Medicinal plant use and adherence problems to TB treatment.

BACKGROUND: Good adherence is essential in the treatment of TB. The aim of this study was to describe medication consumption patterns and to assess factors associated with adherence to TB treatment among TB patients in Lomé, Togo.METHODS: A cross-sectional study was conducted among TB patients in 10 health structures in Lomé from September 2019 to January 2020. TB patients aged ≥18 years and under treatment for at least 2 months were eligible for this study. Adherence to TB treatment was assessed using the Girerd compliance test.RESULTS: A total of 195 TB patients (61.5% male) with a median age of 35 years (IQR 27-44) were recruited. TB-HIV coinfection was 11.3%. Polypharmacy (≥5 medications/day) and using medicinal plants were observed in respectively 6.2% and 42.6% of patients. Prevalence of TB treatment adherence problems was 68.2% (95% CI 61.2-74.7). Being <35 years (aOR 2.79; P = 0.005) and taking medicinal plants (aOR 4.31; P < 0.001) were associated with TB treatment adherence problems.CONCLUSION: Treatment adherence problems, a major obstacle to TB elimination, are highly prevalent in TB patients in Lomé, and were associated with the use of medicinal plants. Reasons for the use of medicinal plants should be documented in order to propose appropriate interventions to reinforce adherence to TB treatment.

[A case of diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH) syndrome]. / Un cas clinique de syndrome d'hyperplasie neuroendocrine pulmonaire diffuse idiopathique (DIPNECH).

INTRODUCTION: DIPNECH is a strictly histological entity according to the WHO 2015 classification and is considered to be at pre-neoplastic risk. It has been proposed that DIPNECH syndrome should be used to describe patients have clinical symptoms, an obstructive ventilatory disorder and compatible radiological abnormalities. The diagnosis is histological and usually based on a surgical lung biopsy. CASE REPORT: We report the case of a 58-year-old woman with a chronic cough for over 20years who had an obstructive airway pattern on spirometry. Diagnoses of asthma and COPD had been discussed. After 7years of follow-up, the DIPNECH hypothesis was evoked on the scanning aspect of mosaic attenuation, expiratory trapping and micronodules, which was subsequently confirmed by surgical pulmonary biopsy. CONCLUSION: It is necessary to consider the possibility of this rare disease in order to avoid inappropriate treatments and in the hope that future therapeutic advances (somatostatin analogs, mTOR inhibitors) improve patients' experience and the progression of respiratory function.

Rheumatoid arthritis-associated lung disease in black Africans: Descriptive study of 28 cases in Lomé.

BACKGROUND: Several studies have shown that lung disease is a common extra-articular manifestation of rheumatoid arthritis (RA). OBJECTIVES: To describe the lung manifestations in the RA population in Lomé, Togo. METHODS: The study was conducted from October 2018 to July 2019 at the pulmonology unit of the Sylvanus Olympio University teaching hospital, in collaboration with rheumatology centres in Lomé, Togo. Patients meeting the American College of Rheumatology criteria for RA were prospectively enrolled. They underwent clinical examination, spirometry, a 6-minute walk test (6MWT) and a chest X-ray (CXR). All information collected and surveys gathered were subjected to statistical analysis. RESULTS: Twenty-four out of 28 patients were women (85.7%). The mean (standard deviation (SD)) duration of illness was 4.1 (2.8) years. Thirteen patients out of 28 (46.4%) had respiratory symptoms. On CXR, interstitial lung disease was the only pleuropulmonary lesion (17.8%). Spirometry was abnormal in 25% of cases, with a predominance of restrictive ventilatory disorder (21.4%). The 6MWT was abnormal in 25% of patients. A total of 20 patients (71.4%) had at least one lung manifestation. We noted that there were significantly more patients with respiratory symptoms and no radiographical abnormalities than those with both respiratory symptoms and radiographical abnormalities (p=0.013). CONCLUSION: Lung changes affect a significant proportion of RA patients in Lomé. Studies conducted with appropriate respiratory investigations and combining cardiovascular explorations will bring us closer to an understanding of the effects of RA-associated lung disease.

Prevalence of multidrug-resistant tuberculosis cases among HIV-positive and HIV-negative patients eligible for retreatment regimen in Togo using GeneXpert MTB/RIF.

Drug-resistant tuberculosis (TB) is emerging as an important health problem in Togo. From sputum of previously treated TB patients, multidrug-resistant (MDR) TB was diagnosed in 24% (10/42) patients via GeneXpert MTB/RIF compared to 25% (6/24) patients via conventional drug susceptibility testing (BACTEC MGIT 960 system). The agreement between these two methods to detect MDR-TB is excellent. However, GeneXpert MTB/RIF offers the advantage of rapidly detecting Mycobacterium tuberculosis complex in sputum samples in instances where the cultures are negative (33%, 14/42) or contaminated (9.5%, 4/42). GeneXpert MTB/RIF permitted us to estimate the prevalence of MDR-TB in previously treated TB patients and to improve TB diagnostics among HIV-positive and -negative patients in Togo, where culturing M. tuberculosis complex from sputum samples is challenging.

