Aspects diagnostiques et cliniques de la tuberculose infantile : à propos de 94 cas colligés en milieu hospitalier à Abidjan, Côte d’Ivoire, de 2015 à 2017 Raoul

La tuberculose infantile (TBI) reste largement sous notifiée. La principale raison de la sous-notification est la difficulté diagnostique. Le diagnostic précoce et la prise en charge de la TBI demeurent donc un défi constant à relever. Il s’est agi d’une étude rétrospective portant sur les données issues des dossiers de 94 enfants de 0 à 14 ans diagnostiqués pour une tuberculose du 1er janvier 2015 au 31 décembre 2017 dans deux centres hospitaliers et universitaires d’Abidjan. Ainsi, la tranche d’âge de 0 à 4 ans était la plus représentée. La localisation pulmonaire était prédominante (71 %). Seulement 32 % des enfants ont été diagnostiqués bactériologiquement en ayant recours à la microscopie (87%) et au tubage gastrique (50 %). Le gène Xpert n’a été utilisé que 11 fois et a décelé 2 cas de résistance. La radiographie pulmonaire a été réalisée chez 87 enfants avec 91% d’anomalies observées. La co-infection TB/VIH était de 24 %. A l’issue de la prise en charge, 71 % ont été adressés dans un centre spécialisé pour la poursuite de leur traitement, 16 % sont décédés et 8,5 % étaient perdus de vue. Le diagnostic de la TBI demeure donc complexe. La vulgarisation des techniques moléculaires peut en améliorer le diagnostic.Mots-clés: Tuberculose, enfant, diagnostic, AfriqueEnglish Title: Diagnostic and clinical aspects of childhood tuberculosis: about 94 cases collected in hospitals in Abidjan, Côte d'Ivoire, from 2015 to 2017English AbstractBackground Childhood TB (CTB) remains massively underreported. The main reason for underreporting is the difficulties with diagnosis. Early diagnosis and management of CTB thus remain a constant challenge to overcome. This was a retrospective chart review study of 94 children aged 0 to 14 diagnosed with Tuberculosis, conducted from 1st January 2015 to 31st December 2017 in 2 university hospitals. For the 94 records collected, the age group from 0 to 4 years was the most represented. The pulmonary localisation was predominant (71%). Only 32% of children were bacteriologically confirmed using microscopy (87%) and gastric aspiration (50%). The GeneXpert was used only 11 times and detected 2 resistance cases. Chest X-ray was performed in 87 children with 91% anomalies observed. The TB/HIV coinfection rate was 24%. At the completion of the treatment and care, 71% were referred to a specialized clinic for the continuation of their treatment and care, 16% died and 8.5% were lost to follow-up. Diagnosis of CTB remains challenging. The popularization of molecular techniques may improve its diagnosis.Keywords: Tuberculosis, child, diagnosis, Afric

Genetically Different Highly Pathogenic Avian Influenza A(H5N1) Viruses in West Africa, 2015

To trace the evolution of highly pathogenic influenza A(H5N1) virus in West Africa, we sequenced genomes of 43 viruses collected during 2015 from poultry and wild birds in 5 countries. We found 2 co-circulating genetic groups within clade 2.3.2.1c. Mutations that may increase adaptation to mammals raise concern over possible risk for humans

Genetically Different Highly Pathogenic Avian Influenza A(H5N1) Viruses in West Africa, 2015

To trace the evolution of highly pathogenic influenza A(H5N1) virus in West Africa, we sequenced genomes of 43 viruses collected during 2015 from poultry and wild birds in 5 countries. We found 2 co-circulating genetic groups within clade 2.3.2.1c. Mutations that may increase adaptation to mammals raise concern over possible risk for humans.status: publishe

Lancet Infect Dis

BACKGROUND: Tuberculosis diagnosis might be delayed or missed in children with severe pneumonia because this diagnosis is usually only considered in cases of prolonged symptoms or antibiotic failure. Systematic tuberculosis detection at hospital admission could increase case detection and reduce mortality. METHODS: We did a stepped-wedge cluster-randomised trial in 16 hospitals from six countries (Cambodia, Cameroon, Côte d'Ivoire, Mozambique, Uganda, and Zambia) with high incidence of tuberculosis. Children younger than 5 years with WHO-defined severe pneumonia received either the standard of care (control group) or standard of care plus Xpert MTB/RIF Ultra (Xpert Ultra; Cepheid, Sunnyvale, CA, USA) on nasopharyngeal aspirate and stool samples (intervention group). Clusters (hospitals) were progressively switched from control to intervention at 5-week intervals, using a computer-generated random sequence, stratified on incidence rate of tuberculosis at country level, and masked to teams until 5 weeks before switch. We assessed the effect of the intervention on primary (12-week all-cause mortality) and secondary (including tuberculosis diagnosis) outcomes, using generalised linear mixed models. The primary analysis was by intention to treat. We described outcomes in children with severe acute malnutrition in a post hoc analysis. This study is registered with ClinicalTrials.gov (NCT03831906) and the Pan African Clinical Trial Registry (PACTR202101615120643). FINDINGS: From March 21, 2019, to March 30, 2021, we enrolled 1401 children in the control group and 1169 children in the intervention group. In the intervention group, 1140 (97·5%) children had nasopharyngeal aspirates and 942 (80·6%) had their stool collected; 24 (2·1%) had positive Xpert Ultra. At 12 weeks, 110 (7·9%) children in the control group and 91 (7·8%) children in the intervention group had died (adjusted odds ratio [OR] 0·986, 95% CI 0·597-1·630, p=0·957), and 74 (5·3%) children in the control group and 88 (7·5%) children in the intervention group had tuberculosis diagnosed (adjusted OR 1·238, 95% CI 0·696-2·202, p=0·467). In children with severe acute malnutrition, 57 (23·8%) of 240 children in the control group and 53 (17·8%) of 297 children in the intervention group died, and 36 (15·0%) of 240 children in the control group and 56 (18·9%) of 297 children in the intervention group were diagnosed with tuberculosis. The main adverse events associated with nasopharyngeal aspirates were samples with blood in 312 (27·3%) of 1147 children with nasopharyngeal aspirates attempted, dyspnoea or SpO(2) less than 95% in 134 (11·4%) of children, and transient respiratory distress or SpO(2) less than 90% in 59 (5·2%) children. There was no serious adverse event related to nasopharyngeal aspirates reported during the trial. INTERPRETATION: Systematic molecular tuberculosis detection at hospital admission did not reduce mortality in children with severe pneumonia. High treatment and microbiological confirmation rates support more systematic use of Xpert Ultra in this group, notably in children with severe acute malnutrition. FUNDING: Unitaid and L'Initiative. TRANSLATION: For the French translation of the abstract see Supplementary Materials section