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The absence of these elements is evidence that the proteins encoded on these elements are not required for the epidemic phenotype.
This microarray allowed us to study the gene contents of the strains involved in the Dutch epidemics and thus to identify (other) polymorphic loci associated with epidemic phenotype.
Other genes common to strains with an epidemic phenotype also have been identified; however, the role of many of these genes in the pathogenesis of cholera remains to be determined (21, 22 ).
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An additional criterion was an epidemiologic association with a distinct pathogenic character in order to facilitate assessment of gene content influencing strain genotype-patient disease phenotype relationships or epidemic behavior.
The bovine spongiform encephalopathy (BSE) epidemic presented homogeneity of the phenotype.
These data highlight the threat of an epidemic shaped by this new MDR phenotype.
During a large epidemic in Burkina Faso in 2002, phenotype W135:2a:P1.5,2 was the predominant strain; this strain belonged to the ST-11 clonal complex (4 ), as did NmW135 strains found in an outbreak among Hajj pilgrims in 2000.
Some pathogenic strains from epidemics have been shown to display this kind of hypermutator phenotype especially during the African epidemics due to serogroup A strains [30], [31].
Previous studies have established that Influenza A strains from the 2009 epidemic had mutated to an Ose-resistant phenotype [ 15].
Cases from the Boston epidemic may fit into an emerging clinical phenotype of CVA6, and it will be interesting to see whether nail loss develops in those patients.
The emergence of all 3 epidemics was strongly associated with the MDR phenotype.
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Justyna Jupowicz-Kozak
CEO of Professional Science Editing for Scientists @ prosciediting.com