Skip to main content
Advertisement
  • Loading metrics

Genetic typing of isolates of Rickettsia typhi

  • Cecilia Y. Kato,

    Roles Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Project administration, Supervision, Visualization, Writing – original draft, Writing – review & editing

    Affiliation Rickettsial Zoonoses Branch, Centers for Disease Control, Atlanta, Georgia, United States of America

  • Ida H. Chung,

    Roles Data curation, Formal analysis, Investigation, Methodology, Supervision, Validation, Visualization, Writing – original draft, Writing – review & editing

    Affiliation Rickettsial Zoonoses Branch, Centers for Disease Control, Atlanta, Georgia, United States of America

  • Lauren K. Robinson,

    Roles Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Resources, Validation, Visualization, Writing – review & editing

    Current address: Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America

    Affiliation Rickettsial Zoonoses Branch, Centers for Disease Control, Atlanta, Georgia, United States of America

  • Marina E. Eremeeva,

    Roles Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Resources, Supervision, Validation, Visualization, Writing – original draft, Writing – review & editing

    Current address: Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, Georgia, United States of America

    Affiliation Rickettsial Zoonoses Branch, Centers for Disease Control, Atlanta, Georgia, United States of America

  • Gregory A. Dasch

    Roles Conceptualization, Data curation, Formal analysis, Funding acquisition, Investigation, Methodology, Project administration, Resources, Supervision, Writing – original draft, Writing – review & editing

    gadaschrickettsia@gmail.com

    Affiliation Rickettsial Zoonoses Branch, Centers for Disease Control, Atlanta, Georgia, United States of America

Abstract

Murine typhus, which is caused by Rickettsia typhi, has a wide range of clinical manifestations. It has a low mortality rate but may result in meningoencephalitis and interstitial pneumonia in severe cases. Comparisons of complete genome sequences of R. typhi isolates from North Carolina, USA (Wilmington), Myanmar (B9991PP), and Thailand (TH1527) identified only 26 single nucleotide polymorphism (SNP) and 7 insertion-deletion (INDEL) sites in these highly syntenic genomes. Assays were developed to further define the distribution of these variant sites among 15 additional isolates of R. typhi with different histories from Asia, the USA, and Africa. Mismatch amplification mutation assays (MAMA) were validated for 22 SNP sites, while the 7 INDEL sites were analyzed directly on agarose gels. Six SNP types, 9 INDEL types, 11 total types were identified among these 18 isolates. Replicate DNA samples as well as comparisons of isolates with different passage and source histories gave consistent genetic typing profiles. Comparison of the SNP and INDEL markers to R. typhi’s nearest neighbor Rickettsia prowazekii demonstrated that the majority of the SNPs represent intra-species variation that arose post divergence of these two species while several INDEL sites also exhibited intraspecies variability among the R. prowazekii genomes that have been completely sequenced. The assays for the presence of these SNP and INDEL sites, particularly the latter, comprise a low technology gel method for consistently distinguishing R. typhi and R. prowazekii as well as for differentiating genetic types of R. typhi.

Author summary

Rickettsia typhi is an obligately intracellular bacterium which is most commonly transmitted by rat fleas to humans and can cause the disease murine (endemic) typhus wherever both humans and infected rats are present. However, this agent is also present in a variety of other arthropod species associated with other vertebrate animals. Its closest relative is Rickettsia prowazekii, the etiologic agent of epidemic typhus (human louse-borne) and sylvatic typhus (associated with flying squirrels and its ectoparasites in the Eastern United States). Both classic louse-borne and flea-borne typhus rickettsiae can cause fatal infections and have the potential for use as biothreat agents as they can be grown in large quantities. We investigated the genetic differences that can be found in different stocks of R. typhi. Our work is important for two reasons. We have developed robust and sensitive methods for distinguishing isolates of R. typhi originating from different continents; these new assays require only simple instrumentation which is available in nearly all biology laboratories. Our results also provided new insights confirming the probable origin of R. typhi in Asia and its likely cosmopolitan spread by rats on ships around the world.

Introduction

Rickettsia typhi is a gram-negative obligate intracellular bacterium transmitted most commonly by the Oriental rat flea, Xenopsylla cheopis [1]. Mammals such as Rattus spp. serve as the main reservoirs involved in the pathogen’s replication cycle [2]. The bacteria can be transmitted through flea saliva or shed in flea feces and infect the host through feeding or skin abrasions, the conjunctivae or by inhalation of aerosolized materials; however, the actual route of infection in many confirmed cases of murine typhus is unknown and many cases present with atypical syndromes [35]. Outbreaks of murine (endemic) typhus have been identified worldwide [4]. In the United States most cases of murine typhus occur in Hawaii, California and Texas [511]. Recent cases have also been reported from South America, Mexico, Europe, the Middle East, Africa, Asia, and Australia, [1224] and travel-acquired cases are not uncommon [2527]. Murine typhus manifests with fever including severe fever with thrombocytopenia, headache, vomiting, myalgia, malaise, and rash and generally has a low mortality rate [6,1223], but may result in meningoencephalitis, interstitial pneumonia, shock, and respiratory failure in severe cases [4,22,2425].

Murine typhus is most commonly suspected and confirmed serologically, primarily requiring the exclusion of epidemic typhus as a potential alternative etiology [2729]. Although direct PCR [30], qPCR [3133], LAMP [34], and RPA (recombinase polymerase amplification) [35] assays have been developed for detecting R. typhi in clinical samples, it is substantially easier to detect this agent in infected fleas because the quantity of organisms that are present can be much higher than in clinical or animal samples [9,11,36]. The simplest method for differentiating R. typhi from R. prowazekii isolates employs restriction fragment length polymorphism (RFLP) analysis of PCR amplicons [37,38]. Eremeeva et al. [37] were unable to differentiate any of the former USSR (Georgia, Azerbaijan) R. typhi isolates investigated from the reference US Wilmington strain by RFLP of their gltA, 17 kD protein antigen or 120 kD (ompB) genes even though they were readily distinguished from a diverse collection of R. prowazekii isolates by this method. While PCR-RFLP has been proven to be a simple and specific method for differentiating species of Rickettsia, nucleotide sequence analysis of PCR amplified target genes is also a rapid, sensitive and convenient technique for distinguishing these two species. Massung et al. [39] reported that isolates of R. prowazekii exhibited insertion deletion (INDEL) variation in their tandem repeats but could not differentiate isolates of R. typhi by this method. Consequently, the work reported here is the first which describes simple gel based PCR laboratory methods by which diverse isolates of R. typhi can be differentiated at a number of genetic loci.

