Distribution of Strain Families of<i>Mycobacterium tuberculosis</i>Causing Pulmonary and Extrapulmonary Disease in Hospitalized Children in Cape Town, South Africa

Nicol, Mark P.; Sola, Christophe; February, Bradley; Rastogi, Nalin; Steyn, Lafras M.; Wilkinson, Robert J.

doi:10.1128/jcm.43.11.5779-5781.2005

Cited by 64 publications

(43 citation statements)

References 14 publications

(10 reference statements)

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“…Similar to a recent report from an adjacent study setting in Cape Town, South Africa (22), this study demonstrates that Beijing is the dominant genotype family in children with culture-confirmed TB. An important finding is that the prevalence of the Beijing genotype in children seems to differ from that described in adults from the same geographic area.…”

Section: Vol 44 2006 Genotype and Drug Resistance In Children With supporting

confidence: 75%

Beijing and Haarlem Genotypes Are Overrepresented among Children with Drug-Resistant Tuberculosis in the Western Cape Province of South Africa

et al. 2006

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Section: Vol 44 2006 Genotype and Drug Resistance In Children With supporting

confidence: 75%

Beijing and Haarlem Genotypes Are Overrepresented among Children with Drug-Resistant Tuberculosis in the Western Cape Province of South Africa

et al. 2006

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“…The distribution of M. tuberculosis genotypes in some areas of South Africa has been described previously (21,28); however, apart from a recent study that investigated the spoligotype patterns among 41 XDR M. tuberculosis isolates, there are, to our knowledge, no studies which have mapped the distribution of M. tuberculosis genotypes across the South African provinces. In this study, 252 isolates from eight of the nine provinces of South Africa were genotyped by spoligotyping.…”

Section: Discussionmentioning

confidence: 87%

High Diversity ofMycobacterium tuberculosisGenotypes in South Africa and Preponderance of Mixed Infections among ST53 Isolates

et al. 2009

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The reemergence of tuberculosis (TB) has become a major health problem worldwide, especially in Asia and Africa. Failure to combat this disease due to nonadherence or inappropriate drug regimens has selected for the emergence of multiple-drug-resistant (MDR) TB. The development of new molecular genotyping techniques has revealed the presence of mixed Mycobacterium tuberculosis infections, which may accelerate the emergence of drug-resistant strains. There are some studies describing the local distribution of circulating strains in South Africa, but to date, reports describing the frequency and distribution of M. tuberculosis genotypes, and specifically MDR genotypes, across the different provinces are limited. Thus, 252 isolates (of which 109 were MDR) from eight of the nine provinces of South Africa were analyzed by spoligotyping. Spoligotyping showed 10 different lineages, and ST53 (11.1%) and ST1 (10.3%) were the most frequent genotypes. Of the 75 different spoligopatterns observed, 20 (7.9%) were previously unreported. Analysis of the mycobacterial interspersed repetitive units of variable-number tandem repeats of the ST53 and ST1 isolates revealed that ϳ54% of the ST53 isolates were of mixed M. tuberculosis subpopulations. Drug resistance (defined as resistance to at least isoniazid and/or rifampin) could only be linked to a history of previous anti-TB treatment (adjusted odds ratio, 4.0; 95% confidence interval, 2.27 to 7.10; P ‫؍‬ <0.0001). This study describes a high diversity of circulating genotypes in South Africa in addition to a high frequency of mixed M. tuberculosis subpopulations among the ST53 isolates. MDR TB in South Africa could not be attributed to the spread of any single lineage.Tuberculosis (TB) is a major cause of illness and death worldwide but especially in Asia and Africa (42). Twenty-two countries designated high TB burden countries account for 80% of all new cases worldwide (42). As of 2008, South Africa was ranked fourth among these, with an incidence rate of 940 cases per 100,000 persons (42) (up from 536 in 2005 [41]). Due to nonadherence to drug regimens or the use of inappropriate drug regimens, the TB epidemic has been largely exacerbated by the emergence of multidrug-resistant (MDR) TB (7).Traditionally, it has been assumed that TB is caused by an infection with a single strain and that recurrences are the result of reactivation of the strain causing the first episode (6, 24, 39). However, it has recently been shown that patients, both human immunodeficiency virus (HIV) positive and HIV negative, in high-incidence settings may have more than one strain in the same sputum sample (24, 39) and that mixed infections may cause complications in the treatment of the disease if a patient is infected with both a sensitive and a resistant Mycobacterium tuberculosis isolate (39). Extensively drug-resistant (XDR) TB strains (defined as resistant to isoniazid [INH] and rifampin [RIF], in addition to any fluoroquinolones and at least one injectable anti-TB drug) (5) were first reported in...

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“…For example, extrapulmonary disease has been associated with polymorphisms in the mycobacterial plcD gene (37) and the Beijing family of strains (14), but these associa-tions appear to hold for some patient populations but not others. Investigators in South Africa failed to find any significant relationship between mycobacterial genotype and extrapulmonary tuberculosis (23).…”

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confidence: 99%

Relationship between Mycobacterium tuberculosis Genotype and the Clinical Phenotype of Pulmonary and Meningeal Tuberculosis

et al. 2008

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We used large sequence polymorphisms to determine the genotypes of 397 isolates of Mycobacterium tuberculosis from human immunodeficiency virus-uninfected Vietnamese adults with pulmonary (n ‫؍‬ 235) or meningeal (n ‫؍‬ 162) tuberculosis. We compared the pretreatment radiographic appearances of pulmonary tuberculosis and the presentation, response to treatment, and outcome of tuberculous meningitis between the genotypes. Multivariate analysis identified variables independently associated with genotype and outcome. A higher proportion of adults with pulmonary tuberculosis caused by the Euro-American genotype had consolidation on chest X-ray than was the case with disease caused by other genotypes (P ‫؍‬ 0.006). Multivariate analysis revealed that meningitis caused by the East Asian/Beijing genotype was independently associated with a shorter duration of illness before presentation and fewer cerebrospinal fluid (CSF) leukocytes. Older age, fewer CSF leukocytes, and the presence of hemiplegia (but not strain lineage) were independently associated with death or severe disability, although the East Asian/Beijing genotype was strongly associated with drugresistant tuberculosis. The genotype of M. tuberculosis influenced the presenting features of pulmonary and meningeal tuberculosis. The association between the East Asian/Beijing lineage and disease progression and CSF leukocyte count suggests the lineage may alter the presentation of meningitis by influencing the intracerebral inflammatory response. In addition, increased drug resistance among bacteria of the East Asian/Beijing lineage might influence the response to treatment. This study suggests the genetic diversity of M. tuberculosis has important clinical consequences.

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Distribution of Strain Families ofMycobacterium tuberculosisCausing Pulmonary and Extrapulmonary Disease in Hospitalized Children in Cape Town, South Africa

Cited by 64 publications

References 14 publications

Beijing and Haarlem Genotypes Are Overrepresented among Children with Drug-Resistant Tuberculosis in the Western Cape Province of South Africa

Beijing and Haarlem Genotypes Are Overrepresented among Children with Drug-Resistant Tuberculosis in the Western Cape Province of South Africa

High Diversity ofMycobacterium tuberculosisGenotypes in South Africa and Preponderance of Mixed Infections among ST53 Isolates

Relationship between Mycobacterium tuberculosis Genotype and the Clinical Phenotype of Pulmonary and Meningeal Tuberculosis

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