Exposure to combustion of solid fuel and tuberculosis: a matched case-control study.

The present study was conducted in Benin to ascertain the association between exposure to combustion of solid fuel (coal and biomass) and tuberculosis. Cases were consecutive, sputum smear-positive tuberculosis patients never previously treated for tuberculosis for as long as 1 month. Two controls were selected from the neighbourhood of each case, matched by age and sex by a predefined procedure. A total of 200 new smear-positive cases and 400 neighbourhood controls were enrolled. In univariate analysis, using solid fuel for cooking (OR 1.7, 95% CI 1.1-2.8), ever smoking (OR 5.5, 95% CI 3.1-9.8), male sex (OR 10.5, 95% CI 1.6-71.1), daily use of alcoholic beverages (OR 2.3, 95% CI 1.2-4.2) and having a family member with tuberculosis in the previous 5 yrs (OR 30.5, 95% CI 10.8-85.8) were all significantly associated with tuberculosis cases. When all significant variables were entered into a multivariate conditional logistic regression model, the association between using solid fuel for cooking and tuberculosis cases was no longer statistically significant (adjusted OR 1.4, 95% CI 0.7-2.7). In conclusion, the association between exposure to combustion of solid fuel and tuberculosis was relatively weak and not statistically significant.

[Air pollution and respiratory disease in a tropical urban setting in Cotonou, Benin]. / Pollution atmosphérique et pathologie respiratoire en milieu urbain et tropical a Cotonou, Bénin.

PURPOSE: To assess the impact of air pollution inside and outside housing on respiratory function in people living around traffic intersections. METHODS: A descriptive analytical study was carried out from February 5 to July 5, 2006. Carbon monoxide (CO), sulfur dioxide (SO2), and nitric dioxide (NO2) were measured over an 8-hour period inside and outside 60 houses near intersections during periods of heavy and light traffic. Spirometry was performed on residents of the same houses. RESULTS: CO levels were higher during heavy than light traffic both inside houses: 65 ppm vs. 43.2 ppm and outside houses: 160 ppm vs. 115 ppm. Similar results were observed for SO2, i.e., 2.8 ppm vs. 0.49 ppm inside houses and 4.3 ppm vs. 0.83 ppm outside houses. Measurements for NO2 were consistently nil. Respiratory symptoms were more frequent during heavy than light traffic: p = 0.0001; odds ratio (OR), 4.73; confidence interval (CI), 2.13-10.51. The frequency of spirometric abnormalities was higher in heavy than light traffic: p = 0.004; OR, 5.78; CI, 1.43-27.10. CONCLUSION: Indoor pollution level is higher during heavy traffic than light traffic. Respiratory symptoms were greater during heavy than light traffic.

[Factors associated with non-conversion of the direct smear after the initial phase of anti-tuberculous treatment. A study undertaken in three tuberculosis management centres in South Benin]. / Facteurs associés à la non-conversion de la bacilloscopie après la phase d'attaque du traitement antituberculeux. Étude réalisée dans trois centres de prise en charge de la tuberculose au Sud Bénin.

The objective of this work was to describe the profile of routinely managed tuberculosis patients whose sputum smear did not become negative after the initial phase of anti-tuberculous treatment and to analyze the factors associated with this. With this aim a cross-sectional, retrospective, descriptive and analytical study was carried out in a population of adults with pulmonary tuberculosis (PTB) between 2013 and 2014 in three cities in southern Benin (Cotonou, Porto-Novo and Abomey). The data of the patients who did not convert (PTB +) were compared with those who did (PTB-). A multivariate logistic regression analysis was performed. In 1989 (94%) of the cases, 305 (15.3%) were TPB+ with significant differences between the cities. The mean age was 38±13 years vs 34±12 years, respectively, for PTB+and PTB -, P=0.091. At the end of the multivariate analysis, the factors associated with non-conversion were: high bacillary load (≥10 AFB/microscopic field) at diagnosis, HIV+status, and adverse outcome at the end of anti-tuberculous treatment. These patients should be monitored carefully.

Treatment outcome with a short multidrug-resistant tuberculosis regimen in nine African countries.