Mismatch Amplification Mutation Assays (MAMA) have been used for genotyping applications to enhance discrimination between alleles [4041]. These MAMA assays are PCR based tests that use a modified primer design to enhance detection of SNP differences and thus to discriminate between alleles. Insertion/deletion (INDEL) typing assays can also be used to detect the presence of genetic differences attributed to insertion or deletion events between species or isolates of Rickettsia using PCR [39,42]. DNA sequencing is not required for these assays, thus resulting in a rapid, simple, and inexpensive tool to differentiate between species and to characterize different isolates into specific groups or clades. Thus, one purpose of the present study was to develop this efficient and inexpensive method for R. typhi isolate discrimination for use in epidemiological investigations. By focusing on variant single nucleotide polymorphism (SNP) and insertion-deletion (INDEL) sites that were detected in the three complete genome sequences available during our laboratory study (we provided the purified isolate DNA for the genome sequencing of RtTH1527 and RtB9991PP), we succeeded in applying this low technology to group isolates of R. typhi into specific clades based on their genomic sequence differences. Some of these sites could also reliably differentiate R. typhi from isolates of R. prowazekii and add to the INDEL site assays previously described [39].

Results

Analysis of variant sites in three complete R. typhi genome sequences

Alignments of complete genome sequences of R. typhi isolates from North Carolina, USA (Wilmington), Myanmar (Burma) (B9991PP), and Thailand (TH1527) identified only 26 single nucleotide polymorphism (SNP) and 10 insertion-deletion (INDEL) sites in these highly syntenic genomes. Three INDEL sites due to single nucleotide deletions were not suitable for MAMA primer design and not studied further. Eighteen different isolates of R. typhi were available for analysis of the SNP and INDEL assays developed for evaluating these variant sites (Table 1). Three isolates (Bb, AZ331, and AZ332) were tested as replicate DNA samples (-a, -b), and two other isolates (Gear & HGear and FLA & HFLA) had different passage histories and origins so 23 total R. typhi DNAs were available for screening for variants with the assays.

thumbnail
Table 1. Isolates of Rickettsia typhi (Rt) and details of their origin.

https://doi.org/10.1371/journal.pntd.0010354.t001

Analysis of SNP sites with mismatch amplification mutation assays (MAMA) in 18 R. typhi isolates

MAMA assays were developed for 22 of the 26 SNP sites and used for discrimination of the variant alleles (S1 Table). The 23 R. typhi DNA preparations from 18 isolates (S2 Table and Fig 1) were each tested. The R. typhi Wilmington PP isolate was plaque purified while the genome sequence obtained for Wilmington was from a differently passaged uncloned stock of this isolate. All 22 SNP assays with these three pairs of isolate DNAs gave identical results (S2 Table). Six lineages of R. typhi and the R. prowazekii outgroup could be resolved with SNP assays (Fig 1). One representative gel result is shown for the SNP assay for site 2_081 (Fig 2A and 2B) and 4 other SNP assays are shown in S1 Fig. Wilmington, the most passaged isolate of R. typhi we examined, was readily separated from all the other isolates including the other two isolates from the USA (Fig 1). The other isolates from Africa, Eastern Europe and the USA (except Wilmington) could not be distinguished (Fig 1 and S2 Table). The strains from Asia exhibited the greatest diversity (Fig 1) as the two isolates from Thailand (TH1527, TA836) could be distinguished by 4 SNPs (1_058, 6_136–1, 16_453-I, 26_832) and both could also be differentiated from all other isolates by a single SNP (9_230) (S2 Table). The four isolates from Myanmar possessed 5 unique SNPs not found in other isolates of R. typhi (2_081, 12-348-I, 17_469, 20_554–1, 25_796); these Myanmar isolates could also be separated into two groups (Bb/B72 and B10056/B9991) with 5 additional SNPs (4_PG07, 7_140, 8_223, 11_290, 18_473) (S2 Table). Three SNP sites differentiated the R. prowazekii isolate sequences from the R. typhi alleles at the SNP locations (3 sites-T5, T12, T16 were not present in R. prowazekii and T20 was polymorphic site specific for R. prowazekii) (S3 Table).

thumbnail
Fig 1. Neighbor joining tree analysis of the variant genetic sites found in isolates of R. typhi.

Clades derived from 22 SNP sites.

https://doi.org/10.1371/journal.pntd.0010354.g001

thumbnail
Fig 2. Representative SNP (MAMA) and INDEL assay results with 23 R. typhi DNAs.

