Global variation in bacterial strains that cause tuberculosis disease: a systematic review and meta-analysis

BMC Medicine

Barun Mathema¹  Irfan Ullah²  Kirsten E Wiens³  Lauren P Woyczynski³  Natalia V Bhattacharjee³  Hmwe H Kyu³  Jorge R Ledesma³  Jennifer M Ross³  Molly H Biehl³  Simon I Hay³  Christopher J L Murray³  Nathaniel J Henry³  Sarah E Ray³  Robert C Reiner³  Roberto Zenteno-Cuevas⁴  Amador Goodridge⁵  Joel Fleury Djoba Siawaya⁶ 

[1] Department of Epidemiology, Mailman School of Public Health, Columbia University;Gomal Centre of Biochemistry and Biotechnology, Gomal University;Institute for Health Metrics and Evaluation, University of Washington;Public Health Institute, University of Veracruz;Tuberculosis Biomarker Research Unit, Instituto de Investigaciones Científicas y Servicios de Alta Tecnología (INDICASAT-AIP);Unité de Recherche et de Diagnostics Spécialisés, Laboratoire National de Santé Publique;

关键词: Tuberculosis;    Mycobacterium tuberculosis;    Genotype;    Genetic variation;    Epidemiology;    Molecular epidemiology;   

DOI  :  10.1186/s12916-018-1180-x

来源: DOAJ

【 摘 要 】

Abstract Background The host, microbial, and environmental factors that contribute to variation in tuberculosis (TB) disease are incompletely understood. Accumulating evidence suggests that one driver of geographic variation in TB disease is the local ecology of mycobacterial genotypes or strains, and there is a need for a comprehensive and systematic synthesis of these data. The objectives of this study were to (1) map the global distribution of genotypes that cause TB disease and (2) examine whether any epidemiologically relevant clinical characteristics were associated with those genotypes. Methods We performed a systematic review of PubMed and Scopus to create a comprehensive dataset of human TB molecular epidemiology studies that used representative sampling techniques. The methods were developed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). We extracted and synthesized data from studies that reported prevalence of bacterial genotypes and from studies that reported clinical characteristics associated with those genotypes. Results The results of this study are twofold. First, we identified 206 studies for inclusion in the study, representing over 200,000 bacterial isolates collected over 27 years in 85 countries. We mapped the genotypes and found that, consistent with previously published maps, Euro-American lineage 4 and East Asian lineage 2 strains are widespread, and West African lineages 5 and 6 strains are geographically restricted. Second, 30 studies also reported transmission chains and 4 reported treatment failure associated with genotypes. We performed a meta-analysis and found substantial heterogeneity across studies. However, based on the data available, we found that lineage 2 strains may be associated with increased risk of transmission chains, while lineages 5 and 6 strains may be associated with reduced risk, compared with lineage 4 strains. Conclusions This study provides the most comprehensive systematic analysis of the evidence for diversity in bacterial strains that cause TB disease. The results show both geographic and epidemiological differences between strains, which could inform our understanding of the global burden of TB. Our findings also highlight the challenges of collecting the clinical data required to inform TB diagnosis and treatment. We urge future national TB programs and research efforts to prioritize and reinforce clinical data collection in study designs and results dissemination.

【 授权许可】

Unknown