Heterogeneity of Mycobacterium tuberculosis Strains Circulating in Panama’s Western Region

Fermin Acosta Tuberculosis Biomarker Research Unit at Centro de Biologia Celular y Molecular de Enfermedades (CBCME) Instituto de Investigaciones Científicas y Servicios de Alta Tecnología (INDICASAT-AIP), City of Knowledge, Panama City, Panama;

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Ricardo Saldaña Hospital Materno Infantil José Domingo de Obaldía, David City, Provincia de Chiriquí, Panama;

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Sara Miranda Tuberculosis Biomarker Research Unit at Centro de Biologia Celular y Molecular de Enfermedades (CBCME) Instituto de Investigaciones Científicas y Servicios de Alta Tecnología (INDICASAT-AIP), City of Knowledge, Panama City, Panama;
Universidad Autónoma de Chiriqui (UNACHI), David City, Provincia de Chiriquí, Panama;

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Daniela Candanedo Tuberculosis Biomarker Research Unit at Centro de Biologia Celular y Molecular de Enfermedades (CBCME) Instituto de Investigaciones Científicas y Servicios de Alta Tecnología (INDICASAT-AIP), City of Knowledge, Panama City, Panama;

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Dilcia Sambrano Tuberculosis Biomarker Research Unit at Centro de Biologia Celular y Molecular de Enfermedades (CBCME) Instituto de Investigaciones Científicas y Servicios de Alta Tecnología (INDICASAT-AIP), City of Knowledge, Panama City, Panama;

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Mitchelle Morán Tuberculosis Biomarker Research Unit at Centro de Biologia Celular y Molecular de Enfermedades (CBCME) Instituto de Investigaciones Científicas y Servicios de Alta Tecnología (INDICASAT-AIP), City of Knowledge, Panama City, Panama;

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Saily Bejarano Hospital Materno Infantil José Domingo de Obaldía, David City, Provincia de Chiriquí, Panama;

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Yeraldine De Arriba Hospital Materno Infantil José Domingo de Obaldía, David City, Provincia de Chiriquí, Panama;

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Angel Reigosa Hospital Materno Infantil José Domingo de Obaldía, David City, Provincia de Chiriquí, Panama;

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Elizabeth De Dixon Hospital Materno Infantil José Domingo de Obaldía, David City, Provincia de Chiriquí, Panama;

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María Atencio Hospital Materno Infantil José Domingo de Obaldía, David City, Provincia de Chiriquí, Panama;

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Ramón Castillo Programa Regional de Tuberculosis de la Provincia de Chiriquí, Ministerio de Salud, David City, Provincia de Chiriquí, Panama

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Amador Goodridge Tuberculosis Biomarker Research Unit at Centro de Biologia Celular y Molecular de Enfermedades (CBCME) Instituto de Investigaciones Científicas y Servicios de Alta Tecnología (INDICASAT-AIP), City of Knowledge, Panama City, Panama;

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ABSTRACT.

Tuberculosis remains a challenge in both rural and urban areas. Although a majority of countries display a higher burden in urban areas compared with rural areas, Panama continues to report the highest mortality rate in Central America. Urban areas, such as Panama City, report a high tuberculosis burden, whereas Panama’s western region, including the provinces of Chiriquí, Bocas del Toro (both semiurban) and Ngäbe-Bugle (rural), show a lower burden. We aimed to identify highly transmitted Mycobacterium tuberculosis strains within rural and semiurban settings of Panama’s western region during a 3-year period (2017, 2019, 2021). We randomly selected 87 M. tuberculosis isolates from a biobank from Panama’s western region and analyzed them using allele-specific oligonucleotide polymerase chain reaction and 24-mycobacterial interspersed repetitive unit-variable number tandem repeat (MIRU-VNTR). Our results show only 11.7% (10/85) of M. tuberculosis strains identified as prevalent A-Beijing, B-Haarlem, or C-LAM Strains. We found a low prevalence of A, B, and C M. tuberculosis strains in both rural and semirural settings compared with isolates collected from the Eastern Colon Province. MIRU-VNTR genotyping revealed a high degree of diversity with no clusters with single loci variation of ≥ 2 loci. These results support the notion that tuberculosis prevalence in the rural and semiurban western region of Panama are not due to previously described highly transmitted strains but is influenced instead by other health determinants, including poor health system access and a lack of systematic transmission chain monitoring. For remote rural and semiurban settings, we recommend allocating resources to reinforce efforts to prevent tuberculosis spread.

Author Notes

Address correspondence to Amador Goodridge, Tuberculosis Biomarker Research Unit at Centro de Biología Molecular y Celular de Enfermedades, Instituto de Investigaciones Científicas y Servicios de Alta Tecnología Bldg. 208, City of Knowledge, Panama City 0843-01103, Panama. E-mail: agoodridge@indicasat.org.pa

These authors contributed equally to this work.

Financial support: This research was funded by INDICASAT-AIP Internal Grant IGI-2020. A. G. and F. A. were funded by the Sistema Nacional de Investigadores of the Secretaría Nacional de Ciencia Tecnología e Innovación (SENACYT) no. 22-2020 and grant no. 072-2022, respectively. F. A. was funded by reinsertion program scholarship Grant DDCCT no. 068-2021 of SENACYT.

Disclosure: The study was approved by Bioethics Committee of the Universidad Santander of Panama with the following Protocols: CBI-USantander-M-041-2022 and CBI-USantander-M-081-2022 (2022).

Authors’ addresses: Fermin Acosta, Daniela Candanedo, Dilcia Sambrano, Mitchelle Morán, and Amador Goodridge, Tuberculosis Biomarker Research Unit at Centro de Biologia Celular y Molecular de Enfermedades (CBCME) Instituto de Investigaciones Científicas y Servicios de Alta Tecnología (INDICASAT-AIP), City of Knowledge, Panama City, Panama, E-mails: fermin2819@gmail.com, danielacandanedo@gmail.com, ludy25305@gmail.com, mitchellemoran@gmail.com, and agoodridge@indicasat.org.pa. Ricardo Saldaña, Saily Bejarano, Yeraldine De Arriba, Angel Reigosa, Elizabeth De Dixon, and María Atencio, Hospital Materno Infantil José Domingo de Obaldía, David City, Provincia de Chiriquí, Panama, E-mails: ricardo.saldana@obaldia.sld.pa, sailyara@hotmail.com, yeraldinedearriba@gmail.com, Angelreigosa@hotmail.com, eliprdixon@gmail.com, anethg89@gmail.com. Sara Miranda, Tuberculosis Biomarker Research Unit at Centro de Biologia Celular y Molecular de Enfermedades (CBCME) Instituto de Investigaciones Científicas y Servicios de Alta Tecnología (INDICASAT-AIP), City of Knowledge, Panama City, Panama, and Universidad Autónoma de Chiriqui (UNACHI), David City, Provincia de Chiriquí, Panama, E-mail: saramirandaro@gmail.com. Ramón Castillo, Programa Regional de Tuberculosis de la Provincia de Chiriquí, Ministerio de Salud, David City, Provincia de Chiriquí, Panama, E-mail: dr.moncho@hotmail.com.

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