Molecular epidemiology of tuberculosis in Sicily, Italy: what has changed after a decade?

BMC Infectious Diseases

Caterina Mammina¹  Christophe Sola²  Anna Giammanco¹  Teresa Fasciana¹  Aurora Aleo¹  Guislaine Refrégier²  Michel K Gomgnimbou²  Celestino Bonura¹ 

[1] Department of Sciences for Health Promotion and Mother-Child Care “G. D’Alessandro”, University of Palermo, Palermo, Italy;CNRS-Université Paris-Sud, Institut de Génétique et Microbiologie, UMR8621, Infection Genetics Emerging Pathogen Evolution Team, Orsay, France

关键词: MIRU-VNTR;    Spoligotyping;    Epidemiology;    Sicily;    Tuberculosis;   

Others  :  1122001
DOI  :  10.1186/s12879-014-0602-4

 received in 2014-09-04, accepted in 2014-10-31,  发布年份 2014

【 摘 要 】

Background

We aimed to investigate the molecular epidemiology of Mycobacterium tuberculosis complex (MTBC) isolates in the province of Palermo, Sicily, Italy, by characterizing 183 isolates identified in the years 2004–2012. A comparison with 104 MTBC strains identified in the same geographic area in the years 1994–2000 was also carried out.

Methods

One hundred eighty-three MTBC isolates identified in Palermo, Italy, in the years 2004–2012 were analyzed by spoligotyping and the 24 mycobacterial interspersed repetitive unit (MIRU)-variable-number tandem-repeat (VNTR) method typing. Susceptibility testing to streptomycin, isoniazid, rifampin and ethambutol was also performed. Furthermore, the spoligotyping dataset obtained from 104 MTBC isolates identified from 1994 to 2000 was reanalyzed. Distribution into lineages and clustering of isolates in the two periods was compared.

Results

One hundred seventy-seven out of the 183 isolates of MTBC submitted to molecular typing were fully characterized. Of these, 108 were from Italian-born and 69 from foreign-born individuals. Eleven different lineages and 35 families-subfamilies were identified with the most represented lineages being Haarlem (26.5%), T (19.2%), LAM (13.6%) and S (8.5%). Except for the Haarlem lineage, where isolates from foreign-born patients were overrepresented, the distribution of isolates in the families belonging to the Euro-American clone reflected the proportions of the two subpopulations. A total of 27 (15.2%) strains were clustered and three clusters were mixed. Approximately 25% of the 183 MTBC isolates under study proved to be resistant to at least one antiTB drug, with only three isolates categorized as multidrug resistant (MDR). When MTBC isolates identified in the years 1994–2000 were reanalyzed, lineages T (30.8%), LAM (29.8%), Haarlem (16.3%) and S (13.5%) proved to be predominant. No MTBC isolates belonging to CAM, U, CAS, Turkish and Ural lineages were identified.

Conclusions

A wide heterogeneity was detected among the MTBC strains isolated in the years 2004–2012. Six lineages were not present among the isolates of the period 1994–2000. Comparison between distribution of lineages in the two consecutive periods depicts rapid and deep changes in the TB epidemiology in Palermo, Italy. An universal and continued laboratory-based surveillance of TB in Sicily is required.

