Extensively Drug-Resistant Tuberculosis, Burkina Faso

Because data from countries in Africa are limited, we measured the proportion of extensively drug-resistant (XDR) tuberculosis (TB) cases among TB patients in Burkina Faso for whom retreatment was failing. Of 34 patients with multidrug-resistant TB, 2 had an XDR TB strain. Second-line TB drugs should be strictly controlled to prevent further XDR TB increase

Diagnostic moléculaire du complexe Mycobacterium tuberculosis résistant à l’isoniazide et à la rifampicine au Burkina Faso

Introduction: cette étude a eu pour objectifs de diagnostiquer la tuberculose pulmonaire par l'examen microscopique et par la PCR des crachats et de déterminer les bases moléculaires de la résistance à la rifampicine et à l'isoniazide. Méthodes: le diagnostic du Complexe Mycobacterium Tuberculosis (CMTB) a été effectué par microscopie après coloration au Ziehl Nielsen et par PCR en temps réel en utilisant le kit d'identification du complexe MTB (Sacace Biotechnologie, Italie). Les résistances à la Rifampicine et à l'Isoniazide ont été étudiées par la technique de la PCR en utilisant le kit MTB résistance 8 (Sacace, Biotechnologie). Résultats: sur les 59 patients diagnostiqués pour la tuberculose pulmonaire, 59,3% étaient positifs en microscopie optique et 44,1% étaient positifs par PCR en Temps réel. Les résistances à la rifampicine (rpoB) et à l'isoniazide (katG et inhA) ont été observées chez 9 patients. La résistance à la rifampicine était due aux mutations (Asp516Val, Ser531Trp, Leu533Pro) et celle à l'isoniazide par les substitutions Ser315Thr du gène katG et C209T du gène inhA. Les multi résistances à la rifampicine et à l'isoniazide ont été observées dans 55,5% des échantillons et concernaient les associations : ropBAsp513Val + inhAC209T et rpoBLeu533Pro + katGSer315Thr. Conclusion: la PCR en temps réel qui permet l'identification des allèles mutants rpoB, katG et inhA de M. tuberculosis est un outil de diagnostic épidémiologique de grande importance car elle permet de déterminer le niveau de résistance à la rifampicine et à l'isoniazide.Keywords: Mycobacterium tuberculosis, résistance, rifampicine, isoniazid

Molecular detection of rifampin and isoniazid resistance to guide chronic TB patient management in Burkina Faso

<p>Abstract</p> <p>Background</p> <p>Drug-resistant tuberculosis (DR-TB) is considered a real threat to the achievement of TB control. Testing of mycobacterial culture and testing of drug susceptibility (DST) capacity are limited in resource-poor countries, therefore inadequate treatment may occur, favouring resistance development. We evaluated the molecular assay GenoType^®MTBDR<it>plus </it>(Hain Lifescience, Germany) in order to detect DR-TB directly in clinical specimens as a means of providing a more accurate management of chronic TB patients in Burkina Faso, a country with a high TB-HIV co-infection prevalence.</p> <p>Methods</p> <p>Samples were collected in Burkina Faso where culture and DST are not currently available, and where chronic cases are therefore classified and treated based on clinical evaluation and sputum-smear microscopy results. One hundred and eight chronic TB patients (sputum smear-positive, after completing a re-treatment regimen for pulmonary TB under directly observed therapy) were enrolled in the study from December 2006 to October 2008. Two early morning sputum samples were collected from each patient, immediately frozen, and shipped to Italy in dry ice. Samples were decontaminated, processed for smear microscopy and DNA extraction. Culture was attempted on MGIT960 (Becton Dickinson, Cockeysville, USA) and decontaminated specimens were analyzed for the presence of mutations conferring resistance to rifampin and isoniazid by the molecular assay GenoType^®MTBDR<it>plus</it>.</p> <p>Results</p> <p>We obtained a valid molecular test result in 60/61 smear-positive and 47/47 smear-negative patients.</p> <p>Among 108 chronic TB cases we identified patients who (i) harboured rifampin- and isoniazid-susceptible strains (n 24), (ii) were negative for MTB complex DNA (n 24), and (iii) had non-tuberculous mycobacteria infections (n 13). The most represented mutation conferring rifampin-resistance was the D516V substitution in the hotspot region of the <it>rpoB </it>gene (43.8% of cases). Other mutations recognized were the H526D (15.6%), the H526Y (15.6%), and the S531L (9.4%).</p> <p>All isoniazid-resistant cases (n 36) identified by the molecular assay were carrying a S315T substitution in the <it>katG </it>gene. In 41.7% of cases, a mutation affecting the promoter region of the <it>inhA </it>gene was also detected.</p> <p>Conclusion</p> <p>The GenoType^®MTBDR<it>plus </it>assay performed directly on sputum specimens improves the management of chronic TB cases allowing more appropriate anti-TB regimens.</p

Effect of Incidence Angle Varying from 0 rad to π/2 rad and Intensity of Radio Waves on the Performance of a Silicon Solar Cell

