HerpeZ

Diagnostics Research & Training in Zambia

Tuberculosis

Useful Links

Tuberculosis (TB) is a leading cause of death among adults globally. In sub-Saharan Africa this is exacerbated by the HIV pandemic, but TB remains a leading cause of death globally, even in the absence of HIV, as it is first an foremost a disease of poverty. Unlike other important infectious disease priorities, TB is unique in that active infection is not readily confirmable through a simple blood test. Microbiological diagnosis requires a sputum specimen, and so you can only confirm TB disease in patients who are symptomatic. Our research at the University Teaching Hospital, has demonstrated culture confirmed TB in up to 10% of ‘non-TB suspects’ who could produce sputum (1). Our 2015 autopsy study showed that despite good awareness of the risk TB within the hospital, there are still many undiagnosed cases at post-mortem. In particular 17% of TB cases were undiagnosed and untreated multiple-drug resistant TB (MDR-TB)(2).


In children TB is grossly under-diagnosed, so much so that epidemiological global burden of disease studies do not even mention ‘TB’ or ‘Tuberculosis’ (3, 4). In stark contrast, autopsy studies undertaken by us and other groups in sub-Saharan Africa, have shown that up to 10% of deaths among hospital admissions are due to undiagnosed and untreated TB (5-7).


At HerpeZ we are trying to address these diagnostic failures through promoting broader screening of both adult and child admissions to the hospital and developing and evaluating new diagnostic tools or strategies. We have recently initiated a study to define the burden of TB in neonates born to mothers with a history of TB infection and we are developing capacity for analysis of TB cultures or fresh clinical specimens by next generation sequencing. We are also interested in nosocomial TB as a threat to both patients and staff working at busy poorly resourced hospitals across the region.

1. Bates, M., et al. 2012. Evaluation of the burden of unsuspected pulmonary tuberculosis and co-morbidity with non-communicable diseases in sputum producing adult inpatients. PLoS One 7:e40774.

2. Bates, M., et al. 2015. Burden of tuberculosis at post mortem in inpatients at a tertiary referral centre in sub-Saharan Africa: a prospective descriptive autopsy study. The Lancet infectious diseases 15:544-551.

3. Liu, L., et al. 2012. Global, regional, and national causes of child mortality: an updated systematic analysis for 2010 with time trends since 2000. Lancet 379:2151-2161.

4. Liu, L., et al. 2015. Global, regional, and national causes of child mortality in 2000-13, with projections to inform post-2015 priorities: an updated systematic analysis. Lancet 385:430-440.

5. Bates, M., et al. 2013. Deaths due to respiratory tract infections in Africa: a review of autopsy studies. Curr Opin Pulm Med 19:229-237.

6. Bates, M., et al. 2016. Burden of respiratory tract infections at post mortem in Zambian children. BMC medicine 14:99.

7. Chintu, C., et al. 2002. Lung diseases at necropsy in African children dying from respiratory illnesses: a descriptive necropsy study. Lancet 360:985-990.

Up and coming TB conferences

TB Publications

Articles

Outcomes of multidrug-resistant tuberculosis in Zambia: a cohort analysis. Kapata N, Grobusch MP, Chongwe G, Chanda-Kapata P, Ngosa W, Tembo M, Musonda S, Katemangwe P, Bates M, Mwaba P, Zumla A, Cobelens F. Infection. 2017 Aug 4.

Enhancing preparedness for tackling new epidemic threats. Zumla A, Ippolito G, McCloskey B, Bates M, Ansumana R, Heymann D, Kock R, Ntoumi F. Lancet Respir Med. 2017 Aug;5(8):606-608.

Health systems in the Republic of Congo: challenges and opportunities for implementing tuberculosis and HIV collaborative service, research, and training activities. Linguissi LS, Gwom LC, Nkenfou CN, Bates M, Petersen E, Zumla A, Ntoumi F. Int J Infect Dis. 2017 Mar;56:62-67.

Performance of the Xpert MTB/RIF assay in the diagnosis of tuberculosis in formalin-fixed, paraffin-embedded tissues. Polepole P, Kabwe M, Kasonde M, Tembo J, Shibemba A, O'Grady J, Kapata N, Zumla A, Bates M. Int J Mycobacteriol. 2017 Jan-Mar;6(1):87-93.

The global dynamics of diabetes and tuberculosis: the impact of migration and policy implications. Girardi E, Sañé Schepisi M, Goletti D, Bates M, Mwaba P, Yeboah-Manu D, Ntoumi F, Palmieri F, Maeurer M, Zumla A, Ippolito G. Int J Infect Dis. 2017 Mar;56:45-53.

Application of highly portable MinION nanopore sequencing technology for the monitoring of nosocomial tuberculosis infection. Bates M, Polepole P, Kapata N, Loose M, O'Grady J. Int J Mycobacteriol. 2016 Dec;5 Suppl 1:S24.

Learning from epidemiological, clinical and immunological studies on Mycobacterium africanum for improving current understanding of host-pathogen interactions, and for the development and evaluation of diagnostics, host-directed therapies and vaccines for Tuberculosis. Zumla A, Otchere ID, Mensah GI, Asante-Poku A, Gehre F, Maeurer M, Bates M, Mwaba P, Ntoumi F, Yeboah-Manu D. Int J Infect Dis. 2016 Dec 12.


Book Chapters

Check out this amazing and moving testimony from TB Proof founders, Darlene and Arne von Delft, about their experience of nosocomial TB infection. We MUST  take better care of our healthcare workers!!

Follow this link to find out about the great work TB Proof are doing to raise awareness of the risks of TB transmission in hospitals, and to tackle stigma