In:
PLOS Medicine, Public Library of Science (PLoS), Vol. 19, No. 2 ( 2022-2-22), p. e1003933-
Abstract:
The incidence of multidrug-resistant tuberculosis (MDR-TB) remains critically high in countries of the former Soviet Union, where 〉 20% of new cases and 〉 50% of previously treated cases have resistance to rifampin and isoniazid. Transmission of resistant strains, as opposed to resistance selected through inadequate treatment of drug-susceptible tuberculosis (TB), is the main driver of incident MDR-TB in these countries. Methods and findings We conducted a prospective, genomic analysis of all culture-positive TB cases diagnosed in 2018 and 2019 in the Republic of Moldova. We used phylogenetic methods to identify putative transmission clusters; spatial and demographic data were analyzed to further describe local transmission of Mycobacterium tuberculosis . Of 2,236 participants, 779 (36%) had MDR-TB, of whom 386 (50%) had never been treated previously for TB. Moreover, 92% of multidrug-resistant M . tuberculosis strains belonged to putative transmission clusters. Phylogenetic reconstruction identified 3 large clades that were comprised nearly uniformly of MDR-TB: 2 of these clades were of Beijing lineage, and 1 of Ural lineage, and each had additional distinct clade-specific second-line drug resistance mutations and geographic distributions. Spatial and temporal proximity between pairs of cases within a cluster was associated with greater genomic similarity. Our study lasted for only 2 years, a relatively short duration compared with the natural history of TB, and, thus, the ability to infer the full extent of transmission is limited. Conclusions The MDR-TB epidemic in Moldova is associated with the local transmission of multiple M . tuberculosis strains, including distinct clades of highly drug-resistant M . tuberculosis with varying geographic distributions and drug resistance profiles. This study demonstrates the role of comprehensive genomic surveillance for understanding the transmission of M . tuberculosis and highlights the urgency of interventions to interrupt transmission of highly drug-resistant M . tuberculosis .
Type of Medium:
Online Resource
ISSN:
1549-1676
DOI:
10.1371/journal.pmed.1003933
DOI:
10.1371/journal.pmed.1003933.g001
DOI:
10.1371/journal.pmed.1003933.g002
DOI:
10.1371/journal.pmed.1003933.g003
DOI:
10.1371/journal.pmed.1003933.g004
DOI:
10.1371/journal.pmed.1003933.t001
DOI:
10.1371/journal.pmed.1003933.t002
DOI:
10.1371/journal.pmed.1003933.s001
DOI:
10.1371/journal.pmed.1003933.s002
DOI:
10.1371/journal.pmed.1003933.s003
DOI:
10.1371/journal.pmed.1003933.s004
DOI:
10.1371/journal.pmed.1003933.s005
DOI:
10.1371/journal.pmed.1003933.s006
DOI:
10.1371/journal.pmed.1003933.r001
DOI:
10.1371/journal.pmed.1003933.r002
DOI:
10.1371/journal.pmed.1003933.r003
DOI:
10.1371/journal.pmed.1003933.r004
DOI:
10.1371/journal.pmed.1003933.r005
DOI:
10.1371/journal.pmed.1003933.r006
DOI:
10.1371/journal.pmed.1003933.r007
DOI:
10.1371/journal.pmed.1003933.r008
Language:
English
Publisher:
Public Library of Science (PLoS)
Publication Date:
2022
detail.hit.zdb_id:
2164823-2
Permalink