[Couple life and management of HIV infection in the pneumology department of the Teaching hospital center of Cocody, Abidjan, Côte d'Ivoire]. / Vie de couple et prise en charge de l'infection à VIH au service de pneumologie du CHU de Cocody, Abidjan, Côte d'Ivoire.

Introduction: The life of a couple is a place of emotional support. It can allow the management of patients infected with HIV on antiretroviral therapy to be optimized.The objective of our study was to analyze the impact of married life on the therapeutic follow-up of patients living with HIV. Methodology: We carried out a mono-centric, prospective, descriptive and analytical study in the care unit of patients living with HIV of the pneumology service of the Cocody Teaching Hospital in Abidjan. The investigation took place from September 1, 2015 to March 31, 2016. Results: We included 411 patients. The sex ratio was 0.51. The average age was 43.2 years with extremes of 19 and 69 years. The patients lived as a couple in 59.1% of cases. Couple life was associated with severe immunosuppression at 12 months in 23.3% (42/180) of cases [p = 0.043 OR = 1.735 (0.964 - 3.121)], the appearance of new opportunistic conditions between the 6th and the 12th month of treatment in 5.6% (13/232) of cases [p = 0.006; OR = 9.438 (1.222 - 72.890)], information sharing with the partner before the start of treatment in 92.4% (208/225) of cases [p = 0.035; OR = 1.976 (1.005-3886)] and the existence of sexual intercourse since the discovery of the disease in 92.6% (225/243) of cases [p < 0.001; OR = 14.423 (8.174 - 25.448)]. Sexual relationships were less protected among people living in a couple 65.9% (149/226) versus 78% (64/82) among others [p = 0.027; OR = 0.544 (0.301 - 0.923)]. The loss of the sexual partner at the onset of the disease was observed regardless of marital status (p = 0.203). Conclusion: The life of a couple negatively influences the management of HIV infection. It appears necessary to set up counseling and testing programs for couples.

[Use of the Xpert® MTB/RIF test in routine screening of new cases of pulmonary tuberculosis in an endemic area]. / Test Xpert® MTB/RIF et dépistage des nouveaux cas de tuberculose pulmonaire en routine dans une zone de haute endémicité tuberculeuse.

BACKGROUND: Developed initially for the diagnosis of multidrug-resistant tuberculosis, the Xpert® MTB/RIF test has shown to be useful for the diagnosis of tuberculosis, especially among HIV-infected subjects. The objective of the study was to determine the contribution of the Xpert® MTB/RIF test for routine pulmonary tuberculosis diagnosis in an endemic area. METHODOLOGY: We undertook a prospective study among patients presenting with cough and sputum. The sputum was submitted to microscopic examination, to the Xpert® MTB/RIF test and cultured by the Mycobacteria growth indicator tube (MGIT) technique. The study compared cases of pulmonary tuberculosis confirmed by a positive sputum culture and cases with cough but negative sputum culture. RESULTS: In multivariate analysis, the factors associated with positive cultures were the following: male gender, cough for more than 2 weeks, loss of weight and fever. The estimated clinical suspicion score consisted of 4 signs each having a coefficient of 1. The sensitivity of each clinical sign varied between 79 and 94%. In 348 cases of negative microscopic examination (composed of 295 cases with score<4 and 53 cases with score=4), the predictive positive value of the Xpert® MTB/RIF was 80% for a score equal to 4 and 40.9% for a score<4. In cases of negative microscopic examination of the sputum, the Xpert® MRT/RIF test should be undertaken if the score=4. CONCLUSION: The diagnosis of tuberculosis in endemic zones could be improved by using the Xpert® MTB/RIF.

[Clinical, paraclinic and evolutive profile of HIV infected subject compared with that of non-HIV infected subject in pneumology hospitalization at Abidjan]. / Profil clinique, paraclinique et évolutif du sujet infecté par le VIH comparé à celui du sujet non infecté par le VIH en milieu pneumologique hospitalier à Abidjan.

