Spoligotype-based comparative population structure analysis of multidrug-resistant and isoniazid-monoresistant Mycobacterium tuberculosis complex clinical isolates in Poland.
The spoligotyping-based population structure of multidrug-resistant (MDR) Mycobacterium tuberculosis strains isolated in Poland (n = 46), representing all culture-positive MDR tuberculosis (MDR-TB) cases, was compared to that of isoniazid (INH)-monoresistant strains (n = 71) isolated in 2004. The latter data set from a previous study (E. Augustynowicz-Kopeć, T. Jagielski, and Z. Zwolska, J. Clin. Microbiol. 2008, 46:4041-4044) represented 87% of all INH-monoresistant strains. The clustering rates and genotypic-diversity indexes for the 2 subpopulations were not significantly different (P = 0.05). The results were entered in the SITVIT2 database to assign specific shared type designations, corresponding genotypic lineages, and geographical distributions and compared to available data from neighboring countries (Germany, n = 704; Czech Republic, n = 530; Sweden, n = 379; Kaliningrad, Russia, n = 90) and strains from previous studies in Poland (n = 317). MDR strains resulted in 27 patterns (20 unique strains within the study and 7 clusters containing 2 to 6 isolates per cluster with a clustering rate of 56.5%) and belonged to the following genotypic lineages: ill-defined T family (28.3%), Haarlem (17.4%), Latin American and Mediterranean (LAM) (13%), Beijing (8.7%), S family (4.35%), and the X clade (2.17%). Comparison of the genetic structure of the MDR strains with that of INH-monoresistant strains showed that a total of 9 patterns were shared by both groups; these represented 1/3 of the MDR strains and 2/3 of the INH-monoresistant strains. Interestingly, 76.1% of the MDR isolates and 71.8% of the INH-resistant isolates yielded spoligotypes that were previously reported from Poland. The observation that nearly half of the spoligotypes identified among both MDR (48.1%) and INH-monoresistant (43.3%) M. tuberculosis isolates were present in Poland's neighboring countries suggested that a significant proportion of MDR and INH-resistant TB cases in Poland were caused by strains actively circulating in Poland or its neighbors. Our results corroborate the leading role of the T and Haarlem genotypes in the epidemiology of drug-resistant TB in Poland. Nevertheless, the LAM and Beijing family strains that infected, correspondingly, 13% and 9% of patients with MDR-TB were absent among the strains from patients with INH-monoresistant TB, suggesting that a proportion of MDR-TB cases in Poland are due to ongoing transmission of MDR clones exhibiting specific genotypes. Study of the population genetic relationships between MDR and INH-monoresistant strains by drawing minimum spanning trees showed that ill-defined T1 sublineage strains (1/3 of all INH-monoresistant strains), represented by its prototype, SIT53, constituted the central node of the tree, followed by strains belonging to the well-defined H3, H1, and S subgroups. However, the MDR group, in addition, contained LAM (n = 6) and Beijing (n = 4) lineage isolates. With the exception of the 4 Beijing lineage strains in the latter group and a single orphan isolate in the INH-monoresistant group, none of the remaining 112/117 isolates belonged to principal genetic group 1 (PGG1) in our study. Given the high rate of clustering and the near absence of immigrants in the study, the persistence of MDR-TB in Poland seems to result from active transmission of MDR strains within the autochthonous population, the bulk of it caused by evolutionarily recent tubercle bacilli.
Jagielski
Tomasz
T
Department of Microbiology, National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland.
