Determining the phylogenetic relationships of mycobacterium tuberculosis complex strains isolated from Turkish Republic citizens and foreign patients with pulmonary tuberculosis by miru-;VNTR and spoligotyping

Pulmonary tuberculosis is one of the major diseases threatening public health, especially in developing countries, despite efforts to prevent, control and treat by medication for more than 70 years.Tuberculosis, which has reached a high incidence in societies with low socioeconemic nutritional and hygienic conditions, has become a serious threat for welfare societies in developed countries after HIV infections, which have turned into a pandemic in the world since the 90's. Irrational use of anti-tuberculosis drugs in treatment, due to the inability to be tolerated by patients, delayed diagnosis and treatment due to insufficiency in the diagnosis of tuberculosis, especially in endemic developing countries and eventually the patient's inaccessibility provoked drug resistance against anti-tuberculosis in Mycobacterium tuberculosis complex (MTBC) strains This development, which started with a single drug resistance, resulted in the emergence of XDR (Extensively Drug Resistant) strains resistant to all major and minor drugs. Today, the new name of the TB threat is MDR, XDR-MTB. The emerging events experienced in the last 7 years in our region, especially in neighboring countries, have caused human movements to a large extent in these countries as well as misery. In this context, our country which receives the highest number of immigrants, especially the Cukurova region, is also have an important potential for health problems caused by immigration movements. In this study, the effects of migration on strain diversity and prevalence of MTBC, which are easily spread among the masses of people in war, poverty and poor hygiene conditions, were examined at the genotype level. We aimed to determine the genotype level by using microbead based spoligotyping and MIRU-VNTR methods; to be able to show the success of ongoing tuberculosis protection and control programs in our region and the effects of outsourced human movements on clonal diversity of MTBK strains in the region and also to reveal possible relationship between clones and patient origin by MTBK strains isolated from clinical materials belonging to TR citizens and Syrian pulmonary tuberculosis patients. In this study we included 100 MTBC strains, isolated from clinical samples of patients with pulmoner tuberculosis and/or suspected contact cases, which were sent to TR Health Ministery of Publich Health Institution Adana Regional Tuberculosis Laboratory that is affiliated to Çukurova University Tropical Disease Research and Application Center from eight city hospitals and Tuberculosis dispensaries. Included 59 and 41 strains were belong to Turkish republic citizens and Syrian patients, respectively. We evaluated these clinical isolates for clonal relation with MIRU-VNTR and TB-SPRINT methods using micro beads. Our isolates included in the study showed that a total of 32 different spoligotype profiles, of which 74 (75.5%) were distributed to 8 clusters with multiple members and 24 strains were unique profiles. Among the Turkish and Syrian patients' clinical samples, the major spoligo family was T1 with 28/59 (47.5%) and 17/39 (43.6%) isolates, also we observed that the TUR family with 17/59 (28.8%) and 11/39 (28.2%) members, respectively. On the other hand, we identified 71 different MIRU-VNTR patterns, in which our strains were distributed to 10 clusters with multiple members using the MIRU-VNTR method. At the end of our evaluation of the general epidemiological findings of the clonal distribution; patient isolates of both nationalities have similar clonal properties. There are a few different clones in Syrian nationals that were not seen among Turkish citizens and also among Syrian patient isolates were not seen in Turkish citizens samples, however, due to the low number of these clones, it is not possible to say that new clones have been moved to the our region. Our research has the index study feature and it is believed that more precise results will be obtained about the movement of MTBC strains in our region, when our results compare with results that will be generated from the periodically repeated long term surveillance studies.