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In the Kaliningrad region, the incidence of tuberculosis (TB) has declined significantly over the past decade (from 134/100 000 in 2006 to 50.6/100 000 in 2015), but still exceeds the average for the North-West Russia (40.7/100 000). In view of the increase in the proportion of primary multidrug resistance (MDR) of the causative agent from 23.9% in 2010 to 30.5% in 2015, the aim of this study was to analyze the current Mycobacterium tuberculosis population structure in the Kaliningrad region and to evaluate its spatial-temporal trends. The 73 M. tuberculosis isolates from patients with pulmonary TB newly diagnosed in 2015 were studied. Drug resistance (DR) was detected in 46 (63.0%) M. tuberculosis strains; of these, 32 (43.8%) were multidrug-resistant (MDR). The 46 (63.0%) of 73 M. tuberculosis strains were of the Beijing genotype with 19.2% (14 out of 73) share of the B0/W148 cluster. Spoligotyping of 27 non-Beijing M. tuberculosis strains made it possible to identify 15 spoligotypes of 5 genetic families — T, LAM, Ural, S, X. About half (16; 51.6%) of non-Beijing strains were represented by spoligotypes — SIT42, SIT53, SIT262, and SIT444. In a heterogeneous group T, mostly drugsusceptible strains of spoligotype SIT53 were prevailing. More than half (55.6%) of the LAM genotype strains exhibited DR. The Ural family was small (5.5%) and included strains of well-known in Russia M. tuberculosis spoligotypes SIT35 and SIT262, and one new, not found previously. MDR was statistically significantly associated with the Beijing genotype: 56.5% versus 25.9% in strains of other genotypes (in total) (P = 0.0134). Moreover, all 14 strains of epidemiologically and clinically significant B0/W148 cluster were MDR. The proportion of MDR strains of the Beijing genotype did not change significantly: in 2006 it was 61.3%, in 2015 — 56.5% (P = 0.6773). However, the spectrum of drug resistance to first-line anti-TB drugs expanded. If previously the majority (78.9%) of MDR strains additionally exhibited resistance to streptomycin only, in present study 72.0% of MDR strains were resistant to streptomycin, ethambutol, and pyrazinamide. The proportion of MDR strains of non-Beijing genotypes was 25.9%, a significantly higher than the similar indicators in 2006 — 2.2% (P = 0.0124). A relatively smaller proportion of strains of the Beijing genotype (50%) was found in TB patients from the shores of the Baltic Sea, a territory with a relatively more favorable socio-economic situation and a higher standard of living. Thus, the current epidemiological situation of TB in the Kaliningrad region is crucially determined by the growing circulation of MDR Beijing family strains, as well as a significant increase in the proportion of MDR strains of other genotypes.


About the authors

A. A. Vyazovaya

St. Petersburg Pasteur Institute, St. Petersburg

Author for correspondence.
PhD (Biology), Senior Researcher, Laboratory of Molecular Epidemiology and Evolutionary Genetics Russian Federation

G. M. Akhmedova

Tuberculosis Dispensary of the Kaliningrad region, Kaliningrad

PhD (Medicine), Head of the Bacteriological Laboratory Russian Federation

N. S. Solovieva

Research Institute of Phthisiopulmonology, St. Petersburg

PhD (Medicine), Head of the Bacteriological Laboratory Russian Federation

A. A. Gerasimova

St. Petersburg Pasteur Institute, St. Petersburg

Junior Researcher, Laboratory of Molecular Epidemiology and Evolutionary Genetics, St. Petersburg Pasteur Institute Russian Federation

D. A. Starkova

St. Petersburg Pasteur Institute, St. Petersburg

PhD (Biology), Researcher, Laboratory of Molecular Epidemiology and Evolutionary Genetics Russian Federation

E. N. Turkin

Tuberculosis Dispensary of the Kaliningrad region, Kaliningrad

Head Physician Russian Federation

V. Yu. Zhuravlev

Research Institute of Phthisiopulmonology, St. Petersburg

PhD (Medicine), Head of Department of the Laboratory Diagnostics Russian Federation

O. V. Narvskaya

St. Petersburg Pasteur Institute, St. Petersburg;
Research Institute of Phthisiopulmonology, St. Petersburg

PhD, MD (Medicine), Professor, Leading Researcher, Laboratory of Molecular Epidemiology and Evolutionary Genetics, St. Petersburg Pasteur Institute, St. Petersburg, Russian Federation; Scientific Advisor, Department of Laboratory Diagnostics, Research Institute of Phthisiopulmonology Russian Federation

I. V. Mokrousov

St. Petersburg Pasteur Institute, St. Petersburg

PhD, MD (Biology), Head of the Laboratory of Molecular Epidemiology and Evolutionary Genetics Russian Federation


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Copyright (c) 2018 Vyazovaya A.A., Akhmedova G.M., Solovieva N.S., Gerasimova A.A., Starkova D.A., Turkin E.N., Zhuravlev V.Y., Narvskaya O.V., Mokrousov I.V.

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