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BMC Infectious Diseases
Published in: BMC Infectious Diseases 1/2021

Open Access 01-12-2021 | Tuberculosis | Research article

Variation in Mycobacterium tuberculosis population structure in Iran: a systemic review and meta-analysis

Authors: Shima Hadifar, Abolfazl Fateh, Vahid Pourbarkhordar, Seyed Davar Siadat, Shayan Mostafaei, Farzam Vaziri

Published in: BMC Infectious Diseases | Issue 1/2021

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Abstract

Background

Acquiring comprehensive insight into the dynamics of Mycobacterium tuberculosis (Mtb) population structure is an essential step to adopt effective tuberculosis (TB) control strategies and improve therapeutic methods and vaccines. Accordingly, we performed this systematic review and meta-analysis to determine the overall prevalence of Mtb genotypes/ sublineages in Iran.

Methods

We carried out a comprehensive literature search using the international databases of MEDLINE and Scopus as well as Iranian databases. Articles published until April 2020 were selected based on the PRISMA flow diagram. The overall prevalence of the Mtb genotypes/sublineage in Iran was determined using the random effects or fixed effect model. The metafor R package and MedCalc software were employed for performing this meta-analysis.

Results

We identified 34 studies for inclusion in this study, containing 8329 clinical samples. Based on the pooled prevalence of the Mtb genotypes, NEW1 (21.94, 95% CI: 16.41–28.05%), CAS (19.21, 95% CI: 14.95–23.86%), EAI (12.95, 95% CI: 7.58–19.47%), and T (12.16, 95% CI: 9.18–15.50%) were characterized as the dominant circulating genotypes in Iran. West African (L 5/6), Cameroon, TUR and H37Rv were identified as genotypes with the lowest prevalence in Iran (< 2%). The highest pooled prevalence rates of multidrug-resistant strains were related to Beijing (2.52, 95% CI) and CAS (1.21, 95% CI).

