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Komakech K, Nakiyingi L, Fred A, Achan B, Joloba M, Kirenga BJ, Ssengooba W. Effect of mixed Mycobacterium tuberculosis infection on rapid molecular diagnostics among patients starting MDR-TB treatment in Uganda. BMC Infect Dis 2024; 24:70. [PMID: 38200467 PMCID: PMC10782568 DOI: 10.1186/s12879-023-08968-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 12/30/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Mixed M. tuberculosis (MTB) infection occurs when one is infected with more than one clonally distinct MTB strain. This form of infection can assist MTB strains to acquire additional mutations, facilitate the spread of drug-resistant strains, and boost the rate of treatment failure. Hence, the presence of mixed MTB infection could affect the performance of some rapid molecular diagnostic tests such as Line Probe Assay (LPA) and GeneXpert MTB/RIF (Xpert) assays. METHODS This was a cross-sectional study that used sputum specimens collected from participants screened for STREAM 2 clinical trial between October 2017 and October 2019. Samples from 62 MTB smear-positive patients and rifampicin-resistant patients from peripheral health facilities were processed for Xpert and LPA as screening tests for eligibility in the trial. From November 2020, processed stored sputum samples were retrieved and genotyped to determine the presence of mixed-MTB strain infection using a standard 24-locus Mycobacterial Interspersed Repetitive Unit-Variable Number Tandem-Repeat (MIRU-VNTR). Samples with at least 20/24 MIRU-VNTR loci amplified were considered for analysis. Agar proportional Drug Susceptibility Test (DST) was performed on culture isolates of samples that had discordant results between LPA and Xpert. The impact of the presence of mixed-MTB strain on Xpert and LPA test interpretation was analyzed. RESULTS A total of 53/62 (85%) samples had analyzable results from MIRU-VNTR. The overall prevalence of mixed-MTB infection was 5/53 (9.4%). The prevalence was highest among male's 3/31 (9.7%) and among middle-aged adults, 4/30 (33.3%). Lineage 4 of MTB contributed 3/5 (60.0%) of the mixed-MTB infection prevalence. Having mixed MTB strain infection increased the odds of false susceptible Xpert test results (OR 7.556, 95% CI 0.88-64.44) but not for LPA. Being HIV-positive (P = 0.04) independently predicted the presence of mixed MTB infection. CONCLUSIONS The presence of mixed-MTB strain infection may affect the performance of the GeneXpert test but not for LPA. For patients with high pre-test probability of rifampicin resistance, an alternative rapid method such as LPA should be considered.
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Affiliation(s)
- Kevin Komakech
- Department of Medical Microbiology, Mycobacteriology (BSL-3) Laboratory, Makerere University, Kampala, Uganda
| | - Lydia Nakiyingi
- Department of Medicine, School of Medicine, Makerere University, Kampala, Uganda
| | - Ashab Fred
- Department of Immunology and Molecular Biology, Makerere University, Kampala, Uganda
| | - Beatrice Achan
- Department of Medical Microbiology, Mycobacteriology (BSL-3) Laboratory, Makerere University, Kampala, Uganda
| | - Moses Joloba
- Department of Immunology and Molecular Biology, Makerere University, Kampala, Uganda
| | - Bruce J Kirenga
- Makerere University Lung Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - Willy Ssengooba
- Department of Medical Microbiology, Mycobacteriology (BSL-3) Laboratory, Makerere University, Kampala, Uganda.
- Makerere University Lung Institute, Makerere University College of Health Sciences, Kampala, Uganda.
