Emerging Infectious Diseases (Mar 2013)

Emergence and Spread of Extensively and Totally Drug-Resistant Tuberculosis, South Africa

  • Marisa Klopper,
  • Robin Mark Warren,
  • Cindy Hayes,
  • Nicolaas Claudius Gey van Pittius,
  • Elizabeth Maria Streicher,
  • Borna Müller,
  • Frederick Adriaan Sirgel,
  • Mamisa Chabula-Nxiweni,
  • Ebrahim Hoosain,
  • Gerrit Coetzee,
  • Paul David van Helden,
  • Thomas Calldo Victor,
  • André Phillip Trollip

DOI
https://doi.org/10.3201/eid1903.120246
Journal volume & issue
Vol. 19, no. 3
pp. 449 – 455

Abstract

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Factors driving the increase in drug-resistant tuberculosis (TB) in the Eastern Cape Province, South Africa, are not understood. A convenience sample of 309 drug-susceptible and 342 multidrug-resistant (MDR) TB isolates, collected July 2008–July 2009, were characterized by spoligotyping, DNA fingerprinting, insertion site mapping, and targeted DNA sequencing. Analysis of molecular-based data showed diverse genetic backgrounds among drug-sensitive and MDR TB sensu stricto isolates in contrast to restricted genetic backgrounds among pre–extensively drug-resistant (pre-XDR) TB and XDR TB isolates. Second-line drug resistance was significantly associated with the atypical Beijing genotype. DNA fingerprinting and sequencing demonstrated that the pre-XDR and XDR atypical Beijing isolates evolved from a common progenitor; 85% and 92%, respectively, were clustered, indicating transmission. Ninety-three percent of atypical XDR Beijing isolates had mutations that confer resistance to 10 anti-TB drugs, and some isolates also were resistant to para-aminosalicylic acid. These findings suggest the emergence of totally drug-resistant TB.

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