National Mycobacterium Reference Laboratory

Tel Aviv, Israel

National Mycobacterium Reference Laboratory

Tel Aviv, Israel
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Bishara H.,Nazareth Hospital | 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.


Bishara H.,Bar - Ilan University | Lidji M.,Tel Aviv Tuberculosis Clinic | Goldblatt D.,National Mycobacterium Reference Laboratory | Rorman E.,National Public Health Laboratory | Weiler-Ravell D.,Bar - Ilan University
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.


Goldblatt D.,National Mycobacterium Reference Laboratory | Rorman E.,National Public Health Laboratory | Chemtob D.,Ministry of Health | Freidlin P.J.,National Mycobacterium Reference Laboratory | And 4 more authors.
International Journal of Tuberculosis and Lung Disease | Year: 2014

SETTING: Israel receives migrants from various countries, some of which have high tuberculosis (TB) prevalence. OBJECTIVE: To assess the predominant Mycobacterium tuberculosis strains in Israel isolated during 2008-2010 among Israeli-born and migrant patients, and to investigate possible transmission of TB from migrants to the local population. METHODS: Molecular characterisation employed 43-spacer spoligotyping and 16-loci mycobacterial interspersed repetitive units-variable number of tandem repeats typing. All patients were classified according to those who were members of a cluster and those who were not. RESULT S : Among 684 M. tuberculosis strains isolated from new patients genotyped and assigned to their specific cohort populations during the study period, major spoligotype families were Central Asian (CAS) (n = 140, 20%), Beijing (n = 101, 15%) and T (n = 160, 23%). Most Beijing strains (66%) were isolated from patients from the former Soviet Union (FSU), while CAS strains were mainly (74%) from Ethiopia, Eritrea and Sudan (EES). For the heterogeneous T-clade, patient countries of origin were 38% EES and 33% FSU. CONCLUSIONS: Predominant M. tuberculosis genotypes in Israel in 2008-2010 were similar to genotypes endemic to the migrants' countries of origin. Epidemiological investigations did not demonstrate transmission between migrants and Israeli-born patients sharing the same cluster. © 2014 The Union.


PubMed | National Mycobacterium Reference Laboratory, National Public Health Laboratory and Nazareth Hospital
Type: Journal Article | Journal: 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 11 and 16 cases/100 000 population, respectively, lower than the national average (70 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.


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.


PubMed | National Mycobacterium Reference Laboratory, National Public Health Laboratory and Ministry of Health
Type: Journal Article | Journal: The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease | Year: 2014

Israel receives migrants from various countries, some of which have high tuberculosis (TB) prevalence.To assess the predominant Mycobacterium tuberculosis strains in Israel isolated during 2008-2010 among Israeli-born and migrant patients, and to investigate possible transmission of TB from migrants to the local population.Molecular characterisation employed 43-spacer spoligotyping and 16-loci mycobacterial interspersed repetitive units-variable number of tandem repeats typing. All patients were classified according to those who were members of a cluster and those who were not.Among 684 M. tuberculosis strains isolated from new patients genotyped and assigned to their specific cohort populations during the study period, major spoligotype families were Central Asian (CAS) (n = 140, 20%), Beijing (n = 101, 15%) and T (n = 160, 23%). Most Beijing strains (66%) were isolated from patients from the former Soviet Union (FSU), while CAS strains were mainly (74%) from Ethiopia, Eritrea and Sudan (EES). For the heterogeneous T-clade, patient countries of origin were 38% EES and 33% FSU.Predominant M. tuberculosis genotypes in Israel in 2008-2010 were similar to genotypes endemic to the migrants countries of origin. Epidemiological investigations did not demonstrate transmission between migrants and Israeli-born patients sharing the same cluster.


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.


