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.
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ABSTRACT: Multidrug resistant tuberculosis (MDR-TB) presents a great challenge to public health, especially for developing countries. Some nontuberculous mycobacteria (NTM) cause the similar clinical and radiological characteristics with tuberculosis. We aimed to identify the frequency of NTM infections among subjects who were suspected to have MDR-TB due to lack of response to anti-TB treatment. This retrospective study evaluated patients with suspected MDR-TB due to lack of sputum conversion after 2-3month therapy with first line anti-TB treatment from 2009 through 2014. Cultures for mycobacteria were performed and identification was done to species level by phenotypic and molecular tests. The outcome of the patients with NTM disease and related risk factors for poor outcome were evaluated. Out of 117 consecutive strains isolated from suspected MDR-TB subjects, 35 (30%) strains were identified as NTM by using conventional and molecular approaches. Of these patients with positive NTM cultures, 32 (27%) patients met ATS/IDSA diagnostic criteria. Out of 32, 29 (90%) individuals with confirmed NTM diseases had underlying disorders including 8 subjects with malignancy, 5 with organ transplantations, and 4 with the human immunodeficiency virus. No known underlying disorder was found in 3 (9%) subjects. Treatment outcomes were available for 27 subjects, 17 (63%) of whom were cured and 10 (37%) had poor outcome including 6 (60%) who failed and 4 (40%) who died during treatment. The high costs to the patient and society should lead health care providers to consider NTM in all patients suspected of having TB. Copyright © 2015. Published by Elsevier B.V.European Journal of Internal Medicine 03/2015; 26(4). DOI:10.1016/j.ejim.2015.03.001 · 2.30 Impact Factor
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ABSTRACT: Background Non-tuberculous mycobacteria (NTM), which are ubiquitous micro-organisms occurring in humans, animals and the environment, sometimes receive public health and veterinary attention as opportunistic disease-causing agents. In Tanzania, there is limited information regarding the diversity of NTM species, particularly at the human-livestock-wildlife interface such as the Serengeti ecosystem, where potential for cross species infection or transmission may exist.Methods Mycobacterial DNA was extracted from cultured isolates obtained from sputum samples of 472 suspect TB patients and 606 tissues from wildlife species and indigenous cattle. Multiplex PCR was used to differentiate NTM from Mycobacterium tuberculosis complex (MTBC) members. NTM were further identified to species level by nucleotide sequencing of the 16S rRNA gene.ResultsA total of fifty five (55) NTM isolates representing 16 mycobacterial species and 5 isolates belonging to the MTBC were detected. Overall, Mycobacterium intracellulare which was isolated from human, cattle and wildlife, was the most frequently isolated species (20 isolates, 36.4%) followed by M. lentiflavum (11 isolates, 20%), M. fortuitum (4 isolates, 7.3%) and M. chelonae-abscessus group (3 isolates, 5.5%). In terms of hosts, 36 isolates were from cattle and 12 from humans, the balance being found in various wildlife species.Conclusion This study reveals a diversity of NTM species in the Serengeti ecosystem, some of which have potential for causing disease in animals and humans. The isolation of NTM from tuberculosis-like lesions in the absence of MTBC calls for further research to elucidate their actual role in causing disease. We are also suggesting a one health approach in identifying risk factors for and possible transmission mechanisms of the NTM in the agro-pastoral communities in the Serengeti ecosystem.BMC Infectious Diseases 11/2014; 14(1):616. DOI:10.1186/s12879-014-0616-y · 2.56 Impact Factor
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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