Molecular epidemiology of pulmonary tuberculosis in belgrade, central serbia

Longitudinal Outbreak of Multidrug-Resistant Tuberculosis in a Hospital Setting, Serbia

A retrospective population-based molecular epidemiologic study of multidrug-resistant Mycobacterium tuberculosis complex strains in Serbia (2008–2014) revealed an outbreak of TUR genotype strains in a psychiatric hospital starting around 1990. Drug unavailability, poor infection control, and schizophrenia likely fueled acquisition of additional resistance and bacterial fitness–related mutations over 2 decades.

Role of Molecular Epidemiology on Tuberculosis Control in the Middle East Countries: a Systematic Review and Meta-Analysis

BACKGROUND

Tuberculosis (TB) is a public health problem in developing countries and yet the numbers of people with the disease are abundant. Early detection of transmission sources and effective treatment of the cases is essential to control the disease which will be possible by application of molecular epidemiology approaches. Studies conducted based on Mycobacterial Interspersed Repetitive Units-Variable Number of Tandem Repeats (MIRU-VNTR) method in Muslim Middle East countries were evaluated to determine their role in TB control.

MATERIALS AND METHODS

All studies from January 2005 to April 2016 were systematically reviewed in four electronic databases and finally 16 articles were found eligible to be included in this study. The mean clustering rate was determined as 44% and the recent transmission rate was 12.3 to 78.8% with average of 33%.

RESULTS

The results showed that both reactivation and recent transmission were important in developing new cases of TB in Middle East countries; but, reactivation plays a more critical role.

CONCLUSION

Regarding to ongoing war and immigration in the region along with the increasing of drug-resistant TB, in the case of improper supervision in the future, the disease, especially drug- resistant TB, will be problematic.

Tuberculosis Control and Role of Molecular Epidemiology Studies in Iran: A Systematic Review

BACKGROUND

Today because of immigration, HIV pandemic and spread of drug resistant tuberculosis, mortality caused by tuberculosis (TB) has increased. To control the disease it is essential to identify the sources of the infection and patterns of transmission. This becomes possible through using molecular epidemiology methods.

MATERIALS AND METHODS

This research reviewed studies based on IS6110-restriction fragment length polymorphism (IS6110-RFLP) as a primary method to recognize the role of molecular epidemiology researches in managing TB in Iran. Within 1995-2015 all human population based studies which had use IS6110-RFLP as the primary method systematically reviewed.

RESULTS

At the end, 11 articles were selected. The mean clustering rate obtained was 28.1%. The rate of recent transmission was variable from 2% to 49% and the mean value was determined 17%.

CONCLUSION

The studies revealed that in Iran both reactivation and recent transmission were significant in developing new cases of TB. Yet, reactivation plays greater role. If the matter is supervised insufficiently and carelessly, because of increasing rate of drug resistant TB, immigration of HIV infected individuals, TB especially drug resistant TB will be problematic in the near future.

Map the gap: missing children with drug-resistant tuberculosis

BACKGROUND

The lack of published information about children with multidrug-resistant tuberculosis (MDR-TB) is an obstacle to efforts to advocate for better diagnostics and treatment.

OBJECTIVE

To describe the lack of recognition in the published literature of MDR-TB and extensively drug-resistant TB (XDR-TB) in children.

DESIGN

We conducted a systematic search of the literature published in countries that reported any MDR- or XDR-TB case by 2012 to identify MDR- or XDR-TB cases in adults and in children.

RESULTS

Of 184 countries and territories that reported any case of MDR-TB during 2005-2012, we identified adult MDR-TB cases in the published literature in 143 (78%) countries and pediatric MDR-TB cases in 78 (42%) countries. Of the 92 countries that reported any case of XDR-TB, we identified adult XDR-TB cases in the published literature in 55 (60%) countries and pediatric XDR-TB cases for 9 (10%) countries.

CONCLUSION

The absence of publications documenting child MDR- and XDR-TB cases in settings where MDR- and XDR-TB in adults have been reported indicates both exclusion of childhood disease from the public discourse on drug-resistant TB and likely underdetection of sick children. Our results highlight a large-scale lack of awareness about children with MDR- and XDR-TB.

Tuberculosis incidence in elderly in Serbia: key trends in socioeconomic transition

AIM

To examine tuberculosis incidence rates among the elderly in Central Serbia in 1992-2006 period, which was characterized by socioeconomic crisis and migration of population.

METHODS

We analyzed all reported active tuberculosis cases in a 15-year period, especially among patients aged > or =65, according to the Annual Reports of the Institute of Lung Diseases and Tuberculosis in Belgrade and Central Tuberculosis Register. Population estimates with extrapolations were based on 1991 and 2002 census data.

RESULTS

Total tuberculosis incidence rates showed a slight but non-significant decreasing trend (P=0.535), and no significant increase was found in patients aged > or =65 years (P=0.064), with an average age-specific incidence rate for the elderly of 64.0 (95% confidence interval, 60.7-67.4). The increase was significant in patients aged > or =70 years (y=49.3549+2.1186x; P=0.001), both in men (y=62.8666+2.3977x; P=0.005) and even more prominently in women (y=39.8240+1.9150x; P<0.001). The proportion of tuberculosis cases in the elderly peaked in 2005, with 35% of all tuberculosis cases.

