Genotype distribution of Mycobacterium tuberculosis in theAegean Region and associated demographic factors

Genotype distribution of Mycobacterium tuberculosis in theAegean Region and associated demographic factors

Background/aim: The Aegean Region is the second-ranking region in Turkey according to the Human Development Index and population density and it hosts 1/8 of Turkey s population. İzmir is the largest city of the region, receiving internal migration both from inside and outside the region. The tuberculosis incidence in İzmir is lower than overall in Turkey: 17.7/100,000 in 2011. Our aims were to determine genotypes of Mycobacterium tuberculosis isolates; to explore possible associations between genotypes with casedemographic data, clinical presentation, and antimicrobial susceptibility patterns; and to determine variations in genotype distribution of strains isolated in Ege University Hospital, İzmir. Materials and methods: Forty-nine M. tuberculosis isolates from 49 patients in 1996 2000 and 421 M. tuberculosis isolates from 421 patients in 2009 2014 were spoligotyped. Drug susceptibility testing and demographic data of the 421 isolates were investigated. Chisquare, Student s t, and Mann Whitney U tests were used for analyses. Results: Among the 470 M. tuberculosis strains, 132 different spoligopatterns were identified and 46 different clusters for 384 strains were determined. The most predominant spoligotypes were ST53 (n = 116; 24.7%) and ST41 (n = 38; 8.1%), followed by ST50 (5.7%), ST284 (4.7%), and ST4 (4.3%), respectively. ST53 was the most predominant type in both sexes. Multidrug resistance (MDR) was determined in 12 isolates, of which six were ST1. Conclusion: As a consequence of worldwide migration and increasing status of HIV-infected hosts, the increasing prevalence of Beijing strains with higher MDR rates may threaten disease control programs. With its increasing trend, ST284 could replace ST41 in the following years in this region.

