Emergence of Increased Resistance and Extensively Drug-Resistant Tuberculosis Despite Treatment Adherence, South Africa
Alistair D. Calver1, Alecia A. Falmer1, Megan Murray, Odelia J. Strauss, Elizabeth M. Streicher, Madelene Hanekom, Thelma Liversage, Mothusi Masibi, Paul D. van Helden, Robin M. Warren, and Thomas C. Victor
Author affiliations: West Vaal Hospital, Orkney, South Africa (A.D. Calver, T. Liversage, M. Masibi); Stellenbosch University, Tygerberg, South Africa (A.A. Falmer, O.J. Strauss, E.M. Streicher, M. Hanekom, P.D. van Helden, R.M. Warren, T.C. Victor); Harvard School of Public Health, Boston, Massachusetts, USA (M. Murray)
Appendix Figure. Genotype and phenotype classification drug-resistant isolates from each case-patient. Insertion sequence (IS) 6110 DNA fingerprints of a single Mycobacterium tuberculosis isolate from 122 case-patients, South Africa, 2003-2005 are shown. Spoligotype patterns from 126 case-patients are shown. Isolated from 74 case-patients were grouped into 11 clusters (4 clusters had 2 cases, 4 clusters had 3 cases, 1 cluster had 4 cases, 1 cluster had 8 cases and 1 cluster had 42 cases). Mycobacterial interspersed repetitive unit (MIRU) types are shown for strains with <5 IS6110 hybridizing bands. Drug-resistant phenotypes of each isolate are illustrated: H, isoniazid, R, rifampin, E, ethambutol, Z, pyrazinamide, Et, ethionamide, S, streptomycin, K, kanamycin, Ofx, ofloxacin. Drug-resistance classification for each case is indicated. RFLP, restriction fragment length polymorphism; NA, not available.
The opinions expressed by authors contributing to this journal do not necessarily reflect the opinions of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.