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Jin C, Wu Y, Chen J, Liu J, Zhang H, Qian Q, Pang T. Prevalence and Patterns of Drug-Resistant Mycobacterium tuberculosis in Newly Diagnosed Patients in China: A Systematic Review and Meta-Analysis. J Glob Antimicrob Resist 2024:S2213-7165(24)00106-1. [PMID: 38825149 DOI: 10.1016/j.jgar.2024.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 05/15/2024] [Accepted: 05/20/2024] [Indexed: 06/04/2024] Open
Abstract
BACKGROUND Tuberculosis (TB), one of the deadliest infectious diseases globally, is increasingly exacerbated in China by the emergence of resistant Mycobacterium tuberculosis (MTB) strains. Drug-resistant TB, including mono-drug resistant TB, multidrug-resistant TB (MDR-TB), and extensively drug-resistant TB (XDR-TB), presents significant public health challenges. METHODS We conducted a systematic literature review from January 2010 to February 2024 using databases such as PubMed, Embase, Web of Science, and Google Scholar. Our focus was on empirical data related to drug resistance patterns in newly diagnosed TB cases. Non-empirical studies were excluded through meticulous filtering. For meta-analysis, we used Review Manager (RevMan) 5.2 and assessed evidence quality using the Newcastle-Ottawa Scale (NOS). RESULTS Our search strategy identified 40 studies that met the inclusion criteria, encompassing a total sample size of 87,667 participants. Among new TB cases, the estimated prevalence of MDR-TB in China was 6.9% (95% CI: 5.6-8.1%). Prevalence rates for mono-drug resistance to first-line anti-TB medications were as follows: isoniazid at 18.2% (95% CI: 16.4-20.6%), rifampicin at 10.5% (95% CI: 8.6-12.8%), and ethambutol at 5.7% (95% CI: 4.1-7.3%). The prevalence of streptomycin resistance, a former first-line anti-TB drug, was 17.1% (95% CI: 14.6-19.1%). The prevalence of other types of mono-drug resistance was 15.2% (95% CI: 13.9-17.3%), and for XDR-TB, it was 0.9% (95% CI: 0.6-1.4%). CONCLUSIONS The high prevalence of drug-resistant TB in China poses a significant public health challenge. There is an urgent need for targeted interventions and continued surveillance to combat the spread of drug-resistant TB.
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Affiliation(s)
- Cong Jin
- School of Public Health, North China University of Science and Technology, Tangshan City, Hebei Province, 063210, China
| | - Yuting Wu
- School of Public Health, North China University of Science and Technology, Tangshan City, Hebei Province, 063210, China
| | - Jiangpo Chen
- Biotecnovo (Langfang) Medical Lab Co. Ltd., Langfang City, Heibei Province, 065001, China
| | - Jing Liu
- Department of Pharmacy, Guangyang Maternal and Child Care Health Hospital, Langfang City, Hebei Province, 065000, China
| | - Hongwei Zhang
- General Practice Department, The Fourth People's Hospital of Langfang, Langfang City, Hebei Province, 065700, China
| | - Qingzeng Qian
- School of Public Health, North China University of Science and Technology, Tangshan City, Hebei Province, 063210, China; Hebei Coordinated Innovation Center of Occupational Health and Safety, Tangshan City, Hebei Province, 063210, China.
| | - Tieliang Pang
- Biotecnovo (Langfang) Medical Lab Co. Ltd., Langfang City, Heibei Province, 065001, China.