[HIV/TB co-infection in rural settings of Benin: case of the Djougou-Ouake-Copargo sanitary district (north-west Benin)]. / Co-infection VIH/Tuberculose en milieu rural au Benin: cas de la zone sanitaire Djougou-Ouake-Copargo (nord-ouest Benin).

AIMS: we measured the burden of TB/HIV co-infection in a rural setting of Benin, and assessed the outcome of tuberculosis treatment at the end of the intensive phase of TB treatment. METHODS: This is a retrospective, cross-sectional, descriptive study, covering January 2006 to December 2011. RESULTS: A total of 256 patients were included, 67 (26.1%) were HIV +. A minority, 25% of co-infected HIV / PTB, had TB bacilli high density (+++) versus 45% of mono-infected (P = 0.005). The smear conversion was obtained in 96% of coinfected versus 93% in HIV- at the end of the intensive phase (P = 0.5). The cure rate was 86% and 93.1% respectively in co-infected and HIV-. A proportion of 13.5% of co-infected died versus 3% in HIV- (P = 0.005). 21% of co-infected with CD4 <200 died versus 3.6% of those with CD4> 200 (P = 0.041). CONCLUSION: This work underlines the high prevalence of HIV / TB co-infection in this region. Co-infected patients respond well to treatment, but their mortality is high when they are very immunocompromised.

BUTS: nous avons mesuré le fardeau que constitue la co-infection VIH/ tuberculose chez des tuberculeux en milieu rural au Bénin ; et évaluer l'issue du traitement antituberculeux à la fin de la phase intensive. MÉTHODES: Il s'agit d'une étude transversale rétrospective, descriptive couvrant Janvier 2006 à Décembre 2011. RÉSULTATS: Au total 256 patients ont été colligés, 67 (26,1%) étaient VIH+. Une proportion de 25 % des co-infectés VIH/TPM+ avaient une densité bacillaire à trois croix (+++) contre 45% des tuberculeux VIH- (P=0,005). La négativation de la bacilloscopie était obtenue chez 96% des patients co-infectés contre 93% chez les tuberculeux VIH- à la fin de la phase intensive (P=0,5). Le taux de guérison était respectivement de 86% et 93,1% chez les co-infectés et les non VIH. Une proportion de 13,5% des co-infectés étaient décédés contre 3% chez les VIH- (P=0,005). 21% des co-infectés ayant un CD4<200 étaient décédés contre 3,6% de ceux dont le CD4>200 (P=0,041). CONCLUSION: Ce travail souligne la forte prévalence de l'infection par le VIH chez les tuberculeux de cette région. Les co-infectés répondent bien au traitement, mais leur taux de mortalité est plus élevé, surtout s'ils sont très immunodéprimés.

[HIV/TB co-infection in rural settings of benin: case of Djougou-Ouake-Copargo district (north-west Benin]. / Co-infection VIH/Tuberculose en milieu rural au benin: cas de la zone sanitaire Djougou-Ouake-Copargo (Nord-ouest Benin).

AIMS: We measured the burden of HIV/tuberculosis (HIV/TB) co-infection in people infected by TB in rural settings of Benin, and assessed the outcome of TB treatment at the end of the intensive phase. METHODS: This is a retrospective, cross-sectional, descriptive study, covering January 2006 to December 2011. RESULTS: A total of 256 patients were gathered, 67 (26.1%) were HIV +. A proportion of 25% of co-infected HIV / PTB had TB bacilli high density (+++) versus 45% of mono-infected (P = 0.005). The smear conversion was obtained in 96% of coinfected versus 93% in HIV- at the end of the intensive phase (P = 0.5). The cure rate was 86% and 93.1% respectively in co-infected and HIV-. A proportion of 13.5% of co-infected died versus 3% in HIV- (P = 0.005). 21% of co-infected with CD4 <200 died versus 3.6% of those with CD4> 200 (P = 0.041). CONCLUSION: This work underlines the high prevalence of HIV / TB co-infection in this region. Co-infected patients respond well to treatment, but their mortality is high when they are very immunocopromissed.

