Multidrug-resistant Mycobacterium tuberculosis (MDR-TB) is a severe health threat to human beings; however, the epidemic and molecular characteristics exist along with the change in the geographic environment and genealogy. Jiangxi province is located in southeast China, which is a high-MDR-TB burden area. Rifampin (RIF) and isoniazid (INH) are the most important first-line anti-tuberculosis drugs. The major drug target genes include rpoB for RIF and katG , inhA , and ahpC for INH. To determine the frequency and distribution of mycobacterial mutations in these genes, we sequenced specific genes of M . tuberculosis that are associated with resistance to RIF and INH in 157 phenotypic MDR isolates. At the same time, RD105 DTM-PCR and 15 loci MIRU-VNTR were performed to demonstrate the genetic lineage. It was shown that the Beijing genotype was predominant (84.1%) among these strains. The results also showed mutations within the 81 bp core region of rpoB in 93.6% of strains and mutations in a structural gene ( katG ) and two regulatory regions (the promoter of inhA and intergenic region of oxyR-ahpC ) were shown in 88.5% of phenotypic MDR isolates. There were no significant differences in codon mutations between the Beijing and non-Beijing genotypes, as well as the clustered and no-clustered strains. The most prevalent mutations involved in RIF and INH were Ser531Leu in rpoB (55.4%) and Ser315Thr in KatG (56.1%), respectively. There was no significant difference in RIF and INH resistance between MDR-TB and other drug-resistant tuberculosis (DR-TB). The results demonstrated that some MDR-TB patients are predicted to have recent transmission.

Setting: Rifampicin-resistant tuberculosis (RR-TB) in elderly people in Jiangxi Province, China. Objective: To investigate the incidence of RR-TB and risk factors in elderly people within a hospital setting in China. Design: Retrospective cohort study. Methods: A comparative study was performed to analyze RR-TB and rifampicin-susceptible TB (RS-TB). The 15-locus mycobacterial interspersed repetitive unit-variable number of tandem repeats (MIRU-VNTR) method was used to distinguish between relapse and reinfection. Results: Twenty-three recurrent cases occurred in 151 elderly patients with RR-TB, and 24 recurrent cases occurred in 466 elderly patients with RS-TB during this period. TB recurrence was significantly different in the RR-TB and RS-TB groups (OR = 0.35, 95% CI: 0.14–0.88; χ 2 = 5.28, P = 0.03). Comparing the risk factors for RR-TB and RS-TB, we found that educational level, age, and pulmonary cavity were inextricably linked to RR-TB in elderly patients. Furthermore, pulmonary cavity, HIV status, and alcohol consumption were associated with recurrence in elderly RR-TB patients. Conclusions: Recurrence is an important source of RR-TB in the elderly population. It is necessary to promptly treat tuberculosis patients, prevent the spread of AIDS, and reduce alcohol intake to control recurrent RR-TB in the elderly population.

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BackgroundTuberculosis remains a serious public health challenge in China and disproportionately affects urban and rural population. This study aimed to investigate the characteristics and treatment outcome of tuberculosis patients among a population with mixed rural and urban inhabitants.MethodsClinical and socio-demographic information was collected for each culture-confirmed tuberculosis (TB) patients (with >15 yrs) from January 1st, 2015 to July 31st, 2017 in a provincial TB designated hospital in Jiangxi, China. We conducted both first- and second-line drug susceptibility testing. A multivariate logistic regression analysis was employed to calculate odds ratios for factors associated with the rural and urban culture-positive tuberculosis patients. ResultsOverall, 381 culture-confirmed TB patients were enrolled, of which 302 were from rural and 79 from urban region. Rural patients were more likely to have previous treatment history, be unemployed, less educated, and had a slightly higher rate of multidrug-resistant TB. Urban TB patients had a similar rate (40.5%) of treatment failure with that among rural patients (34.8%). In the final model, individuals with less education (aOR, 3.32, 95%CI [1.31-8.39]), having sputum smear positive results (2.14 [1.34-3.42]), and with multidrug-resistant TB (4.49 [1.09-18.55]) were associated with treatment failure. ConclusionsDespite the distinct social-demographic characteristics, both TB patients from rural and urban population had high unfavorable treatment outcome.

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