Conclusions

This systematic review showed that Mtb populations are genetically diverse in Iran, and further studies are needed to gain a better insight into the national diversity of Mtb populations and their drug resistance pattern.
Literature
1.
WHO. WHO global report, global tuberculosis report 2019. Geneva: World Health Organization; 2019.
2.
Brites D, Gagneux S. The nature and evolution of genomic diversity in the mycobacterium tuberculosis complex. Adv Exp Med Biol. 2017;1019:1–26.PubMedCrossRef
3.
Ngabonziza JCS, Loiseau C, Marceau M, Jouet A, Menardo F, Tzfadia O, et al. A sister lineage of the mycobacterium tuberculosis complex discovered in the African Great Lakes region. Nat Commun. 2020;11(1):1–11.CrossRef
4.
Comas I, Coscolla M, Luo T, Borrell S, Holt KE, Kato-Maeda M, et al. Out-of-Africa migration and Neolithic coexpansion of mycobacterium tuberculosis with modern humans. Nat Genet. 2013;45(10):1176.PubMedPubMedCentralCrossRef
5.
Gagneux S, DeRiemer K, Van T, Kato-Maeda M, De Jong BC, Narayanan S, et al. Variable host–pathogen compatibility in mycobacterium tuberculosis. Proc Natl Acad Sci. 2006;103(8):2869–73.PubMedCrossRefPubMedCentral
6.
Hadifar S, Behrouzi A, Fateh A, Khatami S, Rahimi Jamnani F, Siadat SD, et al. Comparative study of interruption of signaling pathways in lung epithelial cell by two different mycobacterium tuberculosis lineages. J Cell Physiol. 2019;234(4):4739–53.PubMedCrossRef
7.
Chapman HJ, Phillips SA, Hosford JL, Séraphin MN, Lauzardo M. Is the Beijing strain of mycobacterium tuberculosis associated with cavitary lung disease? Infect Genet Evol. 2015;33:1–5.PubMedCrossRef
8.
Sarkar R, Lenders L, Wilkinson KA, Wilkinson RJ, Nicol MP. Modern lineages of mycobacterium tuberculosis exhibit lineage-specific patterns of growth and cytokine induction in human monocyte-derived macrophages. PLOS ONE. 2012;7(8):e43170.PubMedPubMedCentralCrossRef
9.
Hanekom M, Van Pittius NG, McEvoy C, Victor T, Van Helden P, Warren R. Mycobacterium tuberculosis Beijing genotype: a template for success. Tuberculosis. 2011;91(6):510–23.PubMedCrossRef
10.
Brynildsrud OB, Pepperell CS, Suffys P, Grandjean L, Monteserin J, Debech N, et al. Global expansion of mycobacterium tuberculosis lineage 4 shaped by colonial migration and local adaptation. Sci Adv. 2018;4(10):eaat5869.PubMedPubMedCentralCrossRef
11.
Coscolla M. Biological and epidemiological consequences of MTBC diversity. In: Gagneux S, editor. Strain variation in the Mycobacterium tuberculosis complex: its role in biology, epidemiology and control. Cham: Springer International Publishing; 2017. p. 95–116.CrossRef
12.
Stucki D, Brites D, Jeljeli L, Coscolla M, Liu Q, Trauner A, et al. Mycobacterium tuberculosis lineage 4 comprises globally distributed and geographically restricted sublineages. Nat Genet. 2016;48(12):1535–43.PubMedPubMedCentralCrossRef
13.
Mokrousov I. Emerging resistant clone of mycobacterium tuberculosis in West Asia. Lancet Infect Dis. 2016;16(12):1326–7.PubMedCrossRef
14.
Yasmin M, Gomgnimbou MK, Siddiqui RT, Refrégier G, Sola C. Multi-drug resistant mycobacterium tuberculosis complex genetic diversity and clues on recent transmission in Punjab, Pakistan. Infect Genet Evol. 2014;27:6–14.PubMedCrossRef
15.
Wiens KE, Woyczynski LP, Ledesma JR, Ross JM, Zenteno-Cuevas R, Goodridge A, et al. Global variation in bacterial strains that cause tuberculosis disease: a systematic review and meta-analysis. BMC Med. 2018;16(1):1–13.CrossRef
16.
Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med. 2009;151(4):264–9.CrossRefPubMed
17.
Amirmozafari N, Ramezanzadeh R, Farnia P, Ghazi F. The frequency of Beijing genotype of mycobacterium tuberculosis isolated from tuberculosis patients. Razi J Med Sci. 2006;13(52):7–17.
18.
Ramazanzadeh R, Amirmozafari N, Farnia P, Ghazi F. Genotyping of mycobacterium tuberculosis isolates from TB patients with spoligotyping. Scie J Kurdistan Univ Med Sci. 2006;11(1):50–9.
19.
Masjedi MR, Varahram M, Mirsaeidi M, Ahmadi M, Khazampour M, Tabarsi P, et al. The recent-transmission of mycobacterium tuberculosis strains among Iranian and afghan relapse cases: a DNA-fingerprinting using RFLP and spoligotyping. BMC Infect Dis. 2008;8(1):109.PubMedPubMedCentralCrossRef
20.
Tajeddin E, Farnia P, Kargar M, Noroozi J, Ahmadi M, Kazempour M, et al. Identification of mycobacterium tuberculosis Beijing genotype using three different molecular methods. Koomesh. 2009;11(1):7–14.
21.
Ramazanzadeh R, Farnia P, Amirmozafari N. Characterization of mycobacterium tuberculosis complex isolated from iranian and afghani patients by spoligotyping method. Braz J Microbiol. 2009;40(2):314–20.PubMedPubMedCentralCrossRef