DNA numbers are listed in Table 1. The SNP assay for site 2_081 is shown with 2 selective primer sets for each polymorphism (A and B). Blue boxes in Panel A show no amplicons for this nucleotide type, and are the only amplicons produced in Panel B for the alternative nucleotide type. The INDEL assay (Panel C) for site i5_351 reveals 3 product sizes; yellow boxes 517 bp, while boxes 442 bp, and red boxes 367 bp.

https://doi.org/10.1371/journal.pntd.0010354.g002

INDEL site analysis

INDEL sites in the 18 R. typhi isolate DNAs were also assessed by sizing the products produced by 7 PCR primer sets designed to flank the largest INDEL sites (Tables 2 and S4).

thumbnail
Table 2. Summary of INDEL site analyses (*sizes confirmed by sequencing, colored cells have variable size polymorphisms at that locus).

https://doi.org/10.1371/journal.pntd.0010354.t002

Representative INDEL typing results for the most informative site i-5_351 are shown in Fig 2C. Replicate DNAs (-a, -b) and isolates from different sources (Gear, H1268 Gear; FLA and FLA H6590) gave the same amplicon sizes (Fig 3). Nine R. typhi clades and the R. prowazekii Madrid E outgroup were resolved with the INDEL typing (Fig 3 and Table 2). One Rp INDEL site (i3_162) was predicted to be similar in size (144 bp) to the most common Rt INDEL, and a second Rp INDEL site (i5_351) was predicted to be similar in size (367 bp) to both the Rt Wilmington PP, the two Thailand isolates, and Rt Museibov (Table 2) and is shown in Fig 2. Sequence analyses of the five other INDEL sites contained unique polymorphisms in R. prowazekii relative to the R. typhi isolates (Table 2); however, the R. typhi primer sites contain mismatches to the R. prowazekii homologues (S2 Table) so a different set of primers as predicted in the Tables would be needed to amplify those variant Rt regions. The groupings for R. typhi were similar to those found by SNP typing (Fig 3) but with the following exceptions: Museibov grouped with the two Thai isolates (all three were identical) (clade i_RT2). All four Myanmar isolates had one unique INDEL amplicon (i5_351) (Table 2). The B72 differed by one INDEL site (i10_825) from the other three Myanmar isolates, B9991PP and B10056PP differed from B72 and Bb at two sites (i1_032, i2_052) (Table 2) and all four strains from Myanmar were divergent from all the other isolates (clades i_RT3, i-RT4 and i-RT5) (Fig 3). Finally, one USA strain (Rat 18) and two types of African strains (AZ306 and Gear/HGear) could be separated from each other and the rest of the large USA-African-Russian group of isolates (Clades i_RT6, i_RT7, iRT8) (Fig 3). Wilmington was again markedly different from all the other strains of R. typhi (clade i_RT1) and the PP strain DNA gave the identical INDEL profile as that predicted from the Wilmington genome sequence (Fig 3).

thumbnail
Fig 3. Neighbor joining tree analysis of the variant genetic sites found in isolates of R. typhi.

Clades derived from 7 INDEL sites.

https://doi.org/10.1371/journal.pntd.0010354.g003

Combined SNP and INDEL site analysis

The combined SNP and INDEL site data analysis is shown in Fig 4 and S5 Table. While the INDEL analysis exhibited greater resolution than that detected by SNP analysis, the geographic groupings were nearly the same as the individual SNP and INDEL clades (Figs 1 and 3), so that the primary benefit of using the combined data compared to INDEL typing is that longer branch lengths were obtained and the Museibov and two Thailand strains could be differentiated.

thumbnail
Fig 4. Neighbor joining tree analysis of the variant genetic sites found in isolates of R. typhi.

Clades obtained by combining the SNP and INDEL site data. Bootstrap values are shown on the nodes.

https://doi.org/10.1371/journal.pntd.0010354.g004

Characteristics of unique sites in the genome sequence of R. typhi TM2540

MiSeq methodology was used to obtain an additional genome sequence for another isolate of R. typhi TM2540 from Thailand after our laboratory studies were completed (we do not have this isolate) [47]. In order to determine whether any additional variant sites were present in this isolate when compared to the Wilmington, TH1527, and B9991PP sequences, we performed a global alignment of the four sequences [48] (S6 Table). Thirty-four SNP or INDEL sites were unique to TM2540. Of the 21 sites with deletions, 15 were found in intergenic regions, 5 were in sca2 (no effect on reading frame), and 1 was in RT065_unk and caused a reading frame shift. One additional (147 bp) insert was in the repeat region of sca2 in the same region as the extra 450 bp repeat found in RtB9991PP. One 12 bp unique insert was in an intergenic region, a 16 bp insert caused a frameshift in RT0767_unk and a 552 bp deletion responsible for loss of coding sequences in both Rt0250_pbpB and Rt0251_xthA1. Of the 10 unique SNPs, 1 was in an intergenic region, 6 were non-synonymous substitutions in protein coding sequences and 3 caused synonymous substitutions.

For the 26 SNP sites originally identified among the three RtWilmington, RtB9991PP and RtTH1527 genomes, TM2540 shared 6 SNPs with RtWilmington and RtB9991PP, 11 SNPs with RtWilmington and RtTH1527, and 9 SNPS with RtB9991PP and RtTH1527 9. Among the 7 INDEL sites originally identified in the three RtWilmington, RtB9991PP and RtTH1527 genomes, TM2540 lacked the 14, 84, and 781 bp deletions found only in RtWilmington (i3_161–162, i7_600, and i8_683, respectively), the 33 bp deletion found in RtB999PP and RtB100056PP (i1_032), and the 17 and 150 bp inserts found only in RtB9991PP (i10_825–6 and i5_351, respectively). RtTM2540 also contained only a partial 147 bp fragment of the 450 bp insert found in RtB9991PP (i2_052).

Discussion

Although R. typhi is a cosmopolitan species and has been spreading as a result of human activities that has distributed rats around the world on ships, carrying this agent with them [2], only a few genetic markers were found to exist among the isolates available to us even with complete genomic sequencing of isolates from opposite parts of the world (USA Wilmington, Thailand TH1527, and Myanmar B9991PP). The comparison of the whole genome sequences from the three different isolates resulted in only 26 SNPs and 10 INDEL differences (3 additional single bp deletions were not analyzed) among these three isolates. Strikingly, the highly passaged Wilmington strain genome sequence from a different laboratory [39] exhibited no differences from the sites we examined in the plaque purified Wilmington isolate we used. Seven SNPs and 2 INDEL sites we assayed were unique to Wilmington. This overabundance of unique sites in Wilmington suggests that they may have arisen during laboratory passage of these stocks and may be most useful in discriminating it as a potential contaminant in other isolates of R. typhi. Insufficient passage time exists between the cloned and uncloned stocks of this isolate to generate any differences in these sites although it is possible that other differences may be present elsewhere in the cloned genome. However, it also suggests that the original sequenced stock was clonal. B9991PP was a low passaged clonal stock, but could not be differentiated from the other cloned Myanmar B10056PP isolate with the assays developed here even though one was isolated from a bandicoot and the other from a rat. These observations suggest that these mutations can be stably maintained in nature. Moreover, the origin of mutations in Rickettsia by laboratory passage to attenuate Rickettsia prowazekii Madrid E and R. rickettsii Iowa is well documented [49,50].

