ArticleJournal of clinical microbiology2011
Systematic survey of clonal complexity in tuberculosis at a populational level and detailed characterization of the isolates involved.
Article in Journal of clinical microbiology, 2011. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 21 papers, 1 of them a synthesis that pooled it.
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
21 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Methods for Detecting Mycobacterial Mixed Strain Infections-A Systematic Review.Frontiers in genetics · 2020Pooled it
- Genetic stability ofeLife · 2024Article
- The detection of mixed tuberculosis infections using culture filtrate and resuscitation promoting factor deficient filtrate.Frontiers in cellular and infection microbiology · 2022Article
- Computational Methods for Strain-Level Microbial Detection in Colony and Metagenome Sequencing Data.Frontiers in microbiology · 2020Review
- Article
- Bacterial Genotyping of Central Nervous System Tuberculosis in South Africa: Heterogenic Mycobacterium tuberculosis Infection and Predominance of Lineage 4.Journal of clinical microbiology · 2019Article
- The Evolution of Genotyping Strategies To Detect, Analyze, and Control Transmission of Tuberculosis.Microbiology spectrum · 2018Review
- Clonal Complexity in Mycobacterium tuberculosis Can Hamper Diagnostic Procedures.Journal of clinical microbiology · 2017Article
- In-Depth Characterization and Functional Analysis of Clonal Variants in aFrontiers in microbiology · 2017Article
- Article
- Methodological and Clinical Aspects of the Molecular Epidemiology of Mycobacterium tuberculosis and Other Mycobacteria.Clinical microbiology reviews · 2016Review
- Genomic Diversity of Mycobacterium tuberculosis Complex Strains in Cantabria (Spain), a Moderate TB Incidence Setting.PloS one · 2016Article
- The population genetics of drug resistance evolution in natural populations of viral, bacterial and eukaryotic pathogens.Molecular ecology · 2016Review
- Persistent Infection by a Mycobacterium tuberculosis Strain That Was Theorized To Have Advantageous Properties, as It Was Responsible for a Massive Outbreak.Journal of clinical microbiology · 2015Article
- Mixed Infections and Rifampin Heteroresistance among Mycobacterium tuberculosis Clinical Isolates.Journal of clinical microbiology · 2015Article
- Magnitude and sources of bias in the detection of mixed strain M. tuberculosis infection.Journal of theoretical biology · 2015Article
- Clinical outcomes among persons with pulmonary tuberculosis caused by Mycobacterium tuberculosis isolates with phenotypic heterogeneity in results of drug-susceptibility tests.The Journal of infectious diseases · 2014Article
- Undetected multidrug-resistant tuberculosis amplified by first-line therapy in mixed infection.Emerging infectious diseases · 2013Article
- Population structure of mixed Mycobacterium tuberculosis infection is strain genotype and culture medium dependent.PloS one · 2013Article
- Mixed-strain mycobacterium tuberculosis infections and the implications for tuberculosis treatment and control.Clinical microbiology reviews · 2012Review
Corrections and comments
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Authors and funding
8 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Clonally complex infections by Mycobacterium tuberculosis are progressively more accepted. Studies of their dimension in epidemiological scenarios where the infective pressure is not high are scarce. Our study systematically searched for clonally complex infections (mixed infections by more than one strain and simultaneous presence of clonal variants) by applying mycobacterial interspersed repetitive-unit (MIRU)-variable-number tandem-repeat (VNTR) analysis to M. tuberculosis isolates from two population-based samples of respiratory (703 cases) and respiratory-extrapulmonary (R+E) tuberculosis (TB) cases (71 cases) in a context of moderate TB incidence. Clonally complex infections were found in 11 (1.6%) of the respiratory TB cases and in 10 (14.1%) of those with R+E TB. Among the 21 cases with clonally complex TB, 9 were infected by 2 independent strains and the remaining 12 showed the simultaneous presence of 2 to 3 clonal variants. For the 10 R+E TB cases with clonally complex infections, compartmentalization (different compositions of strains/clonal variants in independent infected sites) was found in 9 of them. All the strains/clonal variants were also genotyped by IS6110-based restriction fragment length polymorphism analysis, which split two MIRU-defined clonal variants, although in general, it showed a lower discriminatory power to identify the clonal heterogeneity revealed by MIRU-VNTR analysis. The comparative analysis of IS6110 insertion sites between coinfecting clonal variants showed differences in the genes coding for a cutinase, a PPE family protein, and two conserved hypothetical proteins. Diagnostic delay, existence of previous TB, risk for overexposure, and clustered/orphan status of the involved strains were analyzed to propose possible explanations for the cases with clonally complex infections. Our study characterizes in detail all the clonally complex infections by M. tuberculosis found in a systematic survey and contributes to the characterization that these phenomena can be found to an extent higher than expected, even in an unselected population-based sample lacking high infective pressure.
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