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Komakech K, Nakiyingi L, Fred A, Achan B, Joloba M, Kirenga BJ, Ssengooba W. Effect of mixed Mycobacterium tuberculosis infection on rapid molecular diagnostics among patients starting MDR-TB treatment in Uganda. RESEARCH SQUARE 2023:rs.3.rs-3324330. [PMID: 37841871 PMCID: PMC10571598 DOI: 10.21203/rs.3.rs-3324330/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2023]
Abstract
Background We evaluated the effect of mixed-MTB strain infection on the performance of Line Probe Assay (LPA) and GeneXpert MTB/RIF (Xpert) assays among patients initiating MDR-TB treatment in Uganda. Methods This was a cross-sectional study using sputum specimens collected from participants screened for STREAM 2 clinical trial between October 2017 and October 2019. Samples from 62 MTB smear-positive patients and rifampicin-resistant patients from the peripheral health facilities were processed for Xpert and LPA as screening tests for eligibility in the trial. From November 2020, processed stored sputum samples were retrieved and genotyped to determine the presence of mixed-MTB strain infection using a standard 24-locus Mycobacterial Interspersed Repetitive Unit-Variable Number Tandem-Repeat (MIRU-VNTR). Samples with at least 20/24 MIRU-VNTR loci amplified were considered for analysis. Agar proportional Drug Susceptibility Test (DST) was performed on culture isolates of samples that had discordant results between LPA and Xpert. The impact of the presence of mixed-MTB strain on Xpert and LPA test interpretation was analyzed. Results A total of 53/62 (85%) samples had analyzable results from MIRU-VNTR. The overall prevalence of mixed-MTB infection was 5/53 (9.4%). The prevalence was highest among males 3/33 (9.7%) and among middle-aged adults, 4/30 (13.3%). Lineage 4 of MTB contributed 3/33 (9.1%) of the mixed-MTB infection prevalence. Having mixed MTB strain infection increased the odds of false susceptible Xpert test results (OR 7.556, 95% CI 0.88-64.44) but not for LPA. Being HIV-positive (P=0.04) independently predicted the presence of mixed MTB infection. Conclusions The presence of mixed-MTB strain infection may affect the performance of the GeneXpert test but not for LPA. For patients with high pre-test probability of rifampicin resistance, an alternative rapid method such as LPA should be considered.
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Affiliation(s)
| | | | | | | | | | - Bruce J Kirenga
- Makerere University Lung Institute, Makerere University College of Health Sciences
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Esmael A, Abebe T, Mihret A, Mussa D, Neway S, Ernst J, Rengarajan J, Wassie L, Howe R. Mycobacterium tuberculosis antigen-specific T cell responses in smear- negative pulmonary tuberculosis patients. Clin Exp Immunol 2022; 209:99-108. [PMID: 35552657 PMCID: PMC9307235 DOI: 10.1093/cei/uxac049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 04/28/2022] [Accepted: 05/09/2022] [Indexed: 11/12/2022] Open
Abstract
Despite recent improvements in microbial detection, smear negative TB remains a diagnostic challenge. In this study, we investigated the potential discriminatory role of polychromatic flow cytometry of M. tuberculosis antigen-specific T cells to discriminate smear negative TB from health controls with or without latent TB infection, and non-TB respiratory illnesses in an endemic setting. A cross-sectional study was conducted on HIV negative, newly diagnosed smear-positive PTB (n=34), smear-negative/Gene Expert negative PTB (n=29) patients, non-TB patients with respiratory illness (n=33) and apparently healthy latent TB infected (n = 30) or non-infected (n = 23) individuals. The expression of activation (HLA-DR, CD-38), proliferation (Ki-67) and functional (IFN-γ, TNF-α) T cell markers using polychromatic flow cytometry was defined after stimulation with PPD antigens. Sputum samples were collected and processed from all patients for Mtb detection using a concentrated microscopy, LJ/MGIT culture, and RD9 typing by PCR. Our study showed CD4 T cells specific for PPD co-expressed activation/proliferation markers together with induced cytokines IFNγ or TNFα were present at substantially higher levels among patients with smear positive and smear negative pulmonary TB than among healthy controls and to a lesser extent among patients with non-TB illness. Our study conclude that Smear negative TB can be distinguished from non-TB respiratory illness and healthy controls with a flow cytometric assay for PPD-specific T cells co-expressing activation/proliferation markers and cytokines.
