Documente Academic
Documente Profesional
Documente Cultură
Research on Tuberculosis
Study settings
Study population
Pop. 6 618 538 I.R. 59/100 000
Moscow
Epidemiologically unlinked M. tuberculosis strains from the Tula, Kaluga, and Moscow regions
Obolensk
Study methods
Kaluga
Pop. 1 041 641 I.R. 72,4 /100 000
Tula
Pop. 1 675 758 I.R. 106.8/100 000
Epidemiological markers (IS6110-RFLP, spoligotyping, MIRU-VNTR typing) Phylogenetic markers (SCG, PGG)
SCG2
SCG3
SCG5
SCG6
SCG7
M
1000bp 500bp 200bp
0.8
0.6
0.4
0.2
LAM-RUS SCG5/PGG2
Phylogenetic tree
MIRU-VNTR typing
LAM-RUS
SCG 2; PGG 1 SCG 3; PGG 2 SCG 5; PGG 2* SCG 6; PGG 3 SCG 5; PGG 2
Beijing
2632075
plcA
IS6110 insertion
plcB
plcC
phospholipase C genes
2627172
Isolates with plcABC::IS6110 genotype 45 (Ins2, plcA) 1 (Ins1, plcA) 1 (Ins3, plcC)
C M
1000bp 500bp 100bp
Study settings
Study population sets of M. tuberculosis strains recovered in Tula dispensary and Ozerki prison hospital (Tula region) during one-year study Ozerki Study methods Epidemiological markers
IS6110-RFLP, spoligotyping, MIRU-VNTR typing
Tula
Phylogenetic markers
Population: TB incidence rate: Incarceration rate: 1 041 641 106.8/100 000 10.44/1 000
SCG, PGG
Patients characteristics
Prison hospital Patient no. Clusters no. Average cluster size % Clustered cases No. of shared clusters 81 11 4.5 72% 7
Prison hospital n.c. Patient no. Susceptible MDR MDR+KAN 24 25% 50% 29% p.t. 57 5% 86% 82%
City dispensary n.c. 58 31% 20% 12% p.t. 109 19% 59% 46%
City dispensary
SCG6 10%
SCG2 29%
SCG3 6%
SCG3 18%
MDR
44(54%) 81(74%) 8(13%)
MDR+K
25(31%) 73(67%) 4(6%)
Others
Total
Beijing
LAM -RUS
RIF
Others
LAM-RUS
0.6
0.4
0.2
Neglected epidemics
Spoligotype ST252: 777477607760771. Belongs to SCG5/PGG2, LAM-RUS strains. Comprises 29% of the study sample (71 of 248 isolates). Prevalent in both prison and civilian population (27 and 44 cases, respectively). Includes 11 newly diagnosed cases. Drug resistance profile STR, KAN, RIF, INH, (EMB) Comprises 53% of all MDR TB in the study population. Genetic markers for drug resistance: S315T katG, D516V rpoB, M306I embB.
Conclusions
Members of tree modern SCG 3, 5 and 6, together with ancestral SCG2 are major contributors to the genetic diversity of the M. tuberculosis strains circulating in central Russia; LAM-RUS family of strains contained an insertion in a unique position in the plcA gene, which can serve as specific genetic marker for this group; Prisons have a significant impact on the TB incidence in the civilian population. Major clusters comprised from isolates recovered in both prison and civilian hospitals, emphasizing the interdependence of two populations; Majority of MDR TB cases in the region are due to Beijing or LAMRUS; Abundance of MDR strains resistant to KAN implies that we may face the XDR epidemics in the region before long.