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A close-up on the epidemiology and transmission of multidrug-resistant tuberculosis in Poland

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Abstract

Multidrug-resistant tuberculosis (MDR-TB) poses a serious challenge to the global control of the disease. The purpose of this study was to characterize MDR-TB patients from Poland and to determine the extent of MDR-TB disease attributable to recent transmission. The study included all 46 patients diagnosed with MDR-TB in Poland in 2004 and followed up for 6 years (until 2011). For each patient, sociodemographic and clinical characteristics, treatment outcomes, and bacteriological data were collected by the review of medical and laboratory records. Mycobacterium tuberculosis isolates from all patients were characterized using spoligotyping, mycobacterial interspersed repetitive unit–variable number tandem repeat (MIRU-VNTR) typing, IS6110 restriction fragment length polymorphism (RFLP) analysis, and sequencing analysis of drug resistance-associated loci (katG, mabA-inhA, rpoβ, rpsL, and embB). The majority of patients were male (86.9 %), 40–64 years of age (60.8 %), with a history of TB treatment (84.8 %), and producing smear-positive sputa (86.9 %). Twenty-two (47.8 %) patients suffered from concomitant diseases and 28 (60.8 %) were alcohol abusers. Treatment outcome assessment revealed that 8 (17.4 %) patients were cured or completed therapy, while 15 (32.6 %) died of TB, 11 (23.9 %) defaulted, 8 (17.4 %) failed, and 1 (2.2 %) was transferred and lost to follow-up. Upon genotyping, 10 (21.7 %) isolates were allocated in four clusters. These were further subdivided by mutational profiling. Overall, in 6 (13 %) patients, MDR-TB was a result of recent transmission. For 4 (8.7 %) of these patients, a direct epidemiological link was established. The study shows that the transmission of MDR-TB occurs at a low rate in Poland. Of urgent need is the implementation of a policy of enforced treatment of MDR-TB patients in Poland.

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Acknowledgments

The authors are greatly indebted to the heads and staff of the regional TB laboratories, in particular to Maria Bełzowska (Wrocław), Mirosława Dąbrowska (Lublin), Łucja Filipczyk (Katowice), Hanna Górecka (Nowy Sącz), Maria Janiak (Nowy Sącz), Maria Kowalska (Otwock), Dorota Krawiecka (Bydgoszcz), Joanna Łukaszewicz (Białystok), Bożena Malinowska (Kielce), Elżbieta Naparta-Kapusta (Łódź), Grażyna Passak-Stańda (Kraków), Bożena Piskuła (Szczecin), Danuta Przytocka (Wrocław), Alicja Sankowska (Gdańsk), Krzysztof Skłodowski (Kowary), Teresa Tarnawska (Częstochowa), and Beata Żmudzin (Rudka), for their excellent help in the collection and interpretation of the clinical and microbiological data concerning patients evaluated in this study.

Special thanks are extended to the clinicians of the regional TB dispensaries and other medical facilities, in particular to Magdalena Biernat-Silczuk (Kraków), Piotr Cichoń (Lubliniec), Jerzy Czyż (Rybnik), Jan Juchacki (Jędrzejów), Małgorzata Jurdyga (Kowary), Krystyna Kaczorowska-Polakiewicz (Nowy Sącz), Lidia Kościółko-Fałkowska (Biłgoraj), Maria Lewandowska-Holewik (Kowary), Małgorzata Kwiatkowska (Bełżyce), Maria Michalska (Jaroszowiec), Beata Michna (Kraków), Hanna Owczarzak (Bydgoszcz), Barbara Patora-Eger (Łódź), Izabela Piętowska-Łazuka (Parczew), Elżbieta Poniatowska-Kubina (Zamość), Hanna Potoczna (Lublin), Bronisław Prystupa (Łęczna), Elżbieta Smaga-Pawluk (Lublin), Anna Szydłowska (Puławy), Mirosława Tałałaj (Sokółka), and Marek Zakościelny (Kraśnik), for providing patients’ medical documentation and for the information on their present situation.

The work was partially financed by the Iuventus Plus grant from the Polish Ministry of Science and Higher Education (contract no. IP2011018771). No additional external funding was received for this study.

Part of the results concerning mutational analysis of the isoniazid, streptomycin, and ethambutol resistance-associated loci have already been published elsewhere [41–43].

Conflict of interest

The authors declare that they have no competing interests. Alex van Belkum is currently working for bioMérieux, a company developing and selling infectious disease diagnostics.

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Authors and Affiliations

  1. Department of Applied Microbiology, Institute of Microbiology, Faculty of Biology, University of Warsaw, I. Miecznikowa 1, 02-096, Warsaw, Poland

    T. Jagielski

  2. Laboratory of Mycobacterium Genetics and Physiology, Institute of Medical Biology, Polish Academy of Sciences, Łódź, Poland

    A. Brzostek & J. Dziadek

  3. bioMérieux, Clinical Unit, Microbiology R&D, La Balme Les Grottes, France

    A. van Belkum

  4. Department of Microbiology, National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland

    E. Augustynowicz-Kopeć & Z. Zwolska

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  1. T. Jagielski
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  2. A. Brzostek
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  3. A. van Belkum
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  4. J. Dziadek
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Correspondence to T. Jagielski.

Electronic supplementary material

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Supplementary Table 1

Primers used for PCR amplification and sequencing of drug resistance-associated genes. (DOCX 18 kb)

Supplementary Table 2

Mutations detected in five genetic loci among 46 MDR M. tuberculosis isolates. (DOCX 18 kb)

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Jagielski, T., Brzostek, A., van Belkum, A. et al. A close-up on the epidemiology and transmission of multidrug-resistant tuberculosis in Poland. Eur J Clin Microbiol Infect Dis 34, 41–53 (2015). https://doi.org/10.1007/s10096-014-2202-z

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