boerlin et al., 1992
, 1991
; Boerlin & Piffaretti, 1995
; Piffaretti et al., 1989
).
In the present study, we used MLEE to analyse the genetic diversity and the population structure of B. fragilis. This may be relevant to identify genotypes, clones or cryptic genospecies nonrandomly associated with clinical manifestations, antibiotic resistance, enterotoxin production or geographical origin.
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METHODS |
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Antibiotic susceptibility testing.
Minimal inhibitory concentrations (MICs) of imipenem were determined on Brucella agar plates supplemented with 5% blood, using the E-test (AB Biodisk) according to the manufacturers instructions. Strains for which the MIC was >16 µg ml-1 were considered resistant to imipenem (Nagy et al., 1995 ).
Enzyme extraction.
This was performed according to Loos et al. (1993) with slight modifications. Briefly, the B. fragilis suspensions in PBS were thawed and kept on ice during all manipulations to preserve the enzyme activity. The cells were lysed for 15 min in 50 mM n-octyl ß-D-glucopyranoside (Sigma) with constant stirring. The suspensions were then sonicated twice for 15 s (small tip setting 6·5% duty cycle, sonifier model MSE; N. Ziwy & Cie) for complete cell disruption and to decrease viscosity. Finally, the lysates were centrifuged at 20000 g at 4 °C for 20 min and the supernatants were stored in 200 µl aliquots at -80 °C.
Enzyme electrophoresis.
Bacterial lysates were thawed and subjected to gel electrophoresis under nondenaturing conditions in 10% starch gels (Connaught Laboratories, Fisher Scientific) as described by Selander et al. (1986) and Boerlin & Piffaretti (1995)
. Out of 27 different enzymes tested with different electrophoretic buffers, 15 could be reliably used for MLEE of B. fragilis: nucleoside phosphorylase (NSP), phosphoglucose isomerase (PGI), guanosine deaminase (GDA), glutamate dehydrogenase, NAD-dependent (GD1), glucose-6-phosphate dehydrogenase (G6P), malate dehydrogenase (MDH), hexokinase (HEX), phosphoglucomutase (PGM), alaninephenylalanine peptidase (AF), phenylalanineproline peptidase (FP), with buffer system F (Tris/maleate, pH 8·2) described by Selander (1986)
; catalase (CAT), with buffer system B (Tris/citrate, pH 6·3/6·7; Selander et al., 1986
); indophenol oxidase (IPO), with buffer system C (borate, pH 8·2/Tris/citrate, pH 8·7; Selander et al., 1986
); and esterase (EST),
-galactosidase (
GAL),
-glucosidase (
GLUS), with buffer system A (Tris/citrate, pH 8; Selander et al., 1986
). Enzyme staining was performed according to Selander et al. (1986)
. Specific staining procedures for
GAL,
GLUS and CAT were performed using the method of Harris & Hopkinson (1976)
.
Another 12 enzymes were tested but not retained because of a lack of activity or uninterpretable results.
DNA extraction and PCR.
Samples (50 µl) of the bacterial suspensions in water were thawed and DNA was extracted with a commercial ion-exchange resin (InstaGene matrix; Bio-Rad) according to the manufacturers instructions. PCR was performed in a total volume of 50 µl containing: 10 µl of the DNA extract, 10 mM Tris/HCl pH 8·3, 50 mM KCl, 2·5 mM MgCl2, 200 µM of each dNTP, 0·01% gelatin type A (Sigma), 0·5 µM of each primer, and 1 unit Taq polymerase (Boehringer Mannheim); the reactions were overlaid with paraffin oil (Merck) to prevent evaporation.
All 93 B. fragilis strains and also the outgroup strains were subjected to the PCR experiments described hereafter to detect enterotoxin-encoding genes and genes encoding antibiotic resistance. A 294 bp fragment of the bft gene was amplified by PCR according to Pantosti et al. (1997a) with the primers BF-1 (5'-GACGGTGTATGTGATTTGTCTGAGAGA-3') and BF-2 (5'-ATCCCTAAGATTTTATTATCCCAAGTA-3'). A thermal profile of 94 °C for 60 s, 52 °C for 60 s and 72 °C for 60 s was repeated for 35 cycles. These primers allowed the amplification of the bft-1 and bft-2 alleles of the enterotoxin-encoding gene. To avoid false negative results due to mutations in the primer regions, a second primer pair was developed in our laboratory: BF-3 (5'-GTTAGTGCCCAGATGCAGG-3') and BF-4 (5'-TAGTTCGTGTGCCATCACCC-3'). To amplify the corresponding 341 bp fragment of bft, a 35-cycle PCR with the following thermal profile was performed: 94 °C for 60 s, 50 °C for 60 s and 72 °C for 90 s. A third PCR, detecting bft-1, bft-2 and also the third bft allele (bft-3), was performed with primers provided by N. Kato (N. Kato, personal communication; Kato et al., 2000
).
