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Published in: BMC Infectious Diseases 1/2008

Open Access 01-12-2008 | Research article

The Recent-Transmission of Mycobacterium tuberculosis Strains among Iranian and Afghan Relapse Cases: a DNA-fingerprinting using RFLP and spoligotyping

Authors: Parissa-Farnia, Mohammad Reza Masjedi, Mohammad Varahram, Mehdi Mirsaeidi, Mojtaba Ahmadi, Mehdi Khazampour, Payam Tabarsi, Parvaneh Baghei, Mojtaba Marjane, Muslam Bahadori, Abolhasan Zia Zarifi, Ali Akbar Velayati

Published in: BMC Infectious Diseases | Issue 1/2008

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Abstract

Background

Relapse of tuberculosis (TB) may develop as the result of reactivation of the endogenous primary infection, or as a result of a exogenous reinfection. This survey evaluated the rate of reactivation versus recent transmission among Iranian and Afghan relapse cases.

Methods

The sputum specimens were digested, examined microscopically for acid-fast bacilli, and inoculated into Löwenstein-Jensen slants by standard procedures. Thereafter, the susceptibility and identification tests were performed on culture positive specimens. Subsequently, the strains that were identified as Mycobacterium tuberculosis (258 isolates) were subjected to IS6110 restriction fragment length polymorphism (RFLP) and spoligotyping. Additional patient's information was collected for further epidemiological analysis. Patients whose isolates had identical genotyping patterns were considered a cluster with recent transmission episode.

Results

Out of 258 available isolates, 72(28%) had multi-drug resistant (MDR-TB) in ratio and 42 (16.2%) had other resistant. Notably, 38 of MDR-TB cases (52%) were isolated from Afghan patients. By IS6110-RFLP typing method, 65 patients (25%) were clustered in 29 clusters. In cluster cases, the intra-community transmissions between Iranian and Afghan patients were 41%. All MDR-TB patients in clusters had either Haarlem I or Beijing characteristic. The risk factors like sex, family history, close contact, living condition, PPD test result and site of TB infection were not associated with clustering. Although, the MDR-TB strains were more frequent in non-cluster cases (31%) than cluster one(18%) (P < 0.05). Majority of M. tuberculosis strains isolated from non-cluster cases were belong to EAI3 (51; 30%) and CASI(32;18.6%) superfamilies.

