[Treatment outcome, survival and their risk factors among new tuberculosis patients co-infected with HIV during the Ebola outbreak in Conakry]. / L'issue du traitement, la survie et ses facteurs de risque chez les nouveaux tuberculeux co-infectés par le VIH pendant l'épidémie d'Ebola à Conakry.

BACKGROUND: Mortality among TB/HIV co-infected patients remains high in Africa. The study aimed to estimate survival and associated factors in a cohort of TB/HIV co-infected patients who started tuberculosis treatment during the Ebola outbreak in Conakry, Guinea. METHODS: A prospective cohort study was conducted from April 2014 to December 2015. TB patients with HIV co-infection were enrolled at the University Hospital of Conakry. Survival and risk factors were analyzed according to Kaplan-Meier's method, log-rank test and Cox's regression. RESULTS: Data from 573 patients were analyzed. From these, 86 (15.0%) died before the end of treatment, 52% occurring within eight weeks of treatment onset. Survival at 4, 12 and 24 weeks after the beginning of the TB treatment was 92%, 86% and 83%, respectively. Independent risk factors associated with death were in the cell CD4 <200 cells/mm3 [adjusted hazard ratio (AHR): 2.25; 95% CI (confidence intervals): 1.16-4.37], opportunistic infections other than TB [AHR: 2.89; 95% CI: 1.39-6.02], and comorbidities [AHR: 4.12; 95% CI: 2.10-8.10]. An increase of one unit in hemoglobin [AHR: 0.81; 95% CI: 0.75-0.91] was protective of death. CONCLUSION: TB/HIV co-infected patients had a higher fatality rate during treatment of tuberculosis. Prevention of opportunistic infections, anemia and proper management of tuberculosis treatment in early comorbidities may improve survival for TB/HIV co-infected patients in restoring immune function.

[Impact of care pathway on the delay for initiation of antituberculosis treatment in Conakry, Guinea]. / Influence des parcours de soins sur le début du traitement antituberculeux à Conakry (Guinée).

Complex care pathways can result in detrimental treatment delay particularly in tuberculosis patients. The purpose of this retrospective study was to assess the care pathways followed by tuberculosis patients prior to diagnosis and to assess impact on the delay for initiation of treatment in Conakry, Guinea. A total of 112 patients were interviewed at the time of first admission for pulmonary tuberculosis with positive bacilloscopy. Based on interview data, pathways were classified as conventional (use of health care facilities only) and mixed (use of health care facilities, self-medication, and traditional medicine). The correlation between patient characteristics and type of pathway was assessed by univariate and multivariate analysis and the two groups, i.e., conventional vs. mixed, were compared with regard to delay for initiation of treatment. The care pathway was classified as mixed in two out of three patients. Multivariate analysis showed that this type of pathway was only correlated with schooling (p=0.02). The mean delay for treatment was similar, i.e., 13.4 and 12.8 weeks for conventional and mixed pathways respectively (p<0.68). The percentage of pathways including three consultations at health care facilities was significantly higher in the conventional than mixed group (72% vs. 30%, p<0.001). The main reasons given for delayed use of health care facilities were poor knowledge of tuberculosis symptoms (26%) and high cost of care (12%). The findings of this study indicate that tuberculosis patients follow a variety of care pathways that can lead to delayed treatment. An information campaign is needed to increase awareness among the population and care providers.

CRA-W's committee of intervention: analyse of catchments polluted with pesticides.

In the Walloon Region of Belgium, a committee of intervention has been created to investigate problems of pesticide contamination of various catchments use for drinking water production. This committee involves the Agricultural Research centre--Wallonia (CRA-W, project coordinator) and some University experts. It is funded by the Société Publique de Gestion des Eaux (SPGE). The diagnosis method, base on the AQUAPLAINE method (Arvatis-France), consists of 4 steps. The first step is the preparation of diagnosis (at the office) that takes into account the paper risk of active ingredients. and their uses, the identification of the agricultural parcels, the collection of cartographic and numeric data, the description of the hydrogeological and pedological contexts and the study of the meteorological data in relation with the period of pollution. The second step consists of making a plot diagnosis (on the field) to identify the way of transfer inside the plot and collecting data. At the third step, the people who can apply PPP treatment close to the catchment are met (farmers and city services). Information are collected on treatments applied and on the state of parcels. Based on the hypothesis of pollution cause, the committee proposes solution to solve the problem. One of the catchment that has been investigated by the committee is located at Biesmerée, (Namur province, in Belgium). A temporally contamination was caused by 4 pesticides : chlortoluron, isoproturon, trifluralin and diflufenican. After investigations, it seems that the pollution was probably due to the hydrogeological context. As the river is locally perched over the aquifer, the presence of Poly-aromatic hydrocarbons (PAHs) could be due to the infiltration of surface water inside the catchment or/and to the presence of a sinkhole temporally activated during river flood period. Infiltration rate has to be assessed and river bank impermeabilization is recommended.

