High prevalence of genotype B0/W148 of Mycobacterium tuberculosis among HIV-TB patients in Perm Krai and Irkutsk Region

Background. The population with HIV-infection plays significant role in ongoing tuberculosis pandemic. Immunosuppression due to HIV-infection is one of the causes of TB disseminated forms in this group of people. Having low immune status is also often associated with a polyclonal M. tuberculosis infection. Aim of the research: comparative assessment of epidemic genotypes of M. tuberculosis prevalence and mixed genotypes identification within HlV-TB co-infected patients in two Russian regions. Materials and methods. The DNAs of 78 clinical isolates from Irkutsk Region (IR) and 64 strains from Perm Krai (PK) have been genotyped by MIRU VNTR 24 and RD105/RD207. Strains were obtained from patients who did not have significant age and sex differences. In the PK age of the patients was 34.5 ± 0.9, in IR - 34.4 ± 1.5 years. The samples were obtained from 67.2 and 65.4 % of men, respectively. Result. The study of the M. tuberculosis indicates significant predominance of Beijing genotype strains in patients with TB-HIV of PK (92.2 %) compared to the IR (59.5 %) (х2 = 18.0; p < 0.01). The prevalence of MDR pathogens in TB-HIV patients exceeded 50 %. The mixed genotype detection in the PK and IR was high (14.1 and 12.7 % respectively). The level of virulent strains B0/W148 was 34.4 % in PK patients and 25.3 % in IR ones. Analysis of the results suggests the epidemic spread of MDR-TB in the immunocompromised individuals. Conclusions: The identified trends may indicate that Perm Kray have a process of active dissemination of transmissible strains of M. tuberculosis within HIV-infected population

ВЫЯВЛЕНИЕ МИКОБАКТЕРИЙ ТУБЕРКУЛЕЗА В КРОВИ КАК МЕТОД ДИАГНОСТИКИ ГЕНЕРАЛ ИЗОВАННОГО ТУБЕРКУЛЕЗА У ПАЦИЕНТОВ С ВИЧ-ИНФЕКЦИЕЙ

Objective: To study the informative value of the detection of mycobacteria in blood with the cultural method in patients with suspected tuberculous sepsis and to determine the most significant clinical and laboratory criteria for testing. Materials and methods: The investigation to detect M.tuberculosis was fulfilled in 159 HIV-positive patients with suspected tuberculosis sepsis. Blood culture was completed with culture medium Myco/F Lytic Culture Vials and analyzer BACTEC 9050. Results: Mycobacteria were detected in blood of 19 patients (11,9% of all patients): in 18 patients the growth of М. tuberculosis complex was detected (25,3% of all patients with diagnosed tuberculosis) and in 1 patient it was Mycobacterium avium complex (0,6% of all patients). It was shown, that the probability of M.tuberculosis detection was especially associated with the severity of the disease, immunosupression (less than 100 cells/mkl), hemoglobin quantity less than 90 g/l (levels were determined through the seeking for the most significant cutoffs). It was not proofed, that meningoencephalitis develops more often in patients with proven bacteremia. There were no evident differences in detection frequency of mycobacteria in sputum between patients with tuberculous sepsis and without it.Цель: изучить информативность культурального исследования крови на МБТ у больных ВИЧ-инфекцией с подозрением на туберкулезной сепсис и определить наиболее значимые предтестовые клинико-лабораторные критерии. Материалы и методы: обследование для выявления микобактерий в крови выполнено 159 больным ВИЧинфекцией с подозрением на туберкулезный сепсис. Посев крови производили на среду Myco/F Lytic Culture Vials и помещали в гемоанализатор BACTEC 9050. Результаты: микобактериальная инфекция кровотока выявлена у 19 пациентов (11,9% от числа тестируемых): у 18 человек обнаружен рост М. tuberculosis complex (25,3% от числа больных туберкулезом) и у одного больного – Mycobacterium avium complex (0,6% от числа тестируемых). Выявлено, что вероятность бактериемии наиболее связана с тяжестью состояния пациента; иммуносупрессией менее 100 клеток/мкл; снижением уровня гемоглобина менее 90 г/л (уровни были определены посредством поиска наиболее значимых порогов). Не удалось доказать, что менингоэнцефалит чаще развивается у лиц с подтвержденной бактериемией. Достоверных различий по частоте выявления МБТ в мокроте у больных с туберкулезным сепсисом и без него выявить не удалось

DETECTION OF MYCOBACTERIUM TUBERCULOSIS IN BLOOD FOR DIAGNOSIS OF GENERALISED TUBERCULOSIS IN HIV-POSITIVE PATIENTS

Objective: To study the informative value of the detection of mycobacteria in blood with the cultural method in patients with suspected tuberculous sepsis and to determine the most significant clinical and laboratory criteria for testing. Materials and methods: The investigation to detect M.tuberculosis was fulfilled in 159 HIV-positive patients with suspected tuberculosis sepsis. Blood culture was completed with culture medium Myco/F Lytic Culture Vials and analyzer BACTEC 9050. Results: Mycobacteria were detected in blood of 19 patients (11,9% of all patients): in 18 patients the growth of М. tuberculosis complex was detected (25,3% of all patients with diagnosed tuberculosis) and in 1 patient it was Mycobacterium avium complex (0,6% of all patients). It was shown, that the probability of M.tuberculosis detection was especially associated with the severity of the disease, immunosupression (less than 100 cells/mkl), hemoglobin quantity less than 90 g/l (levels were determined through the seeking for the most significant cutoffs). It was not proofed, that meningoencephalitis develops more often in patients with proven bacteremia. There were no evident differences in detection frequency of mycobacteria in sputum between patients with tuberculous sepsis and without it