title: Molecular epidemiology of tuberculosis in Sicily, Italy: what has changed after a decade?
abstract: BACKGROUND
  We aimed to investigate the molecular epidemiology of Mycobacterium tuberculosis complex (MTBC) isolates in the province of Palermo, Sicily, Italy, by characterizing 183 isolates identified in the years 2004-2012. A comparison with 104 MTBC strains identified in the same geographic area in the years 1994-2000 was also carried out.
  
  
  METHODS
  One hundred eighty-three MTBC isolates identified in Palermo, Italy, in the years 2004-2012 were analyzed by spoligotyping and the 24 mycobacterial interspersed repetitive unit (MIRU)-variable-number tandem-repeat (VNTR) method typing. Susceptibility testing to streptomycin, isoniazid, rifampin and ethambutol was also performed. Furthermore, the spoligotyping dataset obtained from 104 MTBC isolates identified from 1994 to 2000 was reanalyzed. Distribution into lineages and clustering of isolates in the two periods was compared.
  
  
  RESULTS
  One hundred seventy-seven out of the 183 isolates of MTBC submitted to molecular typing were fully characterized. Of these, 108 were from Italian-born and 69 from foreign-born individuals. Eleven different lineages and 35 families-subfamilies were identified with the most represented lineages being Haarlem (26.5%), T (19.2%), LAM (13.6%) and S (8.5%). Except for the Haarlem lineage, where isolates from foreign-born patients were overrepresented, the distribution of isolates in the families belonging to the Euro-American clone reflected the proportions of the two subpopulations. A total of 27 (15.2%) strains were clustered and three clusters were mixed. Approximately 25% of the 183 MTBC isolates under study proved to be resistant to at least one antiTB drug, with only three isolates categorized as multidrug resistant (MDR). When MTBC isolates identified in the years 1994-2000 were reanalyzed, lineages T (30.8%), LAM (29.8%), Haarlem (16.3%) and S (13.5%) proved to be predominant. No MTBC isolates belonging to CAM, U, CAS, Turkish and Ural lineages were identified.
  
  
  CONCLUSIONS
  A wide heterogeneity was detected among the MTBC strains isolated in the years 2004-2012. Six lineages were not present among the isolates of the period 1994-2000. Comparison between distribution of lineages in the two consecutive periods depicts rapid and deep changes in the TB epidemiology in Palermo, Italy. An universal and continued laboratory-based surveillance of TB in Sicily is required.
authors.affiliation: Department of Sciences for Health Promotion and Mother-Child Care "G. D'Alessandro", University of Palermo, Palermo, Italy. celestino.bonura@unipa.it.
authors.forename: Celestino
authors.initials: C
authors.lastname: Bonura
authors.affiliation: CNRS-Université Paris-Sud, Institut de Génétique et Microbiologie, UMR8621, Infection Genetics Emerging Pathogen Evolution Team, Orsay, France. michel.gomgnimbou@igmors.u-psud.fr.
authors.forename: Michel K
authors.initials: MK
authors.lastname: Gomgnimbou
authors.affiliation: CNRS-Université Paris-Sud, Institut de Génétique et Microbiologie, UMR8621, Infection Genetics Emerging Pathogen Evolution Team, Orsay, France. guislaine.refregier@igmors.u-psud.fr.
authors.forename: Guislaine
authors.initials: G
authors.lastname: Refrégier
authors.affiliation: Department of Sciences for Health Promotion and Mother-Child Care "G. D'Alessandro", University of Palermo, Palermo, Italy. auroraaleo@libero.it.
authors.forename: Aurora
authors.initials: A
authors.lastname: Aleo
authors.affiliation: Department of Sciences for Health Promotion and Mother-Child Care "G. D'Alessandro", University of Palermo, Palermo, Italy. teresa.fasciana@virgilio.it.
authors.forename: Teresa
authors.initials: T
authors.lastname: Fasciana
authors.affiliation: Department of Sciences for Health Promotion and Mother-Child Care "G. D'Alessandro", University of Palermo, Palermo, Italy. anna.giammanco@unipa.it.
authors.forename: Anna
authors.initials: A
authors.lastname: Giammanco
authors.affiliation: CNRS-Université Paris-Sud, Institut de Génétique et Microbiologie, UMR8621, Infection Genetics Emerging Pathogen Evolution Team, Orsay, France. christophe.sola@igmors.u-psud.fr.
authors.forename: Christophe
authors.initials: C
authors.lastname: Sola
authors.affiliation: Department of Sciences for Health Promotion and Mother-Child Care "G. D'Alessandro", University of Palermo, Palermo, Italy. caterina.mammina@unipa.it.
authors.forename: Caterina
authors.initials: C
authors.lastname: Mammina
mesh_terms: D000328:Adult; D000904:Antibiotics, Antitubercular / Q000494:pharmacology; D024881:Drug Resistance, Bacterial / Q000502:physiology; D004977:Ethambutol / Q000494:pharmacology; D005260:Female; D005838:Genotype; D006801:Humans; D007538:Isoniazid / Q000494:pharmacology; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D018598:Minisatellite Repeats; D017720:Molecular Epidemiology; D058889:Molecular Typing; D009169:Mycobacterium tuberculosis / Q000187:drug effects / Q000235:genetics* / Q000502:physiology; D012293:Rifampin / Q000494:pharmacology; D012802:Sicily / Q000453:epidemiology; D014376:Tuberculosis / Q000453:epidemiology / Q000382:microbiology*
chemical_list: D000904:Antibiotics, Antitubercular; D004977:Ethambutol; D007538:Isoniazid; D012293:Rifampin