Middelkoop Keren, Bekker Linda-Gail, Mathema Barun, Myer Landon, Shashkina Elena, Whitelaw Andrew, Kurepina Natalia, Kaplan Gilla, Kreiswirth Barry, Wood Robin
Desmond Tutu HIV Centre, Institute of Infectious Disease & Molecular Medicine, University of Cape Town, Cape Town, South Africa, Department of Medicine, University of Cape Town, Cape Town, South Africa, Department of Epidemiology, Mailman School of Public Health, Columbia University, NY, New York, USA, Public Health Research Institute, Tuberculosis Center, New Jersey Medical School, Rutgers, State University of New Jersey, Newark, USA, Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa, National Health Laboratory Service, Cape Town, South Africa, Division of Medical Microbiology, Department of Clinical Laboratory Sciences, University of Cape Town, Cape Town, South Africa and Laboratory of Mycobacterial Immunity and Pathogenesis, Public Health Research Institute, New Jersey Medical School, Rutgers, The State University of New Jersey, Newark, USADesmond Tutu HIV Centre, Institute of Infectious Disease & Molecular Medicine, University of Cape Town, Cape Town, South Africa, Department of Medicine, University of Cape Town, Cape Town, South Africa, Department of Epidemiology, Mailman School of Public Health, Columbia University, NY, New York, USA, Public Health Research Institute, Tuberculosis Center, New Jersey Medical School, Rutgers, State University of New Jersey, Newark, USA, Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa, National Health Laboratory Service, Cape Town, South Africa, Division of Medical Microbiology, Department of Clinical Laboratory Sciences, University of Cape Town, Cape Town, South Africa and Laboratory of Mycobacterial Immunity and Pathogenesis, Public Health Research Institute, New Jersey Medical School, Rutgers, The State University of New Jersey, Newark, USA
Desmond Tutu HIV Centre, Institute of Infectious Disease & Molecular Medicine, University of Cape Town, Cape Town, South Africa, Department of Medicine, University of Cape Town, Cape Town, South Africa, Department of Epidemiology, Mailman School of Public Health, Columbia University, NY, New York, USA, Public Health Research Institute, Tuberculosis Center, New Jersey Medical School, Rutgers, State University of New Jersey, Newark, USA, Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa, National Health Laboratory Service, Cape Town, South Africa, Division of Medical Microbiology, Department of Clinical Laboratory Sciences, University of Cape Town, Cape Town, South Africa and Laboratory of Mycobacterial Immunity and Pathogenesis, Public Health Research Institute, New Jersey Medical School, Rutgers, The State University of New Jersey, Newark, USADesmond Tutu HIV Centre, Institute of Infectious Disease & Molecular Medicine, University of Cape Town, Cape Town, South Africa, Department of Medicine, University of Cape Town, Cape Town, South Africa, Department of Epidemiology, Mailman School of Public Health, Columbia University, NY, New York, USA, Public Health Research Institute, Tuberculosis Center, New Jersey Medical School, Rutgers, State University of New Jersey, Newark, USA, Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa, National Health Laboratory Service, Cape Town, South Africa, Division of Medical Microbiology, Department of Clinical Laboratory Sciences, University of Cape Town, Cape Town, South Africa and Laboratory of Mycobacterial Immunity and Pathogenesis, Public Health Research Institute, New Jersey Medical School, Rutgers, The State University of New Jersey, Newark, USA.
Int J Epidemiol. 2014 Aug;43(4):1114-22. doi: 10.1093/ije/dyu044. Epub 2014 Mar 7.
Factors associated with Mycobacterium tuberculosis (Mtb) strain success over time in high burdened communities are unknown.
Mtb isolates collected over 10 years from sputum-positive tuberculosis (TB) patients resident in the study site underwent IS6110-based restriction fragment length polymorphism analysis. Clinical, demographic and social data were extracted from clinic records and interviewer-administered questionnaires. Strains were defined as persistently successful, transiently successful or unsuccessful based on the average number of cases per year and their continued presence over time.
Genotyping data were available on 789 TB cases. Of the 311 distinct Mtb strains (≥6 bands) identified, 247 were categorized as unsuccessful strains, 12 transiently successful and 10 persistently successful strains. Strain success was not associated with age, gender, antiretroviral use or social factors. Persistently successful strains were less likely to be drug-resistant compared with transiently successful strains [odds ratio (OR): 0.13; 95% confidence interval (CI): 0.04 - 0.5]. Persistently successful strains were positively associated with host HIV-infection compared with unsuccessful strains, but this finding was not robust in sensitivity analyses.
Pathogen characteristics appear to play a greater role in Mtb strain success compared with social or host factors. This study supports the need for further investigations into the role of pathogen characteristics in strain success.
在高负担社区中，随着时间推移与结核分枝杆菌（Mtb）菌株成功相关的因素尚不清楚。
对从研究地点居住的痰涂片阳性肺结核（TB）患者中收集的10年以上的Mtb分离株进行基于IS6110的限制性片段长度多态性分析。从临床记录和访员管理的问卷中提取临床、人口统计学和社会数据。根据每年的平均病例数及其随时间的持续存在情况，将菌株定义为持续成功、短暂成功或不成功。
有789例TB病例的基因分型数据。在鉴定出的311种不同的Mtb菌株（≥6条带）中，247种被归类为不成功菌株，12种短暂成功菌株和10种持续成功菌株。菌株的成功与年龄、性别、抗逆转录病毒药物使用或社会因素无关。与短暂成功菌株相比，持续成功菌株耐药的可能性较小[比值比（OR）：0.13；95%置信区间（CI）：0.04 - 0.5]。与不成功菌株相比，持续成功菌株与宿主HIV感染呈正相关，但这一发现在敏感性分析中并不稳健。
与社会或宿主因素相比，病原体特征似乎在Mtb菌株的成功中起更大作用。本研究支持需要进一步调查病原体特征在菌株成功中的作用。
