Intercontinental translocation of latent multidrug‐resistant tuberculosis to Australia demonstrated by whole genome sequencing

Sanjay S Gautam, Greg Haug, Louise A Cooley, Micheál Mac Aogáin and Ronan F O'Toole
Med J Aust 2019; 210 (5): . || doi: 10.5694/mja2.50044
Published online: 18 March 2019

TO THE EDITOR: In 2016, there were an estimated 490 000 cases globally of multidrug‐resistant (MDR) tuberculosis exhibiting resistance to isoniazid and rifampicin.1 The first case of MDR tuberculosis diagnosed in Tasmania occurred in 2016 in a Vietnamese‐born person. Vietnam was the second highest reported country of birth for overseas‐born patients with tuberculosis notified in Australia in 2014.2 The patient had previously tested positive for tuberculosis infection in an interferon‐γ release assay test performed in Tasmania in early 2016, but at the time, the patient was asymptomatic and had a normal chest x‐ray and a negative sputum culture. After an episode of colitis, a colon tissue biopsy specimen isolated Mycobacterium tuberculosis. Whole genome sequence of the isolate (TASMDR1), identified high confidence mutations for isoniazid, rifampicin, ethambutol and pyrazinamide, in accordance with the culture‐based drug susceptibility testing, and, in addition, it identified a mutation associated with streptomycin resistance.3

  • 1 University of Tasmania, Hobart, TAS
  • 2 Launceston General Hospital, Launceston, TAS
  • 3 Royal Hobart Hospital, Hobart, TAS
  • 4 Trinity College Dublin, University of Dublin, Dublin, Ireland
  • 5 La Trobe University, Wodonga, VIC



This research was supported by funding from the Royal Hobart Hospital Research Foundation (grant reference no. 17‐104). The ethics approval for this study was obtained from the Tasmanian Health and Medical Human Research Ethics Committee (approval no. H0016214).

Competing interests:

No relevant disclosures.

  • 1. World Health Organization. Global tuberculosis report, 2017. (viewed Feb 2019).
  • 2. Toms C, Stapledon R, Coulter C, Douglas P. Tuberculosis notifications in Australia, 2014. Commun Dis Intell Q Rep 2017; 41: E247–E263.
  • 3. Gautam SS, Mac Aogáin M, Cooley LA, et al. Molecular epidemiology of tuberculosis in Tasmania and genomic characterisation of its first known multi‐drug resistant case. PLoS ONE 2018; 13: e0192351.
  • 4. Walker TM, Ip CL, Harrell RH, et al. Whole‐genome sequencing to delineate Mycobacterium tuberculosis outbreaks: a retrospective observational study. Lancet Infect Dis 2013; 13: 137–146.
  • 5. Houben RM, Dodd PJ. The global burden of latent tuberculosis infection: a re‐estimation using mathematical modelling. PLoS Med 2016; 13: e1002152.


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