Molecular epidemiology, drug susceptibility and economic aspects of tuberculosis in Mubende district, Uganda

PLoS One. 2013 May 31;8(5):e64745. doi: 10.1371/journal.pone.0064745. Print 2013.

Abstract

Background: Tuberculosis (TB) remains a global public health problem whose effects have major impact in developing countries like Uganda. This study aimed at investigating genotypic characteristics and drug resistance profiles of Mycobacterium tuberculosis isolated from suspected TB patients. Furthermore, risk factors and economic burdens that could affect the current control strategies were studied.

Methods: TB suspected patients were examined in a cross-sectional study at the Mubende regional referral hospital between February and July 2011. A questionnaire was administered to each patient to obtain information associated with TB prevalence. Isolates of M. tuberculosis recovered during sampling were examined for drug resistance to first line anti-TB drugs using the BACTEC-MGIT960(TM) system. All isolates were further characterized using deletion analysis, spoligotyping and MIRU-VNTR analysis. Data were analyzed using different software; MIRU-VNTR plus, SITVITWEB, BioNumerics and multivariable regression models.

Results: M. tuberculosis was isolated from 74 out of 344 patients, 48 of these were co-infected with HIV. Results from the questionnaire showed that previously treated TB, co-infection with HIV, cigarette smoking, and overcrowding were risk factors associated with TB, while high medical related transport bills were identified as an economic burden. Out of the 67 isolates that gave interpretable results, 23 different spoligopatterns were detected, nine of which were novel patterns. T2 with the sub types Uganda-I and Uganda-II was the most predominant lineage detected. Antibiotic resistance was detected in 19% and multidrug resistance was detected in 3% of the isolates.

Conclusion: The study detected M. tuberculosis from 21% of examined TB patients, 62% of whom were also HIV positive. There is a heterogeneous pool of genotypes that circulate in this area, with the T2 lineage being the most predominant. High medical related transport bills and drug resistance could undermine the usefulness of the current TB strategic interventions.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Antitubercular Agents / therapeutic use
  • Bacterial Typing Techniques
  • Coinfection
  • Cross-Sectional Studies
  • DNA, Bacterial / genetics
  • DNA, Bacterial / isolation & purification*
  • Drug Resistance, Bacterial
  • Female
  • HIV / isolation & purification*
  • HIV Infections / diagnosis
  • HIV Infections / epidemiology*
  • HIV Infections / microbiology
  • Humans
  • Male
  • Middle Aged
  • Molecular Epidemiology
  • Mycobacterium tuberculosis / genetics
  • Mycobacterium tuberculosis / isolation & purification*
  • Tuberculosis, Pulmonary / diagnosis
  • Tuberculosis, Pulmonary / drug therapy
  • Tuberculosis, Pulmonary / epidemiology*
  • Tuberculosis, Pulmonary / microbiology
  • Uganda / epidemiology

Substances

  • Antitubercular Agents
  • DNA, Bacterial

Grants and funding

This work was carried out by the generous financial support obtained from the Norwegian Educational Load fund as quota scholarship to Dr. Adrian Muwonge as well as from core funding source of the Centre for Epidemiology and Biostatistics, Norwegian School of Veterinary Science and the National Veterinary Institute. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.