Decentralising DOT for drug-susceptible TB from the health facilities to the community level in Togo.

In Togo, the COVID-19 pandemic paved the way for decentralising directly observed treatment (DOT) to the community level through the evaluation of two innovative community-based DOT approaches-a community health worker-based (CHW-DOT) and family-based (FB-DOT). METHODS We conducted an observational prospective study from April 2021 to January 2022. Sputum conversion at Month 2 and favourable treatment outcomes at Month 6 were assessed and compared between the two groups. Sociodemographic and clinical factors related to these outcomes were identified. RESULTS A total of 182 TB patients were enrolled. The CHW-DOT group had significantly increased odds of sputum conversion (aOR 2.95, 95% CI 1.09-7.98) and lower odds of unsuccessful treatment outcomes (aOR 0.37, 95% CI 0.13-1.1). Non-smokers had 4.85 higher odds of converting than smokers (aOR 4.85, 95% CI 1.76-13.42) and lower odds of an unsuccessful treatment than smokers (aOR 0.11, 95% CI 0.04-0.32). CONCLUSION CHW-DOT is associated with higher sputum smear conversion rates and a more favourable treatment outcome. The use of tobacco, significantly associated with outcomes, also suggests that a smoking cessation component may be a valuable adjunct to a CHW-DOT approach during TB treatment..

[The Lady Windermere syndrome: clinical and bacteriological data and progress in seven cases]. / Le syndrome de Lady Windermere : données cliniques, bactériologiques et évolutives.

Described by Reich and Johnson in 1992 [2], the Lady Windermere syndrome occurs exclusively in non-smoking women over the age of 60 years, without significant pre-existing pulmonary disease. It comprises bronchial dilatation, typically in the middle lobe and lingula, together with secondary infection by atypical mycobacteria (Mycobacterium avium in the first cases). Among the 17 cases of atypical mycobacterial infection that we have seen in the past 14 years, there were seven cases of this syndrome. It was associated with cough, sputum, sometimes haemoptysis, febrile episodes and deterioration of general health. The diagnostic criteria and treatment were defined by the American Thoracic Society. The pathophysiological hypothesis proposed by Reich and Johnson was that voluntary suppression of the cough led to congestion of the bronchi and secondary infection with atypical mycobacteria. Currently it is thought more likely that the following factors are involved: progressive increase in dilatation of small bronchi, delayed diagnosis, morphological abnormalities of the thorax, hormonal factors, immune deficiency, genetic neutrophil dysfunction, and even heterozygous forms of cystic fibrosis.

[Tetanus and HIV: a fortuitous association?]. / Tétanos et VIH : une association fortuite ?

OBJECTIVES: To describe the relation between HIV infection and tetanus. METHODS: This prospective study includes all patients admitted to our infectious diseases department with tetanus between July 15 and December 31, 2007, who underwent screening for HIV-1 and 2. RESULTS: The study included 21 patients (sex-ratio = 9.5). Their mean age was 37 years (SD: 5.3) were included. Nine patients (42%) had been immunized, but never received a booster dose. The portal of entry was found in 16 patients (76%) - all but one a skin injury. Tetanus was generalized in all patients (Mollaret classification: 76% Stage II, 24% stage III). Twelve (57%) patients were infected with HIV. Their mean CD4 cell count was 157/mm3 (SD: 75/mm3, range: 74-232/mm3). The overall mortality rate was 53%. It was 100% when no portal of entry was found. It was significantly higher among HIV-positive than HIV-negative patients (82 versus 18%). It did not, however, differ significantly between HIV-positive subjects with a CD4 count < 200/mm3 and those with a CD4 count > or = 200 (58 versus 42%). CONCLUSION: HIV and the absence of portal of entry are poor prognostic factors in tetanus. Therefore, a revision of the Dakar International Classification on tetanus should be revised, to score as 1 those patients with HIV infection and no portal of entry.