INTRODUCTION: The HIV infection is a problem of public health in Côte d'Ivoire. Voluntary screening is encouraged for the premature management of HIV infected patients before the stage of serious opportunist affections. Antiretroviral therapy became free. The purpose of this study was to describe the characteristics of HIV infected subject infected in hospitalization of pneumology. METHODOLOGY: Our retrospective and analytic study concerned the activity period from January 2001 to December 2012 of pneumology department of Cocody university hospital. RESULTS: On 1141 recorded files, the prevalence of HIV infection was 48.20%. The multi-varied analysis showed the following results. Male patients were less HIV infected (OR=0.490 [0.363-0.661]) as the old patients of more than 64 years (OR=0.150 [0.080-0.280]). In case of HIV infection, infectious pathology, severe anemia and renal insufficiency were dominating respectively with OR=1.763 (1.212-2.564), OR=3.167 (2.125-4.720) and OR=2.054 (1.335-3.161). A stronger mortality was associated with HIV infection (OR=1.920 [1.312-2.809]). CONCLUSION: HIV infection always remains frequented in pneumology hospitalization in Abidjan with late discovery, source of complications and abnormally high death rate.

[Dynamic of indicators of ambulatory care of tuberculosis in the antituberculous center of Adjamé]. / Dynamique des indicateurs de la prise en charge ambulatoire de la tuberculose au centre antituberculeux d'Adjamé.

INTRODUCTION: Tuberculosis (TB) remains a real problem of public health in Côte d'Ivoire. The aim of our study is to describe the dynamic of anti-TB fight indicators in anti-TB center (CAT) of Adjamé. METHODOLOGY: We realized a retrospective study, comparing the anti-TB activities of two periods (1999-2001 versus 2010-2012) at the CAT of Adjamé. Over two periods, 24,520 cases of TB were recorded in the registers of TB declaration. RESULTS: Logistic regression results were the following ones. The proportion of the patients of Adjamé municipality increased to detriment of the patients coming from other municipalities. Our study showed an increase of TB contagious forms, a reduction of new cases of TB. The rate of screening of HIV infection increased. We noted a reduction of TB-HIV co-infection prevalence. The proportion of smear positive at the 2nd month decreased. We noted an increase of the rate therapeutic success and a reduction of lost at follow-up. CONCLUSION: Important progresses were realized in the TB fight and TB-HIV co-infection.

[Multidrug resistant tuberculosis among health personnel in Côte d'Ivoire]. / Tuberculose multirésistante chez le personnel de santé en Côte d'Ivoire.

UNLABELLED: Multidrug resistance tuberculosis (MDR-TB) of health workers raises the question of hospital-borne transmission of infection. OBSERVATIONS: We report 4 cases of MDR-TB confirmed at the health workers over a period of 8 years (January, 2005 to December 2012), in the 2 services of pulmonology from Abidjan to Côte d'Ivoire). It was about young grown-up patients (aged between 28 and 39 years), all HIV negatives, in a no-win situation of antituberculosis treatment (3 patients/4). The most concerned staffs were the male nurses (2/4). Two agents worked in general hospital and the only one in a pulmonology department at the time of the diagnosis. The tuberculosis was of lung seat with bilateral radiographic hurt (3/4) and multiples excavations (4/4). The case index, when it was identified (2/2), was a family case. Among 3 agents who benefited from a second line treatment, 1 died further to an extensive drug resistance and 2 are declared to be cured. The fourth died before the beginning of the treatment. These cases of cure were in touch with a premature care. CONCLUSION: Multidrug resistant tuberculosis at the health workers could have a negative impact on the antituberculosis fight imposing rigorous measures of infection control and better implication of the occupational medicine.

[Comparative diagnosis of bacterial pneumonia and pulmonary tuberculosis in HIV positive patients]. / Diagnostic comparé des pneumopathies bactériennes et de la tuberculose pulmonaire chez les patients VIH.