In contrast to this independent experimental analysis of the variability of the sites with MAMA assays we identified from Wilmington, TH1727 and B9991PP genome sequences from Sanger (Wilmington) and or Sanger/454 sequencing, we were surprised at the number of additional sites reported in the TM2540 MiSeq data. The MinIon sequence reported for TM2540 contained an even larger number of apparent sequencing errors [47]. Until these unique sites in TM2540 are evaluated by an independent method (Sanger or MAMA), we are reluctant to consider them as being variant sites indicative of more genetic variation in this species. In particular, some of the sites would cause either deletions of protein genes we would expect to be functional and frame shifts in other protein genes which are conserved in the other three genomes. However, the pattern of variation is consistent with a strong relationship to the Asian isolates and with variability in isolates from Thailand (compare TA837 and TH1527) and the four Myanmar isolate profiles (S2 Table).

Wilmington, Gear, Museibov, Ger and TH1527, and TM2540 isolates were of human origin from cases of murine typhus. Since the human isolates all caused murine typhus, the genetic mutations in these strains did not attenuate their virulence sufficiently to prevent disease and suggests that it is likely all the strains of R. typhi circulating in nature are virulent for humans. We are unaware of consistent geographic differences in the pathogenicity of R. typhi for humans. The FLA (F2) strain from Florida and the Rat18 strain from California are very similar, differing in only one of the INDELs examined here, an INDEL (i7_600) in an 84 bp tandem repeat otherwise found only in R. typhi Wilmington. Changes in tandem repeat numbers are known to occur in Rickettsia rickettsii during laboratory passage [51] and between isolates of other species [39,42]. Six of the seven INDELs examined occurred in tandem repeats found by Tandem Repeat Finder [52] and five of them were in putative proteins.

The US isolates were genetically very close to many of the isolates from Africa, Eastern Europe and Pakistan. No differences were observed in the largest clade (RT 11) with 10 isolates from Georgia, Azerbaijan, USA, Africa, and Pakistan, as all targeted sites retained the most common SNP/INDEL pattern (Fig 3). The greater differences within isolates and relative to the African/US clade observed among R. typhi isolates from Myanmar and Thailand are consistent with the likely origin of this species in the Far East and the more ancient old world co-evolution of rats, oriental rat fleas, and R. typhi [2]. The isolates obtained from other parts of the world may have originated from a common lineage spread by humans, ships, and ship rats in more recent history although a few mutations among the African, US and European lineages were detected. Despite the wide range of habitats and isolate histories represented by our collection, it is very likely that other variant sites may be discovered by whole genome sequencing of additional isolates and by examination of other isolates from other rodent or vector hosts. It is possible that the differences found in isolates in the Myanmar and Thailand isolates suggests that immunological and ecological selective pressures arising from circulation in different vectors and reservoir hosts could give rise to novel genetic variants of R. typhi. However, notwithstanding this speculation, it is striking that so little apparent genetic variation was found to exist even between a US isolate with extensive passage in cell culture, bandicoot and rat isolates from Myanmar and human and rat isolates from Thailand or among the other isolates investigated here. It is therefore very likely that most of the wide spectrum of clinical differences observed for murine typhus among humans [1,4,6] are primarily due to human genetic, health, and nutritional factors and the infecting dose in those patients.

We believe that the primary utility of the assays described here will be in providing public health laboratories with new means to both differentiate Rickettsia prowazekii and R. typhi in clinical and environmental specimens obtained at sites were patients may have been infected. Because the assays were developed with genomic DNA, they will work best with DNA obtained from isolates or DNA amplified first with primers adjacent (flanking) to the MAMA and INSERT primer sites. Gel based PCR product size discrimination works best with significant size differences for INDEL assays but all of these assays work well with agarose gels. The best choice will depend largely on the geographic site from which the samples were obtained. That is the main consideration for choosing MAMA assays as well although it should be remembered that the same yield of amplicon will stain more intensely as its molecular weight increases and primer efficiency does vary between the assays. Alternative fluorescent dyes to ethidium bromide may also provide some increased assay sensitivity. These assays have not yet been validated by quantitative PCR approaches based on fluorescent dye yields but that may provide a possible alternative for their use for amplification of lower DNA copy samples.

Materials and methods

Isolate histories and preparation of DNA

The R. typhi isolates (Table 1) were obtained as yolk sac seeds and passaged one to six times in confluent Vero cells (strain C1008, green monkey kidney cells, obtained originally from the American Type Culture Collection, Manassas, VA) in RPMI 1640 supplemented with 2% fetal bovine serum, 2 mM L-glutamine and 5% tryptose phosphate broth. DNA was isolated from infected cell cultures and supernatants which had been harvested with 5 mm glass beads, pelleted at 12,000 rpm for 20 minutes in a Sorvall GSA rotor, and the pellet washed in PBS (1.0 ml per T150 flask). 0.25 ml of suspension was then lysed and extracted using QIAamp DNA Mini kit reagents (AL buffer plus proteinase K at 50°C overnight) and spin columns from Qiagen (Valencia, CA). DNA was eluted with 0.2 ml of AE buffer, diluted to 1.0 ml and stored at 4°C prior to analysis. Working DNA stocks (diluted 1:10 in water) were generally used for all analyses.

