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Volume 11, Number 6—June 2005
Dispatch

Tuberculosis due to Resistant Haarlem Strain, Tunisia

Helmi Mardassi*Comments to Author , Amine Namouchi*, Raja Haltiti†, Mourad Zarrouk†, Besma Mhenni*, Anis Karboul*, Neila Khabouchi*, Nico C. Gey van Pittius‡, Elizabeth M. Streicher‡, Jean Rauzier§, Brigitte Gicquel§, and Koussay Dellagi*
Author affiliations: *Institut Pasteur de Tunis, Tunis-Belvédère, Tunisia; †Hôpital Régional de Menzel-Bourguiba, Menzel-Bourguiba, Tunisia; ‡University of Stellenbosch, Stellenbosch, South Africa; §Institut Pasteur, Paris, France

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Table 2

Laboratory findings and genotyping of multidrug-resistant isolates from 21 tuberculosis patients, Bizerte, Tunisia, 2001–2004*

Patient Smear result Resistance pattern† RFLP‡ Spoligotype PGG§ Mutational analysis
rpoB katG pncA mutT3 Ogt
P1 +++ HSREZ 11 Haarlem3¶ 2 S531L+V610M S315T A-11C L209L T15S
P2 + HSREZ 11 Haarlem3 2 S531L+V610M S315T A-11C L209L T15S
P3 ++ HSREZ 12 Haarlem3 2 S531L+V610M S315T T11G (L4W) L209L T15S
P4 - HSREZ 11 Haarlem3 2 S531L+V610M S315T A-11C L209L T15S
P5 - HSREZ 12 Haarlem3 2 S531L+V610M S315T WT L209L T15S
P6 + HSREZ 11 Haarlem3 2 S531L+V610M S315T WT L209L T15S
P7 - HSREZ 11 Haarlem3 2 S531L+V610M S315T A-11C L209L T15S
P8 - HSRE 11 Haarlem3 2 S531L+V610M S315T WT L209L T15S
P9 + HSRE 11 Haarlem3 2 S531L+V610M S315T A-11C L209L T15S
P10 - HSREZ 11 Haarlem3 2 S531L+V610M S315T WT L209L T15S
P11 - HSREZ 12 Haarlem3 2 S531L+V610M S315T WT L209L T15S
P12 - HSREZ 11 Haarlem3 2 S531L+V610M S315T A-11C L209L T15S
P13 - HSRE ND# Haarlem3 2 S531L+V610M S315T WT L209L T15S
P14 - HRZ 11 Haarlem3 2 S531L+V610M S315T G insertion (391-392) L209L T15S
P15 - HSREZ 11 Haarlem3 2 S531L+V610M S315T A-11C L209L T15S
P16 ++ HSR 12 Haarlem3 2 S531L+V610M S315T T11G (L4W) L209L T15S
P17 - HSREZ 11 Haarlem3 2 S531L+V610M S315T G insertion (296-297) L209L T15S
P18 - HSREZ 12 Haarlem3 2 S531L+V610M S315T T11G (L4W) L209L T15S
P19 - HSRE 9 Other** 2 ΔN (AAC)519 S315T G insertion (296-297) WT WT
P20 ++ HSR 10 Haarlem3 2 S531L S315 WT L209L T15S
P21 ++ HR 11 Haarlem3 2 S531L+V610M S315T WT L209L T15S

*RFLP, restriction fragment length polymorphism; PGG, principal genetic grouping; WT, wild type (identical to strain H37Rv); ND, not determined.
†H, isoniazid; S, streptomycin; R, rifampicin; E, ethambutol; Z, pyrazinamide.
‡Number of IS6110 bands.
§Principal genetic grouping according to gyrA and katG polymorphisms (11).
¶Absence of spacers 31 and 33–36.
#IS6110 typing was determined by ligation-mediated polymerase chain reaction and the profile was identical to the other outbreak-associated strains.
**Absence of spacers 15, 21–24, and 33–36.

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