title: Mycobacterium tuberculosis causing tuberculous lymphadenitis in Maputo, Mozambique.
abstract: BACKGROUND
  The zoonosis bovine tuberculosis (TB) is known to be responsible for a considerable proportion of extrapulmonary TB. In Mozambique, bovine TB is a recognised problem in cattle, but little has been done to evaluate how Mycobacterium bovis has contributed to human TB. We here explore the public health risk for bovine TB in Maputo, by characterizing the isolates from tuberculous lymphadenitis (TBLN) cases, a common manifestation of bovine TB in humans, in the Pathology Service of Maputo Central Hospital, in Mozambique, during one year.
  
  
  RESULTS
  Among 110 patients suspected of having TBLN, 49 had a positive culture result. Of those, 48 (98%) were positive for Mycobacterium tuberculosis complex and one for nontuberculous mycobacteria. Of the 45 isolates analysed by spoligotyping and Mycobacterial Interspersed Repetitive Unit-Variable Number Tandem Repeat (MIRU-VNTR), all were M. tuberculosis. No M. bovis was found. Cervical TBLN, corresponding to 39 (86.7%) cases, was the main cause of TBLN and 66.7% of those where from HIV positive patients. We found that TBLN in Maputo was caused by a variety of M. tuberculosis strains. The most prevalent lineage was the EAI (n = 19; 43.2%). Particular common spoligotypes were SIT 48 (EAI1_SOM sublineage), SIT 42 (LAM 9), SIT 1 (Beijing) and SIT53 (T1), similar to findings among pulmonary cases.
  
  
  CONCLUSIONS
  M. tuberculosis was the main etiological agent of TBLN in Maputo. M. tuberculosis genotypes were similar to the ones causing pulmonary TB, suggesting that in Maputo, cases of TBLN arise from the same source as pulmonary TB, rather than from an external zoonotic source. Further research is needed on other forms of extrapulmonary TB and in rural areas where there is high prevalence of bovine TB in cattle, to evaluate the risk of transmission of M. bovis from cattle to humans.
authors.affiliation: National Institute of Health, Ministry of Health, Maputo, Mozambique. viegas_sofia@hotmail.com.|Faculty of Veterinary, Eduardo Mondlane University, Maputo, Mozambique. viegas_sofia@hotmail.com.|Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden. viegas_sofia@hotmail.com.
authors.forename: Sofia Omar
authors.initials: SO
authors.lastname: Viegas
authors.affiliation: Department of Microbiology, Public Health Agency of Sweden, Solna, Sweden. solomon.ghebremichael@folkhalsomyndigheten.se.
authors.forename: Solomon
authors.initials: S
authors.lastname: Ghebremichael
authors.affiliation: National Institute of Health, Ministry of Health, Maputo, Mozambique. guessy88@gmail.com.
authors.forename: Leguesse
authors.initials: L
authors.lastname: Massawo
authors.affiliation: Pathology Service, Maputo Central Hospital, Ministry of Health, Maputo, Mozambique. matosalbertozualo@gmail.com.
authors.forename: Matos
authors.initials: M
authors.lastname: Alberto
authors.affiliation: Pathology Service, Maputo Central Hospital, Ministry of Health, Maputo, Mozambique. fernandesfabiolacouto@gmail.com.|Department of Pathology, Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique. fernandesfabiolacouto@gmail.com.
authors.forename: Fabíola Couto
authors.initials: FC
authors.lastname: Fernandes
authors.affiliation: Pathology Service, Maputo Central Hospital, Ministry of Health, Maputo, Mozambique. ellianemz@gmail.com.
authors.forename: Eliane
authors.initials: E
authors.lastname: Monteiro
authors.affiliation: WHO Supranational TB Reference Laboratory, Tuberculosis & Mycobacteria Unit, Institut Pasteur de la Guadeloupe, Abymes, Guadeloupe, France. david.couvin@googlemail.com.
authors.forename: David
authors.initials: D
authors.lastname: Couvin
authors.affiliation: National Institute of Health, Ministry of Health, Maputo, Mozambique. maiane.mjunior@gmail.com.
authors.forename: José Maiane
authors.initials: JM
authors.lastname: Matavele
authors.affiliation: WHO Supranational TB Reference Laboratory, Tuberculosis & Mycobacteria Unit, Institut Pasteur de la Guadeloupe, Abymes, Guadeloupe, France. nrastogi@pasteur-guadeloupe.fr.
authors.forename: Nalin
authors.initials: N
authors.lastname: Rastogi
authors.affiliation: Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden. mcorreianeves@ecsaude.uminho.pt.|Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal. mcorreianeves@ecsaude.uminho.pt.|ICVS/3B's, PT Government Associate Laboratory, Braga/Guimarães, Portugal. mcorreianeves@ecsaude.uminho.pt.
authors.forename: Margarida
authors.initials: M
authors.lastname: Correia-Neves
authors.affiliation: Faculty of Veterinary, Eduardo Mondlane University, Maputo, Mozambique. adelm1966@hotmail.com.
authors.forename: Adelina
authors.initials: A
authors.lastname: Machado
authors.affiliation: Pathology Service, Maputo Central Hospital, Ministry of Health, Maputo, Mozambique. carrilhocarla@hotmail.com.|Department of Pathology, Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique. carrilhocarla@hotmail.com.
authors.forename: Carla
authors.initials: C
authors.lastname: Carrilho
authors.affiliation: Department of Microbiology, Public Health Agency of Sweden, Solna, Sweden. ramona.groenheit@folkhalsomyndigheten.se.
authors.forename: Ramona
authors.initials: R
authors.lastname: Groenheit
authors.affiliation: Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden. gunilla.kallenius@ki.se.
authors.forename: Gunilla
authors.initials: G
authors.lastname: Källenius
authors.affiliation: Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden. tuija.koivula@folkhalsomyndigheten.se.|Department of Microbiology, Public Health Agency of Sweden, Solna, Sweden. tuija.koivula@folkhalsomyndigheten.se.
authors.forename: Tuija
authors.initials: T
authors.lastname: Koivula
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D014644:Genetic Variation; D005838:Genotype; D006801:Humans; D008297:Male; D008875:Middle Aged; D058889:Molecular Typing; D009073:Mozambique / Q000453:epidemiology; D009163:Mycobacterium bovis / Q000302:isolation & purification; D009169:Mycobacterium tuberculosis / Q000145:classification / Q000235:genetics / Q000302:isolation & purification*; D014388:Tuberculosis, Lymph Node / Q000453:epidemiology*; D055815:Young Adult