Molecular Characterization of Mycobacterium tuberculosis Complex Isolates from Al-Medina Region, KSA

Introduction:

Tuberculosis is one of the most dangerous infectious diseases in the world and most common and may cause the killing of the person with it in most cases. Tuberculosis is a bacterium or a type of bacterium that affects the respiratory system, and mainly affects the human lungs. These bacteria can transfer from person to Another is through spray that spreads in the air some coughing or sneezing of the infected person, and although tuberculosis is a very dangerous and deadly disease, it can be prevented and cured, (Kumar V, Abbas AK, Fausto N, Mitchell RN, see it in 2020)

In the year 1985, this disease began to increase and spread in developing countries, and it was found that the main reason for this is due to the emergency situation caused by HIV (AIDS), this virus contributes to a decrease in the body's immunity, including the respiratory system, so the person is unable to resist Germs that cause tuberculosis. (Centers for Disease Control and Prevention, see it in 2020)

We find that after the widespread spread of tuberculosis in that period, it started to decrease in the United States as a result of strong control programs and that was in 1993, but tuberculosis remains a major threat to humanity to this day. (Longo DL, et al., eds, see it in 2020)

For the seriousness represented by tuberculosis, the world was quick to manufacture medicines to treat this disease, and among these drugs is what is known as the mycobacterium tuberculosis compound, which is a set of samples that have been successfully reproduced from both humans and animals, and which is known as the mycobacterium tuberculosis, which has Isolates from Al-Medina Region. And this title is the subject of this research.

 

Chapter one: Tuberculosis disease

What is Tuberculosis (TB)?

X-ray of a patient with tuberculosis - source: (Dylan Tierney, Edward A. Nardell, 2018)

Tuberculosis is one of the serious diseases that affect the respiratory system. The main cause of this disease is what is known as the “mycobacterium tuberculosis.” This bacterium affects the human respiratory system, specifically the lungs. It is classified as a common infectious disease, especially in developing countries. Tuberculosis can also affect different places in the body other than The lung, Tuberculosis relies on the air as a carrier surface, where we find it spread in the air when sneezing or coughing a person with it, and some sources mentioned that a third of the world has hidden tuberculosis, that means that these people became infected with TB but did not have the disease yet, so they could not transmit it. (Kumar V, Abbas AK, Fausto N, Mitchell RN, see it in 2020), (Longo DL, et al., eds, see it in 2020)

And we find that people who have been infected with TB germs are 10% more likely to be infected with tuberculosis. This percentage is for people who have a strong immune system. As for people who suffer from immune deficiency in the body, such as people with diabetes, malnutrition, or other diseases, they are considered more susceptible to infection Tuberculosis, and We find that when a person suffers from TB disease himself and not the bacterium, there are some obvious effects such as (coughing, fever, sweating at night … etc.) These symptoms can be mild in the first months, and this person with the disease can transmit the infection to between 10 - 15 persons a year through mixing. (What is TB? How is it treated?, 2016).

 We find that, according to the statistics, in the year 2000, the lives of about 49 million people were saved and 56 million were cured of TB through treatment and health care, as treatment for active TB is carried out through a full six-month cycle. During this period, the patient is given four antimicrobial drugs that are presented to the patient in the form of procedures with supervision by health care professionals, and we find that most cases of tuberculosis are cured if this course is presented correctly. (What is TB? How is it treated?, 2016)

The classic symptoms of tuberculosis include night sweats, coughing, weight loss and other noticeable symptoms. Tuberculosis can also infect and transmit infection to other body systems, which leads to other symptoms, Medical examinations of tuberculosis are performed by performing an X-ray of the patient's chest, as well as microscopic examinations and microbiological examination of body fluids. (Tuberculosis Fact sheet N°104, 2010)

According to statistics, in the year 2007, the number of chronic cases of tuberculosis was estimated at 13.7 million people around the world, while the number of infections was estimated at about 8.8 million new infections in 2010, in addition to a huge number of deaths related to tuberculosis, most of which were in developing countries Tuberculosis is also more prevalent in the country and developing countries than others. (Tuberculosis Fact sheet N°104, 2010)

where tests have been conducted that 80% of the population in African and Asian countries has had a positive tuberculosis test for them, When the result of this test reached about 10-15% of the population of the United States, and the reason behind the high incidence of tuberculosis cases in developing countries is a decrease in the immunity of the population in those countries, in addition to the large spread of HIV, which in turn contributes to tuberculosis infection. (Epidemiology, 2010), (Lawn, SD, see it in 2020)

