Within-host evolution of bacterial pathogens during persistent infection of humans

ElsevierVolume 70, December 2022, 102197Current Opinion in MicrobiologyHighlights•

Some persistent infections are linked to drug resistance and adverse outcomes such as cancer.

Longitudinal human-infection studies offer access to early and late infection isolates.

Genome sequencing provides a sensitive readout of within-host pathogen evolution.

Convergent trends have emerged in how pathogens evolve during persistent life in host.

Many bacterial pathogens can form persistent infections, providing an infectious reservoir, which allows for infection of new hosts. Currently, the molecular mechanisms and evolutionary dynamics driving persistence are still not well-understood. High-throughput sequencing methods have enabled the study of within-host evolution of persistent bacterial pathogens, revealing common trends among bacterial species in how they adapt to persist. We will focus on trends emerging from longitudinal human-cohort studies, including i) genome-size reduction, ii) metabolic adaptation to the host, iii) antimicrobial resistance, iv) changes in virulence and the bacterial cell surface, and v) hypermutation, and comment on where the field should focus going forward.

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