Epidemiological profile of multidrug-resistant and extensively drug-resistant Mycobacterium Tubrculosis among Congolese patients

Background: There is paucity of data on the prevalence and distribution of multidrug- Resistant-Tuberculosis (MDR-TB) in the Republic of Congo. Among the challenges resides the implementation of a robust TB resistance diagnostic program using molecular tools. In resource limited settings there is a need to gather data to enable prioritization of actions. The objective of this study was is to implement molecular tools as a best of diagnosing MDR and XDR-TB among presumptive tuberculosis patients referred to reference hospital of Makelekele in Brazzaville, Republic of the Congo. Methods: We have conducted a cross-sectional study, including a total of 92 presumptive pulmonary tuberculosis patients and who had never received treatment recruited at the reference hospital of Makelekele from October 2018 to October 2019. The socio-demographic and clinical data were collected as well as sputum samples. Rifampicin resistance was investigated using Xpert (Cepheid) and second-line TB drugs Susceptibility testing were performed by the Brucker HAIN Line Probe Assay (GenoType MTBDRsl VER 2.0 assay) method. Results: From the 92 recruited patients, 57 (62%) were found positive for the Mycobacterium tuberculosis complex. The prevalence of rifampicin-resistant tuberculosis (RR-TB) was 9.8% (9/92) and importantly 2.2% were pre-XDR/XDR. Conclusion: This study showed a high rate of rifampicin resistance and the presence of extensively drug-resistant tuberculosis in the study area in new patients. This study highlights the need for further studies of TB drug resistance in the country

<i>Schistosoma haematobium</i> effects on <i>Plasmodium falciparum</i> infection modified by soil-transmitted helminths in school-age children living in rural areas of Gabon

<div><p>Background</p><p>Malaria burden remains high in the sub-Saharan region where helminths are prevalent and where children are often infected with both types of parasites. Although the effect of helminths on malaria infection is evident, the impact of these co-infections is not clearly elucidated yet and the scarce findings are conflicting. In this study, we investigated the effect of schistosomiasis, considering soil-transmitted helminths (STH), on prevalence and incidence of <i>Plasmodium falciparum</i> infection.</p><p>Methodology</p><p>This longitudinal survey was conducted in school-age children living in two rural communities in the vicinity of Lambaréné, Gabon. Thick blood smear light microscopy, urine filtration and the Kato-Katz technique were performed to detect malaria parasites, <i>S</i>. <i>haematobium</i> eggs and, STH eggs, respectively. <i>P</i>. <i>falciparum</i> carriage was assessed at inclusion, and incidence of malaria and time to the first malaria event were recorded in correlation with Schistosoma carriage status. Stratified multivariate analysis using generalized linear model was used to assess the risk of plasmodium infection considering interaction with STH, and survival analysis to assess time to malaria.</p><p>Main findings</p><p>The overall prevalence on subject enrolment was 30%, 23% and 9% for <i>S</i>. <i>haematobium</i>, <i>P</i>. <i>falciparum</i> infections and co-infection with both parasites, respectively. Our results showed that schistosomiasis in children tends to increase the risk of plasmodium infection but a combined effect with <i>Trichuris trichiura</i> or hookworm infection clearly increase the risk (aOR = 3.9 [_95%CI: 1.7–9.2]). The incidence of malaria over time was 0.51[_95%CI: 0.45–0.57] per person-year and was higher in the Schistosoma-infected group compared to the non-infected group (0.61 <i>vs</i> 0.43, <i>p</i> = 0.02), with a significant delay of time-to first-malaria event only in children aged from 6 to 10-years-old infected with <i>Schistosoma haematobium</i>.</p><p>Conclusions</p><p>Our results suggest that STH enhance the risk for <i>P</i>. <i>falciparum</i> infection in schistosomiasis-positive children, and when infected, that schistosomiasis enhances susceptibility to developing malaria in young children but not in older children.</p></div

Depicts estimates of time to malaria after 52 weeks of follow-up.

<p>Depicted in the vertical axis the proportion of children who did not experience malaria and in the horizontal axis, the follow-up time in months. In red, children in <i>S</i>. <i>haematobium</i> non-infected group and in blue children in <i>S</i>. <i>haematobium</i> infected group. 2A) Kaplan Meier curve for time-to-first malaria case for overall study population. 2B) Kaplan Meier curve for time-to-first malaria case for children aged from 6 to 10 years old. 2C) Kaplan Meier curve for time-to-first malaria case for children aged from 11 to 16 years old.</p

Distribution of <i>P</i>. <i>falciparum</i> and <i>S</i>. <i>haematobium</i> infections among the 739 participants seen at baseline.

<p>Distribution of <i>P</i>. <i>falciparum</i> and <i>S</i>. <i>haematobium</i> infections among the 739 participants seen at baseline.</p

Potential risk factors including <i>S</i>. <i>haematobium</i> infection associated with <i>P</i>. <i>falciparum</i> infection among the 739 participants seen at baseline.

<p>Potential risk factors including <i>S</i>. <i>haematobium</i> infection associated with <i>P</i>. <i>falciparum</i> infection among the 739 participants seen at baseline.</p

Malaria risk and malaria incidence among the 584 participants according to Schistosoma status and other risk factors.

<p>Malaria risk and malaria incidence among the 584 participants according to Schistosoma status and other risk factors.</p

Characteristics of study groups considered for longitudinal analysis regarding Schistosoma status (N = 586).

<p>Characteristics of study groups considered for longitudinal analysis regarding Schistosoma status (N = 586).</p

Performance of a rapid diagnostic test for the detection of Cryptosporidium spp. in African children admitted to hospital with diarrhea.

BackgroundCryptosporidium is a protozoan parasite that causes mild to severe diarrhoeal disease in humans. To date, several commercial companies have developed rapid immunoassays for the detection of Cryptosporidium infection. However, the challenge is to identify an accurate, simple and rapid diagnostic tool for the estimation of cryptosporidiosis burden. This study aims at evaluating the accuracy of CerTest Crypto, a commercialized rapid diagnostic test (RDT) for the detection of Cryptosporidium antigens in the stool of children presenting with diarrhoea.MethodsA cross-sectional study was conducted in four study sites in Sub-Saharan Africa (Gabon, Ghana, Madagascar, and Tanzania), from May 2017 to April 2018. Stool samples were collected from children under 5 years with diarrhoea or a history of diarrhoea within the last 24 hours. All specimens were processed and analyzed using CerTest Crypto RDT against a composite diagnostic panel involving two polymerase chain reaction (PCR) tests (qPCR and RFLP-PCR,) as the gold standard.ResultsA total of 596 stool samples were collected. Evaluation of the RDT yielded a very low overall sensitivity of 49.6% (confidence interval (CI) 40.1-59.0), a specificity of 92.5% (CI 89.8-94.7), positive predictive value of 61.3% (CI 50.6-71.2), and negative predictive value of 88.5% (85.3-91.1) when compared to the composite reference standard of qPCR and RFLP-PCR for the detection of Cryptosporidium species. Moreover, the performance of this test varied across different sites.ConclusionThe weak performance of the studied RDT suggests the need to carefully evaluate available commercial RDTs before their use as standard tools in clinical trials and community survey of Cryptosporidium infections in pediatric cohorts

Flow chart of the participants during the study course.

<p>The inclusion phase is shown as a solid line and the follow-up phase is shown as a broken line.</p