Whole genome sequence analysis

SNP and INDEL sites were identified from alignments of the whole genome sequences of three R. typhi isolates, B9991CWPP = B9991PP (Myanmar) (GenBank NC017062.1), TH1527 (Thailand) (GenBank NC017066.1), and Wilmington (USA) genomes [53] using the MAVID alignment webserver [48]. All SNP and INDEL events are identified relative to the R. typhi strain Wilmington complete genome sequence coordinates (GenBank NC006142.1) [53] (S1 and S3 Tables). BLAST was used to identify the corresponding sites found in complete genome sequence of the R. prowazekii Madrid E isolate (NC_000963) as well as the genome sequences for the other 12 R. prowazekii isolates in GenBank (MadridE_NC_000963.1, MadridE_NMRC_NC_020992.1, Breinl_NC_020993.1, BuV67PP_NC_017056.1, Chernikova_NC_017049.1, Dachau_NC_017051.1, Katsinyian_NC_017050.1, Naples_NZ_CP014865.1, Rp22_NC_017560.1, GvF24_NC_017057.1, GvV257_NC017057.1, Cairo3_APMO01 [10 contigs], GvF12_APMN01 [20 contigs]). Subsequently when a sequence for R. typhi Laos isolate TM2540 became available [47], we prepared a MAVID alignment and used BLAST for obtaining the results shown in S6 Table.

Single nucleotide polymorphism (SNP) assays

Suitable MAMA primers could be designed for 22 of the twenty-three SNP sites found among the three R. typhi isolates. Each SNP assay consists of two PCR reactions (2 primer sets) for each site (S1 Table). Each assay consists of two primer pairs: one standard primer and two nucleotide specific MAMA primers with the SNP of interest at the 3’ ultimate base of the primers. Because Taq polymerase is unable to extend the primer if there are two mismatch bases (3’-penultimate and 3’-ultimate base), MAMA primers were designed with a single mismatch created at the 3’ penultimate base for each SNP type, allowing the assay to differentiate the nucleotide of interest.

Five microliters of template DNA was amplified with each primer set (2 reactions per SNP site) using 12.5μl of the Taq PCR Master Mix (Qiagen, Valencia, CA) in a total volume of 25μl. PCR amplification was performed in 0.2 ml tubes using the Veriti Thermal Cycler (Applied Biosystems, Foster City, CA) using the following parameters: 94°C for 3 min, followed by 35 or 45 cycles of 94°C for 30 s, 50–60°C for 30 s, and 72°C for 30 s, and a final extension step of 72°C for 7 min (Table 2). PCR amplicons were resolved using gel electrophoresis with 3% ultrapure agarose (Invitrogen, Carsbad CA), 0.8X lithium borate buffer (Faster Better Media LLC, Hunt Valley MD), and GelStar Nucleic Acid Stain (Lonza, Rockland, ME) in 1X FBM loading buffer (Faster Better Media LLC, Hunt Valley MD). The gels were run for 30 to 60 min at 200 volts.

Assay conditions were optimized for each of the SNP target sites by adjusting primer concentrations, annealing temperatures, and the number of cycles. Optimal primer concentrations and cycling parameters were determined using the three reference R. typhi DNAs: B9991PP, TH1527, and Wilmington PP. A panel of 23 R. typhi DNA samples (18 isolates including 3 isolate technical replicates with different passage and extraction histories and 2 isolates with different laboratory origins) from humans and rodents were tested (Table 1).

Insertion/Deletion assays

Primers flanking the INDEL sites were designed to produce the smallest amplicons possible consistent with amplification and resolution by agarose gel electrophoresis (predicted Tm >60°C) using Primer 3 (http://primer3.sourceforge.net/) [54] and are listed in S2 Table. PCR was performed with Qiagen Taq PCR Master Mix (Valencia, CA) and prepared at a final concentration of 1X master mix, 1 μM of each primer, and ~0.2 pg DNA in a 20 μl final volume. PCR was conducted in 96-well 9700 GeneAmp thermal cyclers (Applied Biosystems, Foster City, CA), 1 cycle at 95°C for 3 min followed by 35 cycles of 95°C for 30 s, 50°C for 30 s, and 72°C for 30 s; and a final cycle at 72°C for 7 min. PCR amplicon (with 1X FBM loading buffer, Faster Better Media LLC, Hunt Valley MD) separation was performed by agarose gel electrophoresis and visualized by UV imaging. Gels consisting of 3% ultrapure agarose were run as described above except 0.8X SB (sodium borate) buffer was used (Faster Better Media LLC, Hunt Valley MD) and gels electrophoresed for 90 to 570 min at 200 volts.

Sequencing of PCR amplicons

Representative PCR amplicons of unexpected sizes (different from the three reference genome amplicons) were sequenced using the BigDye Terminator 3.0 Kit (Applied Biosystems) and DyeEx 2.0 spin kit (Qiagen) as specified by the manufacturer with a 3130xl Genetic Analyzer (Applied Biosystems). Amplified products were purified with Wizard PCR purification kits (Promega) directly or if secondary products were visible during analysis, the products were excised from agarose gels before purification. The electropherogram data was reviewed and the forward and reverse sequence information assembled with DNASTAR Lasergene 8.0.2. Sequences which were confirmed by sequencing were submitted to GenBank (#MT647569-MT647588, #MT655557-MT655561) and are indicated in Table 2.

Genetic relationships

For each INDEL primer set, PCR amplicon sizes were expected to be B9991-like, TH1527-like, or Wilmington-like (designated as B, T, or U, respectively). If alternate amplicon sizes were detected, the differences were confirmed by sequencing and referenced in relation to the expected sizes using different letter designations. The out-group agent R. prowazekii Madrid E (NC_000963) was analyzed by BLAST and CLUSTALW alignments for each SNP and INDEL polymorphism location. The nucleotide data was summarized as character states and the alignment was generated with Molecular Evolutionary Genetics Analysis software (MEGA4) version 4.0 software [55]. Tree construction was performed using the neighbor joining method with the number of differences model.

