1000. Genotyping Informs Tuberculosis Epidemiology, Clinical Characteristics, and Cluster Identification in Philadelphia and Surrounding Regions
Session: Poster Abstract Session: Clinical Studies of Tuberculosis
Saturday, October 22, 2011
Room: Poster Hall B1

Background: Tuberculosis Genotyping Information Management System (TB GIMS) is a new national centralized database of MTB genotypes (GT).  Molecular analyses range from large sequence polymorphisms (lineage definition) to differences in single nucleotides and interspersed repeating units (spoligotyping & MIRU analyses).  Some evidence suggests genotype may correlate with disease phenotype, especially extrapulmonary TB or strain virulence.

Methods: Pennsylvania (PA) data for 3 highest-risk health districts from 2005 - mid 2010 were extracted from TB GIMS (GT cases) and linked to data from PA Notifiable Electronic Surveillance System.  Descriptive analysis was performed on isolate and patient data for GT cases.

Results: There were 1074 culture-confirmed cases.  Genotyping was performed on 60% (n = 638) and linked to patient-level data; 46% are US born (USB), 52% are foreign born (FB).  Lineages of FB cases are more diverse (Fig); EuroAmerican (EuroAmer) lineage accounts for 86% of USB and 41% of FB.  FB account for the majority of IndoOceanic, East Asian, East African Indian, and Africanum lineages (85%, 80%, 96%, 100% resp).  For GT cases there are 259 spoligotypes and 492 PCR types (spoligotyping + MIRU).  Overall there are 114 unique PA clusters (≥2 with same PCR type).  Six clusters have >5 cases each; of the largest cluster (n=30, East Asian lineage) 67% are FB.  Two clusters have only USB.

Of GT cases, pulmonary (pulm) account for 81% (n=498) and extrapulmonary (extrapulm) 19% (n=140).  Of pulm cases, 52% are USB, 61% are FB.  In USB extrapulm cases, only 15% are non-EuroAmer; however in FB extrapulm cases, no single lineage accounts for >31% of cases.  The most common extrapulm sites are cervical lymph node (cerv LN, n=43, 81% FB) and bone (n=23, 52% FB).  Of cerv LN cases, there is spoligotype grouping (27 unique) but no PCR type clustering despite 49% of cases from only 2 countries.  Within pulm cases, there are 155 spoligotypes and 356 PCR types.


Conclusion: FB cases have greater lineage diversity than USB for pulm and especially extrapulm cases.  Future epidemiologic and molecular cluster analyses are needed to determine how genotyping could best serve to enhance TB control efforts and provide insight into linking disease phenotypes and genotypes.

 


Subject Category: C. Clinical studies of bacterial infections and antibacterials including sexually transmitted diseases and mycobacterial infections (surveys, epidemiology, and clinical trials)

Jennifer Vodzak, MD1, Kendra Viner, PhD, MPH2, Claire Newbern, PhD, MPH2, Jane M. Gould, MD1, Lisa Dettinger, MT3, Sarah Long, MD1, Caroline C. Johnson, MD2 and Irini Daskalaki, MD1,2, (1)St. Christopher's Hospital for Children, Drexel University College of Medicine, Philadelphia, PA, (2)Division of Disease Control, Philadelphia Department of Public Health, Philadelphia, PA, (3)Pennsylvania Department of Health Bureau of Laboratories, Exton, PA

Disclosures:

J. Vodzak, None

K. Viner, None

C. Newbern, None

J. M. Gould, None

L. Dettinger, None

S. Long, None

C. C. Johnson, None

I. Daskalaki, None

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