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

SummaryThe 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 Löwenstein–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

Characteristics of patients with HBeAg negative chronic hepatitis B virus infection in Duhok, Kurdistan region

Background: The objective of this study was to characterize patients with HBeAg-negative chronic hepatitis B in Duhok province.Methods: We recruited all patients with HBeAg negative chronic hepatitis B virus infections who visited viral hepatitis clinic in Azadi Teaching Hospital between September 2015-December 2017. The main evaluation parameters were: serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels, serum albumin, total serum bilirubin (TSB), viral load. Few patients were subjected to Fibro-test, Fibroscan, or liver biopsy.Results: There were 251 patients. The mean age of the patients was 35.75±14.40 years. One hundred fifty-seven cases were male and 94 cases were female. The baseline mean of ALT, AST and viral load was 42.09±2.71U/L, 30.26±19.65U/L, and 1421197.08±14436692.04IU/ml, respectively. Compared with women, men have significantly higher values of ALT and AST, serum albumin, and TSB. There were 217 chronic inactive carrier (IC) patients and 34 chronic active hepatitis (AH) patients. ALT, AST, and viral load levels were significantly higher among AH patients.Conclusions: The majority of patients showed nil to mild liver injury. The higher level of ALT in males is a supporting guide to follow the American Association for the Study of Liver Diseases (AASLD) considering 30U/L and 19U/L levels for males and females, respectively. There was preponderance of males in AH, which indicates greater frequency of advanced fibrosis in such patients. There was a greater probability of AH in old aged people. Serum albumin and TSB were not good markers for differentiation between AH and IC state. Twenty-four patients had ALT above twice upper limit of normal level, but 34 patients showed AH based on liver biopsy, firboscan or fibrotest

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

AbstractBackgroundThe aim of this study was to evaluate the genotypic diversity of Mycobacterium tuberculosis strains using IS6110 RFLP, spoligotyping and MIRU-VNTR typing.Materials and methodsBetween 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 Löwenstein-Jensen (LJ) media. The isolates were identified as M. tuberculosis by using biochemical tests and growth rate. Molecular fingerprinting of all M. tuberculosis strains was performed by IS6110 RFLP, spoligotyping and MIRU-VNTR.ResultsM. 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 & 3516”, “3565 & 3563”, “3605 & 3618” and “865, 877 & 13811”). Complete concordance with RFLP was observed in one cluster of spoligotyping, but no concordance with MIRU-VNTR profile (234426153433 and 236424183433).ConclusionsMolecular 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

Intestinal obstruction secondary to primary ileocecal tuberculosis: A case report

A 22-year-old Iraqi male presented with a case of intestinal obstruction secondary to primary ileocecal tuberculosis (TB). The presumptive diagnosis of either Crohn's disease or neoplasm was expected. A right hemicolectomy was performed. Histopathology revealed an inflammatory mass of TB origin; a polymerase chain reaction (PCR) confirmed the diagnosis. The patient was treated with standard anti-TB drugs for 6 months. Following the treatment, the systemic symptoms disappeared and the laboratory investigations returned to normal. Follow-up period showed no recurrence of the disease

A rare case presentation of oral actinomycosis

Actinomycosis is an infectious disease caused by a gram-positive anaerobic or microaerophilic Actinomyces species that causes both chronic suppurative and granulomatous inflammation. The following study reports a 48-year-old Iranian woman presenting with a spontaneous discharging sinus on the hard palate for 8 months. The patient has no past medical history of note. Laboratory findings were unremarkable. The diagnosis was based on history and clinical evidence of the lesion confirmed by histopathological examination. The patient was treated with a regimen of oral ampicillin 500 mg four times a day. She had a marked response to the treatment after 4 weeks, and it was planned to continue the treatment for at least 6 months with regular follow-up. To the best of the researchers’ knowledge, this is the first report of actinomycotic sinus tract of the hard palate in Iran

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?

Objective/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