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 Table of Contents  
Year : 2014  |  Volume : 3  |  Issue : 1  |  Page : 41-45

Prevalence of Beijing family in Mycobacterium tuberculosis in world population: Systematic Review and Meta-Analysis

1 Cellular * Molecular Research Center and Microbiology Department, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
2 Center for Prevention of Psychosocial Trauma, Ilam University of Medical Science, Ilam, Iran

Date of Web Publication24-Feb-2017

Correspondence Address:
Rashid Ramazanzadeh
Cellular $ Molecular Research Center and Microbiology Department, Faculty of Medicine, Kurdistan University of Medical Sciences, Pasdaran Street, Post cod. 6177-13446 Sanandaj
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Source of Support: None, Conflict of Interest: None

DOI: 10.1016/j.ijmyco.2014.01.001

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Background: In this present study we decided to consider the prevalence and distribution of Beijing family in the world using meta-analysis based on systematic review of articles published and relation with drug resistance, which will provide more detailed information to clearly overview the status of this family and transmission of TB.
Methods: This study used the most available article published in literature database including PubMed, Science direct, Web of Science, Google Scholar, Biological abs, Iranmedex, and SID systematically reviewed prevalence of Beijing family. Data analyzed using meta-analysis with random effects models.
Results: Final analyses included 264 samples that have been selected from 2811 studies. Overall Beijing family prevalence in world was estimated to be 33.2% (95% CI 31.4–35.2). Corresponding estimates by continent were Asia 44.7% (39.5–49.8), Europe 27.9% (25.6–30.1), Africa 12×5% (8.9–16.2), and America 8.9% (6.9–10.9). In all world regions, Beijing families were associated with drug resistance 81.37%.
Conclusions: According to the results, prevalence of Beijing family in Asia is higher than similar studies in other parts of the world and this family is associated with drug resistance. Effective control program is needed in world to control the spread of drug resistance strains specially Beijing family.

Keywords: Beijing, M. tuberculosis, Prevalence, Meta-analysis

How to cite this article:
Ramazanzadeh R, Sayhemiri K. Prevalence of Beijing family in Mycobacterium tuberculosis in world population: Systematic Review and Meta-Analysis . Int J Mycobacteriol 2014;3:41-5

How to cite this URL:
Ramazanzadeh R, Sayhemiri K. Prevalence of Beijing family in Mycobacterium tuberculosis in world population: Systematic Review and Meta-Analysis . Int J Mycobacteriol [serial online] 2014 [cited 2022 Dec 1];3:41-5. Available from: https://www.ijmyco.org/text.asp?2014/3/1/41/200924

  Introduction Top

Tuberculosis (TB) is a major health problem in the world, and based on the World Health Organization (WHO) report the prevalence of TB is 1.7 million cases and the incidence rate is 9.27 million cases globally as of 2007 [1]. The emergence of multidrug-resistant tuberculosis (MDR-TB) is going to worsen this problem and is a threat to infectious disease.

TB has been caused by Mycobacterium tuberculosis (MTB). These bacteria are slow growth and need a well-equipped laboratory for culture and diagnosis. Culture and diagnose of TB agents are cumbersome and difficult. Therefore, molecular methods are of great importance in permitting both rapid diagnosis and genotyping.

Spoligotyping is a polymerase chain reaction (PCR)-based method that was introduced by Kamerbeek in 1997 [2] and can be used directly for clinical samples without culture. This technique detects polymorphism in the chromosomal direct repeat locus in order to diagnose and type the MTB complex.

This method has been used to type isolates in several families, including Beijing, EAI, Haarlem, Lam, T, U, S, X and several others [3],[4]. Based on reports, spoligotypes have their own geographical distribution and specifications [4],[5]. One of the most important of them is the Beijing family, published from Beijing, China, since 1995. However, there are many reports from other parts of the world [6],[7],[8]. The Beijing families of MTB are associated with drug resistance and induce more severe forms of TB and generally have a higher treatment failure and relapse than others [6],[9],[10],[11],[12],[13],[14],[15],[16],[17],[18],[19],[20],[21].

In this present study, it was decided to consider the prevalence and distribution of the Beijing family in the world using meta-analysis based on a systematic review of articles published between 1997 and 2012. The alternate aim is the relation with drug resistance and relevant estimates based on continent estimation and distribution, which will provide more detailed information to clearly overview the status of this family and transmission of TB.

  Materials and methods Top

Literature identification

The available international and domestic literature database, which includes PubMed, Sciencedirect, Web of Science, Google Scholar, Biological abs, Iranmedex, and SID, has been searched for studies that report the prevalence of the Beijing family, published in English or the Persian language. The original articles were screened by using the key words tuberculosis, Beijing, Molecular epidemiology and Spoligotyping in combinational or individual formats.

Inclusion and exclusion criteria

Studies reporting the prevalence of the Beijing family were considered. In duplicate articles, the evaluation of the date was considered. Excluded studies included review articles, congress abstracts, studies reported in languages other than English or Persian, and studies that were not available in abstract or full text. Two reviewers searched independently. When there were disagreements between them in the selection of articles, they discussed their concerns regarding its selection for the study.

