Patterns and profiles of drug resistance-conferring mutations in Mycobacterium tuberculosis genotypes isolated from tuberculosis-suspected attendees of spiritual holy water sites in Northwest Ethiopia

Reta, Melese Abate; Maningi, Nontuthuko Excellent; Fourie, P. Bernard

doi:10.3389/fpubh.2024.1356826

Cited by 2 publications

(5 citation statements)

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“…In our study, participants who shared living space at HWSs were tenfold more likely to have culture-positive PTB. This is because rooms at the HWSs are built as temporary waiting spaces, and they are very small, overcrowded, and poorly ventilated, which can intensify the risk of TB transmission [ 13 , 18 , 52 ]. The overcrowded and poorly ventilated waiting rooms at the HWS, prolonged stays at the HWS, and poor healthcare-seeking behaviors of individuals worsen the active transmission of TB at the HWS.…”

Section: Discussionmentioning

confidence: 99%

“…Our findings were comparable to those of prior studies [ 32 , 34 , 35 ]. Congregate settings, such as HWSs, are places where people live together, and it is common for people to share living space [ 13 , 18 , 52 ]. Hence, poor living conditions and overcrowding in the shared room can increase TB transmission.…”

Section: Discussionmentioning

confidence: 99%

“…In the current study, the prevalence of any DR-TB (resistance to RIF and/or INH) was 16.4%, indicating that it is a significant concern among HWS attendees. This is likely because many people with TB (infected with DR-TB strains) attended HWSs, resulting in DR-TB transmission [ 13 , 18 , 52 ]. This is comparable with previous reports from the study region (10.3 to 20.2%) [ 53 – 59 ], and other parts of Ethiopia (11.1 to 18.4%) [ 60 – 65 ].…”

Section: Discussionmentioning

confidence: 99%

“…Interestingly, all five FLQs-resistant and/or pre-XDR-TB isolates were identified at the South Wello zone. This suggests that these pre-XDR-TB strains may be circulating in this study site and have recently disseminated, although a molecular epidemiology analysis with strong discriminatory power would be required to confirm genotypic similarities, and recent transmission [ 18 , 52 ]. Consistent with our result, an earlier study conducted in the same study region found that 5.7% of TB patients had pre-XDR-TB strains [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

“…Interestingly, five FLQs-resistant and/or pre-XDR-TB strains were identified at the South Wello zone study site. This could be because DR-TB is prominent in this study area and there is recent TB transmission, although further molecular epidemiology analysis with strong discriminatory power would be required to confirm genotypic similarities and transmission patterns of the resistant strains [ 18 , 52 ].…”

Section: Discussionmentioning

confidence: 99%

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Spiritual Holy Water Sites in Ethiopia: Unrecognized High-Risk Settings for Transmission of Pulmonary Tuberculosis