Conclusion

During the studied period, reactivation of a previous infection remain the more probable cause of recurrence. Although, the evidence of intra- community transmission between Iranian and Afghan TB cases, highlighted the impact of afghan immigrants in national tuberculosis control program (NTP) of Iran.
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Literature
1.
go back to reference van Embden JD, Cave MD, Crawford JT, Dale JW, Eisenach KD, Gicquel B, Hermans P, Martin C, Mc Adam R, Shinnick TM, Small PM: Strain identification of Mycobacterium tuberculosis by DNA fingerprinting: recommendation for a standardized methodology. J Clin Microbiol. 1993, 31: 406-409.PubMedPubMedCentral van Embden JD, Cave MD, Crawford JT, Dale JW, Eisenach KD, Gicquel B, Hermans P, Martin C, Mc Adam R, Shinnick TM, Small PM: Strain identification of Mycobacterium tuberculosis by DNA fingerprinting: recommendation for a standardized methodology. J Clin Microbiol. 1993, 31: 406-409.PubMedPubMedCentral
2.
go back to reference Thierry D, Brisson NA, Vincent LF, Nguyen S, Guesdon JL, Gicquel B: Characterization of Mycobacterium tuberculosis insertion sequence, IS6110, and its application in diagnosis. J Clin Microbiol. 1999, 28: 2668-2673. Thierry D, Brisson NA, Vincent LF, Nguyen S, Guesdon JL, Gicquel B: Characterization of Mycobacterium tuberculosis insertion sequence, IS6110, and its application in diagnosis. J Clin Microbiol. 1999, 28: 2668-2673.
3.
go back to reference Farnia P, Masjedi MR, Nasiri B, Mirsaedi M, Sorooch S, Kazeampour M, Velayati AA: Instability of IS6110 patterns in multidrug-resistant strains of Mycobacterium tuberculosis. Epidemiol Infect. 2007, 135: 346-352. 10.1017/S0950268806006790.CrossRefPubMed Farnia P, Masjedi MR, Nasiri B, Mirsaedi M, Sorooch S, Kazeampour M, Velayati AA: Instability of IS6110 patterns in multidrug-resistant strains of Mycobacterium tuberculosis. Epidemiol Infect. 2007, 135: 346-352. 10.1017/S0950268806006790.CrossRefPubMed
4.
go back to reference van Soolingen D, Qian L, de Haas PE, Douglas JT, Traore H, Portaels F, Qing HZ, Enkhsaikan D, Nymadawa P, van Embden JD: Predominnance of a single genotype of Mycobacterium tuberculosis in countries of East Asia. J Clin Microbiol. 1995, 33: 3234-3238.PubMedPubMedCentral van Soolingen D, Qian L, de Haas PE, Douglas JT, Traore H, Portaels F, Qing HZ, Enkhsaikan D, Nymadawa P, van Embden JD: Predominnance of a single genotype of Mycobacterium tuberculosis in countries of East Asia. J Clin Microbiol. 1995, 33: 3234-3238.PubMedPubMedCentral
5.
go back to reference Diel R, Schneider S, Walter KM, Ruf CM, Rusch-Gerdes S, Niemann S: Epidemiology of tuberculosis in Hamburg, Germany: Long-term population-based analysis applying classical and molecular epidemiological techniques. J Clin Microbiol. 2002, 40: 532-539. 10.1128/JCM.40.2.532-539.2002.CrossRefPubMedPubMedCentral Diel R, Schneider S, Walter KM, Ruf CM, Rusch-Gerdes S, Niemann S: Epidemiology of tuberculosis in Hamburg, Germany: Long-term population-based analysis applying classical and molecular epidemiological techniques. J Clin Microbiol. 2002, 40: 532-539. 10.1128/JCM.40.2.532-539.2002.CrossRefPubMedPubMedCentral
6.
go back to reference Bandera A, Gori A, Catozzi L, Esposti AD, Marchetti G, Molteni C, Ferrario G, Codecasa L, Penati V, Matteelli A, Franzetti F: Molecular Epidemiology study of Exogenous reinfection in an area with a low incidence of tuberculosis. J Clin Microbiol. 2001, 39: 2213-2218. 10.1128/JCM.39.6.2213-2218.2001.CrossRefPubMedPubMedCentral Bandera A, Gori A, Catozzi L, Esposti AD, Marchetti G, Molteni C, Ferrario G, Codecasa L, Penati V, Matteelli A, Franzetti F: Molecular Epidemiology study of Exogenous reinfection in an area with a low incidence of tuberculosis. J Clin Microbiol. 2001, 39: 2213-2218. 10.1128/JCM.39.6.2213-2218.2001.CrossRefPubMedPubMedCentral
7.
