Uju Marie-Esther Dibua¹, Arinze Aru¹, Stephen Chiiioke Emencheta²*, Chukwuemeka Ezeh¹ and Chibuzor Nwadibe Eze¹

¹Department of Microbiology, University of Nigeria, Nsukka, Nigeria
²Department of Pharmaceutical Microbiology and Biotechnology, University of Nigeria, Nsukka, Nigeria

*Corresponding Author:Stephen Chiiioke Emencheta, Department of Pharmaceutical Microbiology and Biotechnology, University of Nigeria, Nsukka, Enugu State, Nigeria.

Received: February 20, 2022; Published: February 25, 2022

Abstract

Background: The incidence of tuberculosis (TB) in the world is increasing. Due to the increasing level of immunocompromised individuals resulting from diseases like HIV/AIDS, other nontuberculous mycobacteria (NTM) are beginning to thrive, causing tuberculous infections. However, information on the contribution of nontuberculous mycobacteria (NTM) to mycobacterial infections in Africa is scarce due to several factors. Thus, this study is on the co-infectivity of HIV and Atypical Mycobacteria in Nsukka L.G.A.

Materials and Methods: Two hundred cases (100 HIV-negative and 100 HIV-positive patients) (46.5% males and 53.5% females) were identified. The age ranged between 15 and 71 with a mean age of 37.5 years. HIV antibodies were screened using two test kits: the Determine (preliminary test) and the Uni-Gold (consistency test). CD4+ count was determined using cytometry. Acid-fast bacilli (AFB) were detected using sputum smear microscopy. AFB positive samples were subjected to nested PCR for species identification. T-test was employed to check for statistical significance between the mean prevalence in test and control groups and CD4 count of HIV single infection and co-infection with TB. Correlation analysis was used to check for the relationship between the demographic characteristics and the disease distribution.

Results: A preponderance of HIV infection was observed among the 21-50 age group (72.5%) with an overall HIV prevalence of 19.4%. The highest AFB prevalence of 26.6% was observed among patients aged 21-30 years, with an overall prevalence of 24%. About 79.1% of TB infections occurred at CD4 count less than 400 cells/μl. Nested PCR showed 97(78.9%) M. tuberculosis, 14(11.4%) M. bovis, and 10(8.1%) NTM. The NTM identified was M. avium complex. The prevalence rate of TB/HIV co-infection was 24(24%), of which 14(53.8%) were M. tuberculosis, 5(20.8%) were M. bovis, and 3(12.5%) were NTM. The highest NTM prevalence of 66.7% was observed among patients aged 21-30 years in the HIV positive group while the highest prevalence of 42.8% was observed among 41-50 years in the HIV negative group. TB co-infection was significantly associated with CD4+ cell count (P < 0.05). Respectively, rural settlers (RR = 1.40, P = 0.002) and those with lower education (RR = 3.17, P = 0.01) were at higher risk of TB co-infection with HIV.

Conclusion: The study underscores the role of nontuberculous AFB in pulmonary tuberculosis especially in HIV patients, and is suggestive of the implication of therapies without discrimination between TB and NTM. Molecular screening assays with rapid detection of NTM infections should be a priority for strengthening the public health response.

Keywords: Tuberculosis; Atypical Mycobacteria; Acid Fast Bacilli; Co-Infection; HIV; Nontuberculous Mycobacteria

