Evaluation of chest radiography, lytA real-time PCR, and other routine tests for diagnosis of community-acquired pneumonia and estimation of possible attributable fraction of pneumococcus in northern Togo.

Streptococcus pneumoniae (Spn) is a leading cause of community-acquired pneumonia (CAP), yet existing diagnostic tools remain inadequate. We aimed to evaluate laboratory and radiological methods for detecting pneumococcal aetiology in CAP patients and to estimate Spn prevalence in this group. All-aged patients hospitalized with clinically defined CAP in northern Togo were enrolled during 2010-2013. Latent class analysis pooled results of semi-automated blood culture (SABC), whole blood lytA real-time polymerase chain reaction (rt-PCR), serum C-reactive protein (CRP), and chest radiography (CXR) and categorized patients as likely pneumococcal or non-pneumococcal CAP. We enrolled 1684 patients; 1501 had results for all tests. CXR, SABC, lytA rt-PCR and CRP >71·2 mg/l had sensitivities of 94% [95% confidence interval (CI) 87-100], 13% (95% CI 10-16), 17% (95% CI 14-21) and 78% (95% CI 75-80), and specificities of 88% (95% CI 84-93), 100% (95% CI 99-100), 97% (95% CI 96-99) and 77% (95% CI 75-79), respectively. Pneumococcal attributable proportion was 34% (95% CI 32-37), increasing with age and in men. We estimated that Spn caused one third of CAP. Whole blood lytA rt-PCR was more sensitive than SABC; both had low sensitivity and high specificity. Conversely CXR was highly sensitive and reasonably specific; it could be a useful tool for epidemiological studies aiming to define Spn pneumonia incidence across all ages.

[Evaluation of antiretroviral treatment in a cohort of 1,620 HIV-infected patients in Togo]. / Évaluation du traitement antirétroviral de 1 620 personnes infectées par le VIH au Togo.

PURPOSE: The purpose of this study was to evaluate the efficacy of antiretroviral treatment for HIV-infected patients in Togo. PATIENTS AND METHOD: This retrospective study covered the period from January 2001 to January 2009 and included all HIV-infected patients who received antiretroviral therapy for at least 12 months. RESULTS: The study included 1,620 of the 8,901 patients (18.2%) treated with antiretroviral therapy. Mean patient age was 34.8 ± 11.4 years and the male/female sex-ratio was 0.4. When treatment began, the mean CD4+ T lymphocyte count was 143/mm(3) and mean patient weight was 53.3 kg. Overall, 263 of the 1,620 subjects (16.2%) had opportunistic infections before starting antiretroviral treatment. The most frequently used antiretroviral combination was stavudine/lamivudine/nevirapine (91.7%). The compliance rate for the first 12 months was 89.6%, and the antiretroviral regimen was changed in 5.9% of cases. After 36 months, mean weight gain was 8.8 kg and the mean increase in the CD4(+) T lymphocyte count was 265 cells/mm(3). The number of opportunistic infections decreased from 263 cases at the beginning of antiretroviral treatment to 9 after three years of treatment. During follow-up, 258 deaths were recorded, for a cumulative case fatality rate of 15.9%. The most common side effects were cutaneous toxicity and anemia in the short term and neurological toxicity, lipodystrophy and hepatotoxicity over the long term. DISCUSSION: This study confirms the efficacy of antiretroviral treatment of HIV-infected patients in Togo. These findings should encourage policy-makers to work toward universal access to antiretroviral treatment for people living with HIV.