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Evolutionary History of the Clostridium difficile Pathogenicity Locus

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TLDR
The evolutionary histories of two contrasting but clinically important genetic elements were thus characterized: the PaLoc, mobilized rarely via homologous recombination, and Tn6218, mobilized frequently through transposition.
Abstract
The symptoms of Clostridium difficile infection are caused by toxins expressed from its 19 kb pathogenicity locus (PaLoc). Stable integration of the PaLoc is suggested by its single chromosomal location and the clade specificity of its different genetic variants. However, the PaLoc is variably present, even among closely related strains, and thus resembles a mobile genetic element. Our aim was to explain these apparently conflicting observations by reconstructing the evolutionary history of the PaLoc. Phylogenetic analyses and annotation of the regions spanning the PaLoc were performed using C. difficile population-representative genomes chosen from a collection of 1,693 toxigenic (PaLoc present) and nontoxigenic (PaLoc absent) isolates. Comparison of the core genome and PaLoc phylogenies demonstrated an eventful evolutionary history, with distinct PaLoc variants acquired clade specifically after divergence. In particular, our data suggest a relatively recent PaLoc acquisition in clade 4. Exchanges and losses of the PaLoc DNA have also occurred, via long homologous recombination events involving flanking chromosomal sequences. The most recent loss event occurred ∼30 years ago within a clade 1 genotype. The genetic organization of the clade 3 PaLoc was unique in containing a stably integrated novel transposon (designated Tn6218), variants of which were found at multiple chromosomal locations. Tn6218 elements were Tn916-related but nonconjugative and occasionally contained genes conferring resistance to clinically relevant antibiotics. The evolutionary histories of two contrasting but clinically important genetic elements were thus characterized: the PaLoc, mobilized rarely via homologous recombination, and Tn6218, mobilized frequently through transposition.

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Citations
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ClonalFrameML: efficient inference of recombination in whole bacterial genomes.

TL;DR: This work uses maximum likelihood inference to simultaneously detect recombination in bacterial genomes and account for it in phylogenetic reconstruction and finds evidence for recombination hotspots associated with mobile elements in Clostridium difficile ST6 and a previously undescribed 310kb chromosomal replacement in Staphylococcus aureus ST582.
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Within-host evolution of bacterial pathogens

TL;DR: How whole-genome sequencing studies have advanced understanding of the mechanisms and principles of within-host genome evolution is described, and the consequences of findings such as a potent adaptive potential for pathogenicity are considered.
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Effects of control interventions on Clostridium difficile infection in England: an observational study

TL;DR: Limiting fluoroquinolone prescribing appears to explain the decline in incidence of C difficile infections, above other measures, in Oxfordshire and Leeds, England.
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Evidence for time dependency of molecular rate estimates

TL;DR: There has been mounting evidence that instantaneous mutation rates substantially exceed substitution rates, in a range of organisms (e.g., Denver et al., 2000; Howell et al. 2003; Howell and Holmes, 2001; Lambert and Lambert, 2002; Mao and Mao, 2006; Mumm and Parsons, 1997; Parsons et al.'s 1997; Santos et al, 2005).
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Pan-European longitudinal surveillance of antibiotic resistance among prevalent Clostridium difficile ribotypes

TL;DR: There was a significant correlation between lack of ribotype diversity and greater antimicrobial resistance (measured by cumulative resistance score), and well-known epidemic ribotypes 027 and 001/072 were associated with multiple antimacterial resistance, but high levels of resistance were also observed, raising the possibility of antimicrobial exposure as the underlying reason for their appearance.
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