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Ji L, Tao FX, Yu YF, Liu JH, Yu FH, Bai CL, Wan ZY, Yang XB, Ma J, Zhou P, Niu Z, Zhou P, Xiang H, Chen M, Xiang Z, Zhang FQ, Jiang Q, Liu XJ. Whole-genome sequencing to characterize the genetic structure and transmission risk of Mycobacterium tuberculosis in Yichang city of China. Front Public Health 2023; 10:1047965. [PMID: 36699912 PMCID: PMC9868839 DOI: 10.3389/fpubh.2022.1047965] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 12/19/2022] [Indexed: 01/11/2023] Open
Abstract
Objective The burden of both general and drug-resistant tuberculosis in rural areas is higher than that in urban areas in China. To characterize the genetic structure and transmission risk of Mycobacterium tuberculosis in rural China, we used whole genome sequencing to analyze clinical strains collected from patients in two counties of Yichang for three consecutive years. Methods From 2018 to 2020, sputum samples were collected for cultures from patients with suspected tuberculosis in Yidu and Zigui county, and DNA was extracted from the positive strains for genome sequencing. The online SAM-TB platform was used to identify the genotypes and drug resistance-related mutations of each strain, establish a phylogenetic tree, and calculated the genetic distances between pairwise strains. Twelve single nucleotide polymorphisms (SNPs) were used as thresholds to identify transmission clusters. The risk of related factors was estimated by univariable and multivariable logistic regression. Results A total of 161 out of the collected 231 positive strains were enrolled for analysis, excluding non-tuberculous mycobacterium and duplicate strains from the same patient. These strains belonged to Lineage 2 (92, 57.1%) and Lineage 4 (69, 42.9%), respectively. A total of 49 (30.4%) strains were detected with known drug resistance-related mutations, including 6 (3.7%) multidrug-resistant-TB (MDR-TB) strains and 11 (6.8%) RIF-resistant INH-susceptible TB (Rr-TB) strains. Six of the MDR/Rr-TB (35.3%) were also resistant to fluoroquinolones, which made them pre-extensively drug-resistant TB (pre-XDR-TB). There were another seven strains with mono-resistance to fluoroquinolones and one strain with resistance to both INH and fluoroquinolones, making the overall rate of fluoroquinolones resistance 8.7% (14/161). A total of 50 strains (31.1%) were identified as transmission clusters. Patients under 45 years old (adjusted odds ratio 3.46 [95% confidential intervals 1.28-9.35]), treatment-naive patients (6.14 [1.39-27.07]) and patients infected by lineage 4 strains (2.22 [1.00-4.91]) had a higher risk of transmission. Conclusion The drug resistance of tuberculosis in rural China, especially to the second-line drug fluoroquinolones, is relatively serious. The standardized treatment for patients and the clinical use of fluoroquinolones warrant attention. At the same time, the recent transmission risk of tuberculosis is high, and rapid diagnosis and treatment management at the primary care needs to be strengthened.
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Affiliation(s)
- Lv Ji
- Institute of Public Health Inspection, Yichang Center for Disease Control and Prevention, Yichang, Hubei, China
| | - Feng-Xi Tao
- School of Public Health, Wuhan University, Wuhan, Hubei, China
| | - Yun-Fang Yu
- Institute of Public Health Inspection, Yichang Center for Disease Control and Prevention, Yichang, Hubei, China
| | - Jian-Hua Liu
- Institute of Infectious Disease Prevention and Control, Yichang Center for Disease Control and Prevention, Yichang, Hubei, China
| | - Feng-Hua Yu
- Institute of Public Health Inspection, Yichang Center for Disease Control and Prevention, Yichang, Hubei, China
| | - Chun-Lin Bai
- Institute of Public Health Inspection, Yichang Center for Disease Control and Prevention, Yichang, Hubei, China
| | - Zheng-Yang Wan
- Institute of Public Health Inspection, Yichang Center for Disease Control and Prevention, Yichang, Hubei, China
| | - Xiao-Bo Yang
- Institute of Public Health Inspection, Yichang Center for Disease Control and Prevention, Yichang, Hubei, China
| | - Jing Ma
- Institute of Public Health Inspection, Yichang Center for Disease Control and Prevention, Yichang, Hubei, China
| | - Pan Zhou
- Institute of Public Health Inspection, Yichang Center for Disease Control and Prevention, Yichang, Hubei, China
| | - Zhao Niu
- Institute of Public Health Inspection, Yichang Center for Disease Control and Prevention, Yichang, Hubei, China
| | - Ping Zhou
- Institute of Infectious Disease Prevention and Control, Yichang Center for Disease Control and Prevention, Yichang, Hubei, China
| | - Hong Xiang
- Institute of Infectious Disease Prevention and Control, Yidu Center for Disease Control and Prevention, Yidu, Hubei, China
| | - Ming Chen
- Clinical Laboratory, Yidu First People's Hospital, Yidu, Hubei, China
