Extrapulmonary and Pulmonary Tuberculosis in Antananarivo (Madagascar): High Clustering Rate in Female Patients

Abstract

Antananarivo, the capital city of Madagascar, has an endemic focus of tuberculosis (TB). We specifically studied patients with extrapulmonary TB (EPTB) and grouped patients according to infected body site. The strains were characterized by IS6110 fingerprinting and compared with those isolated from patients with pulmonary TB (PTB) during the same period in order to determine the possible association between the genotype and the clinical expression of TB. A total of 316 TB patients were included in this study: 151 individuals with EPTB, 10 with both PTB and EPTB, and 155 with PTB alone. Pleural TB was the major EPTB localization (77%) and was found more often in older patients, while PTB or EPTB in which the localization was other than pleural (other EPTB) was found in younger patients. The male-to-female ratio was slightly higher in pleural TB patients (3.06:1) than in patients with other EPTB (1.35:1). There was no significant difference in the BCG status among patients with PTB, pleural TB, and other EPTB. Analysis of IS6110 patterns showed that 167 patients (52.8%) were assigned to 37 clusters of 2 to 34 patients. Analysis of the IS6110 clusters and the IS6110 families did not show any association with a particular clinical expression of the disease. Patients with PTB or other EPTB were more likely to have strains with one IS6110 copy than patients with pleural TB. The clustering rate was found to be significantly higher in female patients (62%) than in male patients (48%) (P ‫؍‬ 0.029), suggesting that Malagasy women were more likely to progress to disease after infection than men.

Risk Factors for Extra Pulmonary Tuberculosis in the Health District of Thies, Senegal

“…In Dakar, Senegal, a mean age of 36 years [19], 37 years [20] and 39 years [21] were found respectively with the age range of 30-44 years and 14-45 years being the most affected. In Benin [1] and Madagascar [22], similar results were almost observed with the age range of 25-34 years being the most affected. This was also the case in China [23], Saudi Arabia [24], Brazil [15], Germany [6] and USA [8].…”

Long-Term Population-Based Genotyping Study of Mycobacterium tuberculosis Complex Isolates in the French Departments of the Americas

“…Thus, the rate of recent transmis- sion in FWI is relatively low, with values for Martinique being close to those reported in low-incidence areas like Sweden (14.1% [4]), and London, England (14.4% [17]), and those for Guadeloupe being similar to Denmark (24% [34]) and Paris, France (25% 15). On the contrary, the rate of recent transmission of TB in French Guiana with a value of around 50% is close to data reported from high-incidence areas like Equatorial Guinea (28), Zimbabwe (10), Cape Town, South Africa (31), and Antananarivo, Madagascar (19). However, these clustering rates should be interpreted carefully, because clustering may be observed between individuals without any recent transmission links or established contacts (8).…”

Variation in Gamma Interferon Responses to Different Infecting Strains of Mycobacterium tuberculosis in Acid-Fast Bacillus Smear-Positive Patients and Household Contacts in Antananarivo, Madagascar

“…However, so far there are few data on the effects of M. tuberculosis isolates with different genotypes on clinical presentation or outcome in human TB. In a previous study, we did not find any obvious association between the IS6110-based restriction fragment length polymorphism (IS6110-RFLP) patterns and the clinical presentation of tuberculosis (47). However, there was some association of specific IS6110-RFLP patterns with disease presentation, suggesting that some strains may have the ability to disseminate more easily than others.…”