Almeida Silvia Maria de, Malaspina Ana Carolina, Leite Clarisse Queico Fujimura, Saad Maria Helena Féres
Fundação Oswaldo Cruz, Instituto Oswaldo Cruz, Laboratório de Microbiologia Celular, Rio de Janeiro, Rio de Janeiro, Brazil.
Universidade Federal de São Paulo, Instituto de Ciências Farmacêuticas, São Paulo, São Paulo, Brazil.
Rev Inst Med Trop Sao Paulo. 2019 Sep 12;61:e51. doi: 10.1590/S1678-9946201961051.
A drug resistance survey involving Mycobacterium tuberculosis isolated from patients of a tertiary Hospital in the Rio de Janeiro city (RJ), Brazil, between the years 1996 and 1998 revealed a high frequency of isoniazid (HR) resistance. These isolates were revisited and genotyped. Patients came from different RJ neighborhoods and municipalities, and 70% were outpatients. Applying the 3' and 5' IS 6110 -RFLP and the Spoligotype genotyping methods, the clonal structure of this population was investigated obtaining a snapshot of past epidemiological events. The 3' clusters were subsequently 5' IS 6110 -RFLP typed. Spoligotyping was analyzed in the SITVIT2 database. Epidemiological relationships were investigated. The major lineage was T (54.4%), and SIT 53/T1 and SIT 535/T1 were the most frequent. The T1 sublineage comprises 12.8% of resistant strains and SIT 535 were assigned for 31.8% of them. Orphan patterns corresponded to 12% and 73.3% and belonged to the T lineage. One pattern was unlisted in the SITVIT2. The 5' IS 6110 -RFLP did not confirm 3/12 of the 3' IS 6110 -RFLP clusters. A combination of all methods decreased the number of clusters to three. Nosocomial transmission was associated with one cluster involving a hospital cupbearer. This event was suspected in a multidrug resistant-TB inpatient caregiver who harbored a mixed infection. The 3' IS 6110 clusters were associated with HR (p=0.046). These genotypic retrospective data may reflect a fraction of more extensive recent transmission in different communities that may be corroborated by the concentration of HR patients, and may serve as a database for further evolutionary and characterization evaluation of circulating strains and together with epidemiological data favors a more effective transmission control.
一项耐药性调查涉及1996年至1998年间从巴西里约热内卢市一家三级医院的患者中分离出的结核分枝杆菌，结果显示异烟肼（HR）耐药的频率很高。对这些分离株进行了重新检测和基因分型。患者来自里约热内卢不同的社区和市镇，70%为门诊患者。应用3'和5' IS 6110 -RFLP以及Spoligotype基因分型方法，对该人群的克隆结构进行了研究，以获取过去流行病学事件的概况。随后对3'簇进行了5' IS 6110 -RFLP分型。在SITVIT2数据库中分析了Spoligotyping。调查了流行病学关系。主要谱系为T（54.4%），SIT 53/T1和SIT 535/T1最为常见。T1亚谱系占耐药菌株的12.8%，其中31.8%的菌株被归为SIT 535。孤儿型分别占12%和73.3%，属于T谱系。有一种型别未在SITVIT2中列出。5' IS 6110 -RFLP未确认3' IS 6110 -RFLP簇中的3/12。所有方法结合使用将簇的数量减少到三个。医院内传播与一个涉及医院侍应生的簇有关。这一事件在一名携带混合感染的耐多药结核病住院患者护理人员中被怀疑。3' IS 6110簇与HR相关（p=0.046）。这些基因型回顾性数据可能反映了不同社区近期更广泛传播的一部分，这可能由HR患者的集中情况得到证实，并且可以作为进一步评估流行菌株进化和特征的数据库，与流行病学数据一起有利于更有效地控制传播。
