title: Molecular epidemiology, drug susceptibility and economic aspects of tuberculosis in Mubende district, Uganda.
abstract: BACKGROUND
  Tuberculosis (TB) remains a global public health problem whose effects have major impact in developing countries like Uganda. This study aimed at investigating genotypic characteristics and drug resistance profiles of Mycobacterium tuberculosis isolated from suspected TB patients. Furthermore, risk factors and economic burdens that could affect the current control strategies were studied.
  
  
  METHODS
  TB suspected patients were examined in a cross-sectional study at the Mubende regional referral hospital between February and July 2011. A questionnaire was administered to each patient to obtain information associated with TB prevalence. Isolates of M. tuberculosis recovered during sampling were examined for drug resistance to first line anti-TB drugs using the BACTEC-MGIT960(TM) system. All isolates were further characterized using deletion analysis, spoligotyping and MIRU-VNTR analysis. Data were analyzed using different software; MIRU-VNTR plus, SITVITWEB, BioNumerics and multivariable regression models.
  
  
  RESULTS
  M. tuberculosis was isolated from 74 out of 344 patients, 48 of these were co-infected with HIV. Results from the questionnaire showed that previously treated TB, co-infection with HIV, cigarette smoking, and overcrowding were risk factors associated with TB, while high medical related transport bills were identified as an economic burden. Out of the 67 isolates that gave interpretable results, 23 different spoligopatterns were detected, nine of which were novel patterns. T2 with the sub types Uganda-I and Uganda-II was the most predominant lineage detected. Antibiotic resistance was detected in 19% and multidrug resistance was detected in 3% of the isolates.
  
  
  CONCLUSIONS
  The study detected M. tuberculosis from 21% of examined TB patients, 62% of whom were also HIV positive. There is a heterogeneous pool of genotypes that circulate in this area, with the T2 lineage being the most predominant. High medical related transport bills and drug resistance could undermine the usefulness of the current TB strategic interventions.
authors.affiliation: Department of Food Safety and Infection Biology, Centre for Epidemiology and Biostatistics, Norwegian School of Veterinary Science, Oslo, Norway. Adrian.Muwonge@roslin.ed.ac.uk
authors.forename: Adrian
authors.initials: A
authors.lastname: Muwonge
authors.forename: Sydney
authors.initials: S
authors.lastname: Malama
authors.forename: Tone B
authors.initials: TB
authors.lastname: Johansen
authors.forename: Clovice
authors.initials: C
authors.lastname: Kankya
authors.forename: Demelash
authors.initials: D
authors.lastname: Biffa
authors.forename: Willy
authors.initials: W
authors.lastname: Ssengooba
authors.forename: Jacques
authors.initials: J
authors.lastname: Godfroid
authors.forename: Berit
authors.initials: B
authors.lastname: Djønne
authors.forename: Eystein
authors.initials: E
authors.lastname: Skjerve
mesh_terms: D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use; D015373:Bacterial Typing Techniques; D060085:Coinfection; D003430:Cross-Sectional Studies; D004269:DNA, Bacterial / Q000235:genetics / Q000302:isolation & purification*; D024881:Drug Resistance, Bacterial; D005260:Female; D006678:HIV / Q000302:isolation & purification*; D015658:HIV Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D017720:Molecular Epidemiology; D009169:Mycobacterium tuberculosis / Q000235:genetics / Q000302:isolation & purification*; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D014454:Uganda / Q000453:epidemiology
chemical_list: D000995:Antitubercular Agents; D004269:DNA, Bacterial