| | - Zhou Xiang
- Institute of Infectious Disease Prevention and Control, Zigui Center for Disease Control and Prevention, Zigui, Hubei, China
| | - Fang-Qiong Zhang
- Clinical Laboratory, Zigui County People's Hospital, Zigui, Hubei, China
| | - Qi Jiang
- School of Public Health, Wuhan University, Wuhan, Hubei, China,*Correspondence: Qi Jiang ✉
| | - Xiao-Jun Liu
- Institute of Public Health Inspection, Yichang Center for Disease Control and Prevention, Yichang, Hubei, China,Institute of Infectious Disease Prevention and Control, Yichang Center for Disease Control and Prevention, Yichang, Hubei, China,Xiao-Jun Liu ✉
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Molecular Epidemiology and Genetic Diversity of Multidrug-Resistant Mycobacterium tuberculosis Isolates in Bangladesh. Microbiol Spectr 2022; 10:e0184821. [PMID: 35196788 PMCID: PMC8865560 DOI: 10.1128/spectrum.01848-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Although the number of multidrug-resistant (MDR) tuberculosis (TB) cases is high overall, a major gap exists in our understanding of the molecular characteristics and transmission dynamics of the MDR Mycobacterium tuberculosis isolates circulating in Bangladesh. The present study aims to characterize the MDR-TB isolates of Bangladesh and to investigate the mode of transmission. A total of 544 MDR-TB isolates were obtained from a nationwide drug-resistant TB surveillance study conducted between October 2011 and March 2017 covering all geographic divisions of Bangladesh. The isolates were characterized using TbD1 deletion analysis, spoligotyping, and mycobacterial interspersed repetitive-unit–variable-number tandem-repeat (MIRU-VNTR) typing. Deletion analysis showed that 440 (80.9%) isolates were the modern type, while the remainder were the ancestral type. The largest circulating lineage was the Beijing type, comprising 208 isolates (38.2%), followed by T, EAI, and LAM with 93 (17.1%), 58 (10.7%), and 52 (9.5%) isolates, respectively. Combined MIRU-VNTR and spoligotyping analysis demonstrated that the majority of the clustered isolates were of the Beijing and T1 lineages. The overall rate of recent transmission was estimated at 33.8%. In conclusion, the MDR M. tuberculosis isolates circulating in Bangladesh are mostly of the modern virulent type. The Beijing and T lineages are the predominant types and most of the transmission of MDR-TB can be attributed to them. The findings also suggest that, along with the remarkable transmission, the emergence of MDR-TB in Bangladesh is largely due to acquired resistance. Rapid and accurate diagnosis and successful treatment will be crucial for controlling MDR-TB in Bangladesh. IMPORTANCE Multidrug-resistant TB is considered to be the major threat to tuberculosis control activities worldwide, including in Bangladesh. Despite the fact that the number of MDR-TB cases is high, a major gap exists in our understanding of the molecular epidemiology of the MDR-TB isolates in Bangladesh. In our study, we characterized and classified the MDR-TB isolates circulating in Bangladesh and investigated their mode of transmission. Our results demonstrated that the MDR M. tuberculosis isolates circulating in Bangladesh are mostly of the modern virulent type. The Beijing and T lineages are the predominant types and are implicated in the majority of MDR-TB transmission. Our findings reveal that, along with the remarkable transmission, the emergence of MDR-TB in Bangladesh is largely due to acquired resistance, which may be due to nonadherence to treatment or inadequate treatment of TB patients. Rapid diagnosis and adherence to an appropriate treatment regimen are therefore crucial to controlling MDR-TB in Bangladesh.
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Ryoo S, Kang T, Lee DG, Jung J. The utility of a real-time polymerase chain reaction kit for differentiating between Mycobacterium tuberculosis and the Beijing familythe utility of a real-time polymerase chain reaction kit for differentiating between Mycobacterium tuberculosis and the Beijing family. Int J Mycobacteriol 2022; 11:268-272. [DOI: 10.4103/ijmy.ijmy_99_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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5
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Keikha M, Majidzadeh M. Beijing genotype of Mycobacterium tuberculosis is associated with extensively drug-resistant tuberculosis: A global analysis. New Microbes New Infect 2021; 43:100921. [PMID: 34466269 PMCID: PMC8383003 DOI: 10.1016/j.nmni.2021.100921] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 07/05/2021] [Accepted: 07/15/2021] [Indexed: 02/08/2023] Open
Abstract
We found that the frequency of Beijing genotype among XDR-TB strains was high. The data in this study would help guide the TB control program, and we however need further investigation to confirm the reliability of the present findings.