References

1. World health Organization. “The World Health Report. Life in the 21st Century: A Vision for All”. Report of the Director General WHO Geneva (1998).
2. I Szabo. “Diagnosis and Treatment of Disease Caused by Nontuberculosis mycobacteria”. American Review on Respiratory Diseases 142 (1990): 940-953.
3. DE Griffith., et al. “ATS Mycobacterial Diseases Subcommittee; American Thoracic Society; Infectious Disease Society of America. An official ATS/IDSA Statement: Diagnosis, Treatment, and Prevention of Nontuberculous Mycobacterial Diseases”. American Journal of Respiratory and Critical Care Medicine 175 (2007): 365-416.
4. E Tortoli. “Impact of Genotypic Studies on Mycobacterial Taxonomy: The new Mycobacteria of the 1990s”. Clinical Microbiological Review 16 (2003): 319-354.
5. M Pinner. “Atypical Acid Fast Microorganisms”. American Review on Tuberculosis 32 (1935): 424-445.
6. RJ Wallace., et al. “Diagnosis and Treatment of Disease Caused by Non-Tuberculous Mycobacteria”. American Review Respiratory Disease 142 (1990): 940-953.
7. TK Marras and CL Daley. “Epidemiology of Human Pulmonary Infection with Nontuberculous Mycobacteria”. Clinics in Chest Medicine3 (2002): 553-567.
8. MP Zykov., et al. “Non-tuberculosis Mycobacteria in Africa. 1. Isolation and Identification”. Bulletin of the World Health Organization 37 (1967): 927-938.
9. MP Zykov and H Roulet. “Non-tuberculosis Mycobacteria in Africa. 3. Formamidase activity-its Evaluation and Practical Application”. Bulletin of the World Health Organization 37 (1967): 947-951.
10. E Wolinsky. “Nontuberculous Mycobacteria and Associated Disease”. American Review on Respiratory Diseases 119 (1979): 107-159.
11. Center for Disease Control and Prevention. “Nosocomial Transmission of Multidrug-Resistant Tuberculosis Among HIV-infected Persons-Florida and New York, 1988-1991”. Morbidity and Mortality Weekly Report 40 (1991a): 585-591.
12. CR Horsburgh. “Mycobacterium avium Complex Infection in the Acquired Immunodeficiency Syndrome”. New England Journal Medicine 324 (1991): 1332-1338.
13. SD Nightingale., et al. “Incidence of Mycobacterium avium-intracellulare Complex Bacteremia in Human Immunodeficiency Virus-Positive Patients”. Journal of Infectious Disease 165 (1992): 1082-1085.
14. VM Katoch. “Infections Due to Non-Tuberculous Mycobacteria (NTM)”. Indian Journal of Medical Research 120 (2004): 290-304.
15. JF Kazda. “The Principles of Ecology of Mycobacteria”. In: Biology of Mycobacteria. London: Academic Press 2 (1983): 323-342.
16. RJO’ Brien., et al. “The Epidemiology of Non-Tuberculous Mycobacteria Disease in the United States; Results From a National Survey”. American Review on Respiratory Diseases 135 (1987): 1007-1014.
17. M Tsukamura., et al. “Studies on the Epidemiology of Non-Tuberculous Mycobacteriosis in Japan”. American Review on Respiratory Disease 137 (1988): 1280-1284.
18. Public Health Bull. “Tuberculosis and Atypical Mycobacteria”. New South Wales 4 (1993): 785-832.
19. R Sachdev., et al. “Characterization and Susceptibility Pattern of Extrapulmonary Isolates”. Indian Journal of Medical Research 115 (2002): 102-107.
20. LM Oliver., et al. “Nontuberculous Pycobacteria II: Nested-Cohort Study of Impact on Cystic Fibrosis lung Disease”. American Journal of Respiratory and Critical Care Medicine 167 (2003):835-840.
21. EO Idigbe., et al. “Human Pulmonary Infections with Bovine and Typical Mycobacteria in Lagos, Nigeria”. Journal of Tropical Medicine and Hygiene3 (1986): 143-148.
22. D Wagner and L S Young. “Non-Tuberculous Mycobacterial Infections: A Clinical Review”. Infection 32 (2004): 257-270.
23. YS Park., et al. “Rapid Increase of Non Tuberculous Mycobacteria Lung Disease at a Tertiary Referral Hospital in South Korea”. International Journal of Tuberculosis and Lung Diseases8 (2010): 1069-1071.
24. PCAM Buijtels., et al. “Non Tuberculous Mycobacteria, Zambia”. Emerging Infectious Diseases2 (2009): 242-249.
25. JD Mawak., et al. “Human Pulmonary Infections with Bovine and Environmental (Atypical Mycobacteria) in Jos, Nigeria”. Ghanaian Medical Journal 40 (2006): 132-136.
26. JS Philalay., et al. “Genes Required for Intrinsic Multidrug Resistance in Mycobacterium avium”. Antimicrobial Agents Chemotherapy9 (2004): 3412-3418.
27. WJ Koh and QJ Kwon. “Treatment of Tuberculosis Patients in the Private Sector in Korea”. Tuberculosis and Respiratory Diseases 56 (2004): 443-449.