Augustynowicz-Kopec
Ewa
E
Zozio
Thierry
T
Rastogi
Nalin
N
Zwolska
Zofia
Z
D000328:Adult; D000368:Aged; D000995:Antitubercular Agents / Q000494:pharmacology*; D015373:Bacterial Typing Techniques; D016000:Cluster Analysis; D016172:DNA Fingerprinting; D024881:Drug Resistance, Bacterial; D005260:Female; D005838:Genotype; D006801:Humans; D007538:Isoniazid / Q000494:pharmacology; D008297:Male; D008875:Middle Aged; D017720:Molecular Epidemiology; D009169:Mycobacterium tuberculosis / Q000145:classification* / Q000235:genetics* / Q000302:isolation & purification; D011044:Poland / Q000453:epidemiology; D014376:Tuberculosis / Q000453:epidemiology* / Q000382:microbiology
D000995:Antitubercular Agents; D007538:Isoniazid
J Clin Microbiol. 1999 Aug;37(8):2715-6
10405429
J Clin Microbiol. 2005 Mar;43(3):1220-7
15750087
BMC Microbiol. 2006 Mar 06;6:23
16519816
J Clin Microbiol. 1997 Apr;35(4):907-14
9157152
Emerg Infect Dis. 2002 Aug;8(8):843-9
12141971
J Clin Microbiol. 2006 Jan;44(1):183-91
16390968
Microbes Infect. 2008 May;10(6):699-705
18485780
Infect Genet Evol. 2007 Sep;7(5):609-17
17625987
Int J Tuberc Lung Dis. 2003 Jul;7(7):645-51
12870685
J Clin Microbiol. 2004 Jul;42(7):3046-51
15243058
Med Mal Infect. 2008 Jun;38(6):309-17
18395379
Am J Epidemiol. 2002 Mar 15;155(6):565-71
11882530
Clin Microbiol Infect. 2007 Jun;13(6):620-6
17403134
J Clin Microbiol. 2007 Jun;45(6):1851-7
17460055
J Clin Microbiol. 1997 Mar;35(3):647-51
9041405
J Infect Dis. 1997 Sep;176(3):637-42
9291309
Infect Control Hosp Epidemiol. 2000 Aug;21(8):525-7
10968719
J Clin Microbiol. 2002 Jun;40(6):1930-7
12037045
J Clin Microbiol. 1993 Feb;31(2):406-9
8381814
J Med Microbiol. 2006 Oct;55(Pt 10):1413-1418
17005791
Emerg Infect Dis. 2003 Dec;9(12):1553-7
14720395
Thorax. 2006 Feb;61(2):158-63
16254056
Clin Infect Dis. 2005 Mar 15;40(6):881-6
15736024
Proc Biol Sci. 2001 Jan 7;268(1462):45-52
12123297
J Infect Dis. 1999 Sep;180(3):726-36
10438361
Int J Tuberc Lung Dis. 2004 Dec;8(12):1448-57
15636491
Proc Natl Acad Sci U S A. 1997 Sep 2;94(18):9869-74
9275218
Pneumonol Alergol Pol. 2005;73(3):221-7
16989157
Int J Tuberc Lung Dis. 1999 Dec;3(12):1055-60
10599007
J Clin Microbiol. 2006 Nov;44(11):4258-61
16971648
J Clin Microbiol. 1997 Sep;35(9):2210-4
9276389
Emerg Infect Dis. 2001 May-Jun;7(3):390-6
11384514
Emerg Infect Dis. 2005 Aug;11(8):1242-8
16102314
J Infect. 2006 Nov;53(5):331-6
16476483
Emerg Infect Dis. 2005 Jun;11(6):957-61
15963297
Clin Microbiol Infect. 2006 Aug;12(8):769-75
16842572
Int J Tuberc Lung Dis. 2003 Nov;7(11):1097-103
14598971
Emerg Infect Dis. 2003 Oct;9(10):1310-3
14609469
J Clin Microbiol. 2001 Sep;39(9):3339-45
11526173
Clin Microbiol Infect. 2008 Jun;14(6):605-7
18397329
JAMA. 2005 Jun 8;293(22):2732-9
15941802
N Engl J Med. 1994 Jun 16;330(24):1710-6
7993412
Proc Natl Acad Sci U S A. 2006 Feb 21;103(8):2869-73
16477032
J Clin Microbiol. 2003 May;41(5):1963-70
12734235
J Clin Microbiol. 2008 Dec;46(12):4041-4
18832130
Emerg Infect Dis. 1999 May-Jun;5(3):404-14
10341177
Emerg Infect Dis. 2006 May;12(5):736-43
16704829