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Journal of Clinical Microbiology, July 2003, p. 2878-2883, Vol. 41, No. 7
0095-1137/03/$08.00+0     DOI: 10.1128/JCM.41.7.2878-2883.2003
Copyright © 2003, American Society for Microbiology. All Rights Reserved.

Widespread Pyrazinamide-Resistant Mycobacterium tuberculosis Family in a Low-Incidence Setting

Department of Medicine,¹ Research Institute, McGill University Health Centre,² Department of Epidemiology and Biostatistics,³ Department of Geography,⁵ Respiratory Epidemiology Unit, McGill University,⁶ Laboratoire de Santé Publique du Québec, Montreal, Quebec, Canada⁴

Received 7 January 2003/ Returned for modification 3 March 2003/ Accepted 27 March 2003

An unusually high prevalence of pyrazinamide (PZA) monoresistance in Mycobacterium tuberculosis has been observed in Quebec. In the absence of a recognized outbreak, we hypothesized that these isolates most likely represented reactivation of an old endemic strain in this low-incidence area. A case-control study of 77 PZA-resistant isolates with a specific Quebec mutation and 253 PZA-susceptible control M. tuberculosis isolates was undertaken. By molecular analysis, all 77 case isolates shared a unique mutation profile in the pncA gene which was not present in control isolates. While control isolates manifested diverse IS6110 restriction fragment length polymorphism (RFLP) patterns, spoligotypes, and major genetic groups, case isolates had similar but nonidentical IS6110 RFLP patterns, had common spoligotypes, and were confined to one major genetic group, suggesting a common clonal ancestor. By epidemiologic and geographic analyses, however, there were no significant differences between the cases and the controls. We conclude that a clonally related family of PZA-monoresistant M. tuberculosis isolates in Quebec represents historic rather than recent transmission.

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