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Open Access Research article

TB incidence and characteristics in the remote gulf province of Papua New Guinea: a prospective study

Gail B Cross12, Katie Coles12, Mandana Nikpour34, Owen A Moore3, Justin Denholm5, Emma S McBryde5, Damon P Eisen5, Beverlyn Warigi2, Robyn Carter7, Sushil Pandey7, Paul Harino2, Peter Siba2, Christopher Coulter7, Ivo Mueller1268, Suparat Phuanukoonnon12* and Marc Pellegrini18*

Author Affiliations

1 Infection and Immunity Division, Walter and Eliza Hall Institute of Medical Research, 1G Royal Parade, Parkville, VIC 3052, Australia

2 Papua New Guinea Institute of Medical Research, Goroka, Eastern Highlands Province 441, Papua New Guinea

3 Department of Rheumatology, St Vincent’s Hospital Melbourne, Fitzroy, VIC 3065, Australia

4 Department of Medicine, St Vincent’s Hospital Melbourne, University of Melbourne, Fitzroy, VIC 3065, Australia

5 Victorian Infectious Diseases Service, Royal Melbourne Hospital, Parkville, VIC 3050, Australia

6 Barcelona Center for International Health Research, Barcelona, Spain

7 Queensland Mycobacterium Reference Laboratory, Pathology Queensland, Royal Brisbane and Women’s Hospital Herston, Herston, QLD 4029, Australia

8 Department of Medical Biology, University of Melbourne, Parkville, VIC 3010, Australia

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BMC Infectious Diseases 2014, 14:93  doi:10.1186/1471-2334-14-93

Published: 20 February 2014

Abstract

Background

The incidence and characteristics of tuberculosis (TB) in remote areas of Papua New Guinea (PNG) are largely unknown. The purpose of our study was to determine the incidence of TB in the Gulf Province of PNG and describe disease characteristics, co-morbidities and drug resistance profiles that could impact on disease outcomes and transmission.

Methods

Between March 2012 and June 2012, we prospectively collected data on 274 patients presenting to Kikori Hospital with a presumptive diagnosis of TB, and on hospital inpatients receiving TB treatment during the study period. Sputum was collected for microscopy, GeneXpert analysis, culture and genotyping of isolates.

Results

We estimate the incidence of TB in Kikori to be 1290 per 100,000 people (95% CI 1140 to 1460) in 2012. The proportion of TB patients co-infected with HIV was 1.9%. Three of 32 TB cases tested were rifampicin resistant. Typing of nine isolates demonstrated allelic diversity and most were related to Beijing strains.

Conclusions

The incidence of TB in Kikori is one of the highest in the world and it is not driven by HIV co-infection. The high incidence and the presence of rifampicin resistant warrant urgent attention to mitigate substantial morbidity in the region.

Keywords:
Papua New Guinea; Tuberculosis; Mycobacterium; Incidence; Drug resistance; MDR-TB; HIV; Kikori; GeneXpert