Point-of-Care Ultrasound for Tuberculosis Management in Sub-Saharan Africa-A Balanced SWOT Analysis.

Point-of-care ultrasound (POCUS) is an increasingly accessible skill, allowing for the decentralization of its use to non-specialist healthcare workers to guide routine clinical decision making. The advent of ultrasound-on-a-chip has transformed the technology into a portable mobile health device. Due to its high sensitivity to detect small consolidations, pleural effusions and sub pleural nodules, POCUS has recently been proposed as a sputum-free likely triage tool for tuberculosis (TB). To make an objective assessment of the potential and limitations of POCUS in routine TB management, we present a Strengths, Weaknesses, Opportunities & Threats (SWOT) analysis based on a review of the relevant literature and focusing on Sub-Saharan Africa (SSA). We idenitified numerous strengths and opportunities of POCUS for TB management e.g.; accessible, affordable, easy to use & maintain, expedited diagnosis, extra-pulmonary TB detection, safer pleural/pericardial puncture, use in children/pregnant women/PLHIV, targeted screening of TB contacts, monitoring TB sequelae, and creating AI decision support. Weaknesses and external threats such as operator dependency, lack of visualization of central lung pathology, poor specificity, lack of impact assessments and data from Sub-Saharan Africa must be taken into consideration to ensure that the potential of the technology can be fully realized in research as in practice

Tuberculosis screening among ambulatory people living with HIV: a systematic review and individual participant data meta-analysis.

BackgroundThe WHO-recommended tuberculosis screening and diagnostic algorithm in ambulatory people living with HIV is a four-symptom screen (known as the WHO-recommended four symptom screen [W4SS]) followed by a WHO-recommended molecular rapid diagnostic test (eg Xpert MTB/RIF [hereafter referred to as Xpert]) if W4SS is positive. To inform updated WHO guidelines, we aimed to assess the diagnostic accuracy of alternative screening tests and strategies for tuberculosis in this population.MethodsIn this systematic review and individual participant data meta-analysis, we updated a search of PubMed (MEDLINE), Embase, the Cochrane Library, and conference abstracts for publications from Jan 1, 2011, to March 12, 2018, done in a previous systematic review to include the period up to Aug 2, 2019. We screened the reference lists of identified pieces and contacted experts in the field. We included prospective cross-sectional, observational studies and randomised trials among adult and adolescent (age ≥10 years) ambulatory people living with HIV, irrespective of signs and symptoms of tuberculosis. We extracted study-level data using a standardised data extraction form, and we requested individual participant data from study authors. We aimed to compare the W4SS with alternative screening tests and strategies and the WHO-recommended algorithm (ie, W4SS followed by Xpert) with Xpert for all in terms of diagnostic accuracy (sensitivity and specificity), overall and in key subgroups (eg, by antiretroviral therapy [ART] status). The reference standard was culture. This study is registered with PROSPERO, CRD42020155895.FindingsWe identified 25 studies, and obtained data from 22 studies (including 15 666 participants; 4347 [27·7%] of 15 663 participants with data were on ART). W4SS sensitivity was 82% (95% CI 72-89) and specificity was 42% (29-57). C-reactive protein (≥10 mg/L) had similar sensitivity to (77% [61-88]), but higher specificity (74% [61-83]; n=3571) than, W4SS. Cough (lasting ≥2 weeks), haemoglobin (2), and lymphadenopathy had high specificities (80-90%) but low sensitivities (29-43%). The WHO-recommended algorithm had a sensitivity of 58% (50-66) and a specificity of 99% (98-100); Xpert for all had a sensitivity of 68% (57-76) and a specificity of 99% (98-99). In the one study that assessed both, the sensitivity of sputum Xpert Ultra was higher than sputum Xpert (73% [62-81] vs 57% [47-67]) and specificities were similar (98% [96-98] vs 99% [98-100]). Among outpatients on ART (4309 [99·1%] of 4347 people on ART), W4SS sensitivity was 53% (35-71) and specificity was 71% (51-85). In this population, a parallel strategy (two tests done at the same time) of W4SS with any chest x-ray abnormality had higher sensitivity (89% [70-97]) and lower specificity (33% [17-54]; n=2670) than W4SS alone; at a tuberculosis prevalence of 5%, this strategy would require 379 more rapid diagnostic tests per 1000 people living with HIV than W4SS but detect 18 more tuberculosis cases. Among outpatients not on ART (11 160 [71·8%] of 15 541 outpatients), W4SS sensitivity was 85% (76-91) and specificity was 37% (25-51). C-reactive protein (≥10 mg/L) alone had a similar sensitivity to (83% [79-86]), but higher specificity (67% [60-73]; n=3187) than, W4SS and a sequential strategy (both test positive) of W4SS then C-reactive protein (≥5 mg/L) had a similar sensitivity to (84% [75-90]), but higher specificity than (64% [57-71]; n=3187), W4SS alone; at 10% tuberculosis prevalence, these strategies would require 272 and 244 fewer rapid diagnostic tests per 1000 people living with HIV than W4SS but miss two and one more tuberculosis cases, respectively.InterpretationC-reactive protein reduces the need for further rapid diagnostic tests without compromising sensitivity and has been included in the updated WHO tuberculosis screening guidelines. However, C-reactive protein data were scarce for outpatients on ART, necessitating future research regarding the utility of C-reactive protein in this group. Chest x-ray can be useful in outpatients on ART when combined with W4SS. The WHO-recommended algorithm has suboptimal sensitivity; Xpert for all offers slight sensitivity gains and would have major resource implications.FundingWorld Health Organization

