Mycobacterium tuberculosis population structure shift in a 5-year molecular epidemiology surveillance follow-up study in a low endemic agro-industrial setting in Sao Paulo, Brazil

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Barreto Santos, Adolfo Carlos ; Gaspareto, Rosangela Maria ; Jung Viana, Brunilde Helena ; Mendes, Natalia Helena ; Claudio Pandolfi, Jose Rodrigo ; Cardoso, Rosilene Fressatti ; Sato, Daisy Nakamura ; de Matos David, Susana Correia ; Feres Saad, Maria Helena ; Rastogi, Nalin ; Fujimura Leite, Clarice Queico

• Tipo de documento: Artigo Científico
• Fonte: INTERNATIONAL JOURNAL OF MYCOBACTERIOLOGY; v. 2, n. 3, p. 10-pg., 2013-09-01.

Resumo

Starting with 257 outpatients attending the specialized health service for tuberculosis (TB) between 2002 and 2006 in Araraquara, an agro-industrial area with low tuberculosis (TB) incidence in Sao Paulo state, Brazil, positive mycobacterial cultures were obtained in 130 cases, of which 121 were confirmed as Mycobacterium tuberculosis complex. This report assesses the genetic diversity observed on 69.42% (n = 84) of the clinical isolates, for which both spoligotyping and 12-loci MIRU typing data were fully interpretable. In order to monitor changes in the population dynamics of circulating M. tuberculosis strains over time, spoligotypes were compared from this study (n = 84) with an earlier study from 1998 to 2001 (n = 70 strains); and these two datasets from low-incidence Araraquara area were also compared with a 2-year cohort in the nearby higher-incidence Sao Paulo city area from 2006 to 2008 (n = 93). The results obtained showed that with 58.3% (49/84) of the strains, the LatinAmerican-Mediterranean (LAM) was the predominant lineage in the present follow-up study; major patterns being SIT42/LAM9 11.9% (10/84), and SIT20/LAM1 10.7% (9/84). As compared with the 1998-2001 period when 40% (28/70) of the isolates belonged to the illdefined T family, it was replaced by LAM strains between 2002 and 2006 with a visible shift to a population structure characteristic of the metropolitan Sao Paulo city. Further typing of the follow-up isolates from 2002 to 2006 using 12 loci MIRUs in conjunction with conventional epidemiology did not link this population structure shift to an increase in ongoing transmission or drug-resistance. Instead, it is most probably linked to movements of the important migrant community of Araraquara to higher TB incidence metropolitan areas such as Sao Paulo city. This is of particular concern owing to the increment in the global burden of LAM strains and the recent association of certain LAM sublineages with multidrug-and extensively drug-resistant TB. These observations suggest the need for further molecular monitoring of the TB population structure and the evaluation of transmission trends amongst migrant workers and other risk groups, such as persons in homeless shelters, in correctional facilities, drug users, and those with HIV infection, etc. (C) 2013 Asian-African Society for Mycobacteriology. Published by Elsevier Ltd. All rights reserved. (AU)

• Processo FAPESP: 09/53292-3 - Mycobacterium tuberculosis: genotipagem, perfil de resistência e análise de mutações de isolados clínicosrisc
• Beneficiário: Clarice Queico Fujimura Leite
• Modalidade de apoio: Auxílio à Pesquisa - Pesquisa em Políticas Públicas para o SUS