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 • www.cdc.gov/eid • 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,
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: http://www.who.int/csr/don/2003_
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: email@example.com 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 firstname.lastname@example.org
Disease Control and Prevention or the from domestic animal to human,
institutions with which the authors are
Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 10, No. 5, May 2004 959