Pleuresies hemorragiques au chu sylvanus olympio de Lome : aspects etiologiques et evolutifs

Le but de cette étude était de déterminer les étiologies et de dresser le profil évolutif des pleurésies hémorragiques dans le service de pneumo-phtisiologie du CHU Sylvanus Olympio de Lomé.Matériel et méthode : Il s’agissait d’une étude rétrospective descriptive portant sur l’analyse des dossiers de patients hospitalisés dans le service pour pleurésie hémorragique de janvier 2000 à décembre 2009. Les étiologies néoplasiques ont  té confirmées par l’examen cytohistopathologique du liquide pleural et ou des fragments de biopsie pleurale. En l’absence de preuve d’autres étiologies, les pleurésies hémorragiques survenues chez des patients déjà porteurs d’un carcinome connu ont été considérées métastasiques. Le diagnostic de la tuberculose avait reposé sur des arguments bactériologiques et ou histologiques ou sur une évolution favorable sous traitement antituberculeux.Résultat : Soixante douze cas de pleurésies hémorragiques ont été inclus. Les étiologies étaient dominées par le cancer qui représentait 59,7%. Il s’agissait majoritairement des métastases (58,38%) dont la localisation primitive a été retrouvée dans 69% des cas. La tuberculose était en cause dans 15,3 % et la pancréatite chronique dans 2,8%. L’étiologie était indéterminée dans 22,2 % des cas. Le taux de décès était 30,5% et 58,7 % des patients avaient été perdus de vue après leur sortie de l’hôpital.Mots clés : Pleurésie hémorragique, étiologie, évolution

Caractérisation phénotypique des bacilles à gram négatif multirésistants isolés au Centre National Hospitalier et Universitaire Hubert Mécanismes de résistance

