Journal
CLINICAL MICROBIOLOGY AND INFECTION
Volume 17, Issue 6, Pages 881-887Publisher
ELSEVIER SCI LTD
DOI: 10.1111/j.1469-0691.2010.03358.x
Keywords
Bacterial DNA; extrapulmonary tuberculosis; impact of immigration; low-incidence country; molecular epidemiology; Mycobacterium tuberculosis; SpolDB4
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Funding
- Vastra Gotalandsregionen
- Wilhelm och Martina Lundgrens vetenskapsfond
- Oscar och Hanna Bjorkboms fond
- Stiftelsen for forskning och utveckling inom medicinsk mikrobiologi
- European Commission [A34-05]
- Regional Council of Guadeloupe [CR08/031380]
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Mycobacterium tuberculosis strains from 349 patients were isolated in western Sweden during the years 2001-2005. Only 26% of the tuberculosis (TB) patients were born in Sweden. All the others were born in any of 42 different countries; 17% in other European countries, 28% in Africa, 16% in Asia, 11% in the Middle East, and 2% in South America. The mean age of the Swedish-born patients was 67 years, while the mean age among the foreign-born patients was 37 years. The male/female ratio was 1.6 among the Swedes and 0.9 among those born abroad. Extrapulmonary manifestations of TB were most common among patients born in Africa while lung infections without extra-pulmonary manifestations were most common in patients born in Europe, including Sweden. Spoligotyping showed that patients with T or Beijing strains had more pulmonary TB than extrapulmonary TB, while patients with EAI and CAS strains had a high proportion of extrapulmonary TB. The ancestral and/or evolutionary older PGG1 strains were more often isolated from the foreign-born patients than from the Swedish-born patients, who had strains generally being of the evolutionary recent genogroups PGG2/PGG3. We conclude that immigration from countries with a high incidence of TB has a strong impact on the TB epidemiology in western Sweden, a finding that should be taken into account by TB control strategists when developing programmes for eradication of TB in low prevalence settings.
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