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Aghajani J, Saif S, Farnia P, Farnia P, Ghanavi J, Velayati AA. An 8-year study on the prevalence and drug resistance of mycobacteria in clinical specimens (2011–2018). CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2020. [DOI: 10.1016/j.cegh.2019.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Keikha M. There is significant relationship between Beijing genotype family strains and resistance to the first-line anti-tuberculosis drugs in the Iranian population. J Clin Tuberc Other Mycobact Dis 2020; 19:100161. [PMID: 32368621 PMCID: PMC7186555 DOI: 10.1016/j.jctube.2020.100161] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Affiliation(s)
- Masoud 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
- Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran
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Dekhil N, Meftahi N, Mhenni B, Ben Fraj S, Haltiti R, Belhaj S, Mardassi H. MDR-TB Outbreak among HIV-Negative Tunisian Patients followed during 11 Years. PLoS One 2016; 11:e0153983. [PMID: 27124599 PMCID: PMC4849785 DOI: 10.1371/journal.pone.0153983] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 04/06/2016] [Indexed: 01/09/2023] Open
Abstract
Background Multidrug-resistant tuberculosis (MDR-TB) outbreaks that evolve, from the outset, in a context strictly negative for HIV infection deserve special consideration since they reflect the true intrinsic epidemic potential of the causative strain. To our knowledge, the long-term evolution of such exceptional outbreaks and the treatment outcomes for the involved patients has never been reported hitherto. Here we provide a thorough description, over an 11-year period, of an MDR-TB outbreak that emerged and expanded in an HIV-negative context, Northern Tunisia. Methodology/Principal Findings From October 2001 to June 2011, the MDR-TB outbreak involved 48 HIV-negative individuals that are mainly young (mean age 31.09 yrs; 89.6% male) and noninstitutionalized. Drug susceptibility testing coupled to mutational analysis revealed that initial transmission involved an isolate that was simultaneously resistant to isoniazid, rifampicin, ethambutol, and streptomycin. The causative Haarlem3-ST50 outbreak strain expanded mainly as an 11-banded IS6110 RFLP profile (77.1%), from which a 12-banded subclone evolved. After undergoing a 2-year treatment with second-line drugs, 22 (45.8%) patients were cured and 3 (6.2%) completed treatment, thus yielding an overall treatment success rate of 52.1%. Among the patients that experienced unfavorable treatment outcomes, 10 (20.8%) failed treatment, 3 (6.2%) were lost to follow-up, 5 (10.4%) died, and 5 (10.4%) could not be evaluated. Poor adherence to treatment was found to be the main independent predictor of unfavorable outcomes (HR: 9.15; 95% CI 1.72–48.73; P = 0.014). Intriguingly, the evolved 12-banded subclone proved significantly associated with unfavorable outcomes (HR: 4.90; 95% CI 1.04–23.04, P = 0.044). High rate of fatality and relapse was further demonstrated at the long-term, since 70% of those whose treatment failed have died, and 24% among those deemed successfully treated have relapsed. Conclusions/Significance Taken together, the data obtained in this study indicate that MDR-TB clinical isolates could become fit enough to cause large and severe outbreaks in an HIV-negative context. Such MDR-TB outbreaks are characterized by low treatment success rates and could evolve towards increased severity, thus calling for early detection of cases and the necessity to raise the bar of surveillance throughout and beyond the treatment period.
