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Ethnicity and mycobacterial lineage as determinants of tuberculosis disease phenotype.

Pareek, M, Evans, J, Innes, J, Smith, G, Hingley-Wilson, S, Lougheed, KE, Sridhar, S, Dedicoat, M, Hawkey, P and Lalvani, A (2013) Ethnicity and mycobacterial lineage as determinants of tuberculosis disease phenotype. Thorax, 68 (3). pp. 221-229.

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Abstract

BACKGROUND: Emerging evidence suggests that Mycobacterium tuberculosis (Mtb) lineage and host ethnicity can determine tuberculosis (TB) clinical disease patterns but their relative importance and interaction are unknown. METHODS: We evaluated prospectively collected TB surveillance and Mtb strain typing data in an ethnically heterogeneous UK population. Lineage assignment was denoted using 15-loci mycobacterial interspersed repetitive units containing variable numbers of tandem repeats (MIRU-VNTR) and MIRU-VNTRplus. Geographical and ethnic associations of the six global Mtb lineages were identified and the influence of lineage and demographic factors on clinical phenotype were assessed using multivariate logistic regression. RESULTS: Data were available for 1070 individuals with active TB which was pulmonary only, extrapulmonary only and concurrent pulmonary-extrapulmonary in 52.1%, 36.9% and 11.0% respectively. The most prevalent lineages were Euro-American (43.7%), East African Indian (30.2%), Indo-Oceanic (13.6%) and East Asian (12.2%) and were geo-ethnically restricted with, for example, Indian subcontinent ethnicity inversely associated with Euro-American lineage (OR 0.23; 95% CI 0.14 to 0.39) and positively associated with the East African-Indian lineage (OR 4.04; 95% CI 2.19 to 7.45). Disease phenotype was most strongly associated with ethnicity (OR for extrathoracic disease 21.14 (95% CI 6.08 to 73.48) for Indian subcontinent and 14.05 (3.97 to 49.65) for Afro-Caribbean), after adjusting for lineage. With East Asian lineage as the reference category, the Euro-American (OR 0.54; 95% CI 0.32 to 0.91) and East-African Indian (OR 0.50; 95% CI 0.29 to 0.86) lineages were negatively associated with extrathoracic disease, compared with pulmonary disease, after adjusting for ethnicity. CONCLUSIONS: Ethnicity is a powerful determinant of clinical TB phenotype independently of mycobacterial lineage and the role of ethnicity-associated factors in pathogenesis warrants investigation.

Item Type: Article
Authors :
NameEmailORCID
Pareek, MUNSPECIFIEDUNSPECIFIED
Evans, JUNSPECIFIEDUNSPECIFIED
Innes, JUNSPECIFIEDUNSPECIFIED
Smith, GUNSPECIFIEDUNSPECIFIED
Hingley-Wilson, Ss.hingley-wilson@surrey.ac.ukUNSPECIFIED
Lougheed, KEUNSPECIFIEDUNSPECIFIED
Sridhar, SUNSPECIFIEDUNSPECIFIED
Dedicoat, MUNSPECIFIEDUNSPECIFIED
Hawkey, PUNSPECIFIEDUNSPECIFIED
Lalvani, AUNSPECIFIEDUNSPECIFIED
Date : March 2013
Identification Number : 10.1136/thoraxjnl-2012-201824
Uncontrolled Keywords : Adolescent, Adult, Africa, Americas, Asia, Confidence Intervals, European Continental Ancestry Group, Female, Great Britain, Humans, Interspersed Repetitive Sequences, Male, Middle Aged, Minisatellite Repeats, Mycobacterium tuberculosis, Odds Ratio, Phenotype, Phylogeny, Prospective Studies, Tuberculosis, Tuberculosis, Pulmonary, Young Adult
Related URLs :
Depositing User : Symplectic Elements
Date Deposited : 17 May 2017 09:46
Last Modified : 17 May 2017 14:44
URI: http://epubs.surrey.ac.uk/id/eprint/825032

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