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Origin of patients influences the epidemiology of tuberculosis in western Sweden
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Origin of patients influences the epidemiology of tuberculosis in
western Sweden
Erik SvenssonSahlgrenska University Hospital
Gothenburg, Sweden
Tuberculosis in Sweden
TB per 100.000 population
0
50
100
150
200
250
300
1911
1940
1950
1960
1970
1980
1990
2002
Deaths
Cases
Western Sweden
• 1.8 million inhabitants
• 90 TB cases/year• 5.0 /100,000 population
The study
• 357 patients 2001 – 2005• PCR-based methods
– MIRU typing 12 loci– Spoligotyping
• Comparison with the SITVIT database• Some patient data
Origins
Origin of TB-patients
27%
73%
0%
10%
20%
30%
40%
50%
60%
70%
80%
Sweden Abroad
Regions
0
20
40
60
80
100
120
Africa Asia Europe Middle-East SouthAmerica
Sweden
46 countriesS
WE
SO
MY
UG
IRQ
VN
MA
FGB
IHE
THIR
NP
HL
FIN
THA
PA
KR
OU
TUR
AZE
ER
IIN
DA
LBB
OL
BR
AC
HL
CH
NH
RV
KE
NM
AC
SLV
BD
ID
EU
GB
RH
UN
IDN
IRL
LAO
LBN
MA
RM
NE
MN
GN
GA
NZL
PO
LS
DN
SLE
SY
RU
GA
UK
R
0
10
20
30
40
50
60
70
80
90
100
SWE
SOM YUG
IRQ VNM AFG
BIH ETH IRN PHL FIN THA
PAK
ROU
TUR
AZE ERI
IND ALB
BOL
BRA
CHL
CHN
HRV
KEN
MAC SLV
BDI
DEU
GBR
HUN IDN IRL LAO
LBN
MAR
MNE
MNG
NGA
NZL
POL
SDN
SLE
SYR
UGA
UKR
Manifestation of disease
Gender
Per
cent
of T
otal
0
20
40
60
Female Male
Abroad
Female Male
Sweden
Age and gender
Age
Num
ber o
f cas
es
0
10
2030
40
0 20 40 60 80 100
FemaleAbroad
MaleAbroad
FemaleSweden
0 20 40 60 80 100
0
10
20
3040
MaleSweden
Organs
Pulmonary only vs. any extrapulmonary manifestation
Num
ber o
f cas
es
0
50
100
Extrapulm Lung
Abroad
Extrapulm Lung
Sweden
Genotypes
MIRU and spoligotyping
• 298 MIRU+spoligo-patterns• 25% form clusters• 30 different clusters
PP07
Principal Genetic Groups, PGG
• Reflect evolutionary age
• PGG1 – phylogenetically older Beijing, EAI, CAS, MANU, Bovis
• PGG2/3 – youngerHaarlem, LAM, X, S, T, H37Rv, unclassified
Genogroup and region of birth
Genogroup
Cas
es
0
20
40
60
80
PGG1 PGG2
Africa Asia
PGG1 PGG2
Europe
Middle-East
PGG1 PGG2
South America
0
20
40
60
80Sweden
The origin of the patients influences the epidemiology of tuberculosis in
western Sweden
• Number of patients• Clinical picture• Different distribution of genotypes
Thanks
• Pasteur Institute de la Guadeloupe– Nalin Rastogi– Julie Millet
• University of Gothenburg – Malin Ridell, Christina Welinder-Olsson, Line
Salvesen, Kerstin Florén, Eva Kjellin, Liselott Svensson, Anna Karlsson
• Transmission control unit in Gothenburg– Martin Wahl, Anna Lindqvist, Margareta Olsson,
Leif Dotevall
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