International Spread of MDR TB from Tugela Ferry, South Africa

Cooke, Graham; Beaton, Rory; Lessells, Richard J; John, Laurence; Ashworth, Simon; Kon, Onn Min; Williams, O. Martin; Supply, Philip; Moodley, Prashini; Pym, Alexander S.

doi:10.3201/eid1711.110291

Cited by 23 publications

(20 citation statements)

References 11 publications

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“…In contrast, the LAM9 spoligotype (associated with Panama MDR cluster c1) was not observed among 233 MDR isolates in KwaZulu-Natal and was observed for only 0.7% of the isolates from the Eastern Cape and the Western Cape combined (49). Thus, it appears that the occurrence of the two strains is mostly region specific, with LAM9-c1 in Panama and the KZN strain in KwaZulu-Natal (despite the fact that isolated cases of transmission to other countries have been reported [50]). However, it should be noted that some LAM9 MDR strains have been identified in other provinces near KZN, including Gauteng and Mpumalanga (51).…”

Section: Discussionmentioning

confidence: 93%

Multidrug-Resistant Tuberculosis in Panama Is Driven by Clonal Expansion of a Multidrug-Resistant Mycobacterium tuberculosis Strain Related to the KZN Extensively Drug-Resistant M. tuberculosis Strain from South Africa

et al. 2013

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dMultidrug-resistant tuberculosis (MDR-TB) is a significant health problem in Panama. The extent to which such cases are the result of primary or acquired resistance and the strain families involved are unknown. We performed whole-genome sequencing of a collection of 66 clinical MDR isolates, along with 31 drug-susceptible isolates, that were isolated in Panama between 2001 and 2010; 78% of the MDR isolates belong to the Latin American-Mediterranean (LAM) family. Drug resistance mutations correlated well with drug susceptibility profiles. To determine the relationships among these strains and to better understand the acquisition of resistance mutations, a phylogenetic tree was constructed based on a genome-wide single-nucleotide polymorphism analysis. The phylogenetic tree shows that the isolates are highly clustered, with a single strain (LAM9-c1) accounting for nearly one-half of the MDR isolates (29/66 isolates). The LAM9-c1 strain was most prevalent among male patients of working age and was associated with high mortality rates. Members of this cluster all share identical mutations conferring resistance to isoniazid (KatG S315T mutation), rifampin (RpoB S531L mutation), and streptomycin (rrs C517T mutation). This evidence of primary resistance supports a model in which MDR-TB in Panama is driven by clonal expansion and ongoing transmission of several strains in the LAM family, including the highly successful MDR strain LAM9-c1. The phylogenetic analysis also shows that the LAM9-c1 strain is closely related to the KwaZulu-Natal (KZN) extensively drug-resistant TB strain identified in KwaZulu-Natal, South Africa. The LAM9-c1 and KZN strains likely arose from a recent common ancestor that was transmitted between Panama and South Africa and had the capacity to tolerate an accumulation of multiple resistance mutations.

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Section: Discussionmentioning

confidence: 93%

Multidrug-Resistant Tuberculosis in Panama Is Driven by Clonal Expansion of a Multidrug-Resistant Mycobacterium tuberculosis Strain Related to the KZN Extensively Drug-Resistant M. tuberculosis Strain from South Africa

et al. 2013

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“…There were no other cases where adverse effects lead to overall early cessation. One patient had treatment stopped due to previous psychiatric illness reemerging (528 days of therapy), two informed the service of moving overseas but failed to give contact details, and one died in association with severe immunosuppression secondary to HIV (CD4 count 5 cells/µL) [18] despite effective treatment for MDR-TB (sputum CC achieved).…”

Section: Clinical Treatment Outcomesmentioning

confidence: 99%

Drug resistant TB: UK multicentre study (DRUMS): Treatment, management and outcomes in London and West Midlands 2008–2014

Arnold

Cooke

Kon

et al. 2017

Journal of Infection

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Highlights: Treatment practices and outcomes for MDR-TB treatment in the UK are described.  Treatment success is high limited by adherence rather than microbiological failure.  Variations in public health practice and housing lead to long hospital admissions.  New models and infrastructure are required to reduce poor adherence.  New methods using whole genome sequencing are required to shorten hospitalisation. ABSTRACTObjectives: Detailed information regarding treatment practices and outcomes of MDR-TB treatment in the UK is required as a baseline for care improvements.Methods: 100 consecutive cases between 2008 and 2014 were reviewed retrospectively at 4 MDR-TB treatment centres in England to obtain information on drug treatment choices, hospital admission duration and outcomes for MDR-TB.

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“…This risk must be addressed with work place infection control measures designed to protect the health of both patients and those entrusted with their care [33]. HCWs have the worrisome potential to transmit TB to patients when not aware or afraid to disclose their disease because of stigma and employment concerns [34]. Though they experience greater transmission risk because of long cumulative periods of exposure, HCWs also represent a population of special concern because highly trained nurses and clinical staff are often in short supply in the developing world; the limited workforce is further threatened by both TB and fear of acquiring TB [19•, 35].…”

Section: Health Care Workers (Hcw)mentioning

confidence: 99%

Transmission of Tuberculosis in Resource-Limited Settings

2013

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Unrecognized transmission is a major contributor to ongoing TB epidemics in high-burden, resource-constrained settings. Limitations in diagnosis, treatment, and infection control in health-care and community settings allow for continued transmission of drug-sensitive and drug-resistant TB, particularly in regions of high HIV prevalence. Health-care facilities are common sites of TB transmission. Improved implementation of infection control practices appropriate for the local setting and in combination, has been associated with reduced transmission. Community settings account for the majority of TB transmission and deserve increased focus. Strengthening and intensifying existing high-yield strategies, including household contact tracing, can reduce onward TB transmission. Recent studies documenting high transmission risk community sites and strategies for community-based intensive case finding hold promise for feasible, effective transmission reduction. Infection control in community settings has been neglected and requires urgent attention. Developing and implementing improved strategies for decreasing transmission to children, within prisons and of drug-resistant TB are needed.

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International Spread of MDR TB from Tugela Ferry, South Africa

Cited by 23 publications

References 11 publications

Multidrug-Resistant Tuberculosis in Panama Is Driven by Clonal Expansion of a Multidrug-Resistant Mycobacterium tuberculosis Strain Related to the KZN Extensively Drug-Resistant M. tuberculosis Strain from South Africa

Multidrug-Resistant Tuberculosis in Panama Is Driven by Clonal Expansion of a Multidrug-Resistant Mycobacterium tuberculosis Strain Related to the KZN Extensively Drug-Resistant M. tuberculosis Strain from South Africa

Drug resistant TB: UK multicentre study (DRUMS): Treatment, management and outcomes in London and West Midlands 2008–2014

Transmission of Tuberculosis in Resource-Limited Settings

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