Genetic diversity and drug susceptibility of Mycobacterium tuberculosis in a city with a high prevalence of drug resistant tuberculosis from Southeast of Mexico

Background Mexico is on the top five countries with the highest number of TB cases in America continent, nevertheless, information about genotypes circulating is practically unknown. Considering the above this study aims to characterize the genetic diversity of TB in the city of Veracruz, México. Methods A cross-sectional study was conducted among positive smear samples from patients living in Veracruz City, samples were cultured, and first-line drug profiles determined. Genotyping was made by spoligotyping and MIRU-VNTR 24 loci. Associations of lineages, clusters, and variables were also analyzed. Results Among the 202 isolates analyzed resistance to at least one drug was observed in 60 (30%) isolates and 41(20%) were multidrug-resistant. Three major lineages were identified: L4/Euro-American (88%), L1/Indo-Oceanic (9%), and L2/East Asian (3%). The Euro-American lineage included more than six sublineages, the most abundant were: H (32%), T (23%), LAM (18%), and X (12%). 140 isolates (70%) were placed in 42 SITs patterns. Conclusions These results provide the first baseline data on the genetic structure of TB in the city of Veracruz. Sublineages H, X and LAM were predominant; however, it was founded an important diversity of genotypes that could contribute to the dispersion of TB and explain the high prevalence. This information might be useful for the development of further interventions to reduce impact of TB.

Migration-associated malaria from Africa in southern Spain

Background The western area of the province of Almeria, sited in southern Spain, has one of the highest immigrant population rates in Spain, mainly dedicated to agricultural work. In recent years, there has been a significant increase in the number of cases of imported malaria associated with migrants from countries belonging to sub-Saharan Africa. The objective of our study is to describe the epidemiological, clinical and analytical characteristics of malaria patients treated in a specialized tropical unit, paying special attention to the differences between VFR and non-VFR migrants and also to the peculiarities of microscopic malaria cases compared to submicroscopic ones. Methods Retrospective observational study of migrants over 14 years of age with imported malaria treated from October 2004 to May 2019. Characteristics of VFR and non-VFR migrants were compared. Malaria cases were divided into microscopic malaria (MM) and submicroscopic malaria (SMM). SMM was defined as the presence of a positive malaria PCR test together with a negative direct microscopic examination and a negative rapid diagnostic test (RDT). Microscopic malaria was defined as the presence of a positive RDT and/or a positive smear examination. Results Three hundred thirty-six cases of malaria were diagnosed, 329 in sub-Saharan immigrants. Of these, 78.1% were VFR migrants, in whom MM predominated (85.2% of cases). In non-VFR migrants, SMM represented 72.2% of the cases. Overall, 239 (72.6%) patients presented MM and 90 (27.4%) SMM. Fever was the most frequent clinical manifestation (64.4%), mainly in the MM group (MM: 81.1% vs SMM: 20.0%; p < 0.01). The most frequent species was P. falciparum. Patients with SMM presented fewer cytopenias and a greater number of coinfections due to soil-transmitted helminths, filarial and intestinal protozoa compared to patients with MM. Conclusions Imported malaria in our area is closely related to sub-Saharan migration. VFR migrants are the main risk group, highlighting the need for actions aimed at improving disease prevention measures. On the other hand, almost a third of the cases are due to SMM. This fact could justify its systematic screening, at least for those travelers at greater risk. Graphic Abstract

Identification of New Positive Tuberculosis Cases in Aceh Besar District Using Ordinary Criging

Tuberculosis is a contagious infectious disease caused by Mycobacterium tuberculosis. The risk level of transmission of pulmonary tuberculosis with positive smear of acid-resistant bacteria (BTA). BTA is greater hight risk than pulmonary tuberculosis with negative smear. This study aims to predict areas of the number of new BTA positive tuberculosis cases in Aceh Besar district spatially using the kriging method. The data used are secondary data coordinate the point of the number of new cases of positive smear tuberculosis in each puskesmas in the province of Aceh in 2015-2017. The experimental semivariogram calculation is the first step in estimating using ordinary kriging, which is a reference for getting the parameters to be used in theoretical semivariogram calculations. In this case, the semivariogram suitable for new cases of smear positive tuberculosis is the one of the Spherical model. The sill value used is 126.530, the nugget=62, while the range used is based on the distance of each class = 0.158. The results of the analysis showed that the regions with the lowest positive BTA Tuberculosis prediction cases were around Pulo Aceh Sub-District, Montasik Sub-District, and Indrapuri Sub-District, with less than 15 cases. Whereas the region with the most positive predictions of new cases of BTA Tuberculosis was around Baitussalam Sub-District and Jantho City, with more than 30 cases.