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Affiliation(s)
- Naira Dekhil
- Unit of Typing & Genetics of Mycobacteria, Laboratory of Molecular Microbiology, Vaccinology, and Biotechnology Development, Institut Pasteur de Tunis, Université Tunis El Manar, Tunis, Tunisia
| | - Nedra Meftahi
- Unit of Typing & Genetics of Mycobacteria, Laboratory of Molecular Microbiology, Vaccinology, and Biotechnology Development, Institut Pasteur de Tunis, Université Tunis El Manar, Tunis, Tunisia
| | - Besma Mhenni
- Unit of Typing & Genetics of Mycobacteria, Laboratory of Molecular Microbiology, Vaccinology, and Biotechnology Development, Institut Pasteur de Tunis, Université Tunis El Manar, Tunis, Tunisia
| | - Saloua Ben Fraj
- Unit of Typing & Genetics of Mycobacteria, Laboratory of Molecular Microbiology, Vaccinology, and Biotechnology Development, Institut Pasteur de Tunis, Université Tunis El Manar, Tunis, Tunisia
| | - Raja Haltiti
- Hôpital Régional de Menzel-Bourguiba, Menzel Bourguiba, Tunisia
| | - Sameh Belhaj
- Hôpital Régional de Menzel-Bourguiba, Menzel Bourguiba, Tunisia
| | - Helmi Mardassi
- Unit of Typing & Genetics of Mycobacteria, Laboratory of Molecular Microbiology, Vaccinology, and Biotechnology Development, Institut Pasteur de Tunis, Université Tunis El Manar, Tunis, Tunisia
- * E-mail:
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Honarvar B, Moghadami M, Emami A, Behbahani AB, Taheri M, Roudgari A, Sami Kashkoli G, Rezaee M, Farzanfar E, Zaree Z, Goharnejad J, Khavandegaran F, Bagheri Lankarani K. Mycobacterium Strain and Type of Resistance in Pulmonary Tuberculosis Patients: A Missed Link in Iran’s National Tuberculosis Plan. SHIRAZ E-MEDICAL JOURNAL 2015. [DOI: 10.17795/semj27748] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Fox GJ, Nhung NV, Sy DN, Lien LT, Cuong NK, Britton WJ, Marks GB. Contact investigation in households of patients with tuberculosis in Hanoi, Vietnam: a prospective cohort study. PLoS One 2012; 7:e49880. [PMID: 23166785 PMCID: PMC3499505 DOI: 10.1371/journal.pone.0049880] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2012] [Accepted: 10/15/2012] [Indexed: 11/29/2022] Open
Abstract
Setting Existing tuberculosis control strategies in Vietnam are based on symptomatic patients attending health services for investigation. This approach has not resulted in substantial reductions in the prevalence of tuberculosis disease, despite the National Tuberculosis Program achieving high treatment completion rates. Alternative approaches are being considered. Objective To determine the feasibility and yield of contact investigation in households of patients with smear positive pulmonary tuberculosis among household members of tuberculosis patients in Hanoi, Vietnam. Methods Household contacts of patients with smear positive pulmonary tuberculosis were recruited at four urban and rural District Tuberculosis Units in Hanoi. Clinical and radiological screening was conducted at baseline, six months and 12 months. Sputum microscopy and culture was performed in contacts suspected of having tuberculosis. MIRU-VNTR molecular testing was used to compare the strains of patients and their contacts with disease. Results Among 545 household contacts of 212 patients, four were diagnosed with tuberculosis at baseline (prevalence 734 cases per 100,000 persons, 95% CI 17–1451) and one was diagnosed with tuberculosis during the subsequent 12 months after initial screening (incidence 180 cases per 100,000 person-years, 95% CI 44–131). Two of these cases were culture positive for M. tuberculosis and both had identical or near-identical MIRU-VNTR strain types. Conclusion Household contacts of patients with potentially infectious forms of tuberculosis have a high prevalence of disease. Household contact investigation is feasible in Vietnam. Further research is required to investigate its effectiveness.
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Affiliation(s)
- Gregory James Fox
- Woolcock Institute of Medical Research, Sydney, New South Wales, Australia.
