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Viegas SO, Ghebremichael S, Massawo L, Alberto M, Fernandes FC, Monteiro E, Couvin D, Matavele JM, Rastogi N, Correia-Neves M, Machado A, Carrilho C, Groenheit R, Källenius G, Koivula T. Mycobacterium tuberculosis causing tuberculous lymphadenitis in Maputo, Mozambique. BMC Microbiol 2015; 15:268. [PMID: 26589993 PMCID: PMC4654834 DOI: 10.1186/s12866-015-0603-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 11/12/2015] [Indexed: 01/29/2023] Open
Abstract
Background The zoonosis bovine tuberculosis (TB) is known to be responsible for a considerable proportion of extrapulmonary TB. In Mozambique, bovine TB is a recognised problem in cattle, but little has been done to evaluate how Mycobacterium bovis has contributed to human TB. We here explore the public health risk for bovine TB in Maputo, by characterizing the isolates from tuberculous lymphadenitis (TBLN) cases, a common manifestation of bovine TB in humans, in the Pathology Service of Maputo Central Hospital, in Mozambique, during one year. Results Among 110 patients suspected of having TBLN, 49 had a positive culture result. Of those, 48 (98 %) were positive for Mycobacterium tuberculosis complex and one for nontuberculous mycobacteria. Of the 45 isolates analysed by spoligotyping and Mycobacterial Interspersed Repetitive Unit – Variable Number Tandem Repeat (MIRU-VNTR), all were M. tuberculosis. No M. bovis was found. Cervical TBLN, corresponding to 39 (86.7 %) cases, was the main cause of TBLN and 66.7 % of those where from HIV positive patients. We found that TBLN in Maputo was caused by a variety of M. tuberculosis strains. The most prevalent lineage was the EAI (n = 19; 43.2 %). Particular common spoligotypes were SIT 48 (EAI1_SOM sublineage), SIT 42 (LAM 9), SIT 1 (Beijing) and SIT53 (T1), similar to findings among pulmonary cases. Conclusions M. tuberculosis was the main etiological agent of TBLN in Maputo. M. tuberculosis genotypes were similar to the ones causing pulmonary TB, suggesting that in Maputo, cases of TBLN arise from the same source as pulmonary TB, rather than from an external zoonotic source. Further research is needed on other forms of extrapulmonary TB and in rural areas where there is high prevalence of bovine TB in cattle, to evaluate the risk of transmission of M. bovis from cattle to humans. Electronic supplementary material The online version of this article (doi:10.1186/s12866-015-0603-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sofia Omar Viegas
- National Institute of Health, Ministry of Health, Maputo, Mozambique. .,Faculty of Veterinary, Eduardo Mondlane University, Maputo, Mozambique. .,Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden.
| | | | - Leguesse Massawo
- National Institute of Health, Ministry of Health, Maputo, Mozambique.
| | - Matos Alberto
- Pathology Service, Maputo Central Hospital, Ministry of Health, Maputo, Mozambique.
| | - Fabíola Couto Fernandes
- Pathology Service, Maputo Central Hospital, Ministry of Health, Maputo, Mozambique. .,Department of Pathology, Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique.
| | - Eliane Monteiro
- Pathology Service, Maputo Central Hospital, Ministry of Health, Maputo, Mozambique.
| | - David Couvin
- WHO Supranational TB Reference Laboratory, Tuberculosis & Mycobacteria Unit, Institut Pasteur de la Guadeloupe, Abymes, Guadeloupe, France.
| | | | - Nalin Rastogi
- WHO Supranational TB Reference Laboratory, Tuberculosis & Mycobacteria Unit, Institut Pasteur de la Guadeloupe, Abymes, Guadeloupe, France.
| | - Margarida Correia-Neves
- Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden. .,Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal. .,ICVS/3B's, PT Government Associate Laboratory, Braga/Guimarães, Portugal.
| | - Adelina Machado
- Faculty of Veterinary, Eduardo Mondlane University, Maputo, Mozambique.
| | - Carla Carrilho
- Pathology Service, Maputo Central Hospital, Ministry of Health, Maputo, Mozambique. .,Department of Pathology, Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique.
| | - Ramona Groenheit
- Department of Microbiology, Public Health Agency of Sweden, Solna, Sweden.
| | - Gunilla Källenius
- Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden.
| | - Tuija Koivula
- Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden. .,Department of Microbiology, Public Health Agency of Sweden, Solna, Sweden.
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2
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Merker M, Blin C, Mona S, Duforet-Frebourg N, Lecher S, Willery E, Blum MGB, Rüsch-Gerdes S, Mokrousov I, Aleksic E, Allix-Béguec C, Antierens A, Augustynowicz-Kopeć E, Ballif M, Barletta F, Beck HP, Barry CE, Bonnet M, Borroni E, Campos-Herrero I, Cirillo D, Cox H, Crowe S, Crudu V, Diel R, Drobniewski F, Fauville-Dufaux M, Gagneux S, Ghebremichael S, Hanekom M, Hoffner S, Jiao WW, Kalon S, Kohl TA, Kontsevaya I, Lillebæk T, Maeda S, Nikolayevskyy V, Rasmussen M, Rastogi N, Samper S, Sanchez-Padilla E, Savic B, Shamputa IC, Shen A, Sng LH, Stakenas P, Toit K, Varaine F, Vukovic D, Wahl C, Warren R, Supply P, Niemann S, Wirth T. Evolutionary history and global spread of the Mycobacterium tuberculosis Beijing lineage. Nat Genet 2015; 47:242-9. [PMID: 25599400 PMCID: PMC11044984 DOI: 10.1038/ng.3195] [Citation(s) in RCA: 353] [Impact Index Per Article: 39.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Accepted: 12/19/2014] [Indexed: 01/18/2023]
Abstract
Mycobacterium tuberculosis strains of the Beijing lineage are globally distributed and are associated with the massive spread of multidrug-resistant (MDR) tuberculosis in Eurasia. Here we reconstructed the biogeographical structure and evolutionary history of this lineage by genetic analysis of 4,987 isolates from 99 countries and whole-genome sequencing of 110 representative isolates. We show that this lineage initially originated in the Far East, from where it radiated worldwide in several waves. We detected successive increases in population size for this pathogen over the last 200 years, practically coinciding with the Industrial Revolution, the First World War and HIV epidemics. Two MDR clones of this lineage started to spread throughout central Asia and Russia concomitantly with the collapse of the public health system in the former Soviet Union. Mutations identified in genes putatively under positive selection and associated with virulence might have favored the expansion of the most successful branches of the lineage.
