BeijingW Mycobacterium tuberculosis in Italy by hpq74941



         Beijing/W                                        phism (RFLP) and the spoligotyping                          weak or absent. In our survey, no sub-
                                                          (spacer oligonucleotide typing) tech-                       stantial drug resistance was observed;
      Mycobacterium                                       niques. A total of 216 distinct IS6110                      all Beijing/W strains isolated in
      tuberculosis in                                     RFLP patterns were found among the                          Tuscany were susceptible to rifampin,
           Italy                                          245 isolates; 51 isolates (20.8%)                           ethambutol, pirazinamide, and strep-
                                                          occurred in 23 clusters, each consti-                       tomycin (tested only in two strains),
    To the Editor: Molecular typing                       tuting strains with an identical IS6110                     and all but one were susceptible to
of Mycobacterium tuberculosis strains                     RFLP and spoligotype pattern; 19                            isoniazid.
isolated in several countries in recent                   clusters contained two isolates each, 3                         Although we detected only a few
years has shown that a group of                           contained three isolates, and 1 con-                        cases, our data do not show a trend of
strains known as “Beijing” is                             tained four isolates. Spoligotype                           Beijing/W strains’ being associated
widespread around the world (1). The                      analysis showed seven isolates with                         with infection in young people, as has
Beijing group of M. tuberculosis has                      the typical Beijing/W pattern of probe                      been observed in other settings (3).
been associated with drug resistance;                     hybridization only to spacer                                The age of immigrants with Beijing/W
one      multidrug-resistant     strain,                  sequences 35–43. The Beijing/W iso-                         TB (mean 33.2 years, standard devia-
designated “W,” was found in New                          lates yielded distinct IS6110 RFLP                          tion [SD] 8.2 years) did not signifi-
York City in the early 1990s and                          profiles with similarity coefficient                        cantly differ from that of immigrants
caused large institutional outbreaks of                   >57.8%. Characteristics of the                              infected with non-Beijing/W strains
tuberculosis (TB) in the United States                    Beijing/W strains and respective                            (30.7 years, SD 7.4 years), a find that
(2). M. tuberculosis strains of                           patients, obtained from clinical                            indicates that, at least in our setting,
Beijing/W genotype are mostly                             records, are reported in the Table.                         immigrant status, rather than M.
prevalent in Asia (1), but recent data                    Although the overall prevalence of                          tuberculosis genotype, is associated
suggest that they have been spreading                     Beijing/W strains was low (7/245,                           with infection in young people. The
in Indochina and are prevalent among                      2.9%), five of the seven strains were                       few cases of Beijing/W infections in
younger persons in Vietnam (3).                           from recent immigrants to Italy from                        Italian-born patients do not allow us
Beijing/W strains are also widespread                     China who live in the same area; the                        to draw conclusions regarding non-
in Eastern Europe (1); during the last                    other two strains were from Italian cit-                    immigrant patients.
decade, the Beijing/W genotype of M.                      izens also living in that area. Recent                          In conclusion, M. tuberculosis
tuberculosis, with more prevalent                         immigration from high-prevalence                            strains of Beijing/W genotype are
drug-resistant mutations than non-                        areas is therefore likely to be associat-                   becoming widespread worldwide,
Beijing strains, has been identified in                   ed with the occurrence of the                               including in countries with a low
40% to 50% of clinical isolates                           Beijing/W genotype in Italy. None of                        prevalence of TB. Their association
studied in Russia (4).                                    the Beijing/W strains was associated                        with drug resistance and infection in
    We studied a total of 245 M. tuber-                   with TB outbreaks; nonetheless,                             young people, clearly shown in cer-
culosis strains collected during a 1-                     infection of Italian residents with                         tain settings, remains to be defined.
year period, from January to                              Beijing strains suggests that spread of                     Further molecular epidemiologic sur-
December 2002, from the same num-                         this genotype is ongoing.                                   veillance is needed to monitor trends
ber of TB patients hospitalized in                            Beijing/W strains have been                             in prevalence and spread of these
Tuscany, Italy. All the isolates were                     strongly associated with drug resist-                       strains.
typed by the standardized IS6110                          ance in a number of countries (2,4–6),
restriction fragment length polymor-                      but elsewhere the association was

