Background This study was set out to investigate the magnitude, patterns and molecular characterization of drug-resistant Mycobacterium tuberculosis strains at a tertiary referral hospital in Bangladesh. Methods Pulmonary tuberculosis (TB) patients admitted at National Institute of Diseases of the Chest and Hospital from February 2002 to September 2005 with or without previous history of TB and/or other complications were randomly interviewed. Among 265 participants enrolled, M. tuberculosis isolates from 189 patients were finally tested for susceptibility to rifampicin (RMP), isoniazid (INH), ethambutol (ETM) and streptomycin (STM). Genotyping of M. tuberculosis was done using deletion analysis and spoligotyping. Results Eighty-eight percent (n = 167) of the patients had history of previous anti-TB treatment while the remaining 12% were new TB cases. Of the 189 isolates, 9% were fully susceptible to the first line anti-TB drugs and 73.5% were multi-drug resistant TB. Other susceptibility results showed 79.4%, 77.2%, 76.7% and 78.8% resistance to INH, RMP, ETM and STM respectively. Multi-drug resistance was significantly higher among the 130 (78%) patients with previous history of anti-tuberculosis treatment (95% confidence interval, p = 0.001). Among the 189 analyzed isolates, 69% were classified as “modern” M. tuberculosis strains (i.e. TbD1- strains, lacking the M. tuberculosis-deletion region TbD1), whereas the remaining 31% were found to belong to the “ancestal” TbD1+ M. tuberculosis lineages. One hundred and five different spoligotype patterns were identified in which 16 clusters contained 100 strains and 89 strains had unique pattern. Strains with a spoligotype characteristic for the “Beijing” cluster were predominant (19%) and most of these strains (75%) were multi-drug resistant (MDR). Conclusions A high level of drug resistance observed among the re-treatment patients poses a threat of transmission of resistant strains to susceptible persons in the community. Proper counseling of patients and attention towards the completion of the anti-TB treatment is needed.
References
[1]
(2009) Operational manual for the management of multidrug-resistant TB(MDR TB) National Tuberculosis Control Programme, Bangladesh First Edition.
[2]
Chadha VK (1997) Global trends of tuberculosis NTI Bulletin 33: 11–18.
[3]
Swaminathan S, Nagendran G (2008) HIV and tuberculosis in India. J Biosci 33: 527–537.
[4]
(2007) World Health Organization. Stop TB partnership 2007–2008 XDR and MDR Tuberculosis Global response plan WHO/HTM/TB/2007387.
[5]
(2008) Anti-tuberculosis drug resistance in the world. Fourth global report. The WHO/IUATLD global project on anti-tuberculosis drug resistance surveillance 2002–2007: WHO/HTM/TB/2008394.
[6]
Zaman K, Rahim Z, Yunus M, Arifeen S, Baqui A, et al. (2005) Drug resistance of Mycobacterium tuberculosis in selected urban and rural areas in Bangladesh. Scand J Infect Dis 37: 21–26.
[7]
Miah MR, Ali MS, Saleh AA, Sattar H (2000) Primary drug resistance pattern of mycobacterium tuberculosis in Dhaka, Bangladesh. Bangladesh Med Res Counc Bull 26: 33–40.
[8]
(2010) Multidrug and extensively drug-resistant TB (M/XDR-TB), global report on surveillance and response. WHO/HTM/TB/20103.
[9]
Brosch R, Gordon SV, Marmiesse M, Brodin P, Buchrieser C, et al. (2002) A new evolutionary scenario for the Mycobacterium tuberculosis complex. Proc Natl Acad Sci U S A 99: 3684–3689.
[10]
Parsons LM, Brosch R, Cole ST, Somoskovi A, Loder A, et al. (2002) Rapid and simple approach for identification of Mycobacterium tuberculosis complex isolates by PCR-based genomic deletion analysis. Journal of clinical microbiology 40: 2339.
[11]
Kamerbeek J, Schouls L, Kolk A, van Agterveld M, van Soolingen D, et al. (1997) Simultaneous detection and strain differentiation of Mycobacterium tuberculosis for diagnosis and epidemiology. J Clin Microbiol 35: 907–914.
[12]
Hermans PW, van Soolingen D, Bik EM, de Haas PE, Dale JW, et al. (1991) Insertion element IS987 from Mycobacterium bovis BCG is located in a hot-spot integration region for insertion elements in Mycobacterium tuberculosis complex strains. Infect Immun 59: 2695–2705.
[13]
(2009) National Guidelines and Operational Manual for Tuberculosis Control. National Tuberculosis Control Programme, Bangladesh Fourth Edition.
[14]
(2003) World Health Organization (WHO). Guidelines for surveillance of drug resistance in tuberculosis. WHO/CDS/TB/2003320 Geneva: WHO.
[15]
Petroff S (1915) A new and rapid method for the isolation and culture of tubercle bacilli directly from the sputum and faeces. J Exp Med 21: 38–42.
[16]
Canetti G, Fox W, Khomenko A, Mahler HT, Menon N K, et al. (1969) Advances in techniques of testing mycobacterial drug sensitivity, and the use of sensitivity tests in tuberculosis control programmes. Bull World Health Organization 41.
[17]
Kolk AH, Schuitema AR, Kuijper S, van Leeuwen J, Hermans PW, et al. (1992) Detection of Mycobacterium tuberculosis in clinical samples by using polymerase chain reaction and a nonradioactive detection system. J Clin Microbiol 30: 2567–2575.
[18]
Kox LF, Rhienthong D, Miranda AM, Udomsantisuk N, Ellis K, et al. (1994) A more reliable PCR for detection of Mycobacterium tuberculosis in clinical samples. J Clin Microbiol 32: 672–678.