Effect of extended storage on microbiological quality, somatic cell count, and composition of raw goat milk on a farm.

Dairy goat herds in the United States generally are small, widely scattered, and distant from processing facilities. Unlike the situation for cow milk, it is not cost-effective to collect goat milk everyday or every other day. In some areas, goat milk is collected only once each week, which is in violation of regulations specified in the Pasteurized Milk Ordinance for grade A milk. This study was conducted to determine the effect of up to 7 days of refrigerated bulk tank storage on composition, somatic cell count (SCC), pH, and microbiological quality of goat milk. Duplicate farm bulk tank samples were taken daily after the morning milking for seven consecutive days each month during the lactation season. Samples were analyzed immediately for all variables except free fatty acids. There were no significant changes (P > 0.05) detected in milk fat, protein, lactose, nonfat solids, SCC, or pH during extended storage, although significant effects of stage of lactation (P < 0.05) were observed. The mean standard plate count (SPC) increased to 1.8 x 10(5) CFU/ml after 6 days of storage, exceeding the grade A limit (i.e., 1.0 x 10(5) CFU/ml). The mean psychrotrophic bacteria count increased steadily to 1.5 x 10(4) CFU/ml after 6 days of storage, whereas the mean coliform count was approximately 500 CFU/ml for the first 3 days and less than 2500 CFU/ml throughout the 7 days of storage. No significant changes (P > 0.05) in the concentrations of free fatty acids, except for butyric and caprylic acids, were observed during milk storage. When stored under refrigerated and sanitary conditions, goat milk in farm bulk tanks met the grade A criteria for both SPC and SCC during 5 days of storage but was of low quality thereafter because of the growth of psychrotrophic bacteria.

Benefit of amoxicillin in differentiating between TB suspects whose initial AFB sputum smears are negative.

SETTING: Out-patient dispensary in Conakry, Guinea, West Africa. OBJECTIVE: To differentiate between pulmonary tuberculosis (PTB) and non-PTB diseases among 204 acid-fast bacilli (AFB) smear-negative adult TB suspects. DESIGN: We derived scores from clinical, serological and radiological findings among PTB suspects aged > or = 15 years who, after having had three AFB-negative smears, were treated for 10 days with amoxicillin (AMX, 1.5 g/day). RESULTS: At the selected cut-off score from model 1 (clinical), sensitivity for PTB was 95%, specificity 40%, negative predictive value (NPV) 84%, and positive predictive value (PPV) 69%. Comparable values from model 2 (clinical + serological + radiological) were: sensitivity 99%, specificity 45%, NPV 97%, and PPV 71%. Results from AMX were better: sensitivity 92%, specificity 93%, NPV 94%, and PPV 91%. Of the 117 suspects who failed to respond clinically and radiographically to AMX and remained AFB smear-negative, 110 (94%) had PTB, confirmed either by positive culture (73 patients) or response to anti-tuberculosis treatment (37 patients). CONCLUSION: The clinical and radiographic response to AMX is better than derived scores at differentiating between PTB and non-PTB in TB suspects presenting to a dispensary in Guinea, a low HIV-seroprevalence country.

Serological markers of pulmonary tuberculosis and of response to anti-tuberculosis treatment in a patient population in Guinea.

