Investigation of the high rates of extrapulmonary tuberculosis in Ethiopia reveals no single driving factor and minimal evidence for zoonotic transmission of Mycobacterium bovis infection

BMC Infectious Diseases

Research Article

Gobena Ameni¹  Stefan Berg²  Glyn Hewinson²  Yohannes Derese³  Jemal Hussein³  Girume Erenso³  Shiferaw Bekele³  Lawrence Yamuah³  Abraham Aseffa³  Balako Gumi³  Teklu Kiros³  Wondale Mekonnen³  Endalamaw Gadisa³  Meseret Habtamu³  Araya Mengistu³  Elena Hailu³  Rebuma Firdessa⁴  Brian D Robertson⁵  Rea Tschopp⁶  Esther Schelling⁷  Sebastien Gagneux⁷  Jakob Zinsstag⁷  Stephen V Gordon⁸ 

[1] Aklilu Lemma Institute of Pathobiology, Addis Ababa University, PO Box 1176, Addis Ababa, Ethiopia;Animal and Plant Health Agency, TB Research Group, New Haw, Addlestone, KT15 3NB, Surrey, UK;Armauer Hansen Research Institute, PO Box 1005, Addis Ababa, Ethiopia;Armauer Hansen Research Institute, PO Box 1005, Addis Ababa, Ethiopia;University of Würzburg, Institute for Molecular Infection Biology, Würzburg, Germany;Center for Molecular Bacteriology and Infection, Department of Medicine, Flowers building, South Kensington, Imperial College London, SW7 2AZ, London, UK;Swiss Tropical and Public Health Institute, PO Box CH-4002, Basel, Switzerland;Armauer Hansen Research Institute, PO Box 1005, Addis Ababa, Ethiopia;University of Basel, Basel, Switzerland;Swiss Tropical and Public Health Institute, PO Box CH-4002, Basel, Switzerland;University of Basel, Basel, Switzerland;UCD Schools of Veterinary Medicine, Medicine and Medical Science, Biomolecular and Biomedical Science and UCD Conway Institute, University College Dublin, Dublin, Republic of Ireland;

关键词: Mycobacterium;    Tuberculosis;    Bovis;    Pulmonary;    Extrapulmonary;    Lymphadenitis;    Zoonotic;    Ethiopia;   

DOI  :  10.1186/s12879-015-0846-7

 received in 2014-07-18, accepted in 2015-02-19,  发布年份 2015

来源: Springer

【 摘 要 】

BackgroundEthiopia, a high tuberculosis (TB) burden country, reports one of the highest incidence rates of extra-pulmonary TB dominated by cervical lymphadenitis (TBLN). Infection with Mycobacterium bovis has previously been excluded as the main reason for the high rate of extrapulmonary TB in Ethiopia.MethodsHere we examined demographic and clinical characteristics of 953 pulmonary (PTB) and 1198 TBLN patients visiting 11 health facilities in distinct geographic areas of Ethiopia. Clinical characteristics were also correlated with genotypes of the causative agent, Mycobacterium tuberculosis.ResultsNo major patient or bacterial strain factor could be identified as being responsible for the high rate of TBLN, and there was no association with HIV infection. However, analysis of the demographic data of involved patients showed that having regular and direct contact with live animals was more associated with TBLN than with PTB, although no M. bovis was isolated from patients with TBLN. Among PTB patients, those infected with Lineage 4 reported “contact with other TB patient” more often than patients infected with Lineage 3 did (OR = 1.6, CI 95% 1.0-2.7; p = 0.064). High fever, in contrast to low and moderate fever, was significantly associated with Lineage 4 (OR = 2.3; p = 0.024). On the other hand, TBLN cases infected with Lineage 4 tended to get milder symptoms overall for the constitutional symptoms than those infected with Lineage 3.ConclusionsThe study suggests a complex role for multiple interacting factors in the epidemiology of extrapulmonary TB in Ethiopia, including factors that can only be derived from population-based studies, which may prove to be significant for TB control in Ethiopia.

【 授权许可】

Unknown   
© Berg et al.; licensee BioMed Central. 2015. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.