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Affiliation(s)
- Matthias Merker
- Molecular Mycobacteriology, Research Center Borstel, Borstel, Germany
| | - Camille Blin
- 1] Laboratoire Biologie Intégrative des Population, Evolution Moléculaire, Ecole Pratique des Hautes Etudes, Paris, France. [2] Institut de Systématique, Evolution, Biodiversité, UMR-CNRS 7205, Muséum National d'Histoire Naturelle, Université Pierre et Marie Curie, Ecole Pratique des Hautes Etudes, Sorbonne Universités, Paris, France
| | - Stefano Mona
- 1] Laboratoire Biologie Intégrative des Population, Evolution Moléculaire, Ecole Pratique des Hautes Etudes, Paris, France. [2] Institut de Systématique, Evolution, Biodiversité, UMR-CNRS 7205, Muséum National d'Histoire Naturelle, Université Pierre et Marie Curie, Ecole Pratique des Hautes Etudes, Sorbonne Universités, Paris, France
| | - Nicolas Duforet-Frebourg
- Université Joseph Fourier, Centre National de la Recherche Scientifique, Laboratoire Techniques de l'Ingénierie Médicale et de la Complexité-Informatique, Mathématiques et Applications, Grenoble, France
| | - Sophie Lecher
- 1] INSERM U1019, Center for Infection and Immunity of Lille, Lille, France. [2] Centre National de la Recherche Scientifique, UMR 8204, Lille, France. [3] Université Lille Nord, Center for Infection and Immunity of Lille, Lille, France. [4] Institut Pasteur de Lille, Center for Infection and Immunity of Lille, Lille, France
| | - Eve Willery
- 1] INSERM U1019, Center for Infection and Immunity of Lille, Lille, France. [2] Centre National de la Recherche Scientifique, UMR 8204, Lille, France. [3] Université Lille Nord, Center for Infection and Immunity of Lille, Lille, France. [4] Institut Pasteur de Lille, Center for Infection and Immunity of Lille, Lille, France
| | - Michael G B Blum
- Université Joseph Fourier, Centre National de la Recherche Scientifique, Laboratoire Techniques de l'Ingénierie Médicale et de la Complexité-Informatique, Mathématiques et Applications, Grenoble, France
| | - Sabine Rüsch-Gerdes
- National Reference Center for Mycobacteria, Research Center Borstel, Borstel, Germany
| | - Igor Mokrousov
- Laboratory of Molecular Microbiology, St. Petersburg Pasteur Institute, St. Petersburg, Russia
| | - Eman Aleksic
- Centre for Biomedical Research, Burnet Institute, Melbourne, Victoria, Australia
| | | | - Annick Antierens
- Medical Department, Médecins sans Frontières Switzerland, Geneva, Switzerland
| | - Ewa Augustynowicz-Kopeć
- Department of Microbiology, National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
| | - Marie Ballif
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Francesca Barletta
- Instituto de Medicina Tropical Alexander von Humboldt, Molecular Epidemiology Unit-Tuberculosis, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Hans Peter Beck
- Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Clifton E Barry
- Tuberculosis Research Section, National Institute of Allergy and Infectious Diseases, US National Institutes of Health, Bethesda, Maryland, USA
| | | | - Emanuele Borroni
- Emerging Bacterial Pathogens Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Isolina Campos-Herrero
- Department of Microbiology, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Spain
| | - Daniela Cirillo
- Emerging Bacterial Pathogens Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Helen Cox
- Division of Medical Microbiology, University of Cape Town, Cape Town, South Africa
| | - Suzanne Crowe
- 1] Centre for Biomedical Research, Burnet Institute, Melbourne, Victoria, Australia. [2] Department of Infectious Diseases, Alfred Hospital, Melbourne, Victoria, Australia. [3] Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Valeriu Crudu
- National Tuberculosis Reference Laboratory, Phthysiopneumology Institute, Chisinau, Republic of Moldova
| | - Roland Diel
- Institute for Epidemiology, Schleswig-Holstein University Hospital, Kiel, Germany
| | - Francis Drobniewski
- 1] Public Health England National Mycobacterial Reference Laboratory and Clinical Tuberculosis and Human Immunodeficiency Virus Group, Queen Mary's School of Medicine and Dentistry, London, UK. [2] Department of Infectious Diseases, Imperial College, London, UK
| | | | - Sébastien Gagneux
- Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, Basel, Switzerland
| | | | - Madeleine Hanekom
- Department of Science and Technology/National Research Foundation, Centre of Excellence for Biomedical Tuberculosis Research/Medical Research Council, Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Sven Hoffner
- Department of Diagnostics and Vaccinology, Swedish Institute for Communicable Disease Control, Solna, Sweden
| | - Wei-wei Jiao
- Key Laboratory of Major Diseases in Children and National Key Discipline of Pediatrics (Capital Medical University), Ministry of Education, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Stobdan Kalon
- US Agency for International Development Quality Health Care Project, Bishkek, Kyrgyzstan
| | - Thomas A Kohl
- Molecular Mycobacteriology, Research Center Borstel, Borstel, Germany
| | | | - Troels Lillebæk
- Statens Serum Institute, International Reference Laboratory of Mycobacteriology, Copenhagen, Denmark
| | - Shinji Maeda
- Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association, Tokyo, Japan
| | - Vladyslav Nikolayevskyy
- 1] Public Health England National Mycobacterial Reference Laboratory and Clinical Tuberculosis and Human Immunodeficiency Virus Group, Queen Mary's School of Medicine and Dentistry, London, UK. [2] Department of Infectious Diseases, Imperial College, London, UK
| | - Michael Rasmussen
- Statens Serum Institute, International Reference Laboratory of Mycobacteriology, Copenhagen, Denmark
| | - Nalin Rastogi
- World Health Organization Supranational Tuberculosis Reference Laboratory, Institut Pasteur de la Guadeloupe, Abymes, France
| | - Sofia Samper
- Instituto de Investigación Sanitaria Aragón, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | | | - Branislava Savic
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Isdore Chola Shamputa
- Tuberculosis Research Section, National Institute of Allergy and Infectious Diseases, US National Institutes of Health, Bethesda, Maryland, USA
| | - Adong Shen
- Key Laboratory of Major Diseases in Children and National Key Discipline of Pediatrics (Capital Medical University), Ministry of Education, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Li-Hwei Sng
- Central Tuberculosis Laboratory, Department of Pathology, Singapore General Hospital, Singapore
| | - Petras Stakenas
- Department of Immunology and Cell Biology, Institute of Biotechnology, Vilnius University, Vilnius, Lithuania
| | - Kadri Toit
- Tartu University Hospital United Laboratories, Mycobacteriology, Tartu, Estonia
| | | | - Dragana Vukovic
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | | | - Robin Warren
- Department of Science and Technology/National Research Foundation, Centre of Excellence for Biomedical Tuberculosis Research/Medical Research Council, Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Philip Supply