The aim of the study was to evaluate serological correlates of active tuberculosis and of response to antituberculosis treatment in a cohort of HIV-negative patients with pulmonary tuberculosis studied at diagnosis and during treatment at the Service de Pneumo-Phtisiologie, Centre Hospitalier-Universitaire Ignace Deen, Conakry, Republic of Guinea. Two similar cohorts of HIV-negative healthy households of patients and healthy community controls were included in the study. Plasma samples were obtained from 168 untreated tuberculosis patients, 167 healthy household controls, and 168 healthy community controls. Serial plasma samples were also obtained from the tuberculosis patients at 2 and 8 months after initiation of chemotherapy. IgG antibody levels were measured by an enzyme-linked immunosorbent assay (ELISA) using ten purified M. tuberculosis antigens. ELISA results were analysed by comparing geometric means of data. Of the ten antigens tested, five (14kDa Ag, 19kDa Ag, AlaDH, MS, and MPT83) elicited similar antibody responses in untreated TB patients and controls. In contrast, levels of three antibodies (ESAT-6, LAM, and 38kDa Ag) were higher in untreated TB patients than in household or community controls (p<0.0001). Levels were higher in untreated patients than in community controls also for the anti-Rv2626c antibody (p = 0.0001) and, at a lower significance level, for the anti-FdxA antibody (p<0.025). Antibody levels against ESAT-6 and Rv2626c decreased during therapy, while antibody levels to the 38 kDa antigen and LAM increased during therapy; FdxA antibody levels did not vary with treatment. Neither severity of presentation nor chest X-ray patterns affected levels of these antibodies before treatment. In contrast, after the 8-month therapeutic course, patients who presented with moderate/severe disease had higher levels of anti-ESAT-6, anti-FdxA, and anti-38kDa antibodies than those of patients with mild disease onset. Patients with bilateral lung lesions had significantly higher anti-38kDa and anti-LAM levels, both at diagnosis and after 8-month treatment, than patients with lesions involving only one lung. Antibodies to alanine dehydrogenase and malate synthetase measured at initiation of treatment were higher in tuberculosis patients who subsequently failed therapy than in those who were cured. The main conclusions of the study are: a) plasma levels of antibodies to a number of M. tuberculosis represent serological correlates of active disease; b) these correlates are affected in an antigen-specific fashion by anti-tuberculosis treatment; c) particular serological markers may be predictive of treatment outcome.

Investigation of the risk factors for tuberculosis: a case-control study in three countries in West Africa.

BACKGROUND: Host-related and environment-related factors have been shown to play a role in the development of tuberculosis (TB), but few studies were carried out to identify their respective roles in resource-poor countries. METHODS: A multicentre case-control study was conducted in Guinée, Guinea Bissau, and The Gambia, from January 1999 to March 2001. Cases were newly detected smear positive TB patients. Two controls were recruited for each case, one within the household of the case, and one in the community. RESULTS: Regarding host-related factors, univariate analysis by conditional logistic regression of 687 matched pairs of cases and household controls showed that TB was associated with male sex, family history of TB, absence of a BCG scar, smoking, alcohol, anaemia, HIV infection, and history and treatment of worm infection. In a multivariable model based on 601 matched pairs, male sex, family history of TB, smoking, and HIV infection were independent risk factors of TB. The investigation of environmental factors based on the comparison of 816 cases/community control pairs showed that the risk of TB was associated with single marital status, family history of TB, adult crowding, and renting the house. In a final model assessing the combined effect of host and environmental factors, TB was associated with male sex, HIV infection, smoking (with a dose-effect relationship), history of asthma, family history of TB, marital status, adult crowding, and renting the house. CONCLUSION: TB is a multifactorial disorder, in which environment interacts with host-related factors. This study provided useful information for the assessment of host and environmental factors of TB for the improvement of TB control activities in developing countries.

Useful clues to the presence of smear-negative pulmonary tuberculosis in a West African city.

OBJECTIVE: Tuberculosis suspects with negative sputum smears for acid-fast bacilli (AFB) may have either pulmonary tuberculosis (PTB) or some other pulmonary disease (non-PTB). The aim of this study was to improve the differentiation between PTB and non-PTB. DESIGN: We enrolled 396 tuberculosis suspects 15 years of age or older who had cough of 21 days or longer and three negative AFB smears. Non-PTB was diagnosed by clinical and radiographic responses to amoxicillin; smear-negative PTB was diagnosed by positive culture for Mycobacterium tuberculosis or response to antituberculosis chemotherapy. RESULTS: Multivariate analysis, without X-ray variables, of 79 patients with a final diagnosis of non-PTB and 110 patients with smear-negative PTB indicated that age less than 37 years, family contact with TB, never having been married, loss of weight, lack of expectoration, human immunodeficiency virus (HIV) seropositivity, and tuberculin reactivity were significantly associated with PTB. When the initial X-ray findings were included, age younger than 37 years, lack of expectoration, HIV seropositivity, and tuberculin reactivity remained in the model, and cavitation and patchy densities were significantly associated. CONCLUSION: The response to 10 days of amoxicillin and certain demographic, clinical and radiographic characteristics are useful in separating non-PTB from PTB in tuberculosis suspects with negative AFB smears.