Objectif. Caractériser les bacilles à Gram négatif multirésistants isolés au Centre National Hospitalier et Universitaire Hubert Koutoukou Maga (CNHU-HKM) de CotonouMéthodes. De Mars à Juin 2013, toutes les souches de bacilles à Gram négatif résistantes à au moins une céphalosporine de 3ème génération (pour les Enterobacteriaceae), ou à la ceftazidime (s’il s’agit d’un Pseudomonas) et/ou à uncarbapénème pour toutes les espèces, ont été consécutivement incluses dans l’étude. Pour chaque souche, une large gamme d’antibiotiques a été testée par la méthode de diffusion de disques. Ensuite, les mécanismes de résistance aux  b-lactamines ont été recherchés.Résultats. Parmi les 245 souches de bacilles à Gram négatif isolés dans le laboratoire durant la période d’étude, 113 étaient multirésistantes, soit 46,1%. Escherichia coli et Klebsiella spp étaient les plus fréquentes parmi ces bactéries et représentaient respectivement 45,1% et 23,0%. Les antibiotiques les plus actifs sur ces souches étaient l’amikacine, l’imipénène, la colistine, la fosfomycine et l’ertapénème avec respectivement 92,0%, 92,0%, 87,6%, 81,4% et 80,5% de souches sensibles. Au total, 76,1% des souches de bacilles à Gram négatif multirésistants étaient productrices de  b- lactamase à spectre élargi et 15,0% de céphalosporinase hyperproduite. Aucune souche n’était productrice de carbapénémase.Conclusion. La prévalence des bactéries multirésistantes est élevée au CNHU-HKM de Cotonou. Des mesures urgentes sont nécessaires pour réduire l’ampleur du phénomène.Mots clés : Bactéries multirésistantes, bacilles à Gram négatif, mécanismes de résistance, CotonouEnglish AbstractObjective. To characterise multidrug-resistant strains of Gram-negative bacilli isolated from clinical samples in the National Teaching Hospital Hubert Koutoukou Maga (CNHU-HKM), CotonouMethods. From March to June 2013, all strains of Gram-negative bacilli resistant to at least a third generation cephalosporin for Enterobacteriaceae, or to ceftazidim (for Pseudomonas spp) and/or to carbapenem for all species, were consecutively included in the study. For each strain, susceptibility to a large panel of antibiotics by the disc diffusion method was performed. In addition, resistance mechanisms to  b-lactams were determined.Results. Among the 245 strains of Gram-negative bacilli isolated in the laboratory during the study period, 113 (46.1%) were multidrug-resistant. The most frequent multidrug-resistant bacteria were Escherichia coli (45.1%) and Klebsiella spp (23.0%) and the most active antibiotics were amikacin, imipenem, colistin, fosfomycin and ertapenem with 92.0%, 92.0%, 87.6%, 81.4% and 80.5% susceptibility rate respectively. In total, 76.1% of all multidrug-resistant strains of Gram-negative produced extended-spectrum b-lactamases, and 15.0% hyperproduced cephalosporinase. No strain produced carbapenemase.Conclusion. Prevalence of multidrug-resistant bacteria is high in CNHU-HKM, Cotonou. Urgent actions are needed to limit the development of this phenomenon.Key words: Multidrug-resistant bacteria, Gram-negative bacilli, resistance mechanism, Cotonou

Manifestations allergiques chez les enfants de 13-14 ans en milieu scolaire a lome

Introduction : Les manifestations allergiques constituent de nos jours un problème de santé publique. Les objectifs cette étude, phase 3 de l’étude ISAAC, étaient de déterminer la prévalence des manifestations allergiques (asthme, rhinite, eczéma et conjonctivite) chez les enfants de 13-14 ans.Méthode d’étude : Il s’agissait d’une étude transversale réalisée de novembre 2001 à janvier 2002 dans 23 collèges d’enseignement général de la ville de Lomé. Les enquêtés étaient des élèves de 13-14 ans, présents en classe le jour de l’enquête et qui avaient donné leur consentement pour y participer. Le questionnaire utilisé était la version française de celui proposé par le centre de coordination de l’étude.Résultats Un total de 3090 élèves, 56,7 % de garçons et 43,3 % de filles, avaient participé à l’étude. Les manifestations évocatrices de l’asthme et de rhino-conjonctivites étaient présentes respectivement chez 16,8 % et 14,6 % des élèves. Les symptômes évocateurs d’eczéma étaient retrouvés chez 10,7 % des enquêtés.Conclusion : Les manifestations allergiques sont des réalités non négligeables au TogoMots-clés : Allergie, prévalence, enfance

Low prevalence of diabetes mellitus in patients with tuberculosis in Cotonou, Benin.

