Abstract

Currently, mutations in three genes, namely rrs, rpsL, and gidB, encoding 16S rRNA, ribosomal protein S12, and 16S rRNA-specific methyltransferase, respectively, are considered to be involved in conferring resistance to streptomycin (STR) in Mycobacterium tuberculosis. The aim of this study was to investigate the spectrum and frequency of these mutations in M. tuberculosis clinical isolates, both resistant and susceptible to STR. Sixty-four M. tuberculosis isolates recovered from as many TB patients from Poland in 2004 were included in the study. Within the sample were 50 multidrug-resistant (32 STR-resistant and 18 STR-susceptible) and 14 pan-susceptible isolates. Preliminary testing for STR resistance was performed with the 1% proportion method. The MICs of STR were determined by the Etest method. Mutation profiling was carried out by amplifying and sequencing the entire rrs, rpsL, and gidB genes. Non-synonymous mutations in either rrs or rpsL gene were detected in 23 (71.9%) of the STR-resistant and none of the STR-susceptible isolates. Mutations in the gidB gene were distributed among 12 (37.5%) STR-resistant and 13 (40.6%) STR-susceptible isolates. Four (12.5%) STR-resistant isolates were wild-type at all three loci examined. None of the rrs, rpsL or gidB mutations could be linked to low, intermediate or high level of STR resistance. In accordance with previous findings, the gidB 47T→G (L16R) mutation was associated with the Latin American-Mediterranean genotype family, whereas 276A→C (E92D) and 615A→G (A205A) mutations of the gidB gene were associated with the Beijing lineage. The study underlines the usefulness of rrs and rpsL mutations as molecular markers for STR resistance yet not indicative of its level. The gidB polymorphisms can serve as phylogenetic markers.

Highlights

  • Streptomycin (STR), an aminocyclitol glycoside antibiotic, was the first drug used successfully for the treatment of tuberculosis (TB) in the 1940s

  • In M. tuberculosis resistance to STR is associated with alterations within the rrs, rpsL, and gidB genes whose products are involved in the 30S ribosomal subunit composition

  • All rrs gene mutations found in this study localized in two highly mutable regions known as the 530 loop (514ARC; 517CRT) and the 912 loop (906ARG; 907ART)

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Summary

Introduction

Streptomycin (STR), an aminocyclitol glycoside antibiotic, was the first drug used successfully for the treatment of tuberculosis (TB) in the 1940s. STR has become the drug of first choice for all forms of TB, and, after the introduction of isoniazid (INH), rifampicin (RMP), pyrazinamide (PZA), ethambutol (EMB), and other anti-TB drugs, an important component of combination therapies for the disease. Under the current WHO guidelines, the standard treatment regimen for drug-susceptible TB excludes STR and comprises a combination of INH, RMP, PZA, and EMB during the intensive phase of treatment, followed by INH together with RMP in the continuation phase [1]. Is the drug a component of the retreatment regimens, and, in many parts of the world, it is among the firstline agents to be administered in drug-resistant TB (DR-TB) cases, yet susceptible to aminoglycosides [1]

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