Gurjav Ulziijargal, Erkhembayar Baasansuren, Burneebaatar Buyankhishig, Narmandakh Erdenegerel, Tumenbayar Oyuntuya, Hill-Cawthorne Grant A, Marais Ben J, Sintchenko Vitali
Sydney Medical School, Marie Bashir Institute for Infectious Diseases and Biosecurity, The University of Sydney, Sydney, Australia; Centre for Infectious Diseases and Microbiology - Public Health, Westmead Hospital, Sydney, Australia.
National Tuberculosis Reference Laboratory, National Center for Communicable Diseases, Ulaanbaatar, Mongolia.
Tuberculosis (Edinb). 2016 Dec;101:49-53. doi: 10.1016/j.tube.2016.07.010. Epub 2016 Jul 26.
Mongolia has high and rising rates of multi-drug resistant tuberculosis (MDR-TB). Spatio-temporal and programmatic evidence suggests a major contribution from MDR-TB transmission, but genotypic evidence has not been assessed.
All MDR-TB cases identified during 2012 were examined. Demographic and bacteriological data were obtained from the National Tuberculosis Reference Laboratory. Isolates of Mycobacterium tuberculosis from culture-confirmed category 1 treatment failures were genotyped using 24-loci mycobacterium interspersed repetitive unit (MIRU-24) analysis.
Of the 210 MDR-TB cases identified, 115 (54.8%) were treatment failures (34.8% category 1; 20.0% category 2). Streptomycin resistance was present in 156 (74.3%) cases; including 55/73 (75.3%) category 1 treatment failures who had never been exposed to streptomycin. Among category 1 treatment failures, Beijing lineage strains predominated (88.0%; 59/67 of genotyped isolates). MIRU-24 clustering was documented in 62.7% (42/67) of strains; 55.2% (37/67) remained clustered when drug susceptibility test results were considered. In total 59.5% (25/42) of clustered strains were Beijing lineage and demonstrated in-vitro resistance to all first-line drugs tested.
The MDR-TB epidemic in Mongolia appears to be driven by primary transmission of Beijing lineage strains resistant to all first-line drugs. Enhanced infection control strategies together with early MDR-TB case detection and appropriate treatment are necessary to limit escalation of the MDR-TB epidemic.
蒙古耐多药结核病（MDR-TB）的发病率居高不下且呈上升趋势。时空和项目证据表明耐多药结核病传播起到了主要作用，但尚未对基因分型证据进行评估。
对2012年期间确诊的所有耐多药结核病病例进行检查。人口统计学和细菌学数据来自国家结核病参考实验室。对经培养确诊的1类治疗失败病例的结核分枝杆菌分离株采用24位点分枝杆菌散布重复单位（MIRU-24）分析进行基因分型。
在确诊的210例耐多药结核病病例中，115例（54.8%）为治疗失败病例（1类34.8%；2类20.0%）。156例（74.3%）病例存在链霉素耐药；其中包括73例1类治疗失败病例中的55例（75.3%），这些病例从未接触过链霉素。在1类治疗失败病例中，北京家族菌株占主导（88.0%；基因分型分离株中的59/67）。62.7%（42/67）的菌株存在MIRU-24聚类；考虑药物敏感性试验结果时，55.2%（37/67）的菌株仍聚类。总共59.5%（25/42）的聚类菌株为北京家族，且对所有检测的一线药物均表现出体外耐药。
蒙古的耐多药结核病疫情似乎是由对所有一线药物耐药的北京家族菌株的原发传播驱动的。加强感染控制策略以及早期耐多药结核病病例检测和适当治疗对于限制耐多药结核病疫情的升级是必要的。
