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