title: Minimal diversity of drug-resistant Mycobacterium tuberculosis strains, South Africa.
abstract: Multidrug- (MDR) and extensively drug-resistant tuberculosis (XDR TB) are commonly associated with Beijing strains. However, in KwaZulu-Natal, South Africa, which has among the highest incidence and mortality for MDR and XDR TB, data suggest that non-Beijing strains are driving the epidemic. We conducted a retrospective study to characterize the strain prevalence among drug-susceptible, MDR, and XDR TB cases and determine associations between strain type and survival. Among 297 isolates from 2005-2006, 49 spoligotype patterns were found. Predominant strains were Beijing (ST1) among drug-susceptible isolates (27%), S/Quebec (ST34) in MDR TB (34%) and LAM4/KZN (ST60) in XDR TB (89%). More than 90% of patients were HIV co-infected. MDR TB and XDR TB were independently associated with mortality, but TB strain type was not. We conclude that, although Beijing strain was common among drug-susceptible TB, other strains predominated among MDR TB and XDR TB cases. Drug-resistance was a stronger predictor of survival than strain type.
authors.forename: Neel R
authors.initials: NR
authors.lastname: Gandhi
authors.forename: James C M
authors.initials: JC
authors.lastname: Brust
authors.forename: Prashini
authors.initials: P
authors.lastname: Moodley
authors.forename: Darren
authors.initials: D
authors.lastname: Weissman
authors.forename: Moonseong
authors.initials: M
authors.lastname: Heo
authors.forename: Yuming
authors.initials: Y
authors.lastname: Ning
authors.forename: Anthony P
authors.initials: AP
authors.lastname: Moll
authors.forename: Gerald H
authors.initials: GH
authors.lastname: Friedland
authors.forename: A Willem
authors.initials: AW
authors.lastname: Sturm
authors.forename: N Sarita
authors.initials: NS
authors.lastname: Shah
mesh_terms: D000328:Adult; D000995:Antitubercular Agents / Q000494:pharmacology; D060085:Coinfection; D005260:Female; D014644:Genetic Variation; D060005:Genotyping Techniques; D015658:HIV Infections; D006801:Humans; D015994:Incidence; D008297:Male; D008826:Microbial Sensitivity Tests; D009169:Mycobacterium tuberculosis / Q000145:classification* / Q000187:drug effects / Q000302:isolation & purification; D012189:Retrospective Studies; D013019:South Africa / Q000453:epidemiology; D016019:Survival Analysis; D018088:Tuberculosis, Multidrug-Resistant / Q000453:epidemiology* / Q000382:microbiology*
chemical_list: D000995:Antitubercular Agents
keywords: HIV; Mycobacterium tuberculosis; South Africa; antimicrobial resistance; bacteria; drug resistance; genotype; transmission; tuberculosis; tuberculosis and other mycobacteria