Abstract
Tuberculosis (TB) represents a significant challenge to public health authorities, especially with the emergence of drug-resistant (DR) and multidrug-resistant (MDR) isolates of Mycobacterium tuberculosis. We sought to examine the genomic variations among recently isolated strains of M. tuberculosis in two closely related countries with different population demography in the Middle East. Clinical isolates of M. tuberculosis from both Egypt and Saudi Arabia were subjected to phenotypic and genotypic analysis on gene and genome-wide levels. Isolates with MDR phenotypes were highly prevalent in Egypt (up to 35%) despite its relatively stable population structure (sympatric pattern). MDR-TB isolates were not identified in the isolates from Saudi Arabia despite its active guest worker program (allopatric pattern). However, tuberculosis isolates from Saudi Arabia, where lineage 4 was more prevalent (>65%), showed more diversity than isolates from Egypt, where lineage 3 was the most prevalent (>75%). Phylogenetic and molecular dating analyses indicated that lineages from Egypt were recently diverged (~78 years), whereas those from Saudi Arabia were diverged by over 200 years. Interestingly, DR isolates did not appear to cluster together or spread more widely than drug-sensitive isolates, suggesting poor treatment as the main cause for emergence of drug resistance rather than more virulence or more capacity to persist.
Highlights
Tuberculosis (TB) represents a significant challenge to public health authorities, especially with the emergence of drug-resistant (DR) and multidrug-resistant (MDR) isolates of Mycobacterium tuberculosis
Findings from our analysis suggest the significance of the problem of DR and MDR among M. tuberculosis isolates in the Middle East, in stable communities, is much higher than identified before on a global level (18%)[19] with little influence of migrant workers on disease transmission dynamics
To characterize M. tuberculosis in the Middle East, we analyzed the genomes of archived isolates from sputum samples of 69 patients at the King Abdulaziz University Hospital (KAUH) in Jeddah, Saudi Arabia, that frequented the chest ward between January 2012 and March 2013
Summary
Tuberculosis (TB) represents a significant challenge to public health authorities, especially with the emergence of drug-resistant (DR) and multidrug-resistant (MDR) isolates of Mycobacterium tuberculosis. In the Middle East, drug-resistant isolates of M. tuberculosis are of significant importance and require further scrutiny This is important in Saudi Arabia[5,6] and Egypt[7,8] where disease transmission dynamics are not affected by high levels of infection with human immunodeficiency virus (HIV) found in sub-Saharan Africa[9]. Findings from our analysis suggest the significance of the problem of DR and MDR among M. tuberculosis isolates in the Middle East, in stable communities (up to 35%), is much higher than identified before on a global level (18%)[19] with little influence of migrant workers on disease transmission dynamics
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