title: Distribution of spoligotyping defined genotypic lineages among drug-resistant Mycobacterium tuberculosis complex clinical isolates in Ankara, Turkey.
abstract: BACKGROUND
  Investigation of genetic heterogeneity and spoligotype-defined lineages of drug-resistant Mycobacterium tuberculosis clinical isolates collected during a three-year period in two university hospitals and National Tuberculosis Reference and Research Laboratory in Ankara, Turkey.
  
  
  RESULTS
  A total of 95 drug-resistant M. tuberculosis isolates collected from three different centers were included in this study. Susceptibility testing of the isolates to four major antituberculous drugs was performed using proportion method on Löwenstein-Jensen medium and BACTEC 460-TB system. All clinical isolates were typed by using spoligotyping and IS6110-restriction fragment length polymorphism (RFLP) methods. Seventy-three of the 95 (76.8%) drug resistant M. tuberculosis isolates were isoniazid-resistant, 45 (47.4%) were rifampicin-resistant, 32 (33.7%) were streptomycin-resistant and 31 (32.6%) were ethambutol-resistant. The proportion of multidrug-resistant isolates (MDR) was 42.1%. By using spoligotyping, 35 distinct patterns were observed; 75 clinical isolates were grouped in 15 clusters (clustering rate of 79%) and 20 isolates displayed unique patterns. Five of these 20 unique patterns corresponded to orphan patterns in the SITVIT2 database, while 4 shared types containing 8 isolates were newly created. The most prevalent M. tuberculosis lineages were: Haarlem (23/95, 24.2%), ill-defined T superfamily (22/95, 23.2%), the Turkey family (19/95, 20%; previously designated as LAM7-TUR), Beijing (6/95, 6.3%), and Latin-America & Mediterranean (LAM, 5/95 or 5.3%), followed by Manu (3/95, 3.2%) and S (1/95, 1%) lineages. Four of the six Beijing family isolates (66.7%) were MDR. A combination of IS6110-RFLP and spoligotyping reduced the clustering rate from 79% to 11.5% among the drug resistant isolates.
  
  
  CONCLUSIONS
  The results obtained showed that ill-defined T, Haarlem, the Turkey family (previously designated as LAM7-TUR family with high phylogeographical specifity for Turkey), Beijing and LAM were predominant lineages observed in almost 80% of the drug-Resistant M. tuberculosis complex clinical isolates in Ankara, Turkey.
authors.affiliation: Department of Medical Microbiology, Gulhane Military Medical Academy and School of Medicine, Ankara, Turkey. okisa@gata.edu.tr
authors.forename: Ozgul
authors.initials: O
authors.lastname: Kisa
authors.forename: Gulnur
authors.initials: G
authors.lastname: Tarhan
authors.forename: Selami
authors.initials: S
authors.lastname: Gunal
authors.forename: Ali
authors.initials: A
authors.lastname: Albay
authors.forename: Riza
authors.initials: R
authors.lastname: Durmaz
authors.forename: Zeynep
authors.initials: Z
authors.lastname: Saribas
authors.forename: Thierry
authors.initials: T
authors.lastname: Zozio
authors.forename: Alpaslan
authors.initials: A
authors.lastname: Alp
authors.forename: Ismail
authors.initials: I
authors.lastname: Ceyhan
authors.forename: Ahmet
authors.initials: A
authors.lastname: Tombak
authors.forename: Nalin
authors.initials: N
authors.lastname: Rastogi
mesh_terms: D000328:Adult; D000368:Aged; D015373:Bacterial Typing Techniques / Q000379:methods; D016000:Cluster Analysis; D004251:DNA Transposable Elements / Q000235:genetics; D004269:DNA, Bacterial / Q000235:genetics; D024881:Drug Resistance, Bacterial; D024901:Drug Resistance, Multiple, Bacterial; D005787:Gene Frequency; D005838:Genotype; D060005:Genotyping Techniques / Q000379:methods; D006801:Humans; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000145:classification / Q000235:genetics* / Q000302:isolation & purification; D010802:Phylogeny; D012150:Polymorphism, Restriction Fragment Length; D018088:Tuberculosis, Multidrug-Resistant / Q000382:microbiology*; D014421:Turkey; D055815:Young Adult
chemical_list: D004251:DNA Transposable Elements; D004269:DNA, Bacterial