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Affiliation(s)
- Ahmed Esmael
- Department of Medical Laboratory Science, College of Health Sciences, Debre Markos University, Ethiopia.,Department of Microbiology, Immunology and Parasitology, College of Health Sciences, Addis Ababa University, Ethiopia.,Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Tamrat Abebe
- Department of Microbiology, Immunology and Parasitology, College of Health Sciences, Addis Ababa University, Ethiopia
| | - Adane Mihret
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Daniel Mussa
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Sebsib Neway
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Joel Ernst
- Division of Experimental Medicine, University of California San Francisco, San Francisco, California, USA
| | - Jyothi Rengarajan
- Department of Medicine, Division of Infectious Diseases and Emory Vaccine Center, Emory University School of Medicine, Emory University, Atlanta, Georgia, USA
| | - Liya Wassie
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Rawleigh Howe
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
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Mahero MW, Pelican KM, Waila JM, Namusisi S, Rwego IB, Kajura C, Nyatuna C, Boulware DR, Hartter J, Mugisha L, Robertson C, Travis DA. "There are many fevers": Communities' perception and management of Febrile illness and its relationship with human animal interactions in South-Western Uganda. PLoS Negl Trop Dis 2022; 16:e0010125. [PMID: 35192636 PMCID: PMC8929701 DOI: 10.1371/journal.pntd.0010125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 03/17/2022] [Accepted: 12/22/2021] [Indexed: 11/19/2022] Open
Abstract
Diagnosing the causative agent of febrile illness in resource-limited countries is a challenge in part due to lack of adequate diagnostic infrastructure to confirm cause of infection. Most febrile illnesses (>60%) are non-malarial, with a significant proportion being zoonotic and likely from animal origins. To better characterize the pathways for zoonotic disease transmission and control in vulnerable communities, adequate information on the communities' experiences and lexicon describing fever, and their understanding and perceptions of risk pathways is required. We undertook an ethnographic study to understand behaviors, exposures, and attitudes toward fever at the community level. Our hope is to better elucidate areas of priority surveillance and diagnostic investment. A focused ethnography consisting of participant observation, informal conversations, 4 barazas (community meetings), and formal ethnographic interviews (13 Focus group discussions and 17 Key informant interviews) was conducted between April and November 2015 in Kasese and Hoima Districts in Uganda. Perception of illness and associated risk factors was heavily influenced by the predominant livelihood activity of the community. The term "fever" referred to multiple temperature elevating disease processes, recognized as distinct pathological occurrences. However, malaria was the illness often cited, treated, or diagnosed both at the health facilities and through self-diagnosis and treatment. As expected, fever is as an important health challenge affecting all ages. Recognition of malarial fever was consistent with a biomedical model of disease while non-malarial fevers were interpreted mainly through ethno etiological models of explanation. These models are currently being used to inform education and prevention strategies and treatment regimens toward the goal of improving patients' outcomes and confidence in the health system. Development of treatment algorithms that consider social, cultural, and economic contexts, especially where human-animal interaction is prevalent, should factor animal exposure and zoonotic illnesses as important differentials.
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Affiliation(s)
- Michael Wandanje Mahero
- Department of Veterinary Population Medicine, University of Minnesota, St. Paul, Minnesota United States of America
| | - Katherine M. Pelican
- Department of Veterinary Population Medicine, University of Minnesota, St. Paul, Minnesota United States of America
| | - Jacinta M. Waila
- Makerere University, School of Public Health, Kampala, Uganda
- College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, Kampala, Uganda
| | - Shamilah Namusisi
- Makerere University, School of Public Health, Kampala, Uganda
- College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, Kampala, Uganda
| | - Innocent B. Rwego
- Department of Veterinary Population Medicine, University of Minnesota, St. Paul, Minnesota United States of America
- College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, Kampala, Uganda
| | | | | | - David R. Boulware
- Dept. of Medicine, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Joel Hartter
- Environmental Studies Program, University of Colorado, Boulder, Colorado, United States of America
| | - Lawrence Mugisha
- College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, Kampala, Uganda
- EcoHealth Research Group, Conservation & Ecosystem Health Alliance (CEHA), Kampala, Uganda
| | - Cheryl Robertson
