Primary resistance to antituberculosis drugs: a national survey conducted in Côte d'Ivoire in 1995-1996. Ivoirian Study Group on Tuberculosis Resistance.

SETTING: A national survey of resistance to the antituberculosis drugs used in Côte d'Ivoire was conducted in 1995-1996. OBJECTIVE: To determine the rate of primary resistance to antituberculosis drugs. METHODS: Consecutive new tuberculous patients with positive smear were recruited from tuberculosis centres and rural health centres. Drug susceptibility testing was performed according to the proportion method. Positive cultures were tested against streptomycin, isoniazid, rifampicin, and ethambutol. All resistant strains and 10% of all randomly sampled cultures were sent to an external laboratory for quality control. Human immunodeficiency virus (HIV) tests were performed for consenting patients at the tuberculosis centres. RESULTS: Among the 430 samples, 320 were available for analysis. Primary resistance to antituberculosis drugs was observed for 13.4% of the patients (43/320); multidrug resistance (to at least isoniazid and rifampicin) was observed for 5.3% of the patients; 14.2% of HIV-negative and 16.2% of HIV-positive patients were resistant to at least one antituberculosis drug (P = 0.70). CONCLUSION: This study is representative of antituberculosis drug resistance in Côte d'Ivoire. The rate of primary resistance is high and emphasises the need for a sentinel survey of tuberculous resistance. The National Tuberculosis Control Programme needs to make improvements in its management of tuberculosis cases.

[Aspects of thoracic radiography of patients with tuberculosis and HIV infection in Ivory Coast]. / Les aspects de la radiographie thoracique chez les tuberculeux infectés par le VIH en Côte d'Ivoire.

The aim of this prospective study was to investigate the main features of standard chest X-ray in patients with concomitant tuberculosis and HIV infection. From 21 December 1992 to 21 February 1993, we compared 45 chest X-rays of HIV+patients with pulmonary tuberculosis with those of 73 HIV negative patients with pulmonary tuberculosis. Our results revealed that extrapulmonary thoracic localizations were remarkably frequent in HIV+tuberculosis patients (57.8% versus 22% in HIV-patients; P < 0.05). Extrapulmonary localizations were frequently mediastinal lymph nodes (82.7%). Parenchymal involvement was often extensive including frequent miliary images (20% versus 38.3% in HIV-patients). Thus despite the lack of CD4 counts in our study, we were able to observe that about one half the co-infected tuberculosis patients had reached the stage of AIDS as defined by the CDC in 1987. These findings are in agreement with those reported in the literature and would suggest that thoracic manifestations of tuberculosis is a good marker of the state of immunodepression.

PIP: In the Ivory Coast, pneumologists examined 188 chest X-rays of patients with pulmonary tuberculosis (TB) treated at the Treichville Antituberculosis Center to compare the principal X-ray characteristics of patients with only TB with those of patients infected with TB and HIV. They did not conduct CD4 counts. 45 TB patients were also infected with HIV for an HIV prevalence rate of 38%. 73.3% of HIV infected TB patients were infected with HIV-1. 4.4% were infected with HIV-2. 22.3% were infected with both HIV-1 and HIV-2. Men predominated in both the TB only group and the TB-HIV group (67.1% and 77.7%, respectively). HIV infected patients were more likely to have thoracic extrapulmonary TB lesions than HIV seronegative patients (57.8% vs. 22%; P 0.05). Thus, 57.8% of co-infected patients had AIDS as defined by the CDC in 1987. Among co-infected patients, lesions on the mediastinal lymph nodes predominated (80.7%). Involvement of the parenchyma, demonstrated by miliary X-rays, was rather common (22.3% vs. 38.3% for HIV negative patients). The X-ray of 84.6% of patients with caseous pneumonia were infected with HIV and TB. These findings parallel those in the literature. They suggest that thoracic manifestations of TB indicate the state of immunodepression.