22.
Rohani M, Farnia P, Nasab MN, Moniri R, Torfeh M, Amiri M. Beijing genotype and other predominant mycobacterium tuberculosis spoligotypes observed in Mashhad city, Iran. Indian J Med Microbiol. 2009;27(4):306.PubMedCrossRef
23.
Ahmadi M, Farnia P, Tajedin E, Tabarsi P, Baghaei P, Masjedi M, et al. Mycobacterium tuberculosis complex strains identification with Spoligotyping method in patients attending to Masih Daneshvari hospital. J Adv Med Biomed Res. 2009;17(67):23–32.
24.
Jafarian M, Aghali-Merza M, Farnia P, Ahmadi M, Masjedi MR, Velayati AA. Synchronous comparison of mycobacterium tuberculosis epidemiology strains by “MIRU-VNTR” and “MIRU-VNTR and Spoligotyping” technique. Avicenna J Med Biotechnol. 2010;2(3):145.PubMedPubMedCentral
25.
Merza MA, Farnia P, Salih AM, Masjedi MR, Velayati AA. The most predominant spoligopatterns of mycobacterium tuberculosis isolates among Iranian, afghan-immigrant, Pakistani and Turkish tuberculosis patients: a comparative analysis. Chemotherapy. 2010;56(3):248–57.PubMedCrossRef
26.
Asgharzadeh M, Kafil HS, Roudsary AA, Hanifi GR. Tuberculosis transmission in northwest of Iran: using MIRU-VNTR, ETR-VNTR and IS6110-RFLP methods. Infect Genet Evol. 2011;11(1):124–31.PubMedCrossRef
27.
Jafarian M, Farnia P, Mozafari M, Ahmadi M, Masjiedi M, Velayati A. Comparison of the genetic convergence degree of mycobacterium tuberculosis (TB) strains isolated from patients infected with TB by MIRU-VNTR technique. J Adv Med Biomed Res. 2011;19(75):25–36.
28.
Zaker Bostanabad S, Jabbarzadeh E, Pourazar S, Ghalami M. Typing of mycobacterium tuberculosis isolated from patients in the Tehran City by Spoilgotyping. New Cellular Mol Biotechnol J. 2011;1(2):55–60.
29.
Mozafari M, Farnia P, Jafarian M, Razavi Deligani M, Kazempour M, Masjedi M, et al. Comparison of mycobacterium tuberculosis Beijing genotype with other mycobacterium tuberculosis strains using MIRU-VNTR method. ISMJ. 2012;15(1):1–12.
30.
Haeili M, Darban-Sarokhalil D, Fooladi AAI, Javadpour S, Hashemi A, Siavoshi F, et al. Spoligotyping and drug resistance patterns of mycobacterium tuberculosis isolates from five provinces of Iran. Microbiologyopen. 2013;2(6):988–96.PubMedPubMedCentralCrossRef
31.
Torkaman MRA, Nasiri MJ, FaRnia P, Shahhosseiny MH, Mozafari M, Velayati AA. Estimation of recent transmission of mycobacterium tuberculosis strains among Iranian and afghan immigrants: a cluster-based study. J Clin Diagn Res. 2014;8(9):DC05.PubMedPubMedCentral
32.
Velayati AA, Farnia P, Mozafari M, Sheikholeslami MF, Karahrudi MA, Tabarsi P, et al. High prevelance of rifampin-monoresistant tuberculosis: a retrospective analysis among Iranian pulmonary tuberculosis patients. Am J Trop Med Hyg. 2014;90(1):99–105.PubMedPubMedCentralCrossRef
33.
Varahram M, Farnia P, Nasiri MJ, Karahrudi MA, Dizagie MK, Velayati AA. Association of Mycobacterium tuberculosis lineages with IFN-γ and TNF-α gene polymorphisms among pulmonary tuberculosis patient. Mediterranean J Hematol Infect Dis. 2014;6(1):e2014015–e.
34.
Sharifipour E, Nasiri M, Farnia P, Mozafari M, Irani S. Evaluation of molecular diversity of mycobacterium tuberculosis strains by polymorphisms in RD regions. J Mycobac Dis. 2014;4(153):2161–1068.
35.
Haeili M, Darban-Sarokhalil D, Fooladi AI, Zamani S, Zahednamazi F, Kardan J, et al. Genotyping and drug susceptibility testing of mycobacterium tuberculosis isolates from Iran. Int J Mycobacteriol. 2015;4:122.CrossRef
36.
Sharifipour E, Farnia P, Mozafari M, Irani S, Velayati AA. Deletion of region of difference 181 in mycobacterium tuberculosis Beijing strains. Int J Mycobacteriol. 2016;5:S238–9.PubMedCrossRef
37.
Feyisa SG, Haeili M, Zahednamazi F, Mosavari N, Taheri MM, Hamzehloo G, et al. Molecular characterization of mycobacterium tuberculosis isolates from Tehran, Iran by restriction fragment length polymorphism analysis and spoligotyping. Rev Soc Bras Med Trop. 2016;49(2):204–10.PubMedCrossRef
38.
Zamani S, Haeili M, Nasiri MJ, Imani Fooladi AA, Javadpour S, Feizabadi MM. Genotyping of mycobacterium tuberculosis isolates from Hormozgan Province of Iran based on 15-locus MIRU-VNTR and Spoligotyping. Int J Bacteriol. 2016;2016:7146470.PubMedPubMedCentralCrossRef
39.
Zaniani FR, Moghim S, Mirhendi H, Safaei HG, Fazeli H, Salehi M, et al. Genetic lineages of mycobacterium tuberculosis isolates in Isfahan, Iran. Curr Microbiol. 2017;74(1):14–21.CrossRef
40.
Ravansalar H, Tadayon K, Mosavari N, Derakhshan M, Ghazvini K. Genetic diversity of mycobacterium tuberculosis complex isolated from patients in the northeast of Iran by MIRU-VNTR and spoligotyping. Jundishapur J Microbiol. 2017;10(4):e39568.
