Oral Zeytinli Ulkü, Köksal Fatih
Çukurova University Faculty of Medicine, Department of Medical Microbiology, Adana, Turkey.
Mikrobiyol Bul. 2012 Apr;46(2):202-10.
More rapid, and specific molecular diagnostic methods are required to understand the epidemiology of tuberculosis in the population and to establish effective control measures. Molecular epidemiologic studies about Mycobacterium tuberculosis are yet limited in Turkey. Cukurova (Eastern Mediterranean part of Turkey) region is of special importance in terms of tuberculosis epidemiology due to its neighbourhood countries and relatively high number of immigrants to that area. This study was aimed to determine the genotypic characteristics of M.tuberculosis strains isolated from pulmonary tuberculosis patients in Cukurova region, by spoligotyping and 12 loci MIRU-VNTR (Mycobacterial Interspersed Repetitive Unit- Variable Number Tandem Repeats) methods. A total of 467 M.tuberculosis strains isolated from patients with pulmonary tuberculosis admitted to 20 hospital/dispansery in seven different provinces (Adana, Mersin, Osmaniye, Antakya, Gaziantep, Sanliurfa, Kahramanmaras) at Cukurova region between January 2007-June 2010, were included to the study. Genotypic identification was done by spoligotyping and 12 loci MIRU-VNTR methods. M.tuberculosis complex strains were isolated from different samples (sputum, bronchoalveolar lavage and biopsy material) by MGIT 960-TB (BD Diagnostics, USA) liquid culture method in Regional Tuberculosis Laboratory. Spoligotyping analysis revealed that 443 (94.9%) of the strains were clustered in 21 groups while 24 (5.1%) of the isolates were described as orphan strains according to SpolDB4 database. The most common families were T1 genotype seen in 239 (51.9%) strains and LAM7 TUR genotype seen in 54 (11.5%) strains. Six (1.3%) strains isolated from one province were multidrug resistant strains and belonged to Beijing family. Combination of spoligotyping with 12- locus MIRU-VNTR divided the T1 family into 7 clusters of which members ranged from 2-158. Twenty one isolates showed unique pattern. According to this study, T1 family is the most common genotype among M.tuberculosis strains in Cukurova, Turkey and the prevalence of M.tuberculosis Beijing strains was 1.3%, detected only in one province (Sanliurfa). Active surveillance studies are necessary to follow the regional dissemination of M.tuberculosis genotypes and establish effective precautions to prevent the spread of especially drug resistant strains.
为了解人群中结核病的流行病学情况并制定有效的控制措施，需要更快速、更具特异性的分子诊断方法。在土耳其，关于结核分枝杆菌的分子流行病学研究仍然有限。库库洛瓦（土耳其东地中海地区）地区在结核病流行病学方面具有特殊重要性，因为其邻国众多且该地区移民数量相对较多。本研究旨在通过间隔寡核苷酸分型（spoligotyping）和12个位点的结核分枝杆菌间隔重复单位可变数目串联重复序列（MIRU-VNTR）方法，确定从库库洛瓦地区肺结核患者中分离出的结核分枝杆菌菌株的基因型特征。2007年1月至2010年6月期间，从库库洛瓦地区七个不同省份（阿达纳、梅尔辛、奥斯曼尼耶、安塔基亚、加济安泰普、尚勒乌尔法、哈兰马拉什）的20家医院/诊疗所收治的肺结核患者中分离出的467株结核分枝杆菌菌株被纳入本研究。通过间隔寡核苷酸分型和12个位点的MIRU-VNTR方法进行基因型鉴定。在地区结核病实验室，采用MGIT 960-TB（美国BD诊断公司）液体培养法从不同样本（痰液、支气管肺泡灌洗和活检材料）中分离出结核分枝杆菌复合群菌株。间隔寡核苷酸分型分析显示，根据SpolDB4数据库，443株（94.9%）菌株聚为21个组，而24株（5.1%）分离株被描述为孤儿菌株。最常见的家族是239株（51.9%）菌株中出现的T1基因型和54株（11.5%）菌株中出现的LAM7 TUR基因型。从一个省份分离出的6株（1.3%）菌株为多重耐药菌株，属于北京家族。间隔寡核苷酸分型与12个位点的MIRU-VNTR相结合，将T1家族分为7个簇，每个簇的成员数量从2到158不等。21株分离株表现出独特的模式。根据本研究，T1家族是土耳其库库洛瓦地区结核分枝杆菌菌株中最常见的基因型，结核分枝杆菌北京菌株的流行率为1.3%，仅在一个省份（尚勒乌尔法）检测到。有必要开展主动监测研究，以跟踪结核分枝杆菌基因型的区域传播情况，并制定有效的预防措施，以防止特别是耐药菌株的传播。
