Study of infection levels of Mycobacterium Tuberculosis in a city of Nasiriyah – Iraq

Hayder Yousif Falih¹*, Ali Hasan Ali², Zahraa A. Fadhel²

¹Department of Basic Sciences – College of Dentistry/Mustansiriyah University, Iraq.

²National University for Science and Technology/College of Medical and Health Technologies, Iraq.

*Corresponding Author E-mail: hayderyousiffalih@uomustansiriyah.edu.iq, ali.h.ALI@nust.edu.iq, zahraa.a.fadhel@nust.edu.iq

ABSTRACT:

Tuberculosis happened because of bacteria M. tuberculosis it is complex and one of the world's leading causes of death. Mycobacterium TB is thought to have infected one-third of the world's population. The study of tuberculosis was conducted at a city of southern Iraq for 6-year (from 2014 to 2019). Patients of TB who were clinically identified at the chest clinics of the medical center for Mycobacterium TB diagnosis is based on isolating the tuberculosis germ from the patient's sputum culture, also X-rays or CT scans or PCR are important tools in supporting the diagnosis. In addition, a skin tuberculin test is performed, as a positive result supports the diagnosis of active tuberculosis but does not prove it. The number of isolates tested 3360 was 630 in 2014, 646 in 2015, 585 in 2016, 610 in 2017, 474 in 2018, and 415 in 2019. The current research was carried out from September 2020 to May 2021 in medical center in south of Iraq. Age, sex, educational status, residence, and marital status, history of previous contact with active TB patients, incarceration, and nutritional status were all utilized as variables in smear positive tuberculosis and pervious treatment for tuberculosis. Results of our survey study included samples from different people that suspect infected by M. tuberculosis .Out of them 2628 were with M. tuberculosis positive and 732 with negative. The important increase in the number of cases observed in the medical center in year (2014, 2015, 2017) apparent increase in infection resulted from an increase in detection rate or increased search for the condition, examination was performed on people men/ women ( child or adult )  whose clinical change deviated in any way from the normal, and that patients with mild signs had previously been overlooked, but in 2016 2018, 2019, there is appear decrease in number of tuberculosis , this is rented to health care or devices health care-associated infection, like those associated with vital signs or may be early diagnosis to tuberculosis and last it is caused by using antibiotic with high activity. The research aims to know and study the causes of the increase in tuberculosis and the age groups that can be infected.

KEYWORDS: Tuberculosis, PCR, Hospitals, Sputum, Disease, Pulmonary.

INTRODUCTION:

Tuberculosis happened because of bacteria M. tuberculosis it is complex and one of the world's leading causes of death. Mycobacterium TB is thought to have infected one-third of the world's population^1-3.

Despite investments in tuberculosis control in Europe, the incidence of TB increased between 2000 to 2005 in much country such as Norway, United Kingdom, and Ireland, as well as Romania, Macedonia, and other countries^4,5. Negative results detection is common practice and follows the WHO-recommended Stop TB drawing⁶. All techniques for identifying and subsequently treating people with tuberculosis who have not self-reported to the healthcare system are included in active case detection. The goal is to minimize TB transmission by screening high-risk groups (those who are at a higher risk of contracting the disease, such as contacts of infected cases) and detecting and treating active disease early^7,8. A group of European companies cooperated with their scientists in the fight against tuberculosis was founded in 2006 with the goal of conducting clinical trials and surveys on tuberculosis in Europe. The purpose of this survey was to see if national guidelines or policies in Europe recommend screening about same high-risk groups, using the same methods and locations for screening, and if the nature and expected uptake are the same⁹. When exposed to an amount of drug sufficient to inhibit the growth of sensitive organisms, Mycobacterium tuberculosis develops drug resistance by the selective growth of resistant mutants in a wild population. Drug-resistant mutants are most the result of through a number of reasons, including a chromosomal mutation designed to escape or prevent drug-induced metabolic damage, most likely through a decrease in cell wall permeability and other¹⁰. The best way to understand the epidemiology of tuberculosis is to use a model that follows the pathogenesis of the disease of latent contagion to fatal tuberculosis and which leads to doom¹¹. Muench proposed a method for calculating average annual rates of infection from observed disease Note the increased by using the example of M. tuberculosis infection as an example¹⁰. At the recent epidemiological researchs, smoking was found the responsible for 50% of tuberculosis deaths among Indian peoples in men, while other studies have found a link between smoking and tuberculosis disease^12-14. The genotyping of M. tuberculosis insulate has greatly and quickly improved our understanding of tuberculosis epidemiology¹⁵. It is possible to reveal unnoticed transmission, identify false-positive cultures, and differentiate between reinfection and recrudescence using molecular equipment¹⁶. Spoligotyping (spacer oligonucleotide typing) is a dependable and informative technique for determining the genetic framework of tuberculosis populations. Spoligotyping analyzes genomic polymorphisms in the short direct repeat of M. tuberculosis, a genetic marker, using PCR technology^17,18.