BUTS: Nous avons mesuré le fardeau que constitue la co-infection VIH/ tuberculose chez des tuberculeux en milieu rural au Bénin; et évaluer l'issue du traitement antituberculeux à la fin de la phase intensive. MÉTHODES: Il s'agit d'une étude transversale rétrospective, descriptive couvrant Janvier 2006 à Décembre 2011. RÉSULTATS: Au total 256 patients ont été colligés, 67 (26,1%) étaient VIH+. Une proportion de 25 % des co-infectés VIH/TPM+ avaient une densité bacillaire à trois croix (+++) contre 45% des tuberculeux VIH- (P=0,005). La négativation de la bacilloscopie était obtenue chez 96% des patients co-infectés contre 93% chez les tuberculeux VIH- à la fin de la phase intensive (P=0,5). Le taux de guérison était respectivement de 86% et 93,1% chez les co-infectés et les non VIH. Une proportion de 13,5% des co-infectés étaient décédés contre 3% chez les VIH- (P=0,005). 21% des co-infectés ayant un CD4<200 étaient décédés contre 3,6% de ceux dont le CD4>200 (P=0,041). CONCLUSION: Ce travail souligne la forte prévalence de l'infection par le VIH chez les tuberculeux de cette région. Les co-infectés répondent bien au traitement, mais leur taux de mortalité est plus élevé, surtout s'ils sont très immunodéprimés.

Prevalence of latent TB infection in HIV infected persons in the Sylvanus Olympio teaching hospital of Lomé.

OBJECTIVE: Determine the prevalence of latent TB infection in HIV-infected people. METHOD: Using a cross-sectional study on HIV-infected persons monitored in the Department of Lung and Infectious Diseases of CHU Sylvanus Olympio of Lomé from August 10, 2010 to November 10, 2010. All patients are receiving anti-retroviral therapy and have no clinical or radiological symptoms of TB, and had never received tuberculin skin test (TST) in the last 3months. The CD4 rate of all patients was more than 200cells/µl. The diagnosis of latent TB infection is based on the measurement of at least 5mm of skin induration, 72h after a subcutaneous injection of 5IU of purified tuberculin. RESULTS: One hundred and fifty four persons were included in the study, of which 107 were female and 47 were male. The median age was 40years old. Eleven patients were exposed to a risk of TB and only 70.7% of patients had a BCG scar. A suspicion of former TB was found in 18.8% of patients and approximately 45% of patients were very immunocompromised with a CD4 rate between 200 and 350; 117 patients had a positive TST. This represents an overall prevalence of 76% of latent TB infection. CONCLUSION: The prevalence of latent TB infection obtained with the TST is high in this study. A similar study using the interferon-gamma release assay, which is more specific, would be more helpful to obtain more reliable epidemiological data on patient outcomes and to determine the appropriateness of the use of chemoprophylaxis with isoniazid.

[Becoming new pulmonary tuberculosis patients with sputum smear-positive at the end of second month of anti tubercular treatment in Lome]. / Devenir des nouveaux patients tuberculeux pulmonaires a bacilloscopie positive a la fin du deuxieme mois de traitement antituberculeux a Lome.

AIMS: To determine the frequency of the new smear-positive pulmonary tuberculosis patients at the end of the second month of anti-tuberculosis treatment and to analyze the outcomes of their treatment. PATIENTS AND METHOD: It was a retrospective comparative study from January 2006 to June 2008, based on the analysis of the records and treatment cards from the diagnosis and treatment centers of Lome. New sputum smear-positive tuberculosis patients at the end of the second month (smear positive 2 months) constituted the study population. A comparison group consisted of the new tuberculosis patients with sputum smear-negative at the end of the second month (negative smear 2 months). RESULTS: The proportion of sputum smear-positive at 2 months was 5.34% (163/3050). Cure and failure rates were respectively 69.3% and 17.2% for smear-positive 2 months versus 79.1% and 3.7% for control group. The death rate was similar in both groups (3% and 3.7%). CONCLUSION: The smear positive 2 month's patients have a high risk of failure and must receive special attention during their follow-up to improve the results of treatment.

BUT: Déterminer la fréquence des nouveaux patients tuberculeux pulmonaire à bacilloscopie positive à la fin du 2ème mois de traitement antituberculeux et analyser les résultats de leur traitement. PATIENTS ET MÉTHODE: Il s'agissait d'une étude rétrospective comparative de janvier 2006 à juin 2008, basée sur l'analyse des registres et les cartes de traitement de tuberculose des centres de diagnostic et de traitement de Lomé. Les nouveaux patients tuberculeux à bacilloscopie positive à la fin du deuxième mois (frottis mois 2 positif) constituaient la population de l'étude. Un groupe de comparaison était constitué avec les nouveaux patients tuberculeux à bacilloscopie négatif à la fin du deuxième mois (frottis mois 2 négatif). RÉSULTATS: La proportion des frottis mois 2 positif était de 5,34 % (163/3050). Les taux de guérison et d'échec étaient respectivement de 69,3% et de 17,2% chez les frottis 2 positif contre 79,1% et 3,7 % chez les frottis 2 négatif. Le taux de décès était similaire dans les deux groupes (respectivement 3% et 3,7%). CONCLUSION: Les patients à frottis 2 positif ont un risque élevé d'échec et doivent bénéficier d'une attention particulière au cours de leur suivi afin améliorer les résultats de leur traitement.