- 1] INSERM U1019, Center for Infection and Immunity of Lille, Lille, France. [2] Centre National de la Recherche Scientifique, UMR 8204, Lille, France. [3] Université Lille Nord, Center for Infection and Immunity of Lille, Lille, France. [4] Institut Pasteur de Lille, Center for Infection and Immunity of Lille, Lille, France. [5] Genoscreen, Lille, France
| | - Stefan Niemann
- 1] Molecular Mycobacteriology, Research Center Borstel, Borstel, Germany. [2] German Center for Infection Research, Borstel Site, Borstel, Germany
| | - Thierry Wirth
- 1] Laboratoire Biologie Intégrative des Population, Evolution Moléculaire, Ecole Pratique des Hautes Etudes, Paris, France. [2] Institut de Systématique, Evolution, Biodiversité, UMR-CNRS 7205, Muséum National d'Histoire Naturelle, Université Pierre et Marie Curie, Ecole Pratique des Hautes Etudes, Sorbonne Universités, Paris, France
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3
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Viegas SO, Machado A, Groenheit R, Ghebremichael S, Pennhag A, Gudo PS, Cuna Z, Langa E, Miotto P, Cirillo DM, Rastogi N, Warren RM, van Helden PD, Koivula T, Källenius G. Mycobacterium tuberculosis Beijing genotype is associated with HIV infection in Mozambique. PLoS One 2013; 8:e71999. [PMID: 23940801 PMCID: PMC3737140 DOI: 10.1371/journal.pone.0071999] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Accepted: 07/08/2013] [Indexed: 11/19/2022] Open
Abstract
The Beijing genotype is a lineage of Mycobacterium tuberculosis that is distributed worldwide and responsible for large epidemics, associated with multidrug-resistance. However, its distribution in Africa is less understood due to the lack of data. Our aim was to investigate the prevalence and possible transmission of Beijing strains in Mozambique by a multivariate analysis of genotypic, geographic and demographic data. A total of 543 M. tuberculosis isolates from Mozambique were spoligotyped. Of these, 33 were of the Beijing lineage. The genetic relationship between the Beijing isolates were studied by identification of genomic deletions within some Regions of Difference (RD), Restriction Fragment Length Polymorphism (RFLP) and Mycobacterial Interspersed Repetivie Unit – variable number tandem repeat (MIRU-VNTR). Beijing strains from South Africa, representing different sublineages were included as reference strains. The association between Beijing genotype, Human Immunodeficiency Virus (HIV) serology and baseline demographic data was investigated. HIV positive serostatus was significantly (p=0.023) more common in patients with Beijing strains than in patients with non-Beijing strains in a multivariable analysis adjusted for age, sex and province (14 (10.9%) of the 129 HIV positive patients had Beijing strains while 6/141 (4.3%) of HIV negative patients had Beijing strains). The majority of Beijing strains were found in the Southern region of Mozambique, particularly in Maputo City (17%). Only one Beijing strain was drug resistant (multi-drug resistant). By combined use of RD and spoligotyping, three genetic sublineages could be tentatively identified where a distinct group of four isolates had deletion of RD150, a signature of the “sublineage 7” recently emerging in South Africa. The same group was very similar to South African “sublineage 7” by RFLP and MIRU-VNTR, suggesting that this sublineage could have been recently introduced in Mozambique from South Africa, in association with HIV infection.
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Affiliation(s)
- Sofia O Viegas
- National Institute of Health, Ministry of Health, Maputo, Mozambique.
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4
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Groenheit R, Ghebremichael S, Pennhag A, Jonsson J, Hoffner S, Couvin D, Koivula T, Rastogi N, Källenius G. Mycobacterium tuberculosis strains potentially involved in the TB epidemic in Sweden a century ago. PLoS One 2012; 7:e46848. [PMID: 23056484 PMCID: PMC3466202 DOI: 10.1371/journal.pone.0046848] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2011] [Accepted: 09/10/2012] [Indexed: 11/30/2022] Open
Abstract
A hundred years ago the prevalence of tuberculosis (TB) in Sweden was one of the highest in the world. In this study we conducted a population-based search for distinct strains of Mycobacterium tuberculosis complex isolated from patients born in Sweden before 1945. Many of these isolates represent the M. tuberculosis complex population that fueled the TB epidemic in Sweden during the first half of the 20th century.
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Affiliation(s)
- Ramona Groenheit
- Department of Preparedness, Swedish Institute for Communicable Disease Control, Solna, Sweden.
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5
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Groenheit R, Ghebremichael S, Svensson J, Rabna P, Colombatti R, Riccardi F, Couvin D, Hill V, Rastogi N, Koivula T, Källenius G. The Guinea-Bissau family of Mycobacterium tuberculosis complex revisited. PLoS One 2011; 6:e18601. [PMID: 21533101 PMCID: PMC3080393 DOI: 10.1371/journal.pone.0018601] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2010] [Accepted: 03/07/2011] [Indexed: 11/19/2022] Open
Abstract
The Guinea-Bissau family of strains is a unique group of the Mycobacterium tuberculosis complex that, although genotypically closely related, phenotypically demonstrates considerable heterogeneity. We have investigated 414 M. tuberculosis complex strains collected in Guinea-Bissau between 1989 and 2008 in order to further characterize the Guinea-Bissau family of strains. To determine the strain lineages present in the study sample, binary outcomes of spoligotyping were compared with spoligotypes existing in the international database SITVIT2. The major circulating M. tuberculosis clades ranked in the following order: AFRI (n = 195, 47.10%), Latin-American-Mediterranean (LAM) (n = 75, 18.12%), ill-defined T clade (n = 53, 12.8%), Haarlem (n = 37, 8.85%), East-African-Indian (EAI) (n = 25, 6.04%), Unknown (n = 12, 2.87%), Beijing (n = 7, 1.68%), X clade (n = 4, 0.96%), Manu (n = 4, 0.97%), CAS (n = 2, 0.48%). Two strains of the LAM clade isolated in 2007 belonged to the Cameroon family (SIT61). All AFRI isolates except one belonged to the Guinea-Bissau family, i.e. they have an AFRI_1 spoligotype pattern, they have a distinct RFLP pattern with low numbers of IS6110 insertions, and they lack the regions of difference RD7, RD8, RD9 and RD10, RD701 and RD702. This profile classifies the Guinea-Bissau family, irrespective of phenotypic biovar, as part of the M. africanum West African 2 lineage, or the AFRI_1 sublineage according to the spoligtyping nomenclature. Guinea-Bissau family strains display a variation of biochemical traits classically used to differentiate M. tuberculosis from M. bovis. Yet, the differential expression of these biochemical traits was not related to any genes so far investigated (narGHJI and pncA). Guinea-Bissau has the highest prevalence of M. africanum recorded in the African continent, and the Guinea-Bissau family shows a high phylogeographical specificity for Western Africa, with Guinea-Bissau being the epicenter. Trends over time however indicate that this family of strains is waning in most parts of Western Africa, including Guinea-Bissau (p = 0.048).
