Resistance of Mycobacterium and Outcomes of Pulmonary Tuberculosis Depending on VNTR-Profile Among Different Age Groups of Patients in Ukraine

BACKGROUND: Ukraine is among the five countries with the highest burden of multiple drug-resistance tuberculosis (MDR TB). MDR TB has found in 22 % new cases of TB and in 56 % of retreated cases in Ukraine (WHO, 2015), and the elderlies among TB-affected persons are near 23%. The aim was to study the resistance of Mycobacterium tuberculosis (Mtb) and outcomes of TB depending on Mtb strains’ genotypes among different age groups of TB patients. METHODS: In 2015–2016, 115 clinical cases of severe first diagnosed TB were studied. Identification of Mtb strains was made by using VNTR-genotyping by ETR A-E loci. Resistance of Mtb to drugs was done according to WHO recommendations. There was found out the large cluster of identical strains among Beijing`s family with VNTR-profile 42435 – 53 (46 %). All the cases were divided into 4 groups: group 1 – young adults, Mtb Beijing profile 42435, n = 29, group 2 – elderly adults, Mtb Beijing profile 42435, n = 24, group 3 – young adults, non-42435 profile, n = 29, group 4 – elderly adults, non-42435 profile, n = 33. The outcomes were analyzed after continuation phase of treatment. RESULTS: Beijing strains with VNTR profile 42435 were primary resistant in 37,7 %, and they become secondary resistant after at least 6 month treatment in 50,9 %. In cases of Beijing 42435-profile, the clinical courses of TB were very severe, with episodes of hemoptysis/pulmonary bleeding, the outcomes were unfavorable – treatment success was just in 35,7 % of cases, fail – 33,9 %, lost to follow up – 15,2 % and 15,2% of patients died, with no difference depend on the patient`s age, P < 0.05. Another Mtb strains were primary resistant in 30.6%, and they become secondary resistant after at least 6 month treatment in 32.3% (group 3 – 46.6%, group 4 – 18.8%, P < 0.01). The clinical courses of TB in cases of non-42435 VNTR profile were severe, but without episodes of hemoptysis/pulmonary bleeding, the outcomes were much more favorable – treatment success was in 58.1 % of cases (group 3 – 40%, group 4 – 75.1%, P < 0.05), fail – 22.5 %, lost to follow-up – 11.3% (group 3 – 20%, group 4 – 3.1%, P < 0,05). 8,1% of patients died, with no difference depend on the patient`s age, P < 0,05. CONCLUSION: Beijing strains with VNTR-profile 42435 are spread very fast in Ukraine and compose the cluster of virulent primary resistant strains, with severe clinical course and worst outcomes. DISCLOSURES: O. S. Konstantynovska, Kharkiv Medical Academy of Postgraduate Education: Employee, Salary; P. I. Poteiko, Kharkiv Medical Academy of Postgraduate Education: Employee, Salary; M. M. Kochuieva, Kharkiv Medical Academy of Postgraduate Education: Member, Salary; I. I. Hrek, Kharkiv Medical Academy of Postgraduate Education: Employee, Salary; A. V. Rohozhin, Kharkiv Medical Academy of Postgraduate Education: Employee, Salary; O. S. Solodiankin, National Scientific Center “Institute for Experimental and Clinical Veterinary Medicine: Employee, Salary