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Affiliation(s)
- M Keikha
- Antimicrobial Resistance Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.,Department of Microbiology and Virology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - M Majidzadeh
- Antimicrobial Resistance Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.,Department of Microbiology and Virology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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Rizvi SMS, Tarafder S, Anwar S, Perdigão J, Johora FT, Sattar H, Kamal SMM. Circulating strains of Mycobacterium tuberculosis: 24 loci MIRU-VNTR analysis in Bangladesh. INFECTION GENETICS AND EVOLUTION 2020; 86:104634. [PMID: 33186780 DOI: 10.1016/j.meegid.2020.104634] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 11/06/2020] [Accepted: 11/07/2020] [Indexed: 10/23/2022]
Abstract
Bangladesh is among the high burden countries for tuberculosis (TB) and multidrug resistant TB (MDR-TB). As the genetic diversity and distinct phylogeographic distribution of Mycobacterium tuberculosis are responsible for regional differences in drug resistance, this cross sectional study was conducted to identify the circulating M. tuberculosis strains belonging to different lineages among pulmonary tuberculosis and, to investigate the contribution of distinct M. tuberculosis lineages to rifampicin resistant (RR) and rifampicin sensitive (RS) TB. A total of 40 RR and 20 RS isolates were enrolled in this study, all of which confirmed as M. tuberculosis by MPT 64 antigen detection. Furthermore, all isolates were genotyped by 24 loci Mycobacterial Interspersed Repetitive Units-Variable Number of Tandem Repeats (MIRU-VNTR), thus comprising the first study to employ this approach in Bangladesh. Beijing was the predominant lineage (26.8%) followed by EAI (23.2%), Delhi/CAS (16.1%), H37Rv (8.9%), Haarlem (7.1%), LAM (5.4%), Cameroon (3.6%) and a NEW-1 (1.8%). Four (7.1%) isolates remained as unidentified. Beijing strains were the significantly predominant (36.8%; p = 0.0135) among the RR isolates in comparison with other strains whereas EAI was the predominant (38.8%) lineage among RS isolates. Also, approximately 13% RR isolates showed genotypic resistance against fluoroquinolones by LPA and, hence, classed as pre-XDR TB albeit no specific lineage was found associated with these latter strains. A low transmission rate (10.5%) and high genetic diversity was detected in this setting with all the clustered strains herein identified belonging to the Beijing lineage. This study highlights 24 loci MIRU-VNTR analysis as a powerful tool for genotyping of Mycobacterium tuberculosis in this setting as it shows a high discriminatory index (0.81).
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Affiliation(s)
- S M Shahriar Rizvi
- Communicable Disease Control (CDC), Directorate General of Health Services, Mohakhali, Dhaka 1212, Bangladesh.
