Increasing circulation of multi-drug resistant tuberculosis strains in Buryatia, high-burden and ethnically diverse region in the Russian Far East

Abstract

Buryatia is a multidrug-resistant tuberculosis (MDR-TB) high-burden region in the Russian Far East with ethnically diverse population (30 % Mongoloid Buryats and 65 % Russians). Two hundred M. tuberculosis strains from newly-diagnosed patients were subjected to phenotypic testing and genotyping. The Beijing genotype was more prevalent among Russians than Buryats (68 % vs 53 %; P = 0.055). European non-Beijing genotypes (LAM, Ural, Haarlem) were double more prevalent in Buryats vs Russians (39.2 % vs 20.5 %; P = 0.01). Higher prevalence of Beijing among former prison inmates (79 % vs 61 % in other patients, P = 0.1) suggests its increased transmissibility. The Russian epidemic cluster B0/W148 was in 9.5 %, double smaller than elsewhere in Siberia. The hypervirulent Beijing 14717-15-cluster was endemic in Buryatia but paradoxically enough, it was more frequently isolated from Russians than Buryats (9.1 % vs 3.9 %; P = 0.2). Beijing subtypes B0/W148, CAO, and 14717-15 were associated with poly/multi-drug resistance (P = 0.01–0.0001). HIV coinfection was more frequent in Russians than in Buryats: 35/141 (24.8 %) vs 5/51 (9.8 %), P = 0.03. To conclude, M. tuberculosis population structure in Buryatia retained its singularities compared to other parts of Russia and remains strikingly different from the neighboring Mongolia. A circulation of strongly MDR-associated Beijing subtypes and drug-resistant non-Beijing strains highlights a risk of their broader dissemination.