TABLE OF CONTENTS
Title page
Certification
Dedication
Acknowledgement
Table of Content
List of Figures
List of Tables
List of Acronyms
Appendices
Abstract
CHAPTER ONE: INTRODUCTION AND LITERATURE REVIEW
1.1 Introduction
1.1.1 Statement of Problem
1.1.2 Aims
1.1.3 Objectives of the Research
1.2 Literature Review
1.2.1 General Classification
1.2.2 Prevalence of Tuberculosis
1.3 TB/HIV Co-infection
1.3.1 The Interaction of HIV and Tuberculosis
1.4 Prevalence of Nontuberculous Mycobacteria
1.5 Clinical Manifestations
1.5.1 Cavitary/Fibronodular Disease
1.5.2 Nodular Bronchiectatic Disease
1.5.3 Hypersensitivity-like Pneumonitis
1.5.4 Disseminated NTM Infections
1.5.5 Mycobacterial Lymphadenitis
1.6 Epidemiology
1.6.1 Distribution
1.6.2 Race
1.6.3 Sex
1.6.4 Age
1.6.5 Mortality/Morbidity
1.6.6 Predisposing Factors
CHAPTER TWO: MATERIALS AND METHOD
2.1 Study Design
2.1.1 Study Location
2.1.2 Study Population
2.2 Sample Collection
2.2.1 Sample Collection for HIV Screening and CD4+ Cell Count
2.2.2 Sample Collection for Sputum Microscopy
2.3 Screening for HIV1 and 2 Antibodies
2.4. Determination of CD4+ Count
2.5 Sputum Smear Preparation
2.5.1 Ziehl-Neelsen Staining for Acid Fast Bacilli (AFB)
2.6 DNA Extraction for Mycobacterium Testing
2.6.1 Sputum Lysis for DNA Extraction
2.6.2 DNA Extraction for PCR
2.6.3 Detection of Mycobacterium species by Nested PCR
2.6.4 Agarose Electrophoresis
2.6.5 Nar 1 Restriction Enzyme Digestion
CHAPTER THREE: RESULTS
3.1: Age Distribution of HIV Positive and Negative Patients
3.2: CD4+ cell count of the HIV seropositive patients
3.3: Age specific distribution of TB in HIV positive patients
3.4: Age specific distribution of TB in HIV negative patients
3.5: Species of Mycobacterium characterized from sputa of the subjects
3.6: Prevalence of Mycobacterium species in HIV positive and negative patients
3.7: Percentage age distribution of the species in HIV positive and negative patients
3.8: Demographic Characteristics of the Population
3.9: Attributable and relative risk of the disease in HIV condition
3.10: Attributable and relative risk of the disease at different risk factors
3.11: The distribution of the species with respect to the demographic factors
CHAPTER FOUR: DISCUSSION AND CONCLUSION
REFERENCES
APPENDICES
ABSTRACT
The increasing global incidence of tuberculosis and nontuberculous mycobacteria (NTM) has been attributed to immunosuppresion due to the Human immunodeficiency virus (HIV) epidemic. The paucity of information on the contribution of NTM to mycobacterial infections in Africa including Nigeria has however been closely associated with limited laboratory culture for its isolation and identification. This study investigated the co-infectivity of HIV and Atypical Mycobacteria in Nsukka L.G.A. Two hundred cases (100 HIV negative: 56 males and 44 females and 100 HIV positive- 39 males and 61 females), between the ages of 15 and 71 years with mean age of 37.5 years participated in the research. HIV antibodies were screened using two HIV test kits: the Determine (Abbot Co Ltd, Japan) for preliminary test and the Gold (Unigold) which was used to check for consistency. CD4+ count was carried out using the cytometry (CyFlow®) , while acid fast bacilli (AFB) were identified by the Ziehl-Neelson staining technique. AFB positive samples were subjected to nested PCR for species identification. T-test was employed to check for statistical significance between the mean prevalence in test and control groups and CD4 count of HIV single infection and co infection with TB. Chi square correlation was also employed to check for relationship between the demographic characteristics and the distribution of the disease.
CHAPTER ONE
INTRODUCTION
Tuberculosis (TB) is an infectious disease that primarily affects lungs causing pulmonary tuberculosis but can also affect meninges, intestine, bones, lymph nodes, skin and other tissues of the body. Worldwide, tuberculosis causes 2.9 million deaths annually (WHO, 1998). An estimated two billion persons are currently infected with Mycobacterium tuberculosis and other Mycobacterium species. The rates of increase are even greater in developing countries, primarily because of increased immigration of people from regions of high endemicity, declining socio-economic conditions in densely populated cities and the increasing number of human immunodeficiency virus (HIV) infected individuals (Szabo, 1990). The total number of tuberculosis cases in the world is increasing and the HIV epidemic is implicated for this increased incidence and an estimated three million persons with tuberculosis worldwide also have AIDS. Over 125 Mycobacterium species have been
characterized and identified (Griffith et al, 2007). There are numerous species of Mycobacterium and because of recently developed molecular methods, more are being recognized (Tortoli, 2003), although regional variation in species isolation has been shown (Griffith et al, 2007). Historically M. tuberculosis and M. leprae have caused the preponderance of human disease. However in recent years, other mycobacteria have become more widely appreciated as potential pathogens. Most other mycobacteria are present in the environment as saprophytes. These organisms in the past have been called atypical mycobacteria, the term first coined by Pinner (1935) but species have been described with different nomenclatures such as anonymous, nontuberculous mycobacteria (NTM), environmental, opportunistic and mycobacteria other than tubercle bacilli (MOTT). While there has not been an international consensus on the nomenclature, the American Thoracic Society (ATS) has endorsed the name NTM (Wallace et al, 1990; Katoch and Mohan, 2001). The.....
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