Effect of Preparate Coloring Delay Achid Resistant Bacteria With Ziehl Neelsen Method On The Result of Microscopic Examination

The microscopic examination of smear from sputum specimens plays an important role in the initial diagnosis and monitoring of pulmonary TB treatment. The Ziehl Nelseen method is the method for examining acid-resistant bacteria smear recommended by WHO. This method has high specificity for detecting acid-resistant bacteria in sputum. This study aims to determine the effect of postponement of sputum smear staining on the quality of acid-resistant bacteria germs on the results of microscopic examination using the Ziehl Nelseen staining method. The length of time to delay staining used was 3 days, 2 days and the control was direct preparations staining. The sample used was positive smear sputum. The results showed that from 10 samples of sputum, the results obtained were directly stained with results of 1+ there were 7 samples, and 2+ there were 3 samples, while the samples with the preparations were delayed for 2 days and 3 days at room temperature, respectively +1 as many as 7 samples, and 2+ as many as 3 samples. However, there was no difference in the reading of the staining results between the direct stained samples with the stained preparations with a delay of 2 days and 3 days at room temperature. The results of this study still have many shortcomings and to improve them it is recommended to carry out further research with a larger scale and sample size.

Tuberculosis in Northeastern Brasil (2001-2016): trend, clinical profile, and prevalence of risk factors and associated comorbidities

SUMMARY OBJECTIVE: To describe the temporal trend, clinical profile, and the prevalence of risk factors and associated comorbidities in new cases of tuberculosis in the Northeast (2001-2016). METHODS: A prevalence study involving all tuberculosis cases registered in Northeast Brasil, 2001-2016. Data were obtained from the National System of Notification of Disorders. For statistical analysis, the inflection point regression model and descriptive statistics were used. RESULTS: 331,245 cases of tuberculosis were reported. The overall incidence rate decreased from 44.84/100,000 inhabitants (2001) to 30.92/100,000 inhabitants (2016), with a decreasing trend (AAPC: −2.3; p<0.001). The profile was characterized by men (73.53%), age 20-59 years (73.56%), pulmonary tuberculosis (86.37%), positive smear microscopy (54.78%). The main risk factors and comorbidities were: AIDS (4.64%), HIV (12.10%), Diabetes mellitus (5.46%), alcohol (11.63%), institutionalized, (4.31%) and deprived of liberty (2.30%). The cure rate was 70.66% and the abandonment rate was 9.11%. CONCLUSIONS: Even with a reduced incidence, tuberculosis represents a real public health problem in the Northeast region. The profile was characterized by a male population, in economically-active age, lung smear-positive pulmonary presentation, and the risk factors and comorbidities of Aids, TB/HIV co-infection, diabetes mellitus, alcohol consumption, institutionalized and deprived of freedom reflect the complexity of the challenges in facing the disease.

Tuberculosis at Public Health Unit of Santa Maria da Feira and Arouca (Portugal)

Introduction In the last decade Portugal has seen a decrease of about 40% in the notification and incidence rate of tuberculosis, with incidence values below 20/100,000 inhabitants since 2015. In 2018, a notification rate estimated at a national level was 16,6/100,000 inhabitants and an incidence rate of 16.4/100,000 inhabitants. With this investigation we intend to I) determine the notification and incidence rate of tuberculosis at the Public Health Unit (PHU) of Santa Maria da Feira and Arouca (Portugal); II) analyze the clinical and sociodemographic characteristics. Methods The confirmed cases of tuberculosis between January 1, 2015 and December 31, 2019 were analyzed. Results 105 cases of tuberculosis were identified, most of them male (67%), aged between the 1 year and 94 years age (median: 52 years). About ⅓ of the patients were retired. Among the co-morbidities that constitute a risk for tuberculosis, we highlight COPD (7.6%), alcohol abuse (5.7%) and HIV (3.8%). The pulmonary location prevailed (81.9%). We emphasize that 52 cases had positive smear microscopy and 42 cases cavitation. From 2017 to 2019 we have a median of 61 days from the onset of symptoms to diagnosis. From 2015 to 2019, 4 cases with poly-resistance to isoniazid and streptomycin were identified. In 2019, the incidence rate tuberculosis was 12.5/100,000 inhabitants and the notification rate of 16.3/100,000 inhabitants. Conclusions The incidence and notification rate like the median between the onset of symptoms and the diagnosis, by the public health unit (PHU), are below the national average. Regarding these results, we recommend that the strategy adopted by the PHU should be maintained. Key messages In the last decade Portugal has seen a decrease of about 40% in the notification and incidence rate of tuberculosis, with incidence values below 20/100,000 inhabitants since 2015. In 2019, the incidence rate tuberculosis at PHU was 12.5/100,000 inhabitants and the notification rate of 16.3/100,000 inhabitants.