In this work, a one dimensional approach is presented for modelling the effect of the incidence angle, varying from 0 rad to π/2 rad, and the intensity of radio waves on the performance of a polycrystalline silicon solar cell under constant multispectral illumination. By solving the continuity equation in steady state, we derived the expression of the density of excess minority carriers, the photocurrent density, the photovoltage, the electric power and their dependence on the incidence angle and the intensity of the electromagnetic field is analyzed. Using the electric power curves versus junction dynamic velocity we determined the electric power lost at the junction, the maximum electric power and we calculated the conversion efficiency for various incidence angle and intensity of the electromagnetic field. The leakage photocurrent density, deduced from the photocurrent density curves versus junction dynamic velocity, and the electric power lost at the junction allowed us to calculate the shunt resistance of the solar cell according to the incidence angle and the intensity of the electromagnetic field. The numerical data show the negative effect of radios waves on the performance of a silicon solar cell

Prise en charge de la COVID-19 à domicile à Ouagadougou au Burkina Faso au début de la pandémie (Résultats préliminaires)

Introduction : Face au nombre croissant de cas de refus d’hospitalisation d’une part et à la faiblesse des capacités d’hospitalisation d’autre part, le Burkina Faso a opté pour un programme de suivi des patients à domicile que nous étudions.Méthodologie : Il s’est agi d’une étude transversale descriptive du 16 avril au 20 mai 2020, à Ouagadougou des patients COVID-19 confirmés par PCR et pris en charge à domicile.Résultats : Au total 222 patients avec une COVID-19 ont été recensés dont 30 patients (13,5%) pris en charge à domicile. Le nombre moyen de suivi était de 3,45 visites, l’âge moyen était de 36,1 ± 16,7 ans et les enfants ainsi que les sujets de plus de 60 ans représentaient chacun 10% des cas. Parmi les patients, 60% étaient des célibataires et 22% avaient une comorbidité dont les plus fréquentes étaient le diabète (13,2%) et l’hypertension artérielle (6,7%). Les principaux symptômes étaient la toux (30,0%), l’asthénie physique (26,7%) et les céphalées (16,7%). Au cours du suivi, 33% des patients n’ont pas respecté le confinement à domicile : certains étaient absents et d’autres à leurs occupations sans port de masque ; Dans 10% des cas, les patients ont été hospitalisés et un décès a été constaté.Conclusion : Cette nouvelle pratique de prise en charge, si elle respecte certains critères d’éligibilité permettra de désengorger les structures sanitaires et offrirait plus de confort et de sérénité aux patients. &nbsp; English title: Home Care of COVID-19 in Burkina Faso at the Start of the pandemic (Preliminary Results)Background : Faced with the growing number of cases of refusal of hospitalization on the one hand and the weakness of hospitalization capacity on the other hand, Burkina Faso has opted for a home patient monitoring program, which we study.Methodology : This was a descriptive cross-sectional study carried out on COVID-19 patients confirmed by polymerase chain reaction and cared for at home from April 16 to May 20, 2020, in the city of Ouagadougou. Results : A total of 223 patients were identified in Ouagadougou, including 30 patients (13.5%) who were cared for at home. The mean number of follow-ups was 3.45 visits, average age was 36.1±16.7 years, children and people over 60 years in 10.0% of each. Of the patients, 60.0% were single and 22.0% had a comorbidity; the most common of which were diabetes (13.2%) and hypertension (6.7%). The main symptoms were cough (30.0%), physical asthenia (26.7%), and headache (16.7%). During follow-up, 33.0% did not adhere to containment at home: some of them were absents or doing theirs work without masque. Ten percent of patients takecare at home were hospitalized, and one death was recorded.Conclusion : If this new practice of home care meets certain eligibility criteria, it will relieve congestion at healthcare facilities and offer more comfort and serenity to patients

Long-term Quality of Life in Adult Patients Surviving Purpura Fulminans: An Exposed-Unexposed Multicenter Cohort Study

International audienceAbstract Background Long-term health-related quality of life (HR-QOL) of patients surviving the acute phase of purpura fulminans (PF) has not been evaluated. Methods This was a French multicenter exposed-unexposed cohort study enrolling patients admitted in 55 intensive care units (ICUs) for PF from 2010 to 2016. Adult patients surviving the acute phase of PF (exposed group) were matched 1:1 for age, sex, and Simplified Acute Physiology Score II with septic shock survivors (unexposed group). HR-QOL was assessed during a phone interview using the 36-Item Short-Form Health Survey (SF-36) questionnaire, the Hospital Anxiety and Depression (HAD) scale, the Impact of Event Scale–Revised (IES-R), and the activity of daily living (ADL) and instrumental ADL (IADL) scales. The primary outcome measure was the physical component summary (PCS) of the SF-36 questionnaire. Results Thirty-seven survivors of PF and 37 of septic shock were phone-interviewed at 55 (interquartile range [IQR], 35–83) months and 44 (IQR, 35–72) months, respectively, of ICU discharge (P = .23). The PCS of the SF-36 was not significantly different between exposed and unexposed patients (median, 47 [IQR, 36–53] vs 54 [IQR, 36–57]; P = .18). There was also no significant difference between groups regarding the mental component summary of the SF-36, and the HAD, IES-R, ADL and IADL scales. Among the 37 exposed patients, those who required limb amputation (n = 12/37 [32%]) exhibited lower PCS (34 [IQR, 24–38] vs 52 [IQR, 42–56]; P = .001) and IADL scores (7 [IQR, 4–8] vs 8 [IQR, 7–8]; P = .021) compared with nonamputated patients. Conclusions Long-term HR-QOL does not differ between patients surviving PF and those surviving septic shock unrelated to PF. Amputated patients have an impaired physical HR-QOL but a preserved mental health. Clinical Trials Registration NCT03216577

