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BMC Infectious Diseases
Published in: BMC Infectious Diseases 1/2015

Open Access 01-12-2015 | Research article

Investigation of the high rates of extrapulmonary tuberculosis in Ethiopia reveals no single driving factor and minimal evidence for zoonotic transmission of Mycobacterium bovis infection

Authors: Stefan Berg, Esther Schelling, Elena Hailu, Rebuma Firdessa, Balako Gumi, Girume Erenso, Endalamaw Gadisa, Araya Mengistu, Meseret Habtamu, Jemal Hussein, Teklu Kiros, Shiferaw Bekele, Wondale Mekonnen, Yohannes Derese, Jakob Zinsstag, Gobena Ameni, Sebastien Gagneux, Brian D Robertson, Rea Tschopp, Glyn Hewinson, Lawrence Yamuah, Stephen V Gordon, Abraham Aseffa

Published in: BMC Infectious Diseases | Issue 1/2015

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Abstract

Background

Ethiopia, a high tuberculosis (TB) burden country, reports one of the highest incidence rates of extra-pulmonary TB dominated by cervical lymphadenitis (TBLN). Infection with Mycobacterium bovis has previously been excluded as the main reason for the high rate of extrapulmonary TB in Ethiopia.

Methods

Here we examined demographic and clinical characteristics of 953 pulmonary (PTB) and 1198 TBLN patients visiting 11 health facilities in distinct geographic areas of Ethiopia. Clinical characteristics were also correlated with genotypes of the causative agent, Mycobacterium tuberculosis.

Results

No major patient or bacterial strain factor could be identified as being responsible for the high rate of TBLN, and there was no association with HIV infection. However, analysis of the demographic data of involved patients showed that having regular and direct contact with live animals was more associated with TBLN than with PTB, although no M. bovis was isolated from patients with TBLN. Among PTB patients, those infected with Lineage 4 reported “contact with other TB patient” more often than patients infected with Lineage 3 did (OR = 1.6, CI 95% 1.0-2.7; p = 0.064). High fever, in contrast to low and moderate fever, was significantly associated with Lineage 4 (OR = 2.3; p = 0.024). On the other hand, TBLN cases infected with Lineage 4 tended to get milder symptoms overall for the constitutional symptoms than those infected with Lineage 3.

Conclusions

The study suggests a complex role for multiple interacting factors in the epidemiology of extrapulmonary TB in Ethiopia, including factors that can only be derived from population-based studies, which may prove to be significant for TB control in Ethiopia.
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Metadata
Title
Investigation of the high rates of extrapulmonary tuberculosis in Ethiopia reveals no single driving factor and minimal evidence for zoonotic transmission of Mycobacterium bovis infection
Authors
Stefan Berg
Esther Schelling
Elena Hailu
Rebuma Firdessa
Balako Gumi
Girume Erenso
Endalamaw Gadisa
Araya Mengistu
Meseret Habtamu
Jemal Hussein
Teklu Kiros
Shiferaw Bekele
Wondale Mekonnen
Yohannes Derese
Jakob Zinsstag
Gobena Ameni
Sebastien Gagneux
Brian D Robertson
Rea Tschopp
Glyn Hewinson
Lawrence Yamuah
Stephen V Gordon
Abraham Aseffa
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Infectious Diseases / Issue 1/2015
Electronic ISSN: 1471-2334
DOI
https://doi.org/10.1186/s12879-015-0846-7

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