Dataset Information

Armed conflict and population displacement as drivers of the evolution and dispersal of Mycobacterium tuberculosis.

ABSTRACT: The "Beijing" Mycobacterium tuberculosis (Mtb) lineage 2 (L2) is spreading globally and has been associated with accelerated disease progression and increased antibiotic resistance. Here we performed a phylodynamic reconstruction of one of the L2 sublineages, the central Asian clade (CAC), which has recently spread to western Europe. We find that recent historical events have contributed to the evolution and dispersal of the CAC. Our timing estimates indicate that the clade was likely introduced to Afghanistan during the 1979-1989 Soviet-Afghan war and spread further after population displacement in the wake of the American invasion in 2001. We also find that drug resistance mutations accumulated on a massive scale in Mtb isolates from former Soviet republics after the fall of the Soviet Union, a pattern that was not observed in CAC isolates from Afghanistan. Our results underscore the detrimental effects of political instability and population displacement on tuberculosis control and demonstrate the power of phylodynamic methods in exploring bacterial evolution in space and time.

SUBMITTER: Eldholm V

PROVIDER: S-EPMC5137683 | biostudies-literature | 2016 Nov

REPOSITORIES: biostudies-literature

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Armed conflict and population displacement as drivers of the evolution and dispersal of Mycobacterium tuberculosis.

Eldholm Vegard V Pettersson John H-O JH Brynildsrud Ola B OB Kitchen Andrew A Rasmussen Erik Michael EM Lillebaek Troels T Rønning Janne O JO Crudu Valeriu V Mengshoel Anne Torunn AT Debech Nadia N Alfsnes Kristian K Bohlin Jon J Pepperell Caitlin S CS Balloux Francois F

Proceedings of the National Academy of Sciences of the United States of America 20161121 48

The "Beijing" Mycobacterium tuberculosis (Mtb) lineage 2 (L2) is spreading globally and has been associated with accelerated disease progression and increased antibiotic resistance. Here we performed a phylodynamic reconstruction of one of the L2 sublineages, the central Asian clade (CAC), which has recently spread to western Europe. We find that recent historical events have contributed to the evolution and dispersal of the CAC. Our timing estimates indicate that the clade was likely introduced ...[more]

PMID: 27872285

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Project description:Background:South Sudan has endured decades of armed conflict, with the most recent in 2016. This has left the health system and infrastructure overstretched by a myriad of infectious diseases like tuberculosis. Our study aimed at quantitatively and qualitatively documenting TB dynamics and challenges with access to health care during a period of civil unrest in Wau. Materials & Methods:A cross sectional study was carried out between January and February 2016 at Wau Teaching Hospital (WTH). Sputum was randomly collected from 207 of the 1035?TB suspects and analyzed using Ziehl-Neelsen (ZN) and Fluorescent Microscopy (FM), Culture, Capilia MTBC Neo, and DST. The laboratory results and questionnaire metadata were used for descriptive statistics, logistic regression in R version 3.4.2. These results were presented along with results from a qualitative assessment of the situation at WTH. Results:Of 207?TB suspects, 39 (18.8%) were positive on FM with bacilli growth on culture, later confirmed as Mycobacterium tuberculosis complex. Only 5.4% of the cases were resistant to Isoniazid. Age; 20-45 OR?=?13 (95%CI?=?2.4-25.6, p?=?0.011),?>?46 OR?=?3 (95%CI?=?0.5-58, p?=?0.005) and raw milk consumption OR?=?2.2 (95%CI?=?0.37-42.48, p?=?0.005) were associated with being TB positive. The qualitative evaluation reveals that gunfights in the surroundings of Wau influenced the number of patients attending WTH, with some travelling up to 545?km to seek medical attention. Conclusion:We report a high prevalence of tuberculosis among patients who presented at WTH, with approximately 1 out of 5 individuals testing positive for tuberculosis. This is likely an underestimation given the challenges patients had to endure as they sought medical attention. Tuberculosis epidemiology is likely to be driven by individual and household factors, but further investigations are needed to fully understand the risk profile. The tools in use were adequate for TB diagnostics and we observed a remarkably low prevalence of drug resistance, a statistic that is worth preserving. We therefore call for action from all stakeholders.

Dataset Information

Armed conflict and population displacement as drivers of the evolution and dispersal of Mycobacterium tuberculosis.

Publications

Armed conflict and population displacement as drivers of the evolution and dispersal of Mycobacterium tuberculosis.

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