[Kanamycin-induced ototoxicity during treatment of multidrug-resistant tuberculosis]. / Ototoxicité liée à la kanamycine au cours du traitement de la tuberculose multirésistante.

INTRODUCTION: Aminoglycosides are commonly used in the treatment of multidrug-resistant tuberculosis (MDR-TB). Their use can cause ototoxicity with irreversible hearing loss. The aim of this study was to determine the incidence and to identify factors associated to kanamycin-induced ototoxicity during MDR-TB treatment in Yaounde. METHODS: The records of patients hospitalized in the pulmonology department of the Jamot Hospital of Yaounde between May 2008 and July 2015 (7 years) for treatment of MDR-TB with regimens containing kanamycin were analyzed. Logistic regression was used to identify for factors associated with ototoxicity during this treatment. RESULTS: Of the 79 patients included, 60.7% were male and their median age (25th-75th percentile) was 31 (25-43) years. Eighteen (22.8%) patients had HIV infection. During treatment, the incidence of kanamycin-induced ototoxicity [95% confidence interval (95% CI)] was 36.7 (26.9-47.7) %. Factors independently associated with this ototoxicity [odds ratio (95% CI)] during MDR-TB treatment were age>40 years [13.47 (3.66-49.49)] and a body mass index<18.5kg/m2 [4.58 (1.36-15.44)]. CONCLUSION: The incidence of kanamycin-induced ototoxicity during MDR-TB treatment is relatively high. Taking these factors into consideration at the initiation of MDR-TB treatment would allow to reduce the occurrence of irreversible functional impairment induced by the treatment of MDR-TB.

Implementation of blanket provider-initiated testing and counselling: Predictors of HIV seropositivity among infants, children and adolescents in Cameroon.

Objectives: The number needed to test (NNT) to identify a child infected with HIV remains high in the context of the implementation of the blanket provider-initiated testing and counselling (bPITC) strategy. This study assessed the predictors of HIV seropositivity among outpatient children/adolescents (6 weeks-19 years) in Cameroon. This information is needed to improve the yield of bPITC and reduce the current gap in pediatric and adolescent ART coverage in this country and beyond. Study design: Cross-sectional study conducted in 3 hospitals in Cameroon. Methods: Through biological parents and guardians we systematically invited children and adolescents visiting the outpatient departments for any reason to test for HIV (bPITC) in a 6-month period. Children and adolescents were tested for HIV following the national guidelines and the predictors of HIV seropositivity were assessed using multivariate logistic regression at 5% significant level. Results: A total of 2729 eligible children/adolescents were enrolled. Among these, 90.3% (2465/2729) were tested for HIV. Out of these, 1.6% (40/2465) tested HIV-positive, corresponding to a NNT of 62. In multivariate analysis, HIV seropositivity was 2.5, 3.3, and 5 times more likely to be reported among children/adolescents of the female sex [aOR â€‹= â€‹0.4 (0.2-0.8), p â€‹= â€‹0.008]; whose fathers had no formal school education [aOR â€‹= â€‹0.3 (0.1-0.6), p â€‹= â€‹0.004] and those whose mothers had died [aOR â€‹= â€‹0.2 (0.0-0.9), p â€‹= â€‹0.041], respectively. Conclusions: Focusing HIV testing among female children/adolescents, whose fathers had no education level and whose mothers had died could reduce the NNT, improve the yield of bPITC and increase the pediatric and adolescent ART coverage.

Gatifloxacin is superior to levofloxacin and moxifloxacin in shorter treatment regimens for multidrug-resistant TB.

SETTING: Data were collected from patients starting one of the shorter treatment regimens (STRs) for multidrug-resistant tuberculosis (MDR-TB) in Bangladesh, Niger or Cameroon.OBJECTIVE: To estimate the effect of either a gatifloxacin (GFX), moxifloxacin (MFX) or levofloxacin (LVX) based STR on bacteriological effectiveness.DESIGN: Retrospective study of prospectively collected data.RESULTS: Among 1530 patients, bacteriological effectiveness was 96.7% overall. Stratified by treatment with a GFX-, LVX- or MFX-based regimen effectiveness was respectively 97.5%, 95.5% and 94.7%. Compared to those on a GFX-based regimen, the estimated summary odds ratio of having an adverse outcome was more than double (OR 2.05, 95% CI 1.09-3.90) in patients treated with either an LVX-based or MFX-based regimen. After adjusting for initial resistance, patients treated with an LVX-based regimen and MFX-based regimen had respectively a 4.5- and 8.4-fold times larger odds of an adverse bacteriological outcome. None among 859 patients at risk treated with a GFX-based compared to at least 4 of 228 among those on an MFX-based regimen acquired fluoroquinolone resistance.CONCLUSION: GFX-based regimens had superior bacteriological effectiveness than MFX-based or LVX-based regimens. As GFX is currently unavailable in most MDR-TB programs, its reintroduction should be prioritised.

