Misdiagnosis of tuberculosis and the clinical relevance of non—tuberculous mycobacteria in Zambia

Buijtels, Petronella Catharina Adriana Maria; Iseman, Michael D.; Parkinson, Shelagh; Graaff, Casper de; Verbrugh, Henri A.; Petit, P. L. C.; Soolingen, Dick van

doi:10.1016/s1995-7645(10)60094-6

Cited by 9 publications

(6 citation statements)

References 29 publications

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“…In this study M. fortuitum , was isolated from a clinical case. The other studies conducted in the Western and Northern regions of Zambia [ 18 ] and other parts of the world [ 19 , 20 ] were in contrast with these findings. The reason for this difference is that NTM species distribution differs from one geographical region to another [ 21 ].…”

Section: Discussioncontrasting

confidence: 73%

Molecular identification of non-tuberculous mycobacteria isolated from clinical specimens in Zambia

Mwikuma

Kwenda

Hang’ombe

et al. 2015

Ann Clin Microbiol Antimicrob

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BackgroundThe emergence of Acquired Immunodeficiency Syndrome has highlighted the increased incidence and importance of the disease caused by Non-tuberculous Mycobacteria (NTM). While disease due to M. avium-intracellulare complex is apparently common throughout the world, other Non-tuberculous mycobacterial species have been isolated from both immunocompromised and immunocompetent individuals. The increasing number of infections caused by these organisms has made it clinically important to quickly identify mycobacterial species. The diagnosis of a pathogenic versus a non-pathogenic species not only has epidemiological implications but is also relevant to the demands of patient management. Since antibiotic treatment varies according to the species encountered, species identification would reduce the burden of some of these emerging opportunistic pathogens especially in immunocompromised patients and improve their quality of life.FindingsA total of 91 NTM suspected isolates from four regions of Zambia were included in the study. These isolates were identified using the sequence analysis of the 16S-23S rRNA intergenic transcribed spacer (ITS) region of Mycobacteria.Fifty-four of the 91 (59%) isolates were identified as NTM and these included M. intracellulare (27.8%), M. lentiflavum (16.7%), M. avium (14.8%), M. fortuitum (7.4%), M. gordonae (7.4%), M. kumamotonense (3.7%), M. indicus pranii (3.7%), M. peregrinum (3.7%), M. elephantis (1.85%), M. flavescens (1.85%), M. asiaticum (1.85%), M. bouchedurhonense (1.85%), M. chimaera (1.85%), M. europaeum (1.85%), M. neourum (1.85%), M. nonchromogenicum (1.5%).ConclusionThe study has shown that DNA sequencing of the ITS region may be useful in the preliminary identification of NTM species. All species identified in this study were potentially pathogenic.Electronic supplementary materialThe online version of this article (doi:10.1186/s12941-014-0059-8) contains supplementary material, which is available to authorized users.

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Section: Discussioncontrasting

confidence: 73%

Molecular identification of non-tuberculous mycobacteria isolated from clinical specimens in Zambia

Mwikuma

Kwenda

Hang’ombe

et al. 2015

Ann Clin Microbiol Antimicrob

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“…Our hypothesis was quite simplistic since if IP-10 showed no response, we predicted it was from an unconfirmed patient or a drug-resistant case. However, even though we used a sensitive gold standard diagnostic we can be reasonably certain that a proportion of the clinically diagnosed patients in fact did not have TB 2 , 3 . Thus, we believe we present a minimum estimate of the performance of our predictive model and we would have been more accurate if there was a way of ascertaining the TB status among those who were clinically diagnosed.…”

Section: Discussionmentioning

confidence: 96%

“…Furthermore, only 57% and 15% of notified incident pulmonary and extra pulmonary TB cases respectively are ever bacteriologically confirmed 1 . Among this large group of clinically diagnosed patients, there is likely a proportion of cases who initiate treatment without having TB 2 , 3 , or receive first-line therapy but have drug resistant TB (DR-TB) 4 . Providing TB treatment to a patient without TB risks drug-related toxicity and delays the diagnosis of the true cause of symptoms.…”

Section: Introductionmentioning

confidence: 99%

IP-10 Kinetics in the First Week of Therapy are Strongly Associated with Bacteriological Confirmation of Tuberculosis Diagnosis in HIV-Infected Patients