Based on DNA sequence alignment of the published cfiA (Khushi et al., 1996 ; Tally & Jacobus, 1983
; Thompson & Malamy, 1990
) and cepA (Rasmussen et al., 1990
) genes, four primers corresponding to relatively conserved regions of the coding sequences were designed: cfiA-1 (5'-ATGGTACCTTCCAACGGG-3') and cfiA-2 (5'-CACGATATTGTCGGTCGC-3'), and cepA-1 (5'-TTTCTGCTATGTCCTGCCC-3') and cepA-2 (5'-ATCTTTCACGAAGACGGC-3'). The fragment amplified by cfiA-1 and cfiA-2 was 353 bp long. The cfiA PCR consisted of 35 cycles with a thermal profile of 94 °C for 60 s, 56 °C for 60 s and 72 °C for 60 s. Primers cepA-1 and cepA-2 amplified a 780 bp fragment in a PCR of 35 cycles, with the following thermal profile: 94 °C for 60 s, 52 °C for 60 s and 72 °C for 60 s. Furthermore, based on the published sequences (Podglajen et al., 1994
; Rasmussen et al., 1990
; Thompson & Malamy, 1990
), primers were designed for the insertion sequences IS1186 and IS942. The forward primers were 5'-TCCTCAATACATGAGCCGC-3' for IS942, and 5'-TGACCTACAACATCTTCCG-3' for IS1186. The reverse primer was the same for the detection of both insertion sequences. This primer was designed on position 165186 of the cfiA gene: cfiA-3 (5'-GGTTGTTGATAACAATCATCCC-3'). PCR of 35 cycles was performed using the following conditions: 94 °C for 60 s, 50 °C for 60 s and 72 °C for 90 s.
Isolates showing a genetic distance from other strains higher than 0·60 by MLEE were confirmed to be B. fragilis using 16S rRNA amplification and sequencing. 16S rRNA PCR was performed with universal primers UNI16RNA-L (5'-ATTCTAGAGTTTGATCATGGCTCA-3'; E. coli coordinates 326) and UNI16RNA-R (5'-ATGGTACCGTGTGACGGGCGGTGTGTA-3'; E. coli coordinates 14191393), amplifying a product of roughly 1400 bp (a kind gift from J. Frey, University of Bern). The thermal profile consisted of 35 cycles of 94 °C for 30 s, 52 °C for 30 s and 72 °C for 60 s. The PCR product was identified as B. fragilis 16S rRNA by a BLAST sequence similarity search in GenBank.
DNA sequencing and alignment.
PCR products for direct sequencing were prepared with the QIAquick PCR Purification Kit (Qiagen) and sequenced with the ABI Prism dRhodamine dye terminator Cycle Sequencing Ready Reaction Kit (dRhodamine terminator; Perkin-Elmer Applied Biosystems).
Sequence data were analysed by pairwise sequence alignment and by multi-alignment with the Lasergene program Megalign (DNASTAR). Phylogenetic analysis was performed using MEGA (Molecular Evolutionary Genetics Analysis 1.01; Kumar et al., 1993).
The DNA sequences determined in this work are in the GenBank/EMBL/DDBJ databases under accession numbers AF197508AF197534.
Statistical analysis.
Statistical analysis of the MLEE data was performed using a computer program designed by Whittam et al. (1983) . Briefly, the genetic diversity (h) for each enzyme locus among ETs was calculated as h=(1-
xi2)[n/(n-1)], where xi is the frequency of the ith allele and n is the number of ETs. The genetic distance between ETs was expressed as the proportion of loci at which dissimilar alleles occurred, with the contribution of each locus inversely weighted by the genetic diversity (h) at the locus. The ET clustering and the generation of a dendrogram according to genetic distances were determined with the average-linkage method from a matrix of coefficients of pairwise genetic distances (Selander et al., 1986
). Variance comparison of the distribution of allele mismatches was done by method B of Brown et al. (1980)
.