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Affiliation(s)
- Ramona Groenheit
- Department of Preparedness, Swedish Institute for Infectious Disease Control, Solna, Sweden
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden
| | - Solomon Ghebremichael
- Department of Preparedness, Swedish Institute for Infectious Disease Control, Solna, Sweden
| | - Jenny Svensson
- Department of Preparedness, Swedish Institute for Infectious Disease Control, Solna, Sweden
| | - Paulo Rabna
- Laboratório Nacional de Saúde Pública, Bissau, Guinea-Bissau
- Bandim Health Project, Indepth Network, Bissau, Guinea-Bissau
| | - Raffaella Colombatti
- Hospital “Raoul Follereau”, Bissau, Guinea-Bissau
- Department of Pediatrics, Azienda Ospedaliera-Università di Padova, Padova, Italy
| | - Fabio Riccardi
- Department of Public Health, University of “Tor Vergata”, Rome, Italy
| | - David Couvin
- WHO Supranational TB Reference Laboratory, Tuberculosis and Mycobacteria Unit, Institut Pasteur de la Guadeloupe, Guadeloupe, France
| | - Véronique Hill
- WHO Supranational TB Reference Laboratory, Tuberculosis and Mycobacteria Unit, Institut Pasteur de la Guadeloupe, Guadeloupe, France
| | - Nalin Rastogi
- WHO Supranational TB Reference Laboratory, Tuberculosis and Mycobacteria Unit, Institut Pasteur de la Guadeloupe, Guadeloupe, France
| | - Tuija Koivula
- Department of Preparedness, Swedish Institute for Infectious Disease Control, Solna, Sweden
- Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden
| | - Gunilla Källenius
- Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden
- * E-mail:
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Sandegren L, Groenheit R, Koivula T, Ghebremichael S, Advani A, Castro E, Pennhag A, Hoffner S, Mazurek J, Pawlowski A, Kan B, Bruchfeld J, Melefors Ö, Källenius G. Genomic stability over 9 years of an isoniazid resistant Mycobacterium tuberculosis outbreak strain in Sweden. PLoS One 2011; 6:e16647. [PMID: 21304944 PMCID: PMC3031603 DOI: 10.1371/journal.pone.0016647] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2010] [Accepted: 01/07/2011] [Indexed: 11/18/2022] Open
Abstract
In molecular epidemiological studies of drug resistant Mycobacterium tuberculosis (TB) in Sweden a large outbreak of an isoniazid resistant strain was identified, involving 115 patients, mainly from the Horn of Africa. During the outbreak period, the genomic pattern of the outbreak strain has stayed virtually unchanged with regard to drug resistance, IS6110 restriction fragment length polymorphism and spoligotyping patterns. Here we present the complete genome sequence analyses of the index isolate and two isolates sampled nine years after the index case as well as experimental data on the virulence of this outbreak strain. Even though the strain has been present in the community for nine years and passaged between patients at least five times in-between the isolates, we only found four single nucleotide polymorphisms in one of the later isolates and a small (4 amino acids) deletion in the other compared to the index isolate. In contrast to many other evolutionarily successful outbreak lineages (e.g. the Beijing lineage) this outbreak strain appears to be genetically very stable yet evolutionarily successful in a low endemic country such as Sweden. These findings further illustrate that the rate of genomic variation in TB can be highly strain dependent, something that can have important implications for epidemiological studies as well as development of resistance.
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Affiliation(s)
- Linus Sandegren
- Department of Medical Biochemistry and Microbiology, Uppsala University, Uppsala, Sweden.
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Hasan R, Jabeen K, Ali A, Rafiq Y, Laiq R, Malik B, Tanveer M, Groenheit R, Ghebremichael S, Hoffner S, Hasan Z. Extensively drug-resistant tuberculosis, Pakistan. Emerg Infect Dis 2010; 16:1473-5. [PMID: 20735937 PMCID: PMC3294979 DOI: 10.3201/eid1609.100280] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Frequency of extensively drug-resistant tuberculosis in Pakistan increased from 1.5% in 2006 to 4.5% in 2009 (p<0.01). To understand the epidemiology, we genotyped selected strains by using spoligotyping, mycobacterial interspersed repetitive units–variable number of tandem repeats, and IS6110 restriction fragment length polymorphism analysis.
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Affiliation(s)
- Rumina Hasan
- Department of Pathology and Microbiology, Aga Khan University, Karachi, Pakistan.
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8
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Rosales S, Pineda-García L, Ghebremichael S, Rastogi N, Hoffner SE. Molecular diversity of Mycobacterium tuberculosis isolates from patients with tuberculosis in Honduras. BMC Microbiol 2010; 10:208. [PMID: 20678242 PMCID: PMC2923133 DOI: 10.1186/1471-2180-10-208] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2010] [Accepted: 08/03/2010] [Indexed: 11/24/2022] Open
Abstract
Background Tuberculosis persists as a public health problem in Honduras. A better knowledge of the molecular characteristics of Mycobacterium tuberculosis strains will contribute to understand the transmission dynamics of the disease within the country. The aim of this study was to provide an insight of the genetic biodiversity of M. tuberculosis clinical isolates collected in Honduras between 1994 and 2002. Genotyping was performed using spoligotyping and RFLP. The spoligotypes obtained were compared with the SITVIT2 proprietary database of the Pasteur Institute of Guadeloupe. Results Spoligotyping grouped 84% of the isolates into 27 clusters (2 to 43 strains per cluster). Of the 44 shared international types (SITs) identified among the Honduran stains, 8 SITs were newly identified either within the present study or after match with an orphan type previously identified in the SITVIT2 database. In addition, 16 patterns corresponded to orphan, previously unreported isolates. The Latin American Mediterranean (LAM) lineage was the most common in this study; 55% of the strains belonged to this family. Other genotypes found were Haarlem (16%), T (16%), X-clade (6%), Unknown signature (5%) and S (1%). Only one Beijing strain was identified (0.5%). We observed a high degree of diversity after characterizing the 43 isolates belonging to the main spoligotyping cluster (SIT 33, LAM3) with IS6110-RFLP. A total of 35 different RFLP-fingerprints were detected, of which 6 patterns corresponded to the same number of clusters comprising 14 strains. Conclusions The findings obtained in this study show that tuberculosis transmission in Honduras is due to modern M. tuberculosis lineages with high level of biodiversity.
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Affiliation(s)
- Senia Rosales
- Escuela de Microbiología, Universidad Nacional Autónoma de Honduras, Tegucigalpa, Honduras.
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Viegas SO, Machado A, Groenheit R, Ghebremichael S, Pennhag A, Gudo PS, Cuna Z, Miotto P, Hill V, Marrufo T, Cirillo DM, Rastogi N, Källenius G, Koivula T. Molecular diversity of Mycobacterium tuberculosis isolates from patients with pulmonary tuberculosis in Mozambique. BMC Microbiol 2010; 10:195. [PMID: 20663126 PMCID: PMC2914001 DOI: 10.1186/1471-2180-10-195] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2010] [Accepted: 07/21/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mozambique is one of the countries with the highest burden of tuberculosis (TB) in Sub-Saharan Africa, and information on the predominant genotypes of Mycobacterium tuberculosis circulating in the country are important to better understand the epidemic. This study determined the predominant strain lineages that cause TB in Mozambique. RESULTS A total of 445 M. tuberculosis isolates from seven different provinces of Mozambique were characterized by spoligotyping and resulting profiles were compared with the international spoligotyping database SITVIT2.The four most predominant lineages observed were: the Latin-American Mediterranean (LAM, n = 165 or 37%); the East African-Indian (EAI, n = 132 or 29.7%); an evolutionary recent but yet ill-defined T clade, (n = 52 or 11.6%); and the globally-emerging Beijing clone, (n = 31 or 7%). A high spoligotype diversity was found for the EAI, LAM and T lineages. CONCLUSIONS The TB epidemic in Mozambique is caused by a wide diversity of spoligotypes with predominance of LAM, EAI, T and Beijing lineages.
