Biology subjects

Denholm, J. T.

Publications and source records attributed to Denholm, J. T..

2 recordsLinked to original sources

bioRxiv2025

Extensive endemic transmission of multidrug resistant Mycobacterium tuberculosis in Bhutan: A retrospective genomic-epidemiological study

Despite decreasing overall tuberculosis notifications, the proportion of multidrug-resistant tuberculosis (MDR-TB) cases are increasing in Bhutan. While most MDR-TB cases are diagnosed among patients in the bordering districts and the capital, current diagnostic tests are limited in their ability to differentiate between the recurrent introductions and local transmission. For the first time, we conducted a retrospective genomic-epidemiological study to provide insights into the population structure, genotypic resistance patterns, and explore recent transmission of drug-resistant TB in Bhutan. Whole genome sequencing was performed on randomly selected drug-resistant and drug-sensitive TB isolates from Bhutan, collected between 2018-2022 at Microbiological Diagnostic Unit Public Health Laboratory in Melbourne, Australia. We investigated drug resistance mutations, and genomic clustering of cases using different single nucleotide polymorphisms (SNPs) thresholds. Of the 203 sequences that passed the quality control, 126 (62.1%) were MDR-TB and 15 (7.4%) were isoniazid-resistant TB. There were four different circulating lineages, with most sequences belonging to lineage 2 (86.2%). Using a SNP-threshold of [≤]12 SNPs, 71% of sequences formed 12 genomic clusters. Surprisingly, the largest cluster included of 88% of all MDR-TB sequences and spanned the entire study period. These cases were highly clonal (mean pairwise SNP-distance of 10, range 0-25). Phylogenetic analysis with publicly available international sequence data showed that this MDR-TB cluster formed a distinct clade. The major burden of MDR-TB in Bhutan appears to be due to recent local transmission of cases resulting in a large, single endemic cluster. This information will be critical for TB control program in Bhutan to tackle the major burden of MDR-TB through enhanced contact tracing of this MDR-TB clade. Additionally, this genomic data will be valuable to regional neighbours to monitor for dissemination of the strain. This study highlights the significant value of investing in TB genomics in resource limited settings globally to gain actionable insights into transmission dynamics.

genomics↗

bioRxiv2021

Modelling tuberculosis drug resistance amplification rates in high-burden settings

BackgroundAntimicrobial resistance develops following the accrual of mutations in the bacterial genome, and may variably impact organism fitness and hence, transmission risk. Classical representation of tuberculosis (TB) dynamics using a single or two strain (DS/MDR-TB) model typically does not capture elements of this important aspect of TB epidemiology. To understand and estimate the likelihood of resistance spreading in high drug-resistant TB incidence settings, we used molecular understanding to develop a compartmental epidemiological model of Mycobacterium tuberculosis (Mtb) transmission. MethodsA four-strain (drug-susceptible (DS), isoniazid mono-resistant (INH-R), rifampicin mono-resistant (RIF-R) and multidrug-resistant (MDR)) compartmental deterministic Mtb transmission model was developed to explore the progression from DS-to MDR-TB. The model incorporated strain-specific fitness costs and was calibrated using data from national tuberculosis prevalence surveys and drug resistance surveys from Philippines and Viet Nam. Using an adaptive Metropolis algorithm, we estimated drug resistance amplification and transmission rates. ResultsThe posterior estimates for the proportion of isoniazid mono-resistant amplification among treatment failure was 0.75 (0.64 - 0.85) for Philippines and 0.55 (0.39 - 0.63) for Viet Nam. The proportion of rifampicin mono-resistant amplification among treatment failure was 0.05 (0.04 - 0.06) for Philippines and 0.011 (0.010 - 0.012) for Viet Nam. In Philippines, the estimated proportion of primary resistance resulting from transmission was 56% (42 - 68) for INH-R, 48% (34 - 62) for RIF-R and 42% (34 - 50) for MDR-TB. For Viet Nam, the estimated proportion of drug resistance due to transmission was 79% (70 - 86) for INH-R, 68% (58 - 75) for RIF-R and 50% (45 - 53) for MDR-TB. DiscussionRIF-R strains were more likely to be transmitted than acquired through amplification, while both mechanisms of acquisition were important contributors in the case of INH-R. These findings highlight the complexity of drug resistance dynamics in high-incidence settings, and emphasize the importance of prioritizing testing algorithms which also allow for early detection of INH-R.

microbiology↗