Use of genotyping based clustering to quantify recent tuberculosis transmission in Guadeloupe during a seven years period: analysis of risk factors and access to health care

BMC Infectious Diseases

Nalin Rastogi⁵  Max Théodore²  Maryse Levy²  Pascal Chaud⁴  Sylvie Cassadou¹  Annick Accipe²  Julie Millet⁵  Séverine Ferdinand³ 

[1] CIRE Antilles-Guyane –InVS, Gourbeyre, Guadeloupe, France;Direction des Actions de Solidarité Départementale, Conseil Général de la Guadeloupe, Basse-Terre, Guadeloupe, France;Observatoire Régional de la Santé de la Guadeloupe, Basse-Terre, Guadeloupe, France;CIRE Antilles-Guyane –InVS, Fort de France, Martinique, France;WHO Supranational TB Reference Laboratory, Institut Pasteur de la Guadeloupe, Abymes, Guadeloupe, France

关键词: Drug-resistance;    Database;    Exact-Tandem-Repeats;    Spoligotyping;    Genotyping;    Guadeloupe;    Transmission;    Tuberculosis;    Mycobacterium;   

Others  :  1146502
DOI  :  10.1186/1471-2334-13-364

 received in 2013-04-29, accepted in 2013-07-17,  发布年份 2013

【 摘 要 】

Background

The present study aimed to characterize Mycobacterium tuberculosis population structure and to identify transmission chains and risk factors by prospective molecular typing in conjunction with conventional epidemiological investigations in the French overseas department of Guadeloupe.

Methods

The study included all the culture-positive TB cases (1 clinical isolate per patient; n = 129) diagnosed between a seven year period (April 4^th, 1999 to December 31^st, 2005). Prospective molecular typing was performed using spoligotyping and VNTRs, and a subset of 44 M. tuberculosis isolates found to be clustered was retrospectively typed using 12-loci MIRUs. Data were compared using the SITVIT2 database, followed by analysis of risk factors in function of clustering of the isolates and available demographic and socioeconomic data.

Results

The study sample was characterized by a majority of new cases (87.4%); a moderate proportion of drug-resistance (7.8%); a high level of immigration (51.2% foreign-born) originating from high TB/HIV incidence neighboring islands such as Haiti or Dominican Republic; lower socioeconomic conditions (70.7% of jobless, average income 824 EUR/month); and a significantly higher proportion of TB/HIV co-infected cases (38.2% vs. 8.5%; p < 0.001), and extrapulmonary disease (18.2% vs. 4.8%; p < 0.02) among migrants as compared to French patients. The study revealed an important delay in access to healthcare with a median delay of 74.5 days between the 1st symptoms and clinical suspicion of TB. Prospective molecular typing based on spoligotyping and 5-loci VNTRs showed that evolutionary recent Euro-American lineages predominated in Guadeloupe (91.5% of isolates). In conjunction with epidemiological data, it allowed to estimate a recent transmission rate of 18.6%, which was close to the rate of 16.7% estimated using retrospective 12-loci MIRU typing. Although a higher proportion of cases in older age-group were apparently linked to reactivation; univariate analysis of risk factors did not allow pinpointing specific risk factors for a patient to belong to a TB transmission group.

Conclusions

Ongoing TB transmission in the insular, low TB-incidence setting of Guadeloupe can be defined as follows: (i) a significant proportion of imported cases of the disease from neighboring islands; (ii) significantly higher TB/HIV coinfection among foreign-born cases; and, (iii) a higher proportion of cases affecting older age-group among French patients due to reactivation. This study emphasizes the need for universal typing using spoligotyping and 15-loci MIRUs in prospective studies.

【 授权许可】

   
2013 Ferdinand et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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