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Background Bordetella pertussis is the main agent of whooping cough. Vaccination with acellular pertussis vaccines has been largely implemented in high-income countries. These vaccines contain 1 to 5 antigens: pertussis toxin (PT), filamentous haemagglutinin (FHA), pertactin (PRN) and/or fimbrial proteins (FIM2 and FIM3). Monitoring the emergence of B. pertussis isolates that might partially escape vaccine-induced immunity is an essential component of public health strategies to control whooping cough. Aim We aimed to investigate temporal trends of fimbriae serotypes and vaccine antigen-expression in B. pertussis over a 23-year period in France (1996–2018). Methods Isolates (n = 2,280) were collected through hospital surveillance, capturing one third of hospitalised paediatric pertussis cases. We assayed PT, FHA and PRN production by Western blot (n = 1,428) and fimbriae production by serotyping (n = 1,058). Molecular events underlying antigen deficiency were investigated by genomic sequencing. Results The proportion of PRN-deficient B. pertussis isolates has increased steadily from 0% (0/38) in 2003 to 48.4% (31/64) in 2018 (chi-squared test for trend, p 481 insertion within the prn gene or a 22 kb genomic inversion involving the prn promoter sequence, indicative of convergent evolution. FIM2-expressing isolates have emerged since 2011 at the expense of FIM3. Conclusions B. pertussis is evolving through the rapid increase of PRN-deficient isolates and a recent shift from FIM3 to FIM2 expression. Excluding PRN, the loss of vaccine antigen expression by circulating B. pertussis isolates is epidemiologically insignificant.

International audience; The isolation of Legionella from respiratory samples is the gold standard for diagnosis of Legionnaires' disease (LD) and enables epidemiological studies and outbreak investigations. The purpose of this work was to adapt and to evaluate the performance of an amoebic coculture procedure (the amoeba plate test [APT]) for the recovery of Legionella strains from respiratory samples, in comparison with axenic culture and liquid-based amoebic coculture (LAC). Axenic culture, LAC, and APT were prospectively performed with 133 respiratory samples from patients with LD. The sensitivities and times to results for the three techniques were compared. Using the three techniques, Legionella strains were isolated in 46.6% (n = 62) of the 133 respiratory samples. The sensitivity of axenic culture was 42.9% (n = 57), that of LAC was 30.1% (n = 40), and that of APT was 36.1% (n = 48). Seven samples were positive by axenic culture only; for those samples, there were \textless10 colonies in total. Five samples, all sputum samples, were positive by an amoebic procedure only (5/5 samples by APT and 2/5 samples by LAC); all had overgrowth by oropharyngeal flora with axenic culture. The combination of axenic culture with APT yielded a maximal isolation rate (i.e., 46.6%). Overall, the APT significantly reduced the median time for Legionella identification to 4 days, compared with 7 days for LAC (P \textless 0.0001). The results of this study support the substitution of LAC by APT, which could be implemented as a second-line technique for culture-negative samples and samples with microbial overgrowth, especially sputum samples. The findings provide a logical basis for further studies in both clinical and environmental settings.

Macrolides, alone or in combination, are recommended as first-line therapy of Legionnaires’ disease. Legionella pneumophila is characterized by a constant in vitro susceptibility to macrolides. Resistant variants have never been detected, in contrast with several therapeutic failures observed in patients receiving an adequate treatment. Legionellae isolation from respiratory secretions is needed for antibiotic susceptibility testing, but the reported culture sensitivity reaches only 24% in France. In this work, we improved Legionellae isolation rate by culture and amoebal co-culture. In a second time, we were interested in hypothetic mechanisms involved in therapeutic failures like antibiotic antagonisms and acquired resistance. We found no antagonistic effects for macrolide/fluoroquinolones and macrolide/rifampin combinations in an intracellular Legionella model, which made irrelevant our first hypothesis. In a last step, we propagated Legionella strains with increasing macrolides concentrations. This procedure provided us high-level macrolides-resistant mutants. We found that mutations in the genes encoding L4 and L22 proteins were correlated with low-level resistance. Mutations in domain V of the 23S rRNA were associated with intermediate or high-level resistance. We found a correlation between the kind of nucleotide substitution or the number of mutated ribosomal operons and the resistance level. The speed and efficiency of in vitro selection of L. pneumophila macrolide-resistant mutants suggest a potential acquisition of macrolide resistance in patients under therapy and emphasize the need to explore clinical Legionella macrolide susceptibility in order to track down resistance, Les macrolides sont recommandés seuls ou en association dans le traitement des légionelloses. Cependant, malgré une antibiothérapie adaptée et l'absence de souches résistantes décrites, des échecs thérapeutiques sont régulièrement observés. L'isolement de souches de Legionella à partir de prélèvements respiratoires est indispensable à la réalisation d'antibiogrammes mais il n'est obtenu que dans 24% des cas en France. Au cours de ce travail, nous avons tout d'abord amélioré le rendement d'isolement des souches cliniques, notamment par des techniques de co-culture amibienne, avant de nous intéresser aux mécanismes pouvant expliquer les échecs thérapeutiques (antagonisme entre antibiotiques, sélection de résistance). Nous avons pu montrer, dans un modèle de croissance intracellulaire de Legionella pneumophila, une absence d'antagonisme entre macrolides et fluoroquinolones ou rifampicine invalidant la première hypothèse. Nous avons ensuite généré des lignées de mutants hautement résistants aux macrolides. Nous avons mis en évidence des mutations dans les gènes codant les protéines ribosomales L4 et L22 associées à un faible niveau de résistance. Des mutations dans les gènes codant l'ARN ribosomal 23S étaient associées à un niveau plus élevé de résistance, dépendant de la nature de la mutation et du nombre de copies du gène mutées. La facilité d'obtention de mutants résistants aux macrolides in vitro suggère une potentielle acquisition de résistance in vivo au décours de l'antibiothérapie et justifie une recherche systématique de cette résistance dans les prélèvements cliniques