Journal of Global Infectious Diseases

LETTER TO EDITOR
Year
: 2020  |  Volume : 12  |  Issue : 4  |  Page : 236--237

Detection of Mycobacterium Tuberculosis and rifampicin-resistant gene among hemodialysis patients in Khartoum, Sudan: Using GeneXpert assay


Balsam Adil Mohamed1, Mohammed H Ahmed2, Nadir Abuzeid3,  
1 Department of Clinical Microbiology, Faculty of Medical Laboratory Science, University of Medical Sciences and Technology, Omdurman, Khartoum, Sudan
2 Department of Medicine and HIV Metabolic Clinic, Milton Keynes University Hospital NHS Foundation Trust, Buckinghamshire, UK
3 Department of Medical Microbiology, Faculty of Medical Laboratory Science, Omdurman Islamic University, Omdurman, Khartoum, Sudan

Correspondence Address:
Dr. Nadir Abuzeid
Department of Medical Microbiology, Faculty of Medical Laboratory Science, Omdurman Islamic University, Omdurman, Khartoum
Sudan




How to cite this article:
Mohamed BA, Ahmed MH, Abuzeid N. Detection of Mycobacterium Tuberculosis and rifampicin-resistant gene among hemodialysis patients in Khartoum, Sudan: Using GeneXpert assay.J Global Infect Dis 2020;12:236-237


How to cite this URL:
Mohamed BA, Ahmed MH, Abuzeid N. Detection of Mycobacterium Tuberculosis and rifampicin-resistant gene among hemodialysis patients in Khartoum, Sudan: Using GeneXpert assay. J Global Infect Dis [serial online] 2020 [cited 2021 Feb 27 ];12:236-237
Available from: https://www.jgid.org/text.asp?2020/12/4/236/302007


Full Text



There was an increase in the prevalence of tuberculosis (TB) among individuals with end-stage renal disease on dialysis or those who received renal transplant.[1] Worldwide, TB infection in dialyzed patients ranges from 5% to 25% and a 6.9–52.5-fold risk of TB is reported as compared to the general population. This was attributed to the impaired cellular immunity in these patients.[2] The GeneXpert Mycobacterium tuberculosis/rifampicin (MTB/RIF) test has high sensitivity and specificity for detecting pulmonary and extrapulmonary TB and is also used to detect anti-TB medication resistance.[3]

This is a cross-sectional, hospital-based study that recruited 100 patients undergoing renal hemodialysis. This study was conducted in Khartoum Hospital during April–July 2019. These samples were tested using Ziehl–Neelsen stain, X-ray, erythrocyte sedimentation rate test, and GeneXpert assay method to detect MTB/RIF by GeneXpert assay. The collected data were analyzed using SPSS version 21 (IBM, Chicago, USA), and Univariate and multivariate logistic regression analyses were used.

We found seven (7%) patients with TB positivity, and GeneXpert assay showed sensitivity of all patients to RIF. The mean age of the patients was 46.12 ± 1.95 years; four (57%) of them were female and three patients were male (42.8%). Two patients had a history of contact with TB patients and four patients had HIV diagnosed. In this study, some variables were more commonly associated with active TB among hemodialysis patients than others, for example, logistic regression revealed significant association with: fever (odds ratio [OR]: 2.7, 95% confidence interval [CI]: 0.5–12.8, P < 0.01), chest pain (OR: 6.4, 95% CI: 1–39.4, P < 0.01), night sweats (OR: 8.8, 95% CI: 1.5–49.7, P < 0.01), chills (OR: 4, 95% CI: 0.28–7, P < 0.01), and HIV (OR: 4.9, 95% CI: 0.4–55.2, P < 0.01), as shown in [Table 1].{Table 1}

In this study, the prevalence of TB among hemodialysis patients was 7%. The mean age of the patients is less than that of the study by Ates et al., in which the mean age of the patients was above 50 years.[2] However, in a similar study conducted in Sudan among peritoneal dialysis patients, the mean age of TB patients was 37 years, which is consistent with the fact that end-stage renal failure (ESRF) in Sudan is predominantly affecting the younger population.[4] In addition, the percentage of duration of hemodialysis among patients was about 80% less than 24 months and 20% equal or longer than 24 months, and the period of hemodialysis in TB patients was equal or longer than 24 months.[5] The risk of TB increased in 24 months of hemodialysis in the United Kingdom.[6] Although it has been reported that it is difficult to diagnose TB from the sputum of patients with ESRF,[7] in this study, we found six patients positive for TB by GeneXpert assay. Interestingly, in Sudan, GeneXpert showed high sensitivity and specificity.[2] Further research is needed to assess the success of treatment of TB in hemodialysis patients.

Acknowledgments

The authors wish to express their sincere gratitude to the great and patient supervisor and all hospitals and hemodialysis centers for technical assistance.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1Unissa AN, Hanna LE. Molecular mechanisms of action, resistance, detection to the first-line anti tuberculosis drugs: Rifampicin and pyrazinamide in the post whole genome sequencing era. Tuberculosis (Edib) 2017;105:96-107.
2Ates G, Yildiz T, Danis R, Akyildiz L, Erturk B, Beyazit H, et al. Incidence of tuberculosis disease and latent tuberculosis infection in patients with end stage renal disease in an endemic region. Renal failure. 2010;32:91-5.
3Chegou NN, Hoek KG, Kriel M, Warren RM, Victor TC, Walzl G. Tuberculosis assays: Past, present and future. Expert Rev Anti Infec Ther 2011;9:457-69.
4Banaga AS, Mohammed EB, Siddig RM, Salama DE, Elbashir SB, Khojali MO, et al. Causes of end stage renal failure among haemodialysis patients in Khartoum State/Sudan. BMC Res Notes 2015;8:502.
5Moore DA, Lightstone L, Javid B, Friedland JS. High rates of tuberculosis in end-stage renal failure: the impact of international migration. Emerg Infec Dis 2002;8:77.
6Shu CC, Wu VC, Yang FJ, Pan SC, Lai TS, Wang JY, et al. Predictors and prevalence of latent tuberculosis infection in patients receiving long-term hemodialysis and peritoneal dialysis. PloS one 2012;7:e42592.
7Rao TM, Ram R, Swarnalatha G, Pai BS, Ramesh V, Rao CS, et al. Tuberculosis in haemodialysis patients: A single centre experience. Indian J Nephrol 2013;23:340.