Setting: This study was performed in the city of Minsk in Belarus, where a very severe problem with MDR-TB was demonstrated in a recent drug resistant survey. Objective: The aim of this study was to use molecular typing of MDR and pan-susceptible clinical isolates of Mycobacterium tuberculosis to increase the understanding of the transmission patterns and possible differences between the strains causing susceptible and drug-resistant tuberculosis. Study population and methods: Consecutive isolates from pulmonary TB patients in Minsk were collected at the Belarusian National Reference Laboratory. Isolates found to be either pan-susceptible or MDR were included in the study, which totally comprised 81 MDR and 82 pan-susceptible clinical isolates. All isolates were characterized by spoligotyping. The major clusters were characterized using sequencing of the pncA gene. Results: Three out of four MDR cases were caused by one out of two drug-resistant clones of M. tuberculosis belonging to the Beijing and T1 genotypes, respectively. A single T1 clone, SIT No. 266, found exclusively in the MDR cohort, was shown to cause no less than 30% of all MDR-TB cases. Discussion: The findings indicate that the major cause of MDR-TB in Minsk is an ongoing transmission of certain already resistant M. tuberculosis strains. Conclusion: The significant transmission of MDR-TB in Minsk underlines the urgent need for strengthened infection control measures to limit the transmission in order to better control MDR-TB.

Background and Objectives: In pulmonary tuberculosis, bacteriological status at two months affects subsequent treatment and prognosis. The effect on treatment outcome and risk factors for sputum conversion at two months treatment in previously untreated pulmonary tuberculosis (PTB) patients was studied in the following report. Methods: A 1:1 case-control study was performed from June 2006 to February 2008 on patients in the Revised National Tuberculosis Control Program in a tertiary level institute in Delhi, India. Patients with previously untreated PTB with sputum smear positive at 2 months of treatment (cases) were compared with those who achieved conversion (controls). Results: In 74 cases and 74 controls, independent risk factors for sputum smear positive at two months were: illness for >2 months, presence of cavity or extensive disease on chest X-ray, and interruption in intensive phase of treatment. Patients with smear positive at 2 or 3 months of treatment were more likely to fail or default from treatment. Aforesaid factors were also associated with sputum culture positive status at 2 months in univariate analysis. Patients who interrupted treatment ≥3 times in the first two months were more likely to be culture positive at two months and had a higher rate of default and failure. Conclusions: Illness for more than 2 months, presence of cavity or extensive disease on chest X-ray, and interruption in intensive phase of treatment are independent risk factors for sputum smear positivity at two months, which in turn is associated with poor treatment outcomes. Patients with these factors merit special attention under the national program.

Background: Infection with Mycobacterium ulcerans (MU) causes extensive destruction of tissues with the formation of large ulcers on exposed parts of the body. Healing leads to extensive scarring and other complications which may impair function. Objective: To document the complications of MU disease and the reconstructive surgery performed to correct them. Study design: Prospective from January 2010 to December 2012. Setting: Ahafo Ano, Amansie West, Asunafo, and Upper Denkyira districts of Ghana. Methods: Patients with unhealed lesions after completing 8 weeks of rifampicin and streptomycin treatment, and patients with complications of MU disease were selected and prepared for surgical treatment. Results: 61 patients were treated successfully with rifampicin and streptomycin without complications. 65 patients presented with complications; they comprised 34 males and 31 females. Their ages ranged from 1 year 3 months to 80 years with mean age of 29.7 (S.D. 20.1). The types of lesions seen were ulcers (54), contractures (7), chronic osteomyelitis (one), subluxation of knee joint (one), salivary gland fistula (one) and Marjolin's ulcer (one). The lesions were distributed as follows: 69.2% on the lower, and 23.1% on the upper limbs, 6.2% on the head and neck and 1.5% on the trunk. Wound excision with or without skin grafting was done in 84.6% of patients, surgery for contractures in10.8%, and sequestrectomy, exploration and ligation of fistula, groin dissection and above knee amputation in 4.6%. Conclusion[/TAG:2]: Whilst ulcers, the commonest MU lesions, are being controlled with antibiotics, rare complications of the disease are also emerging.

Tuberculosis (TB) represents a major problem in developing countries. Diagnosis is often difficult and mainly relies on clinical criteria and simple laboratory examinations, as cultural methods and molecular biology are not available in most health facilities. In order to evaluate the reliability of clinical criteria to suggest pulmonary TB, a prospective survey was conducted in Wolisso Hospital, South-West Shewa region, Ethiopia. During the period from April 2006 to September 2008, data from 117 consecutive patients from which the diagnosis of TB was made by either positive sputum examination or by typical chest X-ray were examined. The objective was to identify simple and reproducible clinical and laboratory criteria related to pulmonary TB in low-resource health facilities. Patients' symptoms strongly suggesting pulmonary TB were found to be long-lasting cough (>1 month), dyspnoea, chest pain, weight loss, fever, weakness and night sweats; typical TB patients' physical examination showed emaciated condition, with low systolic blood pressure (BP) and low body mass index (BMI); simple laboratory examinations suggestive of TB were high erythrocyte sedimentation rate (ESR) and normocytic anaemia. Absence of both known TB contact and bloody sputum was not significant to rule out TB, and total and differential white blood cells (WBC) count did not help in the diagnosis.