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RESULTS |
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Population structure and ß-lactam resistance
All B. fragilis strains of division I had the gene cepA but not cfiA, whereas the division II organisms had only the cfiA gene. Division I included a strain (AIP638) previously described as belonging to the cepA-positive/cfiA-negative group (Ruimy et al., 1996 ), whereas division II comprised different strains from the DNA homology group II and the cfiA-positive/cepA-negative group (VPI2393, VPI3392, TAL3636, Bfr81R, Bfr 271, TAL2480; Johnson, 1978
; Podglajen et al., 1995
; Ruimy et al., 1996
).
Five of the ten isolates of division II expressed imipenem resistance (MICs 32 µg ml-1), the other five isolates of division II, and all the isolates of division I, were susceptible to this antibiotic (Table 1
). In division II, the five isolates expressing the resistance contained either IS1186 or IS942, whereas the other five susceptible isolates did not contain either insertion sequence (Table 1
).
Source of the isolates
The human strains analysed were isolated from patients with different clinical manifestations (Table 1). No particular cluster was uniquely associated with specific presentations (Fig. 1
). For example, the 23 B. fragilis cultured from blood were assigned to ETs in both divisions I and II. A separate analysis of these strains showed a genetic diversity of 0·371, comparable to that of the whole B. fragilis population studied (data not shown).
Faecal isolates were examined from six patients from whom clinical isolates were obtained (Table 1): these faecal isolates all clustered in division I but they did not always belong to the same ET as the invasive strains isolated from the same patient.
Isolates obtained from Norway, Japan, Europe and the United States were not represented by distinct ETs or clusters of ETs, and were distributed throughout the population (Fig. 1).
ETs representing the four animal strains included in this study did not form a separate cluster and were randomly distributed among the ETs representing the human strains.
Distribution of enterotoxigenic B. fragilis
Of the 93 B. fragilis strains investigated, 29 were identified as ETBF by PCR assays targeting the bft gene. The first PCR used for this gene (primers BF-1/BF-2; Pantosti et al., 1997a ) detected bft-1 and bft-2. The second PCR used here (primers BF-3/BF-4) detected one additional bft allele (bft-3). This observation was supported by a third PCR with primers obtained from N. Kato, which detect bft-1, bft-2 and bft-3. Strains of all the ETs in division II lacked the bft gene, whereas genotypes carrying the enterotoxin gene were widely distributed in division I (Fig. 1
). A common sequence of 189 bp present in all the amplicons generated by the three pairs of primers used was aligned and compared. Sequence alignment showed two ETBF subgroups characterized by either the bft-1 or the bft-2 gene described by Franco et al. (1997
; Fig. 2a
), and a single isolate (GAI 20240, originating from Japan) with a different bft sequence. We aligned this bft sequence with bft-3 from N. Kato (GenBank accession no. AB026624) and with bft-Korea (Chung et al., 1999
) and discovered that these three sequences were identical. No apparent association between the presence of one of the bft alleles and specific clinical manifestation was observed. Furthermore, from the patient presenting the invasive isolate 64, three faecal isolates were obtained: isolates F64D and F64E carried bft-1, and isolates 64 and F64B carried bft-2.
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Gene linkage disequilibrium
Linkage disequilibrium (nonrandom association of alleles over chromosomal loci) was tested by the method of Whittam et al. (1983) . The ratio of the observed variance of allele mismatches over the 15 loci to the variance expected in the case of random distribution of alleles was 3·050 for the whole B. fragilis population, and 1·079 and 3·384 for divisions I and II, respectively.
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DISCUSSION |
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Using a PCR assay developed in our laboratory, the 83 strains of division I were shown to contain the cepA gene (encoding an Amblers class A ß-lactamase) but not cfiA (encoding an Amblers class B ß-lactamase), whereas the 10 strains of division II contained the cfiA gene but not cepA. After exclusion of the strains obtained from laboratories specifically studying these genes, the proportion of isolates encoding cfiA was similar to the proportion of DNA homology group II strains obtained in previous studies (Johnson, 1978 ). cepA and cfiA have been shown to be related to DNA homology groups I and II, respectively (Ruimy et al., 1996
). The finding in our division II of two strains of the DNA homology group II (Table 1
), including the type strain (VPI2393; Johnson, 1978
), and of isolate 28794, a strain with a ribotype profile similar to that of VPI2393 (Kleivdal & Hofstad, 1995
), strongly suggests that this division corresponds to the DNA homology group II described by Johnson (1978)
.