Heterogeneity of virological suppression in the national antiretroviral programme of Cameroon (ANRS 12288 EVOLCAM).

OBJECTIVES: In terms of HIV infection, western and central Africa is the second most affected region world-wide, and the gap between the regional figures for the testing and treatment cascade and the Joint United Nations Programme on HIV/AIDS (UNAIDS) 90-90-90 targets is particularly worrying. We assessed the prevalence of virological suppression in patients routinely treated in 19 hospitals in Cameroon. METHODS: A cross-sectional survey was performed in adult patients receiving antiretroviral therapy (ART) in the Centre and Littoral regions. The prevalences of virological suppression (<1000 HIV-1 RNA copies/mL) were compared among all 19 hospitals using the χ2 test. Potential individual and health care-related determinants of virological suppression were assessed using multivariate logistic regression models. RESULTS: A total of 1700 patients (74% women; median age 41 years; median time on ART 3.7 years) were included in the study. The prevalence of virological suppression was 82.4% overall (95% confidence interval 80.5-84.2%). It ranged from 57.1 to 97.4% according to the individual hospital (P < 0.001). After adjustment, virological suppression was associated with age, CD4 cell count at ART initiation, disclosure of HIV status to family members, interruption of ART for more than two consecutive days, and location of patient's residence and hospital (rural/urban). These factors did not explain the heterogeneity of virological suppression between the study hospitals (P < 0.001). CONCLUSIONS: The overall prevalence of virological suppression was reassuring. Nevertheless, the heterogeneity of virological suppression among hospitals highlights that, in addition to programme-level data, health facility-level data are crucial in order to tailor the national AIDS programme's interventions with a view to achieving the third UNAIDS 90 target.

Rifampicin resistance in new bacteriologically confirmed pulmonary tuberculosis patients in Cameroon: a cross-sectional survey.

OBJECTIVE: In Cameroon, tuberculosis (TB) cases are diagnosed and treated within a nationwide network of 248 diagnostic and treatment centres. In 2016, the centers notified a total of 175 multidrug-resistant (MDR-)TB cases, most of them retreatment cases. According to the WHO, the expected number of MDR-TB cases was estimated to be 1200 (1000-2200) corresponding to a rate of 6.8 (4.3-9.4) per 100,000 population. This indicates a notification gap of more than 80%. The objective of this study was to estimate the prevalence of MDR-TB in new bacteriologically confirmed pulmonary TB cases. We undertook a nationwide cross sectional survey during 6 weeks. RESULTS: During the study period, the NTP notified 1478 new bacteriologically confirmed pulmonary TB cases. Among them, 1029 (70%) had a valid Xpert result and 16 were identified with rifampicin resistant (RR-TB), a tracer of MDR-TB. This gives a prevalence of 1.6% (95% CI 0.8-2.3) among incident cases. The rate of RR-TB in the regions varied between 0 and 3.3%. If the results of this study are confirmed, the incidence rate given by WHO (2.8%, 95% CI 2.1-3.4) might be an over-estimation.

Pre-treatment loss to follow-up of pulmonary tuberculosis patients in two regions of Cameroon.

SETTING: Thirty-nine tuberculosis diagnosis and treatment units (DTUs) in the North-West and South-West Regions of Cameroon. OBJECTIVE: To determine the proportion of pre-treatment loss to follow-up (PLTFU) of bacteriologically confirmed pulmonary tuberculosis (PTB) patients and its risk factors. DESIGN: A retrospective cohort study was conducted to retrieve information from the TB laboratory and treatment registers for all bacteriologically confirmed PTB patients diagnosed in the 39 DTUs during the last 6 months of 2015. PLTFU was defined as failure to initiate treatment within 7 days of diagnosis. RESULTS: Among 1174 bacteriologically confirmed PTB cases, the proportion of PLTFU was 16.7% (95%CI 14.7-18.9). In the multivariable logistic regression model, travelling >30 km to the DTU was a risk factor for PLTFU (adjusted odds ratio [aOR] 2.31, 95%CI 1.63-3.27) compared with travelling 30 km. Travelling for >30 min to the DTU (aOR 2.19, 95%CI 1.56-3.09) and an urban location of DTU (aOR 2.51, 95%CI 1.51-4.17) were also significant risk factors for PLTFU. CONCLUSION: PLTFU among TB patients remains a significant issue despite the availability of free anti-tuberculosis treatment in Cameroon. Diagnosed patients should be promptly and carefully linked to a treatment unit for treatment initiation.