INTRODUCTION: Immunodepression induced by the human immunodeficiency virus (HIV) modifies the clinical, radiological and microbiological manifestations of pulmonary tuberculosis; leading to similarities between pulmonary tuberculosis and acute community-acquired bacterial pneumonia. A consequence is the high proportion of discordant pre- and post-mortem diagnoses of pneumonia. The aim of our study was to contribute to the improvement in the diagnosis of acute bacterial pneumonia in HIV positive patients in areas where tuberculosis is endemic. METHODS: This retrospective study in HIV positive patients has compared 94 cases of positive smear cases pulmonary tuberculosis and 78 cases of acute community-acquired bacterial pneumonia. RESULTS: Using logistic regression, the following features were positively associated with bacterial pneumonia: the sudden onset of signs (OR=8.48 [CI 95% 2.50-28.74]), a delay in the evolution of symptoms of less than 15 days (OR=3.70 [CI 95% 1.11-12.35]), chest pain (OR=2.81 [CI 95% 1.10-7.18]), radiological alveolar shadowing (OR=12.98 [CI 95% 4.66-36.12) and high leukocytosis (OR=3.52 [CI 95% 1.19-10.44]). These five variables allowed us to establish a diagnostic score for bacterial pneumonia ranging from 0 to 5. The area under the ROC curve was 0.886 [CI 95% 0.84-0.94, P<0.001]). Its specificity was >96.8% for a score of greater than or equal to 4. CONCLUSION: The diagnostic score for acute community-acquired pneumonia may improve the management of bacterial pneumonia in areas where tuberculosis is endemic.

[Influence of care pathways on the time of initiation of TB treatment]. / Influence du parcours de soins sur le délai d'initiation du traitement antituberculeux.

INTRODUCTION: Untreated positive pulmonary TB smear has both individual implications, increasing morbidity and mortality, and collective implications, increasing the contagiousness of the disease. The present study aims to identify the course of patient care and the influence of care pathway on the time of initiation of TB treatment in Abidjan. METHODS: We conducted a prospective and comparative study between two groups with pulmonary smear-positive: 38 with a conventional course (use of only the health facilities) and 198 with mixed driving (combining health facilities, self-medication and traditional medicine). RESULTS: The average time between onset of symptoms and initiation of treatment for patients with conventional path was significantly different from that observed in patients with mixed course (4.28 weeks versus 8.57 weeks, P < 0.001). Multivariate analysis mixed route was related to level of education (OR=2.728 [1.165-6.386]; P=0.02), the district of residence (OR=2.690 [1.168-6.195]; P=0.02), the mode of onset of symptoms (OR=0.33 [0.101-0.6607]; P=0.013) and weight loss (OR=0.259 [0.139-0.798]; P=0.004). CONCLUSIONS: The course of patients are multiple and can induce delays in starting treatment for tuberculosis. The sensitization of the population and the involvement of traditional healers in TB screening may contribute to the early therapeutic management.

[Extensively drug resistant tuberculosis in Ivory Coast]. / Tuberculose ultrarésistante en Côte d'Ivoire.

INTRODUCTION: The emergence of tuberculosis with ultraresistant bacilli (TB-UR or XDR-TB) came to increase the threat concerning the progress realized in tuberculosis control. This observation establishes the only case of XDR-TB documented and published since the beginning of pharmacoresistant tuberculosis management in Ivory Coast from 2000 till 2010. This case was diagnosed in 2005 at a HIV-negative 32-year-old woman, initially declared MDR-TB. Looking forward to a treatment of category IV, she was treated by therapeutic truncated protocols recombining antituberculous molecules to which the patient was still sensitive. This treatment (PAS, cycloserin, ciprofoxacin, ethionamid, ethambutol and kanamycin) was introduced after 9 months of waiting and was completely led in ambulatory under the supervision of a member of the family. The diagnosis of XDR-TB concerned new tests of sensibility spread to second line antituberculous drugs in front of the absence of spits negativation at the end of 14 months of a second line treatment marked by frequent stock shortages. The death arose at M19 of treatment by chronic heart pulmonary. CONCLUSION: XDR-TB remains dark prognosis and is almost synonymic of "death sentence" in our countries with limited resources. The application of the international recommendations for tuberculosis management and better accessibility to antituberculous second line drugs would allow to prevent the appearance of such forms of tuberculosis.

[Clinical manifestations in patients exposed to an environmental toxic accident (Abidjan, Ivory Coast 2006)]. / Manifestations cliniques chez les sujets exposés à un accident toxique environnemental (Abidjan, Côte d'Ivoire 2006).