- School of Nursing, University of Minnesota, Minneapolis, Minnesota, USA United States of America
| | - Dominic A. Travis
- Department of Veterinary Population Medicine, University of Minnesota, St. Paul, Minnesota United States of America
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Madut NA, Muleme J, Kankya C, Nasinyama GW, Muma JB, Godfroid J, Jubara AS, Muwonge A. The Epidemiology of Zoonotic Brucellosis in Bahr el Ghazal Region of South Sudan. Front Public Health 2019; 7:156. [PMID: 31297365 PMCID: PMC6607442 DOI: 10.3389/fpubh.2019.00156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Accepted: 05/28/2019] [Indexed: 11/13/2022] Open
Abstract
Background: In this study, we focused on three zoonotic brucellosis risk groups; abattoir workers, febrile cases at Wau hospital and cattle herders, in Bahr el Ghazal region, South Sudan. Competitive c-ELISA was used to detect anti-Brucella antibodies in 725 individuals between December 2015 and May 2016. In addition, questionnaire metadata, focus group discussions and key informant interviews were used to characterize the epidemiology of zoonotic brucellosis in this region. Results: Overall, we estimate 27.2 % (95% CI = 23.9-30.6) brucellosis sero-prevalence; 32.1% (95% CI = 26.2-38.4), 23.0% (95% CI = 19.1-27.4) and 34.6% (95% CI = 24.4-46.3) among abattoir workers, febrile cases, and herders, respectively. Marital status (Single, OR = 0.58, 95%CI: 0.36-0.91, P = 0.02) and ethnicity (Kerash OR = 6.01, 95%CI: 1.97-21.10, P = 0.003 and Balanda, OR = 3.78, 95%CI: 1.42-12.02, P = 0.01) were associated with brucellosis. While gender and ethnicity were important factors for general awareness of zoonotic diseases. Highly ranked occupations at risk included veterinarian, butchers and milk handlers. We also identified covariate patterns for clinical diagnostics and public health interventions. Conclusion: We report the highest sero-prevalence of zoonotic brucellosis in three risk groups in the East African region. All this is not only occurring in a population with limited awareness that brucellosis is a zoonotic disease but also where one in nine health workers tested was sero-positive. We identified social demographic associations with brucellosis, however, the qualitative analysis suggests these are more complex and nuanced. Therefore, future studies could benefit from the use of the mixed methods approach to add extensiveness and depth to our understanding of zoonotic disease drivers, in order to implement mitigating measures such as cattle vaccination.
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Affiliation(s)
- Nuol Aywel Madut
- Department of Clinical Studies, Faculty of Veterinary Science, University of Bahr el Ghazal, Wau, South Sudan.,Department of Biosecurity, Ecosystems & Veterinary Public Health (BEP), College of Veterinary Medicine Animal Resources & Biosecurity (COVAB), Makerere University, Kampala, Uganda
| | - James Muleme
- Department of Biosecurity, Ecosystems & Veterinary Public Health (BEP), College of Veterinary Medicine Animal Resources & Biosecurity (COVAB), Makerere University, Kampala, Uganda.,Department of Disease Control and Environmental Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Clovice Kankya
- Department of Biosecurity, Ecosystems & Veterinary Public Health (BEP), College of Veterinary Medicine Animal Resources & Biosecurity (COVAB), Makerere University, Kampala, Uganda
| | - George William Nasinyama
- Department of Biosecurity, Ecosystems & Veterinary Public Health (BEP), College of Veterinary Medicine Animal Resources & Biosecurity (COVAB), Makerere University, Kampala, Uganda
| | - John Bwalya Muma
- Department of Disease Control, School of Veterinary Medicine, University of Zambia, Lusaka, Zambia
| | - Jacques Godfroid
- Department of Arctic and Marine Biology, Faculty of Biosciences, Fisheries and Economics, University of Tromsø - The Arctic University of Norway, Tromsø, Norway
| | - Ambrose Samuel Jubara
- Department of Clinical Studies, Faculty of Veterinary Science, University of Bahr el Ghazal, Wau, South Sudan
| | - Adrian Muwonge
- Division of Genetics and Genomics, The Roslin Institute, University of Edinburgh, Edinburgh, United Kingdom
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Sobe Jermano Boyong C, Kankya C, James M, Munyeme M, Jubara AS, Ndoboli D, Ekuka G, Muwonge A. Dynamics of tuberculosis in Wau, South Sudan during a period of armed conflict. J Clin Tuberc Other Mycobact Dis 2018; 12:54-65. [PMID: 31720400 PMCID: PMC6830182 DOI: 10.1016/j.jctube.2018.