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.

Clinical characteristics and outcomes of tuberculosis in Douala, Cameroon: a 7-year retrospective cohort study.

SETTING: Tuberculosis (TB) clinic, Douala Laquintinie Hospital, Douala, Cameroon. OBJECTIVE: To describe the clinical characteristics of TB and to investigate predictors of poor treatment outcomes. DESIGN: A registry-based, retrospective cohort study of all TB cases recorded from 2007 to 2013 was conducted. Multinomial logistic regression models were used to identify predictors of poor outcomes. RESULTS: Of 8902 TB cases included, 5110 (57.4%) were males. The median age was 33 years. The prevalence of human immunodeficiency virus (HIV) infection was 37.6%, with a significant decline over the study years (P = 0.000). The main clinical form of TB was smear-positive TB (50.5%). The treatment success rate was 75.2%, while the mortality rate was 8.1%. The year of TB diagnosis, retreatment cases, sputum non-conversion at the end of month 2, HIV infection and HIV testing not done were associated with death. Retreatment and non-conversion of sputum were associated with treatment failure, while male sex, age, sputum non-conversion, HIV infection and HIV testing not done were associated with loss to follow-up. CONCLUSION: TB management objectives may be attained by focusing specifically on higher risk groups to prevent poor treatment outcomes.

[Residual pleural opacity in patients treated for pleural tuberculosis in Yaounde]. / Opacité pleurale résiduelle en fin de traitement pour tuberculose pleurale à Yaoundé.

INTRODUCTION: The aim of this study was to evaluate the incidence and risk factors of residual pleural opacity (RPO) at the end and after 6 months (M12) of antituberculosis treatment (ATT) in adults with pleural tuberculosis. METHODS: In this prospective cohort study, all patients admitted for pleural tuberculosis between September 2010 and August 2012 in the pneumology A unit of Yaounde Jamot Hospital were included. Each patient was then followed up for 12 months. RPO was considered significant if it was measured 10mm or more on standard chest X-ray. The logistic regression model was used to investigate the risk factors of significant RPO at the end of antituberculosis treatment. RESULTS: Of the 193 patients included, median (interquartile range) age of 33 (25-42) years, 115 (59.6%) were men. The incidence (95% CI) of significant RPO was 22.0% (14.9-29.1) and 11.0% (4.9-17.1) at the end of ATT and at M12 respectively. In multivariate analysis, the risk factors of the occurrence of a significant RPO at the end of ATT and at M12 were smoking, associated parenchymal lesions, and hypoglycopleuria. CONCLUSION: Cumulative incidence of RPO ≥ 10 mm was 22% at the end of ATT and 11% after 12 months from the beginning of treatment. Patients with risk factors of RPO ≥ 10 mm should benefit from greater surveillance and appropriate management.

High effectiveness of a 12-month regimen for MDR-TB patients in Cameroon.

SETTING: Two specialised multidrug-resistant tuberculosis (MDR-TB) treatment units in Cameroon. OBJECTIVE: To assess outcome and adverse drug events with a standardised 12-month regimen for MDR-TB among second-line drug naïve patients. DESIGN: Prospective observational study of MDR-TB patients treated with a standardised 12-month regimen including gatifloxacin, clofazimine, prothionamide, ethambutol and pyrazinamide throughout, supplemented by kanamycin and isoniazid during an intensive phase of a minimum of 4 months. Progress was monitored monthly until treatment completion and twice over one year after treatment cessation. RESULTS: Eighty-seven potentially eligible patients were lost and never treated due to delayed availability of test results. Among the 150/236 eligible and treated patients, 134 (89%) successfully completed treatment, 10 died, 5 were lost, 1 failed and none relapsed. The patients' mean age was 33.7 years (range 17-68), 73 (49%) were females, 120 (80%) had failed on previous treatment, 30 (20%) were human immunodeficiency virus seropositive, 62 (43%) had a body mass index <18.5 kg/m(2) and 41 (27%) had radiographic involvement of five or six of the six lung zones. The most important adverse drug event was hearing impairment, which occurred in 46 of 106 (43%) patients. CONCLUSIONS: These results add further evidence for the usefulness of shorter, standardised regimens among patients without second-line drug resistance.

