Molecular investigation of the aetiology of tuberculosis-like clinical syndromes in  adults presenting for primary health care at Limbe and Ndirande health centres in  Blantyre, Malawi.

Mnyanga, Alice Chimwemwe

Molecular investigation of the aetiology of tuberculosis-like clinical syndromes in adults presenting for primary health care at Limbe and Ndirande health centres in Blantyre, Malawi.

Date

2022-02-09

Authors

Mnyanga, Alice Chimwemwe

Publisher

Kamuzu University of Health Sciences

Abstract

Type of research study: A prospective cohort study Problem to be studied: Tuberculosis (TB) diagnosis is still a challenge worldwide, especially in low- and medium-income countries where resources are limited and most cases are missed in primary health care facilities in resource limited settings. Smear negative TB patients are usually prescribed antibiotics to rule out TB. This practice drives antimicrobial resistance and promotes inappropriate use of antibiotics. A holistic investigation for other respiratory pathogens is rarely considered and sometimes completely ignored. Broad Objective: The broad aim of this study is to determine the aetiology of respiratory symptoms in patients presenting with TB-like cough for tuberculosis screening at Limbe and Ndirande health centres. Specific objectives i. To establish the prevalence of viral pathogens among patients with a microbiologically negative sputum result whose symptoms did not improve after antibiotic treatment. ii. To compare burden of viral infections in the azithromycin, amoxycillin and standard of care treatment arms for patients whose symptoms did not resolve after 8 days iii. To identify bacterial-viral co-infection in all patients randomized in all the 3 treatment arms namely azithromycin, amoxycillin and standard of care Methodology: We will use molecular diagnostic tests to investigate other causes of cough that is TB-like in adults attending primary health care facilities in Blantyre district. We will isolate viral nucleic acid from stored nasopharyngeal swabs collected from 173 patients enrolled in the ACT-TB trial between 2019-2020. These patients will be drawn from the three treatment arms namely azithromycin, amoxycillin and standard of care. Using the Fast-Track Diagnostic 33 respiratory pathogen panel, we will perform multiplex PCR to detect 19 viruses, 12 bacteria and 1 fungal pathogens simultaneously. Specifically, we will analyse only those samples from patients who were prescribed antibiotics after a microbiologically negative TB test, but symptoms of cough did not resolve. Expected findings and dissemination: We expect to identify at least one or more viral and or bacterial respiratory pathogens from these patients who were prescribed antibiotics but whose symptoms did not resolve at day 8. We will use these findings to influence policy makers in introduction of portable viral diagnostic resources in primary health care facilities to ensure proper management of antibiotics , to promote holistic diagnostic investigation to ensure patients conditions are managed adequately and antimicrobial resistance will be managed in the long run. Findings from this study will be submitted to a peer reviewed journal, HNTI, KUHeS and COMREC.