METHODS:

M. tuberculosis isolates:

The survey of tuberculosis was conducted at a city of southern Iraq for 6-year (from 2014- to 2019). Patients of TB who were clinically identified at the chest clinics of the medical center for Mycobacterium TB diagnosis is based on isolating the tuberculosis germ from the patient's sputum culture, X-rays or CT scans or PCR are important tools in supporting the diagnosis. In addition, a skin tuberculin test is performed, as a positive result supports the diagnosis of active tuberculosis but does not prove it. The number of isolates tested was 3360 for five years was 630 in 2014, 646 in 2015, 585 in 2016, 610 in 2017, 474 in 2018, and 415 in 2019. A group of specialized doctors examined assessed isolate samples from patients with clinical presentations that could not be classified according to the American Thoracic Society criteria as pathogenic The infection can stimulation that lead to cause active tuberculosis in about 7% of latently infected people. This can happen in the event of immune suppression, but the reason of reactivation is often unknown. Although tuberculosis is primarily a lung disease, the pathogens can enter and cause disease in almost every organ or tissue, including the central nervous system and bone. Animal models have greatly aided our understanding of the disease, including many of symptoms like the disease's pathogenesis, pathology, and immunology. This present study was conducted from September 2020 to May 2021 in medical center in south of Iraq. Age, sex, educational status, residence, marital status, history of previous contact with active TB cases, prison, nutritional status and previous tuberculosis treatment were all used as variables.

Collecting and processing sputum:

According to WHO standards, the sputum samples were taken from every willing participant tuberculosis doubtful of utilizing tagged and Cans sterilized by workers who work in the laboratory. The fraction that aggregated material was being immediately to use for a smear microscopy with direct smears with a remainder was maintained in the refrigerator at 4⁰C until transported for culture. In under 7 days of collecting the samples. Sample was transported to just the research lab of cultural identity on ice while treated to assimilation and purification with an equivalent amount 4 percent w/v NaOH. Organic waste and undesirable normal flora are removed by sodium hydroxide. The sediment has been separated from the precipitate thorough suspended by 15 min with centrifuging. By employing Red phenol as an indicator treated with NaOH specimens were equalize with HCl. Glycerol and pyruvate-based medium were used to inoculate each sputum sample. The infected culture medium was subsequently incubated at 37⁰C for 8 weeks, with Mycobacterium growth monitored weekly. Mycobacterium growth was verified using colony features and a culture smear¹⁹.

RESULTS DISCUSSION:

There has been a lot of research in the study of pulmonary tuberculosis that points to diverse social cultures in comprehending this illness, and this study will supporting evidence at next period TB to control and protection the city. The study found that the frequency of tuberculosis varies greatly from year to year owing to a variety of variables like age, educational status, domicile, contact with active tuberculosis cases in the past, incarceration, previous tuberculosis treatment, lack of TB patient segregation, ventilation problems, and an ineffective or not found TB control program might all contribute to the high TB burden. Chest discomfort and shortness of breath are crucial indicators that helped detect this condition in the first place and also the fever, loss of weight, sweating at night, appetite loss, coughing for a long time, lack of TB patient segregation, overcrowding and inadequate ventilation and high temperature that also helped to detect. At the Prison systems are already identified as a key community variable for tuberculosis transmission. Owing to the prison environment's large groups of people in close proximity of people for long periods of time in poorly ventilated infrastructures delayed diagnosis, Risk deprivation, substance misuse, and initial healthier habits make it difficult to identify, isolate inmates for treatment, insufficient nutraceuticals and HIV infection. The estimated frequency of pulmonary TB illness in prisons is significantly greater than the general population's estimates²⁰. that depressed and moderate income countries in Southeast Asia like Thailand and Bangladesh similar epidemiological scenario has been reported^21-23. However, just a few studies in Ethiopia have reported the frequency of smear-positive pulmonary TB. Few researches have recorded the amount of TB knowledge among civilians, which has been identified as a key factor. Although it is difficult to quantify the precise rates of infection with this disease, M.tuberculosis infections are regarded one of the most deadly and frequent forms of bacterial infections in individuals. Results of our survey study included 3360 samples from different people that suspect infected by M. tuberculosis during five years 2014 and 2019. Out of them 2628 were with M. tuberculosis positive and 732 with negative (Table 1), (Figure 1). There has been a substantial growth in the number of cases observed in the medical center in year (2014, 2015, 2017) apparent increase in infection resulted from an increase in detection rate or increased search for the condition, examination was performed on people men/ women ( child or adult )  whose clinical change deviated in any way from the normal, and that patients with mild signs had previously been overlooked, but in (2016 2018, 2019), there is appear decrease in number of tuberculosis, this is rented to health care or devices health care-associated infection, like those associated with vital signs or may be early diagnosis to tuberculosis and last it is caused by using antibiotic with high activity. Historically, tuberculosis has considered a risk factor lung for disease of weak immune system, diabetes and acute kidney disease, and people treatment with chemotherapy in. From 3360 samples was only 1655(49.3%) in female and 1750(50.7%) were male, the differences were many (Table 2), (Figure 2), for age the highest disease 2015 occurred in the age group (15-43) and (+65) year, whereas infants age (0-4) very few. (Table 3) who reported that tuberculosis in female was higher than that of males in 2015, 2017, 2018 while males were higher than females in (2014, 2016, 2019). In most cases, men’s and females may get tuberculosis bacteria because weak immune system, severe kidney disease, cancer, Chemotherapy, Malnutrition ,Work in the health care field and close contact with sick people. Wearing a mask, sterilization and washing hands frequently reduces your risk of infection significantly, in our survey study and from a total of 3360 bacterial growth, found the highest type of bacteria was tuberculosis. Sputum samples are important for the documentation of tuberculosis in people. Tuberculosis analysis is very important for diagnosis and support doctors to determine the appropriate treatment for them. Tuberculosis b is the most common organisms isolated from complicated sputum from bacterial meningitis, Klebsiella، Enterobacter، Serratia given a strong suspicion in lung.

