突尼斯艾滋病毒阴性患者中主要 MDR 结核病克隆的发病和传播。

IF 4.8 2区 医学 Q1 INFECTIOUS DISEASES
Naira Dekhil, Helmi Mardassi
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引用次数: 0

摘要

背景:开展一项基于全基因组测序(WGS)的调查,研究自 21 世纪初以来在突尼斯艾滋病毒阴性患者中肆虐的最大规模耐多药结核病(MDR TB)疫情的出现和传播情况:我们基于代表 68 个独特结核分枝杆菌分离株的 WGS 数据集进行了系统地理学分析和分子年代测定,该数据集几乎涵盖了 2001-2016 年期间整个耐多药结核病疫情:数据表明,早在 1974 年(95% CI 1951-1985),MDR 结核病疫情的祖先就出现在比泽特地区,到 1992 年(95% CI 1980-1996),疫情从该地区蔓延到其他地区。通过对基于核心基因组多焦点序列分型(cgMLST)的最小生成树进行分析,发现监狱中的耐受性补偿型 MDR 结核病菌株很早就扩散到了普通人群中。事实上,有监禁史的病例被发现直接或间接地与多达 22 例(32.35%)非监禁人群中新爆发的病例有关。到 2008 年左右,MDR 肺结核爆发菌株获得了额外的抗药性,从而形成了 XDR 表型:WGS 使我们能够更好地了解突尼斯最大规模 MDR 结核病暴发的出现和演变过程,其致病菌株在此之前的近 26 年间一直在悄然流行。我们的研究进一步证实了与监狱有关的病例在疫情早期在普通人群中传播中所起的关键作用。这种流行病克隆向 XDR 表型的转变促使我们迫切需要采取严厉的控制措施。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
On the onset and dispersal of a major MDR TB clone among HIV-negative patients, Tunisia.

Background: To carry out a whole genome sequencing (WGS)-based investigation on the emergence and spread of the largest multidrug-resistant tuberculosis (MDR TB) outbreak that has been thriving among HIV-negative patients, Tunisia, since the early 2000s.

Methods: We performed phylogeographic analyses and molecular dating based on a WGS dataset representing 68 unique Mycobacterium tuberculosis isolates, covering almost the entire MDR TB outbreak for the time period 2001-2016.

Results: The data indicate that the ancestor of the MDR TB outbreak emerged in the region of Bizerte, as early as 1974 (95% CI 1951-1985), from where it spread to other regions by 1992 (95% CI 1980-1996). Analysis of a minimum spanning tree based on core genome Multilocus Sequence Typing (cgMLST) uncovered the early spill-over of the fitness-compensated MDR TB strain from the prison into the general population. Indeed, cases with history of incarceration were found to be directly or indirectly linked to up to 22 new outbreak cases (32.35%) among the non-imprisoned population. By around 2008, the MDR TB outbreak strain had acquired additional resistance, leading to an XDR phenotype.

Conclusions: WGS allowed refining our understanding of the emergence and evolution of the largest MDR TB outbreak in Tunisia, whose causative strain has been circulating silently for almost 26 years before. Our study lends further support to the critical role of prisons-related cases in the early spread of the outbreak among the general population. The shift to an XDR phenotype of such an epidemic clone prompts an urgent need to undertake drastic control measures.

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来源期刊
Antimicrobial Resistance and Infection Control
Antimicrobial Resistance and Infection Control PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH -INFECTIOUS DISEASES
CiteScore
9.70
自引率
3.60%
发文量
140
审稿时长
13 weeks
期刊介绍: Antimicrobial Resistance and Infection Control is a global forum for all those working on the prevention, diagnostic and treatment of health-care associated infections and antimicrobial resistance development in all health-care settings. The journal covers a broad spectrum of preeminent practices and best available data to the top interventional and translational research, and innovative developments in the field of infection control.
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