HIV co-infection with tuberculous and non-tuberculous mycobacteria in western Kenya: Challenges in the diagnosis and management
ABSTRACT Tuberculosis (TB) and HIV co-infections have a global prevalence with devastating morbidity and massive mortality, Sub-Saharan Africa being the worst hit.
To evaluate the prevalence of TB-HIV co-infection and demonstrate the confusion caused by NTM and HIV/AIDS co-infection in TB diagnosis and treatment in western Kenya.
In a cross-sectional study carried out at 10 hospitals in western Kenya, sputa from consenting 872 TB suspects underwent microscopy, and culture on Lowenstein-Jensen and Mycobacteria Growth Index Tube media. Isolates were identified using the Hain's GenoType(®)Mycobacterium CM and GenoType(®)Mycobacterium AS kits. A total of 695 participants were screened for HIV using Uni-Gold™ test and positives confirmed with the enzyme linked immunosorbent assay.
A total of 346 (39.7%) participants were diagnosed with TB. Out of the 346 TB cases, 263 (76%) were tested for HIV infection and 110 (41.8%) of these were sero-positive (co-infected). The female to male TB-HIV co-infection prevalence ratio (PR) was 1.35. This study reports isolation of non-tuberculous mycobacteria from TB suspects at a rate of 1.7%.
A high TB-HIV co-infection rate was observed in this study. The NTM disease could be misdiagnosed and treated as TB in western Kenya.
- SourceAvailable from: Haradhan Kumar Mohajan[Show abstract] [Hide abstract]
ABSTRACT: Kenya faces major socio-economic and health challenges since the independent 1963. Tuberculosis, HIV/AIDS and malaria are the leading causes of morbidity and mortality in Kenya. The Government of Kenya has been trying to build a health system which can effectively provide quality health services to the population of the country. In Kenya, health services are provided through a network of over 5,000 health facilities countrywide. The country spends 5.1% of its GDP on health sector. As a result both mortality and morbidity rates are decreasing in Kenya. Infant and under-5 mortality rates are high in the country compare to the some other developing countries. Despite many attempts are taken by the Government yet the health sector of Kenya is far to reach the Millennium Development Goals. The paper discusses aspects of health of Kenya to make a healthy nation in the world.08/2014; 2(4):159-169. DOI:10.12691/ajphr-2-4-6
- [Show abstract] [Hide abstract]
ABSTRACT: Quinolones are an important group of antibacterial agents that can inhibit DNA gyrase and topoisomerase IV activity. DNA gyrase is responsible for maintaining bacteria in a negatively supercoiled state, being composed of subunits A and B. Topoisomerase IV is a homologue of DNA gyrase and consists of two subunits codified by the parC and parE genes. Mutations in gyrA and gyrB of DNA gyrase may confer resistance to quinolones, and the majority of resistant strains show mutations between positions 67 and 106 of gyrA, a region denoted the quinolone resistance-determining region (QRDR). The most frequent substitutions occur at positions 83 and 87, but little is known about the mechanisms promoting appearance of mutations in the QRDR. The present study proposes that some mutations in the QRDR could be generated as a result of the natural mechanism of conjugation between bacteria in their natural habitat. This event was observed following conjugation in vitro of two different isolates of quinolone-susceptible Pseudomonas aeruginosa, which transferred plasmids of different molecular weights to a recipient strain of Escherichia coli (HB101), also quinolone-susceptible, generating two different transconjugants that presented mutations in DNA gyrase and acquisition of resistance to all quinolones tested.International Journal of Antimicrobial Agents 09/2014; 45(2). DOI:10.1016/j.ijantimicag.2014.07.018 · 4.26 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: The objective of this study was to estimate HIV infection and associated risk factors among smear positive pulmonary TB patients in Southern Ethiopia. A cross-sectional study design was used to recruit 221 consecutive smear positive pulmonary TB patients visiting three hospitals in Gamo Goffa Zone from March, 2013 to February, 2014. A structured questionnaire was used to collect data on socio demographic, behavioral and economic factors from study units. Chi-square, fisher’s exact test and logistic regression were used to assess the association between the above factors and HIV infection among smear positive pulmonary TB. The rate of HIV-TB co-infection among sputum smear-positive pulmonary TB patients in southern Ethiopia was 6.8% with 95% confidence interval of 3.3 to 10.3%. Drinking alcohol was significantly associated with increased risk of HIV infection among smear positive pulmonary TB patients in univariable logistic regression but that association was not maintained after controlling for potential confounding variables. Other factors significantly associated with HIV infection among the study population were previous anti-TB treatment, being resident in urban area and participants who had monthly income of less than or equal to 1000 Ethiopian birr as compared to those who had no regular monthly income. The rate of TB-HIV infection among smear positive pulmonary TB patients in Southern Ethiopia was low. However, the government or other partner organizations should work on decreasing the burden of co-infection through designing strategy on preventing HIV transmission in the urban area; increase the monthly income of citizens while enhancing TB-HIV collaborative activity to prevent reactivation of TB.Science, Technology and Arts Research Journal 09/2014; 3(3):87-92. DOI:10.4314/star.v3i3.14 · 1.47 Impact Factor