JCM Accepts, published online ahead of print on 21 October 2009

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J. Clin. Microbiol. doi:10.1128/JCM.01270-09
Copyright (c) 2009, American Society for Microbiology and/or the Listed Authors/Institutions. All Rights Reserved.

PETRA – Polymorphic Exact Tandem Repeat A – A Newly Defined Lineage of Mycobacterium tuberculosis in Israel Originating Predominantly in Sub-Saharan Africa

Paul J. Freidlin^*, Drora Goldblatt, Hasia Kaidar-Shwartz, and Efrat Rorman

Ministry of Health, National Public Health Laboratory, National Mycobacterium Reference Laboratory, Tel-Aviv, Israel

^* To whom correspondence should be addressed. Email: paul.freidlin{at}phlta.health.gov.il.

As part of the Israel National Program for Prevention and Control of Tuberculosis, the molecular epidemiology of new tuberculosis cases is monitored. Prospective screening showed that about 20% of all new culture positive tuberculosis cases (43 of 222) in Israel for the year 2008 was caused by certain Mycobacterium tuberculosis strains of the central Asian (CAS) spoligotype lineage. The identity and similarity of these strains by Mycobacterial Interspersed Repetitive Units – Variable Number of Tandem Repeats (MIRU-VNTR) typing form a lineage we call PETRA, for polymorphic at locus ETR A. The name PETRA was given to 79 strains we have found since the year 2000, because the largest number of strains with MIRU-VNTR profiles identical other than at locus A, formed 3 groups including 5 of 10 strains that had deleted the ETR A region from their genomes. No PETRA strain was found to be multiple drug resistant (resistant to both isoniazid and rifampin). Most patients (75%, 58 of 77 patients of known origin) infected with PETRA were of Sub-Saharan African origins. The genotypes associated with the 79 PETRA lineage strains presented in this paper, suggest that the PETRA lineage is a large, major contributor to new tuberculosis cases in Israel.