Drug susceptibility profiles and factors associated with non-tuberculous mycobacteria species circulating among patients diagnosed with pulmonary tuberculosis in Tanzania.

BACKGROUND: While most Non-tuberculous mycobacteria (NTM) are saprophytic, several species have been associated with human diseases, from localized infection to disseminated diseases. Pulmonary NTM infections lead to TB-like disease called NTM pulmonary disease (NTM-PD). Due to variation in treatment options among NTM species, it is necessary to identify the species and determine drug susceptibility profiles to inform the choice of appropriate regimen for the disease. DESIGN: A total of 188 culture-positive isolates from patients diagnosed with TB were screened for NTM at the Central Tuberculosis Reference Laboratory. All NTM were further speciated using GenoType® Mycobacterium-Common Mycobacterium and Additional species (GenoType® CM/AS) kit. Mycobacteria avium complex (MAC) and Mycobacteria abscessus complex (MABC) which could not be identified with the test to species were subjected to GenoType® Mycobacteria NTM-DR for further speciation. Using the same test, identified MAC and MABC were genotyped to determine the drug susceptibility profile for each isolate to macrolide and aminoglycosides. RESULTS: Of all isolates identified as mycobacteria, 24 (13%) were NTM. Fifteen isolates could be identified to species level of which prevalent species was M. avium sub. intracellulare 4 (27%). A total of 10 isolates were MAC (n = 6) and MABC (n = 4) were subjected to GenoType® Mycobacteria NTM-DR for determination of macrolide and aminoglycoside susceptibility. Three of the four MABC had a mutation at the T28 position of the erm (41). All MAC were susceptible to both drugs. CONCLUSION: In this study, MAC was the most frequently isolated NTM species followed by MABC. While all MAC and MABC identified, were susceptible to aminoglycosides, three MABC were resistant to the macrolides due to mutation at position 28 of the erm (41) gene. For this, it is important for clinicians need to rule out NTM, understand species and their drug susceptibility for optimal case management.

Brucellosis testing patterns at health facilities in Arusha region, northern Tanzania.

BACKGROUND: Brucellosis is listed as one of six priority zoonoses in Tanzania's One Health strategic plan which highlights gaps in data needed for the surveillance and estimation of human brucellosis burdens. This study collected data on current testing practices and test results for human brucellosis in Arusha region, northern Tanzania. METHODS: Retrospective data were extracted from records at 24 health facilities in Arusha region for the period January 2012 to May 2018. Data were captured on: the test reagents used for brucellosis, procurement and testing protocols, the monthly number of patients tested for brucellosis and the monthly number testing positive. Generalised linear mixed models were used to evaluate relationships between health facility characteristics and the probability that brucellosis testing was conducted in a given month, and the proportion of individuals testing positive. RESULTS: Four febrile Brucella agglutination tests were used widely. The probability of testing for brucellosis in a given month was significantly associated with an interaction between year of testing and facility ownership. Test probability increased over time with more pronounced increases in privately owned as compared to government facilities. The proportion of individuals testing positive for brucellosis was significantly associated with facility type and district, with individuals tested in hospitals in Meru, Monduli and Ngorongoro districts more likely to test positive. CONCLUSIONS: Febrile Brucella agglutination tests, known for their poor performance, were the mainstay of brucellosis testing at health facilities in northern Tanzania. The study indicates that historical data on human brucellosis in Arusha and other regions are likely to provide an inaccurate measure of true disease burden due to poor performance of the tests used and variation in testing practices. Measures to address these identified shortcomings could greatly improve quality of testing and surveillance data on brucellosis and ultimately inform prevention and control of this priority disease.

Prevalence and significant geospatial clusters of bovine tuberculosis infection at livestock-wildlife interface ecosystem in Eastern Tanzania.

Bovine tuberculosis (BTB) is an important neglected zoonosis that affects livestock, wildlife and human. A study to determine prevalence and geospatial clusters for BTB was conducted from June 2010 to March 2012 at livestock-wildlife interface areas (LWIA). A total of 1,288 cattle located in vicinity of Mikumi-Selous ecosystem Tanzania were tested. Single Intradermal Comparative Tuberculin Test and spatial scan statistic analysis were applied to establish the status of the disease and identify significant spatial BTB clusters. Overall individual prevalence was 3.7 % (n=1,288) (95 % CI=2.8-4.9) and 7.8 % (95 % CI=6.4-9.4) with cut-off of >4 and >2 mm, respectively. Villages with at least one reactor were 55.8 % (n=43). Reactivity was significantly higher in Mvomero and Kilosa districts compared with Kilombero and Ulanga districts (χ (2) =15.9; P<0.001). Significant spatial BTB clusters were revealed at 11 villages. BTB clustering was significant in Kilosa and Mvomero districts compared with Kilombero and Ulanga districts. There was overlap and aggregation of BTB clusters covering south and south-east of Kilosa district bordering Mikumi National Park (MNP) and Mvomero. Generally, clustering occurred around major rivers. The current study provides useful information on the dynamics and epidemiological status of BTB around the wildlife-livestock-human interface, it reveals that the wildlife are at risk of BTB from infected livestock. The study revealed hotspots for BTB that can be applied to guide implementation of participatory intervention at LWIA and control strategies in marginalised pastoralist communities. This study calls for similar studies in other Tanzania's LWIA for efficient intervention of BTB countrywide.