Abstract
Recent reports have shown that certain bacterial strains attain the New Delhi Metallo-beta-lactamase-1 (NDM-1) enzyme and become resistant to a broad range of antibiotics. Similarly, more dangerous "superbugs" of multi-drug resistant (MDR) and extensive drug resistant (XDR) Mycobacterium tuberculosis strains are gradually emerging through rapid genetic mutation caused by prescription non-compliance or unsupervised indiscriminate use of anti-tubercular drugs or other antibiotics. Mycobacterium tuberculosis cases have been reported in highly susceptible population groups including the aboriginal communities of US and Canada. In Canada alone, the total number of reported tuberculosis cases has decreased over the past decade. However, there is a steady increase in HIV cases in certain communities including the aboriginal communities. Reintroduction of MDR/XDR strains of tuberculosis is possible in these susceptible communities, which in turn may pose serious public health situation. MDR/XDR strains of tuberculosis are virtually untreatable using current anti-tubercular medication protocols. Thus, MDR/XDR tuberculosis presents a grave global public health threat. The unpredictable genetic mechanism involved in generating MDR/XDR resistant strains of Mycobacterium tuberculosis may pose greater challenges in developing appropriate treatment strategies. In this article, we briefly review potential genetic mechanism of emerging NDM-1 bacterial strains and draw a rationale parallel to the underlying genetic mechanism of MDR/XDR Mycobacterium tuberculosis strain development.
Highlights
The term “superbug” is often used to a specific strain of microbes that have undergone gradual changes within its genome conferring them multi drug resistance. [1,2,3] The emergence of multidrug resistant Escherichia coli, [4] Staphyloccocus aureus, [5] Clostridium difficile, [6, 7] Streptococccus pneumoniae [8] and Klebsiella pneumoniae [9] is documented
New Delhi Metallo-beta-lactamase-1 (NDM-1) enzyme has come to the attention of epidemiologist and infectious disease control experts
The emergence of multi-drug resistant (MDR) strains is partly due to misuse of anti-infectives and rapid migration of infected individuals between continents, which allow for random changes within the microbial genome and developing new mechanisms to generate resistant strains
Summary
The term “superbug” is often used to a specific strain of microbes that have undergone gradual changes within its genome conferring them multi drug resistance. [1,2,3] The emergence of multidrug resistant Escherichia coli, [4] Staphyloccocus aureus, [5] Clostridium difficile, [6, 7] Streptococccus pneumoniae [8] and Klebsiella pneumoniae [9] is documented. The precise mechanisms that link antibiotic resistant Mycobacterium tuberculosis strains to mutations in specific regions of the Class 1 integron gene cassette is briefly discussed below. [35] To understand the mechanism of resistance to ethambutol, a two gene locus (embAB) that encodes arabinosyl transfer has been established Automated sequencing of these regions in clinical isolates discovered that 69% of ethambutol resistant isolates had an amino acid substitution in EmbB that was not found in ethambutol susceptible strains. Several literatures agree that the probability of Mycobacterium tuberculosis to undergo multiple mutations is quite high This may confer specific mycobacterial strains a degree of multi-drug resistance and prove to be unmanageable with current treatment protocols. Monitoring MDR/XDR resistant TB among the population has its limitations, which could provide a window of opportunity of the MDR/XDR strains to rapidly spread within the population group that are susceptible to TB
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