INTRODUCTION: In 2006, 528 tons of petroleum toxic waste have been released in Abidjan (Ivory Coast) during a major environmental accident. This study was aimed to describe the clinical manifestations provoked by these toxic waste. METHODS: We have analysed the records of patients admitted to the university hospital of Cocody (Abidjan) following exposure to toxic waste. All the information were recorded on specific files or on notification files created by the physicians of the National Institute of Public Health, the authority charged with the supervision of this exercise. The files were completed by the physician in the course of the examination of the patient. RESULTS: Over a period of 3-month-period, 10,598 patients were examined. The clinical manifestations affected all age groups. They were dominated by respiratory symptoms: pulmonary (74.5%) and upper respiratory (31.0%). Pulmonary symptoms included cough (48.8%), chest pain (37.9%), dyspnoea (9.5%) and a few cases of hemoptysis. Digestive symptoms mainly comprised abdominal pain (36.2%), diarrhea (23.0%), abdominal distension (19.9%) and vomiting (9.9%). The other symptoms were neurological, ophthalmic, cardiovascular and gynaecological. More than 96% of patients presented with at least two symptoms. The respiratory symptoms were significantly more frequent in patients over the age of 17 while diarrhea and vomiting were more often found in patients less than 17 years old. Chest pain was significantly more common in men while abdominal pain and vomiting predominated in women (P=0.001). CONCLUSION: The clinical consequences of toxic waste exposure were varied and sometimes serious. A medium- and long-term evaluation of the subjects is required.

[Evaluation of multidrug-resistant tuberculosis treatment in Ivory Coast from 2008 to 2010]. / Évaluation du traitement de la tuberculose multi-résistante en Côte d'Ivoire de 2008 à 2010.

This is a retrospective study conducted from January 2008 to December 2010 on sectional descriptive analysis of records of patients treated for MDR-TB and whose follow-up was in the thoracic department of Centre Hospitalier Universitaire (CHU) of Cocody in Abidjan Côte d'Ivoire. We selected eight patients who met the inclusion criteria of 21 MDR-TB patients registered during the study period. The average age was 29.25years ranging from 21 to 39. Males accounted for 75% of the patients (6 males and 2 females). The students represented the professional social layer most affected with 37.5% of the patients. All patients had a history of tuberculosis and only one patient was HIV positive under anti-retroviral (zidovudin, lamivudin and efavirenz). All cultures found Mycobacterium tuberculosis. The resistance profile in addition to isoniazid and rifampicin, found two cases of resistance to ethambutol and streptomycin. The chest radiograph at the time of initiation of second-line treatment showed essentially excavations in 75% of cases and infiltrates in 25%. The lesions were bilateral in 7 of 8 patients (87.5%). The main side effects observed during treatment were limited to cochleovestibular disorders (2 patients) and neuropsychiatric disorders (2 patients) and digestive disorders in half of the patients with removal of the offending molecule kanamycin. After 24months of treatment, it was numbered five cures (62.5%), two failures and one death.

[Correlation of the manifestations of tuberculosis and the degree of immunosuppression in patients with HIV]. / Corrélations des manifestations de la tuberculose pulmonaire avec le degré d'immunodépression au VIH.

CONTEXT: Correlation of the manifestations of tuberculosis and the degree of immunosuppression in patients with HIV. BACKGROUND: The advent of HIV has contributed to the increase in the number of people with tuberculosis. The clinical and paraclinical of TB/HIV co-infected are polymorphic and function of immune status. OBJECTIVES: To determines the clinical and paraclinical characteristics of TB related to different levels of CD4 lymphocytes. METHODOLOGY: A retrospective case series based on analysis of 450 patients with both TB/HIV co-infections. It focused on the records of patients with pulmonary smear-positive (TPM +) with a positive HIV status. The effect of immunosuppression was analyzed in groups based on the CD4 count (<200/mm(3), of 200-350/mm(3) and>350/mm(3)), in a chronological fashion from April to September 2010 until there were 150 patients in each CD4 group. RESULTS: Among the 450 patients, 71.1% were between 25 and 45years old. The clinical signs were more significant as the level of CD4 fell. The clinical signs were predominantly fever (93%) and weight loss (62.7%). Pulmonary cavitation (59.3%), infiltrates (38.7%) and the location of the lesions at the lung apex (72%) were more common in the third group patients. By contrast, extra pulmonary lesions (mediastinal lymphadenopathy, pleurisy) and normal x-ray (9.3%) were more frequent in patients of the first group. The scarcity of cavitations (22.3% compared to 59.3% CD4>350) and the increase in associated lesions became more marked if patients were immunocompromised. Hematologic, hepatic, renal disorders were more frequent and severe in the most immunocompromised patient group. CONCLUSION: HIV-associated tuberculosis has an atypical clinical, radiological, biological presentation and is more severe when there is significant immunosuppression.