| | - Shirin Tarafder
- Department of Microbiology & Immunology, Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka, Bangladesh
| | - Shaheda Anwar
- Department of Microbiology & Immunology, Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka, Bangladesh
| | - João Perdigão
- Research Institute for Medicines (iMed.ULisboa), Faculdade de Farmácia, Universidade de Lisboa, Lisboa, Portugal
| | - Fatima Tuj Johora
- Department of Microbiology, East West Medical College, Dhaka, Bangladesh
| | - Humayun Sattar
- Department of Microbiology & Immunology, Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka, Bangladesh
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Gao Y, Zhang Z, Deng J, Mansjö M, Ning Z, Li Y, Li X, Hu Y, Hoffner S, Xu B. Multi-center evaluation of GenoType MTBDRsl line probe assay for rapid detection of pre-XDR and XDR Mycobacterium tuberculosis in China. J Infect 2018; 77:328-334. [PMID: 29969597 DOI: 10.1016/j.jinf.2018.06.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 06/07/2018] [Accepted: 06/18/2018] [Indexed: 11/18/2022]
Abstract
OBJECTIVES The implementation of rapid and reliable drug susceptibilities diagnosis is fundamental for effective treatment of multidrug-resistant tuberculosis(MDR-TB). The present study aimed to assess the diagnostic performance of the 2nd-version GenoType MTBDRsl kit as well as the impact of its implementation on the turnaround time in a multi-center Chinese study. METHODS Totally 353 MDR-TB patient specimens were consecutively tested. The 2nd-version GenoType MTBDRsl assay, drug susceptibility testing with the MGIT 960 system, and sequencing were performed and compared. RESULTS MTBDRsl testing identified the major genotypes associated with fluoroquinolones resistance, predominated by gyrA MUT3B (Asp94Asn and Asp94Tyr, 26.5%) and MUT3C (Asp94Gly, 19.5%). The genotypes associated with resistance to 2nd-line injectable drugs(SLIDs) were rrsMUT1(A1401G, 64.9%) and absence of WT1(C1402T, 10.5%). The sensitivities for detection of resistance to fluoroquinolones, SLIDs, and their combination (extensively drug resistance, XDR) were 80.5%, 80.7% and 73.5% and specificities were 100.0%, 99.3% and 99.1%, respectively. Implementation of this test significantly reduced the turnaround time between sample collection and result reporting from 45 to 3 days, a reduction by 93.3% (p, 0.001). CONCLUSION With a favorable diagnostic performance and short turnaround time, the 2nd-version GenoType MTBDRsl assay proves its value for early diagnosis of resistance to 2nd-line drugs as well as of XDR-TB in China.
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Affiliation(s)
- Yazhou Gao
- Department of Epidemiology, School of Public Health, China and Key Laboratory of Public Health Safety (Fudan University), Ministry of Education, Fudan University, Shanghai 200032, China
| | - Zhengdong Zhang
- Zigong City Center for Disease Control and Prevention, Zigong City, Sichuan, China
| | - Jianping Deng
- Zigong City Center for Disease Control and Prevention, Zigong City, Sichuan, China
| | | | - Zhu Ning
- Zigong City Center for Disease Control and Prevention, Zigong City, Sichuan, China
| | - Yang Li
- Department of Epidemiology, School of Public Health, China and Key Laboratory of Public Health Safety (Fudan University), Ministry of Education, Fudan University, Shanghai 200032, China
| | - Xuliang Li
- Department of Epidemiology, School of Public Health, China and Key Laboratory of Public Health Safety (Fudan University), Ministry of Education, Fudan University, Shanghai 200032, China
| | - Yi Hu
- Department of Epidemiology, School of Public Health, China and Key Laboratory of Public Health Safety (Fudan University), Ministry of Education, Fudan University, Shanghai 200032, China.
| | - Sven Hoffner
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Biao Xu
- Department of Epidemiology, School of Public Health, China and Key Laboratory of Public Health Safety (Fudan University), Ministry of Education, Fudan University, Shanghai 200032, China; Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
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Xu G, Mao X, Wang J, Pan H. Clustering and recent transmission of Mycobacterium tuberculosis in a Chinese population. Infect Drug Resist 2018; 11:323-330. [PMID: 29563813 PMCID: PMC5846054 DOI: 10.2147/idr.s156534] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose The objectives of the present study were to characterize the clinical isolates prevailing in the northeast of Jiangsu and to investigate the mode of transmission. The study also aimed to explore the extent to which Mycobacterium tuberculosis strains contributed to drug resistance and the possible factors related to the recent transmission. Patients and methods We consecutively enrolled 912 culture-confirmed pulmonary tuberculosis (TB) cases from 1 January 2013 to 31 December 2014 in Lianyungang City, which is located in the center of China’s vast ocean area and the northeast of Jiangsu province. Isolates were genotyped using 15-locus mycobacterial interspersed repetitive unit-variable number tandem repeat (MIRU-VNTR) typing. The Hunter–Gaston discrimination index (HGDI) was used to estimate the discriminatory power and diversity of molecular markers. Results Among 741 successfully genotyped isolates, 144 (19.43%) strains formed 46 clusters, while 597 (80.57%) isolates had the unique MIRU pattern. The total HGDI for all 15 loci was 0.999. The average cluster size was 3 (2–13) patients. The estimated proportion of recent transmission was 13.34%. Patients with unfavorable treatment outcomes were infected with clustered strains at a higher proportion than were those with favorable treatment outcomes (adjusted OR: 1.78, 95% CI: 1.14–2.85, P=0.012). Conclusion The probability of recent TB transmission was relatively low in the study site, while the cases mainly arose from the activation of previous infection. Spatial analysis showed that strains forming larger clusters had the characteristics of regional aggregation.
