Tuberculosis in Sudan: a study of Mycobacterium tuberculosis strain genotype and susceptibility to anti-tuberculosis drugsReportar como inadecuado

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BMC Infectious Diseases

, 11:219

Tuberculosis and other mycobacterial diseases


BackgroundSudan is a large country with a diverse population and history of civil conflict. Poverty levels are high with a gross national income per capita of less than two thousand dollars. The country has a high burden of tuberculosis TB with an estimated 50,000 incident cases during 2009, when the estimated prevalence was 209 cases per 100,000 of the population. Few studies have been undertaken on TB in Sudan and the prevalence of drug resistant disease is not known.

MethodsIn this study Mycobacterium tuberculosis isolates from 235 patients attending three treatment centers in Sudan were screened for susceptibility to isoniazid, rifampicin, ethambutol and streptomycin by the proportion method on Lowenstein Jensen media. 232 isolates were also genotyped by spoligotyping. Demographic details of patients were recorded using a structured questionnaire. Statistical analyses were conducted to examine the associations between drug resistance with risk ratios computed for a set of risk factors gender, age, case status - new or relapse, geographic origin of the patient, spoligotype, number of people per room, marital status and type of housing.

ResultsMulti drug-resistant tuberculosis MDR-TB, being resistance to at least rifampicin and isoniazid, was found in 5% 95% CI: 2,8 of new cases and 24% 95% CI: 14,34 of previously treated patients. Drug resistance was associated with previous treatment with risk ratios of 3.51 95% CI: 2.69-4.60; p < 0.001 for resistance to any drug and 5.23 95% CI: 2.30-11.90; p < 0.001 for MDR-TB. Resistance was also associated with the geographic region of origin of the patient, being most frequently observed in patients from the Northern region and least in the Eastern region with risk ratios of 7.43 95%CI:3.42,16.18; p: < 0.001 and 14.09 95%CI:1.80,110.53; p:0.026 for resistance to any drug and MDR-TB. The major genotype observed was of the Central Asia spoligotype family CAS1 Delhi, representing 49% of the 232 isolates examined.

ConclusionsWe conclude that emergence of drug resistant tuberculosis has the potential to be a serious public health problem in Sudan and that strengthened tuberculosis control and improved monitoring of therapy is needed. Further surveillance is required to fully ascertain the extent of the problem.

Electronic supplementary materialThe online version of this article doi:10.1186-1471-2334-11-219 contains supplementary material, which is available to authorized users.

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Autor: Ghada S Sharaf Eldin - Imad Fadl-Elmula - Mohammed S Ali - Ahmed B Ali - Abdel Latif GA Salih - Kim Mallard - Christian


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