[Etiologies of non tuberculous empyema in adult patients infected with HIV in a service of pneumology, Abidjan (Ivory Coast)]. / Étiologies des pleurésies purulentes non tuberculeuses chez les patients adultes infectés par le VIH dans un service de pneumologie à Abidjan (Côte d'Ivoire).

OBJECTIVES: To identify the main bacteria that cause thoracic empyema of HIV-infected patients. METHODS: Retrospective study analyzing the etiology of thoracic empyema in patients admitted to the pneumology clinic of the university hospital center in Abidjan from January 1998 to December 2010. We included all patients with bacteriologically confirmed thoracic empyema and had serological test for HIV. We compared the different pathogens based on HIV status. RESULTS: There were 42 patients of thoracic empyema composed of 24 (63.3%) HIV-infected patients [15 (62.5%) males and nine (37.5%) women] and 18 (36.7%) HIV-negative patients [13 (72.22%) men and five (27.78%) women]. The average age of HIV-infected patients was 41.2 years and 44.8 years for HIV-negative patients. HIV status was known only for 4.76% patients at admission, and most of them had a severe stage of immune suppression, (the average T CD4 cell count was 96/mm(3)). Pleurisy was monomicrobial in 83.33% HIV-infected patients and 94.4% HIV-negative patients. It was polymicrobial in 16.67% immunocompromised patients and 5.56% HIV-negative patient. Gram-negative bacteria were isolated from 58.33% HIV-infected patients. Streptococcus Pneumoniae was observed in 61.11% HIV-negative patients. CONCLUSIONS: Gram-negative bacteria are the main causes of thoracic empyema in patients HIV-infected.

[Tuberculosis in the elderly: Epidemiology and outcomes of ambulatory followed-up in Abidjan]. / La tuberculose du sujet âgé : épidémiologie et devenir des patients suivis en ambulatoire à Abidjan.

BACKGROUND: Very few works approach elderly's tuberculosis (TB) in developing countries. The aim of this study is to present elderly's TB epidemiology and the outcomes of the ambulatory follow-up of the tuberculous patients aged more than 65years old (TBE) compared to the TB among patients less than 65years old (TBY). METHODS: Our study is retrospective covering period of January 1999 to June 2006 activities of Adjamé's antituberculous center. It is a comparative study between patients of at least 65 years and patients of less than 65years when the diagnosis of TB was made. RESULTS: Among 36,923 cases of TB, the proportion of TBE is 2.33%. In case of TBE, the sex-ratio is 2.16 versus 1.50 among TBY (P<0.001). Localization of TB is pulmonary in 61.70% among TBE versus 67.26% among TBY (P=0.058). Among elderly's TB, the osteoarticular localization is more frequent. TB-VIH co-infection prevalence is estimated to 9.05% among elderly's TB versus 44.38% among patients of less than 65 years (P<0.001). The therapeutic success rate within elderly patients is 52.16% years versus 61.42% when it was patients of less than 65 years. The proportion of lost at follow-up and the rate of patient transfers within the elderly's TB are the most raised. CONCLUSION: The elderly's TB is rare with a more masculine predominance. TB-VIH co-infection is not important among elderly's TB. The aged patient follow-up must be improved.

[Dynamic of respiratory pathology in a service of pneumology in black Africa in the context of HIV infection from 1998 to 2007]. / Dynamique de la pathologie respiratoire dans un service de pneumologie en Afrique noire dans le contexte de l'infection à VIH de 1998 à 2007.

