Predominance of Uganda genotype of Mycobacterium tuberculosis isolated from Ugandan patients with tuberculous lymphadenitis.
BACKGROUND
In Uganda, the emerging Uganda genotype of Mycobacterium tuberculosis is the most common cause of pulmonary tuberculosis (PTB), and accounts for up to 70% of isolates. Extrapulmonary TB (EPTB) is less studied in Uganda.


METHODS
Molecular characterization using deletion analysis and spoligotyping was performed on 121 M. tuberculosis isolates from lymph node fine needle biopsy aspirates of Ugandan patients with tuberculous lymphadenitis. The evolutionary relationships and worldwide distribution of the spoligotypes were analyzed.


RESULTS
Mycobacterium tuberculosis was the only cause of EPTB in this study. The T2 sublineage was the most predominant lineage and the Uganda genotype was the dominant genotype. There were 54 spoligotype patterns among the 121 study isolates. The dominant spoligotypes were shared international types (SIT) SIT420, SIT53, SIT 135, SIT 128 and SIT590 in descending order. All but SIT420 were previously reported in pulmonary TB in this setting. The phylogenetic analysis showed a long descendant branch of spoligotypes belonging to the T2-Uganda sublineage containing specifically SITs 135, 128 and 420.


CONCLUSIONS
In most cases, the spoligotypes were similar to those causing PTB, but the Uganda genotype was found to be less common in EPTB than previously reported for PTB in Uganda. The phylogenetic analysis and the study of the worldwide distribution of clustered spoligotypes indicate an ongoing evolution of the Uganda genotype, with the country of Uganda at the center of this evolution.
Department of Pathology, Mulago Hospital and Makerere University College of Health Sciences, P. O. Box 7072, Kampala, Uganda. dwamala@gmail.com.|Department of Clinical Sciences and Education, Sodersjukhuset. Karolinska Institute, 171 77, Stockholm, Sweden. dwamala@gmail.com.
Dan
D
Wamala
Department of Medical Micobiology, Makerere University College of Health Sciences, P. O. Box 7072, Kampala, Uganda. mosesokee@gmail.com.
Moses
M
Okee
Department of Medical Micobiology, Makerere University College of Health Sciences, P. O. Box 7072, Kampala, Uganda. kigoziedgar@gmail.com.
Edgar
E
Kigozi
Unité de la Tuberculose et des Mycobactéries, Institut Pasteur de Guadeloupe, Pointe-à-Pitre, Guadeloupe, France. david.couvin@googlemail.com.
David
D
Couvin
Unité de la Tuberculose et des Mycobactéries, Institut Pasteur de Guadeloupe, Pointe-à-Pitre, Guadeloupe, France. nrastogi@pastuer-guadeloupe.fr.
Nalin
N
Rastogi
Department of Medical Micobiology, Makerere University College of Health Sciences, P. O. Box 7072, Kampala, Uganda. m.joloba@gmail.com.
Moses
M
Joloba
Department of Clinical Sciences and Education, Sodersjukhuset. Karolinska Institute, 171 77, Stockholm, Sweden. gunilla.kallenius@ki.s.
Gunilla
G
Kallenius
D005838:Genotype; D006801:Humans; D009169:Mycobacterium tuberculosis / Q000145:classification / Q000235:genetics* / Q000302:isolation & purification; D010802:Phylogeny; D014388:Tuberculosis, Lymph Node / Q000382:microbiology*; D014454:Uganda