Drug resistance and population structure of M.tuberculosis isolates from prisons and communities in Ethiopia

Ali, Solomon; Beckert, Patrick; Haileamlak, Abraham; Pritsch, Michael; Heinrich, Norbert; Löscher, Thomas; Höelscher, Michael; Niemann, Stefan; Rachow, Andrea

doi:10.1186/s12879-016-2041-x

Cited by 23 publications

(24 citation statements)

References 29 publications

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“…The predominant MTBC lineages in this study were lineage 4 followed by lineage-3; findings that are similar to other studies conducted in Ethiopia [ 17 , 19 , 26 ]. We also demonstrate that local sub-linages such as the newly described “Ethiopia_4” and the closely related Ethiopia_3 (both part of lineage 4 and related to TUR genotype strains) dominate among Ethiopian TB cases but do not play a major role in the global TB epidemic.…”

Section: Discussionsupporting

confidence: 91%

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Molecular epidemiology and drug resistance patterns of Mycobacterium tuberculosis complex isolates from university students and the local community in Eastern Ethiopia

et al. 2018

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BackgroundPrevious studies suggest the burden of pulmonary tuberculosis (PTB) in Ethiopia may be greater in university students relative to the overall population. However, little is known about the transmission dynamics of PTB among students and members of the communities surrounding university campuses in Eastern Ethiopia.MethodsA cross sectional study was conducted in Eastern Ethiopia among prevalent culture-confirmed PTB cases from university students (n = 36) and community members diagnosed at one of four hospitals (n = 152) serving the surrounding area. Drug susceptibility testing (DST) was performed on Mycobacterium tuberculosis complex (MTBC) isolates using BD Bactec MGIT 960 and molecular genotyping was performed using spoligotyping and 24-loci MIRU-VNTR. MTBC strains with Identical genotyping patterns were assigned to molecular clusters as surrogate marker for recent transmission and further contact tracing was initiated among clustered patients.ResultsAmong all study participants, four MTBC lineages and 11 sub-lineages were identified, with Ethiopia_3 (Euro-American lineage) being most common sub-lineage (29.4%) in both cohorts and associated with strain clustering (P = 0.016). We further identified 13 (8.1%) strains phylogenetically closely related to Ethiopia_3 but with a distinct Spoligotyping pattern and designated as Ethiopia_4. The clustering rate of MTBC strains was 52.9% for university students and 66.7% for community members with a Recent Transmission Index (RTI) of 17.6% and 48.4%, respectively. Female gender, urban residence, and new TB cases were significantly associated with strain clustering (P<0.05). Forty-eight (30%) of the study participants were resistant to one or more first line anti TB drugs, three patients were classified as multidrug resistant (MDR).ConclusionWe found evidence for recent transmission of PTB among Ethiopian university students and the local community in Eastern Ethiopia, mainly linked to strains classified as Ethiopia_3 sub lineage. Drug resistance didn’t have a major impact on recent transmission but comprehensive molecular surveillance in combination with drug resistance profiling of MTBC strains is desirable to better characterize TB transmission dynamics in high risk congregate living environments such as university campuses and guide regional TB control programs.

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Section: Discussionsupporting

confidence: 91%

“…rural vs. metropolitan setting) or other demographic differences (e.g. age, gender) [ 26 ]. However, these studies have consistently shown a large proportion of TB cases in Ethiopia are due to recent transmission.…”

Section: Discussionmentioning

confidence: 99%

Molecular epidemiology and drug resistance patterns of Mycobacterium tuberculosis complex isolates from university students and the local community in Eastern Ethiopia

et al. 2018

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“…The predominant MTBC lineages in this study were lineage 4 followed by lineage 3; findings that are similar to other studies conducted in Ethiopia [10, 19, 22]. We also demonstrate that local sub-linages such as the newly described “Ethiopia_4” and the closely related to Ethiopia_3 (both part of lineage 4 and related to TUR genotype strains) dominate among Ethiopian TB cases but do not play a major role in the global TB epidemic.…”

Section: Discussionsupporting

confidence: 90%

“…Being aware of the limitations mediated by the small sample size and the cross-sectional sampling scheme, our data suggest that MTBC transmission is still a major public health concern in Eastern Ethiopia and is not limited to congregate living facilities, e.g. universities or prisons [22].…”

Section: Discussionmentioning

confidence: 99%

Molecular epidemiology and drug resistance patterns ofMycobacterium tuberculosiscomplex isolates from university students and the local community in Eastern Ethiopia

