Molecular Evidence of Drug-Resistant Tuberculosis in the Balimo Region of Papua New Guinea

Diefenbach-Elstob, Tanya; Guernier, Vanina; Burgess, Graham; Pelowa, Daniel; Dowi, Robert; Gula, Bisato; Puri, Munish; Pomat, William; McBryde, Emma S.; Plummer, David; Rush, Catherine M.; Warner, Jeffrey

doi:10.3390/tropicalmed4010033

Cited by 4 publications

(2 citation statements)

References 31 publications

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“…The population of this region is approximately In Focus 40,000 with most people living a subsistence lifestyle in villages where access to health care is difficultalso typical of a remote tropical community 18 . In this community the reported rate of TB is close to twice the national annual incidence at approximately 700-900/100 000 population, a significant proportion are children, gender equal and evidence of drug resistance is emerging 19,20 . A particular feature of the disease in Balimo is the high rates of extrapulmonary (EP-TB) disease, approaching 75% of all cases.…”

Section: Tb In Rural Png: Is It True?mentioning

confidence: 97%

Tropical fever in remote tropics: tuberculosis or melioidosis, it depends on the lab

Warner

Rush

2021

Microbiol. Aust.

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Diagnostics tests used to identify the cause of infection using proteomics and genomics have revolutionised microbiology laboratories in recent times. However, approaches to build the capacity of clinical microbiology services in the rural tropics by simply transplanting these approaches have proven difficult to sustain. Tropical fever in the remote tropics is, by definition, a clinical diagnosis where the aetiology of fever is not known, treatment is empirical, guided by clinical suspicion with treatment failure often attributed to incorrect diagnosis or antimicrobial resistance. Tuberculosis (TB) in rural Papua New Guinea (PNG) is mostly diagnosed clinically, perhaps supported by microscopy. In fact, a ‘tuberculosis patient’ in rural PNG is included in the TB register upon commencement of TB treatment with or without any laboratory-based evidence of infection. The roll-out of GeneXpert is continuing to transform TB diagnostic certainty in TB endemic communities. Melioidosis is endemic in tropical regions and is increasingly reported to mimic TB. Isolation and identification of the causative agent Burkholderia pseudomallei remains the gold standard. Here, we discuss the increasing divide between rural and urban approaches to laboratory-based infection diagnosis using these two enigmatic tropical infectious diseases, in rural PNG, as examples.

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Section: Tb In Rural Png: Is It True?mentioning

confidence: 97%

Tropical fever in remote tropics: tuberculosis or melioidosis, it depends on the lab

Warner

Rush

2021

Microbiol. Aust.

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“…The number of case noti cations of all forms of TB increased between 2008-2014 but stabilized during 2015-2016 (22). In 2019, PNG had an estimated TB incidence of 432 new cases per 100 000 population compared to 333 per 100 000 in 2016 (22,24). Since the release of the TB-IPC policy, there has been a limited review of implementation in the PNG health sector.…”

Section: Introductionmentioning

confidence: 99%

Tuberculosis infection prevention and control in rural Papua New Guinea: An evaluation using the Infection Prevention and Control Assessment Framework

Marme

Kuzma

Zimmerman

et al. 2022

Preprint

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Background: Papua New Guinea (PNG) is one of the 14 countries categorized as having a triple burden of tuberculosis (TB), multidrug-resistant TB (MDR TB), and TB-human immunodeficiency virus (HIV) co-infections. TB infection prevention and control (TB-IPC) guidelines were introduced in 2011 by the National Health Department of PNG. This study assesses the implementation of this policy in a sample of district hospitals in two regions of PNG. Methods: The implementation of TB-IPC policy was assessed using a survey method based on the World Health Organization (WHO) IPC assessment framework (IPCAF) to implement the WHO’s IPC core components. The study included facility assessment at ten district hospitals and validation observations of TB-IPC practices. Results: Overall, implementation of IPC and TB-IPC guidelines was inadequate in participating facilities. Though 80% of facilities had an IPC program, many needed more clearly defined IPC objectives, budget allocation, and yearly work plans. In addition, they did not include senior facility managers in the IPC committee. Eighty percent (n=8 of 10) of hospitals had no IPC training and education; 90% had no IPC committee to support the IPC team; 70% had no surveillance protocols to monitor infections, and only 20% used multimodal strategies for IPC activities. Similarly, 70% of facilities had a TB-IPC program without a proper budget and did not include facility managers in the TB-IPC team; 80% indicated that patient flow poses a risk of TB transmission; 70% had poor ventilation systems; 90% had inadequate isolation rooms; and though 80% have personal protective equipment available, frequent shortages were reported. Conclusions: The WHO-recommended TB-IPC policy is not effectively implemented in most of the participating district hospitals. Improvements in implementing and disseminating TB-IPC guidelines, monitoring TB-IPC practices, and systematic healthcare worker training are essential to improve TB-IPC guidelines’ operationalization in health settings to reduce TB's prevalence in PNG.

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Diversity of Mycobacterium tuberculosis in the Middle Fly District of Western Province, Papua New Guinea: microbead-based spoligotyping using DNA from Ziehl-Neelsen-stained microscopy preparations

Guernier

Diefenbach-Elstob

Klotoe

et al. 2019

Sci Rep

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Tuberculosis remains the world’s leading cause of death from an infectious agent, and is a serious health problem in Papua New Guinea (PNG) with an estimated 36,000 new cases each year. This study describes the genetic diversity of Mycobacterium tuberculosis among tuberculosis patients in the Balimo/Bamu region in the Middle Fly District of Western Province in PNG, and investigates rifampicin resistance-associated mutations. Archived Ziehl-Neelsen-stained sputum smears were used to conduct microbead-based spoligotyping and assess genotypic resistance. Among the 162 samples included, 80 (49.4%) generated spoligotyping patterns (n = 23), belonging predominantly to the L2 Lineage (44%) and the L4 Lineage (30%). This is consistent with what has been found in other PNG regions geographically distant from Middle Fly District of Western Province, but is different from neighbouring South-East Asian countries. Rifampicin resistance was identified in 7.8% of the successfully sequenced samples, with all resistant samples belonging to the L2/Beijing Lineage. A high prevalence of mixed L2/L4 profiles was suggestive of polyclonal infection in the region, although this would need to be confirmed. The method described here could be a game-changer in resource-limited countries where large numbers of archived smear slides could be used for retrospective (and prospective) studies of M. tuberculosis genetic epidemiology.

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Molecular Evidence of Drug-Resistant Tuberculosis in the Balimo Region of Papua New Guinea

Cited by 4 publications

References 31 publications

Tropical fever in remote tropics: tuberculosis or melioidosis, it depends on the lab

Tropical fever in remote tropics: tuberculosis or melioidosis, it depends on the lab

Tuberculosis infection prevention and control in rural Papua New Guinea: An evaluation using the Infection Prevention and Control Assessment Framework

Diversity of Mycobacterium tuberculosis in the Middle Fly District of Western Province, Papua New Guinea: microbead-based spoligotyping using DNA from Ziehl-Neelsen-stained microscopy preparations

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