Supporting information

S1 Table. SNP MAMA primer sites and sequences designed from comparison of complete genome sequences of R. typhi Wilmington (W), B9991PP (B), and TH1527 (TH) with primer sequences and Wilmington ORF location.

Intergenic locations are indicated with a dash after the ORF closest to the chromosome origin. Variant sites in the MAMA primers are highlighted in red and the plus or minus indicates their directions within the intergenic regions relative to the ORFs or pseudogene (e. g., 4_PG07).

https://doi.org/10.1371/journal.pntd.0010354.s001

(XLS)

S2 Table. Summary of SNP sites identified in DNAs from 18 isolates of R. typhi SNPs are identified by color in each locus column.

The name of the respective open reading frame (ORF) or intergenic region locus (IGR) is indicated at the bottom of each column.

https://doi.org/10.1371/journal.pntd.0010354.s002

(XLS)

S3 Table. Comparison of MAMA primers to 13 R. prowazekii genome sequences from NCBI (listed in Materials and Methods).

https://doi.org/10.1371/journal.pntd.0010354.s003

(XLS)

S4 Table. INDEL sites and sequences designed from comparison of complete genome sequences of R. typhi Wilmington (W), B9991 PP (B), and TH1527 (TH) with primer sequences and Wilmington ORF location.

Intergenic locations are indicated with a dash after the ORF closest to the chromosome origin. Variant sites in the MAMA primers are highlighted in red and the plus or minus indicates their directions within the intergenic regions relative to the ORFs.

https://doi.org/10.1371/journal.pntd.0010354.s004

(XLS)

S5 Table. Summary table of genetic variation by clade identified from SNPs, INDELs, and the combined data in 18 isolates of R. typhi.

https://doi.org/10.1371/journal.pntd.0010354.s005

(XLS)

S6 Table. Comparison of variant sites among four R. typhi genomes available at NCBI (Wilmington, TH1527, B9991PP, and TM2450).

https://doi.org/10.1371/journal.pntd.0010354.s006

(XLS)

S1 Fig. Four representative SNP (MAMA) results (sites 6_136–1, 7_140, 9_230, 24_764) with 23 R. typhi DNAs.

DNA numbers are listed in Table 1.

https://doi.org/10.1371/journal.pntd.0010354.s007

(XLSX)

Acknowledgments

We thank the Biotechnology Facility Core Branch of the CDC for the synthesis of primers used in this work.

The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention or the Department of Health and Human Services of the United States.