The relationship between tuberculosis and HIV:

We find that since the 1980s, the number of people with tuberculosis has increased dramatically due to the spread of HIV, the virus that causes AIDS. HIV infection suppresses the immune system; This makes it difficult for the body to control TB bacteria. As a result, people with HIV are more likely to develop tuberculosis and progress from an underlying disease to more active than non-HIV-infected people. (Centers for Disease Control and Prevention, see it in 2020)

Drug-resistant TB:

One of the main reasons why tuberculosis is considered one of the most dangerous killer diseases is due to the drug-resistant bacteria, as we find that these strains of bacteria are increasing since the first use of antibiotics to treat tuberculosis and that was more than 60 years ago, so some types of these bacteria have developed themselves And became able to survive in the human body despite the presence of drugs, drug-resistant TB strains appear when antibiotics fail to kill the bacteria that cause TB, which makes the remainder of these bacteria able to resist specific drugs, and some bacteria themselves have evolved to resist the most common and effective drugs such as Isoniazid and rifampin.

And we find Others this bacterium has developed itself to resist weak or less effective drugs, such as antibiotics known as fluoroquinolones, in addition to Injectable medicationsdrugs, such as amikacin and capriomycin (Kapastat) and other drugs. (South-Paul JE, et al, 2011).

In this context, a person can see a doctor if you feel one of the main symptoms of tuberculosis, which is fever, unexplained weight loss, night sweats, or a persistent cough. Usually these are symptoms of tuberculosis, but they can also be the result of other pathological problems. Only a doctor can determine this.

The Symptoms of tuberculosis:

The main symptoms of tuberculosis - source: (Schiffman G, 2009)

In the most time we find the bacteria that cause tuberculosis may be present mainly in the human body, but the human immune system helps protect a person from the disease, and it is estimated that about 10 - 5% of people infected with bacteria that cause tuberculosis and who do not have immunity deficiency, it is possible Their disease becomes active during their lifetime, As for 30% of people with HIV, tuberculosis becomes active during their lifetime. Tuberculosis bacteria mainly attack the lungs and infect them (this is known as tuberculosis of the lungs), but they can also attack any part of the body (this is known as tuberculosis other than the lungs) This is if the TB bacteria develop outside the lungs. (eter G. Gibson ; section editors, Michael Abramson...; et al, 2005) (Dolin, [edited by] Gerald L. Mandell, John E. Bennett, Raphae, 2010)

Common symptoms and prominence of active TB disease include the following:

Severe coughing and persistence

Cough with blood coming out

Chest pain and respiratory system

Unintended weight loss

Tired

fever

Sweating at night

Chills

Anorexia

oTB disease rankings:

TB is identified and classified by doctors into two types:

A.Latent tuberculosis: In this pathology, a person is infected with tuberculosis, but the bacteria in his body remain inactive and cause no symptoms. Latent TB disease is also called inactive TB or TB infection, which is a non-infectious condition. This condition can turn into active TB. Therefore it is important for a person with latent TB to undergo treatment, and to help them control the spread of tuberculosis. There are approximately 2 billion people with latent TB, However, it can develop into active TB when a person's immunity is weak (Longo DL, et al., eds, see it in 2020)

B.Active tuberculosis: It is the affliction of the disease itself and this condition makes you feel sick, and it can be passed on to others in most cases. This condition may occur during the first few weeks of infection with TB bacteria, or it may occur years later. (Longo DL, et al., eds, see it in 2020)

Types of tuberculosis:

Depending on the injury, TB disease can be distinguished into two main types:

A.Lung tuberculosis:

Most of the time, when TB bacteria turn into an active state, they need the lungs (in about 90% of people) and the symptoms include chest pain along with a severe cough, and we find that there are about 25% of people who do not show any symptoms of TB, and sometimes The patient is accompanied by bloody cough, but in small quantities as a result of corrosion of the pulmonary artery, which leads to profuse bleeding, and we find that the upper lobes of the lung are more affected by TB bacteria than the lower lobes, but this difference has not been definitively explained. (Schiffman G, 2009), (Dolin, [edited by] Gerald L. Mandell, John E. Bennett, Raphae, 2010)

