title: Long-term dominance of Mycobacterium tuberculosis Uganda family in peri-urban Kampala-Uganda is not associated with cavitary disease.
abstract: BACKGROUND
  Previous studies have shown that Mycobacterium tuberculosis (MTB) Uganda family, a sub-lineage of the MTB Lineage 4, is the main cause of tuberculosis (TB) in Uganda. Using a well characterized patient population, this study sought to determine whether there are clinical and patient characteristics associated with the success of the MTB Uganda family in Kampala.
  
  
  METHODS
  A total of 1,746 MTB clinical isolates collected from 1992-2009 in a household contact study were genotyped. Genotyping was performed using Single Nucleotide Polymorphic (SNP) markers specific for the MTB Uganda family, other Lineage 4 strains, and Lineage 3, respectively. Out of 1,746 isolates, 1,213 were from patients with detailed clinical data. These data were used to seek associations between MTB lineage/sub-lineage and patient phenotypes.
  
  
  RESULTS
  Three MTB lineages were found to dominate the MTB population in Kampala during the last two decades. Overall, MTB Uganda accounted for 63% (1,092/1,746) of all cases, followed by other Lineage 4 strains accounting for 22% (394/1,746), and Lineage 3 for 11% (187/1,746) of cases, respectively. Seventy-three (4 %) strains remained unclassified. Our longitudinal data showed that MTB Uganda family occurred at the highest frequency during the whole study period, followed by other Lineage 4 strains and Lineage 3. To explore whether the long-term success of MTB Uganda family was due to increased virulence, we used cavitary disease as a proxy, as this form of TB is the most transmissible. Multivariate analysis revealed that even though cavitary disease was associated with known risk factors such as smoking (adjusted odds ratio (aOR) 4.8, 95% confidence interval (CI) 3.33-6.84) and low income (aOR 2.1, 95% CI 1.47-3.01), no association was found between MTB lineage and cavitary TB.
  
  
  CONCLUSIONS
  The MTB Uganda family has been dominating in Kampala for the last 18 years, but this long-term success is not due to increased virulence as defined by cavitary disease.
authors.forename: Eddie M
authors.initials: EM
authors.lastname: Wampande
authors.forename: Ezekiel
authors.initials: E
authors.lastname: Mupere
authors.forename: Sara M
authors.initials: SM
authors.lastname: Debanne
authors.forename: Benon B
authors.initials: BB
authors.lastname: Asiimwe
authors.forename: Mary
authors.initials: M
authors.lastname: Nsereko
authors.forename: Harriet
authors.initials: H
authors.lastname: Mayanja
authors.forename: Kathleen
authors.initials: K
authors.lastname: Eisenach
authors.forename: Gilla
authors.initials: G
authors.lastname: Kaplan
authors.forename: Henry W
authors.initials: HW
authors.lastname: Boom
authors.forename: Sebastien
authors.initials: S
authors.lastname: Gagneux
authors.affiliation: Department of Medical Microbiology, College of Health Sciences, Makerere University, Kampala, Uganda. moses.joloba@case.edu.
authors.forename: Moses L
authors.initials: ML
authors.lastname: Joloba
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D009169:Mycobacterium tuberculosis / Q000145:classification* / Q000235:genetics / Q000302:isolation & purification / Q000472:pathogenicity; D010641:Phenotype; D020641:Polymorphism, Single Nucleotide; D011446:Prospective Studies; D014376:Tuberculosis / Q000453:epidemiology / Q000382:microbiology*; D014454:Uganda / Q000453:epidemiology