go back to reference Kruuner A, Pehme Lea, Ghebremichael S, Koivula T, Hoffner SE, Mikelsaar M: Use of Molecular techniques to distinguish between treatment failure and exogenous reinfection with Mycobacterium tuberculosis. Clin Infect Dis. 2002, 35: 146-153. 10.1086/340980.CrossRefPubMed Kruuner A, Pehme Lea, Ghebremichael S, Koivula T, Hoffner SE, Mikelsaar M: Use of Molecular techniques to distinguish between treatment failure and exogenous reinfection with Mycobacterium tuberculosis. Clin Infect Dis. 2002, 35: 146-153. 10.1086/340980.CrossRefPubMed
8.
go back to reference van Rie A, Warren R, Richardson M, Victor TC, Gie RR, Enarson DA, Beyers N, van Helden PD: Exogenous reinfection as a cause of recurrent tuberculosis after curative treatment. N Engl J Med. 1999, 341: 1174-1179. 10.1056/NEJM199910143411602.CrossRefPubMed van Rie A, Warren R, Richardson M, Victor TC, Gie RR, Enarson DA, Beyers N, van Helden PD: Exogenous reinfection as a cause of recurrent tuberculosis after curative treatment. N Engl J Med. 1999, 341: 1174-1179. 10.1056/NEJM199910143411602.CrossRefPubMed
9.
go back to reference Small PM, Shafer RW, Hopewell PC, Singh SP, Murphy MJ, Desmond E, Sierra MF, Schoonik GK: Exogenous reinfection with multidrug-resistant Mycobacterum tuberculosis in patients with advanced HIV infection. N Engl J Med. 1993, 328: 1137-1144. 10.1056/NEJM199304223281601.CrossRefPubMed Small PM, Shafer RW, Hopewell PC, Singh SP, Murphy MJ, Desmond E, Sierra MF, Schoonik GK: Exogenous reinfection with multidrug-resistant Mycobacterum tuberculosis in patients with advanced HIV infection. N Engl J Med. 1993, 328: 1137-1144. 10.1056/NEJM199304223281601.CrossRefPubMed
10.
go back to reference World Health Organization: Stop TB partnership annual report 2004. 2005, WHO. Geneva, Switzerland, 53: 1-200. World Health Organization: Stop TB partnership annual report 2004. 2005, WHO. Geneva, Switzerland, 53: 1-200.
11.
go back to reference World Health Organization: The WHO/IUATLD global project to anti-tuberculosis drug resistance surveillance 2000. 2000, WHO. Geneva, Switzerland, 278: 1-250. World Health Organization: The WHO/IUATLD global project to anti-tuberculosis drug resistance surveillance 2000. 2000, WHO. Geneva, Switzerland, 278: 1-250.
12.
go back to reference Masjedi MR, Farnia P, Sorooch S, Pooramiri MV, Mansoori SD, Zarifi A, Velayati AA, Hoffner S: Extensively drug resistant tuberculosis: 2 years of surveillance in Iran. Clin Infect Dis. 2006, 43: 840-847. 10.1086/507542.CrossRef Masjedi MR, Farnia P, Sorooch S, Pooramiri MV, Mansoori SD, Zarifi A, Velayati AA, Hoffner S: Extensively drug resistant tuberculosis: 2 years of surveillance in Iran. Clin Infect Dis. 2006, 43: 840-847. 10.1086/507542.CrossRef
13.
go back to reference Fomukong N, Beggs M, Hajj EL, Templeton G, Eisenach K, Cave MD: Differences in the prevalence of IS6110 insertion sites in M. tuberculosis strains:low and high copy number of IS6110. Tub Lung Dis. 1998, 78: 109-116. 10.1016/S0962-8479(98)80003-8.CrossRef Fomukong N, Beggs M, Hajj EL, Templeton G, Eisenach K, Cave MD: Differences in the prevalence of IS6110 insertion sites in M. tuberculosis strains:low and high copy number of IS6110. Tub Lung Dis. 1998, 78: 109-116. 10.1016/S0962-8479(98)80003-8.CrossRef
14.
go back to reference Sola C, Horgen L, Maisetti J, Devallois A, Goh KS, Rastogi N: Spoligotyping followed by double-repetitive elements PCR as rapid alternative to IS6110 fingerprinting for epidemiological studies of tuberculosis. J Clin Microbiol. 1998, 36: 1122-1124.PubMedPubMedCentral Sola C, Horgen L, Maisetti J, Devallois A, Goh KS, Rastogi N: Spoligotyping followed by double-repetitive elements PCR as rapid alternative to IS6110 fingerprinting for epidemiological studies of tuberculosis. J Clin Microbiol. 1998, 36: 1122-1124.PubMedPubMedCentral
15.
go back to reference Kent PT, Kubica GP: Public Health Mycobacteriology: a guide for a level III laboratory. 1985, Public Health Services, U.S. Department of Health and Human Services. Atlanta, AG Kent PT, Kubica GP: Public Health Mycobacteriology: a guide for a level III laboratory. 1985, Public Health Services, U.S. Department of Health and Human Services. Atlanta, AG