Reta,

Maningi,

Wubetu

et al. 2024

International Journal of Microbiology

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Ethiopia is a high-tuberculosis (TB) burden country with 157 new cases per 100,000 people, with 23,800 TB-related deaths in 2020. In Ethiopia, TB patients have different healthcare-seeking behaviors. They frequently visit spiritual places, such as holy water sites (HWSs), to seek treatment for their illness spiritually. This study examined the prevalence of pulmonary TB (PTB) and drug susceptibility profiles of Mycobacterium tuberculosis (MTB) isolates among spiritual HWS attendees in Northwest Ethiopia. A cross-sectional study was conducted from June 2019 to March 2020. Sputum samples were collected, processed, and cultured using Löwenstein–Jensen (LJ) culture medium. Second-generation line probe assays (LPAs), GenoType®MTBDRplus VER2.0 and GenoType®MTBDRsl VER2.0, were used to detect anti-TB drug-resistant isolates. STATA 17 was utilized to perform descriptive statistics, bivariate, and multivariate regression analyses. Of 560 PTB-symptomatic participants, 21.8% ((95% confidence interval (95 CI): 18.4–25.2%)) were culture-positive, resulting in a point prevalence of 1,183/100,000 attendees. Amongst HWS attendees, culture-positive TB occurred most commonly in persons 18–33 years of age (28.5% (95 CI 23.4–34.3%)). Other participant characteristics significantly associated with culture-positive PTB were as follows: rural residents (adjusted odds ratio (aOR) 2.65; 95 CI 1.38–5.10), married participants (aOR 2.43; 95 CI 1.28–4.63), family members >5 per household (aOR 1.84; 95 CI 1.04–3.24), and sharing living space (aOR 10.57; 95 CI 3.60–31.13). Also, among 438 participants followed for 12 months after showing negative TB culture results while at the HWS, 6.8% (95 CI 4.4–9.4%) developed or contracted culture-positive TB post-residency at the HWSs. Of the 122 tested isolates, 20 (16.4%) were isoniazid (INH) and/or rifampicin (RIF) resistant. Multidrug-resistant (MDR) TB was detected in 15 cases (12.3%), five of which were fluoroquinolones (FLQs) resistant. The findings from this study should raise a concern about HWSs as potential high-risk settings for TB transmission. It is recommended that appropriate control measures be instituted that include compulsory TB testing and tightened infection control at HWSs, where an increased risk exists for transmission of TB.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Spiritual Holy Water Sites in Ethiopia: Unrecognized High-Risk Settings for Transmission of Pulmonary Tuberculosis

Reta,

Maningi,

Wubetu

et al. 2024

International Journal of Microbiology

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Risk assessment and transmission of fluoroquinolone resistance in drug-resistant pulmonary tuberculosis: a retrospective genomic epidemiology study

Nehru,

Jose Vandakunnel,

Brammacharry

et al. 2024

Sci Rep

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Fluoroquinolone resistance is a major challenge in treating Multidrug-Resistant Tuberculosis globally. The GenoType MTBDR sl Ver 2.0, endorsed by the WHO, was used to characterize fluoroquinolone resistance. The fluoroquinolone resistance rates in the MDR-TB, Rifampicin-Resistant TB, and non-MDR-TB were 33%, 16.5%, and 5.4%, respectively. The most common mutation found in fluoroquinolone-resistant isolates was D94G (49.5%) in the gyrA gene. Of the 150 MDR-TB isolates, the prevalence of Extensively Drug-Resistant Tuberculosis and pre-XDR-TB was 1.33% and 30%, respectively. Among the 139 RR-TB isolates, pre-XDR-TB prevalence was 15.8%. The fluoroquinolone resistance rates were 5.12% among the 1230 isoniazid-monoresistant isolates. The study found that MDR-TB and RR-TB have higher risk of fluoroquinolone resistance than non-MDR tuberculosis. Rifampicin-resistant isolates with a mutation at codon S450L have a higher risk (RR = 12.96; 95%CI: 8.34–20.13) of developing fluoroquinolone resistance than isolates with mutations at other codons in the rpoB gene. Isoniazid-resistant isolates with a mutation at codon S315T have a higher risk (RR = 2.09; 95%CI: 1.25–3.50) of developing fluoroquinolone resistance. The study concludes that rapid diagnosis of fluoroquinolone resistance before starting treatment is urgently needed to prevent the spread and increase of resistance and to achieve better treatment outcomes in areas where it is higher.

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Patterns and profiles of drug resistance-conferring mutations in Mycobacterium tuberculosis genotypes isolated from tuberculosis-suspected attendees of spiritual holy water sites in Northwest Ethiopia

Cited by 2 publications

References 61 publications

Spiritual Holy Water Sites in Ethiopia: Unrecognized High-Risk Settings for Transmission of Pulmonary Tuberculosis

Spiritual Holy Water Sites in Ethiopia: Unrecognized High-Risk Settings for Transmission of Pulmonary Tuberculosis

Risk assessment and transmission of fluoroquinolone resistance in drug-resistant pulmonary tuberculosis: a retrospective genomic epidemiology study

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