title: Mutations responsible for Mycobacterium tuberculosis isoniazid resistance in Italy.
abstract: METHODS
  The incidence of tuberculosis (TB) and drug resistance in Italy is low compared to other countries. Mutations in several genomic regions of Mycobacterium tuberculosis are involved in the occurrence of isoniazid (INH) resistance.
  
  
  OBJECTIVE
  To investigate the mutations responsible for INH resistance among Italian isolates of M. tuberculosis, to assess the feasibility of predicting drug resistance using a genetic approach.
  
  
  METHODS
  The mutations responsible for INH resistance were looked for in selected regions of genes katG, kasA and ndh and in the promoter regions of inhA and ahpC by nucleotide sequencing, and the results were compared with data reported in other studies.
  
  
  RESULTS
  Prevalent INH resistance mutations were found at codon 315 of the katG gene and at position -15 of the inhA regulatory region (respectively 37.8% and 20.0% of isolates). The prevalence of mutations at position -24 of inhA, in ahpC, and in kasA ranged from 2.2% to 4.4%. No mutations were found in 35.6% of the isolates.
  
  
  CONCLUSIONS
  The identification of INH resistance by genetic analysis of the selected regions may be inappropriate in areas with a low prevalence of TB, such as Italy, as the genetic mechanisms of resistance remain unidentified for approximately one third of the isolates.
authors.affiliation: Dipartmento di Patologia Sperimentale, Biotecnologie Mediche, Infettivologia ed Epidemiologia, Università di Pisa, Italy. rindi@biomed.unipi.it
authors.forename: L
authors.initials: L
authors.lastname: Rindi
authors.forename: L
authors.initials: L
authors.lastname: Bianchi
authors.forename: E
authors.initials: E
authors.lastname: Tortoli
authors.forename: N
authors.initials: N
authors.lastname: Lari
authors.forename: D
authors.initials: D
authors.lastname: Bonanni
authors.forename: C
authors.initials: C
authors.lastname: Garzelli
mesh_terms: D000995:Antitubercular Agents / Q000494:pharmacology*; D004252:DNA Mutational Analysis; D006801:Humans; D015994:Incidence; D007538:Isoniazid / Q000494:pharmacology*; D007558:Italy / Q000453:epidemiology; D009169:Mycobacterium tuberculosis / Q000235:genetics* / Q000472:pathogenicity*; D016133:Polymerase Chain Reaction; D011401:Promoter Regions, Genetic; D018088:Tuberculosis, Multidrug-Resistant / Q000235:genetics*
chemical_list: D000995:Antitubercular Agents; D007538:Isoniazid