Thus, our results delineate two major subdivisions within the species B. fragilis one associated with the cfiA gene and the other, more heterogeneous, with the cepA gene and are in agreement with those obtained by DNADNA hybridization (Johnson, 1978 ), ribotyping (Kleivdal & Hofstad, 1995
; Smith & Callihan, 1992
; Leszkzynski et al., 1997
), AP-PCR (Moraes et al., 1999
), insertion sequence content (Podglajen et al., 1995
) as well as 16S rRNA sequence alignment (Ruimy et al., 1996
).
Genetic structure of divisions I and II
The genetic diversity observed in the B. fragilis sample (0·393) was comparable to the genetic diversity observed in many other bacterial populations (Smith & Callihan, 1992 ; Go et al., 1996
; Selander et al., 1986
; Boerlin et al., 1991
, 1992
; Boerlin & Piffaretti, 1995
). This value and the ratio of the observed to the expected variance (3·050) suggest a nonrandom association of the alleles over the chromosome and thus a clonal structure over the whole population. However, the two divisions considered separately show important differences.
Division I presented a large number of ETs separated by low genetic distances (0·0180·401) and a genetic diversity of 0·314. The ratio of the observed to the expected variances of division I was close to one (1·079), suggesting a random association of the genes over the chromosome. The lack of linkage disequilibrium (nonrandom association of the alleles over the chromosome) suggests a higher recombination rate, and thus a nonclonal structure of the B. fragilis population in division I. This hypothesis is supported by the observation that isolates from different geographical regions did not share the same genotype (with only one exception, ET 32 representing isolate 1475, from Paris, and isolate 134, from Switzerland). Furthermore, in the same geographical region, all isolates belonged to different ETs, supporting the hypothesis of a high recombination rate. Such a high recombination rate is in agreement with the observed heterogeneity of capsular polysaccharides in B. fragilis (Pantosti et al., 1995 ).
In contrast, division II presented a different population structure, with a high value of the ratio of the variances (3·384), suggesting a lower recombination rate.
Podglajen et al. (1995) proposed that B. fragilis strains carrying cfiA form a novel species. These authors observed heterogeneous ribotype profiles in the cepA-positive group and highly homogeneous profiles in the cfiA-positive group. The two divisions observed here also showed a different population structure, with a nonclonal evolution in division I and a rather clonal evolution in division II. The genetic distance of 0·60·7, which is empirically considered to be the limit differentiating two species (Boerlin et al., 1991
), further supports the hypothesis of the presence of two genospecies. Moreover, the MLEE data are consistent with previous DNADNA hybridization data, suggesting the existence of two genospecies: Johnson (1978)
indeed observed a DNA relatedness of 6570% between the two DNA homology groups and a
Tm ranging from 7·2 to 9·5 °C (Johnson, 1978
). A DNA relatedness of less than 70% and a
Tm of more than 5 °C is normally considered as the threshold to distinguish bacterial species. Since DNADNA hybridization is the reference technique used for species delineation (Wayne et al., 1987
, 1996
), this method should be performed on our populations to confirm that the cfiA subgroup corresponds to a different genospecies.
Degree of expression of the cfiA gene
The susceptibility assays of the strains of division II to the antibiotic imipenem showed that the gene was expressed and conferred resistance (MIC >32 µg ml-1; Table 1) in five isolates carrying cfiA. These five resistant isolates formed a closely related cluster of strains (ETs 8285) within division II. Furthermore, all isolates expressing the imipenem resistance contained at least one insertion sequence (IS1186 or IS942; Table 1
), whereas the isolates not expressing the resistance did not contain such insertion sequences. These results are in agreement with those of Podglajen et al. (1995)
, showing that imipenem susceptibility in division II is not due to the lack of the cfiA gene but to the absence of a precise insertion sequence element providing the promoter region for the expression of this gene immediately upstream of the gene.
Genetic structure in relation to enterotoxin production
Twenty-nine of the 93 B. fragilis isolates of the collection were identified as ETBF by PCR experiments designed to detect the metalloprotease-enterotoxin-encoding gene. Excluding those isolates obtained from laboratories specifically working on ETBF (Sears et al., 1995 ; Pantosti et al., 1997b
; Kato et al., 2000
), this represents 18% of the population which was analysed. A similar proportion was found by Pantosti et al. (1994
, 1997a
) in Italy. Previous experiments showed complete agreement between in vitro cytotoxicity assays and the results of the PCR experiments amplifying bft-1, bft-2 and bft-3 (the three alleles of the bft gene), suggesting that if the gene is present it is also expressed (Pantosti et al., 1997a
; Chung et al., 1999
). False negative results due to possible primer mutations or to the presence of a further bft allele are not likely since three different PCRs with different primers were performed.