[Sensitization to Blomia tropicalis among asthmatic patients in Yaoundé, Cameroon]. / Sensibilisation à Blomia tropicalis chez les patients asthmatiques à Yaoundé, Cameroun.

INTRODUCTION: The aim of this study was to determine the prevalence and investigate associated factors for Blomia tropicalis (BT) sensitization in adolescent and adult patients with asthma in Yaoundé (Cameroon). METHODS: We performed a cross-sectional study of 18 months duration (January 2012 to June 2013). All asthmatic patients who were seen for a consultation during the study period and who had a skin prick testing for perennial aeroallergens were included in the study. RESULTS: Two hundred and one asthmatic patients (132 female patients, 65.7%) with median age (1st-3rd quartiles) of 35 (20-51.5) years were included in the study. Ninety-six (47.8%) patients had positive skin tests to BT. BT sensitization was associated with sensitization to two other dust mites (Dermatophagoides pteronyssinus [DP] and Dermatophagoides farinae [DF]) in 75 (86.2%) patients. The only clinical factor associated with BT sensitization was the presence of persistent rhinitis (odds ratio [confidence interval 95%]: 2.06 [1.12-3.81]). The independent allergenic factors associated with BT sensitization were sensitization to DP (3.49 [CI 95%: 1.49-8.19]), to DF (4.88 [CI 95%: 2.10-11.36]) and to German cockroach (4.16 [CI 95%: 1.72-10.09]). CONCLUSION: Blomia tropicalis sensitization is common in asthmatic patients in Yaoundé. It occurs most often in the context of sensitization to multiple aeroallergens, particularly with sensitization to other dust mites and German cockroach.

Mycobacterium tuberculosis complex strains and drug susceptibility in a cattle-rearing region of Cameroon.

SETTING: Seven district hospitals in the Adamaoua Region of Cameroon, June 2009 to May 2010. OBJECTIVES: To identify species among Mycobacterium tuberculosis complex (MTC) strains responsible for pulmonary tuberculosis (PTB) and determine their susceptibility to anti-tuberculosis drugs. DESIGN: Sputum specimens were collected from 509 consecutively admitted adults and cultured. Identification of cultured strains was mainly based on culture growth characteristics and standard biochemical tests with spoligotyping for confirmation on a subset of strains. Drug susceptibility testing was performed using the indirect proportion method. RESULTS: Growth of MTC strains occurred in specimens of 445/509 (87.4%) patients: 433 (97.3%) were identified as M. tuberculosis, 10 (2.3%) as M. africanum and 2 (0.4%) as M. bovis. The overall resistance rate was 7.9%, with 7.3% resistance in new cases and 21.1% in previously treated cases. Isoniazid resistance in new cases was most common (4.2%), followed by streptomycin (3.3%), rifampicin (1.9%) and ethambutol (0.9%). Multidrug-resistant tuberculosis was more frequent in previously treated than in new cases (10.5% vs. 1.4%, P < 0.05). CONCLUSION: Although the Adamaoua Region is a stock-farming area, M. tuberculosis is the predominant MTC species responsible for PTB. Anti-tuberculosis drug resistance in new and previously treated cases is well established, underscoring the need to reinforce the DOTS strategy.

[The impact of HIV infection on childhood tuberculosis in Yaounde, Cameroon]. / Impact de l'infection à VIH sur la tuberculose de l'enfant à Yaoundé, Cameroun.

