Abstract
Genotypic variation in Beijing lineages of Mycobacterium tuberculosis (MTB), the causative agent of tuberculosis (TB), has been associated with hyper virulence and the spread of extensively and multiple drug (X/MDR) resistant MTB strains in Eastern Europe, Central Asia, and East Asia. The clinical outcomes of 215 new cases of TB among the population of the Kharkiv region of Eastern Ukraine were analyzed to uncover factors associated with severe infection. Infecting MTB strains were profiled by 5 locus exact tandem repeats (ETRs) and 15 locus mycobacterial interspersed repetitive unit-variable number tandem repeat (MIRU-VNTR) genotyping. Among diverse MTB genotypes discovered in Ukraine, the Beijing genotype (MIRU-VNTR 42425) was significantly associated with risk factors for severe outcomes of disease in the study population, including TB/HIV co-infection and treatment failure. Strain replacement (superinfection) was observed in 10 patients, suggesting repeated exposure to novel MTB strains in hospital or community settings. Inclusion of MTB genotyping data may identify at-risk patients and improve treatment adherence to prevent X/MDR development for effective public health response against tuberculosis in Ukraine.
Highlights
Despite the considerable effort of the global strategy to combat tuberculosis (TB), conducted under the auspices of the World Health Organization (WHO) and other organizations, TB remains a burdensome problem among infectious diseases throughout the world
The aim of this study was to analyze the outcomes of 215 new cases of TB identified in the population of Kharkiv Region, Ukraine, and to find any associations between the strain genotype using exact tandem repeats (ETR) and mycobacterial interspersed repetitive unit-variable number tandem repeat (MIRU-VNTR)-profiles of Mycobacterium tuberculosis (MTB), and risk factors and outcomes of TB treatment
We found that among diverse MTB genotypes in Ukraine, the Beijing genotype (MIRU-VNTR 42425) was associated with risk factors and severe disease outcomes
Summary
Despite the considerable effort of the global strategy to combat tuberculosis (TB), conducted under the auspices of the World Health Organization (WHO) and other organizations, TB remains a burdensome problem among infectious diseases throughout the world. A significant danger has been recognized in the territory of Ukraine with the spread of drug resistant forms of TB. Ukraine is among the five countries with the highest burden of multidrug-resistant tuberculosis (MDR-TB) [1]. The situation for patients with tuberculosis (TB), especially multi- and extensively drug-resistant (M/XDR) TB, has dramatically worsened in Ukraine because of the military conflict that started in 2014 in eastern Ukraine. The European Centers for Disease Prevention and Control reported 3522 patients with M/XDR-TB living in Ukraine in 2012, compared to 1421 in all European Union/European Economic Area countries [2]
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