Detection and management of drug-resistant tuberculosis in HIV-infected patients in lower-income countries.

SETTING: Drug resistance threatens tuberculosis (TB) control, particularly among human immunodeficiency virus (HIV) infected persons. OBJECTIVE: To describe practices in the prevention and management of drug-resistant TB under antiretroviral therapy (ART) programs in lower-income countries. DESIGN: We used online questionnaires to collect program-level data on 47 ART programs in Southern Africa (n = 14), East Africa (n = 8), West Africa (n = 7), Central Africa (n = 5), Latin America (n = 7) and the Asia-Pacific (n = 6 programs) in 2012. Patient-level data were collected on 1002 adult TB patients seen at 40 of the participating ART programs. RESULTS: Phenotypic drug susceptibility testing (DST) was available in 36 (77%) ART programs, but was only used for 22% of all TB patients. Molecular DST was available in 33 (70%) programs and was used in 23% of all TB patients. Twenty ART programs (43%) provided directly observed therapy (DOT) during the entire course of treatment, 16 (34%) during the intensive phase only, and 11 (23%) did not follow DOT. Fourteen (30%) ART programs reported no access to second-line anti-tuberculosis regimens; 18 (38%) reported TB drug shortages. CONCLUSIONS: Capacity to diagnose and treat drug-resistant TB was limited across ART programs in lower-income countries. DOT was not always implemented and drug supplies were regularly interrupted, which may contribute to the global emergence of drug resistance.

Genetic diversity of Mycobacterium tuberculosis in Madang, Papua New Guinea.

SETTING: Madang and surroundings, Papua New Guinea (PNG). OBJECTIVE: To characterise the genetic diversity and drug susceptibility of Mycobacterium tuberculosis isolates collected in Madang and surroundings. DESIGN: M. tuberculosis was isolated from sputum samples from active pulmonary tuberculosis cases. Drug resistance profiles were obtained by drug susceptibility testing. M. tuberculosis lineages were identified by single nucleotide polymorphisms and sub-typing was performed by spoligotyping. Spoligotyping and 24 locus mycobacterial interspersed repetitive units-variable number of tandem repeats were combined to identify clustered isolates. RESULTS: The 173 M. tuberculosis isolates collected belonged predominantly to the Euro-American lineage (Lineage 4) and the East-Asian lineage (Lineage 2). Multidrug-resistant M. tuberculosis were observed in 5.2% of isolates. Lineage 2 M. tuberculosis, which includes the 'Beijing' genotype, was significantly associated with any drug resistance (OR 5.2, 95%CI 1.8-15.1). Cluster analyses showed 44% molecularly clustered isolates, suggesting transmission of M. tuberculosis in the community, including transmission of primary drug-resistant M. tuberculosis. CONCLUSION: These data provide the first insight into the molecular characteristics of M. tuberculosis in the Madang area of PNG, and indicate substantial drug resistance with evidence of ongoing transmission.

[Morphogenesis of the frontal bone in the chick embryo. Study of induction phenomena]. / Morphogenèse de l'os frontal chez l'embryon de poulet. Etude des phénomènes inducteurs.

Comparison of results obtained by SCHOWING (1968) with those of BALLIF (1985) shows that frontal bones of chick embryo, which are completely missing after removal of the anterior encephalic territories, are still partially existent after a localized microinjection of Actinomycin D into the embryonic encephalon. The remaining part of frontal bones corresponds to territories mainly derived from the neural crests (NODEN, 1982). These latters don't need any encephalic induction to develop into ossification centres.

[Intra-encephalic injections of actinomycin D in the chick embryo. Autoradiographic study]. / Injections intraencéphaliques d'actinomycine D chez l'embryon de poulet. Etude autoradiographique.

42 hour-old chick embryos receive intraencephalic injections of a radioactive Actinomycin D solution. The autoradiographic study of the embryonic head after treatment shows that the injected solution remains in the encephalon. In order to avoid some diffusion of the solution in the surrounding territories, it is necessary to take care of the encephalic inner pressure. These experiments allow to a better approach of studying the influence of Actinomycin D upon the embryonic head morphogenesis.