OBJECTIVES: To define the prevalence of HIV infection in childhood tuberculosis and investigate its impact on the clinical presentation, radiographic findings and outcomes among children suffering from tuberculosis in Yaounde. METHODS: The medical records of 101 children aged less than 15years, hospitalized with tuberculosis in the chest clinic of the Yaounde Jamot Hospital between January 2005 and June 2010, were retrospectively reviewed. RESULTS: Twenty-five (24.8%) of the 101 patients were HIV positive. The occurrence of concomitant intrathoracic and extrathoracic tuberculosis was more frequently observed in HIV infected children (P=0.021). Parenchymal pulmonary lesions were bilateral in 20 (90.9%) of the HIV infected children against 31 (56.1%) in the non-infected children (P=0.003). Cavitating lesions were present in 49.1% of the cases in HIV negative group versus 13.6% in HIV positive group (P=0.004), but sub-group analysis restricted to those with confirmed tuberculosis no longer showed a significant difference. The success rate of treatment was 78.9% among HIV negative patients and 56% among HIV positive patients (P=0.024). CONCLUSION: HIV infection modifies the clinical presentation and radiographic features of tuberculosis in children. The treatment success rate is lower in HIV positive children, indicating a stricter medical supervision of these children and more targeted education of their parents.

[Impact of HIV infection on the evolution of tuberculosis among adult patients in Yaounde, Cameroon]. / Impact de l'infection à VIH sur l'évolution de la tuberculose de l'adulte à Yaoundé, Cameroun.

BACKGROUND: Tuberculosis and human immunodeficiency virus infection are two major public health problems in sub-Saharan Africa. The aim of this study was to determine the prevalence of HIV infection in all clinical forms of TB and investigate the effects of HIV status on the evolution of tuberculosis. PATIENTS AND METHODS: This is a retrospective study relating to the 1647 adult's tuberculous patients, HIV status was known in 1419 cases which were followed-up at the diagnosis and treatment center for tuberculosis of the Yaounde Jamot Hospital in 2009. RESULTS: The prevalence of HIV infection was of 35% as a whole and 31.3%, 43.3% and 47.7% respectively for the smear positive pulmonary tuberculosis, smear negative pulmonary tuberculosis and extrapulmonary tuberculosis. Compared to HIV negative patients, HIV positive patients were older (36years versus 30years, P<0.0001) and included more women (57.1% versus 37.3%, P=0.001). The treatment success rate was 79% in HIV negative patients and 69% among HIV positive ones. The equivalent for mortality rate was respectively 1.9% and 10.5% (both P<0.001). In HIV positive patients, the death rate was 3.7% among those with CD4 above 200/mm(3) and 13% among those with CD4 below 200/mm(3) (P<0.02). CONCLUSIONS: The HIV infection is frequent among adult patients with tuberculosis in this setting, particularly among patients with smear negative pulmonary tuberculosis or extrapulmonary tuberculosis. It is associated with a high mortality rate especially on patient with severe immunodeficiency in spite of the antiretroviral treatment and prophylaxis with the cotrimoxazole.

[Nontuberculous purulent pleural effusion in adults in Yaounde, Cameroon]. / La pleurésie purulente non tuberculeuse de l'adulte à Yaoundé (Cameroun).

OBJECTIVE: The aim of this study is to analyze current etiologic, bacteriologic and prognostic features of nontuberculous purulent pleural effusion in adults in Yaounde, Cameroon. METHODS: This study prospectively included 54 adults hospitalized for community-acquired nontuberculous purulent pleural effusion in the chest-disease clinic of the Jamot Hospital in Yaounde from August 2007 to July 2010. RESULTS: The study included 34 men and 20 women with a mean age of 40.8 ± 16.4 years. At least one or more predisposing condition or underlying disease was found in 59.2%. The most frequent predisposing condition was HIV infection, seen in 35.2% of patients. In 92.6% of patients (n=50), purulent pleural effusion followed acute bronchopulmonary infection. Positive cultures of pleural fluid were found in half the patients. Streptococcus pneumoniae was the most common bacteria identified (41.4%) followed by Staphylococcus aureus (20.7%). Anaerobic bacteria were isolated in only 13.4% (n=4). Improvement was achieved in 79.6% of patients (n=43) and the in-hospital mortality rate was 3.7%. The mean duration of hospitalization was 26.8±15.6 days. CONCLUSION: This study indicates that HIV infection is the most frequent predisposing condition for community-acquired nontuberculous purulent pleural effusion in adults in Yaounde. The most commonly isolated bacterial pathogen was S. pneumoniae. Although the mortality rate of this disease is low, its prevention by proper management of acute respiratory tract infection is important.

[Clinical characteristics, microbiologic findings and outcome of non-tuberculous purulent pleural effusion in HIV-infected and non HIV-infected adult patients in Yaounde, Cameroon]. / Caractéristiques cliniques, bactériologiques et évolutives de la pleurésie purulente non-tuberculeuse chez les patients adultes séropositifs et séronégatifs au VIH à Yaoundé, Cameroun.