SETTING: The three Basic Management Units (BMUs) of the National Tuberculosis Programme (NTP) in Cotonou, Benin. OBJECTIVE: To determine the prevalence of diabetes mellitus (DM) among tuberculosis (TB) patients in Cotonou. DESIGN: A cross-sectional study of consecutively registered TB patients treated for a minimum of 2 weeks between June and July 2014 in the three BMUs, with measurement of their fasting blood glucose (FBG). A patient was considered as having DM if venous FBG was ⩾7 mmol/l or if they reported a known history of DM. RESULT: There were 159 patients assessed: 114 with new smear-positive pulmonary tuberculosis (PTB), 5 with new smear-negative PTB, 8 with extra-pulmonary TB, 21 retreatment patients with fully susceptible bacilli and 11 with multidrug-resistant TB. Of these, respectively 31 (19%), 18 (11%) and 10 (6%) were human immunodeficiency virus co-infected, smokers and hypertensive. Eight patients (5%) had impaired fasting glucose and three (1.9%) had DM (FBG ⩾ 7 mmol/l), of whom two were already known to have the disease and one was newly diagnosed. CONCLUSION: DM may not be an important risk factor for TB in Cotonou. A larger study on TB and DM in the whole country is needed

Implementation of genomics research in Africa: challenges and recommendations

Background: There is exponential growth in the interest and implementation of genomics research in Africa. This growth has been facilitated by the Human Hereditary and Health in Africa (H3Africa) initiative, which aims to promote a contemporary research approach to the study of genomics and environmental determinants of common diseases in African populations. Objective: The purpose of this article is to describe important challenges affecting genomics research implementation in Africa. Methods: The observations, challenges and recommendations presented in this article were obtained through discussions by African scientists at teleconferences and face-to-face meetings, seminars at consortium conferences and in-depth individual discussions. Results: Challenges affecting genomics research implementation in Africa, which are related to limited resources include ill-equipped facilities, poor accessibility to research centers, lack of expertise and an enabling environment for research activities in local hospitals. Challenges related to the research study include delayed funding, extensive procedures and interventions requiring multiple visits, delays setting up research teams and insufficient staff training, language barriers and an underappreciation of cultural norms. While many African countries are struggling to initiate genomics projects, others have set up genomics research facilities that meet international standards. Conclusions: The lessons learned in implementing successful genomics projects in Africa are recommended as strategies to overcome these challenges. These recommendations may guide the development and application of new research programs in low-resource settings

Point-of-Care Ultrasound for Tuberculosis Management in Sub-Saharan Africa-A Balanced SWOT Analysis.

Point-of-care ultrasound (POCUS) is an increasingly accessible skill, allowing for the decentralization of its use to non-specialist healthcare workers to guide routine clinical decision making. The advent of ultrasound-on-a-chip has transformed the technology into a portable mobile health device. Due to its high sensitivity to detect small consolidations, pleural effusions and sub pleural nodules, POCUS has recently been proposed as a sputum-free likely triage tool for tuberculosis (TB). To make an objective assessment of the potential and limitations of POCUS in routine TB management, we present a Strengths, Weaknesses, Opportunities & Threats (SWOT) analysis based on a review of the relevant literature and focusing on Sub-Saharan Africa (SSA). We idenitified numerous strengths and opportunities of POCUS for TB management e.g.; accessible, affordable, easy to use & maintain, expedited diagnosis, extra-pulmonary TB detection, safer pleural/pericardial puncture, use in children/pregnant women/PLHIV, targeted screening of TB contacts, monitoring TB sequelae, and creating AI decision support. Weaknesses and external threats such as operator dependency, lack of visualization of central lung pathology, poor specificity, lack of impact assessments and data from Sub-Saharan Africa must be taken into consideration to ensure that the potential of the technology can be fully realized in research as in practice

Tuberculosis screening among ambulatory people living with HIV: a systematic review and individual participant data meta-analysis

