Abstract
Factors driving the increase in drug-resistant tuberculosis (TB) in the Eastern Cape Province, South Africa, are not understood. A convenience sample of 309 drug-susceptible and 342 multidrug-resistant (MDR) TB isolates, collected July 2008–July 2009, were characterized by spoligotyping, DNA fingerprinting, insertion site mapping, and targeted DNA sequencing. Analysis of molecular-based data showed diverse genetic backgrounds among drug-sensitive and MDR TB sensu stricto isolates in contrast to restricted genetic backgrounds among pre–extensively drug-resistant (pre-XDR) TB and XDR TB isolates. Second-line drug resistance was significantly associated with the atypical Beijing genotype. DNA fingerprinting and sequencing demonstrated that the pre-XDR and XDR atypical Beijing isolates evolved from a common progenitor; 85% and 92%, respectively, were clustered, indicating transmission. Ninety-three percent of atypical XDR Beijing isolates had mutations that confer resistance to 10 anti-TB drugs, and some isolates also were resistant to para-aminosalicylic acid. These findings suggest the emergence of totally drug-resistant TB.
Highlights
The fourth report of the WHO/IUATLD Global Project on Anti-Tuberculosis Drug Resistance Surveillance provides the latest data on the magnitude of drug resistance in 81 countries and 2 Special Administrative Regions (SARs) of China collected between 2002 and 2007, as well as the most up to date trends from 47 countries collected over a thirteen year period.The Global Project was initiated in 1994 in order to estimate the global burden of drug resistant TB worldwide using standardized methodologies so that data could be compared across and within regions
Of the 20 settings surveyed with the highest proportion of multi-drug resistant TB2 (MDR-TB) among new cases in the history of the project, 14 are located in countries of the former Soviet Union and four are in China
Magnitude of drug resistant TB The population weighted mean of MDR-TB among all TB cases from the 114 countries and 2 SARs of China that have reported to the global project is 5.3% (95% CLs, 3.9-6.6), but ranges from 0% in some western European countries to over 35% in some countries of the former Soviet Union
Summary
The fourth report of the WHO/IUATLD Global Project on Anti-Tuberculosis Drug Resistance Surveillance provides the latest data on the magnitude of drug resistance in 81 countries and 2 SARs of China collected between 2002 and 2007, as well as the most up to date trends from 47 countries collected over a thirteen year period.The Global Project was initiated in 1994 in order to estimate the global burden of drug resistant TB worldwide using standardized methodologies so that data could be compared across and within regions. The fourth report of the WHO/IUATLD Global Project on Anti-Tuberculosis Drug Resistance Surveillance provides the latest data on the magnitude of drug resistance in 81 countries and 2 SARs of China collected between 2002 and 2007, as well as the most up to date trends from 47 countries collected over a thirteen year period. The report is published every three years as most countries require between 12 and 18 months to complete a drug resistance survey. Following the roll out and successful implementation of "DOTS-Plus" pilot projects for the management of drug resistant TB between 2000 and 2005, a new Stop TB Strategy was launched in 2006. Through the Global Fund and with the help of the Green Light Committee, most countries are initiating or scaling up the diagnosis and management of drug resistant TB. Until diagnosis of drug resistance is routine, surveys or surveillance systems will play an important role in determining the magnitude and trends in drug resistant TB
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