title: Drug-resistant tuberculosis, clinical virulence, and the dominance of the Beijing strain family in Russia.
abstract: BACKGROUND
  Tuberculosis and multidrug-resistant tuberculosis is a serious public health problem in Russia.
  
  
  OBJECTIVE
  To address the extent of "Beijing strain" transmission in the prison/civil sectors and the association of drug resistance, clinical, and social factors with the Beijing genotype.
  
  
  METHODS
  Cross-sectional population-based molecular epidemiological study of all civilian and penitentiary tuberculosis facilities in the Samara region, Russia.
  
  
  METHODS
  Consecutively recruited patients with bacteriologically proven tuberculosis (n = 880).
  
  
  METHODS
  Proportion of Beijing strains and association with drug resistance, human immunodeficiency virus infection, imprisonment, radiological, clinical, and other social factors.
  
  
  RESULTS
  Beijing-family strains (identified by spoligotyping and composed of 2 main types by mycobacterial interspersed repetitive unit analysis) were predominant: 586/880 (66.6%; 95% confidence interval [CI], 63.4%-69.7%) with a significantly higher prevalence in the prison population (rate ratio [RR], 1.3; 95% CI, 1.2-1.5) and those aged younger than 35 years (RR, 1.2; 95% CI, 1.0-1.3). Comparable proportions were co-infected with the human immunodeficiency virus ( approximately 10%), concurrent hepatitis B and C (21.6%), drank alcohol ( approximately 90%), smoked ( approximately 90%), and had a similar sexual history. Drug resistance was nearly 2-fold higher in patients infected with Beijing strains compared with non-Beijing strains: multidrug resistance (RR, 2.4; 95% CI, 1.9-3.0), for isoniazid (RR, 1.8; 95% CI, 1.5-2.1), for rifampicin (RR, 2.2; 95% CI, 1.7-2.7), for streptomycin (RR, 1.9; 95% CI, 1.5-2.3), and for ethambutol (RR, 2.2; 95% CI, 1.6-3.2). Univariate analysis demonstrated that male sex (odds ratio [OR], 1.5; 95% CI, 1.1-1.9), advanced radiological abnormalities (OR, 3.3; 95% CI, 1.3-8.4), homelessness (OR, 5.6; 95% CI, 1.1-6.3), and previous imprisonment (OR, 2.0; 95% CI, 1.5-2.7) were strongly associated with Beijing-strain family disease. Multivariate analysis supported previous imprisonment to be a risk factor (OR, 2.0; 95% CI, 1.4-3.3) and night sweats to be less associated (OR 0.7; 95% CI, 0.5-1.0) with Beijing-strain disease.
  
  
  CONCLUSIONS
  Drug resistance and previous imprisonment but not human immunodeficiency virus co-infection were significantly associated with Beijing-strain infection. There was evidence that Beijing isolates caused radiologically more advanced disease.
authors.affiliation: HPA Mycobacterium Reference Unit, Department of Microbiology and Infection, Guy's King's and St Thomas' Medical School, London, England. francis.drobniewski@kcl.ac.uk
authors.forename: Francis
authors.initials: F
authors.lastname: Drobniewski
authors.forename: Yanina
authors.initials: Y
authors.lastname: Balabanova
authors.forename: Vladyslav
authors.initials: V
authors.lastname: Nikolayevsky
authors.forename: Micheal
authors.initials: M
authors.lastname: Ruddy
authors.forename: Sergey
authors.initials: S
authors.lastname: Kuznetzov
authors.forename: Svetlana
authors.initials: S
authors.lastname: Zakharova
authors.forename: Alexander
authors.initials: A
authors.lastname: Melentyev
authors.forename: Ivan
authors.initials: I
authors.lastname: Fedorin
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections; D006801:Humans; D016015:Logistic Models; D008297:Male; D009169:Mycobacterium tuberculosis / Q000145:classification / Q000235:genetics / Q000472:pathogenicity; D011330:Prisons; D012307:Risk Factors; D012426:Russia / Q000453:epidemiology; D018088:Tuberculosis, Multidrug-Resistant / Q000453:epidemiology* / Q000382:microbiology*; D014774:Virulence