28. TS Alexander., et al. “Absolute CD4 Counts Obtained by a Three-Colour Flow-Cytometric Method without the use of Haematology Analyzer”. Clinical and Diagnostic Laboratory Immunology2 (1998): 266-269.
29. International Union against Tuberculosis and Lung Disease. “Technical Guide: Sputum Examination for Tuberculosis by Direct Microscopy in Low Income Countries”. Paris (2000).
30. TL Wu. et al. “Rapid Identification of Mycobacteria From Smear Positive Sputum Samples By Nested PCR-Restriction Fragment Length Polymorphism Analysis”. Journal of Clinical Microbiology11 (2008): 3591-3594.
31. BT Pokam and AE Asuquo. "Acid-Fast Bacilli Other than Mycobacteria in Tuberculosis Patients Receiving Directly Observed Therapy Short Course in Cross River State, Nigeria". Tuberculosis Research and Treatment (2012): 4.
32. G Aliyu., et al. “Prevalence of Nontuberculous Mycobacterial Infections Among Tuberculosis Suspects in Nigeria”. Plos One5 (2013).
33. EM Marlowe., et al. “Evaluation of the Cepheid Xpert MTB/RIF Assay for Direct Detection of Mycobacterium Tuberculosis Complex in Respiratory Specimens”. Journal of Clinical Microbiology 49 (2011): 1621-1623.
34. S Cadmus., et al. “Molecular Analysis of Human and Bovine Tubercle Bacilli from a Local Setting in Nigeria”. Journal of Clinical Microbiology1 (2006): 29-34.
35. O Cosivi., et al. “Epidemiology of Mycobacterium bovis Infection in Animals and Humans, with Particular Reference to Africa”. Revue Scientifique et Technique3 (1995): 733-746.
36. P Sivasankari., et al. “Atypical Mycobacterial Infection among HIV Seronegative Patients in Pondicherry”. Indian Journal of Chest Diseases and Allied Science 48 (2006): 107-109.
37. F Márquez-Diaz., et al. “Nocardiasis in Patients with HIV Infection”. AIDS Patient Care and STDs11 (1998): 825-832.
38. D Ray., et al. “Tsukamurella Infections. Review of the Literature Apropos of Case”. Pathologie Biologie 45: 60-65.
39. SW Nam., et al. “Tsukamurella spumae sp. Nov., A Novel Actinomycete Associated with Foaming in Activated Sludge Plants”. System Applied Microbial 26 (2003): 367-375.
40. AK Salami and IA Katibi. “Human Immunodeficiency Virus-Associated Tuberculosis: Pattern and Trend in the University of Ilorin Teaching Hospital”. African Journal of Medicine and Medical Science4 (2006): 457-460.
41. OB Awoyemi., et al. “Prevalence of Active Pulmonary Tuberculosis in Human Immunodeficiency Virus Seropositive Adult Patients in University College Hospital, Ibadan, Nigeria”. African Journal of Medicine and Medical Science 4 (2002): 329-332.
42. I Zubairu and B Musa. “Prevalence and Predictors of Tuberculosis Co-infection among HIV-Seropositive Patients Attending the Aminu Kano Teaching Hospital, Northern Nigeria”. Journal of Epidemiology2 (2009): 81-87.
43. R Albalak., et al. “Trends in Tuberculosis/Human Immunodeficiency Virus Comorbidity, United States, 1993-2004”. Archives of Internal Medicine 22 (2007): 2443-2452.
44. HR Brodt., et al. “Changing Incidence of AIDS-Defining Illnesses in the Era of Antiretroviral Combination Therapy”. AIDS 11 (1997): 1731-1738.
45. P Nun and KP MeAdam. “Mycobacterium infection in AIDS”. British Medical Bull 44 (1985): 801.
46. AO Onipede., et al. “Seroprevalence of HIV Antibodies in Tuberculosis Patients in Ile-Ife, Nigeria”. East African Medical Journal3 (1999): 127-132.
47. AJ Nunn., et al. “Mortality Associated with HIV-1 Infection Over Five Years in a Rural Ugandan Population: Cohort Study”. British Medical Journal 315 (1997): 767-771.
48. N Markowitz., et al. “Incidence of Tuberculosis in the United States among HIV-Infected Persons”. Annals of Internal Medicine 2 (1997): 123-132.
49. NW Schluger and WN Rom. “The Host Immune Response to TB”. American Journal Respiratory Critical Care Medicine 157 (1998): 679-691.
50. D Vukovic., et al. “Knowledge and Misconceptions of Tuberculosis in the General Population in Serbia”. European Journal of Clinical Microbiology and Infectious Diseases9 (2008): 761-767.
51.  

Citation

Citation: Stephen Chiiioke Emencheta., et al. “Co-infectivity of HIV and Atypical Mycobacteria in Nsukka Local Government Area of Enugu State”.Acta Scientific Microbiology 5.3 (2022): 82-97.

Copyright

Copyright: © 2022 Stephen Chiiioke Emencheta., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.