title: Genotyping and drug resistance patterns of Mycobacterium tuberculosis strains observed in a tuberculosis high-burden municipality in Northeast, Brazil.
abstract: OBJECTIVE
  This study has used a combination of clinical information, spoligotyping, and georeferencing system to elucidate the genetic diversity of the Mycobacterium tuberculosis isolates circulating in a TB-prevalent municipality of Northeast Brazil.
  
  
  METHODS
  A total of 115 M. tuberculosis strains were isolated from pulmonary tuberculosis patients from January 2007 to March 2008 in Fortaleza. Drug susceptibility and spoligotyping assays were performed and place of residence of the patients were georeferenced.
  
  
  RESULTS
  Of the M. tuberculosis strains studied, 51 (44.3%) isolates were resistant to at least one drug (R-TB) and 64 (55.7%) were sensitive to all the drugs tested (S-TB). A high frequency of resistance was found in previously treated cases (84%) and among new cases (16%; p<0.001). A total of 74 (64%) isolates were grouped into 22 spoligotyped lineages, while 41 (36%) isolates were identified as new. Among the predominant genotypes, 33% were Latim American Mediterranean (LAM), 12% Haarlem (H), and 5% U. There was no association of geographic distribution of RT-TB patients as compared to the controls and also the geographic location to the spoligotype patterns. The geospatial analysis revealed that 24 (23%) patients (hot spot zones) either shared the same residence or lived in a close neighborhood of a case. Among these concentration zones, the patients lived in the same residence and shared a common genotype pattern and resistance pattern.
  
  
  CONCLUSIONS
  It was observed that the spoligopatterns family distribution was similar to that reported for South America, prevailing the LAM and H lineages. A high rate-case among the resistant TB group occurs as a result of transmitted and acquired resistance. A more effective surveillance program is needed in order to succeed in reducing tuberculosis in Northeast Brazil.
authors.affiliation: Department of Pathology, Medical School, Universidade Federal do Ceará (UFC), Fortaleza, Ceará, Brazil.
authors.forename: Roberta Dos Santos Silva
authors.initials: Rdos S
authors.lastname: Luiz
authors.forename: Phillip
authors.initials: P
authors.lastname: Suffys
authors.forename: Elizabeth Clara
authors.initials: EC
authors.lastname: Barroso
authors.forename: Ligia Regina Franco Sansigolo
authors.initials: LR
authors.lastname: Kerr
authors.forename: Cynthia Romariz
authors.initials: CR
authors.lastname: Duarte
authors.forename: Max Victor Carioca
authors.initials: MV
authors.lastname: Freitas
authors.forename: Rosa Maria Salani
authors.initials: RM
authors.lastname: Mota
authors.forename: Cristiane Cunha
authors.initials: CC
authors.lastname: Frota
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000995:Antitubercular Agents / Q000494:pharmacology; D001938:Brazil / Q000453:epidemiology; D016022:Case-Control Studies; D004269:DNA, Bacterial / Q000235:genetics; D005260:Female; D014644:Genetic Variation; D005838:Genotype; D040362:Geographic Information Systems; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000187:drug effects* / Q000235:genetics* / Q000302:isolation & purification; D015995:Prevalence; D011446:Prospective Studies; D014397:Tuberculosis, Pulmonary / Q000453:epidemiology / Q000382:microbiology*; D055815:Young Adult
chemical_list: D000995:Antitubercular Agents; D004269:DNA, Bacterial