[Evaluation of the acid-fast bacilli gradations before and after treatment of the expectorations by sodium hypochlorite [corrected] in the tuberculosis diagnosis]. / Evaluation de la densité bacillaire avant et après traitement des expectorations par l'hypochlorite de sodium dans le diagnostic de la tuberculose.

To assess the impact of the sputum samples treatment by sodium hypochloride (NaOCl) 5% on the acid-fast bacilli (AFB) gradations in the tuberculosis diagnosis, 516 sputum samples were collected in 244 patients. The sputum smears made before and after expectorations treatment with NaOCl 5%, were stained by Ziehl-Neelsen hot method. The values obtained from the two microscopic readings were compared by using the chi2 test of McNemar. The statistical significance was set at p < 0.05. The results obtained before using NaOCl 5% showed that 357 samples were negative, while 41 were AFB scanty (gradation 1-9), 28, 40 and 50 were positive 1+, 2+ and 3+. After treatment, among 357 AFB negative expectorations, 14 (3.9%) were AFB-positive, while the AFB gradation increased for 77 (48.4%) in the 159 positive specimens. The two microscopic readings differ significantly (p = 0.001). The application of the process on a routine basis in the laboratory will require a reorganization of the tasks in order to give back the results to the patients in time. It is necessary to take into account the aspect of the samples.

Drug resistance of Mycobacterium tuberculosis complex among newly diagnosed tuberculosis cases in Burkina Faso.

BACKGROUND: In Burkina Faso, there is no recent data about the level of drug resistance in Mycobacterium tuberculosis strains among newly diagnosed tuberculosis cases. OBJECTIVE: To provide an update of the primary drug resistance of mycobacterium tuberculosis among patients in Burkina faso. METHODS: Mycobacterium strains were identified in 323 newly diagnosed tuberculosis patients between April 2005 and September 2006, and their susceptibility to isoniazid, rifampicin, streptomycin, and ethambutol was determined according to the proportions method. Among these patients, 243 accepted voluntarily to be tested for antibodies to HIV. RESULTS: The age range of the patients was 11 and 75 years and included 221 (68.4%) males and 102 (21.6%) females. The isolates included 314 (97.2%) M. tuberculosis, eight (0.3%) M. africanum and one M. bovis. Thirty-nine (12.4%) of the M. tuberculosis strains were resistant, with 7.3% resistant to one drug, 2.9% to two drugs, 0.3% to three drugs and 1.9% to four drugs. In total 3.2% of the isolates were multidrug-resistant (MDR). One isolate of M. africanum was resistant to all drugs while the single strain of M. bovis was sensitive to all the drugs. Among the 243 patients tested for HIV 77 were positive. However, there was no relationship between drug resistance and gender, age group or HIV serostatus of the patients. CONCLUSION: The resistance rate of M. tuberculosis strains to all the four drugs tested (12.4%) and the rate of MDR (3.2%) are high. These results demand an increased effort by the National Tuberculosis Program to limit the spread of MDR strains of tuberculosis.

The impact of Xpert® MTB/RIF depends on service coordination: experience in Burkina Faso.

Translating the potential of Xpert(®) MTB/RIF into more effective tuberculosis (TB) care and control in low-income settings is challenged by operational issues. We report the experience in introducing this technology in Burkina Faso through a centralised approach. Xpert was successfully integrated into the diagnostic algorithm of multidrug-resistant TB cases. However, barriers to Xpert use for the diagnosis of TB in vulnerable populations, such as persons living with human immunodeficiency virus infection and children, were observed, mainly due to lack of coordination between services. Lessons learnt can be exploited to optimise the roll-out of this technology at country level.

[Comparison of Kinyoun, auramine O, and Ziehl-Neelsen staining for diagnosing tuberculosis at the National Tuberculosis Center in Burkina Faso]. / Comparaison des performances des colorations de Kinyoun et à l'auramine O, avec celle de Ziehl-Neelsen pour le diagnostic de la tuberculose au Centre national de lutte antituberculeuse du Burkina Faso.

CONTEXT: This study was conducted at the National Tuberculosis Center in Burkina Faso from October 2007 through May 2008. OBJECTIVE: Our objective was to compare the diagnostic performance of three staining methods: Kinyoun, auramine O, and Ziehl-Neelsen. METHODS: Ziehl-Neelsen staining served as the reference method to assess the diagnostic performance of Kinyoun and auramine O staining. In all, 616 sputum smears from 233 patients were read with each method to detect acid-fast bacilli. SPSS was used for data analysis. RESULTS: The results of auramine O staining showed positive diagnoses in 15.9% of the samples; sensitivity was 100%, specificity 95.6%, and the positive and negative predictive values 75.7% and 100% respectively. Kinyoun staining produced a positive diagnosis rate of 12%, sensitivity of 96.4%, specificity of 99.5%, and positive and negative predictive values of 96.4% and 99.5%. CONCLUSION: Our study indicates that auramine O staining had a better sensitivity for detecting acid-fast bacilli than Kinyoun staining. Accordingly, the use of auramine O staining should increase the detection rate for pulmonary tuberculosis in Burkina Faso.

Anti-tuberculosis drug resistance in new and previously treated pulmonary tuberculosis cases in Burkina Faso.

