Genotyping of Burkholderia mallei from an Outbreak of Glanders in Bahrain Suggests Multiple Introduction Events.

Background: Glanders, caused by the gram-negative bacterium Burkholderia mallei, is a highly infectious zoonotic disease of solipeds causing severe disease in animals and men. Although eradicated from many Western countries, it recently emerged in Asia, the Middle-East, Africa, and South America. Due to its rareness, little is known about outbreak dynamics of the disease and its epidemiology. Methodology/Principal Findings: We investigated a recent outbreak of glanders in Bahrain by applying high resolution genotyping (multiple locus variable number of tandem repeats, MLVA) and comparative whole genome sequencing to B. mallei isolated from infected horses and a camel. These results were compared to samples obtained from an outbreak in the United Arab Emirates in 2004, and further placed into a broader phylogeographic context based on previously published B. mallei data. The samples from the outbreak in Bahrain separated into two distinct clusters, suggesting a complex epidemiological background and evidence for the involvement of multiple B. mallei strains. Additionally, the samples from Bahrain were more closely related to B. mallei isolated from horses in the United Arab Emirates in 2004 than other B. mallei which is suggestive of repeated importation to the region from similar geographic sources. Conclusion/Significance: High-resolution genotyping and comparative whole genome analysis revealed the same phylogenetic patterns among our samples. The close relationship of the Dubai/UAE B. mallei populations to each other may be indicative of a similar geographic origin that has yet to be identified for the infecting strains. The recent emergence of glanders in combination with worldwide horse trading might pose a new risk for human infections. Author Summary: Glanders is a disease of antiquity, recognized as a malady of equines by Hippocrates and Aristotle. The causative agent, Burkholderia mallei, is currently feared as a potential biological weapon and has been used as such in the American Civil War and both World Wars to cripple equine military components. In the more economically developed countries, glanders has been eradicated through large scale culling. As a result, our understanding of transmission dynamics and networks is limited. However, regions of endemicity still exist in Asia, the Middle-East, Africa, and South America where it infects solipeds and camels. These areas provide reservoirs for re-introduction of glanders into countries previously listed as glanders-free. Here, we demonstrate the utility of high-resolution genotyping and whole genome sequence analysis in the investigation of a recent outbreak of glanders in horses and camels in Bahrain, a previously declared glanders-free country. Our analyses demonstrate that not one, but two strains likely caused this outbreak, and that these strains probably came from a similar geographic region via importation of infected animals. Even with careful monitoring, the global trade of animals from glanders-endemic regions can re-introduce and possibly re-establish this disease in animal populations of countries that have previously eradicated it. [ABSTRACT FROM AUTHOR]