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Bishara H.,Bar - Ilan University | Lidji M.,Tel Aviv Tuberculosis Clinic | Goldblatt D.,National Mycobacterium Reference Laboratory | Rorman E.,National Public Health Laboratory | And 2 more authors.
Scandinavian Journal of Infectious Diseases | Year: 2014

Tuberculosis (TB) outbreaks in congregate settings pose a public health concern and a clinical challenge. We report a TB outbreak involving 6 cases of active TB among 28 recent Ethiopian immigrants (EIs) in an immigrant reception center in Israel. The outbreak erupted several weeks after a meticulous pre-immigration TB screening of this group. All five culture-positive TB patients were infected with the CAS1-DELHI family, SIT 25 strain. Pulmonary involvement manifested as only a persistent cough without systemic symptoms. This outbreak occurred because of miscommunication among healthcare staff and between healthcare staff and the EI index case. It was fuelled by the staff ignorance of the social bonds within the group, and the sluggish once-monthly schedule of the on-site TB clinic operated at the reception center, which further lacked radiography facilities. This outbreak highlights the challenges of screening for active TB among immigrants and hard to reach groups. © 2014 Informa Healthcare.

Cooke G.S.,Imperial College London | Cooke G.S.,University of KwaZulu - Natal | Beaton R.K.,National Mycobacterium Reference Laboratory | Lessells R.J.,University of KwaZulu - Natal | And 7 more authors.
Emerging Infectious Diseases | Year: 2011

We describe a death associated with multidrug-resistant tuberculosis and HIV infection outside Africa that can be linked to Tugela Ferry (KwaZulu-Natal, South Africa), the town most closely associated with the regional epidemic of drug-resistant tuberculosis. This case underscores the international relevance of this regional epidemic, particularly among health care workers.

Shamriz O.,Hebrew University of Jerusalem | Engelhard D.,Hebrew University of Jerusalem | Engelhard D.,Monash University | Rajs A.P.,Hebrew University of Jerusalem | And 3 more authors.
Pediatric Infectious Disease Journal | Year: 2013

We report a 17-year-old patient with inherited STAT1 deficiency, who was diagnosed with Mycobacterium szulgai chronic multifocal osteomyelitis and responded well to the therapy with ethambutol, rifampicin and azithromycin. Seven other reported cases of M. szulgai osteomyelitis are reviewed. This is the first description of M. szulgai osteomyelitis in an adolescent with a primary immunodeficiency. © 2013 Lippincott Williams &Wilkins.

Bishara H.,Tuberculosis Clinic | Bishara H.,Bar - Ilan University | Goldblatt D.,National Mycobacterium Reference Laboratory | Rorman E.,National Public Health Laboratory | Mor Z.,Ministry of Health
Epidemiology and Infection | Year: 2015

The incidence of tuberculosis (TB) in native ethnic minorities remains high in developed countries. Arabs, the major ethnic minority in Israel, comprise 21% of its population. This retrospective study compared TB incidence, demographic, clinical, laboratory, genotyping characteristics and treatment outcomes in all Israeli-born citizens diagnosed with TB between 1999 and 2011 by ethnicity, i.e. Israeli-born Arabs (IA) and Jews (IJ). A total of 831 Israeli-born TB patients were reported. Of those, there were 530 (64%) IJ and 301 (36%) IA, with an average annual TB rate of 1·1 and 1·6 cases/100 000 population, respectively, lower than the national average (7·0 cases/100 000 population). TB rates in IA and IJ declined and converged to 1 case/100 000 residents. IA TB patients were more likely to be older, have more pulmonary TB and have lower treatment success rates than IJ. Older age and HIV co-infection, but not ethnicity, were predictive of non-success in TB treatment. Ten mixed IA-IJ clades were detected by spoligotyping and three mixed IA-IJ clusters were identified by MIRU-VNTR typing. Only one IA-IJ couple recalled mutual contact. In conclusion, TB rate in IA was higher than in IJ, but declined and converged in both to 1 case/100 000. Treatment success was high in both groups, and was unrelated to ethnicity. Copyright © Cambridge University Press 2015.

Phelan J.E.,London School of Hygiene and Tropical Medicine | Coll F.,London School of Hygiene and Tropical Medicine | Bergval I.,Royal Tropical Institute | Anthony R.M.,Royal Tropical Institute | And 24 more authors.
BMC Genomics | Year: 2016

Background: Approximately 10 % of the Mycobacterium tuberculosis genome is made up of two families of genes that are poorly characterized due to their high GC content and highly repetitive nature. The PE and PPE families are typified by their highly conserved N-terminal domains that incorporate proline-glutamate (PE) and proline-proline-glutamate (PPE) signature motifs. They are hypothesised to be important virulence factors involved with host-pathogen interactions, but their high genetic variability and complexity of analysis means they are typically disregarded in genome studies. Results: To elucidate the structure of these genes, 518 genomes from a diverse international collection of clinical isolates were de novo assembled. A further 21 reference M. tuberculosis complex genomes and long read sequence data were used to validate the approach. SNP analysis revealed that variation in the majority of the 168 pe/ppe genes studied was consistent with lineage. Several recombination hotspots were identified, notably pe_pgrs3 and pe_pgrs17. Evidence of positive selection was revealed in 65 pe/ppe genes, including epitopes potentially binding to major histocompatibility complex molecules. Conclusions: This, the first comprehensive study of the pe and ppe genes, provides important insight into M. tuberculosis diversity and has significant implications for vaccine development. © 2016 Phelan et al.

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