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Journal of Clinical Microbiology, May 2002, p. 1636-1643, Vol. 40, No. 5
0095-1137/02/$04.00+0     DOI: 10.1128/JCM.40.5.1636-1643.2002
Copyright © 2002, American Society for Microbiology. All Rights Reserved.

Molecular Epidemiology and Drug Resistance of Mycobacterium tuberculosis Isolates from Ethiopian Pulmonary Tuberculosis Patients with and without Human Immunodeficiency Virus Infection

Judith Bruchfeld,^1* Getachew Aderaye,² Ingela Berggren Palme,¹ Bjarne Bjorvatn,³ Solomon Ghebremichael,⁴ Sven Hoffner,⁴ and Lars Lindquist¹

Division of Infectious Diseases, Institution of Medicine, Karolinska Institute, Huddinge University Hospital, 141 86 Stockholm,¹ Department of Bacteriology, Swedish Institute for Infectious Disease Control, 171 82 Solna, Sweden,⁴ Department of Internal Medicine, Faculty of Medicine, Black Lion University Hospital, Addis Ababa, Ethiopia,² Department of Microbiology and Immunology, The Gade Institute, Haukeland University Hospital, 5021 Bergen, Norway³

Received 21 November 2001/ Returned for modification 14 January 2002/ Accepted 12 February 2002

We have analyzed the molecular epidemiology and drug resistance of 121 Mycobacterium tuberculosis isolates from consecutive patients with culture-positive pulmonary tuberculosis attending a university hospital outpatient department in Addis Ababa, Ethiopia. Restriction fragment length polymorphism analysis and spoligotyping were used to analyze the DNA fingerprinting patterns. Fifty-one (41.2%) of the isolates were found in 13 clusters with two or more identical DNA patterns. Two such clusters contained 49.0% of all clustered isolates. In a multivariate logistic regression model, human immunodeficiency virus (HIV)-positive serostatus was significantly associated with clustering of isolates for patients of both sexes (odds ratio [OR], 2.55; 95% confidence interval [CI], 1.17 to 5.80). There was a trend toward increased clustering of isolates from tuberculous women residing in Addis Ababa (OR, 2.10; 95% CI, 0.85 to 5.25). In total, 17 of 121 isolates (14.0%) were resistant to one or more of the antituberculosis drugs isoniazid (8.3%), streptomycin (7.4%), rifampin (2.5%), and ethambutol (1.7%). The high rate of drug-resistant isolates (29.6%) coincided with the peak prevalence of HIV infection (77.8%) in patients 35 to 44 years old. The majority (62.5%) of resistant isolates in this group were found within clusters. The simultaneous accumulation of certain bacterial clones in a patient population likely reflects recent transmission. Hence, we conclude that tuberculosis is commonly caused by recent infection with M. tuberculosis in HIV-positive Ethiopian patients. Furthermore, with the rapidly increasing prevalence of HIV infection in Ethiopia, the burden of tuberculosis, including drug-resistant tuberculosis, is likely to increase. Strengthening of classical tuberculosis control measures by promoting active case finding among HIV-positive adults with tuberculosis is warranted to reduce rates of transmission.

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* Corresponding author. Mailing address: Dept. of Infectious Diseases, I 73, Huddinge University Hospital, 141 86 Huddinge, Sweden. Phone: 0046-8-58581933. Fax: 0046-8-58581916. E-mail: Judith.Bruchfeld{at}medhs.ki.se.

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Journal of Clinical Microbiology, May 2002, p. 1636-1643, Vol. 40, No. 5
0095-1137/02/$04.00+0     DOI: 10.1128/JCM.40.5.1636-1643.2002
Copyright © 2002, American Society for Microbiology. All Rights Reserved.

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