Emergence and Spread of Extensively and Totally Drug-Resistant Tuberculosis, South Africa

作者：Klopper Marisa; Warren Robin Mark^*; Hayes Cindy; Gey van Pittius Nicolaas Claudius; Streicher Elizabeth Maria; Mueller Borna; Sirgel Frederick Adriaan; Chabula Nxiweni Mamisa; Hoosain Ebrahim; Coetzee Gerrit; van Heiden Paul David; Victor Thomas Calido; Trollip Andre Phillip

来源：Emerging Infectious Diseases, 2013, 19(3): 449-455.

DOI：10.3201/eid1903.120246

Factors driving the increase in drug-resistant tuberculosis (TB) in the Eastern Cape Province, South Africa, are not understood. A convenience sample of 309 drug-susceptible and 342 multidrug-resistant (MDR) TB isolates, collected July 2008-July 2009, were characterized by spoligotyping, DNA fingerprinting, insertion site mapping, and targeted DNA sequencing. Analysis of molecular-based data showed diverse genetic backgrounds among drug-sensitive and MDR TB sensu stricto isolates in contrast to restricted genetic backgrounds among pre-extensively drug-resistant (pre-XDR) TB and XDR TB isolates. Second-line drug resistance was significantly associated with the atypical Beijing genotype. DNA fingerprinting and sequencing demonstrated that the pre-XDR and XDR atypical Beijing isolates evolved from a common progenitor; 85% and 92%, respectively, were clustered, indicating transmission. Ninety-three percent of atypical XDR Beijing isolates had mutations that confer resistance to 10 anti-TB drugs, and some isolates also were resistant to para-aminosalicylic acid. These findings suggest the emergence of totally drug-resistant TB.

• 出版日期2013-3