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Drug-Resistant Tuberculosis, Clinical Virulence, and the Dominance of the Beijing Strain Family in Russia
Francis Drobniewski, MD, PhD;
Yanina Balabanova, MD, PhD;
Vladyslav Nikolayevsky, PhD;
Micheal Ruddy, MD;
Sergey Kuznetzov, MD;
Svetlana Zakharova, MD;
Alexander Melentyev, MD;
Ivan Fedorin, MD
JAMA. 2005;293:2726-2731.
Context Tuberculosis and multidrug-resistant tuberculosis is a serious public health problem in Russia.
Objective To address the extent of "Beijing strain" transmission in the prison/civil sectors and the association of drug resistance, clinical, and social factors with the Beijing genotype.
Design and Setting Cross-sectional population-based molecular epidemiological study of all civilian and penitentiary tuberculosis facilities in the Samara region, Russia.
Patients Consecutively recruited patients with bacteriologically proven tuberculosis (n = 880).
Main Outcome Measure Proportion of Beijing strains and association with drug resistance, human immunodeficiency virus infection, imprisonment, radiological, clinical, and other social factors.
Results Beijing-family strains (identified by spoligotyping and composed of 2 main types by mycobacterial interspersed repetitive unit analysis) were predominant: 586/880 (66.6%; 95% confidence interval [CI], 63.4%-69.7%) with a significantly higher prevalence in the prison population (rate ratio [RR], 1.3; 95% CI, 1.2-1.5) and those aged younger than 35 years (RR, 1.2; 95% CI, 1.0-1.3). Comparable proportions were co-infected with the human immunodeficiency virus ( 10%), concurrent hepatitis B and C (21.6%), drank alcohol (90%), smoked (90%), and had a similar sexual history. Drug resistance was nearly 2-fold higher in patients infected with Beijing strains compared with non-Beijing strains: multidrug resistance (RR, 2.4; 95% CI, 1.9-3.0), for isoniazid (RR, 1.8; 95% CI, 1.5-2.1), for rifampicin (RR, 2.2; 95% CI, 1.7-2.7), for streptomycin (RR, 1.9; 95% CI, 1.5-2.3), and for ethambutol (RR, 2.2; 95% CI, 1.6-3.2). Univariate analysis demonstrated that male sex (odds ratio [OR], 1.5; 95% CI, 1.1-1.9), advanced radiological abnormalities (OR, 3.3; 95% CI, 1.3-8.4), homelessness (OR, 5.6; 95% CI, 1.1-6.3), and previous imprisonment (OR, 2.0; 95% CI, 1.5-2.7) were strongly associated with Beijing-strain family disease. Multivariate analysis supported previous imprisonment to be a risk factor (OR, 2.0; 95% CI, 1.4-3.3) and night sweats to be less associated (OR 0.7; 95% CI, 0.5-1.0) with Beijing-strain disease.
Conclusions Drug resistance and previous imprisonment but not human immunodeficiency virus co-infection were significantly associated with Beijing-strain infection. There was evidence that Beijing isolates caused radiologically more advanced disease.
Author Affiliations: HPA Mycobacterium Reference Unit, Department of Microbiology and Infection, Guy’s King’s and St Thomas’ Medical School, (Dulwich), London, England (Drs Drobniewski, Balabanova, Nikolayevsky, and Ruddy); Samara Regional TB Service, Samara Oblast Dispensary, Russia Federation (Drs Balabanova and Fedorin); Samara Regional Ministry of Health, Russia Federation (Dr Kuznetzov); Samara City TB Service, Russia Federation (Dr Zakharova); Samara Prison TB Service, Samara, Russia Federation (Dr Melentyev).
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