Extensively drug-resistant tuberculosis in Myanmar

Burden and mutations causing second-line drug resistance

P. W. Ei, W. W. Aung, W. W. Nyunt, T. L. Swe, M. M. Htwe, S. M. Win, S. T. Aung, C. L. Chang, Hyeyoung Lee, J. S. Lee

Research output: Contribution to journalArticle

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Abstract

Setting: Two tuberculosis (TB) reference laboratories in Myanmar. Objectives: To determine the proportion of extensively drug-resistant TB (XDR-TB) cases among multidrug-resistant TB (MDR-TB) cases and the mutations that cause resistance to second-line drugs in Myanmar. Design: This was a cross-sectional, retrospective study. Multidrug-resistant Mycobacterium tuberculosis isolates were collected during 2015-2016. Phenotypic drug susceptibility testing (DST) was performed and drugresistant mutations identified by sequencing. Genotypes were determined to explain relationships between drug resistance patterns and genotypes. Rwsults: Of 89 MDR-TB isolates, 12 were XDR-TB and 24 were pre-XDR-TB, with 21 resistant to fluoroquinolones (FQs) and 3 to second-line injectable agents (SLIDs). High rates of cross-resistance among second-line drugs were observed. Correlations between phenotypic and molecular DST against FQs and SLIDs were 91% in both cases. The most frequent mutation in FQ-resistant isolates was D94G (8/21) in gyrA and A1401G (11/15) in rrs in those resistant to SLIDs. The dominant genotype was the Beijing type (76/89). Conclusion: There were high proportions of XDRTB and pre-XDR-TB among MDR-TB cases; crossresistance among second-line drugs was high, with various types of genetic mutations. These data suggest that resistance to second-line anti-tuberculosis drugs should be monitored intensively, and molecular DST should be employed.

Original languageEnglish
Pages (from-to)47-53
Number of pages7
JournalInternational Journal of Tuberculosis and Lung Disease
Volume22
Issue number1
DOIs
Publication statusPublished - 2018 Jan 1

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Extensively Drug-Resistant Tuberculosis
Myanmar
Drug Resistance
Mutation
Tuberculosis
Multidrug-Resistant Tuberculosis
Fluoroquinolones
Pharmaceutical Preparations
Genotype
Mycobacterium tuberculosis
Retrospective Studies
Cross-Sectional Studies
Injections

All Science Journal Classification (ASJC) codes

  • Pulmonary and Respiratory Medicine
  • Infectious Diseases

Cite this

Ei, P. W. ; Aung, W. W. ; Nyunt, W. W. ; Swe, T. L. ; Htwe, M. M. ; Win, S. M. ; Aung, S. T. ; Chang, C. L. ; Lee, Hyeyoung ; Lee, J. S. / Extensively drug-resistant tuberculosis in Myanmar : Burden and mutations causing second-line drug resistance. In: International Journal of Tuberculosis and Lung Disease. 2018 ; Vol. 22, No. 1. pp. 47-53.
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abstract = "Setting: Two tuberculosis (TB) reference laboratories in Myanmar. Objectives: To determine the proportion of extensively drug-resistant TB (XDR-TB) cases among multidrug-resistant TB (MDR-TB) cases and the mutations that cause resistance to second-line drugs in Myanmar. Design: This was a cross-sectional, retrospective study. Multidrug-resistant Mycobacterium tuberculosis isolates were collected during 2015-2016. Phenotypic drug susceptibility testing (DST) was performed and drugresistant mutations identified by sequencing. Genotypes were determined to explain relationships between drug resistance patterns and genotypes. Rwsults: Of 89 MDR-TB isolates, 12 were XDR-TB and 24 were pre-XDR-TB, with 21 resistant to fluoroquinolones (FQs) and 3 to second-line injectable agents (SLIDs). High rates of cross-resistance among second-line drugs were observed. Correlations between phenotypic and molecular DST against FQs and SLIDs were 91{\%} in both cases. The most frequent mutation in FQ-resistant isolates was D94G (8/21) in gyrA and A1401G (11/15) in rrs in those resistant to SLIDs. The dominant genotype was the Beijing type (76/89). Conclusion: There were high proportions of XDRTB and pre-XDR-TB among MDR-TB cases; crossresistance among second-line drugs was high, with various types of genetic mutations. These data suggest that resistance to second-line anti-tuberculosis drugs should be monitored intensively, and molecular DST should be employed.",
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Extensively drug-resistant tuberculosis in Myanmar : Burden and mutations causing second-line drug resistance. / Ei, P. W.; Aung, W. W.; Nyunt, W. W.; Swe, T. L.; Htwe, M. M.; Win, S. M.; Aung, S. T.; Chang, C. L.; Lee, Hyeyoung; Lee, J. S.

