巴基斯坦白沙瓦地区动物源性分枝杆菌感染的发病情况和耐药性分析。
Incidence and Drug Resistance of Zoonotic Mycobacterium bovis Infection in Peshawar, Pakistan.
机构信息
Department of Epidemiology and Public Health, University of Veterinary and Animal Sciences, Lahore, Pakistan.
College of Animal Husbandry & Veterinary Sciences, Abdul Wali Khan University, Mardan, Pakistan.
出版信息
Adv Exp Med Biol. 2018;1057:111-126. doi: 10.1007/5584_2018_170.
Prevalence of zoonotic Mycobacterium bovis (bTB) disease in human population is underreported from the North of Pakistan. Here, we report on the proportion of human bTB disease among the overall TB patients, drug resistance pattern of bTB isolates, and knowledge, attitude, and practices (KAP)-based analysis of bTB disease. For this purpose, sputum samples from a total of 300 clinically diagnosed TB patients and 100 randomly selected school children suspected of pulmonary TB were processed by culture as well as polymerase chain reaction (PCR) for isolation, identification, and confirmation of Mycobacterium tuberculosis (mTB) and bTB species. Isolates of bTB were processed for drug susceptibility tests. Data on KAP regarding TB were obtained on a pretested questionnaire. Sputum-based PCR results indicated that 288/300 (96%) were confirmed as mTB, while 12/300 (4%) were found as bTB diseases. Interestingly, none of the school child was declared positive for either mTB or bTB. Notably, 274/300 (91.3%) positively cultured samples were identified as mTB, 13/300 (4.3%) as bTB, while 5/300 (1.7%) as mixed containing both. Importantly, except one, all of the bTB isolates were found resistant to pyrazinamide. Surprisingly, most of the bTB isolates (~70%) were found resistant to a broad range of first- and second-line anti-TB drugs. SplitsTree and recombination analysis indicated no evidence of intergenic recombination. Finally, residence, occupation, presence of animals at home, and sleeping alongside animals were found significantly associated with occurrence of bTB disease. To the best of our knowledge, we report for the first time on the high (4%) burden of bTB disease in human TB patients in Peshawar, Pakistan.
巴基斯坦北部地区对人感染牛分枝杆菌（bTB）病的报告率较低。在此，我们报告了 bTB 病在所有结核病患者中的比例、bTB 分离株的耐药模式以及基于 bTB 病的知识、态度和实践（KAP）的分析。为此，我们对总共 300 名临床诊断为结核病的患者和 100 名疑似肺结核的随机选择的在校儿童的痰液样本进行了培养，并通过聚合酶链反应（PCR）进行了分离、鉴定和确认结核分枝杆菌（mTB）和 bTB 种。对 bTB 分离株进行了药敏试验。关于结核病的 KAP 数据是通过预测试问卷获得的。基于痰液的 PCR 结果表明，300 例中有 288 例（96%）被确认为 mTB，而 300 例中有 12 例（4%）被确认为 bTB 病。有趣的是，没有一个在校儿童被宣布为 mTB 或 bTB 阳性。值得注意的是，300 例中有 274 例（91.3%）阳性培养样本被鉴定为 mTB，13 例（4.3%）为 bTB，5 例（1.7%）为混合含有两者。重要的是，除了一个，所有的 bTB 分离株都被发现对吡嗪酰胺耐药。令人惊讶的是，大多数 bTB 分离株（~70%）对广泛的一线和二线抗结核药物都有耐药性。SplitsTree 和重组分析表明没有种间重组的证据。最后，居住、职业、家中动物的存在以及与动物同睡与 bTB 病的发生有显著相关性。据我们所知，这是首次在巴基斯坦白沙瓦报告人感染结核病患者的 bTB 病负担较高（4%）。
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