E Roycroft1, R F O'Toole2, M M Fitzgibbon3, L Montgomery4, M O'Meara5, P Downes5, S Jackson6, J O'Donnell6, I F Laurenson7, A M McLaughlin8, J Keane8, T R Rogers3. 1. Irish Mycobacteria Reference Laboratory, Labmed Directorate, St. James's Hospital, Dublin, Ireland; Department of Clinical Microbiology, Trinity Translational Medicine Institute, Trinity College, Dublin, Ireland. Electronic address: eroycroft@stjames.ie. 2. Department of Clinical Microbiology, Trinity Translational Medicine Institute, Trinity College, Dublin, Ireland; School of Medicine, Faculty of Health, University of Tasmania, Hobart, Australia. 3. Irish Mycobacteria Reference Laboratory, Labmed Directorate, St. James's Hospital, Dublin, Ireland; Department of Clinical Microbiology, Trinity Translational Medicine Institute, Trinity College, Dublin, Ireland. 4. Irish Mycobacteria Reference Laboratory, Labmed Directorate, St. James's Hospital, Dublin, Ireland. 5. Department of Public Health, Dr. Steeven's Hospital, Dublin, Ireland. 6. Health Protection Surveillance Centre, Dublin, Ireland. 7. Scottish Mycobacteria Reference Laboratory, Edinburgh, UK. 8. Department of Respiratory Medicine, St. James's Hospital and Trinity Translational Medicine Institute Trinity College Dublin, Ireland.
Abstract
OBJECTIVES: The primary objective of this work was to examine the acquisition and spread of multi-drug resistant (MDR) tuberculosis (TB) in Ireland. METHODS: All available Mycobacterium tuberculosis complex (MTBC) isolates (n = 42), from MDR-TB cases diagnosed in Ireland between 2001 and 2014, were analysed using phenotypic drug-susceptibility testing, Mycobacterial-Interspersed-Repetitive-Units Variable-Number Tandem-Repeat (MIRU-VNTR) genotyping, and whole-genome sequencing (WGS). RESULTS: The lineage distribution of the MDR-TB isolates comprised 54.7% Euro-American, 33.3% East Asian, 7.2% East African Indian, and 4.8% Indo-Oceanic. A significant association was identified between the East Asian Beijing sub-lineage and the relative risk of an isolate being MDR. Over 75% of MDR-TB cases were confirmed in non-Irish born individuals and 7 MIRU-VNTR genotypes were identical to clusters in other European countries indicating cross-border spread of MDR-TB to Ireland. WGS data provided the first evidence in Ireland of in vivo microevolution of MTBC isolates from drug-susceptible to MDR, and from MDR to extensively-drug resistant (XDR). In addition, they found that the katG S315T isoniazid and rpoB S450L rifampicin resistance mutations were dominant across the different MTBC lineages. CONCLUSIONS: Our molecular epidemiological analyses identified the spread of MDR-TB to Ireland from other jurisdictions and its potential to evolve to XDR-TB.
OBJECTIVES: The primary objective of this work was to examine the acquisition and spread of multi-drug resistant (MDR) tuberculosis (TB) in Ireland. METHODS: All available Mycobacterium tuberculosis complex (MTBC) isolates (n = 42), from MDR-TB cases diagnosed in Ireland between 2001 and 2014, were analysed using phenotypic drug-susceptibility testing, Mycobacterial-Interspersed-Repetitive-Units Variable-Number Tandem-Repeat (MIRU-VNTR) genotyping, and whole-genome sequencing (WGS). RESULTS: The lineage distribution of the MDR-TB isolates comprised 54.7% Euro-American, 33.3% East Asian, 7.2% East African Indian, and 4.8% Indo-Oceanic. A significant association was identified between the East Asian Beijing sub-lineage and the relative risk of an isolate being MDR. Over 75% of MDR-TB cases were confirmed in non-Irish born individuals and 7 MIRU-VNTR genotypes were identical to clusters in other European countries indicating cross-border spread of MDR-TB to Ireland. WGS data provided the first evidence in Ireland of in vivo microevolution of MTBC isolates from drug-susceptible to MDR, and from MDR to extensively-drug resistant (XDR). In addition, they found that the katG S315T isoniazid and rpoB S450Lrifampicin resistance mutations were dominant across the different MTBC lineages. CONCLUSIONS: Our molecular epidemiological analyses identified the spread of MDR-TB to Ireland from other jurisdictions and its potential to evolve to XDR-TB.
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