SETTING: Nine countries in West and Central Africa. OBJECTIVE: To assess outcomes and adverse drug events of a standardised 9-month treatment regimen for multidrug-resistant tuberculosis (MDR-TB) among patients never previously treated with second-line drugs. DESIGN: Prospective observational study of MDR-TB patients treated with a standardised 9-month regimen including moxifloxacin, clofazimine, ethambutol (EMB) and pyrazinamide (PZA) throughout, supplemented by kanamycin, prothionamide and high-dose isoniazid during an intensive phase of a minimum of 4 to a maximum of 6 months. RESULTS: Among the 1006 MDR-TB patients included in the study, 200 (19.9%) were infected with the human immunodeficiency virus (HIV). Outcomes were as follows: 728 (72.4%) cured, 93 (9.2%) treatment completed (81.6% success), 59 (5.9%) failures, 78 (7.8%) deaths, 48 (4.8%) lost to follow-up. The proportion of deaths was much higher among HIV-infected patients (19.0% vs. 5.0%). Treatment success did not differ by HIV status among survivors. Fluoroquinolone resistance was the main cause of failure, while resistance to PZA, ethionamide or EMB did not influence bacteriological outcome. The most important adverse drug event was hearing impairment (11.4% severe deterioration after 4 months). CONCLUSIONS: The study results support the use of the short regimen recently recommended by the World Health Organization. Its high level of success even among HIV-positive patients promises substantial improvements in TB control.

Anti-tuberculosis drug resistance among new and previously treated pulmonary tuberculosis patients in Cotonou, Benin.

OBJECTIVES: To assess the current anti-tuberculosis drug resistance situation in Cotonou, at the largest anti-tuberculosis centre of Benin. METHODS: A total of 470 isolates of Mycobacterium tuberculosis complex from pulmonary tuberculosis (TB) patients were analysed: 244 from new cases and 226 from previously treated cases. Drug susceptibility testing of isolates against first-line drugs was performed using the proportion method. RESULTS: Primary multidrug resistance (MDR) depends on the patients' origin: MDR in new cases is relatively high (1.6%) when all patients are considered, but low (0.5%) and comparable to 1994 national survey results when only patients residing in Benin are considered. MDR in previously treated patients (11.1%) remains comparable to the study performed in Benin in 1994. No relation was found between human immunodeficiency virus co-infection and anti-tuberculosis drug resistance. CONCLUSION: This study shows the great importance of correct patient identification in epidemiological surveys, where results may vary according to the population(s) studied.

[Tuberculoma of the cerebellar tonsils: a case study]. / Tuberculome de l'amygdale cerebelleux: a propos d'un cas.

Tuberculoma of the cerebellum is a rare presentation of human tuberculosis and the presence of this disease in central nervous system in particular. We report the case of an immunocompetent 53 year old man who initially had an instability when walking, bitemporo-occipital headaches and insomnia, secondarily complicated state of agitation accepted into psychiatric care. The diagnosis was possible with MRI that revealed a mass in the cerebellar tonsil, not taking the contrast after gadolinium injection. The evolution under treatment for tuberculosis was positive. The control MRI performed at 15 months showed no more damage.

Le Tuberculome du cervelet est une présentation rarissime de la tuberculose humaine en général et de l'atteinte par cette maladie du système nerveux central en particulier. Nous rapportons le cas d'un homme de 53 ans immunocompétent qui présentait initialement une instabilité à la marche, des céphalées bitemporo-occipitales et une insomnie, compliquée secondairement d'état d'agitation prise en charge en psychiatrie. Le diagnostic a été possible grâce à l'IRM qui a mis en évidence une masse de l'amygdale cérébelleux, ne prenant pas le contraste après l'injection de gadolinium. L'évolution sous traitement antituberculeux a été favorable. L'IRM de contrôle réalisée à 15 mois ne montrait plus de lésion.

[Sensitisation profile to airborne allergens of patients followed for asthma in Cotonou, Benin. A cross-sectional study using prick-tests]. / Profil de sensibilisation aux pneumallergènes des patients suivis pour asthme à Cotonou, Bénin : étude transversale par prick-tests.

