Abstract
BackgroundAfter the collapse of the Soviet Union, dramatically increasing rates of tuberculosis and multidrug-resistant tuberculosis (MDR-TB) have been reported from several countries. This development has been mainly attributed to the widespread breakdown of TB control systems and declining socio-economic status. However, recent studies have raised concern that the Beijing genotype of Mycobacterium tuberculosis might be contributing to the epidemic through its widespread presence and potentially enhanced ability to acquire resistance.MethodsA total of 397 M. tuberculosis strains from a cross sectional survey performed in the Aral Sea region in Uzbekistan and Turkmenistan have been analysed by drug susceptibility testing, IS6110 fingerprinting, and spoligotyping.ResultsFifteen isolates showed mixed banding patterns indicating simultaneous infection with 2 strains. Among the remaining 382 strains, 152 (40%) were grouped in 42 clusters with identical fingerprint and spoligotype patterns. Overall, 50% of all isolates were Beijing genotype, with 55% of these strains appearing in clusters compared to 25% of non-Beijing strains. The percentage of Beijing strains increased with increasing drug resistance among both new and previously treated patients; 38% of fully-susceptible isolates were Beijing genotype, while 75% of MDR-TB strains were of the Beijing type.ConclusionThe Beijing genotype is a major cause of tuberculosis in this region, it is strongly associated with drug resistance, independent of previous tuberculosis treatment and may be strongly contributing to the transmission of MDR-TB. Further investigation around the consequences of Beijing genotype infection for both tuberculosis transmission and outcomes of standard short course chemotherapy are urgently needed.
Highlights
After the collapse of the Soviet Union, dramatically increasing rates of tuberculosis and multidrug-resistant tuberculosis (MDR-TB) have been reported from several countries
Primary isolation and drug susceptibility testing Sputum specimens were shipped from Uzbekistan and Turkmenistan throughout the survey to the SupraNational Reference Laboratory (SRL) in Borstel, Germany
Out of the 416 strains included in the drug resistance survey, 397 were available for the IS6110 DNA fingerprint and spoligotyping analysis performed in this study (19 strains did not grow at the time the DNA fingerprinting was started)
Summary
After the collapse of the Soviet Union, dramatically increasing rates of tuberculosis and multidrug-resistant tuberculosis (MDR-TB) have been reported from several countries. This development has been mainly attributed to the widespread breakdown of TB control systems and declining socio-economic status. There is a 1.8% annual rise in new tuberculosis cases, with a 6% yearly increase in the former Soviet Union (1). These data are increasingly accompanied by the phenomenon of drug-resistance, making successful treatment and control of the disease even more difficult. Of particular concern are parts of Eastern Europe and Central Asia where tuberculosis patients are 10 times more likely to have MDR-TB than in the rest of the world [4]
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