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Affiliation(s)
- Sofia O Viegas
- Faculty of Veterinary, Eduardo Mondlane University, Maputo Mozambique.
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Asiimwe BB, Asiimwe J, Kallenius G, Ashaba FK, Ghebremichael S, Joloba M, Koivula T. Molecular characterisation of Mycobacterium bovis
isolates from cattle carcases at a city slaughterhouse in Uganda. Vet Rec 2009; 164:655-8. [DOI: 10.1136/vr.164.21.655] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- B. B. Asiimwe
- Department of Medical Microbiology; Makerere University Medical School; PO Box 7072 Kampala Uganda
| | - J. Asiimwe
- Department of Veterinary Parasitology and Microbiology; Faculty of Veterinary Medicine; Makerere University; PO Box 7062 Kampala Uganda
| | - G. Kallenius
- Department of Microbiology, Tumour and Cell Biology; Karolinska Institute; SE-171 77 Stockholm Sweden
| | - F. K. Ashaba
- Department of Medical Microbiology; Makerere University Medical School; PO Box 7072 Kampala Uganda
| | - S. Ghebremichael
- Department of Microbiology, Tumour and Cell Biology; Karolinska Institute; SE-171 77 Stockholm Sweden
| | - M. Joloba
- Department of Medical Microbiology; Makerere University Medical School; PO Box 7072 Kampala Uganda
| | - T. Koivula
- Department of Bacteriology; Swedish Institute for Infectious Disease Control; SE-171 82 Solna Sweden
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Asiimwe BB, Ghebremichael S, Kallenius G, Koivula T, Joloba ML. Mycobacterium tuberculosis spoligotypes and drug susceptibility pattern of isolates from tuberculosis patients in peri-urban Kampala, Uganda. BMC Infect Dis 2008; 8:101. [PMID: 18662405 PMCID: PMC2519071 DOI: 10.1186/1471-2334-8-101] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2008] [Accepted: 07/28/2008] [Indexed: 11/27/2022] Open
Abstract
Background The poor peri-urban areas of developing countries with inadequate living conditions and a high prevalence of HIV infection have been implicated in the increase of tuberculosis (TB). Presence of different lineages of Mycobacterium tuberculosis has been described in different parts of the world. This study determined the predominant strain lineages that cause TB in Rubaga division, Kampala, Uganda, and the prevalence of resistance to key anti-tuberculosis drugs in this community. Methods This was a cross-sectional study of newly diagnosed sputum smear-positive patients aged ≥ 18 years. A total of 344 isolates were genotyped by standard spoligotyping and the strains were compared with those in the international spoligotype database (SpolDB4). HIV testing and anti-tuberculosis drug susceptibility assays for isoniazid and rifampicin were performed and association with the most predominant spoligotypes determined. Results A total of 33 clusters were obtained from 57 spoligotype patterns. According to the SpolDB4 database, 241 (70%) of the isolates were of the T2 family, while CAS1-Kili (3.5%), LAM9 (2.6%), CAS1-Delhi (2.6%) were the other significant spoligotypes. Furthermore, a major spoligotype pattern of 17 (4.5%) strains characterized by lack of spacers 15–17 and 19–43 was not identified in SpolDB4. A total of 92 (26.7%) of the patients were HIV sero-positive, 176 (51.2%) sero-negative, while 76 (22.1%) of the patients did not consent to HIV testing. Resistance to isoniazid was found in 8.1% of strains, while all 15 (4.4%) strains resistant to rifampicin were multi-drug resistant. Additionally, there was no association between any strain types in the sample with either drug resistance or HIV sero-status of the patients. Conclusion The TB epidemic in Kampala is localized, mainly caused by the T2 family of strains. Strain types were neither associated with drug resistance nor HIV sero-status.
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Affiliation(s)
- Benon B Asiimwe
- Department of Medical Microbiology, Makerere University Medical School, Kampala, Republic of Uganda.
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Asiimwe BB, Koivula T, Källenius G, Huard RC, Ghebremichael S, Asiimwe J, Joloba ML. Mycobacterium tuberculosis Uganda genotype is the predominant cause of TB in Kampala, Uganda. Int J Tuberc Lung Dis 2008; 12:386-391. [PMID: 18371263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Abstract
SETTING Rubaga Division, Kampala, Uganda. OBJECTIVE To use polymerase chain reaction (PCR) based regions of difference (RD) analysis to study the species diversity of Mycobacterium tuberculosis complex isolates from a community-based sample of tuberculosis (TB) patients from Rubaga and to perform long sequence polymorphism (LSP) analysis to further characterise the M. tuberculosis Uganda genotype, a group of strains previously recognised by their characteristic spoligotype patterns. DESIGN For the present study, 344 consecutive TB patients attending clinics in Rubaga Division were enrolled. Sample processing and culture were performed at the National Tuberculosis and Reference Laboratory and molecular assays at Makerere Medical School. Species identification was achieved by determining the RDs, while spoligotyping and LSP analysis were performed to characterise the M. tuberculosis Uganda genotype. RESULTS Of the 344 isolates, 343 (99.7%) were M. tuberculosis sensu stricto, while one was classical M. bovis. The Uganda genotype strains characteristically lacked RD724, a locus that defines one of the major sub-lineages of M. tuberculosis, which suggested that this geographically constrained lineage is specifically adapted to a central African human host population. CONCLUSION M. tuberculosis is the most prevalent species of the M. tuberculosis complex in Kampala, and the Uganda genotype is the predominant strain.
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Affiliation(s)
- B B Asiimwe
- Department of Medical Microbiology, Makerere University Medical School, Kampala, Uganda
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Ghebremichael S, Petersson R, Koivula T, Pennhag A, Romanus V, Berggren I, Petrini B, Hoffner S, Källenius G. Molecular epidemiology of drug-resistant tuberculosis in Sweden. Microbes Infect 2008; 10:699-705. [PMID: 18485780 DOI: 10.1016/j.micinf.2008.03.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2007] [Revised: 03/17/2008] [Accepted: 03/18/2008] [Indexed: 11/29/2022]
Abstract
Drug-resistant tuberculosis (TB), including the more severe forms of multidrug- and extensively drug-resistant forms, is an increasing public health concern globally. In Sweden the majority of patients with TB are immigrants from countries with a high incidence of TB including the drug-resistant forms. In this study, the spread of resistant TB in Sweden was investigated by molecular fingerprinting. Isolates resistant to at least one of the drugs, isoniazid, rifampicin, ethambutol or streptomycin, from 400 patients collected between 1994 and 2005, were studied by restriction fragment length polymorphism (RFLP) and by spoligotyping. Thirty-five clusters of patients infected with strains with identical RFLP and spoligotyping patterns (2-96 patients per cluster), comprising a total of 203 patients, were found. One large outbreak of isoniazid resistant tuberculosis was identified, involving 96 patients, mainly from the Horn of Africa. To identify chains of transmission, molecular epidemiological characterization of TB isolates should, if possible, be performed on isolates from all new TB patients.
