Mycobacterial Variation in Tajikistan
Molecular characteristics of novel MDR strains of Mycobacterium in Tajikistan
Tech Area / Field
3 Approved without Funding
Tajik State Medical University, Tajikistan, Dushanbe
- Universite de Paris-Sud / Institut de Génétique et Microbiologie, France, Orsay\nUniversité de Paris VI / UMRS 872, INSERM, CNRS, France, Paris\nThe Microbe Company, LLC, USA, VA, Christiansburg\nCanadian Food Inspection Agency / Ottawa Laboratory Fallowfield, Canada, ON, Ottawa
Project summaryThe project presented focuses on the need for containing the spread of tuberculosis, both sensitive and polyresistant forms, in Tajikistan. In the context of a developing economy and inadequately structured health system and also absence of adequate preventive measures it is important to tackle this dangerous disease in different ways. In fact TB is the main health problem in Tajikistan with infection rate up by 28% in recent years. One places the figure of tuberculosis affected persons as 134 in 100 000 inpiduals. This is of concern to the general population and health authorities. The wide spread and increasing rate of tuberculosis will have also a repercussion on populations in the neighboring republics. The fibrous-cavernous form of the disease has increased 5 times in the last decade and the death rate has shot up by 25%. A general and quick survey indicated to us that the disease is prevalent throughout the country but however incident rate varied from region to region as also the strain distribution.
Vose region in Hatlon area is the most affected zone. This was the same even during the period of the Soviet Union. According to the medical service of the Republic of Tajikistan there are TB patients nearly in every family unit. This is a not only a health but also an economic hazard. This area is also characterized by epizootic problems. In the light of this situation our objective is to carry out strain determination and virulence pattern prevalent in the region. Due to several reasons, mainly lack of knowledge and poor patient compliance there are several forms of polyresistant tuberculosis bacilli found in the region. It is therefore essential to make early diagnosis and that too as quickly as possible. Early diagnosis and strain identification followed by appropriate antibiotherapy with unfailing patient compliance will allow us to prevent further increase of MDR strains.
We will focus special attention on the region of Vose. This region has one of the highest incidence of MDR TB. We will collect all clinical samples, identify the strains, classify them into sensitive and resistant strains. Antibiograms with second line antibiotics and others will be done on the MDR strains so as to come out with an effective antibiotic for each patient. In this way we keep track of the strains and the patients making sure that further spread as also resistance development is prevented. TB is a real health problem and should be tackled with knowledge and use of modern technology in the area of microbial disease containment. While out institute pilots this project we also will have help and input from two prestigious Institutes from France namely Hospital Raymond Poincare (France, Public Health service in Garches) and Institute Pasteur (Paris).
The Institution from Tajikistan will be Avicenna Tajik State Medical University (TSMU), chair of microbiology, virology and immunology. This Institute has a combined man power of over 70 professors and an equal number of research staff. The Avicenna Tajik State Medical University will carry out the field studies including epidemiological, drug testing antibiograms on samples collected from inpiduals in Tajikistan. They will also identify the polyresistant strains and confirm the same with the help of the reference laboratories elsewhere.
Molecular basis of strain difference will be studied. This will be done by sequence comparison using as reference the strain H37Rv.
We expect to identify the virulence inducing genes from a selected number of strains by amplification and sequencing.
We also hope to understand the mechanisms involved in MDR induction in the Tajik strains.
Our collaborators from France and the United States in this project will provide support and know-how for serological work, for rapid molecular identification, identification of dormant bacilli from fat cells and dendritic cells from infected inpiduals during the evolution of the disease and during remission.
Treatment assays and outcomes will be monitoried by ISTC.
We are convinced that with our effort and those of our colleagues, we should be able to empower ourselves to combat tuberculosis in Tajikistan. We may not be able to totally eliminate or erradicate the disease but we should be able to prevent its progression and spread through appropriate sanitary measures and knowledge gathering.
In a population of 7 million inpiduals, who are struggling to find their place in the modern era of 21 century a disease like tuberculosis should have no scope to hamper our desire for progress and better health for our citizens.
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