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Affiliation(s)
- Guisheng Xu
- Department of Epidemiology, Key Laboratory of Infectious Diseases, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Xuhua Mao
- Department of Clinical Laboratory, Yixing People's Hospital, Wuxi, China
| | - Jianming Wang
- Department of Epidemiology, Key Laboratory of Infectious Diseases, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Hongqiu Pan
- Department of Tuberculosis, The Third Hospital of Zhenjiang, Zhenjiang, China
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Yang C, Gao Q. Recent transmission of Mycobacterium tuberculosis in China: the implication of molecular epidemiology for tuberculosis control. Front Med 2018; 12:76-83. [PMID: 29357036 DOI: 10.1007/s11684-017-0609-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 10/31/2017] [Indexed: 11/28/2022]
Abstract
Tuberculosis (TB) has remained an ongoing concern in China. The national scale-up of the Directly Observed Treatment, Short Course (DOTS) program has accelerated the fight against TB in China. Nevertheless, many challenges still remain, including the spread of drug-resistant strains, high disease burden in rural areas, and enormous rural-to-urban migrations. Whether incident active TB represents recent transmission or endogenous reactivation has helped to prioritize the strategies for TB control. Evidence from molecular epidemiology studies has delineated the recent transmission of Mycobacterium tuberculosis (M. tuberculosis) strains in many settings. However, the transmission patterns of TB in most areas of China are still not clear. Studies carried out to date could not capture the real burden of recent transmission of the disease in China because of the retrospective study design, incomplete sampling, and use of low-resolution genotyping methods. We reviewed the implementations of molecular epidemiology of TB in China, the estimated disease burden due to recent transmission of M. tuberculosis strains, the primary transmission of drug-resistant TB, and the evaluation of a feasible genotyping method of M. tuberculosis strains in circulation.
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Affiliation(s)
- Chongguang Yang
- Key Laboratory of Medical Molecular Virology of Ministries of Education and Health, School of Basic Medical Science, Fudan University, Shanghai, 200032, China.,Department of Epidemiology of Microbial Diseases, School of Public Health, Yale University, 60 College Street, New Haven, CT, 06510, USA
| | - Qian Gao
- Key Laboratory of Medical Molecular Virology of Ministries of Education and Health, School of Basic Medical Science, Fudan University, Shanghai, 200032, China.
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Wei W, Jiang J, Gao L, Liang B, Huang J, Zang N, Ning C, Liao Y, Lai J, Yu J, Qin F, Chen H, Su J, Ye L, Liang H. A New Hybrid Model Using an Autoregressive Integrated Moving Average and a Generalized Regression Neural Network for the Incidence of Tuberculosis in Heng County, China. Am J Trop Med Hyg 2017; 97:799-805. [PMID: 28820678 PMCID: PMC5590565 DOI: 10.4269/ajtmh.16-0648] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 06/05/2017] [Indexed: 01/09/2023] Open
Abstract
It is a daunting task to eradicate tuberculosis completely in Heng County due to a large transient population, human immunodeficiency virus/tuberculosis coinfection, and latent infection. Thus, a high-precision forecasting model can be used for the prevention and control of tuberculosis. In this study, four models including a basic autoregressive integrated moving average (ARIMA) model, a traditional ARIMA-generalized regression neural network (GRNN) model, a basic GRNN model, and a new ARIMA-GRNN hybrid model were used to fit and predict the incidence of tuberculosis. Parameters including mean absolute error (MAE), mean absolute percentage error (MAPE), and mean square error (MSE) were used to evaluate and compare the performance of these models for fitting historical and prospective data. The new ARIMA-GRNN model had superior fit relative to both the traditional ARIMA-GRNN model and basic ARIMA model when applied to historical data and when used as a predictive model for forecasting incidence during the subsequent 6 months. Our results suggest that the new ARIMA-GRNN model may be more suitable for forecasting the tuberculosis incidence in Heng County than traditional models.
