Department of Pathology, Medical School, Universidade Federal do Ceará (UFC), Fortaleza, Ceará, Brazil.
Braz J Infect Dis. 2013 May-Jun;17(3):338-45. doi: 10.1016/j.bjid.2012.10.019. Epub 2013 Apr 20.
This study has used a combination of clinical information, spoligotyping, and georeferencing system to elucidate the genetic diversity of the Mycobacterium tuberculosis isolates circulating in a TB-prevalent municipality of Northeast Brazil.
A total of 115 M. tuberculosis strains were isolated from pulmonary tuberculosis patients from January 2007 to March 2008 in Fortaleza. Drug susceptibility and spoligotyping assays were performed and place of residence of the patients were georeferenced.
Of the M. tuberculosis strains studied, 51 (44.3%) isolates were resistant to at least one drug (R-TB) and 64 (55.7%) were sensitive to all the drugs tested (S-TB). A high frequency of resistance was found in previously treated cases (84%) and among new cases (16%; p<0.001). A total of 74 (64%) isolates were grouped into 22 spoligotyped lineages, while 41 (36%) isolates were identified as new. Among the predominant genotypes, 33% were Latim American Mediterranean (LAM), 12% Haarlem (H), and 5% U. There was no association of geographic distribution of RT-TB patients as compared to the controls and also the geographic location to the spoligotype patterns. The geospatial analysis revealed that 24 (23%) patients (hot spot zones) either shared the same residence or lived in a close neighborhood of a case. Among these concentration zones, the patients lived in the same residence and shared a common genotype pattern and resistance pattern.
It was observed that the spoligopatterns family distribution was similar to that reported for South America, prevailing the LAM and H lineages. A high rate-case among the resistant TB group occurs as a result of transmitted and acquired resistance. A more effective surveillance program is needed in order to succeed in reducing tuberculosis in Northeast Brazil.
本研究采用临床信息、 spoligotyping 和地理参考系统相结合的方法，阐明了在巴西东北部一个结核病流行市流行的结核分枝杆菌分离株的遗传多样性。
从 2007 年 1 月至 2008 年 3 月，在福塔雷萨共从肺结核患者中分离出 115 株结核分枝杆菌。进行了药物敏感性和 spoligotyping 检测，并对患者的居住地进行了地理参考。
在所研究的结核分枝杆菌菌株中，51 株（44.3%）分离株至少对一种药物耐药（R-TB），64 株（55.7%）对所有测试药物敏感（S-TB）。既往治疗病例（84%）和新发病例（16%）耐药率较高（p<0.001）。共有 74 株（64%）分离株分为 22 种 spoligotyped 谱系，41 株（36%）分离株为新分离株。在主要基因型中，33%为拉丁美洲地中海型（LAM），12%为 Haarlem 型（H），5%为 U 型。耐药性结核病患者的地理分布与对照组无关联，与 spoligotype 模式的地理位置也无关联。地理空间分析显示，24 名（23%）患者（热点区域）要么居住在同一地点，要么居住在病例的附近。在这些集中区域，患者居住在同一住所，具有相同的基因型和耐药模式。
观察到 spoligopatterns 家族分布与南美洲报道的相似，主要为 LAM 和 H 谱系。耐药性结核病组中的高病例率是由于传播和获得性耐药所致。为了成功减少巴西东北部的结核病，需要一个更有效的监测计划。
