Genomic epidemiology of Neisseria gonorrhoeae to investigate the distribution of gonococcal lineages in all five main macroregions of Brazil, 2015-2016
Objectives: Of the 35 countries in the WHO Region of the Americas only 9 countries are monitoring the antimicrobial resistance (AMR) in N. gonorrhoeae in the WHO Gonococcal Antimicrobial Surveillance Program (GASP). Genomic studies of N. gonorrhoeae have shown to be ideal for enhanced understanding of gonococcal populations, molecular epidemiology of AMR gonococcal strains, and to detect AMR determinants and predict AMR in gonococci. To provide additional data on the circulating N. gonorrhoeae lineages in Brazil we aimed to describe the molecular epidemiology of the previously reported isolates from all five macroregions in Brazil and the molecular AMR determinants.Methods: In total, 548 isolates from Brazil were genome sequenced using Illumina technology. For comparison, a dataset from Argentina (n=158) and the 2016 WHO reference strains were included.Results: We found 302, 68, and 214 different NG-MAST, MLST, and NG-STAR sequence types among the isolates from Brazil. Among the isolates from the seven regions, we found penA mosaics in 16.6% and 23S rRNA C2611T mutations in 1.8%. The phylogenomic analysis showed two main lineages, lineage A and B, and two sublineages of B, namely A1 and A2. Lineage B consisted of multidrug-resistant isolates with different AMR profiles between the two sublineages of lineage B.Conclusions: This study describes the first genomic baseline study to support the national surveillance system of gonococcal AMR in Brazil. The high prevalence of AMR determinants for ciprofloxacin, tetracycline, and penicillin G, as well as the number of isolates with mosaic penA and azithromycin resistance mutations in 23S rRNA, should prompt to continue and expand the AMR surveillance of N. gonorrhoeae in Brazil.