Relationship Between Beijing Family Strains And Recent Recurrence Of Tuberculosis

Background and purpose of the study: China is one of the 30 countries with high burden of tuberculosis(TB)in the world.There were 889,000 new TB patients in China,which was the second highest only to India in the world,and 37,000 people died from TB.Van Soolingen et al.first discovered and defined the Beijing family of Mycobacterium tuberculosis in 1995.The Beijing family is the second most prevalent strain in the world.It accounts for more than 11% of the global epidemic strains,more than 50% in Southeast Asia,60%-80% in China and over 90% in the North.Polymerase chain reaction(PCR)00002 is the dominant cluster in the Beijing family,which accounts for about 30% of the Beijing family.It has selective advantages and high frequency mutations,and increases the risk of rifampi CI:n resistance and to some extent increases the risk of developing into multidrug-resistant tuberculosis(MDR-TB).Tuberculosis patients have a recurrence risk of 5% to 20% after successful treatment,which is also an important factor hindering the achievement of the goal of ending TB.Previous studies have explored the relationship between Beijing family strains and recurrence of TB,but the conclusions were inconsistent and the sample size were small.The purpose of this study was to analyze the distribution and epidemic situation of Beijing family and its PCR 00002 sub-cluster in Jiangsu Province.This study relies on 30 established tuberculosis drug resistance monitoring points in Jiangsu Province to obtain a large sample of tuberculosis patients with representative population in the community;Furthermore,to follow up the TB patients cured by different genotypes,to observe the recent recurrence of TB of different genotypes,and to further explore the relationship between Beijing family and its sub-cluster of PCR00002 and the recent recurrence of TB.Materials and Methods: From October 1,2013 to December 31,2015,we collected all new sputum smear positive TB patients in 30 TB surveillance sites in Jiangsu province,followed them for 1 year and analyzed the recurrence of TB patients.We collected sputum samples conducted Ziehl-Neelsen sputum smear test and L-J culture test.Traditional proportional drug sensitivity test,strain identification and sample DNA extraction were carried out on strains with positive sputum culture.We did genotyping on 12 sites using MIRU-VNTR(MIRU2,MIRU4,MIRU10,MIRU16,MIRU20,MIRU23,MIRU24,MIRU26,MIRU27,MIRU31,MIRU39,MIRU40)and did RD105 Beijing Family Identification Test.All included subjects were surveyed by questionnaire.We double-entered the data using Epi Data 3.1 software(Odense,Denmark).We used SPSS22.0statistical software to analyze general demographic data,lifestyle and treatment outcomes of tuberculosis patients.Chi-square analysis and multivariate logistic regression were used to analyze the risk factors related to recurrence of TB,and the asso CI:ation between recent recurrence of TB and Beijing family and its PCR 00002 sub-cluster.Results:1.From October 01,2013 to December 31,2015,we enrolled 2111 new TB patients,of which 1642(77.78%)were males,and 469(22.22%)were females.Among them,729 cases(34.53%)were under 46 years old,690 cases(32.69%)were between 47 and 65 years old,and 692 cases(32.78%)were over 66 years old.Of all the patients,886(41.97%)were farmers and 328(15.53%)were unemployed.Among all TB patients,834(39.51%),and 388(18.38%)patients drank alcohol.Among all the strains,125(5.92%)were rifampi CI:n resistant,rifampi CI:n resistant rate was;187(8.86%)cases were isoniazid resistant;91(4.31%)cases were MDR-TB patients.2.The results of MIRU-VNTR genotyping showed that among 2111 strains,1735(82.19%)were Beijing family genotype,of whom 1337 were males and 398 were females,and 1625 were new patients and 110 were retreated patients.Among 1337 Beijing family strains,(27.90%)were PCR00002 was strains.Among 589 PCR00002 strains,470 were males and 119 were females,and559 were new patients and 30 were relapsed patients.3.The influen CI:ng factors of recurrence.Among 2111 cases,51 cases completed the course of treatment,1849 cases were cured,1900 cases were treated successful with the success rate of90.00%;84 cases failed with the failure rate 3.98%;63 cases died.Among the successful tuberculosis patients,124 patients had a recent recurrence of TB during one-year follow-up with a recurrence rate of 6.53%,among whom 106 were males and 18 were females.Among the recurrent patients,there were 110 Beijing family genotypes,of which 30 were in the Beijing family PCR00002 sub-cluster.Univariate logistic regression analysis showed that male(OR=0.578,95% CI: 0.347-0.964),age47-66(OR=1.752,95%CI: 1.062-2.891),age over 66(OR=2.381,95% CI: 1.477-3.837),farmers(OR=0.67,95% CI: 0.454-0.988)and bilateral pulmonary cavity(OR=1.61,95% CI: 1.073-2.418)were risk factors of recent recurrence of TB.Multivariate logistic regression analysis showed that patients over 66 years of age(OR=2.313,95%CI: 1.406-3.806),bilateral cavity(OR=1.708,95%CI:1.128-2.587)and Beijing family strain(OR=2.079,95%CI: 1.160-3.726)affected the recent recurrence of TB.There was no significant difference in both single factor Logistic resultsr(OR=0.815,95% CI: 0.534-1.244)and multifactor logistic results of PCR 00002 sub-cluster(OR=0.706,95% CI: 0.457-1.092).It is not believed that patients with PCR 00002 sub-cluster are prone to recurrence.Conclusion: The Beijing family of Mycobacterium TB was the main epidemic strain of TB in Jiangsu Province.The proportion of Beijing family sub-cluster PCR 00002 in Jiangsu was as high as 33.95%,which was the dominant sub-cluster of tuberculosis in our province.Recent recurrence rate of tuberculosis was 6.53%.Multivariate logistic analysis showed that men,older age and bilateral cavity could increase the recent recurrence of tuberculosis;Patients infected with Beijing family strain were more likely to have recent recurrence.In the cured tuberculosis patients,it is necessary to strengthen the follow-up work after the cure,and the genotype analysis of the strain may also provide a certain predictive effect for the patient’s treatment outcome.