ZooTB - Drug sensitive and resistant tuberculosis and zoonotic infections as causes of lymph-node infections in two provinces in Papua New Guinea

Drug sensitive and resistant tuberculosis and zoonotic infections as causes of lymph-node infections in two provinces in Papua New Guinea

What we aim to achieve:

Determine the proportion of presumptive Tuberculosis lymphadenitis attributable to Mycobacterium tuberculosis complex and the proportion of confirmed TB lymphadenitis attributable to Mycobacterium bovis.

How we will achieve it:  

Conducting a prospective cohort study.

 Partners:

  • Burnet Institute, Australia
  • Victorian Infectious Diseases Reference Laboratory (VIDRL), Australia
  • Papua New Guinea Institute of Medical Research
  • Papua New Guinea National Department of Health

Where:

East New Britain and Eastern Highlands provinces, Papua New Guinea.

Funding: $250,000 co-funded by ACIAR and DFAT.

Tuberculosis (TB) is now the leading cause of death amongst infectious diseases worldwide. In the Pacific region it is an important health issue. Papua New Guinea (PNG) is listed by the World Health Organization (WHO) as one of 30 high TB burden countries, with an estimated incidence rate of 432 per 100,000 population, and an incidence of multi-drug resistant (MDR) TB of 23 per 100,000.

The Mycobacterium Tuberculosis complex (MTBC) is a group of closely related acid-fast bacilli including M. tuberculosis and M. bovis. Both domestic and wild animal species are hosts for M. bovis. While M. tuberculosis is avirulent in cattle and transmission back to humans is extremely rare, M. bovis can infect humans and humans can infect livestock.

This project will address two major gaps in TB care and response in PNG. Firstly, defining what proportion of clinically diagnosed TB lymphadenitis is due to drug sensitive and drug resistant TB, which will have implications for clinical and programmatic management of TB. Secondly, this may demonstrate that a large proportion of clinically diagnosed cases are negative for TB by molecular and culture methods, suggesting that other pathogens may be responsible and requiring a change in clinical diagnostic algorithms.

The key objectives of the project are:

  • Determine the proportion of presumptive TB lymphadenitis attributable to Mycobacterium tuberculosis complex in East New Britain and Eastern Highlands provinces, Papua New Guinea.
  • Determine the proportion of confirmed TB lymphadenitis attributable to Mycobacterium bovis in East New Britain and Eastern Highlands provinces, Papua New Guinea.
  • Explore animal-human interactions that may pose a risk for zoonotic infections.

These will be done through three activities:

  • A prospective cohort study of presumptive TB lymphadenitis
  • Exploratory ethnographic research into animal-human interactions that may pose a risk for zoonotic infections
  • Establishing a stored bank of lymph node and blood samples for future studies on other potential causes of lymphadenitis.

Chief Investigator: 

Dr Philipp DuCros