Long-term quality of life in adult patients surviving purpura fulminans: an exposed-unexposed multicenter cohort study

International audienceBACKGROUND : Long-term health-related quality of life (HR-QOL) of patients surviving the acute phase of purpura fulminans (PF) has not been evaluated.METHODS : This was a French multicenter exposed-unexposed cohort study enrolling patients admitted in 55 intensive care units (ICUs) for PF from 2010 to 2016. Adult patients surviving the acute phase of PF (exposed group) were matched 1:1 for age, sex, and Simplified Acute Physiology Score II with septic shock survivors (unexposed group). HR-QOL was assessed during a phone interview using the 36-Item Short-Form Health Survey (SF-36) questionnaire, the Hospital Anxiety and Depression (HAD) scale, the Impact of Event Scale-Revised (IES-R), and the activity of daily living (ADL) and instrumental ADL (IADL) scales. The primary outcome measure was the physical component summary (PCS) of the SF-36 questionnaire.RESULTS : Thirty-seven survivors of PF and 37 of septic shock were phone-interviewed at 55 (interquartile range [IQR], 35-83) months and 44 (IQR, 35-72) months, respectively, of ICU discharge (P = .23). The PCS of the SF-36 was not significantly different between exposed and unexposed patients (median, 47 [IQR, 36-53] vs 54 [IQR, 36-57]; P = .18). There was also no significant difference between groups regarding the mental component summary of the SF-36, and the HAD, IES-R, ADL and IADL scales. Among the 37 exposed patients, those who required limb amputation (n = 12/37 [32%]) exhibited lower PCS (34 [IQR, 24-38] vs 52 [IQR, 42-56]; P = .001) and IADL scores (7 [IQR, 4-8] vs 8 [IQR, 7-8]; P = .021) compared with nonamputated patients.CONCLUSIONS : Long-term HR-QOL does not differ between patients surviving PF and those surviving septic shock unrelated to PF. Amputated patients have an impaired physical HR-QOL but a preserved mental healt

Characteristics of HIV-2 and HIV-1/HIV-2 Dually Seropositive Adults in West Africa Presenting for Care and Antiretroviral Therapy: The IeDEA-West Africa HIV-2 Cohort Study.

HIV-2 is endemic in West Africa. There is a lack of evidence-based guidelines on the diagnosis, management and antiretroviral therapy (ART) for HIV-2 or HIV-1/HIV-2 dual infections. Because of these issues, we designed a West African collaborative cohort for HIV-2 infection within the framework of the International epidemiological Databases to Evaluate AIDS (IeDEA).We collected data on all HIV-2 and HIV-1/HIV-2 dually seropositive patients (both ARV-naive and starting ART) and followed-up in clinical centres in the IeDEA-WA network including a total of 13 clinics in five countries: Benin, Burkina-Faso Côte d'Ivoire, Mali, and Senegal, in the West Africa region.Data was merged for 1,754 patients (56% female), including 1,021 HIV-2 infected patients (551 on ART) and 733 dually seropositive for both HIV-1 and HIV 2 (463 on ART). At ART initiation, the median age of HIV-2 patients was 45.3 years, IQR: (38.3-51.7) and 42.4 years, IQR (37.0-47.3) for dually seropositive patients (p = 0.048). Overall, 16.7% of HIV-2 patients on ART had an advanced clinical stage (WHO IV or CDC-C). The median CD4 count at the ART initiation is 166 cells/mm(3), IQR (83-247) among HIV-2 infected patients and 146 cells/mm(3), IQR (55-249) among dually seropositive patients. Overall, in ART-treated patients, the CD4 count increased 126 cells/mm(3) after 24 months on ART for HIV-2 patients and 169 cells/mm(3) for dually seropositive patients. Of 551 HIV-2 patients on ART, 5.8% died and 10.2% were lost to follow-up during the median time on ART of 2.4 years, IQR (0.7-4.3).This large multi-country study of HIV-2 and HIV-1/HIV-2 dual infection in West Africa suggests that routine clinical care is less than optimal and that management and treatment of HIV-2 could be further informed by ongoing studies and randomized clinical trials in this population