Diverse Genotypes of Yersinia pestis Caused Plague in Madagascar in 2007.

Background: Yersinia pestis is the causative agent of human plague and is endemic in various African, Asian and American countries. In Madagascar, the disease represents a significant public health problem with hundreds of human cases a year. Unfortunately, poor infrastructure makes outbreak investigations challenging. Methodology/Principal Findings: DNA was extracted directly from 93 clinical samples from patients with a clinical diagnosis of plague in Madagascar in 2007. The extracted DNAs were then genotyped using three molecular genotyping methods, including, single nucleotide polymorphism (SNP) typing, multi-locus variable-number tandem repeat analysis (MLVA), and Clustered Regularly Interspaced Short Palindromic Repeats (CRISPR) analysis. These methods provided increasing resolution, respectively. The results of these analyses revealed that, in 2007, ten molecular groups, two newly described here and eight previously identified, were responsible for causing human plague in geographically distinct areas of Madagascar. Conclusions/Significance: Plague in Madagascar is caused by numerous distinct types of Y. pestis. Genotyping method choice should be based upon the discriminatory power needed, expense, and available data for any desired comparisons. We conclude that genotyping should be a standard tool used in epidemiological investigations of plague outbreaks. Author Summary: Yersinia pestis is a highly pathogenic bacterium and the causative agent of human plague. It has caused three recognized pandemics and is a current human health problem in many countries of Africa, Asia and the Americas, including Madagascar. The pathogen cannot be eradicated from natural plague foci as it persists in various known and cryptic rodent reservoir species. Genotyping is a critical tool in understanding the molecular epidemiology and possible kinetics of plague. In the present study, we succeeded in extracting DNA and genotyping directly from human clinical samples from Madagascar. We applied three different methods, including single nucleotide polymorphism (SNP) typing, multi-locus variable-number tandem repeat (VNTR) analysis (MLVA), and Clustered Regularly Interspaced Short Palindromic Repeats (CRISPR) analysis. Relative to their discriminatory power, all three methods provided important genotype information useful for understanding the molecular epidemiology of the disease, revealing that multiple, distinct genotypes caused human plague in Madagascar within one year, 2007. [ABSTRACT FROM AUTHOR]