Hubungan Antara Kadar Laju Endap Darah (LED) Dengan Kadar C-Reaktiv Protein (CRP) Pada Penderita Tuberkulosis (TBC) Di Wilayah Kerja Puskesmas Alas Barat

Tuberculosis is a disease caused by rod-shaped bacteria (basil) with another name Mycrobacterium tuberculosis. Mycrobacterium tuberculosis enters the body then causes inflammation, inflammation and bacterial invasion which then induces liver cells to synthesize acute phase C-reactive protein protein (CRP). CRP will increase sharply after inflammation, as well as the formation of aggregates derived from the acute phase protein hormone which causes an increase in the Erythrocyte sedimentation rate (ESR)). The purpose of this study was to determine the relationship Erytrocyte sedimentation rate (ESR) and levels of C-Reactiv protein (CRP) in tuberculosis (TBC) patients. This research is an analytical descriptive study using cross sectional. Data collectors are done using the Non Random Accidental Sampling technique. The number of respondents in this study were 11 people with tuberculosis. Based on the results of this study it is known that TBC patients with smear negative as much as 7 people (63.6%) and TB patients with positive smear as much as 4 people (36.4%), both in TB patients with negative smear and positive smear both have levels of ESR not normal with an average ESR level in positive smear of 101.3 mm / hour and the average ESR level in smear negative is 20.8 mm / hour. All TBC patients with smear positive CRP levels (not normal) with an average mean value of CRP of 36 mg / L or an average CRP level in TBC smear negative patients of 0.9 mg / L. Based on the Pearson test results between levels of erythrocyte sedimentation rate (ESR) with C-Reactive protein (CRP) in tuberculosis (TBC) patients obtained a value of p <0.01 (0.000 <0.01). This shows a strong relationship between LED and CRP levels in TB patients

ANALISIS SPASIAL TB PARU BTA POSITIF DI WILAYAH KERJA PUSKESMAS WUNA TAHUN 2015 - 2017

Background: One area with high rates of positive sputum in West Muna district, high TB patients is in the Wuna Community Health Center work area. Positive smear pulmonary TB sufferers in 2015 recorded 25 positive cases, in 2016 as many as 41 positive cases, whereas in 2017 there was an increase from the previous year which was 45 positive cases. Objective: To find out the distribution of cases tuberculosis with positive sputum from 2015 to 2017, then to be related to population density. Methods: This type of research is observational with spatio temporal modeling, based on geographic information systems. Results: There has been a shift in the pattern of positive pulmonary tuberculosis pulmonary TB sufferers from 2015 to 2017. TB cases in Maperaha, Nihi, Bungkolo villages have been concentrated in the same area for three years, as well as Waulai Village during 2016 and 2017. In Wuna Village. In 2015 and 2016 cases of tuberculosis were still concentrated around the same area, but differed in 2017, the concentration of cases shifted to the west. Conclusion: Cases of tuberculosis with positive sputum in the working area of Wuna Health Center from 2015-2017 have increased.

Risk score to predict time-to sputum smear and culture conversions in patients treated with shorter MDR-tuberculosis regime in Guinea (Conakry): A retrospective cohort study.

Background Sputum smear and culture examination were used as bacteriological marker to monitor multidrug-resistant tuberculosis (MDR-TB) treatment. We aimed to identify the strongest contributing factors that affect time-to sputum bacteriological conversion, and to develop a practical risk scoreMethods Patients treated with shorter MDR-TB treatment regime between June 07, 2016 and June 22, 2018 from three major drug-resistance TB centres in Guinea, who had a positive smear or culture at baseline, and who had rifampicin resistance were analysed. Sputum bacteriological conversion was defined as two consecutive negative smear or culture taken at least 30 days apart. Cox regression model was used to analyse time-to initial sputum conversion, and to identify influencing factors. A simple risk score was constructed using the regression coefficients from each final model. Time-dependent AUC was used to determine the optimal time points of bacteriological conversion.Results 75% (173/232) of patients with a positive smear and culture at baseline were analyzed. A total, 90.2% (156/173) and 89% (154/173) of the patients had smear and culture conversions in a median of 59 days (inter-quartile range: 59 – 61) respectively. Lower colony count (< 3 +) of initial culture (aHR = 1.52, 1.09 – 2.14) and previously history of TB treatment (aHR = 2.10, 1.26 – 3.51) were more likely to have culture conversion, while only the higher BMI (aHR = 1.10, 1.03 – 1.18) was associated with rapid smear conversion. The predicted risk score from independent predictors showed good discrimination (0.855 ± 0.023 and 0.883 ± 0.02 respectively for smear and culture conversions). Time-to initial culture conversion provided a better discriminative capacity (AUC) to detect patients with higher chance to being treatment success during the first three months.Conclusion The identified predictors can be considered to improve the management of MDR-TB patients. The optimal time points for culture conversion was three months in shorter regime. Keywords: Conversion, Multidrug-resistant, Tuberculosis, Guinea.