Skip directly to site content Skip directly to page options Skip directly to A-Z link Skip directly to A-Z link Skip directly to A-Z link
Volume 16, Number 2—February 2010
Research

Emergence of Increased Resistance and Extensively Drug-Resistant Tuberculosis Despite Treatment Adherence, South Africa

Alistair D. Calver1, Alecia A. Falmer1, Megan B. Murray, Odelia J. Strauss, Elizabeth M. Streicher, Madelene Hanekom, Thelma Liversage, Mothusi Masibi, Paul D. van Helden, Robin M. Warren, and Thomas C. VictorComments to Author 
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)

Main Article

Figure 2

Phylogenetic history of the largest multidrug-resistant tuberculosis (MDR TB) cluster, South Africa, 2003–2005. Genetic data from isolates from 40 of the 42 case-patients were analyzed. The phylogenetic tree was constructed by using the neighbor joining algorithm (PAUP 4.0*; Sinauer Associates, Sunderland, MA, USA) and was rooted to the H37Rv wild-type DNA sequence (ANC) (20). The gene and the codon conferring resistance are indicated at the internal node where they occurred. Bootstrap values ar

Figure 2. Phylogenetic history of the largest multidrug-resistant tuberculosis (MDR TB) cluster, South Africa, 2003–2005. Genetic data from isolates from 40 of the 42 case-patients were analyzed. The phylogenetic tree was constructed by using the neighbor joining algorithm (PAUP 4.0*; Sinauer Associates, Sunderland, MA, USA) and was rooted to the H37Rv wild-type DNA sequence (ANC) (20). The gene and the codon conferring resistance are indicated at the internal node where they occurred. Bootstrap values are shown in brackets at the internal nodes. The sequential evolution of resistance to HRZE and Ofx is indicated. The date of MDR TB diagnosis follows each case number. The 3 XDR TB cases are indicated in boldface. H, isoniazid, R, rifampin, E, ethambutol, Z, pyrazinamide, Ofx, ofloxacin.