Data extraction

The following data were extracted from the original publications: first author and year of publication, association with drug resistance, literature database, and study enrollment time and population, prevalence of the Beijing family, source type (abstract or full text), and association with drug resistance.

Statistical analysis

Prevalence of the Beijing family of TB in all of the studies was chosen as the main outcome. The variance of prevalence was computed using binomial distribution. There was heterogeneity among studies. I2 and Q statistics tests were used to check heterogeneity among studies. Meta-analyses with random effect model was applied to combine prevalence among studies. Meta-analyses were carried out using Stata ver. 10. Stratified analyses were subsequently performed with respect to the geographic areas and the drug-resistant TB among the Beijing family isolates [20]. Random effects models were used, taking into account the possibility of heterogeneity between studies, which were tested with the Q test and the I2 test. Subgroup analyses were assessed by chi-square tests for continents.

Ethical approval

This study project was approved by the Kurdistan University of Medical Science, scientific board research committee.

  Results Top

In the primary search, 2811 published articles have been saved in literature by using key word combinations. Articles that have no information about prevalence or extractable date were excluded, and finally 264 articles were selected for evaluation ([Table 1]). Out of the 264 articles, 6 were in Persian and the rest were in English.
Table 1: Total searched and selected publication based on available sites in internet.

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In the total of 264 studied articles, the prevalence was 0.33% in 118,348 as indicated in (Table 2).
Table 2: Association of Beijing family with drug resistance based on continents.

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In considering prevalence based on continent, the Beijing family is prevalent in Asia 47.91%, as indicated in (Table 3).
Table 3: Drug resistance association with Beijing family based on study place (country).

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There was an association between drug resistance and prevalence of the Beijing family in the total continents of 81.6 % (Table 2).

In most countries, the same rate of association in relation to drug resistance was present (Table 3).

There are more reports from China (31.20%) among Asian countries, and Iran was (14.40%) as indicated in [Table 4]
Table 4: Distribution of reports in Asian countries.

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  Discussion Top

This study includes the most recent research with regard to the prevalence of TB in the world health population. The importance of TB and the Beijing family is evident for all scientists. The spreading of the Beijing family among different nationalities and the dynamics of transmission is helpful for tracking and designing a program for the control of TB. As shown in [Table 1] and 264 articles were identified for meta-analysis. The difference in percent in the database is logic based on specialists in publishing medical journals and publicity. A search using Endnote software was used and overlap studies were deleted. Therefore, some database sites such as Pubmed (31.1%) (28.3–33.8) has more published articles on TB.

Molecular epidemiology establishes a dynamic of transmission of infectious disease. Several molecular techniques are used to fingerprint microbial agents. For M. tuberculosis, spoligotyping has been used extensively in the world and database SPODB has been established in order to trace the migration and dissemination of M. tuberculosis complex in a given population. Spoligotyping is better than other molecular methods in that data can be shared between laboratories. There are a lot of families in the M. tuberculosis complex, and the best known among them is the Beijing family. The meta-analysis prevalence of this family is 33.3% (31.4–35.2%). The extreme data was excluded by statistical analysis. This type was more prevalent in Asia (44.7%) and lowest in America (8.9%). In published meta-analysis literature, the prevalence rate was the same, especially in Asian countries [5]. The present study is an update used to revise the vision of the prevalence of TB in the world. In this regard, a glance at the data indicates that the prevalence from Asia to America was diminished in transmission. The Beijing family originated from China; therefore, it is not surprising that the highest rate has been reported from this region. In contrast, America is far from the origin of emergence, so it is logical that the low prevalence of this type is predictable.

The association of antibiotic resistance and the prevalence of the Beijing family is controversial. There are a lot of reports with regard to the relation of the Beijing family and its association with drug resistance [22],[23],[24]. On the other hand, some studies reported no correlation of drug resistance and the Beijing family [25],[26],[27]. This study considered all articles and analyzed them statistically, as shown in [Table 2] and [Table 3]) in the overall Beijing family associated with drug resistance. Overall, 81.60% were associated with drug resistance. Although there is a difference in the number of reports from the four continents, the percent is nearly the same in all. As indicated in the [Table 2] and [Table 3], the highest rates were reported from China and Russia. In previous meta-analysis done by 16 studies, the relationship with drug resistance was restricted to some regions, not all of the world [5]. In this review, 264 studies were selected for analysis; therefore, the impact of this statistical analysis with regard to drug resistance association should weigh heavily against the total number of published reports.

In conclusion, the prevalence of the Beijing family in the world population and its association with drug-resistance has been summarized in this systematic review. The results of this study indicate the dynamics of transmission of the Beijing family and its association with drug resistance, and this information should improve the vision concerning TB in the world population.

  Acknowledgment Top

This is part of our project. The authors wish to extend their gratitude to the Research Deputy of Kurdistan University of Medical Sciences for financial support.

  References Top

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