Molecular epidemiology of tuberculosis in Cambodian children

Abstract

SUMMARY We analysed Mycobacterium tuberculosis strains from children, hospitalized from January 2004 to July 2008 in the largest paediatric hospital complex in Cambodia. Specimens were tested for drug susceptibility and genotypes. From the 260 children, 161 strains were available. The East African-Indian genotype family was the most common (59.0%), increasing in frequency with distance from the Phnom Penh area, while the frequency of the Beijing genotype family strains decreased. The drug resistance pattern showed a similar geographical gradient: lowest in the northwest (4.6%), intermediate in the central (17.1%), and highest in the southeastern (30.8%) parts of the country. Three children (1.9%) had multidrug-resistant tuberculosis. The Beijing genotype and streptomycin resistance were significantly associated (P < 0.001). As tuberculosis in children reflects recent transmission patterns in the community, multidrug resistance levels inform about the current quality of the tuberculosis programme.

Keywords: tuberculosis (TB).

Fig. 1.

Map of Cambodia with 24 provinces/municipalities. Light grey shading: Siem Reap group; intermediate grey shading: Kampong Thom; dark grey shading: Phnom Penh group of provinces. The location of the Jayavarman VII Hospital in Siem Reap province is shown as a solid symbol (●). Cambodia, Kantha Bopha hospitals, 1 January 2004 to 15 July 2008.

Fig. 2.

Prevalence of drug resistance, against any drug, streptomycin, and isoniazid, by province group of patient's provenance. Symbols (circles, squares, diamonds) are point estimates; vertical lines denote 95% confidence intervals. Numbers in parentheses are number of child strains. Cambodia, Kantha Bopha hospitals, 1 January 2004 to 15 July 2008.