Table. Characteristics of Mycobacterium tuberculosis strains of Beijing/W genotype isolated in 2002 in Tuscany, Italya
              Patient’s                                                                                     Drug resistanceb
Strain no. country of birth  Sex      Age     HIV status Years in Italy        Site of TB         Str    Inh      Rif      Eth                                       Pza
669            China          M        40         –               1            Pulmonary           S      S        S         S                                        S
763            China          M        42         –              <1            Pulmonary           S      S        S         S                                        S
804            China          F        23         –               4            Pulmonary         NT       S        S         S                                        S
836            China          M        34         –               1            Pulmonary         NT       S        S         S                                        S
884              Italy        F        39         +              NA          Extrapulmonary      NT       S        S         S                                        S
952              Italy        F        28         –              NA            Pulmonary         NT       R        S         S                                        S
974            China          F        27         –               1            Pulmonary         NT       S        S         S                                        S
 TB, tuberculosis; Str, streptomycin; Inh, isoniazid; Rif, rifampin; Eth, ethambutol; Pza, pirazinamide; S, susceptible; R, resistant; M, male; F, female; NA, not
applicable; NT, not tested.
  Drug resistance was assessed by the radiometric BACTEC system (Becton Dickinson, Towson, MD) according to the proportion method.

958                                  Emerging Infectious Diseases • • Vol. 10, No. 5, May 2004

     This work was supported by National            Animal-to-Human                          despite the widely accepted hypothe-
Research Program on AIDS grant no.                                                           sis of the animal origin of SARS-CoV
50D.11 from the Istituto Superiore di               SARS-associated                          (4–6), cannot be ascertained. If the
Sanità, Rome, Italy.                                  Coronavirus                            transmission of SARS-CoV from ani-
                                                     Transmission?                           mal to human is as easy as that from
   Nicoletta Lari,* Laura Rindi,*                                                            humans to domestic cats, the specula-
 Daniela Bonanni,* Enrico Tortoli,†                   To the Editor: Martina et al.          tion that the outbreak of SARS in the
        and Carlo Garzelli*                       reported that domestic cats and ferrets    Amoy Garden in Hong Kong was
*Università di Pisa, Pisa, Italy; and
                                                  are susceptible to infection by severe     caused by environmental sources,
†Ospedale Careggi, Firenze, Italy                 acute respiratory syndrome (SARS)–         such as U-traps in bathrooms contam-
                                                  associated coronavirus (SARS-CoV)          inated with SARS-CoV (3), we
References                                        isolated from a patient infected with      should reevaluate, because this out-
                                                  SARS. These infected animals could         break of SARS in these apartments
 1. Glynn JR, Whiteley J, Bifani PJ, Kremer K,
    van Soolingen D. Worldwide occurrence of
                                                  efficiently transmit the virus to unin-    might also be caused by infected cats
    Beijing/W strains of Mycobacterium tuber-     fected animals housed with them (1).       or other mammalian hosts.
    culosis: a systematic review. Emerg Infect    This finding is similar to that of SARS
    Dis 2002;8:843–9.                             transmission in humans in which            Zhao-Rong Lun* and Liang-Hu Qu*
 2. Bifani PJ, Mathema B, Liu Z, Moghazeh
    SL, Shopsin B, Tempalski B, et al.
                                                  SARS-CoV can be quickly spread             *Zhongshan (Sun Yat-Sen) University,
                                                  from person to person through close        Guangzhou, People’s Republic of China
    Identification of a W variant outbreak of
    Mycobacterium tuberculosis via popula-        contact. Ferrets and domestic cats not
    tion-based molecular epidemiology. JAMA       only can be infected by SARS-CoV in        References
 3. Anh DD, Borgdorff MW, Van LN, Lan NT,
                                                  the laboratory, but also can shed           1. Martina BE, Haagmans BL, Kuiken T,
    van Gorkom T, Kremer K, et al..               SARS-CoV from the pharynx at 2                 Fouchier RA, Rimmelzwaan GF, Van