[19]
Van Soolingen D, De Haas P, Hermans P, Groenen P, Van Embden J (1993) Comparison of various repetitive DNA elements as genetic markers for strain differentiation and epidemiology of Mycobacterium tuberculosis. Journal of clinical microbiology 31: 1987.
[20]
Borrell S, Gagneux S (2009) Infectiousness, reproductive fitness and evolution of drug-resistant Mycobacterium tuberculosis. Int J Tuberc Lung Dis 13: 1456–1466.
[21]
Mostofa Kamal SM, Mahmud AM, Ahsan CR, Islam MR, Sarwar G, et al. (2009) Use of Mycobacterial Culture for the Diagnosis of Smear Negative TB Cases Among New Outpatients at NIDCH, Dhaka. Bangladesh J Med Microbiol. pp. 23–26.
[22]
Mostafizur R, Kamal SMM, Mohammed FR, Alam MB, Ahasan HN (2009) Anti-tuberculosis drug resistance pattern among different category of tuberculosis patients. J Medicine 10: 45–47.
[23]
Organization WH (2008) Global tuberculosis control: surveillance, planning, financing: WHO report 2008. Geneva.
[24]
Saltini C (2006) Chemotherapy and diagnosis of tuberculosis. Respiratory medicine 100: 2085–2097.
[25]
(2008) The World Health Organization. Global tuberculosis control: surveillance, planning, financing. WHO report 2008. Geneva WHO/HTM/TB/2008393.
[26]
Rahman M, Kamal S, Mohammed FR, Alam MB, Ahasan H (2009) Anti-tuberculosis Drug Resistance Pattern among Different Category of Tuberculosis Patients. Journal of Medicine 10: 45–47.
[27]
Kim S, Bai G, Hong Y (1997) Drug-resistant tuberculosis in Korea, 1994. The International Journal of Tuberculosis and Lung Disease 1: 302–308.
[28]
Cox H, Kebede Y, Allamuratova S, Ismailov G, Davletmuratova Z, et al. (2006) Tuberculosis recurrence and mortality after successful treatment: impact of drug resistance. PLoS medicine 3: e384.
[29]
Chan ED, Iseman MD (2002) Current medical treatment for tuberculosis. Bmj 325: 1282–1286.
[30]
Faustini A, Hall AJ, Perucci CA (2006) Risk factors for multidrug resistant tuberculosis in Europe: a systematic review. Thorax 61: 158–163.
[31]
Djuretic T, Herbert J, Drobniewski F, Yates M, Smith EG, et al. (2002) Antibiotic resistant tuberculosis in the United Kingdom: 1993–1999. Thorax 57: 477–482.
[32]
Kordy FN, Al-Thawadi S, Alrajhi AA (2004) Drug resistance patterns of Mycobacterium tuberculosis in Riyadh, Saudi Arabia. Int J Tuberc Lung Dis 8: 1007–1011.
[33]
Banu S, Gordon SV, Palmer S, Islam MR, Ahmed S, et al. (2004) Genotypic analysis of Mycobacterium tuberculosis in Bangladesh and prevalence of the Beijing strain. J Clin Microbiol 42: 674–682.
[34]
Banu S, Uddin M, Islam M, Zaman K, Ahmed T, et al. (2012) Molecular epidemiology of tuberculosis in rural Matlab, Bangladesh. The International Journal of Tuberculosis and Lung Disease 16: 319–326.
[35]
Anh DD, Borgdorff MW, Van LN, Lan NT, van Gorkom T, et al. (2000) Mycobacterium tuberculosis Beijing genotype emerging in Vietnam. Emerg Infect Dis 6: 302–305.
[36]
van Soolingen D, Qian L, de Haas PE, Douglas JT, Traore H, et al. (1995) Predominance of a single genotype of Mycobacterium tuberculosis in countries of east Asia. J Clin Microbiol 33: 3234–3238.
[37]
Bifani PJ, Mathema B, Liu Z, Moghazeh SL, Shopsin B, et al. (1999) Identification of a W variant outbreak of Mycobacterium tuberculosis via population-based molecular epidemiology. JAMA 282: 2321–2327.
[38]
Diaz R, Kremer K, de Haas PE, Gomez RI, Marrero A, et al. (1998) Molecular epidemiology of tuberculosis in Cuba outside of Havana, July 1994–June 1995: utility of spoligotyping versus IS6110 restriction fragment length polymorphism. Int J Tuberc Lung Dis 2: 743–750.
[39]
Kurepina NE, Sreevatsan S, Plikaytis BB, Bifani PJ, Connell ND, et al. (1998) Characterization of the phylogenetic distribution and chromosomal insertion sites of five IS6110 elements in Mycobacterium tuberculosis: non-random integration in the dnaA-dnaN region. Tuber Lung Dis 79: 31–42.
[40]
Mistry NF, Iyer AM, D’Souza D T, Taylor GM, Young DB, et al. (2002) Spoligotyping of Mycobacterium tuberculosis isolates from multiple-drug-resistant tuberculosis patients from Bombay, India. J Clin Microbiol 40: 2677–2680.
[41]
Singh UB, Suresh N, Bhanu NV, Arora J, Pant H, et al. (2004) Predominant tuberculosis spoligotypes, Delhi, India. Emerg Infect Dis 10: 1138–1142.
[42]
Sola C, Filliol I, Gutierrez MC, Mokrousov I, Vincent V, et al. (2001) Spoligotype database of Mycobacterium tuberculosis: biogeographic distribution of shared types and epidemiologic and phylogenetic perspectives. Emerg Infect Dis 7: 390–396.