【 授权许可】

   
2014 Bonura et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]Baussano I, Mercadante S, Pareek M, Lalvani A, Bugiani M: High rates of Mycobacterium tuberculosis among socially marginalized immigrants in low-incidence area, 1991–2010. Italy. Emerg Infect Dis 2013, 19(9):1437-1445.
• [2]Kamper-Jørgensen Z, Andersen AB, Kok-Jensen A, Kamper-Jørgensen M, Bygbjerg IC, Andersen PH, Thomsen VO, Lillebaek T: Migrant tuberculosis: the extent of transmission in a low burden country. BMC Infect Dis 2012, 12:60. BioMed Central Full Text
• [3]European Centre for Disease Prevention and Control/WHO Regional Office for Europe: Tuberculosis surveillance and monitoring in Europe 2014. Stockholm: European Centre for Disease Prevention and Control; 2014
• [4]Barniol J, Niemann S, Louis VR, Brodhun B, Dreweck C, Richter E, Becher H, Haas W, Junghanss T: Transmission dynamics of pulmonary tuberculosis between autochthonous and immigrant sub-populations. BMC Infect Dis 2009, 9:197. BioMed Central Full Text
• [5]Dahle UR, Eldholm V, Winje BA, Mannsåker T, Heldal E: Impact of immigration on the molecular epidemiology of Mycobacterium tuberculosis in a low-incidence country. Am J Respir Crit Care Med 2007, 176(9):930-935.
• [6]Garzelli C, Lari N, Cuccu B, Tortoli E, Rindi L: Impact of immigration on tuberculosis in a low-incidence area of Italy: a molecular epidemiological approach. Clin Microbiol Infect 2010, 16(11):1691-1697.
• [7]Fallico L, Couvin D, Peracchi M, Pascarella M, Franchin E, Lavezzo E, Rassu M, Manganelli R, Rastogi N, Palù G. Four year longitudinal study of Mycobacterium tuberculosis complex isolates in a region of North-Eastern Italy.Infect Genet Evol 2014, 26:58–64.
• [8]Sandgren A, Schepisi MS, Sotgiu G, Huitric E, Migliori GB, Manissero D, van der Werf MJ, Girardi E: Tuberculosis transmission between foreign- and native-born populations in the EU/EEA: a systematic review. Eur Respir J 2014, 43(4):1159-1171.
• [9][http://www.istat.it] webcite National Institute of Statistics (ISTAT). Italy in figures. 2013. At:
• [10]Centro Studi e Ricerche IDOS. Dossier statistico Immigrazione 2013. Rome: Edizioni IDOS; 2013
• [11][http://www.salute.gov.it/imgs/C_17_pubblicazioni_1472_allegato.pdf] webcite Ministero della Salute: La tubercolosi in Italia. Rapporto 2008. At:
• [12]Demay C, Liens B, Burguière T, Hill V, Couvin D, Millet J, Mokrousov I, Sola C, Zozio T, Rastogi N: SITVITWEB-a publicly available international multimarker database for studying Mycobacterium tuberculosis genetic diversity and molecular epidemiology. Infect Genet Evol 2012, 12(4):755-766.
• [13]Mathema B, Kurepina NE, Bifani PJ, Kreiswirth BN: Molecular epidemiology of tuberculosis: current insights. Clin Microbiol Rev 2006, 19(4):658-685.
• [14]Nastasi A, Mammina C: Epidemiological study of tuberculosis in Palermo, Italy: IS6110 fingerprinting of Mycobacterium tuberculosis strains isolated in the years 1994–1998. Infection 1999, 27(6):318-322.
• [15]Sola C, Ferdinand S, Mammina C, Nastasi A, Rastogi N: Genetic diversity of Mycobacterium tuberculosis in Sicily based on spoligotyping and variable number of tandem DNA repeats and comparison with a spoligotyping database for population-based analysis. J Clin Microbiol 2001, 39(4):1559-1565.
• [16]Zhang J, Abadia E, Refregier G, Tafaj S, Boschiroli ML, Guillard B, Andremont A, Ruimy R, Sola C: Mycobacterium tuberculosis complex CRISPR genotyping: improving efficiency, throughput and discriminative power of ‘spoligotyping’ with new spacers and a microbead-based hybridization assay. J Med Microbiol 2010, 59(Pt 3):285-294.
• [17]Tafaj S, Zhang J, Hauck Y, Pourcel C, Hafizi H, Zoraqi G, Sola C: First insight into genetic diversity of the Mycobacterium tuberculosis complex in Albania obtained by multilocus variable-number tandem-repeat analysis and spoligotyping reveals the presence of Beijing multidrug-resistant isolates. J Clin Microbiol 2009, 47:1581-1584.
• [18]Sarno S, Boattini A, Carta M, Ferri G, Alù M, Yao DY, Ciani G, Pettener D, Luiselli D: An ancient mediterranean melting pot: investigating the uniparental genetic structure and population history of Sicily and southern Italy. PLoS One 2014, 9(4):e96074.
• [19]The European Union Summary Report on Trends and Sources of Zoonoses, Zoonotic Agents and Food-borne Outbreaks in the European Union in 2010.EFSA J 2012, 10(3):2597.