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Journal of Clinical Microbiology, August 2007, p. 2467-2473, Vol. 45, No. 8
0095-1137/07/$08.00+0     doi:10.1128/JCM.02293-06
Copyright © 2007, American Society for Microbiology. All Rights Reserved.

First Insight into the Population Structure of Mycobacterium tuberculosis in Saudi Arabia{triangledown} ,{dagger}

Sahal A. M. Al-Hajoj,1* Thierry Zozio,2 Fahad Al-Rabiah,3 Viquar Mohammad,1 Maryam Al-Nasser,1 Christophe Sola,2,{ddagger} and Nalin Rastogi2*

Departments of Comparative Medicine and Medicine, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia,1 Unité de la Tuberculose et des Mycobactéries, Institut Pasteur de Guadeloupe, Abymes, Guadeloupe2

Received 12 November 2006/ Returned for modification 1 January 2007/ Accepted 7 May 2007

This study constitutes a first attempt to describe the genetic population structure and drug resistance of the tubercle bacilli circulating in Saudi Arabia. A total of 1,505 clinical isolates of M. tuberculosis, isolated between 2002 and 2005 from seven regions of Saudi Arabia, were studied. The sample studied showed a male-to-female sex ratio of 1.27, with half of the cases among foreign-born individuals and 47% within the 21- to 40-year-old age group; a total resistance rate of 19.7%; and multiple drug resistance of 4.5%. Upon spoligotyping, a total of 387 individual patterns were obtained (clustering rate, 86.4%; 182 clusters containing between 2 and 130 isolates per cluster). A total of 94% of the strains matched the spoligotype patterns in an international database. Nearly 81% of the isolates in this study belonged to established phylogeographic clades: Central Asian (CAS), 22.5%; ill-defined T clade, 19.5%; East African-Indian (EAI), 13.5%; Haarlem, 7.5%; Latin American-Mediterranean, 7.2%; Beijing, 4.4%; Manu, 2.7%; X, 0.9%; and Bovis, 0.9%. Two clonal complexes with unique spoligotyping signatures (octal codes 703777707770371 and 467777377413771) specific to Saudi Arabia were identified. These belonged to the CAS and EAI clades, respectively, as confirmed upon secondary typing using mycobacterial interspersed repetitive units (MIRUs). The results obtained underline the predominance of historic clones of principal genetic group 1, which are responsible for roughly 45% of all tuberculosis cases in Saudi Arabia. The high rate of clustering observed might be an indication of rapid ongoing transmission within certain communities and/or subpopulations in Saudi Arabia; nonetheless, spoligotyping is known to overestimate clustering, and only a systematic second-line typing, such as MIRUs, coupled with a better tuberculosis registry and epidemiological investigations would allow us to know the exact rate of ongoing transmission and associated risk factors in Saudi Arabia.

* Corresponding author. Mailing address for Sahal Al-Hajoj: Department of Comparative Medicine, King Faisal Specialist Hospital and Research Center (MBC 03), PO Box 3354, Riyadh 11211, Saudi Arabia. Phone: 966 (1) 4424992. Fax: 966 (1) 4427872. E-mail: hajoj{at}kfshrc.edu.sa. Mailing address for Nalin Rastogi: Institut Pasteur de Guadeloupe, BP484, 97183 Abymes, Guadeloupe. Phone: 590-590-897661. Fax: 590-590-893880. E-mail: nrastogi{at}pasteur-guadeloupe.fr

{triangledown} Published ahead of print on 16 May 2007.

{dagger} Supplemental material for this article may be found at http://jcm.asm.org.

{ddagger} Present address: Unité de Recherche de Génétique Mycobactérienne, Institut Pasteur, 25 Rue du Dr Roux, 75724 Paris, Cedex 15, France.

Journal of Clinical Microbiology, August 2007, p. 2467-2473, Vol. 45, No. 8
0095-1137/07/$08.00+0     doi:10.1128/JCM.02293-06
Copyright © 2007, American Society for Microbiology. All Rights Reserved.



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