Re-emergence of the progenitors of a multidrug-resistant outbreak strain of Mycobacterium tuberculosis among the post-outbreak case patients.

Amine Namouchi 1 Raja Haltiti 2 Dorra Hawari 2 Helmi Mardassi 1
1 LR11IPT01 - Laboratoire de Microbiologie Moléculaire, Vaccinologie et Développement Biotechnologique
2 Hôpital régional de Menzel-Bourguiba, Tunisie
Abstract : BACKGROUND. The progenitors of multidrug-resistant tuberculosis (MDR-TB) outbreak strains might evolve into new outbreak strains. We hypothesized that these strains could re-emerge among post-outbreak patients with TB and must thus be tracked. METHODS. To identify the progenitors of the outbreak strain, we first determined the precise IS6110 genomic insertion locations of a Haarlem3 strain that caused a severe MDR-TB outbreak in Tunisia. Next, we searched by polymerase chain reaction for these outbreak-specific IS6110 transposition sites in all the Haarlem3 post-outbreak isolates recovered in the epidemic region. RESULTS. By analyzing the distribution of the outbreak-specific IS6110 transposition sites, we were able to trap, among isolates recovered from post-outbreak new patients, drug-susceptible and drug-resistant isolates that are likely to represent the very close progenitors of the outbreak strain. Mycobacterial interspersed repetitive units-variable number of tandem repeats typing and sequential accumulation of rifampicin resistance-associated rpoB mutations further confirmed the identity of the outbreak's progenitor strains. CONCLUSIONS. The data of the current study show that the progenitors of an MDR-TB outbreak strain could re-emerge among post-outbreak TB cases. We provide an IS6110 insertion site-based approach to better trace back the events preceding the emergence of MDR-TB outbreaks, irrespective of the availability of a pre-outbreak strain collection.
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Submitted on : Thursday, September 22, 2011 - 1:37:08 PM
Last modification on : Monday, October 8, 2018 - 5:44:07 PM

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Amine Namouchi, Raja Haltiti, Dorra Hawari, Helmi Mardassi. Re-emergence of the progenitors of a multidrug-resistant outbreak strain of Mycobacterium tuberculosis among the post-outbreak case patients.. Journal of Infectious Diseases, Oxford University Press (OUP), 2010, 201 (3), pp.390-8. ⟨10.1086/649900⟩. ⟨pasteur-00621010⟩

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