Objective: Tuberculosis (TB) caused by Mycobacterium tuberculosis has been identified as a re-emerging infectious disease with public health importance globally. Exploitation of new laboratory techniques for precise identification of mycobacteria in clinical specimens is of great importance to improve the diagnosis as part of the global TB control efforts. Methods: The current study was conducted for the evaluation of BACTEC MGIT 960 method in comparison with Lowenstein–Jensen (LJ) culture and light emitting diode (LED) fluorescence microscopy for isolation of mycobacteria among TB suspects from Bangladesh. A total of 421 specimens were tested with these methods. Results: Among the tested samples, 3.6% (n = 15) were LED fluorescence microscopy positive; while 18 (4.2%) and 45 (10.6%) were recovered from LJ and MGIT 960 culture. The relative positivity found through MGIT 960 system were 60% and 66.7% higher than that of LJ culture and LED fluorescence microscopy, respectively. Recovery rate of Mycobacterium tuberculosis complex ([MTC], 21 by MGIT and 16 by LJ culture) and non-tubercular mycobacteria ([NTM], 24 by MGIT and 2 by LJ culture) by MGIT 960 was 24% and 96% greater, respectively than LJ culture. Moreover, MGIT 960 was found to be highly sensitive (100%), specific (93.3%), accurate (93.6%) and a more rapid method in detecting mycobacteria when compared with LJ culture. Conclusion: Extended recovery of NTM and MTC through MGIT 960 urged frequent application of this method to detect mycobacteria more effectively and rapidly.

Background: Mycobacterium tuberculosis (MTB) H₃₇Ra is an attenuated tubercle bacillus closely related to the virulent type strain MTB H₃₇Rv. In spite of extensive study, variation in virulence between the MTB H₃₇Rv and MTB H₃₇Ra strains is still to be understood. The difference in protein expression or structure due to mutation may probably be an important factor for the virulence property of MTB H₃₇Rv strain. Methods: In this study, a whole proteome comparison between these two strains was carried out using bioinformatics approaches to elucidate differences in their protein sequences. Results: On comparison of whole proteome using NCBI standalone BLAST program between these two strains, 3759 identical proteins in both the strains out of 4003 proteins were revealed in MTB H₃₇Rv and 4034 proteins were revealed in MTB H₃₇Ra; 244 proteins of MTB H₃₇Rv and 260 proteins of MTB H₃₇Ra were found to be non-identical. A total of 172 proteins were identified with mutations (Insertions/deletions/substitutions) in MTB H₃₇Ra while 53 proteins of MTB H₃₇Rv and 85 proteins of MTB H₃₇Ra were found to be distinct. Among 244 non-identical proteins, 19 proteins were reported to have an important biological function; In this study, mutation was shown in these proteins of MTB H₃₇Ra. Conclusion: This study reports the protein differences with mutations between MTB H₃₇Rv and H₃₇Ra, which may help in better understanding the pathogenesis and virulence properties of MTB H₃₇Rv.

Acute tubercular appendicitis has remained a rare disease despite frequent cases of tuberculosis. The following study reports a patient with multidrug-resistant (MDR) pulmonary tuberculosis that developed acute appendicitis. Histopathology of the appendix was compatible with tuberculosis. The patient had a good outcome after surgery and medical therapy.

Cutaneous leukocytoclastic vasculitis (CLV) is an inflammatory vascular disorder rarely reported to be associated with tuberculosis. The following report describes the case of a young man with multifocal tuberculosis revealed by CLV. Diagnosis was confirmed by the presence of tuberculoid granuloma with caseous necrosis on pleural and perianal biopsy, and a rapid improvement in anti-tuberculous quadritherapy. Although rarely seen, Mycobacterium tuberculosis should be considered as a potential cause of CLV.

The following is a case of multidrug-resistant pulmonary tuberculosis (MDR-TB) that was treated successfully with a linezolid-containing regimen. It was found that linezolid is an efficient medicine for MDR-TB treatment with an acceptable side effect profile. Treatment was maintained for 18 months, and closely monitoring toxicities did not reveal evidence of any neurologic adverse effects. However, despite our expectation, thrombocytopenia was seen after 2 years follow-up.

This study was carried out to ascertain the prevalence of Mycobacterium tuberculosis by insertion sequence 6110 (IS6110) based DNA fingerprinting method in Gulbarga district belonging to the southern part of India. Results showed that among the 52 M. tuberculosis isolates studied, 57.7% exhibited more than 5 copies of IS6110 showing the prevalence of M. tuberculosis with multiple copies of IS6110 elements.

The purpose of this study is to describe the experience of the completion of the Tuberculosis (TB) Contact Screening Logbook (TB-CSL). The TB-CSL was retrospectively analyzed from July 2007 until June 2012. During the study period, 122 patients were included in the TB-CSL; however, 17 (13.9%) patients with TB were written in the TB-CSL, but without registering any contacts. Of the 105 TB patients with contacts registered, the family and household contacts were finally performed in 68 index TB patients (55.7% of TB patients). These 68 index TB cases had 299 family and household contacts; the median contact per patient was 4.4 ( ±1.9). Of the 299 contacts, 160 (53.5%) were screened. The median of those screened per patient was 2.3 ( ±1.9). Of the 160 family and household contacts screened, 34 (31.3%) of them were children ≤5 years of age. TB was diagnosed after screening in 16 (10.1%) contacts. Isoniazid preventive therapy was prescribed in 22 of 34 (64%) children <5 years of age. Alternative methods should be implemented in rural areas to improve TB screening contacts, especially in children under 5 years of age.

The present study evaluated the ability of MIRU–VNTRs to discriminate Mycobacterium tuberculosis (MTB) clinical isolates belonging to the SIT11/EAI3-IND ancestral genotypic lineage, which is highly prevalent in Kerala, India. Starting from 168 MTB clinical isolates, spoligotyping (discriminatory index of 0.9113) differentiated the strains into 68 distinct patterns, the biggest cluster being SIT11/48 SIT11 (n = 48). The present study shows that 12-loci MIRUs and 3 ETRs allowed an efficient discrimination of these isolates (discriminatory indexes of 0.7819 and 0.5523, respectively).