{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,4]],"date-time":"2026-10-04T02:42:54Z","timestamp":1791081774283,"version":"4.1.0"},"reference-count":49,"publisher":"American Society for Microbiology","issue":"6","license":[{"start":{"date-parts":[[2013,6,1]],"date-time":"2013-06-01T00:00:00Z","timestamp":1370044800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.asm.org\/non-commercial-tdm-license"}],"content-domain":{"domain":["journals.asm.org"],"crossmark-restriction":true},"short-container-title":["J Clin Microbiol"],"published-print":{"date-parts":[[2013,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n          <jats:p>\n            Numerous reports have documented isolated transmission events or clonal outbreaks of multidrug-resistant\n            <jats:named-content content-type=\"genus-species\">Mycobacterium tuberculosis<\/jats:named-content>\n            strains, but knowledge of their epidemic spread remains limited. In this study, we evaluated drug resistance, strain diversity, and clustering rates in patients diagnosed with multidrug-resistant (MDR) tuberculosis (TB) at the National Health Laboratory Service (NHLS) Central TB Laboratory in Johannesburg, South Africa, between March 2004 and December 2007. Phenotypic drug susceptibility testing was done using the indirect proportion method, while each isolate was genotyped using a combination of spoligotyping and 12-MIRU typing (12-locus multiple interspersed repetitive unit typing). Isolates from 434 MDR-TB patients were evaluated, of which 238 (54.8%) were resistant to four first-line drugs (isoniazid, rifampin, ethambutol, and streptomycin). Spoligotyping identified 56 different strains and 28 clusters of variable size (2 to 71 cases per cluster) with a clustering rate of 87.1%. Ten clusters included 337 (77.6%) of all cases, with strains of the Beijing genotype being most prevalent (16.4%). Combined analysis of spoligotyping and 12-MIRU typing increased the discriminatory power (Hunter Gaston discriminatory index [HGDI] = 0.962) and reduced the clustering rate to 66.8%. Resolution of Beijing genotype strains was further enhanced with the 24-MIRU-VNTR (variable-number tandem repeat) typing method by identifying 15 subclusters and 19 unique strains from twelve 12-MIRU clusters. High levels of clustering among a variety of strains suggest a true epidemic spread of MDR-TB in the study setting, emphasizing the urgency of early diagnosis and effective treatment to reduce transmission within this community.\n          <\/jats:p>","DOI":"10.1128\/jcm.00200-13","type":"journal-article","created":{"date-parts":[[2013,4,4]],"date-time":"2013-04-04T06:34:49Z","timestamp":1365057289000},"page":"1818-1825","update-policy":"https:\/\/doi.org\/10.1128\/asmj-crossmark-policy-page","source":"Crossref","is-referenced-by-count":65,"title":["Epidemic Spread of Multidrug-Resistant Tuberculosis in Johannesburg, South Africa"],"prefix":"10.1128","volume":"51","author":[{"given":"Ben J.","family":"Marais","sequence":"first","affiliation":[{"name":"Sydney Emerging Infectious Diseases and Biosecurity Institute (SEIB), the University of Sydney, Sydney, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charmaine K.","family":"Mlambo","sequence":"additional","affiliation":[{"name":"Division of Clinical Microbiology and Infectious Diseases, School of Pathology, of the University of the Witwatersrand and National Health Laboratory Service, Johannesburg, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nalin","family":"Rastogi","sequence":"additional","affiliation":[{"name":"WHO Supranational TB Reference Laboratory, TB and Mycobacteria Unit, Institut Pasteur de la Guadeloupe, Abymes, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thierry","family":"Zozio","sequence":"additional","affiliation":[{"name":"WHO Supranational TB Reference Laboratory, TB and Mycobacteria Unit, Institut Pasteur de la Guadeloupe, Abymes, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adriano G.","family":"Duse","sequence":"additional","affiliation":[{"name":"Division of Clinical Microbiology and Infectious Diseases, School of Pathology, of the University of the Witwatersrand and National Health Laboratory Service, Johannesburg, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas C.","family":"Victor","sequence":"additional","affiliation":[{"name":"DST\/NRF Centre of Excellence for Biomedical Tuberculosis Research\/MRC Centre for Molecular and Cellular Biology, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Else","family":"Marais","sequence":"additional","affiliation":[{"name":"Division of Clinical Microbiology and Infectious Diseases, School of Pathology, of the University of the Witwatersrand and National Health Laboratory Service, Johannesburg, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robin M.","family":"Warren","sequence":"additional","affiliation":[{"name":"DST\/NRF Centre of Excellence for Biomedical Tuberculosis Research\/MRC Centre for Molecular and Cellular Biology, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"235","reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.5588\/ijtld.12.0083"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(02)07880-7"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(12)60727-2"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1126\/science.118.3063.297"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1098\/rspb.2000.1328"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(06)69573-1"},{"key":"e_1_3_2_8_2","first-page":"115","article-title":"A city-wide outbreak of a multiple-drug-resistant strain of Mycobacterium tuberculosis in New York","volume":"1","author":"Moss AR","year":"1997","unstructured":"MossAR AllandD TelzakE HewlettDJr SharpV ChiliadeP LaBombardiV KabusD HannaB PalumboL BrudneyK WeltmanA StoeckleK ChirgwinK SimberkoffM MoghazehS EisnerW LutfeyM KreiswirthB. 1997. A city-wide outbreak of a multiple-drug-resistant strain of Mycobacterium tuberculosis in New York. Int. J. Tuberc. Lung Dis. 1:115\u2013121.","journal-title":"Int. J. Tuberc. Lung Dis"},{"key":"e_1_3_2_9_2","unstructured":"WHO. 2006. The Stop TB strategy. World Health Organization Geneva Switzerland. http:\/\/www.who.int\/tb\/strategy\/stop_tb_strategy\/en\/index.html. Accessed 12 January 2012."},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra0908076"},{"key":"e_1_3_2_11_2","unstructured":"WHO. 2012. Global tuberculosis report 2012. World Health Organization Geneva Switzerland. http:\/\/apps.who.int\/iris\/bitstream\/10665\/75938\/1\/9789241564502_eng.pdf. 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