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Revised: 04/10/2018] [Accepted: 06/05/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND South Sudan has endured decades of armed conflict, with the most recent in 2016. This has left the health system and infrastructure overstretched by a myriad of infectious diseases like tuberculosis. Our study aimed at quantitatively and qualitatively documenting TB dynamics and challenges with access to health care during a period of civil unrest in Wau. MATERIALS & METHODS A cross sectional study was carried out between January and February 2016 at Wau Teaching Hospital (WTH). Sputum was randomly collected from 207 of the 1035 TB suspects and analyzed using Ziehl-Neelsen (ZN) and Fluorescent Microscopy (FM), Culture, Capilia MTBC Neo, and DST. The laboratory results and questionnaire metadata were used for descriptive statistics, logistic regression in R version 3.4.2. These results were presented along with results from a qualitative assessment of the situation at WTH. RESULTS Of 207 TB suspects, 39 (18.8%) were positive on FM with bacilli growth on culture, later confirmed as Mycobacterium tuberculosis complex. Only 5.4% of the cases were resistant to Isoniazid. Age; 20-45 OR = 13 (95%CI = 2.4-25.6, p = 0.011), > 46 OR = 3 (95%CI = 0.5-58, p = 0.005) and raw milk consumption OR = 2.2 (95%CI = 0.37-42.48, p = 0.005) were associated with being TB positive. The qualitative evaluation reveals that gunfights in the surroundings of Wau influenced the number of patients attending WTH, with some travelling up to 545 km to seek medical attention. CONCLUSION We report a high prevalence of tuberculosis among patients who presented at WTH, with approximately 1 out of 5 individuals testing positive for tuberculosis. This is likely an underestimation given the challenges patients had to endure as they sought medical attention. Tuberculosis epidemiology is likely to be driven by individual and household factors, but further investigations are needed to fully understand the risk profile. The tools in use were adequate for TB diagnostics and we observed a remarkably low prevalence of drug resistance, a statistic that is worth preserving. We therefore call for action from all stakeholders.
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Affiliation(s)
- Caeser Sobe Jermano Boyong
- Department of Clinical Studies University of Bahr El Ghazal, College of Veterinary Science, Wau South, Sudan
- Department of Biosecurity, Ecosystems and Veterinary Public health, College of Veterinary Medicine Animal Resources and Biosecurity, Makerere University, Uganda
| | - Clovice Kankya
- Department of Biosecurity, Ecosystems and Veterinary Public health, College of Veterinary Medicine Animal Resources and Biosecurity, Makerere University, Uganda
| | - Muleme James
- Department of Biosecurity, Ecosystems and Veterinary Public health, College of Veterinary Medicine Animal Resources and Biosecurity, Makerere University, Uganda
| | - M Munyeme
- Department of Disease Control, The University of Zambia, School of Veterinary Medicine, Zambia
| | - AS Jubara
- Department of Surgery and Gynecology, University of Bahr El Ghazal-College of Veterinary Science-Wau
| | - D Ndoboli
- Central Diagnostic Laboratory, College of Veterinary Medicine, Makerere University, Uganda
| | - G Ekuka
- National Tuberculosis Referral Laboratory, Uganda, Kampala
| | - A Muwonge
- Division of Genetics and Genomics, The Roslin Institute, The Royal (Dick) School of Veterinary Studies, College of Medicine and Veterinary studies, University of Edinburgh, Easter Bush, Midlothian, EH25 9RG, UK
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Riello FN, Brígido RTS, Araújo S, Moreira TA, Goulart LR, Goulart IMB. Diagnosis of mycobacterial infections based on acid-fast bacilli test and bacterial growth time and implications on treatment and disease outcome. BMC Infect Dis 2016; 16:142. [PMID: 27039183 PMCID: PMC4818481 DOI: 10.1186/s12879-016-1474-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 03/17/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The establishment of therapeutic regimens for mycobacteriosis depends on the accurate identification of Mycobacterium species, and misdiagnosis can result in inappropriate treatment and increased mortality of patients. Differential diagnosis among Mycobacterium species has been made by conventional phenotypic and biochemical tests after a long culture period. Specialized molecular diagnostics of mycobacteria allows rapid detection and species identification; however, such tests are not available in public health programs. Our aim was to demonstrate the clinical implications of erroneous diagnosis by performing molecular genotyping of mycobacterial infections in patients that were diagnosed based on symptoms, culture and bacilloscopy. METHODS Culture samples of mycobacterial infections from 55 patients clinically diagnosed as tuberculosis in 2013 and 2014, based on conventional methods, were identified by PCR -RFLP and results are discussed. RESULTS We have confirmed 35 (63.6%) positive samples as M. tuberculosis, but 18 (32.7%) were identified as non-tuberculous mycobacteria (M. avium type 1, M. avium type 2, M. kansasii type 1 type 1, M. mucogenicum, M. chelonae, M. terrae type 3, and 1 unknown RFLP pattern) and two were negative. Regarding clinical diagnosis, 61.8% (34/55) was classified as pulmonary tuberculosis. It is important to emphasize that 36.4% (20/55) of samples were misdiagnosed by conventional methods, and 11 (61.1%) of the HIV positive patients (18/55) were NTM-coinfected. CONCLUSION The identification of species in mycobacterial infections is essential for correct diagnosis and choice of treatment regimen, and misdiagnosis by conventional tools can lead to chronic disease, increased resistance and death.
