In this study, we analyzed the M. tuberculosis complex (MTBc) population structure among multidrug-resistant TB (MDR-TB) patients in Niger and tested whether the Cameroon family displayed a slower response to MDR-TB treatment. We genotyped baseline clinical isolates that had been collected from pulmonary MDR-TB patients recruited consecutively between 2008 and 2016 in Niger. Spoligotyping was used to analyze the genetic diversity of mycobacterial lineages, and Kaplan Meier's analysis to compare treatment outcomes. A total of 222 MTBc isolates were genotyped; 204 (91,9%) were identified as the Euro-American L4 lineage, with the Ghana family (106, 47,4%) and the Cameroon family (63, 28,4%) being predominant. Patients infected by Cameroon family isolates 61(96,8%) showed faster conversion (log-rank p < 0.01) than those infected with Ghana family isolates (91,5%), and were more likely to experience favorable outcome (adjusted odds ratio [aOR] 4.4; 95%CI 1.1-17.9]; p = 0.015). We found no association between MTBc families and second-line drug resistance profiles (p > 0.05). Our findings show that MDR-TB in Niger is caused by major spoligotypes of the Euro-American L4; with more rapid smear and culture conversion in patients infected with the Cameroon family. These first insights may alert clinicians that slow conversion may be associated with the type of infecting strain.

译文

:在这项研究中,我们分析了尼日尔耐多药结核病(MDR-TB)患者中的结核分枝杆菌复合群(MTBc)人口结构,并测试了喀麦隆家族对MDR-TB治疗的反应是否较慢。我们对从2008年至2016年在尼日尔连续招募的肺部MDR-TB患者收集的基线临床分离株进行了基因分型。 Spoligotyping用于分析分枝杆菌谱系的遗传多样性,Kaplan Meier的分析用于比较治疗效果。总共对222种MTBc分离株进行了基因分型。欧裔美国人L4血统为204(91,9%),其中加纳(106,47,4%)和喀麦隆(63,28.4%)家族为主要血统。被喀麦隆家族分离株61(96,8%)感染的患者显示出比被加纳家族分离株(91,5%)感染的患者更快的转化(log-rank p <0.01),并且更有可能获得有利的结局(调整后的优势比) [aOR] 4.4; 95%CI 1.1-17.9]; p = 0.015)。我们发现MTBc家族与二线耐药性谱之间无关联(p> 0.05)。我们的研究结果表明,尼日尔的耐多药结核病是由欧美L4的主要嗜血型引起的。感染喀麦隆家庭的患者的涂片和培养转换速度更快。这些最初的见解可能会提醒临床医生,转换缓慢可能与感染株的类型有关。

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