CONCLUSION

High incidence rates and increasing time trend of tuberculosis in the elderly in Central Serbia is a serious problem, especially among those aged 70 years and over, who might present a target group for active case-finding of the disease.

Knowledge and misconceptions of tuberculosis in the general population in Serbia

This study was conducted in Serbia, including Vojvodina and central Serbia, but excluding Kosovo. We aimed to assess the level of knowledge and misconceptions about tuberculosis (TB) in the general population in Serbia. A total of 1,129 inhabitants aged at least 15 years old were interviewed. A combination of telephone and field surveys was used. More than 20% of respondents correctly understood the modes of transmission of TB. However, more than a quarter (28.5%) of respondents had some misconceptions about the possible modes of transmission. Analysis showed that the only significant predictors of a correct understanding of the modes of transmission were the education level and a close personal relationship with a patient with TB. The strongest predictors of misconceptions were older age and an urban type of settlement (odds ratio [OR] 1.5, confidence interval [CI] 1.3-1.6; OR 0.4, CI 0.3-0.6, respectively). A total of 33.9% of respondents could not identify any sign of TB and 86.6% of respondents knew that TB could be treated effectively, but only 20.1% knew that the treatment was free of charge. Our study showed that knowledge about TB is not satisfactory in the general population in Serbia.

Evaluation and genotyping of multidrug-resistant cases of tuberculosis in southern Brazil

Sixty isolates of Mycobacterium tuberculosis identified as multidrug-resistant (MDR) at a reference laboratory in Rio Grande do Sul State during the years 1999 and 2000 were analyzed using the IS6110-restriction fragment length polymorphism (RFLP) technique. We also genotyped 202 susceptible strains to compare the genotyping results, as well as the clinical and demographic data. Spacer oligotyping (spoligotyping) analysis was performed for isolates presenting low IS6110 copy number. Patients with identical DNA pattern strains were considered clustered. From 262 isolates, 94 (36%) belonged to 20 distinct RFLP clusters, and after spoligotyping analysis, 89 of the isolates (34%) remained in cluster. MDR isolates did not differ statistically in clustering proportion from susceptible strains. A significant association between the occurrence of MDR and previous tuberculosis (TB) treatment was observed (p < 0.001), as well as failure on TB treatment (p < 0.001). Human immunodeficiency virus (HIV)-positive patients were associated with susceptible tuberculosis (p = 0.024). We also identified that unmarried patients were more likely to develop TB due to recent transmission than married patients (p < 0.005). The introduction of directly observed therapy short-course (DOTS) strategy will be important in decreasing default and failure rates and avoiding the development of new MDR strains.

Molecular epidemiology of drug-resistant tuberculosis in Hungary

Sixty-eight drug-resistant Mycobacterium tuberculosis isolates (44.2% of all resistant cases) were analyzed by IS6110 restriction fragment length polymorphism fingerprinting and spoligotyping to provide a deeper insight into the status of drug-resistant tuberculosis in Hungary. A total of 54.4% of the drug-resistant cases and 75% of the multidrug-resistant cases could be clustered. Analysis of the spoligotyping patterns of the strains revealed a high rate (66.2%) of infection by the Haarlem genotype, while none of the patients were infected by the Beijing genotype. The magnitude and the dynamics of drug-resistant tuberculosis are underestimated in Hungary.

IS6110 restriction fragment length polymorphism typing of Mycobacterium tuberculosis isolates from East Azerbaijan Province of Iran

To investigate the genetic variation among Mycobacterium tuberculosis isolates in the East Azerbaijan Province of Iran and to evaluate the level of and risk factors for recent transmission of tuberculosis (TB), we performed IS6110-based restriction fragment length polymorphism analysis of strains, isolated from 105 patients during the period of September 2002 to March 2003 in TB centers and university hospitals of the province. Among 105 isolates, 81 different IS6110 patterns were found, of which 70 were observed only once and 11 were shared by two to eight isolates. Ninety-six isolates (91.4%) were found to have more than five copies of IS6110 and together with high patterns polymorphism, shows that IS6110-RFLP typing could be useful for studying the epidemiology of TB in Azerbaijan. The minimum estimated rate of recent transmission was 23%, suggesting that the degree of recent transmission in East Azerbaijan Province is relatively low. Clustering was not associated with age, sex or site of infection of TB but drug-resistant isolates were less likely to be clustered than sensitive isolates (p < 0.05).

Molecular Epidemiology: A Tool for Understanding Control of Tuberculosis Transmission

One of the primary goals of tuberculosis control programs is to interrupt the transmission of Mycobacterium tuberculosis. The development of several genotyping tools has allowed tracking of strains of M. tuberculosis as they spread through communities. Studies that have combined the use of genotyping with conventional epidemiologic investigation have increased the understanding of the transmission and pathogenesis of tuberculosis. This article reviews some of the lessons learned using these new epidemiologic tools.