Beijing strains of Mycobacterium tuberculosis in smear-positive tuberculosis patients in North-West and West of Iran

Document Type : Original Article

Authors
Leyla Sahebi 1
Khalil Ansarin 1
Sven Hoffner 2
Parviz Mohajeri 3
Abolghasem Mohammadi 4
1 Department of Tuberculosis and Lung Disease, Tuberculosis and Lung Disease Research Centre, Tabriz University of Medical Sciences, Tabriz, Iran
2 Department of Microbiology, Karolinska Institute, The Public Health Agency of Sweden, Stockholm, Sweden
3 Department of Microbiology, Faculty of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
4 Department of Plant Breeding and Biotechnology, School of Agriculture, University of Tabriz, Tabriz, Iran
Abstract
Background: Tuberculosis (TB) is the leading cause of morbidity and mortality among chronic infectious diseases. The goal of this cross-sectional study (2012–2014) was to examine the prevalence of Mycobacterium TB (MTB) Beijing strains in regions near the Iranian border and to identify any epidemiological links.
Materials and Methods: To this end, MTB isolates were harvested, from 64 HIV-negative, pulmonary smear-positive TB patients from the Iranian border provinces of East Azerbaijan (North-West), Kurdistan (West), and Kermanshah (West) (2012–2014). Isolates were subjected to restriction fragment length polymorphism (RFLP) analysis, using the insertion sequence IS6110 as a probe (IS6110 RFLP), and drug susceptibility testing by the proportion method. We gathered demographic and clinical data using a questionnaire and reviewing patient records. Results were analyzed with Gel Compare II 6.6 and SPSS-18.
Results: The mean age of the patients was 54.4 years and 46.9% were male. The prevalence of Beijing strains among the isolates was 9.4% (17.6% in the Western provinces and 0% in East Azerbaijan). There was a statistically significant relationship between the Beijing strains and drug resistance and also between these strains, and the recurrence of TB in patients that had previously received treatment (P = 0.02 and P = 0.04, respectively).
Conclusions: Finally, the prevalence of Beijing strains in Western Iran was greater than expected. Our results therefore indicate that regional and cross-border tracing may be necessary to control spread of this organism.

Keywords

1.
Young DB. Blueprint for the white plague. Nature 1998;393:515-6.  Back to cited text no. 1
    
2.
Global Health Observatory Data Repository. Iran (Islamic Republic of) Statistics Summary (2002 – Present). WHO; 2014. Available from: https://extranet.who.int/sree/Reports?op=Replet&name=/WHO_HQ_Reports/G2/PROD/EXT/TBCountryProfile and ISO2=IR&outtype=html. [Last updated on 2016 Jun 08].  Back to cited text no. 2
    
3.
Glynn JR, Whiteley J, Bifani PJ, Kremer K, van Soolingen D. Worldwide occurrence of Beijing/W strains of Mycobacterium tuberculosis: A systematic review. Emerg Infect Dis 2002;8:843-9.  Back to cited text no. 3
    
4.
Kremer K, Glynn JR, Lillebaek T, Niemann S, Kurepina NE, Kreiswirth BN, et al. Definition of the Beijing/W lineage of Mycobacterium tuberculosis on the basis of genetic markers. J Clin Microbiol 2004;42:4040-9.  Back to cited text no. 4
    
5.
van Embden JD, Cave MD, Crawford JT, Dale JW, Eisenach KD, Gicquel B, et al. Strain identification of Mycobacterium tuberculosis by DNA fingerprinting: Recommendations for a standardized methodology. J Clin Microbiol 1993;31:406-9.  Back to cited text no. 5
    
6.
Anti-Tuberculosis Drug Resistance in the World. Report No. 4. WHO/IUATLD; 2008. Available from: http://www.who.int/tb/publications/2008/drs_report4_26feb08.pdf. Last updated: 2016-06-08.  Back to cited text no. 6
    
7.
van Soolingen D, Qian L, de Haas PE, Douglas JT, Traore H, Portaels F, et al. Predominance of a single genotype of Mycobacterium tuberculosis in countries of east Asia. J Clin Microbiol 1995;33:3234-8.  Back to cited text no. 7
    
8.
Rahmo A, Alsalamah B, Habous M. Testing for the presence of Mycobacterium tuberculosis Beijing genotype strains in Syrian samples. Int J Mycobacteriol 2012;1:87-93.  Back to cited text no. 8
    