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Affiliation(s)
- Fabiane N. Riello
- />National Reference Center for Sanitary Dermatology and Leprosy (CREDESH) Clinical Hospital Federal University of Uberlândia, Uberlândia, Minas Gerais Brazil
| | - Rebecca T. S. Brígido
- />National Reference Center for Sanitary Dermatology and Leprosy (CREDESH) Clinical Hospital Federal University of Uberlândia, Uberlândia, Minas Gerais Brazil
| | - Sergio Araújo
- />National Reference Center for Sanitary Dermatology and Leprosy (CREDESH) Clinical Hospital Federal University of Uberlândia, Uberlândia, Minas Gerais Brazil
| | - Tomaz A. Moreira
- />Laboratory of Clinical Analysis, Clinics’ Hospital of the Federal University of Uberlândia, Uberlândia, Minas Gerais Brazil
| | - Luiz Ricardo Goulart
- />Federal University of Uberlandia, Institute of Genetics and Biochemistry, Laboratory of Nanobiotechnology, Campus Umuarama, Block 2E, Room 248, CEP 38400-902 Uberlandia, Minas Gerais Brazil
| | - Isabela M. B. Goulart
- />National Reference Center for Sanitary Dermatology and Leprosy (CREDESH) Clinical Hospital Federal University of Uberlândia, Uberlândia, Minas Gerais Brazil
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Yuen CM, Rodriguez CA, Keshavjee S, Becerra MC. Map the gap: missing children with drug-resistant tuberculosis. Public Health Action 2015; 5:45-58. [PMID: 26400601 PMCID: PMC4525371 DOI: 10.5588/pha.14.0100] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 01/08/2015] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The lack of published information about children with multidrug-resistant tuberculosis (MDR-TB) is an obstacle to efforts to advocate for better diagnostics and treatment. OBJECTIVE To describe the lack of recognition in the published literature of MDR-TB and extensively drug-resistant TB (XDR-TB) in children. DESIGN We conducted a systematic search of the literature published in countries that reported any MDR- or XDR-TB case by 2012 to identify MDR- or XDR-TB cases in adults and in children. RESULTS Of 184 countries and territories that reported any case of MDR-TB during 2005-2012, we identified adult MDR-TB cases in the published literature in 143 (78%) countries and pediatric MDR-TB cases in 78 (42%) countries. Of the 92 countries that reported any case of XDR-TB, we identified adult XDR-TB cases in the published literature in 55 (60%) countries and pediatric XDR-TB cases for 9 (10%) countries. CONCLUSION The absence of publications documenting child MDR- and XDR-TB cases in settings where MDR- and XDR-TB in adults have been reported indicates both exclusion of childhood disease from the public discourse on drug-resistant TB and likely underdetection of sick children. Our results highlight a large-scale lack of awareness about children with MDR- and XDR-TB.
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Affiliation(s)
- C. M. Yuen
- Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | | | - S. Keshavjee
- Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Partners In Health, Boston, Massachusetts, USA
| | - M. C. Becerra
- Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Partners In Health, Boston, Massachusetts, USA
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