OBJECTIVE: To investigate the impact of HIV infection on clinical presentation, etiologic features and outcome of non-tuberculous purulent pleural effusion in adult patients in Yaounde. METHODS: We prospectively studied 55 consecutive patients aged 15 years and above, hospitalized in chest clinic of Yaounde Jamot Hospital for non-tuberculous purulent pleural effusion from August 2007 to September 2010. RESULTS: Twenty (36.4%) of the 55 patients were HIV-positive and 35 (63.6%) were HIV-negative. The mean age of HIV-positive patients was 37.5±11.7 years compare to 43.2 ±18.5 years on HIV-negative patients (P=0.159). Twelve (60%) HIV-positive patients were females compared to eight (22.6%) of HIV-negative patients (P=0.006). No significant differences were found between the two groups of patients in regard to clinical and radiological features. The mean hemoglobin level was 10.5±2.8g/L in HIV-negative patients and 8.8±2.2g/L in HIV-positive patients (P=0.031). Streptococcus pneumoniae was the most common single bacterial etiology in the two groups with four (50%) cases in HIV-positive and eight (38.1%) cases in HIV-negative. Poor outcome (failure of thoracocenthesis or chest tube drainage and death) was observed in eight (40%) HIV-infected patients and only in four (11.4%) non-infected-HIV patients (P=0.019). CONCLUSION: The prevalence of HIV infection among adult patients with non-tuberculous purulent pleural effusion in Yaounde is high. HIV infection does not seem to have any impact on clinical, radiological and bacteriologic characteristics of patients suffering from purulent pleural effusion, but it seems to modify hematologic parameters of these patients. Failure of thoracocenthesis or chest tube drainage was significantly most frequent in HIV-infected patients.

[Tuberculous pleural effusion in Yaounde, Cameroon: The influence of HIV infection]. / La pleurésie tuberculeuse à Yaoundé, Cameroun: influence de l'infection à VIH.

INTRODUCTION: The objective of this study was to investigate the current impact of HIV infection on the clinical presentation, laboratory features and outcome of tuberculous pleural effusion in adult patients in Yaounde. METHODS: We studied prospectively 196 consecutive patients, aged 15 years and above, hospitalized in the chest clinic of Yaounde Jamot Hospital with tuberculous pleural effusion between October 2007 and February 2010. RESULTS: Eighty-two (41.8%) of the 196 patients were HIV positive. Cough, sputum production, fever, night sweats and weight loss were significantly more common in HIV positive patients than in HIV negative patients. Pulmonary infiltrates were found in 39 (47.6%) of HIV positive patients versus 34 (29.8%) of HIV negative patients (P=0.011). No significant differences were found between HIV positive and HIV negative patients with regard to pleural granuloma formation. The therapeutic success rate was 80.7% among HIV negative patients and 72% among HIV positive patients (P=0.151). CONCLUSIONS: HIV infection modifies the clinical presentation and chest radiographic features of tuberculous pleural effusion, but not pleural granuloma formation or the therapeutic success rate of this affection.

Outcome assessment of a Global Fund grant for tuberculosis control at the district level in rural Cameroon.

SETTING: Batibo District Hospital (BDH), North-West Cameroon. OBJECTIVE: To assess the outcome of the implementation of the Global Fund (GF) Grant Round 3 for tuberculosis (TB) control at the district level. DESIGN: A retrospective study for the period 2003-2008 comparing TB programme outcome indicators before (2003-2005) and after (2006-2008) the GF grant. RESULTS: During the study period 293 TB cases were enrolled on treatment. Comparing the cumulative outcome indicators for smear-positive pulmonary TB cases 3 years before and after the grant, case notification increased by >50%, case detection by almost 50% and treatment success by nearly 20% during the grant period. The case detection rate for smear-positive pulmonary TB nearly doubled, while the treatment success rate reached 100% in 2006. Default and mortality rates dropped to zero in 2006 and 2007 from maximum values of respectively 15% and 23% in 2004 and 2005. However, in 2008, there was a decline across all programme indicators, probably due to staff turnover. CONCLUSION: Outcome indicators of the TB programme in BDH increased markedly following the implementation of the GF grant. Nevertheless, if not tackled appropriately, staff turnover might impede the sustainability of this positive outcome.