Zoonotic tuberculosis in a high bovine tuberculosis burden area of Ethiopia

BackgroundTuberculosis (TB) is a major cause of ill health and one of the leading causes of death worldwide, caused by species of the Mycobacterium tuberculosis complex (MTBC), with Mycobacterium tuberculosis being the dominant pathogen in humans and Mycobacterium bovis in cattle. Zoonotic transmission of TB (zTB) to humans is frequent particularly where TB prevalence is high in cattle. In this study, we explored the prevalence of zTB in central Ethiopia, an area highly affected by bovine TB (bTB) in cattle.MethodA convenient sample of 385 patients with pulmonary tuberculosis (PTB, N = 287) and tuberculous lymphadenitis (TBLN, N = 98) were included in this cross-sectional study in central Ethiopia. Sputum and fine needle aspirate (FNA) samples were obtained from patients with PTB and TBLN, respectively, and cultures were performed using BACTEC™ MGIT™ 960. All culture positive samples were subjected to quantitative PCR (qPCR) assays, targeting IS1081, RD9 and RD4 genomic regions for detection of MTBC, M. tuberculosis and M. bovis, respectively.ResultsTwo hundred and fifty-five out of 385 sampled patients were culture positive and all were isolates identified as MTBC by being positive for the IS1081 assay. Among them, 249 (97.6%) samples had also a positive RD9 result (intact RD9 locus) and were consequently classified as M. tuberculosis. The remaining six (2.4%) isolates were RD4 deficient and thereby classified as M. bovis. Five out of these six M. bovis strains originated from PTB patients whereas one was isolated from a TBLN patient. Occupational risk and the widespread consumption of raw animal products were identified as potential sources of M. bovis infection in humans, and the isolation of M. bovis from PTB patients suggests the possibility of human-to-human transmission, particularly in patients with no known contact history with animals.ConclusionThe detected proportion of culture positive cases of 2.4% being M. bovis from this region was higher zTB rate than previously reported for the general population of Ethiopia. Patients with M. bovis infection are more likely to get less efficient TB treatment because M. bovis is inherently resistant to pyrazinamide. MTBC species identification should be performed where M. bovis is common in cattle, especially in patients who have a history of recurrence or treatment failure

Dietary diversity and related factors among lactating women visiting public health facilities in Aksum town, Tigray, Northern Ethiopia

BACKGROUND: Dietary diversity is a proxy indicator of maternal nutrient adequacy. However, little is documented on dietary diversity among lactating mothers. Therefore, this study assessed diet diversity and associated factors among lactating mothers visiting public health facilities in Aksum town, Tigray, Northern Ethiopia. METHODS: An institution based cross-sectional study was conducted on 346 randomly selected lactating women visiting public health facilities of Aksum town in June 2015. Dietary diversity was assessed using 24 h dietary recall method. A mean dietary diversity score (DDS) was computed of nine food groups. Food insecurity access was measured using 9 items Household Food Insecurity Access Scale (HFIAS). Data were entered and analyzed using SPSS version 20. RESULTS: More than a quarter (27.2 %) of the lactating mothers was from food insecure households. The mean DDS was 3.4 and a total of 56.4 % lactating mothers had low dietary diversity (less than mean DDS). Average monthly income, home gardening and source of drinking water were associated with low dietary diversity. Lactating mothers who had monthly income of less than 501 ETB [AOR = 2.3, 95 % CI (1.2, 4.6)] and 501 to 1500 ETB [AOR = 3.0, 95 % CI (1.4, 6.3)] were more likely to have low dietary diversity than those who had monthly income above 1500 ETB. And those who did not practice home gardening were more likely to have low dietary diversity than their counterparts [AOR = 2.1, 95 % CI (1.01, 4.2)]. Regarding source of drinking water, mothers who reported protected well as a main source were more likely to have low dietary diversity compared to those who reported tap water as main source [AOR = 4.5, 95 % CI (1.1, 18.2)]. CONCLUSIONS: Dietary diversity among lactating mothers was low. Factors like monthly income less than 501 ETB and 501 to 1500 ETB, not having home gardening, and source of drinking water from protected well were significantly associated with low dietary diversity. Attention should be paid to dietary diversity of lactating mothers to improve their nutritional status, and that of their children and their family

Spoligotype analysis of Mycobacterium bovis isolates from cattle and assessment of zoonotic TB transmission among individuals working in bovine TB-infected dairy farms in Ethiopia.

Funder: ETHICOBOTSBovine tuberculosis (bTB) is a disease with impact on dairy productivity, as well as having the potential for zoonotic transmission. Understanding the genetic diversity of the disease agent Mycobacterium bovis is important for identifying its routes of transmission. Here we investigated the level of genetic diversity of M. bovis isolates and assessed the zoonotic potential in risk groups of people working in bTB-infected dairy farms in central Ethiopia. M. bovis was isolated and spoligotyped from tissue lesions collected from slaughtered cattle as well as from raw milk collected from bTB positive cows in dairy farms from six urban areas of central Ethiopia. From consented dairy farm workers, knowledge and practices related to zoonotic TB transmission, together with demographic and clinical information, was collected through interviews. Sputum or Fine Needle Aspirate (FNA) samples were collected from suspected TB cases. Spoligotyping of 55 M. bovis isolates that originated either from cattle tissues with tuberculous lesion or from raw milk revealed seven spoligotype patterns where SB1176 was the most prevalent type (47.3%). Most isolates (89.1%) were of the M. bovis African 2 clonal complex. All sputum and FNA samples from 41 dairy farm workers with symptoms of TB were culture negative for any mycobacteria. Among the 41 TB suspected farm workers, 61% did not know about bTB in cattle and its zoonotic potential, and over two-third of these workers practiced raw milk consumption. Our spoligotype analysis suggests a wider transmission of a single spoligotype in the study area. The results reported here may be useful in guiding future work to identify the source and direction of bTB transmission and hence design of a control strategy. Isolation of M. bovis from milk, knowledge gap on zoonotic TB and practice of consumption of raw milk in the study population showed potential risk for zoonotic transmission