title: Population structure of multi- and extensively drug-resistant Mycobacterium tuberculosis strains in South Africa.
abstract: Genotyping of multidrug-resistant (MDR) Mycobacterium tuberculosis strains isolated from tuberculosis (TB) patients in four South African provinces (Western Cape, Eastern Cape, KwaZulu-Natal, and Gauteng) revealed a distinct population structure of the MDR strains in all four regions, despite the evidence of substantial human migration between these settings. In all analyzed provinces, a negative correlation between strain diversity and an increasing level of drug resistance (from MDR-TB to extensively drug-resistant TB [XDR-TB]) was observed. Strains predominating in XDR-TB in the Western and Eastern Cape and KwaZulu-Natal Provinces were strongly associated with harboring an inhA promoter mutation, potentially suggesting a role of these mutations in XDR-TB development in South Africa. Approximately 50% of XDR-TB cases detected in the Western Cape were due to strains probably originating from the Eastern Cape. This situation may illustrate how failure of efficient health care delivery in one setting can burden health clinics in other areas.
authors.affiliation: DST/NRF Centre of Excellence for Biomedical Tuberculosis Research/MRC Centre for Molecular and Cellular Biology, Division of Molecular Biology and Human Genetics,Faculty of Health Sciences, Stellenbosch University, Stellenbosch, South Africa. vchihota@auruminstitute.org
authors.forename: Violet N
authors.initials: VN
authors.lastname: Chihota
authors.forename: Borna
authors.initials: B
authors.lastname: Müller
authors.forename: Charmaine K
authors.initials: CK
authors.lastname: Mlambo
authors.forename: Manormoney
authors.initials: M
authors.lastname: Pillay
authors.forename: Marisa
authors.initials: M
authors.lastname: Tait
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Streicher
authors.forename: Else
authors.initials: E
authors.lastname: Marais
authors.forename: Gian D
authors.initials: GD
authors.lastname: van der Spuy
authors.forename: Madeleine
authors.initials: M
authors.lastname: Hanekom
authors.forename: Gerrit
authors.initials: G
authors.lastname: Coetzee
authors.forename: Andre
authors.initials: A
authors.lastname: Trollip
authors.forename: Cindy
authors.initials: C
authors.lastname: Hayes
authors.forename: Marlein E
authors.initials: ME
authors.lastname: Bosman
authors.forename: Nico C
authors.initials: NC
authors.lastname: Gey van Pittius
authors.forename: Tommie C
authors.initials: TC
authors.lastname: Victor
authors.forename: Paul D
authors.initials: PD
authors.lastname: van Helden
authors.forename: Robin M
authors.initials: RM
authors.lastname: Warren
mesh_terms: D000995:Antitubercular Agents / Q000494:pharmacology*; D001426:Bacterial Proteins; D044822:Biodiversity; D024901:Drug Resistance, Multiple, Bacterial; D014644:Genetic Variation; D005838:Genotype; D006801:Humans; D017720:Molecular Epidemiology; D058889:Molecular Typing; D009154:Mutation; D009169:Mycobacterium tuberculosis / Q000145:classification* / Q000187:drug effects / Q000235:genetics / Q000302:isolation & purification*; D010088:Oxidoreductases; D011401:Promoter Regions, Genetic; D013019:South Africa; D018088:Tuberculosis, Multidrug-Resistant / Q000382:microbiology*
chemical_list: D000995:Antitubercular Agents; D001426:Bacterial Proteins; D010088:Oxidoreductases; C085257:InhA protein, Mycobacterium