Extensively drug-resistant tuberculosis in South Africa: genomic evidence supporting transmission in communities

Sara C. Auld, N. Sarita Shah, Barun Mathema, Tyler S. Brown, Nazir Ismail, Shaheed Vally Omar, James C.M. Brust, Kristin N. Nelson, Salim Allana, Angela Campbell, Koleka Mlisana, Pravi Moodley, Neel R. Gandhi

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Despite evidence that transmission is driving an extensively drug-resistant TB (XDR-TB) epidemic, our understanding of where and between whom transmission occurs is limited. We sought to determine whether there was genomic evidence of transmission between individuals without an epidemiologic connection.We conducted a prospective study of XDR-TB patients in KwaZulu-Natal, South Africa, during the 2011-2014 period. We collected sociodemographic and clinical data, and identified epidemiologic links based on person-to-person or hospital-based connections. We performed whole-genome sequencing (WGS) on the Mycobacterium tuberculosis isolates and determined pairwise single nucleotide polymorphism (SNP) differences.Among 404 participants, 123 (30%) had person-to-person or hospital-based links, leaving 281 (70%) epidemiologically unlinked. The median SNP difference between participants with person-to-person and hospital-based links was 10 (interquartile range (IQR) 8-24) and 16 (IQR 10-23), respectively. The median SNP difference between unlinked participants and their closest genomic link was 5 (IQR 3-9) and half of unlinked participants were within 7 SNPs of at least five participants.The majority of epidemiologically-unlinked XDR-TB patients had low pairwise SNP differences with at least one other participant, consistent with transmission. These data suggest that much of transmission may result from casual contact in community settings between individuals not known to one another.

Original languageEnglish (US)
JournalThe European respiratory journal
Volume52
Issue number4
DOIs
StatePublished - Oct 1 2018

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Extensively Drug-Resistant Tuberculosis
Single Nucleotide Polymorphism
South Africa
Mycobacterium tuberculosis
Genome
Prospective Studies
Pharmaceutical Preparations

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

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Extensively drug-resistant tuberculosis in South Africa : genomic evidence supporting transmission in communities. / Auld, Sara C.; Shah, N. Sarita; Mathema, Barun; Brown, Tyler S.; Ismail, Nazir; Omar, Shaheed Vally; Brust, James C.M.; Nelson, Kristin N.; Allana, Salim; Campbell, Angela; Mlisana, Koleka; Moodley, Pravi; Gandhi, Neel R.

In: The European respiratory journal, Vol. 52, No. 4, 01.10.2018.

Research output: Contribution to journalArticle

Auld, SC, Shah, NS, Mathema, B, Brown, TS, Ismail, N, Omar, SV, Brust, JCM, Nelson, KN, Allana, S, Campbell, A, Mlisana, K, Moodley, P & Gandhi, NR 2018, 'Extensively drug-resistant tuberculosis in South Africa: genomic evidence supporting transmission in communities', The European respiratory journal, vol. 52, no. 4. https://doi.org/10.1183/13993003.00246-2018
Auld, Sara C. ; Shah, N. Sarita ; Mathema, Barun ; Brown, Tyler S. ; Ismail, Nazir ; Omar, Shaheed Vally ; Brust, James C.M. ; Nelson, Kristin N. ; Allana, Salim ; Campbell, Angela ; Mlisana, Koleka ; Moodley, Pravi ; Gandhi, Neel R. / Extensively drug-resistant tuberculosis in South Africa : genomic evidence supporting transmission in communities. In: The European respiratory journal. 2018 ; Vol. 52, No. 4.
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