Marseillevirus in the Pharynx of a Patient with Neurologic Disorders

(isolate RND19188), even though she had no distinct symptoms of cholera. The source of infection for the woman and child was unclear but was assumed to be related to eating fruit rinsed in tap water while in the city of Vrindavan in India. Maximum-likelihood phylogenetic analysis based on high-quality orthologous single-nucleotide polymorphisms (hqSNPs) among 75 V. cholerae genomes showed that all the isolates from the travel-associated cases clustered with cholera cases that occurred in 2010. The isolates from the 29-year-old woman and her daughter (RND19187 and RND19188) accurately clustered with isolates from the Nepal-3 clade (2) (Figure). Isolate RND19187 exhibited no hqSNP differences from VC-15 and differed from VC-18 by only 1 hqSNP. Isolate RND19191 was located in the Haiti\Nepal-4 clade and differed by only 1 hqSNP (132291G>A), located in the in-tegrative and conjugative element encodes resistance to sul-fametoxazol and trimethoprim (SXT-ICE) gene Vch1786-I0110 (Figure). RND19191 and 2010EL-1786 showed high genetic similarity and nucleotide identity to Vibrio patho-genic islands (VPI-1, VPI-2), Vibrio seventh pandemic is-Notably, isolate RND19191 has intact SXT-ICE, whereas all 3 Nepal-4 genomes have an SXT-ICE 13-gene deletion (Vch1786_I0089-I0102) (3). This genome also carries a ctxB7 variant of the ctxB gene and five 7-mer tandem repeats (TTTTGAT). Finally, isolate RND6878 and the Haiti/Nepal-4 clade formed a well-supported monophy-letic group with an estimated most recent common ancestor date of 2009 (95% CI 2008–2010) (Figure). In addition, the RND6878 genome harbored virulence-associated mobile genomic elements similar to 2010EL-1786 and contained a ctxB7 allele and an intact SXT-ICE, but only four 7-mer tandem repeats (TTTTGAT). The phylogenetic relatedness between the India and Nepal strains shows that the strains similar to the latter were first found in northern India not far from the frontier of Nepal. Collectively, these data support previously established assumptions that V. cholerae strains similar to those from Nepal can be detected in countries other than Nepal and Haiti (2). Moreover, isolate RND6878, which is phylo-genetically related to the Haiti/Nepal-4 clade and was isolated in 2012, might have a common genetic lineage with the Haiti-like strains found in Nepal and northern India since 2009 (Figure). However, sequencing of representative strains isolated from different geographic regions and varying time frames is needed to reconstruct this lineage. Remarkably, an India isolate (RND19191) from 3 months before the first cholera cases occurred in Haiti showed higher genetic similarity to the Haiti strain than Ne-pal isolate VC-25. This finding should be interpreted with …