Low prevalence of hepatitis B and C among tuberculosis patients in Duhok Province, Kurdistan: Are HBsAg and anti-HCV prerequisite screening parameters in tuberculosis control program?

Objectiue/background: Viral hepatitis, particularly hepatitis B virus [HBV] and hepatitis C virus [HCV], infections and tuberculosis [TB] are a global public health concern. Co-infection with HBV or HCV among TB patients may potentiate the risk of hepatotoxicity induced by anti-TB drugs. Hence, the aim of this study was to identify the prevalence of HBV and HCV among TB patients included in the Duhok National Tuberculosis Program [NTP]

Methods: The Duhok NTP Center is a specialized institution in Duhok City, Iraq, concerned with management and follow-up of TB patients. A cross-sectional study was conducted at the center between June 2015 and May 2016. All documented TB patients were analyzed on the basis of socio-demographic and other characteristics

Thereafter, all patients underwent screening for hepatitis B surface antigen [HBsAg], anti-HCV, and anti-HIV using enzyme-linked immunosorbent assay [ELISA]

The results obtained were analyzed by entering the data in binary format into a Microsoft Excel spreadsheet. A p value of <.05 was considered to be statistically significant

Results: Two-hundred fourteen documented TB patients were recruited in this study, with 127 [59.3%] males and 87 [40.7%] females. The mean age of the patients was 40.34 years [+/-20.29]. Of the total number of patients, four cases [1.8%] were HBsAg-positive and one case [0.9%] was positive for anti-HCV. The variables significantly associated with HBV were history of surgical dental procedure [odds ratio [OR], 0.04; 95% confidence interval [CI], -0.01 to 0.04; p = .03], and nationality [OR, 13.67; 95% CI, 0.46-210.85; p = .007]

Conclusion: The prevalence of HBV and HCV co-infection among TB patients in this study was low. This may be explained by the low rate of blood transfusion among the patients, the very low prevalence of HIV infections in Kurdistan, the negative history of injection drug use, and adherence to universal infection-control measures, including vaccination for HBV. Both history of dental intervention and belonging to a Syrian population were independent risk factors for HBV/ TB co-infection

Infection with Helicobacter pylori strains carrying babA2 and cagA is associated with an increased risk of peptic ulcer disease development in Iraq

Several genes of Helicobacter pylori, such as vacA, cagA, iceA and babA, have been reported to significantly increase the risk of gastrointestinal diseases. The aim of this study was to study the relationship between H. pylori virulence factors and clinical outcomes and identify the independent markers of peptic ulcer disease in Iraq. DNA was extracted from specimens taken from 154 unselected H. Pylori positive Iraqi patients. Genotyping was performed by the polymerase chain reaction [PCR] using specific primers for cagA, vacA [s, m], iceA and babA2 genes. A total of 56 [82%] peptic ulcer disease [PUD] patients carried cagA+ strains, significantly more than the 56 [65%] non-ulcer disease [NUD] patients [p = 0.017]. The difference in the prevalence ofbabA2 positivity was significant between patients with NUD [33.7%] and PUD [58.8%] [p = 0.002]. In addition, babA2 was associated as an independent factor, with PUD [p = 0.005; odds ratio [OR] = 0.4; confidence interval [CI] = 0.18-0.68] followed by cagA [p = 0.05; OR = 0.4; CI = 0.18-0.85]. Forty-five isolates [29%] were typed as 'triple positive' strains, and their presence was significantly associated with PUD [p = 0.001]. The cagA and babA2 genotypes might be considered as useful markers for PUD patients. However, iceAl and iceA2 seem not to be good markers for the disease. The presence of H. pylori strains with triple-positive status is of high clinical relevance to H. pylori-associated diseases

First insight into the genetic diversity of Mycobacterium tuberculosis strains from patients in Duhok, Iraq

The aim of this study was to evaluate the genotypic diversity of Mycobacterium tuberculosis strains using IS6110 RFLP, spoligotyping and MIRU-VNTR typing. Between June 2008 and June 2009, all smear positive pulmonary specimens were collected prospectively at the national tuberculosis program [NTP] center of Duhok province. The specimens were processed for culture by modified Petroff's method and were inoculated into two tubes of L?wenstein-Jensen [LJ] media. The isolates were identified asM. tuberculosis by using biochemical tests and growth rate. Molecular fingerprinting of all M. tuberculosis strains was performed by IS6110 RFLP, spoligotyping and MIRU-VNTR. M. tuberculosis strains were isolated from 53 Iraqi patients with pulmonary TB. Spoligotyping of M. tuberculosis isolates showed T family [30%] as the predominant genotype. By using the three molecular techniques, there were four spoligotyping clusters of strains ["3540 and 3516", "3565 and 3563", "3605 and 3618" and "865, 877 and 13811"]. Complete concordance with RFLP was observed in one cluster of spoligotyping, but no concordance with MIRU-VNTR profile [234426153433 and 236424183433]. Molecular fingerprinting methods are vital for differentiating a reactivation of latent infection from a recent transmission; however, it should be coupled with clinical epidemiological investigation. The low clustering rate in this study suggests that either reactivation of latent infections may be the main driving force for the endemic situation of the disease in Duhok, or it may indicate that a big circle of TB transmission is missed in the community, which means effective control measures have not been achieved yet in Duhok

First insight into the drug resistance pattern of mycobacterium tuberculosis in Dohuk, Iraq: using spoligotyping and MIRU-VNTR to characterize multidrug resistant strains

The objectives of this study were to determine drug resistance pattern in new and previously treated tuberculosis [TB] patients, to assess function of TB control program, and to characterize multidrug resistant TB [MDR-TB] by molecular fingerprinting methods. Anti-micorbial susceptibility testing [AST] to the first line anti-TB drugs was performed on L?wenstein-Jensen [middlebrook 7H10] medium according to the proportion method. Molecular fingerprinting of all MDR strains was performed by spoligotyping and MIRU-VNTR. Mycobacterium tuberculosis strains were isolated from 53 Iraqi patients with pulmonary TB. Thirty eight patients [71.7%] tested cases, and 15 [28.3%] were previously treated. Four of the 38 new cases [10.5%] had resistant, of which 3 [7.9%] were MDR. Eight [53.3%] of the 15 previously treated patients had resistant strains, of which 7 [46.7%] were MDR. Spoligotyping of MDR strains showed CAS family [40%] as the predominant genotype. Using MIRU-VNTR typing, all isolates had a unique profile. MDR-TB prevalence is higher among previously treated patients than among the new cases. The many drug resistant strains, in absence of evidence of recent transmission and in combination with the many previously treated cases, highlight the need for an improved control program, coupled with a need to improve detection rate and early diagnosis of MDR-TB