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Affiliation(s)
- Wudi Wei
- Guangxi Key Laboratory of AIDS Prevention and Treatment and Guangxi Universities Key Laboratory of Prevention, Guangxi Medical University, 22 Shuangyong Road, Nanning, Guangxi, China
| | - Junjun Jiang
- Guangxi Key Laboratory of AIDS Prevention and Treatment and Guangxi Universities Key Laboratory of Prevention, Guangxi Medical University, 22 Shuangyong Road, Nanning, Guangxi, China
| | - Lian Gao
- Department of Infectious Diseases, Heng County Centers for Disease Control and Prevention, 16 Gongyuan Road, Heng County, China
| | - Bingyu Liang
- Guangxi Key Laboratory of AIDS Prevention and Treatment and Guangxi Universities Key Laboratory of Prevention, Guangxi Medical University, 22 Shuangyong Road, Nanning, Guangxi, China
| | - Jiegang Huang
- Guangxi Key Laboratory of AIDS Prevention and Treatment and Guangxi Universities Key Laboratory of Prevention, Guangxi Medical University, 22 Shuangyong Road, Nanning, Guangxi, China
| | - Ning Zang
- Guangxi Key Laboratory of AIDS Prevention and Treatment and Guangxi Universities Key Laboratory of Prevention, Guangxi Medical University, 22 Shuangyong Road, Nanning, Guangxi, China
- Life Sciences Institute, Guangxi Medical University, 22 Shuangyong Road, Nanning, China
| | - Chuanyi Ning
- Guangxi Key Laboratory of AIDS Prevention and Treatment and Guangxi Universities Key Laboratory of Prevention, Guangxi Medical University, 22 Shuangyong Road, Nanning, Guangxi, China
- Life Sciences Institute, Guangxi Medical University, 22 Shuangyong Road, Nanning, China
| | - Yanyan Liao
- Guangxi Key Laboratory of AIDS Prevention and Treatment and Guangxi Universities Key Laboratory of Prevention, Guangxi Medical University, 22 Shuangyong Road, Nanning, Guangxi, China
- Life Sciences Institute, Guangxi Medical University, 22 Shuangyong Road, Nanning, China
| | - Jingzhen Lai
- Guangxi Key Laboratory of AIDS Prevention and Treatment and Guangxi Universities Key Laboratory of Prevention, Guangxi Medical University, 22 Shuangyong Road, Nanning, Guangxi, China
| | - Jun Yu
- Guangxi Key Laboratory of AIDS Prevention and Treatment and Guangxi Universities Key Laboratory of Prevention, Guangxi Medical University, 22 Shuangyong Road, Nanning, Guangxi, China
| | - Fengxiang Qin
- Guangxi Key Laboratory of AIDS Prevention and Treatment and Guangxi Universities Key Laboratory of Prevention, Guangxi Medical University, 22 Shuangyong Road, Nanning, Guangxi, China
| | - Hui Chen
- Geriatrics Digestion Department of Internal Medicine, The First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Nanning, China
| | - Jinming Su
- Guangxi Key Laboratory of AIDS Prevention and Treatment and Guangxi Universities Key Laboratory of Prevention, Guangxi Medical University, 22 Shuangyong Road, Nanning, Guangxi, China
| | - Li Ye
- Guangxi Key Laboratory of AIDS Prevention and Treatment and Guangxi Universities Key Laboratory of Prevention, Guangxi Medical University, 22 Shuangyong Road, Nanning, Guangxi, China
| | - Hao Liang
- Guangxi Key Laboratory of AIDS Prevention and Treatment and Guangxi Universities Key Laboratory of Prevention, Guangxi Medical University, 22 Shuangyong Road, Nanning, Guangxi, China
- Life Sciences Institute, Guangxi Medical University, 22 Shuangyong Road, Nanning, China
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Prevalence and Molecular Characterization of Second-Line Drugs Resistance among Multidrug-Resistant Mycobacterium tuberculosis Isolates in Southwest of China. BIOMED RESEARCH INTERNATIONAL 2017; 2017:4563826. [PMID: 28798931 PMCID: PMC5536135 DOI: 10.1155/2017/4563826] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Revised: 05/28/2017] [Accepted: 06/18/2017] [Indexed: 01/13/2023]
Abstract