References

  1. 1. Tselentis B, Gikas A. Murine typhus. In: Raoult D, Parola P, editors. Rickettsial diseases. London: Informa Healthcare; 2010. pp. 37–49.
  2. 2. Traub R, Wisseman CL, Farhang-Azad A. The ecology of murine typhus-a critical review. Trop Dis Bull. 1978; 75(4):237–317. pmid:705902
  3. 3. Civen R, Ngo V. Murine typhus: an unrecognized suburban vector-borne disease. Clin Infect Dis. 2008; 46:913–918. pmid:18260783
  4. 4. Tsioutis C, Zafeiri M, Avramopoulos A, Prousali E, Miligkos M, Karageorgos SA. Clinical and laboratory characteristics, epidemiology, and outcomes of murine typhus: A systematic review. Acta Trop. 2017; 166:16–24. pmid:27983969
  5. 5. Blanton LS, Idowu BM, Tatsch TN, Henderson JM, Bouyer DH, Walker DH. Opossums and cat fleas: New insights in the ecology of murine typhus in Galveston, Texas. Am J Trop Med Hyg. 2016; 95(2):457–61. pmid:27273642
  6. 6. Howard A, Fergie J. Murine typhus in south Texas children: An 18-year review. Pediatr Infect Dis J. 2018; 37(11):1071–1076. pmid:29465481.
  7. 7. Adjemian J, Parks S, McElroy K, Campbell J, Eremeeva ME, Nicholson WL, et al. Murine typhus in Austin, Texas, USA, 2008. Emerg Infect Dis. 2010; 16(3):412–417. pmid:20202415
  8. 8. Centers for Disease Control and Prevention. Outbreak of Rickettsia typhi infection—Austin, Texas, 2008. 2009; MMWR Morb Mortal Wkly Rep. 58:1267–1270. pmid:19940832
  9. 9. Eremeeva ME, Warashina WR, Sturgeon MM, Buchholz AE, Olmsted GK, Park SY, et al. Rickettsia typhi and R. felis in rat fleas (Xenopsylla cheopis), Oahu, Hawaii. Emerg Infect Dis. 2008; 14(10):1613–1615. pmid:18826827
  10. 10. Abramowicz KF, Rood MP, Krueger L, Eremeeva ME. Urban focus of Rickettsia typhi and Rickettsia felis in Los Angeles, California. Vector Borne Zoonotic Dis. 2011; 11(7):979–984. pmid:21142968
  11. 11. Eremeeva ME, Karpathy SE, Krueger L, Hayes EK, Williams AM, Zaldivar Y, et al. Two pathogens and one disease: detection and identification of flea-borne rickettsiae in areas endemic for murine typhus in California. J Med Entomol. 2012; 49:1485–1494. pmid:23270180
  12. 12. Hidalgo M, Montoya V, Martínez A, Mercado M, De la Ossa A, Vélez C, et al. Flea-borne rickettsioses in the north of Caldas province, Colombia. Vector Borne Zoonotic Dis. 2013; 13:289–294. pmid:23473218
  13. 13. Dzul-Rosado K, González-Martínez P, Peniche-Lara G, Zavala-Velázquez J, Zavala-Castro J. Murine typhus in humans, Yucatan, Mexico. Emerg Infect Dis. 2013; 19:1021–1022. pmid:23735173
  14. 14. Blum-Domínguez S, Sánchez-Montes S, Núñez-Oreza LA, Mendoza-Zamudio J, Becker I, Berzunza-Cruz M, et al. First description of a clinical case of murine typhus in Campeche, Mexico. Rev Soc Bras Med Trop. 2019; 52(6):e20190009. pmid:31188917
  15. 15. Tsioutis C, Chaliotis G, Kokkini S, Doukakis S, Tselentis Y, Psaroulaki A, Gikas A. Murine typhus in elderly patients: a prospective study of 49 patients. Scand J Infect Dis. 2014; 46:779–782. pmid:25119441
  16. 16. Bernabeu-Wittel M, Pachón J, Alarcón A, López-Cortés LF, Viciana P, Jiménez-Mejías ME, et al. Murine typhus as a common cause of fever of intermediate duration: a 17-year study in the south of Spain. Arch Intern Med. 1999; 159:872–876. pmid:10219934
  17. 17. Aouam A, Toumi A, Ben Brahim H, Loussaief C, Jelliti B, Ben Romdhane F, Ben Yahia S, Khairallah M, Chakroun M. Epidemiological, clinical and laboratory features of murine typhus in central Tunisia. Med Mal Infect. 2015; 45: 24–127. pmid:25687303
  18. 18. Oguntomole O, Nwaeze U, Eremeeva ME. Tick-, flea-, and louse-borne diseases of public health and veterinary significance in Nigeria. Trop Med Infect Dis. 2018; 3(1):pii:E3. pmid:30274402
  19. 19. Grouteau G, Lancelot O, Bertolotti A, Poubeau P, Manaquin R, Foucher A, Jaubert J, Parola P, Pagès F, Camuset G. Emergence of murine typhus in La Réunion, France, 2012–2017. Med Mal Infect. 2020; 50(1):22–27. pmid:31387814
  20. 20. Rogozin E, Lazarovitch T, Weinberger M. High morbidity due to murine typhus upsurge in urban neighborhoods in Central Israel. Am J Trop Med Hyg. 2019; 100(4):952–956. pmid:30761983
  21. 21. Hamaguchi S, Cuong NC, Tra DT, Doan YH, Shimizu K, Tuan NQ, Yoshida LM, Mai LQ, Duc-Anh D, Ando S, Arikawa J, Parry CM, Ariyoshi K, Thuy PT. Clinical and Epidemiological characteristics of scrub typhus and murine typhus among hospitalized patients with acute undifferentiated fever in Northern Vietnam. Am J Trop Med Hyg. 2015; 92(5):972–978. pmid:25778504.
  22. 22. Zhang SF, Du J, Mi XM, Lu QB, Bai JY, Cui N, et al. Rickettsia typhi infection in severe fever with thrombocytopenia patients, China. Emerg Microbes Infect. 2019; 8(1):579–584. pmid:30958100
  23. 23. McGready R, Prakash JA, Benjamin SJ, Watthanaworawit W, Anantatat T, Tanganuchitcharnchai A, Ling CL, Tan SO, Ashley EA, Pimanpanarak M, Blacksell SD, Day NP, Singhasivanon P, White NJ, Nosten F, Paris DH. Pregnancy outcome in relation to treatment of murine typhus and scrub typhus infection: a fever cohort and a case series analysis. PLoS Negl Trop Dis. 2014; 8:e3327. pmid:25412503
  24. 24. Simon NG, Cremer PD, Graves SR. Murine typhus returns to New South Wales: a case of isolated meningoencephalitis with raised intracranial pressure. Med J Aust. 2011; 194(12):652–654. pmid:21692726
  25. 25. Sakamoto N, Nakamura-Uchiyama F, Kobayashi K, Takasaki T, Ogasawara Y, et al. Severe murine typhus with shock and acute respiratory failure in a Japanese traveler after returning from Thailand. J Travel Med. 2013; 20(1):50–53. Epub 2012 Nov 30 pmid:23279232
  26. 26. Theunissen C, Cnops L, Van Esbroeck M, Huits R, Bottieau E. Acute-phase diagnosis of murine and scrub typhus in Belgian travelers by polymerase chain reaction: a case report. BMC Infect Dis. 2017; 17(1):273. pmid:28407761
  27. 27. Walter G, Botelho-Nevers E, Socolovschi C, Raoult D, Parola P. Murine typhus in returned travelers: a report of thirty-two cases. Am J Trop Med Hyg. 2012; 86(6):1049–1053. pmid:22665617