Mekonnen

Merker

Collins

et al. 2018

Preprint

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BackgroundPrevious studies suggest the burden of pulmonary tuberculosis (PTB) in Ethiopia may be greater in university students relative to the overall population. However, little is known about the transmission dynamics of PTB among students and members of the communities surrounding university campuses in Eastern Ethiopia.MethodsA cross sectional study was conducted in Eastern Ethiopia among culture-confirmed PTB cases from university students (n=36) and community members diagnosed at one of four hospitals (n=152) serving the surrounding area. Drug susceptibility testing (DST) was performed on Mycobacterium Tuberculosis Complex (MTBC) isolates using BD Bactec MGIT 960 and molecular genotyping was performed using spoligotyping and 24-loci MIRU-VNTR. MTBC strains with Identical genotyping patterns were assigned to molecular clusters as surrogate marker for recent transmission and further contact tracing was initiated among clustered patients.ResultsAmong all study participants, four MTBC lineages and 11 sub-lineages were identified, with Ethiopia_3 being most common sub-lineage (29.4%) and associated with strain clustering (P= 0.016). We identified 13 (8.1%) strains phylogenetically related to the known Ethiopian sub-lineages with a distinct Spoligotyping patterns and designated as Ethiopia_4. The clustering rate of MTB strains was 52.9% for university students and 66.7% for community members with a Recent Transmission Index (RTI) of 17.6% and 48.4%, respectively. Female gender, urban residence, and new TB cases were significantly associated with strain clustering (p<0.05). Forty-eight (30%) of the study participants were resistant to one or more first line anti TB drugs, three patients were classified as multidrug resistant (MDR), defined by isoniazid and rifampicin resistance.ConclusionWe found evidence of significant PTB cases clustering and recent transmission among Ethiopian university students and the local community in eastern Ethiopia; with Ethiopia_3 being the predominant circulating sub-lineage. A country wide comprehensive molecular surveillance and drug resistance profiling of MTBC strains and Implementation of TB control programs within universities and the surrounding community should be considered to decrease TB transmission.

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“…The goals of this study were to calculate the prevalence of self-reported TB diagnosed in all the Peruvian correctional facilities (CFs), and to evaluate its relationship with various demographic and clinical factors registered on a nation-wide survey among prison inmates conducted for the first time in Peru. The importance of this research lies on the pivotal role that people deprived of their liberty played on TB transmission, especially resistant forms [16,17] which are difficult to manage and could result in high mortality rates [18]. Importantly, we have not found previous studies in Peru where its prevalence was calculated at national level, and there are limited efforts investigating factors associated with TB in local prisons.…”

Section: Introductionmentioning

confidence: 99%

High prevalence of self‐reported tuberculosis and associated factors in a nation‐wide census among prison inmates in Peru

Cuba

Ardiles‐Paredes

Araujo‐Castillo

et al. 2019

Tropical Med Int Health

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Objective To estimate the prevalence of self‐reported tuberculosis TB diagnosed at Peruvian correctional facilities (CFs), and their associated factors. Methods Cross‐sectional study based on secondary analysis of the National Census held in all Peruvian CFs in 2016. Outcome was defined as self‐reported TB diagnosed by a healthcare professional intra‐penitentiary. A descriptive bivariate analysis was carried out, followed by multivariate analysis using Poisson regression in order to calculate the adjusted prevalence ratios (PRa). Additionally, a mixed effects multilevel model adjusted by CFs as clusters was performed. Results Of 77 086 prison inmates in 66 CFs participated in the original census, of which 69 890 were included. Of these, 1754 self‐reported TB diagnosed intra‐penitentiary, yielding a prevalence of 2510/100 000 PDL. In the final model, self‐reported TB was associated with younger age, male gender, lower educational level, not having a stable partner, having prison readmissions and having relatives in prison. There was also strong association with HIV/AIDS (PRa 2.77; 1.84–4.18), STIs (PRa 2.13; 1.46–3.10), DM (PRa 1.99; 1.59–2.50) and recreational drugs use (PRa 1.41; 1.23–1.61). The mixed model showed significant variance for belonging to different CFs (2.13; 1.02–4.44) and CF overcrowding (3.25; 1.37–7.71). Conclusions Self‐reported TB prevalence found was higher than reported by other lower/lower‐middle income countries. Demographic factors, individual clinical features and overcrowding increases the likelihood of self‐reported TB.

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Drug resistance and population structure of M.tuberculosis isolates from prisons and communities in Ethiopia

Cited by 23 publications

References 29 publications

Molecular epidemiology and drug resistance patterns of Mycobacterium tuberculosis complex isolates from university students and the local community in Eastern Ethiopia

Molecular epidemiology and drug resistance patterns of Mycobacterium tuberculosis complex isolates from university students and the local community in Eastern Ethiopia

Molecular epidemiology and drug resistance patterns ofMycobacterium tuberculosiscomplex isolates from university students and the local community in Eastern Ethiopia

High prevalence of self‐reported tuberculosis and associated factors in a nation‐wide census among prison inmates in Peru

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