B.Other than Lung tuberculosis:

It was found that approximately 5-10% of active cases of tuberculosis occur in infection or bacteria that cause tuberculosis in other body organs or in other words, other body systems other than the respiratory system, and this is what causes the emergence of other types of tuberculosis. These cases are medically referred to as tuberculosis outside the Lung, These types are more prevalent among young people, and individuals who have undergone Immune suppression procedures, and this condition can occur as much as 50% in people with HIV, and the prominent sites of TB bacteria outside the lungs include the central nervous system (this is what results from it Tuberculosis, meningitis), lymphatic system (what results in tuberculosis in the neck), pleura, in addition to a urinary tract infection (what results in urogenital tuberculosis) in addition to other places in the human body.

Also, it was discovered that other types of tuberculosis are considered more dangerous than the other types, which is called "millet tuberculosis". This type constitutes about 10% of cases of tuberculosis outside the pulmonary. (Dolin, [edited by] Gerald L. Mandell, John E. Bennett, Raphae, 2010), ( Jindal, editor-in-chief SK, 2014)

Causes of infection with TB

Essentially, tuberculosis is caused by the bacteria that cause it, which are transmitted from one person to another through the air, through various activities such as sneezing, coughing, in addition to saliva and others, although tuberculosis is considered contagious to be difficult to catch from a stranger Here we will discuss the main causes that cause tuberculosis:

1.The Fungal bacteria (Mycobacteria):

Mycobacterium tuberculosis - Source: (Mycobacterium tuberculosis, see it in 2020)

The main cause of infection and infection with tuberculosis is fungal tuberculosis, which is a small non-biotic mobile bacillus, and the main reason why I found many unique clinical properties of this pathogen is because of the high fat content, These bacteria are divided in a period of time ranging between 16 to 20 hours and is considered a very slow rate compared to other types of bacteria, which we usually find divided in less than an hour, The fungal bacteria contain a double outer membrane consisting of fatty layers, if a gram color is used on them. As for these bacteria, mycobacterium tuberculosis remains "Gram-positive" but very weakly, or it does not retain the colored substance due to the high content of its cell wall. (Southwick F, 2007), ( Jindal, editor-in-chief SK, 2014), ( Niederweis M, Danilchanka O, Huff J, Hoffmann C, Engelhardt H, 2010)

By using tissue dyes on expectorant samples with sputum cough, scientists can identify tuberculous fungi under a normal (optical) microscope. This is because tuberculous fungi retain some coloring matter even after being treated with acidic solutions, they are classified as an acid-stabilizing bacillus (AFB). Acid The most common techniques for fixing acidic colourants are the Telsen-Nielsen colourant technique, which stains the bacilli-acidic AFBs with a bright red color that we find prominently visible in a blue background, a colorless orin-rodamine color followed by a fluorescence microscope. (Kumar V, Abbas AK, Fausto N, Mitchell RN, see it in 2020), (Madison B, 2001), (Medical Laboratory Science: Theory and Practice, 2000)

 

2.The Risk factors:

We find a number of factors that make people more susceptible to infection with TB. Among these factors is the risk factor, which is considered the most important globally, and that is HIV. According to statistics, it was found that 13% of all TB cases are infected with this virus and this is a special problem in sub-Saharan Africa, where HIV infection rates are high and TB is closely related to both overcrowding and malnutrition, which makes it one of the main diseases of poverty. (World Health Organization, 2011), (Chaisson, RE, 2008)

Chronic lung disease is another major risk factor with silicosis, which increases the risk rate by about 30 times. We find that in people who smoke cigarettes approximately twice the possibility of tuberculosis compared to non-smokers, other conditions can also increase the risk of tuberculosis, including addiction. Alcohol and diabetes (three times the possibility) Some medications, such as corticosteroids and infliximab (monoclonal antibody against alpha necrosis factor) have become increasingly important risk factors, especially in the developed world. There is also a genetic predisposition, whose degree of importance is still not yet determined. (Chaisson, RE, 2008), (ATS/CDC Statement Committee on Latent Tuberculosis Infection (200), see it in 2020)