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Affiliation(s)
- Solomon Ghebremichael
- Department of Bacteriology, Swedish Institute for Infectious Disease Control, S-17182 Solna, Sweden
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14
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Kan B, Berggren I, Ghebremichael S, Bennet R, Bruchfeld J, Chryssanthou E, Källenius G, Petersson R, Petrini B, Romanus V, Sylvan S, Kalin M. Extensive transmission of an isoniazid-resistant strain of Mycobacterium tuberculosis in Sweden. Int J Tuberc Lung Dis 2008; 12:199-204. [PMID: 18230254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023] Open
Abstract
SETTING City of Stockholm, Sweden. BACKGROUND The incidence of tuberculosis (TB) in Sweden increased by 40% between 2003 and 2005. The spread of a unique TB strain resistant to isoniazid (INH) contributed to this increase. OBJECTIVE To describe outbreaks of TB caused by this single strain, elucidate possible causes for its extensive spread and identify shortcomings of the TB control programme in Sweden. RESULTS We identified a cluster consisting of 102 culture-confirmed TB cases with identical DNA fingerprints and 26 epidemiologically related cases, not confirmed by culture, all diagnosed between 1996 and 2005. Five partly separate outbreaks of this strain were discovered. Epidemiological links were established for 56% of the culture-confirmed cases and for all cases not confirmed by culture. Three patients died while receiving treatment, four became failures and eight defaulted or were lost to follow-up. Only eight patients received directly observed treatment (DOT) up to a period of 3 months, although 40% had poor adherence. CONCLUSIONS Shortcomings of the national TB programme were revealed. Improved contact tracing and case holding, including DOT, is crucial to reduce TB transmission in Sweden.
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Affiliation(s)
- B Kan
- Infectious Diseases Unit, Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Solna, Sweden.
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Ali A, Hasan Z, Tanveer M, Siddiqui AR, Ghebremichael S, Kallenius G, Hasan R. Characterization of Mycobacterium tuberculosis Central Asian Strain 1 using mycobacterial interspersed repetitive unit genotyping. BMC Microbiol 2007; 7:76. [PMID: 17686185 PMCID: PMC1988810 DOI: 10.1186/1471-2180-7-76] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2007] [Accepted: 08/09/2007] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Central Asian Strain 1 (CAS1) genogroup of Mycobacterium tuberculosis (MTB) is the most prevalent in Pakistan, India and Bangladesh. Mycobacterial interspersed repetitive units variable number tandem repeat (MIRU-VNTR) typing is a reliable and reproducible method for differentiation of MTB isolates. However, information of its utility in determining the diversity of CAS1 strain is limited. We performed standard 12 loci based MIRU-VNTR typing on previously spoligotyped CAS1 strains and 'unique' strains in order to evaluate its discriminatory power for these isolates. METHODS Twelve loci based MIRU- VNTR typing was used to type 178 CAS1 and 189 'unique' MTB strains. The discriminatory index for each of the loci was calculated using the Hunter Gaston Discriminatory Index (HGDI). A subset of these strains (n = 78) were typed using IS6110 restriction fragment length polymorphism (RFLP). MIRU-VNTR profiles were studied together with their drug susceptibility patterns. RESULTS A total of 349 MIRU patterns were obtained for the 367 strains tested. The CAS1 strains were subdivided into 160 distinct patterns; 15 clusters of 2 strains each, 1 cluster of four strains and 144 unique patterns. Using HGDI, seven MIRU loci, (numbers 26, 31, 27, 16, 10, 39, and 40) were found to be "highly discriminatory" (DI: >or=0.6), four MIRU loci (numbers 20, 24, 23, and 4) were "moderately discriminatory" (DI: 0.3-0.59), and one locus (number 2) was "poorly discriminatory" (DI< 0.3). Loci 26 and 31 were the most discriminatory for the CAS1 isolates. Amongst 'unique' strains in addition to loci 26, 31, 27, 16, 10, 39, and 40, locus 23 was highly discriminatory, while no locus was poorly discriminating. DI values for loci 4, 10 and 26 were significantly lower (P-value < .01) in CAS1 strains than in 'unique' strains. The association between CAS1 strains and MDR was not found to be significant (p value = 0.21). CONCLUSION We propose that MIRU typing could be used to estimate the phylogenetic relatedness amongst prevalent CAS1 strains, for which MIRU loci 26, 31, 16, 10, 27, 39 and 40 were found to be the most discriminatory.
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Affiliation(s)
- Asho Ali
- Department of Pathology and Microbiology, The Aga Khan University, Stadium Road, PO Box 3500, Karachi, Pakistan
| | - Zahra Hasan
- Department of Pathology and Microbiology, The Aga Khan University, Stadium Road, PO Box 3500, Karachi, Pakistan
| | - Mahnaz Tanveer
- Department of Pathology and Microbiology, The Aga Khan University, Stadium Road, PO Box 3500, Karachi, Pakistan
| | - Amna R Siddiqui
- Department of Community Health Sciences, The Aga Khan University, Stadium Road, PO Box 3500, Karachi, Pakistan
| | - Solomon Ghebremichael
- Department of Bacteriology, Swedish Institute for Infectious Diseases Control, Stockholm, Sweden
| | - Gunilla Kallenius
- Department of Bacteriology, Swedish Institute for Infectious Diseases Control, Stockholm, Sweden
- Microbiology and Tumor Cell Biology, Karolinska Institute, Nobels Vag 16, Stockholm, Sweden
| | - Rumina Hasan
- Department of Pathology and Microbiology, The Aga Khan University, Stadium Road, PO Box 3500, Karachi, Pakistan
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16
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Hasan Z, Tanveer M, Kanji A, Hasan Q, Ghebremichael S, Hasan R. Spoligotyping of Mycobacterium tuberculosis isolates from Pakistan reveals predominance of Central Asian Strain 1 and Beijing isolates. J Clin Microbiol 2006; 44:1763-8. [PMID: 16672404 PMCID: PMC1479214 DOI: 10.1128/jcm.44.5.1763-1768.2006] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The estimated incidence of tuberculosis in Pakistan is 181 per 100,000; however, there is limited information on Mycobacterium tuberculosis genotypes circulating in the country. We studied 314 M. tuberculosis clinical isolates; of these, 197 (63%) isolates grouped into 22 different clusters, while 119 (37%) had unique spoligotypes. Eighty-nine percent of the isolates were pulmonary (Pul), and 11% were extrapulmonary (E-Pul). We identified Central Asian Strain (CAS), Beijing, T1, Latin American-Mediterranean, and East African-Indian genogroups. Beijing strains, reportedly the most prevalent spoligotype worldwide, constituted 6% of our strain population. The CAS1 strain comprised 121 (39%) of the study isolates. No difference was observed between clustered isolates from cases of Pul and E-Pul tuberculosis. However, E-Pul isolates included a greater number of unique spoligotypes than Pul isolates (P = 0.005). The overall percentage of drug resistance was 54%, and that of MDR strains was 40%. While CAS1 strains were not associated with drug resistance, the relative risk of MDR was significant in Beijing strains compared to the non-Beijing groups (95% confidence interval, 1.2 to 8.9). The fact that the predominant strain, CAS1, is not associated with drug resistance is encouraging and suggests that an effective tuberculosis control program should be able to limit the high incidence of disease in this region.