The ETs marking the strains carrying bft were distributed in division I, but were not present in division II. Furthermore, they were not associated with particular clinical symptoms, nor clustered in a specific genetic group, which is not surprising in a nonclonal population like that of division I. Recent studies suggested a role for ETBF in bacteraemia (Kato et al., 1996 ). However, out of 23 strains isolated from blood cultures only 4 carried the bft gene. This finding, together with the existence of a high number of healthy carriers (Pantosti et al., 1994
, 1997b
), does not support an association between ETBF and bacteraemia.
The data obtained using MLEE are in agreement with previous results based on antigen analysis (Myers & Shoop, 1987 ), RFLP (Smith & Callihan, 1992
) and ribotyping (Leszkzynski et al., 1997
), showing no particular feature that would place the ETBF strains within a distinct subgroup of B. fragilis. Recently, the bft gene has been localized on a pathogenicity islet (Moncrief et al., 1998
; Franco et al., 1999
). Pathogenicity islets, like the pathogenicity islands, are transmitted by horizontal gene transfer between bacterial populations. The mobility of these unstable DNA elements and the observation that the bft gene is found only in division I, which presents an apparently higher recombination rate, could explain the observed distribution of the enterotoxin gene in the B. fragilis population, independently from the presence of a particular cluster of genotypes.
The alignment of the bft gene DNA sequences of the 29 ETBF strains showed three distinct alleles in the population studied. By sequence alignment and PCR performed with primers obtained from N. Kato, the B. fragilis strains were shown to harbour only one of these three alleles, confirming that the different bft alleles do not coexist (Franco et al., 1997 ). The distribution of the sequences in the two clusters was independent of the host origin or clinical manifestation (Table 1
). bft-3 may represent the only exception, since this allele was absent from European and American isolates, supporting the idea of Chung et al. (1999)
that the third bft allele may have originated by a different molecular evolution specific to Asian B. fragilis. An interesting finding was the high degree of sequence conservation: the 294 bp amplicon showed no mutations within each allele and 14 point mutations between bft-1 and bft-2 (except 1475, showing two point mutations with respect to the other bft-2 sequences). This conservation should be further investigated, since the primers used have not been designed to amplify a highly conserved DNA region, such as the zinc-binding site. Also bft-3 seems to be highly conserved and allows a similar observation as for bft-1 and bft-2: an alignment of bft-3 (N. Kato, GenBank accession number AB026624), bft-Korea (Chung et al., 1999
) and the amplicon obtained from GAI20240 showed no mutation between the three sequences.
Genetic structure in relation to clinical manifestation
The number of ETs observed, the absence of ETs represented by a large number of isolates and the absence of particular genotypes associated with distinct clinical manifestations showed that in B. fragilis populations, pathogenicity (invasiveness) is not caused by a few specific genomic types or clones. No particular clusters of B. fragilis were implicated in bacteraemia, abscesses or other clinical manifestations.
Genetic structure of the B. fragilis population colonizing patients
Invasive B. fragilis seem not to present a genomic group distinct from those of the intestinal flora and patients could be colonized by isolates of different genotypes, e.g. ET 21, 13 and 76 from patient 64.
Genetic structure of B. fragilis in different hosts
ETs representing B. fragilis isolated from animals did not form a separate cluster and were randomly distributed among the ETs representing the human strains. However, only four animal strains were included in the analysis of B. fragilis and they may not be representative.
Conclusion
The observations inferred from MLEE are based on a panel of genes representing the chromosome as a whole and not on a single gene or a unique region of the genome. The data obtained strongly correlated with those provided by other techniques (DNADNA hybridization, ribotyping, RFLP, AP-PCR and 16S rRNA), allowing the differentiation of B. fragilis into two subgroups associated with different antibiotic resistance traits (cepA and cfiA). Three alleles of an enterotoxin-encoding gene (bft-1, bft-2 and bft-3) were identified in the population. The production of the enterotoxin does not, however, seem to be related to a particular genomic group and seems not to represent a distinctive feature for invasive strains. No definite clones of B. fragilis are associated with specific clinical manifestations or geographical origin. Patients are thus infected by B. fragilis belonging to a wide variety of genomic types, supporting the hypothesis that B. fragilis is largely opportunistic or that invasive bacteria acquire by horizontal gene transfer a gene encoding an as yet unidentified virulence factor.
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ACKNOWLEDGEMENTS |
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This research was supported by grant 31-45914.95 from the Swiss National Science Foundation and by the Helmut Horten Foundation.
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Received 13 October 1999;
revised 20 January 2000;
accepted 7 February 2000.