Browsing by Author "Sirgel, Frederick Adriaan"

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    Emergence and spread of extensively and totally drug-resistant tuberculosis, South Africa
    (Centers for Disease Control and Prevention, 2013-03) Klopper, Marisa; Warren, Robin Mark; Hayes, Cindy; Gey van Pittius, Nicolaas Claudius; Streicher, Elizabeth M.; Muller, Borna; Sirgel, Frederick Adriaan; Chabula-Nxiweni, Mamisa; Hoosain, Ebrahim; Coetzee, Gerrit; Van Helden, Paul David; Victor, Thomas Calldo; Trollip, Andre Phillip
    ENGLISH ABSTRACT: Factors driving the increase in drug-resistant tuberculosis (TB) in the Eastern Cape Province, South Africa, are not understood. A convenience sample of 309 drug-susceptible and 342 multidrug-resistant (MDR) TB isolates, collected July 2008–July 2009, were characterized by spoligotyping, DNA fingerprinting, insertion site mapping, and targeted DNA sequencing. Analysis of molecular-based data showed diverse genetic backgrounds among drug-sensitive and MDR TB sensu stricto isolates in contrast to restricted genetic backgrounds among pre–extensively drug-resistant (pre-XDR) TB and XDR TB isolates. Second-line drug resistance was significantly associated with the atypical Beijing genotype. DNA fingerprinting and sequencing demonstrated that the pre-XDR and XDR atypical Beijing isolates evolved from a common progenitor; 85% and 92%, respectively, were clustered, indicating transmission. Ninety-three percent of atypical XDR Beijing isolates had mutations that confer resistance to 10 anti-TB drugs, and some isolates also were resistant to para-aminosalicylic acid. These findings suggest the emergence of totally drug-resistant TB.