  28. 28. Dill T, Dobler G, Saathoff E, Clowes P, Kroidl I, Ntinginya E, et al. High seroprevalence for typhus group rickettsiae, southwestern Tanzania. Emerg Infect Dis. 2013; 19(2):317–320. pmid:23347529
  29. 29. Phetsouvanh R, Thojaikong T, Phoumin P, Sibounheuang B, Phommasone K, Chansamouth V, et al. Inter- and intra-operator variability in the reading of indirect immunofluorescence assays for the serological diagnosis of scrub typhus and murine typhus. Am J Trop Med Hyg. 2013; 88(5):932–936. Epub 2013 Mar 11 pmid:23478577
  30. 30. Carl M, Tibbs CW, Dobson ME, Paparello S, Dasch GA. Diagnosis of acute typhus infection using the polymerase chain reaction. J Infect Dis. 1990; 161(4):791–793. pmid:2108225
  31. 31. Giulieri S, Jaton K, Cometta A, Trellu LT, Greub G. Development of a duplex real-time PCR for the detection of Rickettsia spp. and typhus group rickettsia in clinical samples. FEMS Immunol Med Microbiol. 2012; 64(1):92–97. pmid:22098502
  32. 32. Henry KM, Jiang J, Rozmajzl PJ, Azad AF, Macaluso KR, Richards AL. Development of quantitative real-time PCR assays to detect Rickettsia typhi and Rickettsia felis, the causative agents of murine typhus and flea-borne spotted fever. Mol Cell Probes. 2007; 21(1):17–23. pmid:16893625
  33. 33. Znazen A, Sellami H, Elleuch E, Hattab Z, Ben Sassi L, Khrouf F, Dammak H, Letaief A, Ben Jemaa M, Hammami A. Comparison of two quantitative real time PCR assays for Rickettsia detection in patients from Tunisia. PLoS Negl Trop Dis. 2015; 9:e0003487. pmid:25706392
  34. 34. Dittrich S, Castonguay-Vanier J, Moore CE, Thongyoo N, Newton PN, Paris DH. Loop-mediated isothermal amplification for Rickettsia typhi (the causal agent of murine typhus): problems with diagnosis at the limit of detection. J Clin Microbiol. 2014; 52(3):832–838. pmid:24371248
  35. 35. Chao CC, Belinskaya T, Zhang Z, Ching WM. Development of recombinase polymerase amplification assays for detection of Orientia tsutsugamushi or Rickettsia typhi. PLoS Negl Trop Dis. 2015; 9(7):e0003884. pmid:26161793
  36. 36. Webb L, Carl M, Malloy DC, Dasch GA, Azad AF. Detection of murine typhus infection in fleas by using the polymerase chain reaction. J Clin Microbiol. 1990; 28(3):530–534. pmid:2108995
  37. 37. Eremeeva ME, Ignatovich VF, Dasch GA, Raoult D, Balayeva NM. Genetic, biological and serological differentiation of Rickettsia prowazekii and Rickettsia typhi. In J. Kazar, editor. Rickettsiae and Rickettsial Diseases. Vth International Symposium. Bratislava: Slovak Academy of Sciences; 1996. pp. 43–50.
  38. 38. Tselentis Y, Psaroulaki A, Maniatis J, Spyridaki I, Babalis T. Genotypic identification of murine typhus rickettsia in rats and their fleas in an endemic area of Greece by the polymerase chain reaction and restriction fragment length polymorphism. Am J Trop Med Hyg. 1996; 54(4):413–417. pmid:8615457
  39. 39. Massung RF, Dasch GA, Eremeeva ME. Rickettsia and Coxiella. In Budowle B, Schutzer SE, Breeze RG, Keim PS, Morse SA, editors. Microbial Forensics, 2nd Edition. Burlington, MA: Academic Press-Elsevier; 2011. pp. 275–299.
  40. 40. Cha RS, Zarbl H, Keohavong P, Thilly WG. Mismatch amplification mutation assay (MAMA): application to the c-H-ras gene. PCR Methods Appl. 1992; 2(1):14–20. pmid:1490171
  41. 41. Li B, Kadura I, Fu DJ, Watson DE. Genotyping with TaqMAMA. Genomics. 2004; 83(2):311–320. pmid:14706460
  42. 42. Eremeeva ME, Dasch GA. Closing the gaps between genotype and phenotype in Rickettsia rickettsii. Ann N Y Acad Sci. 2009; 1166:12–26. pmid:19538260
  43. 43. Gear J. The rickettsial diseases of Southern Africa: a review of recent studies. S Afr J Clin Sci. 1954; 5(3):158–175. pmid:13216322
  44. 44. Woodman DR, Weiss E, Dasch GA, Bozeman FM. Biological properties of Rickettsia prowazekii strains isolated from flying squirrels. Infect Immun. 1977; 16(3):853–860. pmid:408272
  45. 45. Perez Gallardo F, Fox JP. Infection of guinea pigs with massive doses of rickettsiae of epidemic and murine typhus. J Immunol. 1948; 60(4):455–463. pmid:18122727
  46. 46. Maxcy KF. Endemic typhus of the southeastern United States: the reaction of the white rat. Pub Health Rep. 1929; 44:1935–1943.
  47. 47. Elliott I, Batty EM, Ming D, Robinson MT, Nawtaisong P, de Cesare M, Newton PN, Bowden R. Oxford Nanopore MinION sequencing enables rapid whole genome assembly of Rickettsia typhi in a resource-limited setting. Am J Trop Med Hyg. 2020;102(2):408–414. pmid:31820709\
  48. 48. Bray N, Pachter L. MAVID multiple alignment server. Nucleic Acids Res. 2003; 31(13):3525–3526. pmid:12824358
  49. 49. Ellison DW, Clark TR, Sturdevant DE, Virtaneva K, Porcella SF, Hackstadt T. Genomic comparison of virulent Rickettsia rickettsii Sheila Smith and avirulent Rickettsia rickettsii Iowa. Infect Immun. 2008; 76(2):542–550. pmid:18025092
  50. 50. Bechah Y, El Karkouri K, Mediannikov O, Leroy Q, Pelletier N, Robert C, et al. Genomic, proteomic, and transcriptomic analysis of virulent and avirulent Rickettsia prowazekii reveals its adaptive mutation capabilities. Genome Res. 2010; 20(5):655–663. pmid:20368341
  51. 51. Matsumoto M, Tange Y, Okada T, Inoue Y, Horiuchi T, Kobayashi Y, et al. Deletion in the 190 kDa antigen gene repeat region of Rickettsia rickettsii. Microb Pathog. 1996; 20(1):57–62. pmid:8692010.
  52. 52. Benson G. Tandem repeats finder: a program to analyze DNA sequences. Nucleic Acids Res. 1999; 27(2):573–580. pmid:9862982
  53. 53. McLeod MP, Qin X, Karpathy SE, Gioia J, Highlander SK, Fox GE, et al. Complete genome sequence of Rickettsia typhi and comparison with sequences of other rickettsiae. J Bacteriol. 2004; 186(17):5842–5855. pmid:15317790
  54. 54. Rozen S, Skaletsky H. Primer3 on the WWW for general users and for biologist programmers. Methods Mol Biol. 2000; 132:365–386. pmid:10547847.
  55. 55. Tamura K, Dudley J, Nei M, Kumar S. MEGA4: Molecular Evolutionary Genetics Analysis (MEGA) software version 4.0. Mol Biol Evol. 2007 24(8):1596–1599. pmid:17488738