Drug Resistance Pattern of M. tuberculosis Complex in Oromia Region of Ethiopia.

PURPOSE: Multidrug resistant tuberculosis is an emerging problem in many parts of the world. The aim of this study was to determine the drug resistance pattern of Mycobacterium tuberculosis complex in Oromia Region of Ethiopia. PATIENTS AND METHODS: A cross-sectional study was conducted from Jan 2017 to June 2018 on 450 pulmonary tuberculosis patients who visited health facilities in nine administrative zones of Oromia Region. Socio-demographic characteristics and relevant clinical information were obtained using a structured questionnaire. Line Probe Assay for first and second line drugs was used to assess the pattern of drug resistance. SPSS version 20 was used for statistical analysis. RESULTS: Median age was 26 years and 240 (53.3%) patients were males. About 24% of them were previously treated for tuberculosis. Thirty-four (7.6%) were HIV co-infected. Line Probe Assay interpretable results were obtained for 387 isolates. Thirty (7.8%) were resistant to rifampicin and isoniazid and thus were multidrug resistant isolates. Among the multidrug resistant samples, three were found to be extensively drug resistant and one was pre-extensively drug resistant. Previous treatment history (AOR 9.94 (95% CI 3.73-26.51), P < 0.001) and nutritional status below normal (AOR 3.15 (95% CI 1.13-8.81), P < 0.029) were found to be associated with multidrug resistance. The chi-square tests have shown that there was a significant difference between the BCG vaccinated and the non-vaccinated in developing multidrug resistant tuberculosis at P = 0.027. CONCLUSION: The proportion of multidrug resistance is above the WHO estimate for the country, Ethiopia, and the fact that some zones were at risk of transmission of extensively drug resistant tuberculosis warrant great attention of the control program holders even though it has to be verified through the conventional method.

Protein and Microbial Biomarkers in Sputum Discern Acute and Latent Tuberculosis in Investigation of Pastoral Ethiopian Cohort.

Differential diagnosis of tuberculosis (TB) and latent TB infection (LTBI) remains a public health priority in high TB burden countries. Pulmonary TB is diagnosed by sputum smear microscopy, chest X-rays, and PCR tests for distinct Mycobacterium tuberculosis (Mtb) genes. Clinical tests to diagnose LTBI rely on immune cell stimulation in blood plasma with TB-specific antigens followed by measurements of interferon-γ concentrations. The latter is an important cytokine for cellular immune responses against Mtb in infected lung tissues. Sputum smear microscopy and chest X-rays are not sufficiently sensitive while both PCR and interferon-γ release assays are expensive. Alternative biomarkers for the development of diagnostic tests to discern TB disease states are desirable. This study's objective was to discover sputum diagnostic biomarker candidates from the analysis of samples from 161 human subjects including TB patients, individuals with LTBI, negative community controls (NCC) from the province South Omo, a pastoral region in Ethiopia. We analyzed 16S rRNA gene-based bacterial taxonomies and proteomic profiles. The sputum microbiota did not reveal statistically significant differences in α-diversity comparing the cohorts. The genus Mycobacterium, representing Mtb, was only identified for the TB group which also featured reduced abundance of the genus Rothia in comparison with the LTBI and NCC groups. Rothia is a respiratory tract commensal and may be sensitive to the inflammatory milieu generated by infection with Mtb. Proteomic data supported innate immune responses against the pathogen in subjects with pulmonary TB. Ferritin, an iron storage protein released by damaged host cells, was markedly increased in abundance in TB sputum compared to the LTBI and NCC groups, along with the α-1-acid glycoproteins ORM1 and ORM2. These proteins are acute phase reactants and inhibit excessive neutrophil activation. Proteomic data highlight the effector roles of neutrophils in the anti-Mtb response which was not observed for LTBI cases. Less abundant in the sputum of the LTBI group, compared to the NCC group, were two immunomodulatory proteins, mitochondrial TSPO and the extracellular ribonuclease T2. If validated, these proteins are of interest as new biomarkers for diagnosis of LTBI.

Bovine tuberculosis is more prevalent in cattle owned by farmers with active tuberculosis in central Ethiopia.

A case control study was conducted between October 2004 and April 2005 to determine the prevalence of bovine tuberculosis (BTB) in cattle in central Ethiopia relative to the tuberculosis status of their owners. A total of 174 farmers (87 with active tuberculosis and 87 with no active tuberculosis), and 1041 cattle (506 owned by farmers with active tuberculosis and 535 by farmers without active tuberculosis) were included. The comparative intradermal cervical tuberculin test was used in cattle while clinical symptoms, chest X-ray and Ziehl-Neelsen staining were used for the diagnosis of tuberculosis in the farmers. In addition, mycobacterial culture, biochemical tests, and drug susceptibility tests were performed for the identification Mycobacterium spp. from both humans and cattle. The prevalence of BTB was threefold higher (odds ratio [OR]=4.2, 95% confidence interval [CI]=2.79-6.2) in cattle owned by farmers with active tuberculosis (24.3%) than in those owned by farmers who did not have active tuberculosis (8.6%). Cattle owned by farmers with active tuberculosis were four times more likely to have tuberculosis than cattle owned by farmers with no active tuberculosis. Furthermore, cattle owners who consumed raw milk were at greater risk (chi2=14.1, P<0.001, OR=3.34) of having active tuberculosis than those who consumed boiled milk. Of the 42 human isolates, 31 (74%) were Mycobacterium tuberculosis, seven (16%) were Mycobacterium bovis while four (10%) were considered a typical mycobacteria on the basis of biochemical and drug sensitivity tests. Of the 11 cattle isolates, two (18%) were Mycobacterium tuberculosis, five (46%) Mycobacterium bovis, and four (36%) were atypical mycobacteria. The prevalence of tuberculosis was higher in cattle owned by farmers with active tuberculosis than in cattle owned by farmers who did not have active tuberculosis, which could suggest possible transmission of Mycobacterium spp. between cattle and their owners.