TB incidence and characteristics in the remote gulf province of Papua New Guinea: a prospective study

Gail B Cross,Justin Denholm,Peter Siba,Suparat Phuanukoonnon,Katie Coles,Owen A Moore,Emma S Mcbryde,Marc Pellegrini,Paul Harino,Ivo Mueller,Beverlyn Warigi,Damon P Eisen,Christopher Coulter,Robyn Carter,Mandana Nikpour,Sushil Pandey

doi:10.1186/1471-2334-14-93

Abstract

BackgroundThe incidence and characteristics of tuberculosis (TB) in remote areas of Papua New Guinea (PNG) are largely unknown. The purpose of our study was to determine the incidence of TB in the Gulf Province of PNG and describe disease characteristics, co-morbidities and drug resistance profiles that could impact on disease outcomes and transmission.MethodsBetween March 2012 and June 2012, we prospectively collected data on 274 patients presenting to Kikori Hospital with a presumptive diagnosis of TB, and on hospital inpatients receiving TB treatment during the study period. Sputum was collected for microscopy, GeneXpert analysis, culture and genotyping of isolates.ResultsWe estimate the incidence of TB in Kikori to be 1290 per 100,000 people (95% CI 1140 to 1460) in 2012. The proportion of TB patients co-infected with HIV was 1.9%. Three of 32 TB cases tested were rifampicin resistant. Typing of nine isolates demonstrated allelic diversity and most were related to Beijing strains.ConclusionsThe incidence of TB in Kikori is one of the highest in the world and it is not driven by HIV co-infection. The high incidence and the presence of rifampicin resistant warrant urgent attention to mitigate substantial morbidity in the region.

Highlights

The incidence and characteristics of tuberculosis (TB) in remote areas of Papua New Guinea (PNG) are largely unknown
We sought to determine the incidence of TB, the frequency of drug resistance and the incidence of concurrent Human immunodeficiency virus (HIV) infection in the remote Kikori community of PNG
Sputum and clinical specimens from 39 of the 56 cases were acid fast bacilli (AFB) positive or had Mycobaterium tuberculsosis (MTB) DNA detected by GeneXpert (Table 1)

Summary

Introduction

The incidence and characteristics of tuberculosis (TB) in remote areas of Papua New Guinea (PNG) are largely unknown. The purpose of our study was to determine the incidence of TB in the Gulf Province of PNG and describe disease characteristics, co-morbidities and drug resistance profiles that could impact on disease outcomes and transmission. A substantial proportion of the morbidity and mortality caused by tuberculosis (TB) is attributed to HIV co-infection and the emergence of drug resistance [1] These factors and their impact on TB incidence and outcomes have been well studied in many African countries [2,3,4]. The incidence of TB in countries with geographically isolated communities such as Papua New Guinea (PNG) is largely unknown and there is very limited. We sought to determine the incidence of TB, the frequency of drug resistance and the incidence of concurrent HIV infection in the remote Kikori community of PNG

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Conclusion