Main Article

References
  1. Crofton  J, Chaulet  P, Maher  D. Guidelines for the management of drug resistant tuberculosis. 1997 [cited 2008 Mar 1]. http://whqlibdoc.who.int/hq/1997/WHO_TB_96.210_(Rev.1).pdf
  2. Coker  RJ. Multidrug-resistant tuberculosis: public health challenges. Trop Med Int Health. 2004;9:25–40. DOIPubMedGoogle Scholar
  3. Weyer  K. Survey of tuberculosis drug resistance, 2001–2002, Western Cape. 2001 [cited 2008 Mar 1]. http://www.sahealthinfo.org/tb/tbdrugresistance.htm
  4. Global  WHO-IUTALD. Project on anti-tuberculosis drug resistance surveillance. Anti-tuberculosis drug resistance in the world (Report no. 4). 2008 [cited 2008 Apr 1]. http://www.who.int/tb/publications/2008/drs_report4_26feb08.pdf.
  5. Centers for Disease Control and Prevention (CDC). Emergence of Mycobacterium tuberculosis with extensive resistance to second-line drugs—worldwide, 2000–2004. MMWR Morb Mortal Wkly Rep. 2006;55:301–5.PubMedGoogle Scholar
  6. Gandhi  NR, Moll  A, Sturm  AW, Pawinski  R, Govender  T, Lalloo  U, Extensively drug resistant tuberculosis as a cause of death in patients co-infected with tuberculosis and HIV in a rural area of South Africa. Lancet. 2006;368:1575–80. DOIPubMedGoogle Scholar
  7. Van Rie  A, Enarson  D. XDR tuberculosis: an indicator of public-health negligence. Lancet. 2006;368:1554–6. DOIPubMedGoogle Scholar
  8. Pillay  M, Sturm  AW. Evolution of the extensively drug-resistant F15/LAM4/KZN strain of Mycobacterium tuberculosis in KwaZulu-Natal, South Africa. Clin Infect Dis. 2007;45:1409–14. DOIPubMedGoogle Scholar
  9. Cox  HS, Sibilia  K, Feuerriegel  S, Kalon  S, Polonsky  J, Khamraev  AK, Emergence of extensive drug resistance during treatment for multidrug-resistant tuberculosis. N Engl J Med. 2008;359:2398–400. DOIPubMedGoogle Scholar
  10. Stop TB partnership. Stop TB working group on DOTS-Plus for MDR-TB. 2006 [cited 2008 Mar 1]. http://www.stoptb.org/wg/dots_plus
  11. Mlambo  CK, Warren  RM, Poswa  X, Victor  TC, Duse  AG, Marais  E. Genotypic diversity of extensively drug-resistant tuberculosis (XDR-TB) in South Africa. Int J Tuberc Lung Dis. 2008;12:99–104.PubMedGoogle Scholar
  12. Louw  GE, Warren  RM, Donald  PR, Murray  MB, Bosman  M, van Helden  PD, Frequency and implications of pyrazinamide resistance in managing previously treated tuberculosis patients. Int J Tuberc Lung Dis. 2006;10:802–7.PubMedGoogle Scholar
  13. van Embden  JD, Cave  MD, Crawford  JT, Dale  JW, Eisenach  KD, Gicquel  B, Strain identification of Mycobacterium tuberculosis by DNA fingerprinting: recommendations for a standardized methodology. J Clin Microbiol. 1993;31:406–9.PubMedGoogle Scholar
  14. Kamerbeek  J, Schouls  L, Kolk  A, van Agterveld  M, van Soolingen  D, Kuijper  S, Simultaneous detection and strain differentiation of Mycobacterium tuberculosis for diagnosis and epidemiology. J Clin Microbiol. 1997;35:907–14.PubMedGoogle Scholar
  15. Supply  P, Lesjean  S, Savine  E, Kremer  K, van Soolingen  D, Locht  C. Automated high-throughput genotyping for study of global epidemiology of Mycobacterium tuberculosis based on mycobacterial interspersed repetitive units. J Clin Microbiol. 2001;39:3563–71. DOIPubMedGoogle Scholar
  16. Johnson  R, Streicher  EM, Louw  GE, Warren  RM, van Helden  PD, Victor  TC. Drug resistance in Mycobacterium tuberculosis. Curr Issues Mol Biol. 2006;8:97–111.PubMedGoogle Scholar
  17. van Rie  A, Warren  R, Richardson  M, Gie  RP, Enarson  DA, Beyers  N, Classification of drug-resistant tuberculosis in an epidemic area. Lancet. 2000;356:22–5. DOIPubMedGoogle Scholar
  18. Swofford  DL. PAUP: Phylogenetic analysis using parsimony. Champaign (IL): Illinois Natural History Survey; 1991.
  19. Small  PM, Hopewell  PC, Singh  SP, Paz  A, Parsonnet  J, Ruston  DC, The epidemiology of tuberculosis in San Francisco. A population-based study using conventional and molecular methods. N Engl J Med. 1994;330:1703–9. DOIPubMedGoogle Scholar
