Population structure of drug-resistant Mycobacterium tuberculosis in Central Asia

Anna Engström,Harald Hoffmann,Asliddin Rajabov,Nargiza Parpieva,Gulmira Kalmambetova,Matthias Merker,Zayniddin Sayfudtinov,Katharina Kranzer,Evgeni Sahalchyk,Uladzimir Antonenka,Olim Kabirov,Abdylat Kadyrov,Stefan Niemann

doi:10.1186/s12879-019-4480-7

Abstract

BackgroundDrug-resistant tuberculosis (TB) is a major public health concern threathing the success of TB control efforts, and this is particularily problematic in Central Asia. Here, we present the first analysis of the population structure of Mycobacterium tuberculosis complex isolates in the Central Asian republics Uzbekistan, Tajikistan, and Kyrgyzstan.MethodsThe study set consisted of 607 isolates with 235 from Uzbekistan, 206 from Tajikistan, and 166 from Kyrgyzstan. 24-loci MIRU-VNTR (Mycobacterial Interspersed Repetitive Units - Variable Number of Tandem Repeats) typing and spoligotyping were combined for genotyping. In addition, phenotypic drug suceptibility was performed.ResultsThe population structure mainly comprises strains of the Beijing lineage (411/607). 349 of the 411 Beijing isolates formed clusters, compared to only 33 of the 196 isolates from other clades. Beijing 94–32 (n = 145) and 100–32 (n = 70) formed the largest clusters. Beijing isolates were more frequently multidrug-resistant, pre-extensively resistant (pre-XDR)- or XDR-TB than other genotypes.ConclusionsBeijing clusters 94–32 and 100–32 are the dominant MTB genotypes in Central Asia. The relative size of 100–32 compared to previous studies in Kazakhstan and its unequal geographic distribution support the hypothesis of its more recent emergence in Central Asia. The data also demonstrate that clonal spread of resistant TB strains, particularly of the Beijing lineage, is a root of the so far uncontroled MDR-TB epidemic in Central Asia.

Highlights

Drug-resistant tuberculosis (TB) is a major public health concern threathing the success of TB control efforts, and this is particularily problematic in Central Asia
This is particularily problematic in the Central Asian Republics (CARs) Uzbekistan, Tajikistan, and Kyrgyzstan where multidrug-resistant (MDR)-TB rates reach 24%, 22%, 27%, and 63%, 45% and 60% among new and previously treated cases, respectively [1]
Twenty four-loci MIRU-VNTR typing and spoligotyping were successfully performed for 607 isolates, while 76 isolates (62 from Uzbekistan, seven from Tajikistan, and seven from Kyrgyzstan) yielded indeterminate results

Summary

Introduction

Drug-resistant tuberculosis (TB) is a major public health concern threathing the success of TB control efforts, and this is particularily problematic in Central Asia. Drug-resistant tuberculosis (TB) is a public health concern threathing the success of TB control efforts This is particularily problematic in the Central Asian Republics (CARs) Uzbekistan, Tajikistan, and Kyrgyzstan where multidrug-resistant (MDR)-TB rates reach 24%, 22%, 27%, and 63%, 45% and 60% among new and previously treated cases, respectively [1]. MIRU-VNTR data allow to generate parsimonious phylogenetic networks such as minimumspanning trees (MST) [6]. These results were combined with phenotypic drug susceptibility data to determine the presence of highly resistant dominant clones

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Results

Discussion

Conclusion