16.
go back to reference World Health Organization: The WHO/IUATLD global project to anti-tuberculosis drug resistance surveillance 2000. 2000, WHO. Geneva, Switzerland;WHO, 278- World Health Organization: The WHO/IUATLD global project to anti-tuberculosis drug resistance surveillance 2000. 2000, WHO. Geneva, Switzerland;WHO, 278-
17.
go back to reference Kamerbeek J, Schouts L, Kolk A, van Agterveld , van Solingen D, Kuijper S, Bunschoten A, Molhuizen H, Shaw R, Goyal M, van Embden J: Simultaneous detection and strain differentiation of Mycobacterium tuberculosis for diagnosis and epidemiology. J Clin Microbiol. 1997, 35: 907-14.PubMedPubMedCentral Kamerbeek J, Schouts L, Kolk A, van Agterveld , van Solingen D, Kuijper S, Bunschoten A, Molhuizen H, Shaw R, Goyal M, van Embden J: Simultaneous detection and strain differentiation of Mycobacterium tuberculosis for diagnosis and epidemiology. J Clin Microbiol. 1997, 35: 907-14.PubMedPubMedCentral
18.
go back to reference Fine PE, Small PM: Exogenous reinfection in tuberculosis. N Engl J Med. 1999, 341: 1226-1227. 10.1056/NEJM199910143411609.CrossRefPubMed Fine PE, Small PM: Exogenous reinfection in tuberculosis. N Engl J Med. 1999, 341: 1226-1227. 10.1056/NEJM199910143411609.CrossRefPubMed
19.
go back to reference Nardell E, McInnis B, Thomas B, Weidhaas S: Exogenous reinfection with tuberculosis in a shelter for the homeless. N Engl J Med. 1986, 315: 1570-1575.CrossRefPubMed Nardell E, McInnis B, Thomas B, Weidhaas S: Exogenous reinfection with tuberculosis in a shelter for the homeless. N Engl J Med. 1986, 315: 1570-1575.CrossRefPubMed
20.
go back to reference Velayati AK, Farnia P, Mirsaeidi M, Masjedi MR: The most prevalent Mycobacterium tuberculosis superfamilies among Iranian and Afghan TB cases. Scan J Infect Dis. 2006, 38: 463-468. 10.1080/00365540500504117.CrossRef Velayati AK, Farnia P, Mirsaeidi M, Masjedi MR: The most prevalent Mycobacterium tuberculosis superfamilies among Iranian and Afghan TB cases. Scan J Infect Dis. 2006, 38: 463-468. 10.1080/00365540500504117.CrossRef
21.
go back to reference Farnia P, Masjedi MR, Mirsaeidi M, Mohammadi F, Ghanavi J, Vincent V, Bahadori M, Velayati AK: Prevalence of Haarlem I and Beijing Types of Mycobacterium tuberculosis strains in Iranian and Afghan MDR-TB patients. J Infect. 2006, 53: 331-336. 10.1016/j.jinf.2005.12.020.CrossRefPubMed Farnia P, Masjedi MR, Mirsaeidi M, Mohammadi F, Ghanavi J, Vincent V, Bahadori M, Velayati AK: Prevalence of Haarlem I and Beijing Types of Mycobacterium tuberculosis strains in Iranian and Afghan MDR-TB patients. J Infect. 2006, 53: 331-336. 10.1016/j.jinf.2005.12.020.CrossRefPubMed
22.
go back to reference Brudey K, Driscoll JR, Rigouts L, Prodinger WM, Gori A, Al-Hajoj SA, Allix C, Aristimuno L, Arora J, Baumanis V, Binder L, Cafrune P, Cataldi A, Cheong S, Diel R, Ellermeier C, Evans JT, Dufaux FM, Ferdinand S, de Viedma GD, Garzelli C, Gazzola L, Gomes HM, Gutierrez MC, Hawkey PM, van Helden PD, Kadival GV, Kreiswirth BN, Kremer K, Kubin M, Kulkarni SP, Liens B, Lillebaek T, Ly HM, Martin C, Mokrousov I, Narvskaia O, Ngeow YF, Naumann L, Niemann S, Parwati I, Rahim MZ, Razanamparany RV, Rasolonavalona T, Rossetti ML, Gerdes RS, Sajduda A, Samper S, Shemyakin I, Singh UB, Somoskovi A, Skuce R, van Soolingen D, Streicher EM, Suffys PN, Tortoli E, Tracevska T, Vincent V, Victor TC, Warren R, Yap SF, Zaman K, Portaels F, Rastogi N, Sola C: Mycobacterium tuberculosis complex genetic diversity: mining the fourth international spoligotyping database (SpolDB4) for classification, population genetics and epidemiology. BMC Microbiol. 