SETTING: National Tuberculosis (TB) Control Centre in Ouagadougou, Burkina Faso. OBJECTIVE: To evaluate Mycobacterium tuberculosis drug resistance among newly diagnosed and previously treated cases. METHODS: A total of 416 M. tuberculosis complex strains were isolated from 323 new and 93 previously treated patients under DOTS. Susceptibility to four anti-tuberculosis drugs (isoniazid [INH], rifampicin [RMP], streptomycin [SM] and ethambutol [EMB]) was determined using the proportion method. Human immunodeficiency virus (HIV) status was determined in 316 patients, 249 new and 67 previously treated cases, with informed consent. RESULTS: Among new cases, 12.4% of strains were resistant to any drug, and 3.4% were multidrug-resistant (MDR). Resistance rates were very high in previously treated patients: INH (66.7%), RMP (51.6%), SM (44.1%), EMB (50.5%) and MDR (INH+RMP; 50.5%). Of 316 patients tested, 28.7% were HIV-positive. There was no statistically significant association between HIV status and MDR-TB in new (P = 0.95) and previously treated patients (P = 0.5). CONCLUSION: Drug resistance is high in Burkina Faso. Early detection of infectious patients and completion of treatment are essential.

Mycobacterium tuberculosis drug-resistance in previously treated patients in Ouagadougou, Burkina Faso.

BACKGROUND: Tuberculosis drug-resistance becomes common in sub-Saharan Africa; however, very few data are available in Burkina Faso. The aim of this study is to assess the acquired resistance of Mycobacterium tuberculosis complex strains identified in TB patients to four first-line drugs in Ouagadougou. METHODS: One hundred and ten (110) pulmonary tuberculosis patients with acid-fast bacilli-positive sputum and in situation of failure, relapse, or treatment abandonment were included in the study. Ninety six strains, including 92 (95.8%) M. tuberculosis and 4 (4.2%) M. africanum, were isolated from the sputum samples of these patients. Their drug susceptibility testing was performed using the proportion method. The first-line drugs tested were isoniazid (INH), streptomycin (STR), ethambutol (EMB), and rifampicin (RIF). RESULTS: The overall drug-resistance rate of M. tuberculosis was 67.4% (n=60), including 3.4% to one drug, 18% to two, 10.1% to three, and 35.9% to four drugs. The resistance to INH, RIF, EMB, and STR were 67.4%, 51.7%, 50.6%, and 44.9%, respectively. Two strains of M. africanum were resistant to all drugs. Forty-six (51.7%) strains were multidrug-resistant (resistant to at least INH and RIF). CONCLUSIONS: In previously treated patients, the level of resistance of M. tuberculosis complex to commonly used anti-tuberculosis drugs is very high in Ouagadougou. Our results showed that multidrug-resistant tuberculosis could be a public health problem in Burkina Faso.

Campylobacter Spp. epidemiology and antimicrobial susceptibility in a developing country, Burkina Faso (West Africa)

Data on campylobacteriosis are almost nonexistent in Burkina Faso. In this study conducted from 2006 to 2008 in Ouagadougou; stool specimens and sociodemographic data were collected from 1 246 patients attending the university teaching hospital for enteritis. Stool samples were analyzed for the presence of Campylobacter by the direct culture method on selective mCCDA agar followed by antibiotic susceptibility testing on the isolated strains. The isolation rate of Campylobacter was 2.3;comprising of the following species C. jejuni (51.8); C. coli (13.8); and C. upsaliensis (3.5). However; 30.9of the isolates were unidentified. No resistant strain was found to gentamicin. The resistance to amoxicillin+clavulanic acid (3.4) was lower than those (10.3-34.5) to the other antibiotics: erythromycin (10.3); tetracycline (10.3); ciprofloxacin (13.8); amoxicillin (24.1) and ceftriaxone (34.5); nalidixic acid (34.5). Significant associations were found between Campylobacter enteritis and contact with animals (P=0.03); and HIV infection (P0.0001); in contrast to other sociodemographic and seasonal factors. From the data obtained Amoxicillin+clavulanic acid appear to be the first choice for treatment. The implementation of a national program may be helpful in controlling the spread of the disease and the increase of resistance to antibiotics

Mycobacterium tuberculosis Drug-Resistance in Previously Treated Patients in Ouagadougou; Burkina Faso

Background: Tuberculosis drug-resistance becomes common in sub-Saharan Africa; however; very few data are available in Burkina Faso. The aim of this study is to assess the acquired resistance of Mycobacterium tuberculosis complex strains identified in TB patients to four first-line drugs in Ouagadougou. Methods: One hundred and ten (110) pulmonary tuberculosis patients with acid-fast bacilli-positive sputum and in situation of failure; relapse; or treatment abandonment were included in the study. Ninety six strains; including 92 (95.8) M. tuberculosis and 4 (4.2) M. africanum; were isolated from the sputum samples of these patients. Their drug susceptibility testing was performed using the proportion method. The first-line drugs tested were isoniazid (INH); streptomycin (STR); ethambutol (EMB); and rifampicin (RIF). Results: The overall drug-resistance rate of M. tuberculosis was 67.4(n=60); including 3.4to one drug; 18to two; 10.1to three; and 35.9to four drugs. The resistance to INH; RIF; EMB; and STR were 67.4; 51.7; 50.6; and 44.9; respectively. Two strains of M. africanum were resistant to all drugs. Forty-six (51.7) strains were multidrug-resistant (resistant to at least INH and RIF). Conclusions: In previously treated patients; the level of resistance of M. tuberculosis complex to commonly used anti-tuberculosis drugs is very high in Ouagadougou. Our results showed that multidrug-resistant tuberculosis could be a public health problem in Burkina Faso