    Mycobacterium tuberculosis Beijing geno-      days postinfection and continuing              Amerongen G, et al. SARS virus infection
    type emerging in Vietnam. Emerg Infect                                                       of cats and ferrets. Nature 2003;425:915.
                                                  through 10 and 14 days postinfection,       2. Kuiken T, Fouchier RA, Schutten M,
    Dis 2000;6:302–5.
 4. Mokrousov I, Otten T, Vyazovaya A,
                                                  respectively (1). No clinical signs            Rimmelzwaan GF, van Amerongen G, van
    Limeschenko E, Filipenko ML, Sola C, et       were observed in six cats that were            Riel D, et al. Newly discovered SARS-CoV
    al. PCR-based methodology for detecting       injected with SARS-CoV, whereas                coronavirus as the primary cause of severe
    multidrug-resistant         strains      of                                                  acute respiratory syndrome. Lancet
                                                  three of six ferrets that were injected        2003;362:263–70.
    Mycobacterium tuberculosis Beijing family
    circulating in Russia. Eur J Clin Microbiol
                                                  with SARS-CoV became lethargic              3. World Health Organization. Severe acute
    Infect Dis 2003;22:342–8.                     within 2 to 4 days postinfection, and          respiratory syndrome (SARS)–multi-coun-
 5. Diaz R, Kremer K, de Haas PE, Gomez RI,       one of the three ferrets died at day 4         try outbreak [monograph on the Internet].
    Marrero A, Valdivia JA, et al. Molecular                                                     [cited 2003 Apr 18] Update 33. Available
                                                  postinfection (1,2). This finding indi-        from:
    epidemiology of tuberculosis in Cuba
    outside of Havana, July 1994–June 1995:
                                                  cates that domestic cats may not only          04_18/en/
    utility of spoligotyping versus IS6110        be a useful animal model for evaluat-       4. Guan Y, Zheng BJ, He YQ, Liu XL, Zhuang
    restriction fragment length polymorphism.     ing candidate vaccines and drugs               ZX, Cheung CL, et al. Isolation and charac-
    Int J Tuberc Lung Dis 1998;2:743–50.                                                         terization of viruses related to the SARS
                                                  against SARS (1) but also may be               coronavirus from animals in southern
 6. Kruuner A, Hoffner SE, Sillastu H,
    Danilovits M, Levina K, Svenson SB, et al.
                                                  good reservoirs of SARS-CoV.                   China. Science 2003;302:276–8.
    Spread of drug-resistant pulmonary            Domestic cats living in the Amoy            5. Antia R, Regoes RR, Koella JC, Bergstrom
    tuberculosis in Estonia. J Clin Microbiol     Gardens in Hong Kong, where >100               CT. The role of evolution in the emergence
    2001;39:3339–45.                                                                             of infectious diseases. Nature 2003;
                                                  residents contracted SARS in the               426:658–61.
                                                  spring of 2003, were infected with          6. Stavrinides J, Guttman DS. Mosaic evolu-
Address for correspondence: C. Garzelli,
                                                  SARS-CoV (1,3). This fact suggests             tion of the severe acute respiratory syn-
Dipartimento di Patologia Sperimentale,
                                                  that domestic cats can be naturally            drome coronavirus. J Virol 2004;78:76–82.
Biotecnologie Mediche, Infettivologia ed
                                                  infected with SARS-CoV from
Epidemiologia, Università di Pisa, Via San                                                   Address for correspondence: Zhao-Rong Lun,
                                                  humans infected with SARS, although
Zeno, 35/39, I-56127 Pisa, Italy; fax: +39-050-                                              Zhongshan (Sun Yat-Sen) University, Center
                                                  how this SARS-CoV transmission
2213671; email:                                                     for Parasitic Organisms, 135 Xingan Xi Road,
                                                  occurs is unclear. Unfortunately, how-
                                                  ever, the transmission capability of       Guangzhou, 510275, People’s Republic of
  The opinions expressed by authors con-
  tributing to this journal do not necessari-     the SARS-CoV strain transmitting           China,     fax:    8620-8403-6215;    email:
  ly reflect the opinions of the Centers for                                       
  Disease Control and Prevention or the           from domestic animal to human,
  institutions with which the authors are

                                 Emerging Infectious Diseases • • Vol. 10, No. 5, May 2004                             959

To top