blood neutrophil count, sputum mycobacterial load and

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  • ADDIS ABABA UNIVERSITY, COLLEGE OF HEALTH

    SCIENCE, SCHOOL OF GRADUATE STUDIES

    BLOOD NEUTROPHIL COUNT, SPUTUM MYCOBACTERIAL LOAD

    AND MYCOBACTERIAL LINEAGES IN HIV POSITIVE INDIVIDUALS

    SUSPECTED WITH PULMONARY TUBERCULOSIS, ADDIS ABABA,

    ETHIOPIA.

    BY: NEGERI DEBELA (BSc)

    DECEMBER, 2015

    ADDIS ABABA, ETHIOPIA

  • ii

    ADDIS ABABA UNIVERSITY, COLLEGE OF HEALTH SCIENCE,

    SCHOOL OF GRADUATE STUDIES

    Blood neutrophil count, sputum mycobacterial load and mycobacterial lineages

    in HIV positive individuals suspected with pulmonary tuberculosis,

    Addis Ababa, Ethiopia.

    By: Negeri Debela (BSc)

    Advisors:

    Tamrat Abebe (MSc, PhD, Assistant professor)

    Adane Mihret (DVM, PhD, Associate professor)

    Co-advisor:

    Gobena Ameni (DVM, PhD, Professor)

    A Thesis Submitted to the School of Graduate Studies of Addis Ababa University, College of

    Health Sciences, Department of Microbiology, Immunology and Parasitology in the partial

    fulfillment of the requirements for the Degree of Master of Science in Medical Microbiology.

    December, 2015

    Addis Ababa, Ethiopia

  • iii

    Acknowledgements

    I would like to express my deepest gratitude to my advisors Dr. Tamrat Abebe and Dr. Adane

    Mihret for their unreserved effort in advising me to conduct my research on this topic and

    providing me valuable information and as well as correction of the paper.

    My sincere appreciation is also extended to the School of Graduate Studies (SGS), Addis Ababa

    University (AAU) for their financial supports and Aklilu Lemma Institute of Pathology (ALIPB)

    for covering the cost of reagents, chemicals and for permitting me to use their laboratory and

    materials.

    My special thank is to Prof. Gobena Ameni for the study was not started if he would have not been

    allowed his lab and facility in the very beginning and for his unlimited follow up.

    The cooperation of Zewoditu hospital and Police hospital laboratory personnel are also greatly

    acknowledged for helping and facilitating in the collection of samples and in sharing their

    laboratory skill during complete blood count.

    The assistances obtained from Mr. Adane Worku and Mr. Haile, the laboratory staff of ALIPB,

    during processing of the sample was greatly valued, and really I appreciate them.

    I was not worthy to deserve this without participants willingness to participate in the study. I am

    very thankful and wish them consolation and the healing power of God.

    Finally, my diction is too poor to translate my appreciation to my brothers, Habtamu and Argeta

    and my staff Gebeyehu Tesema for their all rounded support and without whom I was not able to

    move footstep. I couldnt find ways I can pay them back but the least I can do is just to appreciate.

  • iv

    Table of contents

    Content Page

    Acknowledgements ........................................................................................................................... iii

    Table of contents ............................................................................................................................... iv

    Content .............................................................................................................................................. iv

    Lists of Tables ................................................................................................................................... vi

    List of Figures .................................................................................................................................. vii

    List of Abbreviations ...................................................................................................................... viii

    Abstract .............................................................................................................................................. x

    CHAPTER ONE ................................................................................................................................ 1

    1. INTRODUCTION ......................................................................................................................... 1

    1.1. Background .......................................................................................................................................... 1

    1.2. Statement of the problem ..................................................................................................................... 3

    1.3. Significance of the study ...................................................................................................................... 4

    1.4. Literature Review ................................................................................................................................. 5

    1.4.1. Mycobacterium Tuberculosis Complex (MTC) ............................................................................ 5

    1.4.2. Pathogenesis of tuberculosis ......................................................................................................... 6

    1.4.3. Clinical manifestation of tuberculosis ........................................................................................... 7

    1.4.4. Tuberculosis diagnosis .................................................................................................................. 7

    1.4.5. Treatment and prevention............................................................................................................ 11

    1.4.6. Immune response to TB .............................................................................................................. 12

    1.5. Objectives ........................................................................................................................................... 22

    1.5.1. General objectives ....................................................................................................................... 22

    1.5.2. Specific objectives ...................................................................................................................... 22

    CHAPTER TWO ............................................................................................................................. 23

    2. MATERIALS AND METHODS ................................................................................................ 23

    2.1 Study area ............................................................................................................................................ 23

    2.2. Study design and period ..................................................................................................................... 23

    2.3. Source and study populations ............................................................................................................. 23

    2.4. Sample size and sampling techniques ................................................................................................ 23

  • v

    2.4.1. Sample size.................................................................................................................................. 23

    2.4.2. Sampling technique ..................................................................................................................... 24

    2.5. Selection criteria................................................................................................................................. 24

    2.5.1. Inclusion criteria .......................................................................................................................... 24

    2.5.2. Exclusion criteria ........................................................................................................................ 24

    2.6. Data collection methods and laboratory diagnosis ............................................................................. 24

    2.6.1. Data collection methods ............................................................................................................ 24

    2.6.2. Laboratory diagnosis ................................................................................................................... 24

    2.7. Operational definitions ....................................................................................................................... 29

    2.8. Quality assurance ............................................................................................................................... 29

    2.9. Statistical analysis .............................................................................................................................. 30

    2.11. Dissemination of the result ............................................................................................................... 30

    CHAPTER THREE ......................................................................................................................... 31

    3. RESULTS ........................................................................................................................