The high prevalence of Mycobacterium tuberculosis Beijing strain at an early age and extra-pulmonary tuberculosis cases

  • Hanifeh Erie Department of Microbiology, Ayatollah Amoli Branch, Islamic Azad University, Amol, Iran
  • Hami Kaboosi Department of Microbiology, Ayatollah Amoli Branch, Islamic Azad University, Amol, Iran
  • Naeme Javid Department of Microbiology, Golestan University of Medical Sciences, Gorgan, Iran
  • Hesamaddin Shirzad-Aski Infectious Diseases Research Center, Golestan University of Medical Sciences, Gorgan, Iran
  • Masoumeh Taziki Tuberculosis Laboratory Center, Golestan University of Medical Sciences, Gorgan, Iran
  • Maya Babaee Kuchaksaraee Department of Microbiology, Golestan University of Medical Sciences, Gorgan, Iran
  • Ezzat Allah Ghaemi Department of Microbiology, Golestan University of Medical Sciences, Gorgan, Iran; Laboratory Sciences Research Center, Golestan University of Medical Sciences, Gorgan, Iran
Keywords: Mycobacterium tuberculosis, Beijing, Pulmonary tuberculosis, Extra-pulmonary tuberculosis, Real-time PCR


Background and Objectives: Tuberculosis (TB) is still responsible for a wide range of deaths worldwide. Beijing genotype is one of the most important and virulent strains in Mycobacterium tuberculosis. This study was designed for determination Beijing genotypes of M. tuberculosis in Golestan province, north of Iran.Materials and Methods: In the current descriptive study, 238 clinical MTB isolates, obtained from patients with pulmonary and extra-pulmonary TB in north of Iran, were evaluated. Oligonucleotide primers for the Beijing and non-Beijing genotypes and specific probes for their detection by a real-time PCR method were employed. In addition, an association between the Beijing genotype and possible clinical and demographic factors was evaluated.Results: The method revealed that 33 cases (13.9%) were the Beijing lineage and 205 (86.1%) the non-Beijing genotype. The mean age of patients infected with the Beijing and non-Beijing strains was 37.27 ± 18.3 and 51 ± 21.2 years, respectively; the difference was statistically significant (P = 0.001). In addition, the prevalence of the Beijing strain decreased with age. Patients with a TB infection caused by the Beijing genotype were also more vulnerable to treatment failure. Based on the origin of the samples, the Beijing genotype was more often observed in extra-pulmonary samples compared with Pulmonary ones (P = 0.001).Conclusion: The Beijing genotype of MTB is prevalent in our region especially among young people which could indicate the risk of further expansion in the future.


World Health Organization. Global tuberculosis report 2013. World Heal Organ. 2013 (Appia, Geneva, Switzerland: WHO Press). Available from:

Toungoussova OS, Bjune G, Caugant DA. Epidemic of tuberculosis in the former Soviet Union: social and biological reasons. Tuberculosis (Edinb) 2006; 86: 1-10.

Van Soolingen D, Qian L, de Haas PE, Douglas JT, Traore H, Portaels F, et al. Predominance of a single genotype of Mycobacterium tuberculosis in countries of east Asia. J Clin Microbiol 1995; 33: 3234-3238.

Comas I, Coscolla M, Luo T, Borrell S, Holt KE, Kato-Maeda M, et al. Out-of-Africa migration and Neolithic coexpansion of Mycobacterium tuberculosis with modern humans. Nat Genet 2013; 45: 1176-1182.

Zanini F, Carugati M, Schiroli C, Lapadula G, Lombardi A, Codecasa L, et al. Mycobacterium tuberculosis Beijing family: Analysis of the epidemiological and clinical factors associated with an emerging lineage in the urban area of Milan. Infect Genet Evol 2014; 25: 14-19.

Reed MB, Domenech P, Manca C, Su H, Barczak AK, Kreiswirth BN, et al. A glycolipid of hypervirulent tuberculosis strains that inhibits the innate immune response. Nature 2004; 431(7004): 84-87.

Glynn J, Kremer K, Borgdorff M, Rodriguez M, Glynn, Judith R, et al. Beijing/W genotype Mycobacterium tuberculosis and drug resistance. Emerg Infect Dis 2006; 12: 736-743.

Lasunskaia E, Ribeiro SCM, Manicheva O, Gomes LL, Suffys PN, Mokrousov I, et al. Emerging multidrug resistant Mycobacterium tuberculosis strains of the Beijing genotype circulating in Russia express a pattern of biological properties associated with enhanced virulence. Microbes Infect 2010; 12: 467-475.

Ebrahimi-Rad M, Bifani P, Martin C, Kremer K, Samper S, Rauzier J, et al. Mutations in putative mutator genes of Mycobacterium tuberculosis strains of the W-Beijing family. Emerg Infect Dis 2003; 9: 838-845.

Wu S, Barnes PF, Samten B, Pang X, Rodrigue S, Ghanny S, et al. Activation of the eis gene in a W-Beijing strain of Mycobacterium tuberculosis correlates with increased SigA levels and enhanced intracellular growth. Microbiology 2009; 155(Pt 4): 1272-1281.