In: International Journal of Tuberculosis and Lung Disease, Vol. 22, No. 1, 01.01.2018, p. 47-53.

Research output: Contribution to journalArticle

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T1 - Extensively drug-resistant tuberculosis in Myanmar

T2 - Burden and mutations causing second-line drug resistance

AU - Ei, P. W.

AU - Aung, W. W.

AU - Nyunt, W. W.

AU - Swe, T. L.

AU - Htwe, M. M.

AU - Win, S. M.

AU - Aung, S. T.

AU - Chang, C. L.

AU - Lee, Hyeyoung

AU - Lee, J. S.

PY - 2018/1/1

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N2 - Setting: Two tuberculosis (TB) reference laboratories in Myanmar. Objectives: To determine the proportion of extensively drug-resistant TB (XDR-TB) cases among multidrug-resistant TB (MDR-TB) cases and the mutations that cause resistance to second-line drugs in Myanmar. Design: This was a cross-sectional, retrospective study. Multidrug-resistant Mycobacterium tuberculosis isolates were collected during 2015-2016. Phenotypic drug susceptibility testing (DST) was performed and drugresistant mutations identified by sequencing. Genotypes were determined to explain relationships between drug resistance patterns and genotypes. Rwsults: Of 89 MDR-TB isolates, 12 were XDR-TB and 24 were pre-XDR-TB, with 21 resistant to fluoroquinolones (FQs) and 3 to second-line injectable agents (SLIDs). High rates of cross-resistance among second-line drugs were observed. Correlations between phenotypic and molecular DST against FQs and SLIDs were 91% in both cases. The most frequent mutation in FQ-resistant isolates was D94G (8/21) in gyrA and A1401G (11/15) in rrs in those resistant to SLIDs. The dominant genotype was the Beijing type (76/89). Conclusion: There were high proportions of XDRTB and pre-XDR-TB among MDR-TB cases; crossresistance among second-line drugs was high, with various types of genetic mutations. These data suggest that resistance to second-line anti-tuberculosis drugs should be monitored intensively, and molecular DST should be employed.

AB - Setting: Two tuberculosis (TB) reference laboratories in Myanmar. Objectives: To determine the proportion of extensively drug-resistant TB (XDR-TB) cases among multidrug-resistant TB (MDR-TB) cases and the mutations that cause resistance to second-line drugs in Myanmar. Design: This was a cross-sectional, retrospective study. Multidrug-resistant Mycobacterium tuberculosis isolates were collected during 2015-2016. Phenotypic drug susceptibility testing (DST) was performed and drugresistant mutations identified by sequencing. Genotypes were determined to explain relationships between drug resistance patterns and genotypes. Rwsults: Of 89 MDR-TB isolates, 12 were XDR-TB and 24 were pre-XDR-TB, with 21 resistant to fluoroquinolones (FQs) and 3 to second-line injectable agents (SLIDs). High rates of cross-resistance among second-line drugs were observed. Correlations between phenotypic and molecular DST against FQs and SLIDs were 91% in both cases. The most frequent mutation in FQ-resistant isolates was D94G (8/21) in gyrA and A1401G (11/15) in rrs in those resistant to SLIDs. The dominant genotype was the Beijing type (76/89). Conclusion: There were high proportions of XDRTB and pre-XDR-TB among MDR-TB cases; crossresistance among second-line drugs was high, with various types of genetic mutations. These data suggest that resistance to second-line anti-tuberculosis drugs should be monitored intensively, and molecular DST should be employed.

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