García‐Basteiro

Mambuque

Hertog

et al. 2017

Sci Rep

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Simple effective tools to monitor the long treatment of tuberculosis (TB) are lacking. Easily measured host derived biomarkers have been identified but need to be validated in larger studies and different population groups. Here we investigate the early response in IP-10 levels (between day 0 and day 7 of TB therapy) to identify bacteriological status at diagnosis among 127 HIV-infected patients starting TB treatment. All participants were then classified as responding or not responding to treatment blindly using a previously described IP-10 kinetic algorithm. There were 77 bacteriologically confirmed cases and 41 Xpert MTB/RIF® and culture negative cases. Most participants had a measurable decline in IP-10 during the first 7 days of therapy. Bacteriologically confirmed cases were more likely to have high IP-10 levels at D0 and had a steeper decline than clinically diagnosed cases (mean decline difference 2231 pg/dl, 95% CI: 897–3566, p = 0.0013). Bacteriologically confirmed cases were more likely to have a measurable decline in IP-10 at day 7 than clinically diagnosed cases (48/77 (62.3%) vs 13/41 (31.7%), p < 0.001). This study confirms the association between a decrease in IP-10 levels during the first week of treatment and a bacteriological confirmation at diagnosis in a large cohort of HIV positive patients.

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“…Of these 1/14 (7.14%) is focusing on humans and water (42), 1/14 (7.14%) was done in humans, cattle and Kafue Lechwe (5) and another one is a case report 1/14 (7.14%) (43), one is a pilot study 1/14 (7.14%) (44) and one a case control study 1/14 (7.14%) (44). The remaining 9/14 (64.29%) are all cross section study focusing on NTM in humans (20,(45)(46)(47)(48)(49)(50)(51)(52)(53). The study shows that the main specimens collected were sputum samples 10/14 studies (71.43%), one was a combination of sputum samples and brochoalveolar lavage, one was done on stored or archived isolates, one on a combination of stool samples, internal lavage and biopsy of the descending colon and lastly one was done on gastric lavage.…”

Section: Literature Searchmentioning

confidence: 99%

Nontuberculous Mycobacteria in Humans, Animals, and Water in Zambia: A Systematic Review

et al. 2021

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Nontuberculous mycobacteria (NTM) are environmental opportunistic pathogens of humans and animals that are emerging with a serious public health impact particularly in individuals with Acquired Immunodeficiency Syndromes. Recent scientific evidence is shifting from NTMs being known as traditional environmental organisms to serious pathogenic organisms in both animals and humans. In humans, factors attributable to this rise have been linked mainly to Human Immunodeficiency Virus and Acquired Immunodeficiency Syndrome pandemic. In recent years there has been an increase in multidrug resistant Tuberculosis in Zambia and it is thought that NTMs could possibly be the cause. This study was therefore formulated to review available information on the prevalence of NTM in humans, animals and the environment, species distribution, zoonotic potential and public health importance in Zambia. This review was conducted in accordance with PRISMA guidelines. A literature search was done in PubMed and Google scholar using predefined search terms such as ‘nontuberculous mycobacteria’, ‘atypical mycobacteria’, ‘mycobacteria other than mycobacterium tuberculosis’ and ‘Zambia’, in combination with Boolean operators (AND, OR). This particular systematic review draws findings based on literature search between 2000 and 2020. Through literature search 243 papers were identified, 23 duplicates were identified and removed and 206 articles were excluded as they did not meet the inclusion criteria. The full text of the remaining 14 articles were considered for this review. The overall prevalence of NTM in humans was 24.39%, in water 21.5%, in animals 16.05% of which the prevalence in cattle was 14.81% and Kafue Lechwe 1.23%. Mycobacterium intracellulare was the most common isolated nontuberculous mycobacteria in humans and cattle while Mycobacterium gordonae was the most common in water, and Mycobacterium stomatepiae sp Nov in Kafue Lechwe. Nontuberculous mycobacteria are an emerging public health threat in Zambia both in humans and animals and this calls for the need for molecular information on the zoonotic transmission of nontuberculous mycobacteria. Increased awareness of nontuberculous mycobacteria diseases among clinicians and laboratory personnel is crucial for patient management and an essential step for facilitating the identification of nontuberculous mycobacteria species in laboratories.

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Misdiagnosis of tuberculosis and the clinical relevance of non—tuberculous mycobacteria in Zambia

Cited by 9 publications

References 29 publications

Molecular identification of non-tuberculous mycobacteria isolated from clinical specimens in Zambia

Molecular identification of non-tuberculous mycobacteria isolated from clinical specimens in Zambia

IP-10 Kinetics in the First Week of Therapy are Strongly Associated with Bacteriological Confirmation of Tuberculosis Diagnosis in HIV-Infected Patients

Nontuberculous Mycobacteria in Humans, Animals, and Water in Zambia: A Systematic Review

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