Endogenous relapse and exogenous reinfection in recurrent pulmonary tuberculosis: A retrospective study revealed by whole genome sequencing

Frontiers in Microbiology

Microbiology

Yunhong Tan¹  Binbin Liu¹  Huiwen Zheng²  Zexuan Song³  Wencong He³  Yiting Wang³  Ping He³  Bing Zhao⁴  Aijing Ma⁴  Shengfen Wang⁴  Xiaolong Cao⁴  Hui Xia⁴  Fei Huang⁴  Yanlin Zhao⁴  Xichao Ou⁴  Chunfa Liu⁴  Shaojun Pei⁵  Dongxin Liu⁶ 

[1] Hunan Provincial Chest Hospital, Tuberculosis Control Institution of Hunan Province, Changsha, Hunan, China;Laboratory of Respiratory Diseases, Beijing Key Laboratory of Pediatric Respiratory Infection Diseases, Beijing Pediatric Research Institute, Beijing Children’s Hospital, Capital Medical University, Beijing, China;National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China;National Tuberculosis Reference Laboratory, Chinese Center for Disease Control and Prevention, Beijing, China;School of Public Health, Peking University, Beijing, China;Shenzhen Third People’s Hospital, Shenzhen, China;

关键词: tuberculosis;    recurrence;    relapse;    reinfection;    whole genome sequencing;   

DOI  :  10.3389/fmicb.2023.1115295

 received in 2022-12-06, accepted in 2023-02-02,  发布年份 2023

来源: Frontiers

【 摘 要 】

BackgroundTuberculosis may reoccur due to reinfection or relapse after initially successful treatment. Distinguishing the cause of TB recurrence is crucial to guide TB control and treatment. This study aimed to investigate the source of TB recurrence and risk factors related to relapse in Hunan province, a high TB burden region in southern China.MethodsA population-based retrospective study was conducted on all culture-positive TB cases in Hunan province, China from 2013 to 2020. Phenotypic drug susceptibility testing and whole-genome sequencing were used to detect drug resistance and distinguish between relapse and reinfection. Pearson chi-square test and Fisher exact test were applied to compare differences in categorical variables between relapse and reinfection. The Kaplan–Meier curve was generated in R studio (4.0.4) to describe and compare the time to recurrence between different groups. p < 0.05 was considered statistically significant.ResultsOf 36 recurrent events, 27 (75.0%, 27/36) paired isolates were caused by relapse, and reinfection accounted for 25.0% (9/36) of recurrent cases. No significant difference in characteristics was observed between relapse and reinfection (all p > 0.05). In addition, TB relapse occurs earlier in patients of Tu ethnicity compared to patients of Han ethnicity (p < 0.0001), whereas no significant differences in the time interval to relapse were noted in other groups. Moreover, 83.3% (30/36) of TB recurrence occurred within 3 years. Overall, these recurrent TB isolates were predominantly pan-susceptible strains (71.0%, 49/69), followed by DR-TB (17.4%, 12/69) and MDR-TB (11.6%, 8/69), with mutations mainly in codon 450 of the rpoB gene and codon 315 of the katG gene. 11.1% (3/27) of relapse cases had acquired new resistance during treatment, with fluoroquinolone resistance occurring most frequently (7.4%, 2/27), both with mutations in codon 94 of gyrA.ConclusionEndogenous relapse is the main mechanism leading to TB recurrences in Hunan province. Given that TB recurrences can occur more than 4 years after treatment completion, it is necessary to extend the post-treatment follow-up period to achieve better management of TB patients. Moreover, the relatively high frequency of fluoroquinolone resistance in the second episode of relapse suggests that fluoroquinolones should be used with caution when treating TB cases with relapse, preferably guided by DST results.

【 授权许可】

Unknown   
Copyright © 2023 He, Tan, Song, Liu, Wang, He, Xia, Huang, Liu, Zheng, Pei, Liu, Ma, Cao, Zhao, Ou, Wang and Zhao.