Clonal Expansion of Multidrug-Resistant and Extensively Drug-Resistant Tuberculosis, Japan

Murase, Yoshiro; Maeda, Shingo; Yamada, Hiroyuki; Ohkado, Akihiro; Chikamatsu, Kinuyo; Mizuno, Kazue; Kato, Seiya; Mitarai, Satoshi

doi:10.3201/eid1606.091844

Cited by 37 publications

(36 citation statements)

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“…98 A major outcome of largescale genotyping studies was that, in several highincidence settings, the contribution of transmission for fuelling the drug resistance epidemic was underestimated. 49,82,[99][100][101] In most regions of the world, drug-resistant tuberculosis is now predominantly caused by transmission rather than acquisition of resistance, with an estimated 95·9% of MDR tuberculosis in new tuberculosis cases and 61·3% in previously treated cases being due to transmission. 42 Even the epidemiology of XDR tuberculosis-defined as resistance to isoniazid, rifampicin, a fluoroquinolone, and an injectable agent-is now better understood as reflecting endemics rather than epidemics, 48,95,102,103 and population migration is recognised as a vehicle for spread beyond the region of the strain's origin.…”

Section: Advantagesmentioning

confidence: 99%

The epidemiology, pathogenesis, transmission, diagnosis, and management of multidrug-resistant, extensively drug-resistant, and incurable tuberculosis

Dheda

Gumbo

Maartens

et al. 2017

The Lancet Respiratory Medicine

519

474

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Section: Advantagesmentioning

confidence: 99%

The epidemiology, pathogenesis, transmission, diagnosis, and management of multidrug-resistant, extensively drug-resistant, and incurable tuberculosis

Dheda

Gumbo

Maartens

et al. 2017

The Lancet Respiratory Medicine

519

474

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“…10,11,15,23 Entretanto, na região de Lisboa desconhece-se o que possa ter acontecido com estas estirpes, nomeadamente, nos primeiros anos da epidemia de TB MR, em que predominavam os co-infectados por VIH, os UDI, a TB MR secundária à má adesão ao tratamento e a família Lisboa. 36,38 Nos cinco doentes do estudo não identificámos quaisquer manifestações clínicas ou sinais radiológicos, que fossem atributos da TB causada por esta família Beijing quer nos doentes imunocompetentes, quer no co-infectado por VIH, todos eles com TB pulmonar, contudo é de salientar a frequência das cavitações.…”

Section: Discussionunclassified

“…4 Depois, seria isolada em vários países vizinhos e, actualmente, constitui a família dominante na Ásia, com prevalências, por exemplo, de 48% no Vietname, de 44% na Tailândia, de 70% em Hong-Kong e excedendo 50% em muitos países, como na China e na Coreia do Sul. [4][5][6][7][8] Num estudo efectuado numa província chinesa, 90% das estirpes eram Beijing e, destas, 27% eram multirresistentes (MR) e no Japão e em Taiwan representaram, respectivamente, 70% das estirpes extensivamente resistentes (ER) e 48% das estirpes MR. [9][10][11] A família Beijing tem, também, grande prevalência na Rússia onde se documentou que era responsável por 48% dos casos de TB MR e por transmissão activa na comunidade. [12][13][14][15] O seu aparecimento nos Estados Unidos da América (EUA) foi, de igual modo, bem demonstrado.…”

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Tuberculose Multirresistente por Estirpes da Família Beijing, em Doentes de Lisboa, Portugal: Estudo Preliminar

et al. 2017

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Beijing family strains of Mycobacterium tuberculosis are associated with multidrug-resistance. Although strains of the Lisboa family are the most common among multidrug-resistant and extensively drug-resistant patients in the region, several studies have reported the presence of the Beijing family. However, the features of patients from whom they were isolated, are not yet known. Material and Methods:Retrospective study involving 104 multidrug-resistant and extensively drug-resistant strains of Mycobacterium tuberculosis, from the same number of patients, isolated and genotyped between 1993 and 2015 in Lisbon. We assessed the prevalence of strains of both families and the epidemiologic and clinical features of those infected with Beijing family strains. Results: Seventy-four strains (71.2%) belonged to the Lisboa family, 25 (24.0%) showed a unique genotypic pattern and five (4.8%) belonged to the Beijing family, the latter identified after 2009. Those infected with Beijing family strains were angolan (n = 1), ukrainian (n = 2) and portuguese (n = 2), mainly young-aged and, four of five immunocompetent and with no past history of tuberculosis. All had multidrug-resistant tuberculosis. We did not find any distinctive clinical or radiological features, neither a predominant resistance pattern. Cure rate was high (four patients). Discussion: Although the number of infected patients with Beijing strains was small, it suggests an important proportion of primary tuberculosis, a potential for transmission in the community but also a better clinical outcome when compared to other reported strains, such as W-Beijing and Lisboa. Conclusion: Although Lisboa family strains account for most of the multidrug and extensively drug-resistant tuberculosis cases in Lisbon area, Beijing strains are transmitted in the city and might change the local characteristics of the epidemics.