[Prevalence of HIV-TB co-infection and impact of HIV infection on pulmonary tuberculosis outcome in Togo]. / Prévalence de la co-infection VIH-tuberculose et impact de l'infection VIH sur l'évolution de la tuberculose pulmonaire au Togo.

The aim of this study was to determine the prevalence of HIV infection in tuberculosis patients and its impact on the TB treatment. We enrolled 569 pulmonary TB patients in four diagnosis and treatment centres in Togo. All patients were new TB cases and received the first-line TB drugs: two months of rifampicin-pyrazinamide-isoniazid-ethambutol and six months of isoniazid-ethambutol. HIV testing was done according to the national guidelines, using rapid diagnosis tests. The CD4 lymphocyte counting was performed by Facscalibur (BD, Sciences) for all HIV-positive patients. Of the 569 TB patients enrolled, 135 (23.7%) were HIV positive (TB/HIV+). HIV prevalence was 22.4% (76 of 339) among men and 25.6% (59 of 230) among women without statistical difference. The global rate of treatment success was 82.2%. The rate of treatment success was lower (64.3%) in TB/HIV+ patients than in TB/HIV- patients (87.5%) (p <0.01). The mortality rates were 25.6% and 11.8% in TB/HIV+ patients and TB/HIV- patients, respectively, with a statistically significant difference (p <0.01). We did not found any statistical difference between the rates of treatment success among TB/HIV- (87.5%) patients and TB/HIV+ patients who had TCD4 lymphocyte counts above 200/µl (84.4%). TB program in Togo must take into account HIV infection to improve its performance.

Attitudes of private pharmacists in the management of asthma patients in Lomé.

BACKGROUND: Optimal asthma management requires interventions by a number of health professionals, including pharmacists. OBJECTIVE: To assess the attitudes of pharmacists towards asthma patients and to evaluate their knowledge about how to use the metered dose inhaler. METHODS: A descriptive survey through self-administered questionnaire was conducted among pharmacists in private pharmacies in Lomé, Togo. Pharmacists who did not respond before the sixth round of the investigator were excluded from the study. RESULTS: The participation rate was 76.4%. All pharmacists stated that asthma patients visited their pharmacies during and/or between acute episodes. Some asthma patients visited the pharmacies without prior medical prescription. Asthma drugs were delivered without medical prescription, particularly during acute episodes. In case of acute episodes, care was provided by 51.2% of pharmacists. Aerosol devices were the most widely used treatment, although the technical procedures required for correct inhalation were found to be poorly understood by 27.4% of the pharmacists. Pharmacists provided recommendations to patients on long-term treatment, regular medical follow-up and avoidance of allergens and tobacco smoking. CONCLUSION: Rather than limiting their action to dispensing drugs, pharmacists can also become involved in educating asthma patients.

Prevalence of symptoms of asthma, rhinitis and eczema in 13- to 14-year-old children in Africa: the International Study of Asthma and Allergies in Childhood Phase III.

Phase I of the International Study of Asthma and Allergies in Childhood has provided valuable information regarding international prevalence patterns and potential risk factors in the development of asthma, allergic rhinoconjunctivitis and eczema. However, in Phase I, only six African countries were involved (Algeria, Tunisia, Morocco, Kenya, South Africa and Ethiopia). Phase III, conducted 5-6 years later, enrolled 22 centres in 16 countries including the majority of the centres involved in Phase I and new centres in Morocco, Tunisia, Democratic Republic of Congo, Togo, Sudan, Cameroon, Gabon, Reunion Island and South Africa. There were considerable variations between the various centres of Africa in the prevalence of the main symptoms of the three conditions: wheeze (4.0-21.5%), allergic rhinoconjunctivitis (7.2-27.3%) and eczema (4.7-23.0%). There was a large variation both between countries and between centres in the same country. Several centres, including Cape Town (20.3%), Polokwane (18.0%), Reunion Island (21.5%), Brazzaville (19.9%), Nairobi (18.0%), Urban Ivory Coast (19.3%) and Conakry (18.6%) showed relatively high asthma symptom prevalences, similar to those in western Europe. There were also a number of centres showing high symptom prevalences for allergic rhinoconjunctivitis (Cape Town, Reunion Island, Brazzaville, Eldoret, Urban Ivory Coast, Conakry, Casablanca, Wilays of Algiers, Sousse and Eldoret) and eczema (Brazzaville, Eldoret, Addis Ababa, Urban Ivory Coast, Conakry, Marrakech and Casablanca).