2006, 6: 23-10.1186/1471-2180-6-23.CrossRefPubMedPubMedCentral Brudey K, Driscoll JR, Rigouts L, Prodinger WM, Gori A, Al-Hajoj SA, Allix C, Aristimuno L, Arora J, Baumanis V, Binder L, Cafrune P, Cataldi A, Cheong S, Diel R, Ellermeier C, Evans JT, Dufaux FM, Ferdinand S, de Viedma GD, Garzelli C, Gazzola L, Gomes HM, Gutierrez MC, Hawkey PM, van Helden PD, Kadival GV, Kreiswirth BN, Kremer K, Kubin M, Kulkarni SP, Liens B, Lillebaek T, Ly HM, Martin C, Mokrousov I, Narvskaia O, Ngeow YF, Naumann L, Niemann S, Parwati I, Rahim MZ, Razanamparany RV, Rasolonavalona T, Rossetti ML, Gerdes RS, Sajduda A, Samper S, Shemyakin I, Singh UB, Somoskovi A, Skuce R, van Soolingen D, Streicher EM, Suffys PN, Tortoli E, Tracevska T, Vincent V, Victor TC, Warren R, Yap SF, Zaman K, Portaels F, Rastogi N, Sola C: Mycobacterium tuberculosis complex genetic diversity: mining the fourth international spoligotyping database (SpolDB4) for classification, population genetics and epidemiology. BMC Microbiol. 2006, 6: 23-10.1186/1471-2180-6-23.CrossRefPubMedPubMedCentral
23.
go back to reference Mokrousov I, Jiao WW, Valcheva V, Vyazovaya A, Otten T, Ly HM, Lan NN, Limeschenko E, Markova N, Vyshnevskiy B, Shen AD, Narvskaya O: Rapid Detection of the Mycobacterium tuberculosis Beijing Genotype and Its Ancient and Modern Sublineages by IS6110-Based Inverse PCR. J Clin Microbiol. 2006, 44: 2851-2856. 10.1128/JCM.00705-06.CrossRefPubMedPubMedCentral Mokrousov I, Jiao WW, Valcheva V, Vyazovaya A, Otten T, Ly HM, Lan NN, Limeschenko E, Markova N, Vyshnevskiy B, Shen AD, Narvskaya O: Rapid Detection of the Mycobacterium tuberculosis Beijing Genotype and Its Ancient and Modern Sublineages by IS6110-Based Inverse PCR. J Clin Microbiol. 2006, 44: 2851-2856. 10.1128/JCM.00705-06.CrossRefPubMedPubMedCentral
24.
go back to reference British Thoracic Association: A controlled trial of six months chemotherapy in pulmonary tuberculosis: second report: results during the 24 months after the end of chemotherapy. Am Rev Respir Dis. 1982, 126: 460-462. British Thoracic Association: A controlled trial of six months chemotherapy in pulmonary tuberculosis: second report: results during the 24 months after the end of chemotherapy. Am Rev Respir Dis. 1982, 126: 460-462.
25.
go back to reference Hong Kong Chest Services/British Medical Research Council: Controlled trial of 6-month and 9-month regimens of daily and intermittent streptomycin plus isoniazid plus pyrazinamide for pulmonary tuberculosis in Hong Kong; the results up to 30 months. Am Rev Respir Dis. 1977, 115: 727-735. Hong Kong Chest Services/British Medical Research Council: Controlled trial of 6-month and 9-month regimens of daily and intermittent streptomycin plus isoniazid plus pyrazinamide for pulmonary tuberculosis in Hong Kong; the results up to 30 months. Am Rev Respir Dis. 1977, 115: 727-735.
26.
go back to reference Sreevatsan S, Pan X, Stockbauerk K, Connell ND, Kreiswirth BN, Whittam T, Musser JM: Restricted structural gene polymorphism in the Mycobacterium tuberculosis complex indicates evolutionary recent global dissemination. Proc Natl Acad Sci USA. 1997, 97: 9869-9874. 10.1073/pnas.94.18.9869.CrossRef Sreevatsan S, Pan X, Stockbauerk K, Connell ND, Kreiswirth BN, Whittam T, Musser JM: Restricted structural gene polymorphism in the Mycobacterium tuberculosis complex indicates evolutionary recent global dissemination. Proc Natl Acad Sci USA. 1997, 97: 9869-9874. 10.1073/pnas.94.18.9869.CrossRef
27.
go back to reference Mitchison DA: How drug resistance emerges as a result of poor compliance during short course chemotherapy for tuberculosis. Int J Tuberc Lung Dis. 1998, 2: 10-15.PubMed Mitchison DA: How drug resistance emerges as a result of poor compliance during short course chemotherapy for tuberculosis. Int J Tuberc Lung Dis. 1998, 2: 10-15.PubMed
Metadata
Title
The Recent-Transmission of Mycobacterium tuberculosis Strains among Iranian and Afghan Relapse Cases: a DNA-fingerprinting using RFLP and spoligotyping
Authors
Parissa-Farnia
Mohammad Reza Masjedi
Mohammad Varahram
Mehdi Mirsaeidi
Mojtaba Ahmadi
Mehdi Khazampour
Payam Tabarsi
Parvaneh Baghei
Mojtaba Marjane
Muslam Bahadori
Abolhasan Zia Zarifi
Ali Akbar Velayati
Publication date
01-12-2008
Publisher
BioMed Central
Published in
BMC Infectious Diseases / Issue 1/2008
Electronic ISSN: 1471-2334
DOI
https://doi.org/10.1186/1471-2334-8-109

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