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“…We all know that TB is an infectious disease spread by air so although, we are taking care of disease at individual level but we should study and understand the drug resistant TB at communitywide level and such studies have been conducted by Murase et al and future such studies may help us to treat this disease at communitywide level [35]. Till now our knowledge …”

Section: Resultsmentioning

confidence: 99%

Multidrug resistant and Extensively drug resistant TB: A Nuisance to Medical Science

Singh¹,

Rajni²,

Meena³

et al. 2011

J Bacteriol Parasitol

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Tuberculosis is the topic of discussion for researchers due to the indocile nature of its causative micro-organism, Mycobacterium tuberculosis H 37 Rv (MTB). MTB escapes the human immune system by employing different strategies to render the drugs used for treatment ineffective, due to ultimate alterations in genes such as gyr 90, 91 and 94 which make it resistant to different drugs. Different techniques and methodologies are being developed and used to diagnose, treat and prevent the spread of the disease caused due to drug-resistant MTB. Drug resistance is reported from all over the world. Although very less treatment options are available in case of MDR and XDR-TB but still they are curable. HIV co-infection is also a big hurdle in the way of successful treatment of drug resistant TB as drug-drug interaction is an issue. It is better to improve the community medicine system to battle the TB in a better way. Highest percent of people is showing the resistant against INH so one should be careful about this fact while using the INH in regimen. Multidrug resistant and Extensively drug resistant Journal of Bacteriology and ParasitologyCitation: Singh R, Rajni, Meena A, Meena LS (2011) [12]. Study conducted at All India Institute of Medical Sciences, New Delhi, India, is showing the prevalence of XDR-TB is 2.4% among the MDR-TB cases [13], but these figures are not giving the right picture of XDR-TB scenario in India because sample size is small and all cases belongs to only one hospital. The actual dimensions of prevalence of XDR-TB are still not defined due to the lack of infrastructure and well equipped laboratories to diagnose it in many countries. Potential causes of MDR-TB and XDR-TBFactors related to treatment history: In most of the countries which are adversely affected by drug resistant TB, public health care system is not very good and private practitioners are not used to maintain the treatment history of patient and due to this patient are subjected to be treated improperly.Improper and incomplete treatment: Mismanagement of the treatment for instance, prescribing a single drug and later on adding up off another drug to the collapsing regimen, undiagnosed pre-existing resistance to drugs, prescribing inadequate regimen, inadequate follow up of the regimen by the patient results in the reduced susceptibility of the patient to anti-TB drugs. Non -adherence to the prescribed regimen is mostly ignored by the clinicians dealing with the treatment which makes the patient susceptible to MDR-TB and XDR-TB [2,14,15]. The patients are reluctant to adhere to the prescribed regimen due to the adverse effects of the most of the anti-TB drugs (Table 1) [2]. Incomplete treatment and improper regimen, both poses a selection pressure on the drug resistant strains that's why the prevalence of MDR-TB is higher among the retreated patients compared to the new cases (Figure 4, 5).Infrastructure: Due to the lack of well equipped laboratories and facilities for growing culture for determining the sensitivity of ...

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Clonal Expansion of Multidrug-Resistant and Extensively Drug-Resistant Tuberculosis, Japan

Abstract: Strain clustering suggests community transmission plays a critical role in incidence.

Cited by 37 publications

References 20 publications

The epidemiology, pathogenesis, transmission, diagnosis, and management of multidrug-resistant, extensively drug-resistant, and incurable tuberculosis

The epidemiology, pathogenesis, transmission, diagnosis, and management of multidrug-resistant, extensively drug-resistant, and incurable tuberculosis

Tuberculose Multirresistente por Estirpes da Família Beijing, em Doentes de Lisboa, Portugal: Estudo Preliminar

Multidrug resistant and Extensively drug resistant TB: A Nuisance to Medical Science

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