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Nguyen VAT, Choisy M, Nguyen DH, Tran THT, Pham KLT, Thi Dinh PT, Philippe J, Nguyen TS, Ho ML, Van Tran S, Bañuls AL, Dang DA. High prevalence of Beijing and EAI4-VNM genotypes among M. tuberculosis isolates in northern Vietnam: sampling effect, rural and urban disparities. PLoS One 2012; 7:e45553. [PMID: 23029091 PMCID: PMC3454422 DOI: 10.1371/journal.pone.0045553] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2012] [Accepted: 08/21/2012] [Indexed: 11/26/2022] Open
Abstract
A total of 221 isolates of M. tuberculosis were sampled from hospitals and the general population in the northern plain of Vietnam, one of the most populated region of the country. Genotypic composition and diversity were characterized, and we investigated how they are affected by sampling (hospital vs. general population), correcting for potential confounding effects (location, age and gender of the patients). Spoligotyping and 12 MIRU-VNTR typing were used as first line. Then 15 MIRU-VNTR standard set was used, making 21 MIRU-VNTR typing for the clustered isolates. Result showed that 8 lineages and 13 sub-lineages were circulating in the region. The most predominant lineages were Beijing (38.5%) and EAI (38.5%). Others appeared with small proportions H (1.4%), LAM (1.8%), T (8.1%), X (0.9%), MANU (2.3%), and Zero (0.4%). Higher clustering rate was found in the hospital samples (17.9% in urban and 19.2% in rural areas) compared to the population ones (0%). The typical Vietnamese EAI4-VNM sub-lineage of EAI lineage accounted for 67% of EAI strains and was associated with older ages. Beijing genotypes were associated with younger, urban population and were characterized by high clustering rates. These characteristics strongly suggest that Beijing strains are invading the population, replacing the local EAI-VNM4, thus predicting a more serious tuberculosis situation in the future in the absence of more effective control strategies.
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Affiliation(s)
- Van Anh Thi Nguyen
- Department of Bacteriology, National Institute of Hygiene and Epidemiology, Hanoi, Vietnam.
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Taghavi K, Farnia P, Varahram M, Sheikhoslami FM, Ahmadi M, Kazempoor M, Masjedi MR, Velayati AA. Rapid Detection of Isoniazid Resistance in Mycobacterium tuberculosis by a Single Multiplex Allele-specific Polymerase Chain Reaction Assay. CELL JOURNAL 2011; 13:97-102. [PMID: 23508230 PMCID: PMC3584461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2010] [Accepted: 03/15/2011] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Global surveillance has shown that drug resistant (DR) tuberculosis (TB) is widespread. Prompt detection of Mycobacterium tuberculosis drug resistance is essential for effective control of TB. The most frequent mutations associated with Isoniazid (INH) resistance in Mycobacterium are substitutions at codons 315 in the katG gene and the mabA-inhA promoter region (-15). This survey evaluated INH resistant-associated mutations in order to determine rapid detection of TB resistance. MATERIALS AND METHODS Through a descriptive cross- sectional study total of 96 sputum specimens were digested, examined microscopically for acid-fast bacilli and inoculated into Löwenstein-Jensen slants. Thereafter, the susceptibility and identification tests were performed on culture positive specimens. Subsequently, the strains were subjected to multiplex allele-specific polymerase chain reaction (MAS-PCR) targeting in the codons 315 in the katG gene and the mabA-inhA promoter region. Distinct PCR banding patterns were observed for different mutation profiles. RESULTS Drug susceptibility testing revealed that out of 96 available isolates, 30 (31.3%) were susceptible, 36 (37.5%) had multi-drug resistance (MDR-TB) and 30 (31.3%) showed mono- drug resistance. In comparison with the culture-based phenotypic drug susceptibility test, the sensitivity and specificity of MAS-PCR assay for drug resistance-related genetic mutations were 76.7% and 71.4%, respectively. The correlation between MAS-PCR and culture-based phenotypic drug susceptibility testing findings was 99.4%. CONCLUSION The profile of the isolates suggests a significant number of different DR strains with a high frequency of mutations at codon 315 of the katG gene. MAS-PCR provides a rapid, simple and cost-effective method for detecting MDR-TB.