___

  • 1. World Health Organization. Global Tuberculosis Report. 20th ed. Geneva, Switzerland: WHO Press; 2015.
  • 2. Türkiye Halk Sağlığı Kurumu. Türkiye’de Verem Savaşı 2012 Raporu. No 884. Ankara, Turkey: Anıl Matbaacılık Ltd. Şti.; 2013 (in Turkish).
  • 3. Çavuşoğlu C. History of tuberculosis and tuberculosis control program in Turkey. Microbiol Australia 2014; 35: 169-173.
  • 4. Ünal Ç. Regional differences in Turkey by human development index. Coğrafi Bilimler Dergisi 2008, 6: 89-113 (in Turkish with abstract in English).
  • 5. Işık Ş. Internal migrations to İzmir (1995-2000). Türk Coğrafya Dergisi 2009: 52: 9-16 (in Turkish with abstract in English).
  • 6. Kamerbeek J, Schouls L, Kolk A, Agterveld M, Soolingen D, Kuijper S, Bunschoten A, Molhuizen H, Shaw R, Goyal M et al. Simultaneous detection and strain differentiation of Mycobacterium tuberculosis for diagnosis and epidemiology. J Clin Microbiol 1997; 35: 907-914.
  • 7. Clinical and Laboratory Standards Institute. Susceptibility Testing of Mycobacteria, Nocardiae, and Other Aerobic Actinomycetes. Approved Standard M24-A2. 2nd ed. Wayne, PA, USA: CLSI; 2011.
  • 8. Bicmen C, Esen N, Graviss EA, Williams-Bouyer N, Ramaswamy SV, Yulug N. Molecular characterization of Mycobacterium tuberculosis isolates from Izmir, Turkey. New Microbiol 2007; 30: 229-240.
  • 9. Aktaş E, Zozio T, Cömert FB, Külah C, Aydin O, Rastogi N, Sola C. A first insight into the genetic diversity and population structure of Mycobacterium tuberculosis in Zonguldak, Turkey Clin Microbiol Infect 2008; 14: 55-59.
  • 10. Otlu B, Durmaz R, Gunal S, Sola C, Zozio T, Rastogi N. Beijing/W and major spoligotype families of Mycobacterium tuberculosis strains isolated from tuberculosis patients in Eastern Turkey. New Microbiol 2009; 32: 255-263.
  • 11. Kisa O, Albay A, Baylan O, Tozkoparan E, Acikel C H, Doganci L. Genetic diversity of Mycobacterium tuberculosis isolates at the Military Medical Academy in Ankara, Turkey. Res Microbiol 2007; 158: 318-323.
  • 12. Sezen F, Albayrak N, Özkara Ş, Karagöz A, Alp A, Duyar Ağca F, İnan Süer A, Müderris T, Ceyhan I, Durmaz R et al. Tuberculosis Laboratory Surveillance Network (TuLSA) study group. The first step for national tuberculosis laboratory surveillance: Ankara, 2011. Mikrobiyol Bul 2015; 49: 143-155.
  • 13. Zozio T, Allix C, Gunal S, Saribas Z, Alp A, Durmaz R, FauvilleDufaux M, Rastogi N, Sola C. Genotyping of Mycobacterium tuberculosis clinical isolates in two cities of Turkey: description of a new family of genotypes that is phylogeographically specific for Asia Minor. BMC Microbiol 2005; 5: 44.
  • 14. Durmaz R, Zozio T, Gunal S, Allix C, Fauville-Dufaux M, Rastogi N. Population-based molecular epidemiological study of tuberculosis in Malatya, Turkey. J Clin Microbiol 2007; 45: 4027-4035.
  • 15. Sürücüoğlu S, Günal S, Özkütük N, Biçmen C, Özsöz A, Gazi H, Durmaz R. Molecular diversity of drug resistant Mycobacterium tuberculosis strains in Western Turkey. Balkan Med J 2012; 29: 160-165.
  • 16. Kisa O, Tarhan G, Gunal S, Albay A, Durmaz R, Saribas Z, Zozio T, Alp A, Ceyhan I, Tombak A et al. Distribution of spoligotyping defined genotypic lineages among drug-resistant Mycobacterium tuberculosis complex clinical isolates in Ankara, Turkey. PLoS One 2012; 7: e30331.
  • 17. Koksalan OK, Kilicaslan Z, Zanlier G, Guzel R, Seber E. Prevalence of Beijing genotype Mycobacterium tuberculosis strains in Istanbul. Int J Tuberc Lung Dis 2006; 10: 469-472.
  • 18. Durmaz R, Zozio T, Gunal S, Yaman A, Cavusoglu C, Guney C, Sola C, Rastogi N. Genetic diversity and major spoligotype families of drug-resistant Mycobacterium tuberculosis clinical isolates from different regions of Turkey. Infect Genet Evol 2007; 7: 513-519.
  • 19. Coscolla M, Gagneux S. Does M. tuberculosis genomic diversity explain disease diversity? Drug Discov Today Dis Mech 2010; 7: e43-e59.
  • 20. Demay C, Liens B, Burguière T, Hill V, Couvin D, Millet J, Mokrousov I, Sola C, Zozio T, Rastogi N. SITVITWEB – A publicly available international multimarker database for studying Mycobacterium tuberculosis genetic diversity and molecular epidemiology. Infect Genet Evol 2012; 12: 755-766.
  • 21. Gonzalez OY, Adams G, Teeter LD, Bui TT, Musser JM, Graviss EA. Extra-pulmonary manifestations in a large metropolitan area with a low incidence of tuberculosis. Int J Tuberc Lung Dis 2003; 7: 1178-1185.
  • 22. Noertjojo K, Tam CM, Chan SL, Chan-Yeung MM. Extrapulmonary and pulmonary tuberculosis in Hong Kong. Int J Tuberc Lung Dis 2002; 6: 879-886.
  • 23. Lin JN, Lai CH, Chen YH, Lee SS, Tsai SS, Huang CK, Chung HC, Liang SH, Lin HH. Risk factors for extra-pulmonary tuberculosis compared to pulmonary tuberculosis. Int J Tuberc Lung Dis 2009; 13: 620-625.
  • 24. Yang Z, Kong Y, Wilson F, Foxman B, Fowler AH, Marrs CF, Cave MD, Bates JH. Identification of risk factors for extrapulmonary tuberculosis. Clin Infect Dis 2004; 38: 199-205.
  • 25. Sreeramareddy CT, Panduru KV, Verma SC, Joshi HS, Bates MN. Comparison of pulmonary and extra-pulmonary tuberculosis in Nepal a hospital-based retrospective study. BMC Infect Dis 2008; 8: 8.
  • 26. Lari N, Rindi L, Cristofani R, Rastogi N, Tortoli E, Garzelli C. Association of Mycobacterium tuberculosis complex isolates of M. bovis and Central Asian (CAS) genotypic lineages with extrapulmonary disease. Clin Microbiol Infect 2009; 15: 538- 543.
  • 27. Mathema B, Kurepina NE, Bifani PJ, Kreiswirth BN. Molecular epidemiology of tuberculosis: current insights. Clin Microbiol Rev 2006; 19: 658-685.
  • 28. Papaventsis D, Casali N, Kontsevaya I, Drobniewski F, Cirillo DM, Nikolayevskyy V. Whole genome sequencing of Mycobacterium tuberculosis for detection of drug resistance: a systematic review. Clin Microbiol Infect 2017; 23: 61-68.
Turkish Journal of Medical Sciences-Cover
  • ISSN: 1300-0144
  • Yayın Aralığı: Yılda 6 Sayı
  • Yayıncı: TÜBİTAK