Rifampin- and multidrug-resistant tuberculosis in Russian civilians and prison inmates: dominance of the beijing strain family.

Francis Drobniewski,Timothy Brown,Ivan Fedorin,Yanina Balabanova,Ebgeny Mutovkin,Nadezdna Malomanova,Elvira Elizarova,Svetlana Zhakharova,Alexander Melentyey,Katya Jeltkova,Laura Weldon,Michael Ruddy

doi:10.3201/eid0811.020507

Abstract

Consecutive patient cultures (140) of Mycobacteriium tuberculosis were collected from five Russian civilian and prison tuberculosis laboratories and analyzed for rifampin (rpoB) and isoniazid resistance (inhA, katG, ahpC); transmission of Beijing family isolates; and the importance of prison and previous therapy in drug resistance. Rifampin, isoniazid, and multidrug resistance occurred in 58.2%, 51.6%, and 44.7% of cultures, respectively; 80% of prison cultures were rifampin resistant. Spoligotyping and variable number tandem repeat (VNTR) fingerprinting divided the isolates into 43 groups. Spoligotyping demonstrated that a high proportion (68.1%) of patients were infected with Beijing family strains and that most (69.1%) were rifampin resistant; the highest proportion (81.6%) occurred in prison. One VNTR subgroup (42435) comprised 68 (72.3%) of the Beijing isolates with a small number of IS6110 types; 50 (73.5%) were rifampin resistant. Rifampin-resistant Beijing isolates are dominant within the patient population, especially among prisoners, and threaten treatment programs.

Highlights

Consecutive patient cultures [140] of Mycobacterium tuberculosis were collected from five Russian civilian and prison tuberculosis laboratories and analyzed for rifampin and isoniazid resistance; transmission of Beijing family isolates; and the importance of prison and previous therapy in drug resistance
We initiated a pilot study in Samara, Russia, 1 of 89 oblasts to determine the following: the value of genotypic methods for identifying rifampin resistance and multidrug-resistant TB; the extent of rifampin and multiple-drug resistance within the civilian and prison systems; the extent to which this drug resistance was associated with dominant strains, such as those of the Beijing family, by using molecular DNA fingerprinting techniques; and whether drug resistance was associated with being a prisoner or with previous TB treatment
Drug Resistance One hundred forty cultures were collected from the five sites, and genotypic analysis was performed in London by British and Russian scientists to determine rifampin and isoniazid resistance (Table 1)

Summary

Introduction

Consecutive patient cultures [140] of Mycobacterium tuberculosis were collected from five Russian civilian and prison tuberculosis laboratories and analyzed for rifampin (rpoB) and isoniazid resistance (inhA, katG, ahpC); transmission of Beijing family isolates; and the importance of prison and previous therapy in drug resistance. Spoligotyping demonstrated that a high proportion (68.1%) of patients were infected with Beijing family strains and that most (69.1%) were rifampin resistant; the highest proportion (81.6%) occurred in prison. We initiated a pilot study in Samara, Russia, 1 of 89 oblasts to determine the following: the value of genotypic methods for identifying rifampin resistance and multidrug-resistant TB; the extent of rifampin and multiple-drug resistance within the civilian and prison systems; the extent to which this drug resistance was associated with dominant strains, such as those of the Beijing family, by using molecular DNA fingerprinting techniques; and whether drug resistance was associated with being a prisoner or with previous TB treatment

Methods

Results

Conclusion