The knowledge of inpatients with schizophrenia on their medication at hospital discharge.

Purpose-To examine the knowledge of schizophrenic in patients regarding their medication.Methods-Fifty male and 50 female patients with schizophrenia were interviewed before discharge from the University Psychiatric Hospital in Ljubljana, Slovenia. Socio-demographic and clinical data were collected and the Global Assessment Scale (GAS) was used. Patients were asked to give the name, purpose and adverse effects of their prescribed drugs.Results-The mean age of the patients was 40.0 years and they had, on average, 6.9 admissions. Their mean GAS score was 58.5, indicating moderately impaired everyday functioning. The majority of patients were prescribed two to four psychotropic drugs. Most patients (87.0%) could name the antipsychotic, 77.0% knew the purpose of their medication and 65.0% knew its side-effects. The same was true for the name (90.3%) and purpose (77.0%) of the anticholinergic, but its side-effects were less well known (28.9%). The name of the hypnotic was known to 76.5% patients, the purpose to 90.6% and its side-effects to 34.4%. Only 58% of patients had ever requested information on their medication. The majority of patients received information from package inserts (35%) or from psychiatrists (29%). Most patients (55%) were satisfied with the information.Conclusions-The information on medication among patients is insufficient. Clinicians should regularly offer and repeat relevant information. Copyright (c) 2000 John Wiley & Sons, Ltd.

Serodiagnosis of cercarial dermatitis with antigens of Trichobilharzia szidati and Schistosoma mansoni.

In patients with parasitologically revealed dermatitis caused by cercariae of avian schistosomes (Trichobilhariza szidati) diagnostic indirect immunofluorescence technique (IFAT) was employed for the detection of antibodies. The efficacy of antigens prepared from cercariae of T. szidati and Schistosoma mansoni was tested in serodiagnosis. The results have shown that antigen of T. szidati is more reactive with the sera of patients than that of S. mansoni: the antibodies were detected already 3 days after penetration of cercariae, contrary to 10 days after penetration of avian schistosomes when antigen of S. mansoni was used. The results were confirmed with enzyme-linked immunosorbent assay (ELISA) and IFAT techniques in SPF mice (Mus musculus) experimentally infected with cercariae of T. szidati and S. mansoni or with fractions isolated from cercariae of T. szidati.

Influence des parcours de soins sur le debut du traitement antituberculeux a Conakry (Guinee)

Les parcours de soins sont souvent complexes et peuvent induire des retards de traitement; avec des effets particulierement deleteres en cas de tuberculose. Nous avons cherche a identifier de facon retrospective; les parcours de soins des patients avant le diagnostic de tuberculose et l'influence de ces parcours sur les delais de traitement a Conakry-Guinee.Nous avons interroge 112 nouveaux patients a leur enregistrement pour tuberculose pulmonaire a bacilloscopie positive. Ont ete distingues les parcours conventionnels (recours aux seules structures sanitaires) et mixtes (associant structures sanitaires; automedication et medecine traditionnelle). L'influence des caracteristiques des patients sur le type de parcours a ete testee en analyses uni et multivariees et les delais de mise sous traitement ont ete compares pour les deux types de parcours. Deux patients sur trois ont suivi un parcours mixte. Ce type de parcours n'etait lie; en analyse multivariee; qu'au niveau de scolarisation (p=0;02). Les delais moyens de traitement etaient similaires (respectivement 13;4 et 12;8 semaines pour les parcours conventionnels etmixtes; p=0;68). La proportion de parcours comportant plus de trois recours aux structures sanitaires etait significativement plus elevee pour les parcours conventionnels que pour les parcours mixtes (72vs 30; p0;001). Les principales raisons invoquees pour l'utilisation tardive des structures sanitaires etaient l'ignorance des signes de la tuberculose (26) et le cout eleve des soins (12). Les parcours des patients sont multiples et peuvent induire des retards a la mise sous traitement antituberculeux. Une sensibilisation de la population et des soignants est necessaire