This study aimed to investigate the prevalence of multidrug-resistant tuberculosis (MDR-TB) isolates resistant to the second-line antituberculosis drugs (SLDs) and its association with resistant-related gene mutations in Mycobacterium tuberculosis (M.tb) isolates from Southwest of China. There were 81 isolates resistant to at least one of the SLDs among 156 MDR-TB isolates (81/156, 51.9%). The rates of general resistance to each of the drugs were as follows: OFX (66/156, 42.3%), KAN (26/156, 16.7%), CAP (13/156, 8.3%), PTO (11/156, 7.1%), PAS (22/156, 14.1%), and AMK (20/156, 12.8%). Therefore, the most predominant pattern was resistant to OFX compared with other SLDs (P < 0.001). The results of sequencing showed that 80.2% OFX-resistant MDR-TB isolates contained gyrA mutation and 88.5% KAN-resistant isolates had rrs mutations with the most frequent mutation being A1401G. These results suggest that improper use of SLDs especially OFX is a real threat to effective MDR-TB treatment not only in China but also in the whole world. Furthermore the tuberculosis control agencies should carry out SLDs susceptibility testing and rapid screening in a broader population of TB patients immediately and the SLDs should be strictly regulated by the administration in order to maintain their efficacy to treat MDR-TB.
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Chen Y, Yuan Z, Shen X, Wu J, Wu Z, Xu B. Resistance to Second-Line Antituberculosis Drugs and Delay in Drug Susceptibility Testing among Multidrug-Resistant Tuberculosis Patients in Shanghai. BIOMED RESEARCH INTERNATIONAL 2016; 2016:2628913. [PMID: 27652260 PMCID: PMC5019859 DOI: 10.1155/2016/2628913] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Revised: 08/01/2016] [Accepted: 08/08/2016] [Indexed: 11/18/2022]
Abstract
Introduction. Second-line antituberculosis drugs (SLDs) are used for treating multidrug-resistant tuberculosis (MDR-TB). Prolonged delays before confirming MDR-TB with drug susceptibility testing (DST) could result in transmission of drug-resistant strains and inappropriate use of SLDs, thereby increasing the risk of resistance to SLDs. This study investigated the diagnostic delay in DST and prevalence of baseline SLD resistance in Shanghai and described the distribution of SLD resistance with varied delays to DST. Methods. All registered patients from 2011 to 2013 in Shanghai were enrolled. Susceptibility to ofloxacin, amikacin, kanamycin, and capreomycin was tested. Total delay in DST completion was measured from the onset of symptoms to reporting DST results. Results. Resistance to SLDs was tested in 217 of the 276 MDR-TB strains, with 118 (54.4%) being resistant to at least one of the four SLDs. The median total delay in DST was 136 days. Patients with delay longer than median days were roughly twice more likely to have resistance to at least one SLD (OR 2.22, 95% CI 1.19-4.11). Conclusions. During prolonged delay in DST, primary and acquired resistance to SLDs might occur more frequently. Rapid diagnosis of MDR-TB, improved nosocomial infection controls, and regulated treatment are imperative to prevent SLD resistance.
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Affiliation(s)
- Yong Chen
- Department of Epidemiology, School of Public Health, Fudan University, 138 Dongan Road, Shanghai 200032, China
- Shanghai Municipal Center for Disease Control and Prevention, 1380 West Zhongshan Road, Shanghai 200336, China
| | - Zhengan Yuan
- Shanghai Municipal Center for Disease Control and Prevention, 1380 West Zhongshan Road, Shanghai 200336, China
| | - Xin Shen
- Shanghai Municipal Center for Disease Control and Prevention, 1380 West Zhongshan Road, Shanghai 200336, China
| | - Jie Wu
- Shanghai Municipal Center for Disease Control and Prevention, 1380 West Zhongshan Road, Shanghai 200336, China
| | - Zheyuan Wu
- Shanghai Municipal Center for Disease Control and Prevention, 1380 West Zhongshan Road, Shanghai 200336, China
| | - Biao Xu
- Department of Epidemiology, School of Public Health, Fudan University, 138 Dongan Road, Shanghai 200032, China
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