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Journal of Clinical Microbiology, January 2003, p. 67-72, Vol. 41, No. 1
0095-1137/03/$08.00+0     DOI: 10.1128/JCM.41.1.67-72.2003
Copyright © 2003, American Society for Microbiology. All Rights Reserved.

Deciphering an Outbreak of Drug-Resistant Mycobacterium tuberculosis

Ulf R. Dahle,1* Per Sandven,1 Einar Heldal,1 Turid Mannsaaker,2 and Dominique A. Caugant1

Norwegian Institute of Public Health, N-0403 Oslo,1 Ullevaal University Hospital, N-0407 Oslo, Norway2

Received 30 August 2002/ Returned for modification 2 October 2002/ Accepted 14 October 2002

There have been ample warnings that multidrug-resistant (MDR) tuberculosis (TB) will continue to emerge if countries do not strengthen their control of TB. In low-incidence European countries, however, these warnings have been substantiated mainly by outbreaks in association with human immunodeficiency virus (HIV)-positive patients. The aim of this study was to investigate an outbreak of infection with MDR and drug-resistant Mycobacterium tuberculosis that was diagnosed among 20 HIV-negative patients living in Norway. Of these, 19 were immigrants from East Africa and one was an ethnic Norwegian. We wanted to find out if transmission had taken place in Norway or abroad and to identify the genetic basis of drug resistance. The strains were analyzed by IS6110 restriction fragment length polymorphism, antibiotic susceptibility tests, spoligotyping, reverse hybridization to regions of the rpoB gene, and sequencing of the katG gene. Epidemiological links between the patients were mapped, and the strains were compared to those isolated in 36 other countries and regions. All strains were resistant to isoniazid and carried Ala234Gly, Ser315Thr, and Arg463Leu substitutions in the katG gene. Eleven strains were MDR and carried a Ser531Leu substitution in the rpoB gene. MDR was acquired in the index patient after arrival in Norway. Links were found among 14 patients. The strain was imported from Somalia but acquired MDR and was transmitted in Norway. This demonstrated that MDR strains are not necessarily imported from high-incidence countries and can be highly communicable. The outbreak underscores a deficiency in the TB control measures employed in many countries and challenges the adequacy of the policy of screening immigrants for TB only on arrival.

* Corresponding author. Mailing address: Division of Infectious Disease Control, Norwegian Institute of Public Health, P.O. Box 4404 Nydalen, N-0403 Oslo, Norway. Phone: (47) 22 04 23 65. Fax: (47) 22 04 25 18. E-mail: ulf.dahle{at}fhi.no.

Journal of Clinical Microbiology, January 2003, p. 67-72, Vol. 41, No. 1
0095-1137/03/$08.00+0     DOI: 10.1128/JCM.41.1.67-72.2003
Copyright © 2003, American Society for Microbiology. All Rights Reserved.



This article has been cited by other articles:

  • Dahle, U. R., Eldholm, V., Winje, B. A., Mannsaker, T., Heldal, E. (2007). Impact of Immigration on the Molecular Epidemiology of Mycobacterium tuberculosis in a Low-Incidence Country. Am. J. Respir. Crit. Care Med. 176: 930-935 [Abstract] [Full Text]  
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