Greif G, Coithino C, Bentancor M N, Robello C
Laboratorio de Interacciones Hospedero-Patógeno/Unidad de Biología Molecular, Institut Pasteur de Montevideo, Montevideo, Uruguay.
Comisión Honoraria de Lucha Anti-Tuberculosis y Enfermedades Prevalentes. Departamento de Laboratorio, Montevideo, Uruguay.
J Clin Tuberc Other Mycobact Dis. 2024 Oct 14;37:100482. doi: 10.1016/j.jctube.2024.100482. eCollection 2024 Dec.
Whole genome sequencing (WGS) is sensitive tool for the analysis of tuberculosis transmission and drug-resistance. We used WGS to analyze the evolution from isoniazid monoresistance to MDR/preXDR during a prolonged household outbreak. The outbreak started with a isoniazid resistant strain (katG S315T mutation) and evolve in two cases to pre-XDR phenotype (with mutations in katG, rpoB, embB, pncA and gyrA genes). Based on WGS data and epidemiological interview we proposed a possible chain of transmission an evolution of the strains. Similar intra-patient and inter-patient acquisition of variability was observed, making difficult to distinguish reinfection or reactivation. Analysis of WGS data together with epidemiological clinical history are discussed in order to distinguish between prolonged infections or transition from latency to reactivation. Classical interview and clinical history taking should be consider to fully understanding WGS data. With a still low incidence of TB cases, Uruguay could use universal WGS of all isolates to reduce time of diagnosis, detect outbreaks and perform public actions to reduce TB incidence.
全基因组测序（WGS）是分析结核病传播和耐药性的灵敏工具。我们使用WGS分析了在一次长期家庭疫情期间从异烟肼单耐药到耐多药/广泛耐药前的演变情况。此次疫情始于一株异烟肼耐药菌株（katG S315T突变），并在两例病例中演变为广泛耐药前表型（katG、rpoB、embB、pncA和gyrA基因发生突变）。基于WGS数据和流行病学访谈，我们提出了菌株可能的传播链和演变情况。观察到患者内和患者间类似的变异性获得情况，难以区分再感染或再激活。讨论了结合WGS数据与流行病学临床病史分析，以区分长期感染或从潜伏到再激活的转变。应考虑采用经典访谈和临床病史采集来全面理解WGS数据。鉴于乌拉圭结核病病例发病率仍然较低，该国可对所有分离株进行普遍WGS，以缩短诊断时间、检测疫情并采取公共行动降低结核病发病率。
