Annals of Laboratory Medicine

Korean Society for Laboratory Medicine (대한진단검사의학회)
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Phenotypic and Genotypic Analysis of Anti-Tuberculosis Drug Resistance in Mycobacterium tuberculosis Isolates in Myanmar

  • Aung, Wah Wah (Advanced Molecular Research Centre, Department of Medical Research) ;
  • Ei, Phyu Win (Advanced Molecular Research Centre, Department of Medical Research) ;
  • Nyunt, Wint Wint (National Tuberculosis Program, Nay Pyi Taw) ;
  • Swe, Thyn Lei (National Tuberculosis Program, Nay Pyi Taw) ;
  • Lwin, Thandar (National Tuberculosis Program, Nay Pyi Taw) ;
  • Htwe, Mi Mi (Advanced Molecular Research Centre, Department of Medical Research) ;
  • Kim, Kyung Jun (Department of Laboratory Medicine, Pusan National University Yangsan Hospital) ;
  • Lee, Jong Seok (International Tuberculosis Research Center) ;
  • Kim, Chang Ki (Korean Institute of Tuberculosis) ;
  • Cho, Sang Nae (Yonsei University College of Medicine) ;
  • Song, Sun Dae (International Tuberculosis Research Center) ;
  • Chang, Chulhun L. (Department of Laboratory Medicine, Pusan National University Yangsan Hospital)
  • Received : 2015.01.27
  • Accepted : 2015.06.22
  • Published : 2015.09.01
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Abstract

Background: Tuberculosis (TB) is one of the most serious health problems in Myanmar. Because TB drug resistance is associated with genetic mutation(s) relevant to responses to each drug, genotypic methods for detecting these mutations have been proposed to overcome the limitations of classic phenotypic drug susceptibility testing (DST). We explored the current estimates of drug-resistant TB and evaluated the usefulness of genotypic DST in Myanmar. Methods: We determined the drug susceptibility of Mycobacterium tuberculosis isolated from sputum smear-positive patients with newly diagnosed pulmonary TB at two main TB centers in Myanmar during 2013 by using conventional phenotypic DST and the Geno-Type MTBDRplus assay (Hain Lifescience, Germany). Discrepant results were confirmed by sequencing the genes relevant to each type of resistance (rpoB for rifampicin; katG and inhA for isoniazid). Results: Of 191 isolates, phenotypic DST showed that 27.7% (n=53) were resistant to at least one first-line drug and 20.9% (n=40) were resistant to two or more, including 18.3% (n=35) multidrug-resistant TB (MDR-TB) strains. Monoresistant strains accounted for 6.8% (n=13) of the samples. Genotypic assay of 189 isolates showed 17.5% (n=33) MDR-TB and 5.3% (n=10) isoniazid-monoresistant strains. Genotypic susceptibility results were 99.5% (n=188) concordant and agreed almost perfectly with phenotypic DST (kappa=0.99; 95% confidence interval 0.96-1.01). Conclusions: The results highlight the burden of TB drug resistance and prove the usefulness of the genotypic DST in Myanmar.

Keywords

Acknowledgement

Supported by : National Research Foundation of Korea (NRF)

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