Parwati I, van Crevel R, van Soolingen D. Possible underlying mechanisms for successful emergence of the Mycobacterium tuberculosis Beijing genotype strains. Lancet Infect Dis 2010; 10: 103-111.

Lopez B, Aguilar D, Orozco H, Burger M, Espitia C, Ritacco V, et al. A marked difference in pathogenesis and immune response induced by different Mycobacterium tuberculosis genotypes. Clin Exp Immunol 2003; 133: 30-37.

Pang Y, Song Y, Xia H, Zhou Y, Zhao B, Zhao Y. Risk factors and clinical phenotypes of Beijing genotype strains in tuberculosis patients in China. BMC Infect Dis 2012; 12: 354.

Tanveer M, Hasan Z, Siddiqui AR, Ali A, Kanji A, Ghebremicheal S, et al. Genotyping and drug resistance patterns of M. tuberculosis strains in Pakistan. BMC Infect Dis 2008; 8: 171.

Wang H, Kim H, Kim S, Kim D, Cho S-N, Lee H. Performance of a real-time PCR assay for the rapid identification of Mycobacterium species. J Microbiol 2015; 53: 38-46.

Van Soolingen D, Kremer K, Vynycky E (2003). New perspectives in the molecular epidemiology of tuberculosis. In: Mycobacteria and TB. Ed, SHE Kaufmann and H Hahn. KARGER publishing. Basel, Switzerland, pp. 17-45.

Kamerbeek J, Schouls L, Kolk A, Van Agterveld M, Van Soolingen D, Kuijper S, et al. Simultaneous detection and strain differentiation of Mycobacterium tuberculosis for diagnosis and epidemiology. J Clin Microbiol 1997; 35: 907-914.

Hillemann D, Warren R, Kubica T, Rusch-Gerdes S, Niemann S. Rapid Detection of Mycobacterium tuberculosis Beijing genotype strains by real-time PCR. J Clin Microbiol 2006; 44: 302-306.

Kong Y, Cave MD, Zhang L, Foxman B, Marrs CF, Bates JH, et al. Association between Mycobacterium tuberculosis Beijing/W Lineage strain infection and extrathoracic tuberculosis: insights from epidemiologic and clinical characterization of the three principal genetic groups of M. tuberculosis clinical isolates. J Clin Microbiol 2007; 45: 409-414.

Masjedi MR, Farnia P, Sorooch S, Pooramiri MV, Mansoori SD, Zarifi AZ, et al. Extensively drug-resistant tuberculosis: 2 years of surveillance in Iran. Clin Infect Dis 2006; 43: 841-847.

Reischl U, Pulz M, Ehret W, Wolf H. PCR-based detection of mycobacteria in sputum samples using a simple and reliable DNA extraction protocol. Biotechniques 1994;17: 844-845.

Kam KM, Yip CW, Tse LW, Wong KL, Lam TK, Kremer K, et al. Utility of mycobacterial interspersed repetitive unit typing for differentiating multidrug-resistant Mycobacterium tuberculosis isolates of the Beijing family. J Clin Microbiol 2005; 43: 306-313.

Haeili M, Darban-Sarokhalil D, Fooladi AAI, Javadpour S, Hashemi A, Siavoshi F, et al. Spoligotyping and drug resistance patterns of Mycobacterium tuberculosis isolates from five provinces of Iran. Microbiologyopen 2013;2:988-996.

Arif H, Hussain Z. Prevalence of Mycobacterium tuberculosis Beijing strains in Punjab Pakistan. Int J Curr Res Aca Rev 2014; 2: 74-82.

Niemann S, Diel R, Khechinashvili G, Gegia M, Mdivani N, Tang Y-W. Mycobacterium tuberculosis Beijing lineage favors the spread of multidrug-resistant tuberculosis in the republic of Georgia. J Clin Microbiol 2010; 48: 3544-3550.

Khosravi AD, Goodarzi H, Alavi SM, Akhond MR. Application of deletion- targeted multiplex PCR technique for detection of Mycobacterium tuberculosis Beijing strains in samples from tuberculosis patients. Iran J Microbiol 2014; 6: 330-334.

Rohani M, Farnia P, Nasab N, Moniri R, Torfeh M, Amiri M. Beijing genotype and other predominant Mycobacterium tuberculosis spoligotypes observed in Mashhad city, Iran. Indian J Med Microbiol 2009; 27: 306-310.

Lan NTN, Lien HTK, Tung LB, Borgdorff MW, Kremer K, Van Soolingen D. Mycobacterium tuberculosis Beijing genotype and risk for treatment failure

and relapse, Vietnam. Emerg Infect Dis 2003; 9: 1633-1635.

How to Cite
Erie H, Kaboosi H, Javid N, Shirzad-Aski H, Taziki M, Babaee Kuchaksaraee M, Ghaemi EA. The high prevalence of Mycobacterium tuberculosis Beijing strain at an early age and extra-pulmonary tuberculosis cases. IJM. 9(6):312-7.
Original Article(s)