title: Conspicuous multidrug-resistant Mycobacterium tuberculosis cluster strains do not trespass country borders in Latin America and Spain.
abstract: Multidrug-resistant Mycobacterium tuberculosis strain diversity in Ibero-America was examined by comparing extant genotype collections in national or state tuberculosis networks. To this end, genotypes from over 1000 patients with multidrug-resistant tuberculosis diagnosed from 2004 through 2008 in Argentina, Brazil, Chile, Colombia, Venezuela and Spain were compared in a database constructed ad hoc. Most of the 116 clusters identified by IS6110 restriction fragment length polymorphism were small and restricted to individual countries. The three largest clusters, of 116, 49 and 25 patients, were found in Argentina and corresponded to previously documented locally-epidemic strains. Only 13 small clusters involved more than one country, altogether accounting for 41 patients, of whom 13 were, in turn, immigrants from Latin American countries different from those participating in the study (Peru, Ecuador and Bolivia). Most of these international clusters belonged either to the emerging RD(Rio) LAM lineage or to the Haarlem family of M. tuberculosis and four were further split by country when analyzed with spoligotyping and rifampin resistance-conferring mutations, suggesting that they did not represent ongoing transnational transmission events. The Beijing genotype accounted for 1.3% and 10.2% of patients with multidrug-resistant tuberculosis in Latin America and Spain, respectively, including one international cluster of two cases. In brief, Euro-American genotypes were widely predominant among multidrug-resistant M. tuberculosis strains in Ibero-America, reflecting closely their predominance in the general M. tuberculosis population in the region, and no evidence was found of acknowledged outbreak strains trespassing country borders.
authors: Instituto Nacional de Enfermedades Infecciosas ANLIS Carlos Malbrán, Vélez Sarsfield 563, 1281 Buenos Aires, Argentina. vritacco@anlis.gov.ar
authors: Viviana
authors: V
authors: Ritacco
authors: María-José
authors: MJ
authors: Iglesias
authors: Lucilaine
authors: L
authors: Ferrazoli
authors: Johana
authors: J
authors: Monteserin
authors: Elis R
authors: ER
authors: Dalla Costa
authors: Alberto
authors: A
authors: Cebollada
authors: Nora
authors: N
authors: Morcillo
authors: Jaime
authors: J
authors: Robledo
authors: Jacobus H
authors: JH
authors: de Waard
authors: Pamela
authors: P
authors: Araya
authors: Liselotte
authors: L
authors: Aristimuño
authors: Raúl
authors: R
authors: Díaz
authors: Patricia
authors: P
authors: Gavin
authors: Belen
authors: B
authors: Imperiale
authors: Vera
authors: V
authors: Simonsen
authors: Elsa M
authors: EM
authors: Zapata
authors: María S
authors: MS
authors: Jiménez
authors: Maria L
authors: ML
authors: Rossetti
authors: Carlos
authors: C
authors: Martin
authors: Lucía
authors: L
authors: Barrera
authors: Sofia
authors: S
authors: Samper
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015373:Bacterial Typing Techniques; D016000:Cluster Analysis; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D005838:Genotype; D006801:Humans; D007843:Latin America / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D058885:Multilocus Sequence Typing; D009154:Mutation; D009169:Mycobacterium tuberculosis / Q000145:classification* / Q000235:genetics*; D012150:Polymorphism, Restriction Fragment Length; D012042:Registries; D013030:Spain / Q000453:epidemiology; D018088:Tuberculosis, Multidrug-Resistant / Q000453:epidemiology*; D055815:Young Adult