RATIONALE: The sensitisation profile to airborne allergens of asthma patients followed in Benin is not known. PATIENTS AND METHODS: A descriptive cross-sectional study was conducted from April to June 2013 at the hospital reference centre. A prick-test was performed in all adults with asthma consulting during this period. The standardized allergenic extracts tested were: mites (Dermatophagoides pteronyssinus [DP], Dermatophagoides farinae [DF] and Blomia tropicalis [BT]), cockroaches, 5 different grasses, Alternaria, dogs and cats. The test was positive when the diameter of the wheal was more than half that of the positive control and/or when the diameter of the wheal was ≥3mm than the negative control. RESULTS: Of the 253 asthmatics tested, 247 (97.6%) had at least one positive skin reaction. The average age was 44 years, the sex ratio was 0.81. Sensitization to mites was the most frequent (99.6%), followed by cockroaches (71.3%), 5 grasses (71.3%), Alternaria (71%), dog (68%) and cat (63.6%). The average number of sensitivities was 5±2. CONCLUSION: Asthmatics monitored in Cotonou have multiple sensitisations dominated by mites.

Information management in national tuberculosis control programmes and national health information systems.

A good notification system is one of the key elements for the success of national tuberculosis programmes (NTPs). The national health information system (NHIS) in low income countries is often weak and unreliable. When restructuring this system, what circuit should be used to integrate TB data: the NTP or the NHIS? Experience from several countries shows that unlike the NHIS, only the data generated by the NTP are reliable and complete, and arrive rapidly enough to be used for programme management. It is therefore the duty of the NTP to collect this information and transmit it to the NHIS at each level of the health system. These were the conclusions of a seminar held in Cotonou, Benin, organised by the International Union Against Tuberculosis and Lung Disease, which involved the leaders of the NHIS and of NTPs of six West African countries.

Prevalence of primary and acquired resistance of Mycobacterium tuberculosis to antituberculosis drugs in Benin after 12 years of short-course chemotherapy.

SETTING: Benin National Tuberculosis Programme, West Africa. OBJECTIVE: To measure the prevalence of primary and acquired resistance of Mycobacterium tuberculosis to the antituberculosis drugs isoniazid, rifampicin, ethambutol and streptomycin in Benin from 1994-1995, after 12 years of short-course chemotherapy regimens. METHODS: Prospective study by cluster sampling according to the methodology recommended by the International Union Against Tuberculosis and Lung Disease (IUATLD) and the World Health Organization (WHO). RESULTS: The survey of primary resistance included 333 strains, of which 28 (8.4%) were drug-resistant, one to both rifampicin and isoniazid (multidrug-resistant). For acquired resistance, out of 57 strains tested 26 (45.6%) were resistant, six of which (11%) were multidrug-resistant. CONCLUSION: Despite the considerable increase in the number of tuberculosis cases observed in recent years (52% between 1987 and 1995), direct observation of patients taking their antituberculosis drugs during the intensive phase of treatment has limited the development of drug resistance in Benin.

Outcome of tuberculosis retreatment in routine conditions in Cotonou, Benin.

SETTING: National Tuberculosis Programme (NTP), Cotonou, Benin. OBJECTIVE: To study the patient characteristics and outcome of tuberculosis retreatment cases in a well-functioning NTP. METHODS: A retrospective, register-based study of all smear-positive pulmonary tuberculosis cases put on retreatment (2SERHZ/1ERHZ/5R3H3E3) between 1992 and 2001 in Cotonou. For comparison, information on new smear-positive cases in Cotonou in 1999 was entered and analysed. RESULTS: Of 8103 tuberculosis patients registered, 642 were put on retreatment. The analysis is mainly based on the 236 patients whose initial treatment regimen records were available (113 relapses, 84 failures, 39 returns after default). Most of the relapse (57%) and return after default (72%) cases were put on retreatment within 12 months after stopping their initial treatment. Overall, the retreatment results were satisfactory (78% success) and comparable with those of new cases (82%); the failure rates were low (3%), as were those for initial treatment (1%). There were more defaulters from retreatment among those who had already defaulted from initial treatment (21%). Treatment success rates were better among women than men. CONCLUSION: The standardised retreatment regimen is effective in Cotonou, probably because the NTP is functioning well, there are no drug shortages, drug taking is strictly supervised, and a good treatment plan is followed.

Evaluation of a standardized recording tool for sputum smear microscopy for acid-fast bacilli under routine conditions in low income countries.

