Emergence and Spread of Extensively and Totally Drug-Resistant Tuberculosis, South Africa

• DOI: 10.3201//eid1903.120246
• Publication Date: 2013-01-29T18:30:23Z
• Authors: Marisa Klopper; Robin Mark Warren; Cindy Hayes; Nicolaas Claudius...; Elizabeth Maria S...; Borna Müller; Frederick Adriaan...; Mamisa Chabula-Nx...; Ebrahim Hoosain; Gerrit Coetzee; Paul David van He...; Thomas Calldo Victor; André Phillip Tro...
• Keywords: Extensively drug-resistant tuberculosis; DNA profiling; Molecular Epidemiology

Factors driving the increase in drug-resistant tuberculosis (TB) 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, targeted sequencing. Analysis molecular-based data showed diverse genetic backgrounds among drug-sensitive MDR sensu stricto isolates contrast to restricted pre-extensively (pre-XDR) XDR isolates. Second-line drug resistance was significantly associated with atypical Beijing genotype. fingerprinting sequencing demonstrated that pre-XDR evolved from a common progenitor; 85% 92%, respectively, clustered, indicating transmission. Ninety-three percent had mutations confer 10 anti-TB drugs, some also resistant para-aminosalicylic acid. These findings suggest emergence totally TB.