INTRODUCTION: The pneumology in developing countries is practiced in a singular context: population mostly younger, endemic tuberculosis, high prevalence of HIV infection and growing pollution. OBJECTIVE: The aim of this study is to present respiratory pathology evolution in hospitalization of pneumology department in black Africa. METHODOLOGY: Our study is retrospective and descriptive. We consulted the register of hospitalization activities from January 1998 to December 2007. RESULTS: The age group of 20-49 years represents 78.36% of all patients. Tuberculosis (TB) remains the first affection from 1998 to 2007 with a frequency varying between 38.2% and 45.2%. The cases of pneumonia are in regression since 2001, but cases of febrile alveolar interstitial pneumonia (FAIP) increase. The pathologies bound to tobacco addiction are rare. HIV infection is associated to TB (82.86%), to pneumonia (77.22%), to FAIP (92.23%). On 832 cases of death recorded, 46.15% of deaths are assigned to TB, 15.98% to pneumonia and 14.66% to FAIP. The global lethality of the TB and the pneumonia is respectively 20.1% and 17.6%. The one of FAIP is 32.5%. Mortality attributable to TB and pneumonia decreases progressively but the one attributable to FAIP remains important. CONCLUSION: Respiratory pathology is dominated by TB, pneumonia and FAIP. These pathologies associated to HIV infection cause a strong mortality.

[Non-tuberculous pleural infections versus tuberculous pleural infections]. / Atteintes pleurales non tuberculeuses versus atteintes pleurales tuberculeuses.

INTRODUCTION: In countries where tuberculosis is endemic, the main differential diagnosis for pleural infection by common bacteria is pleural tuberculosis. OBJECTIVE: The purpose of our study was to determine the differences between pleural infection by common bacteria and that caused by pleural tuberculosis. METHODOLOGY: Our study was a retrospective analysis and compared the characteristics of confirmed pleural infection by common bacteria (PIB) and that due to pleural tuberculosis (PT). RESULTS: For the PIB, the signs evolved for 2.4 ± 1.4 weeks versus 5.6 ± 2.2 weeks for the PT (P=0.01). In multivariate analysis, for PIB the onset of symptoms was more abrupt (OR=3.8 [1.5; 9.9]; P=0.01), asthenia was less frequent (OR=0.3 [0.1; 0.9]; P=0.03), pleural liquid was more purulent (OR=40.0 [15.0; 106.7]; P<0.01). The blood neutrophil count was more frequently raised in cases of PIB (OR=2.5 [1.2; 5.4]; P=0.02). Pneumothorax/hydropneumothorax was less frequent in PIB (OR=0.3 [0.1; 1.0]; P=0.04). CONCLUSION: Clinical differences exist between pleural effusions caused by tuberculosis (TB) and those due to other bacterial infections. However, they are not sufficiently sensitive and therefore the search for the tuberculous bacillus must be systematic while waiting for implementation of new diagnostic tests for the organism.

[Clinical manifestations related to kitchen biomass smoke in African women]. / Manifestations cliniques liées à la fumée de cuisine chez les femmes en milieu africain.

CONTEXT: Fires of wood and charcoal play an essential part in the cooking of food in Africa. These fires emit thick smoke that has definite health consequences. OBJECTIVES: To determine the clinical manifestations related to kitchen smoke and to identify the type of fire most often incriminated. METHODS: It was a transverse study comparing the clinical features in women using three types of fire: wood, charcoal and gas. We questioned 200 women in each group who used one type of fire exclusively for five days a week for at least five years. RESULTS: Clinical manifestations associated with the smoke were reported in all the women using wood as opposed to 98.5% using charcoal and 45.5% using gas. More than 80% had physical signs. These comprised 89.1% upper respiratory and 77% pulmonary signs. Upper respiratory signs were the most common, mainly sneezing and nasal obstruction. At the pulmonary level, a predominance of signs was found in women using wood fires (47.3%) and charcoal (36.2%), the difference being statistically significant. The signs included chronic cough, chest pain and dyspnoea. Wheezes were found in 15% of the women. CONCLUSION: Cooking smoke exposes women to complications which are most frequently associated with the use of wood or charcoal.