41.
Mansoori N, Yaseri M, Vaziri F, Douraghi M. Genetic diversity of mycobacterium tuberculosis complex isolates circulating in an area with high tuberculosis incidence: using 24-locus MIRU-VNTR method. Tuberculosis. 2018;112:89–97.PubMedCrossRef
42.
Azimi T, Nasiri MJ, Zamani S, Hashemi A, Goudarzi H, Fooladi AAI, et al. High genetic diversity among mycobacterium tuberculosis strains in Tehran, Iran. J Clin Tubercul Mycobacterial Dis. 2018;11:1–6.CrossRef
43.
Kamakoli MK, Khanipour S, Hadifar S, Ghajavand H, Farmanfarmaei G, Fateh A, et al. Challenge in direct Spoligotyping of mycobacterium tuberculosis: a problematic issue in the region with high prevalence of polyclonal infections. BMC Res Notes. 2018;11(1):486.CrossRef
44.
Babai Kochkaksaraei M, Kaboosi H, Ghaemi EA. Genetic variation of the mycobacterium tuberculosis in north of Iran; the Golestan Province. Iran Red Crescent Med J. 2019;21(8):e91553.
45.
Hadifar S, Shamkhali L, Kamakoli MK, Mostafaei S, Khanipour S, Mansoori N, et al. Genetic diversity of mycobacterium tuberculosis isolates causing pulmonary and extrapulmonary tuberculosis in the capital of Iran. Mol Phylogenet Evol. 2019;132:46–52.PubMedCrossRef
46.
Afaghi GA, Moaddab SR, Darbouy M, Ansarian K, Hanifian S. Genotypic diversity of resistant mycobacterium tuberculosis strains isolated from tuberculosis patients in East Azerbaijan center by MIRU-VNTR. J Microb World. 2019;11(4):320–31.
47.
Hadifar S, Kamakoli MK, Fateh A, Siadat SD, Vaziri F. Enhancing the differentiation of specific genotypes in mycobacterium tuberculosis population. Sci Rep. 2019;9(1):1–9.CrossRef
48.
Vaziri F, Kohl TA, Ghajavand H, Kargarpour Kamakoli M, Merker M, Hadifar S, et al. Genetic diversity of multi- and extensively drug-resistant mycobacterium tuberculosis isolates in the Capital of Iran, revealed by whole-genome sequencing. J Clin Microbiol. 2019;57(1):e01477–18.PubMedPubMedCentralCrossRef
49.
Kargarpour Kamakoli M, Hadifar S, Khanipour S, Farmanfarmaei G, Fateh A, Siadat SD, et al. Comparison of MIRU-VNTR genotyping between old and fresh clinical samples in tuberculosis. Infect Dis. 2019;51(9):659–67.CrossRef
50.
Kamakoli MK, Farmanfarmaei G, Masoumi M, Khanipour S, Gharibzadeh S, Sola C, et al. Prediction of the hidden genotype of mixed infection strains in Iranian tuberculosis patients. Int J Infect Dis. 2020;95:22–7.CrossRef
51.
Von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. Ann Intern Med. 2007;147(8):573–7.CrossRef
52.
Stijnen T, Hamza TH, Özdemir P. Random effects meta-analysis of event outcome in the framework of the generalized linear mixed model with applications in sparse data. Stat Med. 2010;29(29):3046–67.PubMedCrossRef
53.
Huedo-Medina TB, Sánchez-Meca J, Marín-Martínez F, Botella J. Assessing heterogeneity in meta-analysis: Q statistic or I2 index? Psychol Methods. 2006;11(2):193.PubMedCrossRef
54.
Viechtbauer W. Conducting meta-analyses in R with the metafor package. J Stat Softw. 2010;36(3):1–48.CrossRef
55.
56.
Hershberg R, Lipatov M, Small PM, Sheffer H, Niemann S, Homolka S, et al. High functional diversity in mycobacterium tuberculosis driven by genetic drift and human demography. PLoS Biol. 2008;6(12):e311.PubMedPubMedCentralCrossRef
57.
Couvin D, Reynaud Y, Rastogi N. Two tales: worldwide distribution of central Asian (CAS) versus ancestral east-African Indian (EAI) lineages of mycobacterium tuberculosis underlines a remarkable cleavage for phylogeographical, epidemiological and demographical characteristics. PLoS One. 2019;14(7):e0219706.PubMedPubMedCentralCrossRef
58.
Tarashi S, Fateh A, Jamnani FR, Siadat SD, Vaziri F. Prevalence of Beijing and Haarlem genotypes among multidrug-resistant mycobacterium tuberculosis in Iran: systematic review and meta-analysis. Tuberculosis. 2017;107:31–7.PubMedCrossRef
59.
Mokrousov I, Shitikov E, Skiba Y, Kolchenko S, Chernyaeva E, Vyazovaya A. Emerging peak on the phylogeographic landscape of mycobacterium tuberculosis in West Asia: definitely smoke, likely fire. Mol Phylogenet Evol. 2017;116:202–12.PubMedCrossRef
Metadata
Title
Variation in Mycobacterium tuberculosis population structure in Iran: a systemic review and meta-analysis
Authors
Shima Hadifar
Abolfazl Fateh
Vahid Pourbarkhordar
Seyed Davar Siadat
Shayan Mostafaei
Farzam Vaziri
Publication date
01-12-2021
Publisher
BioMed Central
Published in
BMC Infectious Diseases / Issue 1/2021
Electronic ISSN: 1471-2334
DOI
https://doi.org/10.1186/s12879-020-05639-7

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