SETTING: Laboratories performing sputum smear microscopy for tuberculosis in Benin, Malawi, Nicaragua and Senegal. METHODS: Analysis of computerized laboratory registers to ascertain workload, yield from serial smear examination, and demographic characteristics of examinees. RESULTS: Data from more than 60,000 examinees in 42 laboratories showed that the average number of smears examined per day ranged from 4 to 19 (mean 6) per country. To find one case of tuberculosis, on average 21 smears of suspects were examined (range 8 to 50). Of all cases with ultimately at least one positive result, 87% were already positive on the first examination. Demographic characteristics of cases differed considerably by country and gender. In 35 of 42 laboratories, males were more frequently found to be cases than females, and with increasing age an increasingly larger number of female than male suspects had to be examined to identify one case. CONCLUSIONS: This study demonstrates the usefulness of a standardized recording system for results of acid-fast microscopy in obtaining essential information for program management and on demographic characteristics of persons presenting for examination.

[Granulomatous peritonitis from ascariasis: apropos of 1 case in a Benin child]. / Péritonite granulomateuse sur ascaridiose: à propos d'un cas chez un enfant béninois.

We report a case of granulomatous peritonitis in a child, due to Ascaris lumbricoïdes eggs. A 6 year-old child was admitted to the emergency ward with acute abdomen pain. Upon performing a laparotomy, severe adhesive inflammation and adenopathies were found and abdominal tuberculosis was diagnosed. Specific treatment was administered. Later, the acurage diagnosis of Ascaris ova peritonitis was made by histopathological examination of tissue removed during the operation. The pathogenesis is briefly discussed.

[Seroprevalence of treponematosis among pregnant women in Cotonou (Benin)]. / Séroprévalence des tréponématoses chez des femmes enceintes à Cotonou (Bénin).

A study of frequency of treponematosis among pregnant women in Mother Hood of Zogbo (Cotonou) shows 5.1 +/- 2.8% of positivity with risk of 5% by TPHA and VDRL. The low level of endemicity, associated with the absence of cutaneous lesions of treponematosis in Cotonou may correspond to a syphilis infection. This study points out the necessity to strengthen the struggle against the all other sexually transmitted diseases (MST) in the same way that the HIV infection in Benin.

[Initial resistance to streptomycin, isoniazid, rifampicin and ethambutol in bacillus-laden tuberculosis patients at the National Center of Pneumo-physiology at Cotonou (Benin)]. / Résistance initiale à la streptomycine, l'isoniazide, la rifampicine et l'éthambutol chez des malades tuberculeux bacillifères au Centre national de pneumo-phtisiologie à Cotonou (Bénin).

The authors are reporting results from a study about BK sensitivity among principal antituberculosis drugs in Benin Republic: 81.5% of them are susceptible for all specific antibiotics, 8.5% are offering resistance to INH and Streptomycin together. In this preliminary study no primitive resistance for RMP has been found.

[Epidemiological observations on the first case of human paragonimiasis and potential intermediate hosts of Paragonimus sp. in Benin]. / Observations épidémiologiques sur le premier cas de paragonimose humaine et les hôtes intermédiaires potentiels de Paragonimus sp. au Bénin.

Parasitological investigations were carried out for four months in 1998 in two Beninese centres of pneumo-phtisiology (Akpakpa, at Cotonou, and Akron, at Porto-Novo) to detect the patients harbouring eggs of Paragonimus sp. amongst the persons consulting for tuberculosis and showing a broncho-pneumopathy without mycobacteria. Eggs of Paragonimus sp. were detected in the sputum of a single patient out of 369 persons examined (prevalence, 0.2%). This patient had eaten crabs in the months preceding the date of diagnosis. A treatment using praziquantel has improved clinical symptomatology and biological signs found in this patient. These studies have been completed by visiting markets located in the coastal plain of Benin to identify the crabs that were sold and to find metacercariae of Paragonimus sp. Negative results were obtained when 126 Cardisoma armatum ("hole crab") were dissected. In contrast, the dissection of 176 Callinectes marginatus ("swimming crab") was successful, with 5% of crabs harbouring metacercariae of probably Paragonimus sp. Further studies are necessary to confirm these first results and to determine the global prevalence of Paragonimus infection in these definitive and intermediary hosts.

[Mycobacterium fortuitum in a patient with human immunodeficiency syndrome (AIDS) in Benin)]. / Infection pulmonaire à Mycobactérium fortuitum chez un malade atteint du syndrome d'immunodéficience acquise humaine (SIDA) au Bénin.

