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Clustering and recent transmission of Mycobacterium tuberculosis in a Chinese population

机译：结核分枝杆菌在中国人群中的聚集和近期传播

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Purpose: The objectives of the present study were to characterize the clinical isolates prevailing in the northeast of Jiangsu and to investigate the mode of transmission. The study also aimed to explore the extent to which Mycobacterium tuberculosis strains contributed to drug resistance and the possible factors related to the recent transmission. Patients and methods: We consecutively enrolled 912 culture-confirmed pulmonary tuberculosis (TB) cases from 1 January 2013 to 31 December 2014 in Lianyungang City, which is located in the center of China’s vast ocean area and the northeast of Jiangsu province. Isolates were genotyped using 15-locus mycobacterial interspersed repetitive unit-variable number tandem repeat (MIRU-VNTR) typing. The Hunter–Gaston discrimination index (HGDI) was used to estimate the discriminatory power and diversity of molecular markers. Results: Among 741 successfully genotyped isolates, 144 (19.43%) strains formed 46 clusters, while 597 (80.57%) isolates had the unique MIRU pattern. The total HGDI for all 15 loci was 0.999. The average cluster size was 3 (2–13) patients. The estimated proportion of recent transmission was 13.34%. Patients with unfavorable treatment outcomes were infected with clustered strains at a higher proportion than were those with favorable treatment outcomes (adjusted OR: 1.78, 95% CI: 1.14–2.85, P =0.012). Conclusion: The probability of recent TB transmission was relatively low in the study site, while the cases mainly arose from the activation of previous infection. Spatial analysis showed that strains forming larger clusters had the characteristics of regional aggregation.
机译：目的：本研究的目的是鉴定江苏东北部流行的临床分离株，并研究其传播方式。该研究还旨在探讨结核分枝杆菌菌株在多大程度上促进了耐药性以及与近期传播有关的可能因素。患者和方法：2013年1月1日至2014年12月31日，我们在中国大洋洲中部，江苏省东北部的连云港市，共纳入912例经培养证实的肺结核（TB）病例。使用15个位点的分枝杆菌重复单元可变数串联重复序列（MIRU-VNTR）分型对分离株进行基因分型。使用Hunter-Gaston鉴别指数（HGDI）来评估分子标记物的鉴别力和多样性。结果：在741个成功的基因分型菌株中，有144个（19.43％）菌株形成了46个簇，而597个（80.57％）菌株则具有独特的MIRU模式。所有15个基因座的总HGDI为0.999。平均簇大小为3（2-13）名患者。估计最近传播的比例为13.34％。治疗结果不良的患者感染簇状菌株的比例要高于治疗结果良好的患者（校正后OR：1.78，95％CI：1.14–2.85，P = 0.012）。结论：研究地点近期结核病传播的可能性相对较低，而病例主要是由先前感染的激活引起的。空间分析表明，形成较大簇的菌株具有区域聚集的特征。

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