TY - JOUR AU - Klopper, Marisa AU - Warren, Robin Mark AU - Hayes, Cindy AU - Gey van Pittius, Nicolaas Claudius AU - Streicher, Elizabeth Maria AU - Müller, Borna AU - Sirgel, Frederick Adriaan AU - Chabula-Nxiweni, Mamisa AU - Hoosain, Ebrahim AU - Coetzee, Gerrit AU - David van Helden, Paul AU - Victor, Thomas Calldo AU - Trollip, André Phillip T1 - Emergence and Spread of Extensively and Totally Drug-Resistant Tuberculosis, South Africa T2 - Emerging Infectious Disease journal PY - 2013 VL - 19 IS - 3 SP - 449 SN - 1080-6059 AB - 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. KW - Tuberculosis KW - multidrug-resistant tuberculosis KW - MDR-TB KW - extensively drug-resistant tuberculosis KW - XDR-TB KW - totally drug-resistant tuberculosis KW - South Africa KW - bacteria KW - TB KW - MDR TB KW - totally drug resistant TB KW - mycobacteria KW - Mycobacterium tuberculosis DO - 10.3201/eid1903.120246 UR - https://wwwnc.cdc.gov/eid/article/19/3/12-0246_article ER - End of Reference