Mixed strain infections of tuberculosis in TB Portals: case characteristics and associated risk factors

Authors

• MP Peyton
• BM Jeffrey
• G Rosenfeld
• AE Gabrielian
• KR Wollenberg
• MR Galac
• MA Harris
• Z Yaniv
• A Rosenthal
• DE Hurt

Abstract

Mixed strain infection of tuberculosis (MSI-TB), defined as infection of a host with multiple strains of Mycobacterium tuberculosis, has been implicated in contributing to drug resistance and challenges in the management and care of TB patients. Comprehensive understanding of MSI-TB is often lacking the important details about co-infection dynamics, contribution to drug resistance, and socioeconomic risk factors involved. The National Institute of Allergy and Infectious Diseases spearheaded TB Portals program is a multi-national collaboration of 19 countries focused on sharing data on TB. The aim of this study was to analyze characteristics of MSI-TB in the TB Portals data. QuantTB was used to identify MSI-TB on TB isolates with whole genome sequencing data (n = 4,446). After applying stringent TB case selection criteria (e.g., specimen collection time, specimen type, case type), 1,264 patient cases were identified. The prevalence of MSI-TB among the identified cases was 5.7% (68). We observed significant associations between MSI and the number of social risk factors (p = 0.001), comorbidities (0.046), case type (new vs. relapse; p = 0.037), and TB type (sensitive vs. resistant; p = 0.032). Additionally, in a subset of cases (n = 800) examining radiological findings, significant differences in percent abnormal lung (p = 0.007) and Timika score (p = 0.008) were found between MSI compared to no-MSI. This study is important in furthering our understanding of MSI-TB etiology, and may enhance the monitoring, diagnosis, treatment, and management of patients with TB.

Scientific Focus Area: Computational Biology

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