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Affiliation(s)
- Zahra Hasan
- Department of Pathology and Microbiology, The Aga Khan University, Stadium Road, P.O. Box 3500, Karachi 74800, Pakistan
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Lewerin SS, Olsson SL, Eld K, Röken B, Ghebremichael S, Koivula T, Källenius G, Bölske G. Outbreak of Mycobacterium tuberculosis infection among captive Asian elephants in a Swedish zoo. Vet Rec 2005; 156:171-5. [PMID: 15736698 DOI: 10.1136/vr.156.6.171] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Between 2001 and 2003, there was an outbreak of tuberculosis in a Swedish zoo which involved elephants, giraffes, rhinoceroses and buffaloes. Cultures of trunk lavages were used to detect infected elephants, tuberculin testing was used in the giraffes and buffaloes, and tracheal lavage and tuberculin testing were used in the rhinoceroses. The bacteria isolated were investigated by spoligotyping and restriction fragment length polymorphism. Five elephants and one giraffe were found to have been infected by four different strains of Mycobacterium tuberculosis.
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Krüüner A, Jureen P, Levina K, Ghebremichael S, Hoffner S. Discordant resistance to kanamycin and amikacin in drug-resistant Mycobacterium tuberculosis. Antimicrob Agents Chemother 2003; 47:2971-3. [PMID: 12937004 PMCID: PMC182599 DOI: 10.1128/aac.47.9.2971-2973.2003] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
It is generally thought that there is full cross-resistance in Mycobacterium tuberculosis between the aminoglycoside drugs kanamycin and amikacin. However, kanamycin resistance and amikacin susceptibility were seen in 43 of 79 (54%) multidrug-resistant Estonian isolates, indicating that there might be a need to test the resistance of M. tuberculosis isolates to both drugs.
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Affiliation(s)
- Annika Krüüner
- Department of Bacteriology, Swedish Institute for Infectious Disease Contro, Microbiology and Tumor Biology Center, Karolinska Institute, Stockholm, Sweden.
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Krüüner A, Pehme L, Ghebremichael S, Koivula T, Hoffner SE, Mikelsaar M. Use of molecular techniques to distinguish between treatment failure and exogenous reinfection with Mycobacterium tuberculosis. Clin Infect Dis 2002; 35:146-55. [PMID: 12087520 DOI: 10.1086/340980] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2001] [Revised: 02/15/2002] [Indexed: 11/03/2022] Open
Abstract
We investigated the means by which drug resistance emerges among drug-susceptible Mycobacterium tuberculosis strains during antituberculosis therapy. Patients who experienced failure of treatment for active pulmonary tuberculosis, who initially received diagnoses of infection with drug-susceptible M. tuberculosis, and who had had at least 3 isolates tested for drug susceptibility were selected from a 6-year period in the Estonian National Reference Laboratory archive. Eleven patients from whom 35 sequential isolates of M. tuberculosis had been obtained were recruited into the study. Their clinical data and treatment charts were analyzed and correlated with drug-susceptibility patterns and IS6110 restriction fragment-length polymorphism (RFLP) profiles. Six patients excreted isogenic drug-susceptible M. tuberculosis strains, whereas, in the other 5 patients, the isolated strain shifted from a susceptible to a resistant phenotype. In all cases, this shift correlated to a shift in RFLP pattern, which showed reinfection with a new strain. Exogenous reinfection with drug-resistant M. tuberculosis may be misinterpreted as the emergence of drug resistance if molecular testing techniques are not used.
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Ghebremichael S, Koivula T, Hoffner S, Romanus V, Petrini B, Norén B, Sylvan S, Källenius G. [Resistant tuberculosis is spreading in Sweden. Molecular epidemiological strain identification by "fingerprinting" can make the infection tracing easier]. Lakartidningen 2002; 99:2618-9, 2622-3. [PMID: 12101614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
Abstract
Resistance of Mycobacterium tuberculosis to antibiotics is a world wide problem. A study is reported with the aim to analyse the spread of resistant isolates of M tuberculosis complex from patients with tuberculosis in Sweden. The study is based on a sample of 192 M tuberculosis complex isolates from patients with drug resistant tuberculosis during 1994-2000. All isolates resistant to at least one of the drugs streptomycin, isoniazid, ethambutol and rifampicin were included in the study. Restriction fragment length polymorphism (RFLP) was performed, using IS6110 as a probe for hybridisation. Visualised bands were analysed by Gel Compar software. The majority of the isolates were from patients born in high TB prevalence countries. During the years 1996-2000 there was one major cluster generated from 34 isolates. In 1996-1998 there were two isolates per year, in 1999 it increased to 20 isolates, and eight cases in 2000. All strains were resistant to isoniazid. All patients in this cluster were found to be from Africa. In comparing the pattern in the T-base the strains matched with strain BEA-000007341 isolated from a patient in Rwanda. The majority of patients with drug resistant tuberculosis in Sweden are immigrants from countries with high incidence of tuberculosis. Spread of disease to the Swedish born population is uncommon. However, an increasingly prevalent clone of isoniazid resistant tuberculosis was found among African immigrants, mainly living in the Stockholm area.
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Bruchfeld J, Aderaye G, Palme IB, Bjorvatn B, Ghebremichael S, Hoffner S, Lindquist L. Molecular epidemiology and drug resistance of Mycobacterium tuberculosis isolates from Ethiopian pulmonary tuberculosis patients with and without human immunodeficiency virus infection. J Clin Microbiol 2002; 40:1636-43. [PMID: 11980933 PMCID: PMC130945 DOI: 10.1128/jcm.40.5.1636-1643.2002] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We have analyzed the molecular epidemiology and drug resistance of 121 Mycobacterium tuberculosis isolates from consecutive patients with culture-positive pulmonary tuberculosis attending a university hospital outpatient department in Addis Ababa, Ethiopia. Restriction fragment length polymorphism analysis and spoligotyping were used to analyze the DNA fingerprinting patterns. Fifty-one (41.2%) of the isolates were found in 13 clusters with two or more identical DNA patterns. Two such clusters contained 49.0% of all clustered isolates. In a multivariate logistic regression model, human immunodeficiency virus (HIV)-positive serostatus was significantly associated with clustering of isolates for patients of both sexes (odds ratio [OR], 2.55; 95% confidence interval [CI], 1.17 to 5.80). There was a trend toward increased clustering of isolates from tuberculous women residing in Addis Ababa (OR, 2.10; 95% CI, 0.85 to 5.25). In total, 17 of 121 isolates (14.0%) were resistant to one or more of the antituberculosis drugs isoniazid (8.3%), streptomycin (7.4%), rifampin (2.5%), and ethambutol (1.7%). The high rate of drug-resistant isolates (29.6%) coincided with the peak prevalence of HIV infection (77.8%) in patients 35 to 44 years old. The majority (62.5%) of resistant isolates in this group were found within clusters. The simultaneous accumulation of certain bacterial clones in a patient population likely reflects recent transmission. Hence, we conclude that tuberculosis is commonly caused by recent infection with M. tuberculosis in HIV-positive Ethiopian patients. Furthermore, with the rapidly increasing prevalence of HIV infection in Ethiopia, the burden of tuberculosis, including drug-resistant tuberculosis, is likely to increase. Strengthening of classical tuberculosis control measures by promoting active case finding among HIV-positive adults with tuberculosis is warranted to reduce rates of transmission.
