Mycobacterium tuberculosis Complex and HIV Co-Infection among Extrapulmonary Tuberculosis Suspected Cases at the University of Gondar Hospital, Northwestern Ethiopia

RESEARCH ARTICLE Mycobacterium tuberculosis Complex and HIV Co-Infection among Extrapulmonary Tuberculosis Suspected Cases at the University of Gondar Hospital, Northwestern Ethiopia Alemu Fanosie1, Baye Gelaw1*, Belay Tessema1, Wogahta Tesfay2, Aschalew Admasu3, Gashaw Yitayew3 1 School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences (CMHS), The University of Gondar (UOG), P.O. box 196, Gondar, Ethiopia, 2 School of Medicine, College of Medicine and Health Sciences (CMHS), The University of Gondar (UOG), P.O. box 196, Gondar, Ethiopia, 3 Bahir Dar Regional Health and Research Laboratory Center, Bahir Dar, Ethiopia * OPEN ACCESS Citation: Fanosie A, Gelaw B, Tessema B, Tesfay W, Admasu A, Yitayew G (2016) Mycobacterium tuberculosis Complex and HIV Co-Infection among Extrapulmonary Tuberculosis Suspected Cases at the University of Gondar Hospital, Northwestern Ethiopia. PLoS ONE 11(3): e0150646. doi:10.1371/ journal.pone.0150646 Editor: Katalin Andrea Wilkinson, University of Cape Town, SOUTH AFRICA Received: November 25, 2015 Accepted: February 16, 2016 Published: March 7, 2016 Copyright: © 2016 Fanosie 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. Data Availability Statement: Due to ethical restrictions regarding patient privacy, data are available upon request. Requests for the data may be made to the corresponding author. Funding: The authors have no support or funding to report. Competing Interests: The authors have declared that no competing interests exist. Abstract Background Extrapulmonary Tuberculosis (EPTB) and Human Immunodeficiency Virus (HIV) infection are interrelated as a result of immune depression. The aim of this study was to determine the prevalence of Mycobacterium tuberculosis complex isolates and the burden of HIV coinfection among EPTB suspected patients. Method An institution based cross-sectional study was conducted among EPTB suspected patients at the University of Gondar Hospital. Socio-demographic characteristics and other clinical data were collected using a pretested questionnaire. GeneXpert MTB/RIF assay was performed to diagnosis Mycobacterium tuberculosis complex and Rifampicin resistance. All samples were also investigated by cytology and culture. The HIV statuses of all patients were screened initially by KHB, and all positive cases were further re-tested by STAT-pack. Data was analyzed using SPSS version 20 computer software and a P-value of < 0.05 was taken as statistically significant. Results A total of 141 extrapulmonary suspected patients were enrolled in this study. The overall prevalence of culture confirmed extrapulmonary tuberculosis infection was 29.8%, but the GeneXpert result showed a 26.2% prevalence of Mycobacterium tuberculosis complex infection. The 78.4% prevalence of extrapulmonary tuberculosis infection was found to be higher among the adult population. The prevalence of HIV infection among EPTB PLOS ONE | DOI:10.1371/journal.pone.0150646 March 7, 2016 1 / 15 Mycobacterium tuberculosis Complex and HIV Co-Infection suspected patients was 14.1%, while it was 32.4% among GeneXpert-confirmed extrapulmonary TB cases (12/37). Tuberculosis lymphadenitis was the predominant (78.4%) type of EPTB infection followed by tuberculosis cold abscess (10.7%). Adult hood, previous history of contact with known pulmonary tuberculosis patients, and HIV co-infection showed a statistically significant association with extrapulmonary tuberculosis infection (P<0.013). Conclusion The prevalence of culture confirmed-EPTB infection was high, and a higher EPTB-HIV coinfection was also observed. Introduction Tuberculosis is predominantly associated with lung diseases, but it can also affect other parts of the body, extrapulmonary tuberculosis (EPTB). Globally, there were 8.6 million new TB cases in 2012, and an estimated 1 million people developed EPTB [1]. In Africa, the proportion of EPTB infection was reported as 17.7% by the year 2013 [2]. In Ethiopia, a 32.5% EPTB proportion was reported by the year 2012 among the total TB cases [3]. Extrapulmonary tuberculosis most commonly occur at sites, such as lymph node, pleura, bone and joints, central nervous system, ocular, pancreatic and genitourinary tract [4,5]. In immune-competent hosts, Mycobacterium tuberculosis complex dissemination to other tissues is usually controlled. In immune-compromised patients however, the tubercle bacilli may disseminate to different parts of the human body [6, 7]. Before the beginning of the Human Immunodeficiency Virus (HIV) epidemic, about 85% of the reported tuberculosis cases were limited to the lungs [8]. This distribution has been substantially different since the emergence of HIV [9], because the frequency of the extrapulmonary TB tends to increase if the immune function is compromised [10]. Previous report showed that, in countries with HIV epidemic, there were dramatic increases in extrapulmonary TB cases and deaths because of immunity deteriorations [11]. Mortality in HIV-associated extrapulmonary tuberculosis was high because of a combination of higher stage HIV disease-related opportunistic infections and delays in the diagnosis and treatment of the disease [12]. The deadly TB-HIV synergy and the occurrence of the multidrug-resistant M. tuberculosis (MDR-TB) have further complicated tuberculosis control and increased the development of active TB [13, 14]. In 2013, there were an estimated 9 million incidental cases of tuberculosis in the world, out of which 1.1 million were HIV positive. This TB/HIV co- infection and related deaths are high in African region. In Ethiopia, the prevalence of HIV co-infection among TB patients was reported as 5.9 per 100,000 [15]. According to reports, the incidence of EPTB has been increasing among TB patients across Ethiopia since the 1990’s [16]. However, Iwnetu et al disagreed with the report on the ground that the increase might be observed due to a simple over diagnosis and stated that up to 15% of all tuberculosis lymphadenitis (TBLP) cases could be wrongly diagnosed [17]. Although reports document that cytology has a lower specificity as a method of diagnosis of EPTB infection, it is most frequently used for the purpose in Ethiopia. The chief difficulty with extrapulmonary specimens is that they yield very few bacilli which are consequently associated with a low sensitivity of acid-fast bacillus [18]. The prevalence of EPTB varies across studies from 15 to 50% and depends on the region, the ethnic group studied, and HIV co-infection rates [19]. In Gondar, studies done to evaluate the magnitude of this form of tuberculosis (EPTB), the various PLOS ONE | DOI:10.1371/journal.pone.0150646 March 7, 2016 2 / 15 Mycobacterium tuberculosis Complex and HIV Co-Infection sites invo (...truncated)