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PLoS One. 2017 Sep 19;12(9):e0184510. doi: 10.1371/journal.pone.0184510. eCollection 2017.

Whole-genome sequencing illuminates the evolution and spread of multidrug-resistant tuberculosis in Southwest Nigeria.

Author information

1
Vaccines and Immunity Theme, Medical Research Council Unit The Gambia, Fajara, The Gambia.
2
Microbiology and Infection Unit, The University of Warwick, Coventry, United Kingdom.
3
Institute of Infection and Immunity, St George's University of London, London, United Kingdom.
4
Institute of Tropical Medicine, Antwerp, Belgium.
5
Department of Medical Microbiology & Parasitology, University College Hospital, Ibadan, Nigeria.
6
National Tuberculosis Reference Laboratory, Nigeria Institute of Medical Research, Lagos, Nigeria.
7
Quadram Institute, Norwich Research Park, Norwich, Norfolk, NR4 7UA.
8
Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom.

Abstract

Nigeria has an emerging problem with multidrug-resistant tuberculosis (MDR-TB). Whole-genome sequencing was used to understand the epidemiology of tuberculosis and genetics of multi-drug resistance among patients from two tertiary referral centers in Southwest Nigeria. In line with previous molecular epidemiology studies, most isolates of Mycobacterium tuberculosis from this dataset belonged to the Cameroon clade within the Euro-American lineage. Phylogenetic analysis showed this clade was undergoing clonal expansion in this region, and suggests that it was involved in community transmission of sensitive and multidrug-resistant tuberculosis. Five patients enrolled for retreatment were infected with pre-extensively drug resistant (pre-XDR) due to fluoroquinolone resistance in isolates from the Cameroon clade. In all five cases resistance was conferred through a mutation in the gyrA gene. In some patients, genomic changes occurred in bacterial isolates during the course of treatment that potentially led to decreased drug susceptibility. We conclude that inter-patient transmission of resistant isolates, principally from the Cameroon clade, contributes to the spread of MDR-TB in this setting, underscoring the urgent need to curb the spread of multi-drug resistance in this region.

PMID:
28926571
PMCID:
PMC5604961
DOI:
10.1371/journal.pone.0184510
[Indexed for MEDLINE]
Free PMC Article

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