JCM Accepts, published online ahead of print on 28 October 2009

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J. Clin. Microbiol. doi:10.1128/JCM.00665-09
Copyright (c) 2009, American Society for Microbiology and/or the Listed Authors/Institutions. All Rights Reserved.

Increase of Denmark¹⁴-230 clone as a cause of pneumococcal infection in Portugal within a background of diverse serotype 19A lineages

Sandra I. Aguiar, Francisco R. Pinto, Sónia Nunes, Isa Serrano, José Melo-Cristino, Raquel Sá-Leão, Mário Ramirez^*, and Hermínia de Lencastre

Instituto de Microbiologia, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal; Centro de Química e Bioquímica, Departamento de Química e Bioquímica, Faculdade de Ciências da Universidade de Lisboa, Lisboa, Portugal; Instituto de Tecnologia Química e Biológica, Universidade Nova de Lisboa, Oeiras, Portugal; Centro de Matemática e Aplicações Fundamentais, Universidade de Lisboa, Lisboa, Portugal; and Laboratory of Microbiology, The Rockefeller University, New York, NY, USA

^* To whom correspondence should be addressed. Email: ramirez{at}fm.ul.pt.

Pneumococci of serotype 19A are increasingly found as causes of infection in various geographic regions. We have characterized the 19A isolates (n=288) found among pneumococci responsible for infections (n=1,925) and recovered from asymptomatic carriage (n=1,973) in Portugal between 2001 and 2006. We show that, in spite of the existence of 19A clones that have a higher invasive disease potential or an enhanced colonization capacity, the lineage increasing as a cause of infections in Portugal is a multiresistant clone, competent at both. The expanding Denmark¹⁴-230 clone found in Portugal is disseminated in other Mediterranean countries where it is also increasingly responsible for invasive infections in both children and adults. The lineages driving the rise of serotype 19A in infection in Asia and the US (ST320 and ST199) are either absent or account for a small proportion of isolates in Portugal. These data highlight the importance of locally circulating clones having the ability to compete in the nasopharyngeal niche for the emergence of the 19A lineages which are an increasing cause of infection in various geographic regions.