  20. Cole  ST, Brosch  R, Parkhill  J, Garnier  T, Churcher  C, Harris  D, Deciphering the biology of Mycobacterium tuberculosis from the complete genome sequence. Nature. 1998;393:537–44. DOIPubMedGoogle Scholar
  21. van Rie  A, Warren  RM, Beyers  N, Gie  RP, Classen  CN, Richardson  M, Transmission of a multidrug-resistant Mycobacterium tuberculosis strain resembling “strain W” among noninstitutionalized, human immunodeficiency virus-seronegative patients. J Infect Dis. 1999;180:1608–15. DOIPubMedGoogle Scholar
  22. Victor  TC, Streicher  EM, Kewley  C, Jordaan  AM, van der Spuy  GD, Bosman  M, Spread of an emerging Mycobacterium tuberculosis drug-resistant strain in the western Cape of South Africa. Int J Tuberc Lung Dis. 2007;11:195–201.PubMedGoogle Scholar
  23. Li  X, Zhang  Y, Shen  X, Shen  G, Gui  X, Sun  B, Transmission of drug-resistant tuberculosis among treated patients in Shanghai, China. J Infect Dis. 2007;195:864–9. DOIPubMedGoogle Scholar
  24. Verver  S, Warren  RM, Beyers  N, Richardson  M, van der Spuy  GD, Borgdorff  MW, Rate of reinfection tuberculosis after successful treatment is higher than rate of new tuberculosis. Am J Respir Crit Care Med. 2005;171:1430–5. DOIPubMedGoogle Scholar
  25. Whalen  C, Horsburgh  CR, Hom  D, Lahart  C, Simberkoff  M, Ellner  J. Accelerated course of human immunodeficiency virus after tuberculosis infection. Am J Respir Crit Care Med. 1995;151:129–35.PubMedGoogle Scholar
  26. Getahun  H, Harrington  M, O’Brien  R, Nunn  P. Diagnosis of smear-negative pulmonary tuberculosis in people with HIV infection or AIDS in resource-constrained settings: informing urgent policy changes. Lancet. 2007;369:2042–9. DOIPubMedGoogle Scholar
  27. van Helden  PD, Donald  PR, Victor  TC, Schaaf  HS, Hoal  EG, Walzl  G, Antimicrobial resistance in tuberculosis: an international perspective. Expert Rev Anti Infect Ther. 2006;4:759–66. DOIPubMedGoogle Scholar
  28. Seung  KJ, Gelmanova  IE, Peremitin  GG, Golubchikova  VT, Pavlova  VE, Sirotkina  OB, The effect of initial drug resistance on treatment response and acquired drug resistance during standardized short-course chemotherapy for tuberculosis. Clin Infect Dis. 2004;39:1321–8. DOIPubMedGoogle Scholar
  29. Johnson  R, Jordaan  AM, Pretorius  L, Engelke  E, van der Spuy  G, Kewley  C, Ethambutol resistance testing by mutation detection. Int J Tuberc Lung Dis. 2006;10:68–73.PubMedGoogle Scholar
  30. Cox  HS, Niemann  S, Ismailov  G, Doshetov  D, Orozco  JD, Blok  L, Risk of acquired drug resistance during short-course directly observed treatment of tuberculosis in an area with high levels of drug resistance. Clin Infect Dis. 2007;44:1421–7. DOIPubMedGoogle Scholar
  31. Mphahlele  M, Syre  H, Valvatne  H, Stavrum  R, Mannsaker  T, Muthivhi  T, Pyrazinamide resistance among South African multidrug-resistant Mycobacterium tuberculosis isolates. J Clin Microbiol. 2008;46:3459–64. DOIPubMedGoogle Scholar
  32. Temple  B, Ayakaka  I, Ogwang  S, Nabanjja  H, Kayes  S, Nakubulwa  S, Rate and amplification of drug resistance among previously-treated patients with tuberculosis in Kampala, Uganda. Clin Infect Dis. 2008;47:1126–34. DOIPubMedGoogle Scholar
  33. World Health Oganization. Guidelines for the programmatic management of drug-resistant tuberculosis. Rich M, Cegielski P, Jaramillo E, Lambregts K, editors. 2006 [cited 2008 Mar 1]. http://whqlibdoc.who.int/publications/2006/9241546956_eng.pdf
  34. Barnard  M, Albert  H, Coetzee  G, O'Brien  R, Bosman  ME. Rapid molecular screening for multidrug-resistant tuberculosis in a high-volume public health laboratory in South Africa. Am J Respir Crit Care Med. 2008;177:787–92. DOIPubMedGoogle Scholar

Main Article

1These authors contributed equally to this article.

Page created: December 13, 2010
Page updated: December 13, 2010
Page reviewed: December 13, 2010
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position 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.
file_external