Abstract
BackgroundThe poor peri-urban areas of developing countries with inadequate living conditions and a high prevalence of HIV infection have been implicated in the increase of tuberculosis (TB). Presence of different lineages of Mycobacterium tuberculosis has been described in different parts of the world. This study determined the predominant strain lineages that cause TB in Rubaga division, Kampala, Uganda, and the prevalence of resistance to key anti-tuberculosis drugs in this community.MethodsThis was a cross-sectional study of newly diagnosed sputum smear-positive patients aged ≥ 18 years. A total of 344 isolates were genotyped by standard spoligotyping and the strains were compared with those in the international spoligotype database (SpolDB4). HIV testing and anti-tuberculosis drug susceptibility assays for isoniazid and rifampicin were performed and association with the most predominant spoligotypes determined.ResultsA total of 33 clusters were obtained from 57 spoligotype patterns. According to the SpolDB4 database, 241 (70%) of the isolates were of the T2 family, while CAS1-Kili (3.5%), LAM9 (2.6%), CAS1-Delhi (2.6%) were the other significant spoligotypes. Furthermore, a major spoligotype pattern of 17 (4.5%) strains characterized by lack of spacers 15–17 and 19–43 was not identified in SpolDB4. A total of 92 (26.7%) of the patients were HIV sero-positive, 176 (51.2%) sero-negative, while 76 (22.1%) of the patients did not consent to HIV testing. Resistance to isoniazid was found in 8.1% of strains, while all 15 (4.4%) strains resistant to rifampicin were multi-drug resistant. Additionally, there was no association between any strain types in the sample with either drug resistance or HIV sero-status of the patients.ConclusionThe TB epidemic in Kampala is localized, mainly caused by the T2 family of strains. Strain types were neither associated with drug resistance nor HIV sero-status.
Highlights
The poor peri-urban areas of developing countries with inadequate living conditions and a high prevalence of Human immunodeficiency virus (HIV) infection have been implicated in the increase of tuberculosis (TB)
Confirmatory microscopy and culture and susceptibility testing were performed at the National Tuberculosis and Reference Laboratory (NTRL); molecular assays were run at Makerere Medical School, and data analysis for spoligotyping was done at the Swedish Institute for Infectious Disease Control, Stockholm
The population of Rubaga division is mainly low to middle income, and the clinics chosen are the subsidized mission founded hospitals at which a Spoligotypes To determine the strain lineages present in the sample, the 344 isolates were spoligotyped and binary outcomes compared with those existing in SpolDB4 so as to assign spoligotype international type (SIT) designations
Summary
The poor peri-urban areas of developing countries with inadequate living conditions and a high prevalence of HIV infection have been implicated in the increase of tuberculosis (TB). Presence of different lineages of Mycobacterium tuberculosis has been described in different parts of the world. This study determined the predominant strain lineages that cause TB in Rubaga division, Kampala, Uganda, and the prevalence of resistance to key anti-tuberculosis drugs in this community. A previous characterization of 234 MTC strains collected between 1995 and 1997 at the National Referral Hospital in Kampala grouped 67% of the isolates into two closely related spoligotype families [4] but provided neither an estimate of the burden of other strain lineages and associated HIV sero-status data nor the anti-tuberculosis susceptibility pattern of the isolates
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