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Affiliation(s)
- Judith Bruchfeld
- Division of Infectious Diseases, Institution of Medicine, Karolinska Institute, Huddinge University Hospital, 141 86 Stockholm, Sweden.
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Krüüner A, Hoffner SE, Sillastu H, Danilovits M, Levina K, Svenson SB, Ghebremichael S, Koivula T, Källenius G. Spread of drug-resistant pulmonary tuberculosis in Estonia. J Clin Microbiol 2001; 39:3339-45. [PMID: 11526173 PMCID: PMC88341 DOI: 10.1128/jcm.39.9.3339-3345.2001] [Citation(s) in RCA: 130] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Restriction fragment length polymorphism (RFLP) analysis of 209 Mycobacterium tuberculosis clinical isolates obtained from newly detected pulmonary tuberculosis patients (151 male and 58 female; mean age, 41 years) in Estonia during 1994 showed that 61 isolates (29%) belonged to a genetically closely related group of isolates, family A, with a predominant IS6110 banding pattern. These strains shared the majority of their IS6110 DNA-containing restriction fragments, representing a predominant banding pattern (similarity, >65%). This family A comprised 12 clusters of identical isolates, and the largest cluster comprised 10 strains. The majority (87.5%) of all multidrug-resistant (MDR) isolates, 67.2% of all isolates with any drug resistance, but only 12% of the fully susceptible isolates of M. tuberculosis belonged to family A. These strains were confirmed by spoligotyping as members of the Beijing genotype family. The spread of Beijing genotype MDR M. tuberculosis strains was also frequently seen in 1997 to 1999. The members of this homogenous group of drug-resistant M. tuberculosis strains have contributed substantially to the continual emergence of drug-resistant tuberculosis all over Estonia.
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Affiliation(s)
- A Krüüner
- Institute of Microbiology, Tartu University, Tartu, Estonia
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Källenius G, Koivula T, Ghebremichael S, Hoffner SE, Norberg R, Svensson E, Dias F, Marklund BI, Svenson SB. Evolution and clonal traits of Mycobacterium tuberculosis complex in Guinea-Bissau. J Clin Microbiol 1999; 37:3872-8. [PMID: 10565899 PMCID: PMC85833 DOI: 10.1128/jcm.37.12.3872-3878.1999] [Citation(s) in RCA: 72] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Two hundred twenty-nine consecutive isolates of Mycobacterium tuberculosis complex from patients with pulmonary tuberculosis in Guinea-Bissau, which is located in West Africa, were analyzed for clonal origin by biochemical typing and DNA fingerprinting. By using four biochemical tests (resistance to thiophene-2-carboxylic acid hydrazide, niacin production, nitrate reductase test, and pyrazinamidase test), the isolates could be assigned to five different biovars. The characteristics of four strains conformed fully with the biochemical criteria for M. bovis, while those of 85 isolates agreed with the biochemical criteria for M. tuberculosis. The remaining 140 isolates could be allocated into one of three biovars (biovars 2 to 4) representing a spectrum between the classical bovine (biovar 1) and human (biovar 5) tubercle bacilli. By using two genotyping methods, restriction fragment length polymorphism analysis with IS6110 (IS6110 RFLP analysis) and spoligotyping, the isolates could be separated into three groups (groups A to C) of the M. tuberculosis complex. Group A (n = 95), which contained the majority of classical human M. tuberculosis isolates, had large numbers of copies of IS6110 elements (mean number of copies, 9) and a distinctive spoligotyping pattern that lacked spacers 33 to 36. Isolates of the major group, group B (n = 119), had fewer IS6110 copies (mean copy number, 5) and a spoligotyping pattern that lacked spacers 7 to 9 and 39 and mainly comprised isolates of biovars 1 to 4. Group C isolates (n = 15) had one to three IS6110 copies, had a spoligotyping pattern that lacked spacers 29 to 34, and represented biovar 3 to 5 isolates. Four isolates whose biochemical characteristics conformed with those of M. bovis clustered with the group B isolates and had spoligotype patterns that differed from those previously reported for M. bovis, in that they possessed spacers 40 to 43. Interestingly, isolates of group B and, to a certain extent, also isolates of group C showed a high degree of variability in biochemical traits, despite genotypic identity in terms of IS6110 RFLP and spoligotype patterns. We hypothesize that isolates of groups B and C have their evolutionary origin in West Africa, while group A isolates are of European descent.
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Affiliation(s)
- G Källenius
- Department of Bacteriology, Swedish Institute for Infectious Disease Control, S-17182 Solna, Sweden.
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Abstract
Clarithromycin and rifabutin are among the most promising drugs for the therapy of infections caused by Mycobacterium avium or other atypical mycobacteria. Since synergism of combined drugs is important in order to achieve strong antimycobacterial activity, the combined inhibitory effects of antibacterial agents should also be investigated when agents are evaluated for possible use in antimycobacterial drug therapy. In the present study we examined the antimycobacterial activity of clarithromycin, rifabutin, and their combination against 51 clinical isolates of the M. avium complex from patients with acquired immune deficiency syndrome (AIDS) with disseminated mycobacteriosis. A concentration-dependent inhibition was seen for each drug. The antibacterial effect was significantly more pronounced for the combined drugs than for the agents tested separately. Synergism, against up to 88% of the strains tested, was seen for the tested drugs combined at different concentrations. All 51 M. avium strains were susceptible to the combination of 4 mg/l clarithromycin and 2 mg/l rifabutin.
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Affiliation(s)
- S Ghebremichael
- Swedish Institute for Infectious Disease Control, Karolinska Institute, Stockholm, Sweden
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Hoffner SE, Svenson SB, Norberg R, Dias F, Ghebremichael S, Källenius G. Biochemical heterogeneity of Mycobacterium tuberculosis complex isolates in Guinea-Bissau. J Clin Microbiol 1993; 31:2215-7. [PMID: 8370754 PMCID: PMC265727 DOI: 10.1128/jcm.31.8.2215-2217.1993] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Fifty-six strains of the Mycobacterium tuberculosis complex from patients in Guinea-Bissau were examined by using four biochemical tests (niacin production, nitrate reductase, pyrazinamidase, and resistance to thiophen-2-carboxylic acid hydrazide). The isolates were divided into five different biovars within a spectrum ranging from classical human M. tuberculosis to classical M. bovis.
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Affiliation(s)
- S E Hoffner
- National Bacteriological Laboratory, Stockholm, Sweden
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