Figure 1: Rates of tuberculosis infection during the year

Table1: Rates of tuberculosis infection during the year

Years	Cases	Positive	%	Negative	%	Chi-Square-χ^2
2014	630	497	78.9	133	21.1	5.136 *
2015	646	475	73.5	171	26.5	4.654 *
2016	585	467	79.8	118	20.2	5.234 *
2017	610	448	73.4	162	26.6	4.541 *
2018	474	394	83.1	80	16.9	6.198 *
2019	415	347	83.6	68	16.4	6.261 *
Total	3360	2628	78.7	732	21.3	5.090 *
Chi-Square-χ^2	---	---	3.336**	---	3.336**	---

* (P<0.05), ** (P<0.01).

Table2: Rates of tuberculosis among male and female in every year

Years	Male	%	Female	%	Total	Chi-Square-χ^2
2014	350	55.6	280	44.4	630	1.519 *
2015	307	47.5	339	52.5	646	3.912 **
2016	298	50.9	287	49.1	585	1.010 *
2017	295	48.4	315	51.6	610	2.451 **
2018	236	49.8	238	50.2	474	1.976 **
2019	219	52.8	196	47.2	415	1.002 *
Total	1705	50.7	1655	49.3	3360	---
Chi-Square-χ^2	---	5.826 **	---	5.826 **	---	---

* (P<0.05), ** (P<0.01).

Figure 2: Rates of tuberculosis infection during the year

Table3: Rates of tuberculosis according to age groups in each year

Year	gender	0-4	5-14	15-24	25-34	35-44	45-54	55-64	+65	Total	Total No.
2014	Male	7	53	59	63	55	48	44	58	387	697
	female	3	15	45	44	47	55	48	53	310
2015	Male	4	50	57	48	39	23	35	56	312	663
	female	0	24	58	61	44	63	43	58	351
2016	Male	2	38	50	63	49	14	23	59	298	585
	female	5	52	45	34	39	26	37	49	287
2017	Male	8	14	39	51	54	54	28	47	295	610
	female	4	15	60	53	41	50	39	53	315
2018	Male	5	31	46	52	32	11	22	37	236	474
	female	3	47	41	38	41	16	27	25	238
2019	Male	2	33	37	54	37	10	21	25	219	415
	female	2	39	31	30	24	14	23	33	196
Total											3444

ACKNOWLEDGMENTS:

Researchers want to give thanks to Mustansiriyah University [www.uomustansiriyah.edu.iq] Baghdad -Iraq and National University for Science and Technology/College of Medical and Health Technologies Iraq for standing with us while working on this scientific research.

CONCLUSIONS:

Pneumococcal TB is one of the most disconcerting respiratory illnesses in the world, owing to the many modes of infection as well as the various ages of infection, whether men, women, children, or the elderly through air or any various resources. Furthermore the knowledge of the rates of TB infection in hospitals and medical centers may be managed via preventive and minimize the frequency of infections, according to this study, men are more likely to be infected than females. We propose that further research be done on these bacteria, its infection mechanism, and transmission routes, since it is critical to educate the public in order to prevent the spread of such illnesses.

CONFLICT OF INTEREST:

The authors have no conflicts of interest regarding this investigation.

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Received on 20.10.2021            Modified on 03.12.2021

Accepted on 06.01.2022           © RJPT All right reserved

Research J. Pharm. and Tech 2022; 15(9):4230-4234.

DOI: 10.52711/0974-360X.2022.00711