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Affiliation(s)
- Kimia Taghavi
- 1. Mycobacteriology Research Centre, Shahid Beheshti Medical University, Tehran, Iran
| | - Parissa Farnia
- 1. Mycobacteriology Research Centre, Shahid Beheshti Medical University, Tehran, Iran
| | - Mohammad Varahram
- 1. Mycobacteriology Research Centre, Shahid Beheshti Medical University, Tehran, Iran,* Corresponding Address:P.O. Box: 19575/154Mycobacteriology Research CentreNational Research Institute of Tuberculosis
and Lung Disease (NRITLD)Shahid Beheshti Medical UniversityTehranIran
| | | | - Mojtaba Ahmadi
- 1. Mycobacteriology Research Centre, Shahid Beheshti Medical University, Tehran, Iran
| | - Mehdi Kazempoor
- 2. Statistics Deptartment, Mycobacteriology Research Centre, Shahid Beheshti Medical University, Tehran, Iran
| | - Mohammad Reza Masjedi
- 3. Internal Medicine Department, Mycobacteriology Research Centre Shahid Beheshti Medical University, Tehran, Iran
| | - Ali Akbar Velayati
- 4. Pediatric Deptartment, Mycobacteriology Research Centre, Shahid Beheshti Medical University, Tehran, Iran
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Farnia P, Masjedi MR, Varahram M, Mirsaeidi M, Ahmadi M, Khazampour M, Tabarsi P, Baghei P, Marjane M, Bahadori M, Zarifi AZ, Velayati AA. The recent-transmission of Mycobacterium tuberculosis strains among Iranian and Afghan relapse cases: a DNA-fingerprinting using RFLP and spoligotyping. BMC Infect Dis 2008; 8:109. [PMID: 18681980 PMCID: PMC2518555 DOI: 10.1186/1471-2334-8-109] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2007] [Accepted: 08/06/2008] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Relapse of tuberculosis (TB) may develop as the result of reactivation of the endogenous primary infection, or as a result of a exogenous reinfection. This survey evaluated the rate of reactivation versus recent transmission among Iranian and Afghan relapse cases. METHODS The sputum specimens were digested, examined microscopically for acid-fast bacilli, and inoculated into Löwenstein-Jensen slants by standard procedures. Thereafter, the susceptibility and identification tests were performed on culture positive specimens. Subsequently, the strains that were identified as Mycobacterium tuberculosis (258 isolates) were subjected to IS6110 restriction fragment length polymorphism (RFLP) and spoligotyping. Additional patient's information was collected for further epidemiological analysis. Patients whose isolates had identical genotyping patterns were considered a cluster with recent transmission episode. RESULTS Out of 258 available isolates, 72(28%) had multi-drug resistant (MDR-TB) in ratio and 42 (16.2%) had other resistant. Notably, 38 of MDR-TB cases (52%) were isolated from Afghan patients. By IS6110-RFLP typing method, 65 patients (25%) were clustered in 29 clusters. In cluster cases, the intra-community transmissions between Iranian and Afghan patients were 41%. All MDR-TB patients in clusters had either Haarlem I or Beijing characteristic. The risk factors like sex, family history, close contact, living condition, PPD test result and site of TB infection were not associated with clustering. Although, the MDR-TB strains were more frequent in non-cluster cases (31%) than cluster one(18%) (P < 0.05). Majority of M. tuberculosis strains isolated from non-cluster cases were belong to EAI3 (51; 30%) and CASI(32;18.6%) superfamilies. CONCLUSION During the studied period, reactivation of a previous infection remain the more probable cause of recurrence. Although, the evidence of intra- community transmission between Iranian and Afghan TB cases, highlighted the impact of afghan immigrants in national tuberculosis control program (NTP) of Iran.
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Affiliation(s)
- Parissa Farnia
- Mycobacteriology Research Centre, Iranian National Reference TB Laboratory, National Research Institute Of Tuberculosis and Lung Disease, Shaheed Bahesti University of Medical Sciences (Medical Campus), Darabad, Tehran, Iran.
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