title: Spread of an emerging Mycobacterium tuberculosis drug-resistant strain in the western Cape of South Africa.
abstract: BACKGROUND
  South Africa has a high burden of drug-resistant tuberculosis (TB).
  
  
  METHODS
  Routine drug susceptibility testing was performed prospectively over a 2-year period on Mycobacterium tuberculosis isolates in two health districts of the Western Province, South Africa. A cluster of drug-resistant strains that shared a rare mutation in katG315 was found in 64 of the 450 cases identified as having been infected with drug-resistant TB. Isolates belonging to this cluster were phenotypically and genotypically characterised. Epidemiological and clinical characteristics were used to identify mechanisms leading to the acquisition and spread of this drug-resistant strain.
  
  
  RESULTS
  An outbreak of an emerging non-Beijing drug-resistant strain infecting 64 pulmonary tuberculosis (PTB) cases was identified. This previously undetected genotype (now designated DRF150) is characterised by five IS6110 insertions, specific spoligotypes and high levels of resistance to the first-line TB medications isoniazid, streptomycin and rifampicin. In 45% of the cases it is also resistant to ethambutol and pyrazinamide. Key factors leading to the development and spread of this drug-resistant genotype were inappropriate chemotherapy, poor adherence to treatment and prolonged periods of infectiousness due to delays in susceptibility testing.
  
  
  CONCLUSIONS
  Molecular markers allowed early identification of an emerging non-Beijing drug-resistant strain.
authors.affiliation: Department of Science and Technology/National Research Foundation (DST/NRF) Centre for Biomedical TB Research/ Medical Research Council (MRC) Centre for Molecular and Cellular Biology, Stellenbosch University, Tygerberg, South Africa. tv@sun.ac.za
authors.forename: T C
authors.initials: TC
authors.lastname: Victor
authors.forename: E M
authors.initials: EM
authors.lastname: Streicher
authors.forename: C
authors.initials: C
authors.lastname: Kewley
authors.forename: A M
authors.initials: AM
authors.lastname: Jordaan
authors.forename: G D
authors.initials: GD
authors.lastname: van der Spuy
authors.forename: M
authors.initials: M
authors.lastname: Bosman
authors.forename: H
authors.initials: H
authors.lastname: Louw
authors.forename: M
authors.initials: M
authors.lastname: Murray
authors.forename: D
authors.initials: D
authors.lastname: Young
authors.forename: P D
authors.initials: PD
authors.lastname: van Helden
authors.forename: R M
authors.initials: RM
authors.lastname: Warren
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D004196:Disease Outbreaks; D024901:Drug Resistance, Multiple, Bacterial / Q000235:genetics; D005260:Female; D005838:Genotype; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000145:classification* / Q000187:drug effects* / Q000235:genetics; D010802:Phylogeny; D012150:Polymorphism, Restriction Fragment Length; D013019:South Africa / Q000453:epidemiology; D014397:Tuberculosis, Pulmonary / Q000453:epidemiology*