Mycobacterium tuberculosis evolution from monoresistance to pre-extensive drug resistance during a prolonged household outbreak

IF 1.9 Q3 INFECTIOUS DISEASES
G. Greif , C. Coithino , M.N. Bentancor , C. Robello
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Abstract

Whole genome sequencing (WGS) is sensitive tool for the analysis of tuberculosis transmission and drug-resistance. We used WGS to analyze the Mycobacterium tuberculosis evolution from isoniazid monoresistance to MDR/preXDR during a prolonged household outbreak. The outbreak started with a isoniazid resistant strain (katG S315T mutation) and evolve in two cases to pre-XDR phenotype (with mutations in katG, rpoB, embB, pncA and gyrA genes). Based on WGS data and epidemiological interview we proposed a possible chain of transmission an evolution of the strains.
Similar intra-patient and inter-patient acquisition of variability was observed, making difficult to distinguish reinfection or reactivation. Analysis of WGS data together with epidemiological clinical history are discussed in order to distinguish between prolonged infections or transition from latency to reactivation. Classical interview and clinical history taking should be consider to fully understanding WGS data. With a still low incidence of TB cases, Uruguay could use universal WGS of all isolates to reduce time of diagnosis, detect outbreaks and perform public actions to reduce TB incidence.
在一次长期家庭疫情中,结核分枝杆菌从单一抗药性进化到前期广泛抗药性
全基因组测序(WGS)是分析结核病传播和耐药性的灵敏工具。我们利用 WGS 分析了在一次长期家庭疫情中结核分枝杆菌从异烟肼单耐药到 MDR/preXDR 的演变过程。疫情始于耐异烟肼菌株(katG S315T 突变),并在两个病例中演变为前 XDR 表型(katG、rpoB、embB、pncA 和 gyrA 基因突变)。根据 WGS 数据和流行病学访谈,我们提出了菌株可能的传播链和演变过程。我们对 WGS 数据分析和流行病学临床病史进行了讨论,以区分是长期感染还是从潜伏期过渡到再激活。要充分理解 WGS 数据,应考虑传统的访谈和临床病史采集。在结核病发病率仍然较低的情况下,乌拉圭可以利用对所有分离菌株进行普遍的 WGS 检测来缩短诊断时间、发现疫情爆发并采取公共行动降低结核病发病率。
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来源期刊
Journal of Clinical Tuberculosis and Other Mycobacterial Diseases
Journal of Clinical Tuberculosis and Other Mycobacterial Diseases Medicine-Pulmonary and Respiratory Medicine
CiteScore
4.00
自引率
5.00%
发文量
44
审稿时长
30 weeks
期刊介绍: Journal of Clinical Tuberculosis and Mycobacterial Diseases aims to provide a forum for clinically relevant articles on all aspects of tuberculosis and other mycobacterial infections, including (but not limited to) epidemiology, clinical investigation, transmission, diagnosis, treatment, drug-resistance and public policy, and encourages the submission of clinical studies, thematic reviews and case reports. Journal of Clinical Tuberculosis and Mycobacterial Diseases is an Open Access publication.
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