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BMC Infect Dis. 2015 Mar 3;15:112. doi: 10.1186/s12879-015-0846-7.

Investigation of the high rates of extrapulmonary tuberculosis in Ethiopia reveals no single driving factor and minimal evidence for zoonotic transmission of Mycobacterium bovis infection.

Author information

1
Animal and Plant Health Agency, TB Research Group, New Haw, Addlestone, Surrey, KT15 3NB, UK. stefan.berg@apha.gsi.gov.uk.
2
Swiss Tropical and Public Health Institute, PO Box CH-4002, Basel, Switzerland. esther.schelling@unibas.ch.
3
University of Basel, Basel, Switzerland. esther.schelling@unibas.ch.
4
Armauer Hansen Research Institute, PO Box 1005, Addis Ababa, Ethiopia. elenahailu@yahoo.com.
5
Armauer Hansen Research Institute, PO Box 1005, Addis Ababa, Ethiopia. rebumab@yahoo.com.
6
University of Würzburg, Institute for Molecular Infection Biology, Würzburg, Germany. rebumab@yahoo.com.
7
Armauer Hansen Research Institute, PO Box 1005, Addis Ababa, Ethiopia. balako.gumi@yahoo.com.
8
Armauer Hansen Research Institute, PO Box 1005, Addis Ababa, Ethiopia. girum1825@yahoo.com.
9
Armauer Hansen Research Institute, PO Box 1005, Addis Ababa, Ethiopia. gadisa.endalamaw@googlemail.com.
10
Armauer Hansen Research Institute, PO Box 1005, Addis Ababa, Ethiopia. armen.kassa@gmail.com.
11
Armauer Hansen Research Institute, PO Box 1005, Addis Ababa, Ethiopia. mekonnen.meseret@gmail.com.
12
Armauer Hansen Research Institute, PO Box 1005, Addis Ababa, Ethiopia. jemaldr@yahoo.com.
13
Armauer Hansen Research Institute, PO Box 1005, Addis Ababa, Ethiopia. kmengie@yahoo.com.
14
Armauer Hansen Research Institute, PO Box 1005, Addis Ababa, Ethiopia. shiferawbekele92@yahoo.com.
15
Armauer Hansen Research Institute, PO Box 1005, Addis Ababa, Ethiopia. hevewondale@yahoo.com.
16
Armauer Hansen Research Institute, PO Box 1005, Addis Ababa, Ethiopia. yohannesderese@yahoo.com.
17
Swiss Tropical and Public Health Institute, PO Box CH-4002, Basel, Switzerland. jakob.zinsstag@unibas.ch.
18
University of Basel, Basel, Switzerland. jakob.zinsstag@unibas.ch.
19
Aklilu Lemma Institute of Pathobiology, Addis Ababa University, PO Box 1176, Addis Ababa, Ethiopia. gobenachimdi2009@yahoo.co.uk.
20
Swiss Tropical and Public Health Institute, PO Box CH-4002, Basel, Switzerland. sebastien.gagneux@unibas.ch.
21
University of Basel, Basel, Switzerland. sebastien.gagneux@unibas.ch.
22
Center for Molecular Bacteriology and Infection, Department of Medicine, Flowers building, South Kensington, Imperial College London, London, SW7 2AZ, UK. b.robertson@imperial.ac.uk.
23
Swiss Tropical and Public Health Institute, PO Box CH-4002, Basel, Switzerland. rea.tschopp@unibas.ch.
24
Armauer Hansen Research Institute, PO Box 1005, Addis Ababa, Ethiopia. rea.tschopp@unibas.ch.
25
University of Basel, Basel, Switzerland. rea.tschopp@unibas.ch.
26
Animal and Plant Health Agency, TB Research Group, New Haw, Addlestone, Surrey, KT15 3NB, UK. glyn.hewinson@apha.gsi.gov.uk.
27
Armauer Hansen Research Institute, PO Box 1005, Addis Ababa, Ethiopia. yamuahlk@ahrialert.org.
28
UCD Schools of Veterinary Medicine, Medicine and Medical Science, Biomolecular and Biomedical Science and UCD Conway Institute, University College Dublin, Dublin, Republic of Ireland. stephen.gordon@ucd.ie.
29
Armauer Hansen Research Institute, PO Box 1005, Addis Ababa, Ethiopia. aseffaa@gmail.com.

Abstract

BACKGROUND:

Ethiopia, a high tuberculosis (TB) burden country, reports one of the highest incidence rates of extra-pulmonary TB dominated by cervical lymphadenitis (TBLN). Infection with Mycobacterium bovis has previously been excluded as the main reason for the high rate of extrapulmonary TB in Ethiopia.

METHODS:

Here we examined demographic and clinical characteristics of 953 pulmonary (PTB) and 1198 TBLN patients visiting 11 health facilities in distinct geographic areas of Ethiopia. Clinical characteristics were also correlated with genotypes of the causative agent, Mycobacterium tuberculosis.

RESULTS:

No major patient or bacterial strain factor could be identified as being responsible for the high rate of TBLN, and there was no association with HIV infection. However, analysis of the demographic data of involved patients showed that having regular and direct contact with live animals was more associated with TBLN than with PTB, although no M. bovis was isolated from patients with TBLN. Among PTB patients, those infected with Lineage 4 reported "contact with other TB patient" more often than patients infected with Lineage 3 did (OR = 1.6, CI 95% 1.0-2.7; p = 0.064). High fever, in contrast to low and moderate fever, was significantly associated with Lineage 4 (OR = 2.3; p = 0.024). On the other hand, TBLN cases infected with Lineage 4 tended to get milder symptoms overall for the constitutional symptoms than those infected with Lineage 3.

CONCLUSIONS:

The study suggests a complex role for multiple interacting factors in the epidemiology of extrapulmonary TB in Ethiopia, including factors that can only be derived from population-based studies, which may prove to be significant for TB control in Ethiopia.

PMID:
25886866
PMCID:
PMC4359574
DOI:
10.1186/s12879-015-0846-7
[Indexed for MEDLINE]
Free PMC Article

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