The authors report a case of Mycobacterium Fortuitum infection in one AIDS patient. This case underlines the interest for the clinicians to investigate systematically a possible infection by Mycobacterium fortuitum in all AIDS patients with pulmonary tuberculosis.

[Renal complications associated with human acquired immunodeficiency virus infection in a population of hospital patients at the Hospital and University National Center in Cotonou]. / Complications rénales associées à l'infection par le virus de l'immunodéficience acquise humaine dans une population hospitalisée au CNHU de Cotonou.

We studied 92 HIV-positive patients retrospectively between January 1994 and December 1996 and prospectively from January to July 1997. We determined serum creatinine and 24-hour proteinuria. The median age of the patients was 22 (+/- 4) years and most patients were aged between 25 and 45 years. The sex ratio was 2.17 and most patients were infected with HIV-1 (67.39%). Renal failure occurred in 27.16% of cases, due to changes in blood pressure and infectious diseases. Three patients had a nephrotic syndrome caused by HIV. Thirty-eight cases of lung infection, ten of urinary infection, twelve infections of the digestive system and fifteen cases of skin infection were recorded. The median duration of stay in hospital was 23 (+/- 8) days and the median cost of hospitalization was 147,450 F CFA (+/- 31,057). The treatment given was purely symptomatic and three patients died during the study. One patient suffered chronic renal failure and is now undergoing hemodialysis. Preventive treatment would be of great value.

[Epidemiologic study of adult bronchial asthma in a Benin hospital environment]. / Contribution à l'étude épidémiologique de l'asthme bronchique de l'adulte en milieu hospitalier au Bénin.

This work is a contribution to the epidemiological study of bronchial asthma in adults in a hospital environment at Cotonou. It is a question of the necessity of admission to hospital of clinical cases. The study has emphasized the following points: Separation according to age has shown that 52% of patients are less than 35 years old, young subjects are in this group. The two sexes are equally involved, with a sex ratio of 1. The different socio-professional groups involved have shown a predominance of those without profession. The main allergic factors identified by questioning are dominated by housedust, which suggests, failing allergological tests, that the role of mites is probably preponderant. There does not seem to be any particular influence of meteorological factors (rain or dryness) on the frequency of crises. Finally, it should be emphasized that technical difficulties make it very difficult to study asthma in Benin.

Management of asthma in Benin: the challenge of loss to follow-up.

SETTING: An asthma pilot project in Benin. OBJECTIVE: To assess the implementation of standard case management of asthma at three referral centres and three primary care centres. METHODS: The project began with local adaptation of international asthma guidelines, followed by situation analysis, pre-intervention, training and intervention. The initial dosage of inhaled beclometasone was determined by asthma severity. Outcome of treatment was assessed annually, starting from one year after enrolment. RESULTS: Of 103 asthma patients identified during situation analysis, only 11 (11%) were prescribed inhaled corticosteroids. After health worker training, a total of 430 asthma patients were identified in 2008, of whom 273 (63.5%) returned after initial management with 7-day oral prednisolone. Of the 273 patients, 261 (95.6%) had persistent asthma, 231 (86.2%) had peak flow measurement variability of ≥20%, and 155 (56.8%) had had one or more unplanned visits to health facilities in the previous year. Outcome at one year evaluation was as follows: 63 (24.1%) had improved, 48 (18.4%) remained stable, 14 (5.4%) were worse and 136 (52.4%) were lost to follow-up. CONCLUSION: It is feasible to train health workers to manage asthma patients in a standardised manner. However, a high proportion of patients were lost to follow-up during treatment.

Integrating HIV testing and care into tuberculosis services in Benin: programmatic aspects.

SETTING: Between 2005 and 2008, the diagnosis and care of human immunodeficiency virus (HIV) infection and tuberculosis (TB) services were integrated in Benin. RESULTS: The appointment of a TB-HIV Coordinator by the National Tuberculosis Control Programme and quarterly supervisory visits to TB clinics have bolstered the implementation of integrated HIV-TB activities. HIV testing and cotrimoxazole preventive therapy were integrated smoothly into the TB services. The strategy chosen to facilitate access of HIV-positive TB patients to antiretroviral treatment contributed to greater integration over time, but perpetuated, for some, the burden of attending two facilities. CONCLUSION: The integration and decentralisation of TB and HIV care services at national level in Benin resulted in a high uptake of HIV services among TB patients.