BackgroundThe WHO-recommended tuberculosis screening and diagnostic algorithm in ambulatory people living with HIV is a four-symptom screen (known as the WHO-recommended four symptom screen [W4SS]) followed by a WHO-recommended molecular rapid diagnostic test (eg Xpert MTB/RIF [hereafter referred to as Xpert]) if W4SS is positive. To inform updated WHO guidelines, we aimed to assess the diagnostic accuracy of alternative screening tests and strategies for tuberculosis in this population.MethodsIn this systematic review and individual participant data meta-analysis, we updated a search of PubMed (MEDLINE), Embase, the Cochrane Library, and conference abstracts for publications from Jan 1, 2011, to March 12, 2018, done in a previous systematic review to include the period up to Aug 2, 2019. We screened the reference lists of identified pieces and contacted experts in the field. We included prospective cross-sectional, observational studies and randomised trials among adult and adolescent (age ≥10 years) ambulatory people living with HIV, irrespective of signs and symptoms of tuberculosis. We extracted study-level data using a standardised data extraction form, and we requested individual participant data from study authors. We aimed to compare the W4SS with alternative screening tests and strategies and the WHO-recommended algorithm (ie, W4SS followed by Xpert) with Xpert for all in terms of diagnostic accuracy (sensitivity and specificity), overall and in key subgroups (eg, by antiretroviral therapy [ART] status). The reference standard was culture. This study is registered with PROSPERO, CRD42020155895.FindingsWe identified 25 studies, and obtained data from 22 studies (including 15 666 participants; 4347 [27·7%] of 15 663 participants with data were on ART). W4SS sensitivity was 82% (95% CI 72-89) and specificity was 42% (29-57). C-reactive protein (≥10 mg/L) had similar sensitivity to (77% [61-88]), but higher specificity (74% [61-83]; n=3571) than, W4SS. Cough (lasting ≥2 weeks), haemoglobin (<10 g/dL), body-mass index (<18·5 kg/m2), and lymphadenopathy had high specificities (80-90%) but low sensitivities (29-43%). The WHO-recommended algorithm had a sensitivity of 58% (50-66) and a specificity of 99% (98-100); Xpert for all had a sensitivity of 68% (57-76) and a specificity of 99% (98-99). In the one study that assessed both, the sensitivity of sputum Xpert Ultra was higher than sputum Xpert (73% [62-81] vs 57% [47-67]) and specificities were similar (98% [96-98] vs 99% [98-100]). Among outpatients on ART (4309 [99·1%] of 4347 people on ART), W4SS sensitivity was 53% (35-71) and specificity was 71% (51-85). In this population, a parallel strategy (two tests done at the same time) of W4SS with any chest x-ray abnormality had higher sensitivity (89% [70-97]) and lower specificity (33% [17-54]; n=2670) than W4SS alone; at a tuberculosis prevalence of 5%, this strategy would require 379 more rapid diagnostic tests per 1000 people living with HIV than W4SS but detect 18 more tuberculosis cases. Among outpatients not on ART (11 160 [71·8%] of 15 541 outpatients), W4SS sensitivity was 85% (76-91) and specificity was 37% (25-51). C-reactive protein (≥10 mg/L) alone had a similar sensitivity to (83% [79-86]), but higher specificity (67% [60-73]; n=3187) than, W4SS and a sequential strategy (both test positive) of W4SS then C-reactive protein (≥5 mg/L) had a similar sensitivity to (84% [75-90]), but higher specificity than (64% [57-71]; n=3187), W4SS alone; at 10% tuberculosis prevalence, these strategies would require 272 and 244 fewer rapid diagnostic tests per 1000 people living with HIV than W4SS but miss two and one more tuberculosis cases, respectively.InterpretationC-reactive protein reduces the need for further rapid diagnostic tests without compromising sensitivity and has been included in the updated WHO tuberculosis screening guidelines. However, C-reactive protein data were scarce for outpatients on ART, necessitating future research regarding the utility of C-reactive protein in this group. Chest x-ray can be useful in outpatients on ART when combined with W4SS. The WHO-recommended algorithm has suboptimal sensitivity; Xpert for all offers slight sensitivity gains and would have major resource implications.FundingWorld Health Organization