Pulmonary tuberculosis in Harare, Zimbabwe: analysis by spoligotyping
a Department of Medicine, b Department of Medical
Laboratory Technology, c Medical School,
University of Zimbabwe, Zimbabwe Department of Respiratory
Medicine, National Heart and Lung Institute, Imperial College School of
Medicine, London, UK, d Health Services, City of Harare, Zimbabwe, e Department of Bacteriology, Research
Laboratory for Infectious Diseases, National Institute of Public Health
and the Environment, Bilthoven, The Netherlands
Correspondence to: Dr R S Heyderman, Department of Infection and Tropical Medicine, Imperial College School of Medicine, Northwick Park Hospital, Harrow, Middlesex HA1 3UJ, UK.
Received 7 April 1997; Returned to authors 17 June 1997; Revised version received 17 September 1997; Accepted for publication 5 November 1997
BACKGROUND
Over the last 10 years there has
been a fourfold increase in cases of tuberculosis in Harare, Zimbabwe.
The use of molecular epidemiology to understand tuberculosis
transmission in this epidemic has been hampered by the availability of
suitable culture facilities. A study was therefore undertaken to
explore the potential of spoligotyping, a polymerase chain reaction
based technique that does not require tuberculosis culture.
METHODSAdults attending a chest clinic with
clinical or radiological pulmonary tuberculosis and one smear positive
sputum were enrolled over one month. Demographic, socioeconomic, and
clinical data were gathered using a standardised questionnaire.
Molecular fingerprinting of genomic DNA recovered from sputum was
performed by spoligotyping.
RESULTSSixty one subjects (median age 28 years (range 18-73); 61% men) were recruited and 57 provided adequate
sputum samples. Recent rural-urban migration or immigration was not
common; 40% of subjects lived in crowded living conditions. DNA
suitable for spoligotyping was recovered from 28 patients and 20 different genotypes of Mycobacterium tuberculosis were
identified. Fifteen patients were infected with an M
tuberculosis strain shared by one or more individuals. Patients infected with a shared spoligotype were not closely linked
geographically within Harare, but were more likely to live in
overcrowded conditions (69% versus 23%; odds ratio 6.85 (95% CI 1.2 to 47), p = 0.026). Analysis of the patients' original rural family
homes revealed two geographically related spoligotype clusters.
CONCLUSIONSSpoligotyping may yield
valuable molecular typing information in populations where tuberculosis
culture is not available. This novel technique requires further
development and evaluation in larger epidemiological studies.
© 1998 by Thorax
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