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This is partly a consequence of particular MDR clones being associated with multiple capsule types likely as a consequence of "serotype switching": The acquisition of a novel capsule type through exchange of sequence at the capsule polysaccharide synthesis (cps) locus, which determines the serotype.
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Specifically, the highly skewed distribution is a consequence of serotype-specific clustering.
Studies in our laboratory indicate that another consequence of serotype switch is changes in disease severity and tissue localization during infection: Serotype 1 of B. turicatae (Bt1), defined by expression of Vsp1, localizes to the brain in 5- to 10-fold higher numbers than serotype 2 (Bt2), defined by expression of Vsp2 [8], [9], [10] [10].
Replacement with non-vaccine pneumococcal serotypes as a consequence of vaccination is a fact [ 26], and therefore it is important to study all aspects of emerging serotypes.
Transitions from noncarriage to double carriage (target types A and B) were estimated to take place half of the time through carriage of type A, as a consequence of the assumed similarity of all target serotypes.
On the contrary, evidence from several countries suggests that serotype replacement in carriage generates as a consequence of vaccination [ 9- 12].
These high avidity cross-reactive cells cannot be detected in convalescent samples, presumably a consequence of activation-induced cell death[36], leaving only populations that show a much greater degree of serotype specificity.
The observed predominance of rare serotypes during cocolonization suggests that simultaneous colonization is not simply a consequence of cumulative exposure to transmission opportunities.
More research is needed to know whether this could be a consequence of improved diagnosis and efficient treatment of symptomatic infections caused by virulent C. trachomatis serotypes linked with stronger symptoms [ 13- 17].
Also, this "lineage turnover" phenomenon appears to be a consequence of the stochastic forces and host immunity pressures, which ultimately determines the prevalence of a specific clade or serotype in a particular season [25], [27].
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Justyna Jupowicz-Kozak
CEO of Professional Science Editing for Scientists @ prosciediting.com