[Predictive factors of lost to follow-up status during tuberculosis treatment]. / Facteurs prédictifs du statut « perdus de vue ¼ au cours du traitement de la tuberculose.

INTRODUCTION: Patients with contagious tuberculosis who are lost to follow-up risk sowing the disease among their circle of acquaintances. Moreover, a history of inadequate anti-tuberculous treatment is an important risk factor for the development of drug-resistant organisms. The purpose of this study was to identify risk factors for loss to follow-up among patients undergoing treatment for tuberculosis. METHODOLOGY: We performed a prospective cohort study among patients with contagious tuberculosis, beginning with anti-tuberculous treatment followed during six months, after initial education-information about their condition. We compared the characteristics of 152 patients lost to follow-up from tuberculosis treatment against those of 492 patients who were not lost to follow-up. RESULTS: Independent factors associated with a reduction in the risk of being lost to follow-up were: the presence of night-sweats (OR=0.46 [0.24-0.88]; P=0.018), the presence of thoracic pain (OR=0.27 [0.14-0.54]; P<0.001), screening for HIV (OR=0.41 [0.17-0.98]; P=0.045), fact to inform a person of its disease (OR=0.06 [0.01-0.41]; P=0.004), the application of directly observed treatment in the community (OR=0.34 [0.17-0.66]; P<0.001). CONCLUSION: Reducing loss to follow-up during treatment for tuberculosis requires the development of a "good attitude" through education-information about tuberculosis.

[Contribution of the surgical treatment of drug-resistant tuberculosis during medical follow-up (experience of the pneumology department of the CHU of Cocody, in connection with five observations)]. / Apport du traitement chirurgical de la tuberculose à bacilles résistants au cours du suivi médical (expérience du service de pneumologie du CHU de Cocody : à propos de cinq observations).

Multidrug resistance is defined as a resistance to two major antituberculosis drugs, which are isoniazid and rifampicin. The aim of the study was to specify the place of the thoracic surgery during the medical follow-up of the TB-MDR. Five files were kept over six years during this retrospective study. On the clinical and radiological level, localised lesions and a negative HIV serology were noted in the five patients. The completion date of the surgery varied between the third month and the 22nd after the beginning of the medical treatment. This delay in carrying out the surgery was encouraged by the social conditions of the patients. Three series of expectoration culture post-surgery were all negative. After surgery, the medical treatment was drawn out over six and 12 months depending on the clinical condition of the patient. No recurrence was observed. Only one patient died one year after the surgery from hemoptysis in relation to pulmonary sequelae.

[Multi-drug resistance of tuberculosis: 81 patients monitored in an Ivory Coast pneumology unit]. / Tuberculose multirésistante: à propos de 81 patients suivis dans un service de pneumologie en Côte d'Ivoire.

BACKGROUND: The Ivory Coast management of chronic tuberculosis (TB) began in 2000. OBJECTIVES: The aim of this study is to determine the characteristics of the patients monitored for chronic TB and note the difficulties in patient management and outcome. METHOD: A retrospective review of the medical records of the patients receiving second-line treatment for chronic tuberculosis for at least 12 months. RESULTS: Eighty-one medical records were included. The average of age was 33.37 years. The sex ratio was 2.68. All of the patients lived in conditions of promiscuity. The recommendations for the treatment of failures and relapses were not always respected: 33.33% did not comply with the protocols, 53.1% non-prescription of the mycobiogramme and 22.2% non-respect for the follow-up calendar. During the diagnosis of the chronic tuberculosis, bilateral radiological lesions were found in 72.5% of the cases and one lung was destroyed in 14.7% of the cases. The isolates were Mycobacterium tuberculosis. The multi-drug-resistance of Mycobacterium tuberculosis was estimated at 95.5%. The side effects of the treatments were polymorphous with a frequency ranging from 46.4% to 61.3% during the follow-up period. The outcome of the patients is the following: 39.2% dropped out; 15.2% died; 30.4% were in the attack phase; 5.1% were cured; 5.1% were in the consolidation phase. CONCLUSION: The results of the treatment are disappointing. It is urgent to develop a strategy to reduce the number of drop-outs and provide the early diagnosis and treatment of multi-drug resistant tuberculosis.