9.
Durmaz R, Gunal S, Yang Z, Ozerol IH, Cave MD. Molecular epidemiology of tuberculosis in Turkey. Clin Microbiol Infect 2003;9:873-7.  Back to cited text no. 9
    
10.
Ereqat S, Nasereddin A, Azmi K, Abdeen Z, Greenblatt CL, Spigelman M, et al. Genetic characterization of Mycobacterium tuberculosis in the West Bank, Palestinian Territories. BMC Res Notes 2012;5:270.  Back to cited text no. 10
    
11.
Brudey K, Driscoll JR, Rigouts L, Prodinger WM, Gori A, Al-Hajoj SA, et al. Mycobacterium tuberculosis complex genetic diversity: Mining the fourth international spoligotyping database (SpolDB4) for classification, population genetics and epidemiology. BMC Microbiol 2006;6:23.  Back to cited text no. 11
    
12.
Kubica T, Agzamova R, Wright A, Aziz MA, Rakishev G, Bismilda V, et al. The Beijing genotype is a major cause of drug-resistant tuberculosis in Kazakhstan. Int J Tuberc Lung Dis 2005;9:646-53.  Back to cited text no. 12
    
13.
Al-Hajoj S, Varghese B, Al-Habobe F, Shoukri MM, Mulder A, van Soolingen D. Current trends of Mycobacterium tuberculosis molecular epidemiology in Saudi Arabia and associated demographical factors. Infect Genet Evol 2013;16:362-8.  Back to cited text no. 13
    
14.
Doroudchi M, Kremer K, Basiri EA, Kadivar MR, Van Soolingen D, Ghaderi AA. IS6110-RFLP and spoligotyping of Mycobacterium tuberculosis isolates in Iran. Scand J Infect Dis 2000;32:663-8.  Back to cited text no. 14
    
15.
Bifani PJ, Mathema B, Kurepina NE, Kreiswirth BN. Global dissemination of the Mycobacterium tuberculosis W-Beijing family strains. Trends Microbiol 2002;10:45-52.  Back to cited text no. 15
    
16.
Drobniewski F, Balabanova Y, Nikolayevsky V, Ruddy M, Kuznetzov S, Zakharova S, et al. Drug-resistant tuberculosis, clinical virulence, and the dominance of the Beijing strain family in Russia. JAMA 2005;293:2726-31.  Back to cited text no. 16
    
17.
Toungoussova OS, Sandven P, Mariandyshev AO, Nizovtseva NI, Bjune G, Caugant DA. Spread of drug-resistant Mycobacterium tuberculosis strains of the Beijing genotype in the Archangel Oblast, Russia. J Clin Microbiol 2002;40:1930-7.  Back to cited text no. 17
    
18.
Pfyffer GE, Strässle A, van Gorkum T, Portaels F, Rigouts L, Mathieu C, et al. Multidrug-resistant tuberculosis in prison inmates, Azerbaijan. Emerg Infect Dis 2001;7:855-61.  Back to cited text no. 18
    
19.
Asiimwe BB, Ghebremichael S, Kallenius G, Koivula T, Joloba ML. Mycobacterium tuberculosis spoligotypes and drug susceptibility pattern of isolates from tuberculosis patients in peri-urban Kampala, Uganda. BMC Infect Dis 2008;8:101.  Back to cited text no. 19
    
20.
Glynn JR, Crampin AC, Traore H, Yates MD, Mwaungulu FD, Ngwira BM, et al. Mycobacterium tuberculosis Beijing genotype, Northern Malawi. Emerg Infect Dis 2005;11:150-3.  Back to cited text no. 20
    
21.
Buu TN, van Soolingen D, Huyen MN, Lan NT, Quy HT, Tiemersma EW, et al. Increased transmission of Mycobacterium tuberculosis Beijing genotype strains associated with resistance to streptomycin: A population-based study. PLoS One 2012;7:e42323.  Back to cited text no. 21
    
22.
Lan NT, Lien HT, Tung le B, Borgdorff MW, Kremer K, van Soolingen D. Mycobacterium tuberculosis Beijing genotype and risk for treatment failure and relapse, Vietnam. Emerg Infect Dis 2003;9:1633-5.  Back to cited text no. 22
    
23.
Sun YJ, Lee AS, Wong SY, Paton NI. Association of Mycobacterium tuberculosis Beijing genotype with tuberculosis relapse in Singapore. Epidemiol Infect 2006;134:329-32.  Back to cited text no. 23
Advanced Biomedical Research
Volume 2016, November
November 2016
Pages 1-5