Vaishnavi Kardale, Bioinformatics Centre, Savitribai Phule Pune University
Tuberculosis is a major health concern in many low and middle-income countries. TB continues to be the top killer infectious disease in the world. In 2019 over 10.0 million people were affected with TB and 1.41 million deaths were attributed to it. TB affects all countries of all age groups but its epidemiological distribution is heavily skewed toward low-income countries. Ethiopia is one of the worst TB-affected countries and continues to be a high TB-burden country. The woes of the country only seem to increase as the country now faces multidrug-resistant TB. All over the world the cases of TB are on a decline however low detection of drug-resistant disease threatens to reverse the progress made so far.
The increased spread of Tuberculosis in Ethiopia can be attributed to poverty, lack of health infrastructure, weak TB control program, prevailing HIV/AIDS in the country, overcrowding of living conditions, and increased vulnerability in the elderly and infants. Alcoholism, smoking, and diabetes mellitus may also significantly impact the prevalent TB condition. Drug-resistant TB bacteria can be identified using a newly developed rapid molecular diagnostic test. These tests are dependent on the prevalence of gene mutations in the pathogen population.
Anti-TB drug resistance arises as a result of spontaneous gene mutations that decrease the bacterium’s susceptibility to common anti-TB drugs like rifampicin and isoniazid. Therefore, it is critical to understand the frequency and prevalence of these mutations that provide drug resistance to the pathogen. The lack of knowledge of variations limits the effectiveness of the molecular diagnostic tools currently available for testing and retards the development of better diagnostic tools.
It was found that a prevalence of 95.8% for katG315 mutation and 5.9% for inhA promoter region gene mutation in patients with drug-resistant TB, suggests the presence of drug-resistant tuberculosis among these patients, in Ethiopia. Rifampicin resistance occurred most commonly due to mutations in rpoBMUT3 followed by rpoBMUT2A genes. Isoniazid resistance occurred most frequently due to mutations in the katG315 gene. These mutations have also been linked with polydrug resistance.
An understanding of the mutation and its mechanism is crucial for the development of better diagnostic tools. However, the frequency of these mutations was found to vary with region thereby affecting the sensitivity of the molecular diagnostic tools if the tests were to be based only on these mutations. This would require us to modify the tests based on the geographic location for better testing, identification of variants, and treatment.
Reference:
- Reta, M.A., Alemnew, B., Abate, B.B., Fourie, P.B. (2021). Prevalence of drug resistance-conferring mutations associated with isoniazid and rifampicin-resistant Mycobacterium tuberculosis in Ethiopia: A systematic review and meta-analysis. Journal of Global Antimicrobial Resistance, ISSN 2213-7165.https://doi.org/10.1016/j.jgar.2021.06.009.
About author:
Vaishnavi is a master’s student at the Bioinformatics Centre, Savitribai Phule University. She is interested in protein folding mechanisms and wants to study it further.
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- https://bioxone.in/news/worldnews/artificial-intelligence-ai-for-efficient-covid-testing/
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