Freidlin P.J.,National Mycobacterium Reference Laboratory | Goldblatt D.,National Mycobacterium Reference Laboratory | Kaidar-Shwartz H.,National Mycobacterium Reference Laboratory | Dveyrin Z.,National Public Health Laboratory | Rorman E.,National Public Health Laboratory
Accreditation and Quality Assurance | Year: 2011

In the National Mycobacterium Reference Laboratory of the Israeli National Public Health Laboratory (hereafter referred to as "the laboratory"), three methods are employed for the molecular epidemiology of Mycobacterium tuberculosis: IS6110 restriction fragment length polymorphism typing (RFLP typing), 43 spacer oligonucleotide typing (spoligotyping), and 24 loci Mycobacterial Interspersed Repeating Unit-Variable Number of Tandem Repeats typing (MIRU-VNTR typing). In this article, we describe the main practical aspects concerning quality assurance of these methods that are based on standardized, internationally agreed upon conditions, including consensus reference strains and markers. All three methods were validated by classical epidemiology (confirmed transmission) and clinical information. The laboratory has introduced a new 5 colors, 4 primer sets multiplex modification of the optimal 24-miru typing system that includes an easily produced in-house internal standard for the high-throughput capillary electrophoresis system. Quantitative measurement of the internal standards yielded statistics for measurement uncertainty that include the frequency distribution, mean, standard deviation, 95% confidence interval and coefficient of variation. Use of the new internal standard developed in our laboratory allowed us to introduce the first quantitative evaluation of the system performance of the AB3130xl capillary electrophoresis genetic analyzer for MIRU-VNTR typing. The results are discussed in terms of expected accuracy and precision of MIRU-VNTR results, and possible implications for forensic microsatellite typing which may be much more sensitive to the observed intra- and inter-plate variation. © 2011 Springer-Verlag.


PubMed | Imperial College London, London North West Healthcare NHS Trusts and National Mycobacterium Reference Laboratory
Type: | Journal: Respiratory medicine | Year: 2016

Clinical, radiological and microbiological criteria inform diagnosis of pulmonary Non-Tuberculous Mycobacteria (NTM) disease and treatment decisions. This multicentre, review aims to characterise NTM disease meeting ATS/IDSA criteria and define factors associated with initiation of treatment.Sputum samples growing NTM from 5 London hospitals between 2010 and 2014 were identified. Data for HIV-negative individuals meeting ATS/IDSA guidelines for pulmonary NTM disease were extracted. Associations between clinical variables and treatment decision were investigated using Chi-squared, Fishers-exact or Mann Whitney tests. Factors associated with treatment in univariate analysis (p<0.150) were included in a multivariate logistic regression model.NTM were identified from 817 individuals sputum samples. 108 met ATS/IDSA criteria. 42/108 (39%) were initiated on treatment. Median age was 68 (56-78) in the cohort. On multivariate analysis, factors significantly associated with treatment of pulmonary NTM infection were: Cavitation on HRCT (OR: 6.49; 95% CI: 2.36-17.81), presenting with night sweats (OR 4.18; 95% CI: 1.08-16.13), and presenting with weight loss (OR 3.02; 95% CI: 1.15-7.93). Of those treated, 18(43%) have completed treatment, 9(21%) remain on treatment, 10(24%) stopped due to side effects, 5(12%) died during treatment. Mortality was 31% (n=13) in treated versus 21% (n=14) in the non-treated cohort. Subgroup analysis of individual NTM species did not observe any differences in treatment initiation or outcomes between groups.Decision to treat pulmonary NTM infection requires clinical judgement when interpreting clinical guidelines. Factors independently associated with decision to treat in this HIV-negative cohort include cavitation on HRCT and presenting with night sweats or weight loss.


Gonzalo X.,National Mycobacterium Reference Laboratory | Hutchison D.C.S.,National Mycobacterium Reference Laboratory | Drobniewski F.A.,National Mycobacterium Reference Laboratory | Pimkina E.,Vilnius University | Davidaviciene E.,Vilnius University
International Journal of Tuberculosis and Lung Disease | Year: 2014

Rates of resistance to first- and second-line drugs in multidrug-resistant tuberculosis (MDR-TB) cases in the United Kingdom were studied during 2010-2012. The highest rates for ethambutol, pyrazinamide and aminoglycosides occurred among patients originating in Eastern Europe, of whom 47% were Lithuanian. Rates of resistance to kanamycin were significantly lower (P < 0.0001) in the Lithuanian National TB Register than among Lithuanian patients resident in the United Kingdom (5% vs. 78%). In 2010, the majority of UK patients of Eastern European origin were located within the London region, whereas in 2011 the majority were located outside this region, a significant change (P = 0.01). © 2014 The Union.

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