Tuberculosis drug resistance in Bamako, Mali, from 2006 to 2014.

BACKGROUND: Although Drug resistance tuberculosis is not a new phenomenon, Mali remains one of the "blank" countries without systematic data. METHODS: Between 2006 and 2014, we enrolled pulmonary TB patients from local TB diagnostics centers and a university referral hospital in several observational cohort studies. These consecutive patients had first line drug susceptibility testing (DST) performed on their isolates. A subset of MDR was subsequently tested for second line drug resistance. RESULTS: A total of 1186 mycobacterial cultures were performed on samples from 522 patients, including 1105 sputa and 81 blood samples, yielding one or more Mycobacterium tuberculosis complex (Mtbc) positive cultures for 343 patients. Phenotypic DST was performed on 337 (98.3%) unique Mtbc isolates, of which 127 (37.7%) were resistant to at least one drug, including 75 (22.3%) with multidrug resistance (MDR). The overall prevalence of MDR-TB was 3.4% among new patients and 66.3% among retreatment patients. Second line DST was available for 38 (50.7%) of MDR patients and seven (18.4%) had resistance to either fluoroquinolones or second-line injectable drugs. CONCLUSION: The drug resistance levels, including MDR, found in this study are relatively high, likely related to the selected referral population. While worrisome, the numbers remained stable over the study period. These findings prompt a nationwide drug resistance survey, as well as continuous surveillance of all retreatment patients, which will provide more accurate results on countrywide drug resistance rates and ensure that MDR patients access appropriate second line treatment.

Tuberculosis specific responses following therapy for TB: Impact of HIV co-infection.

Characterizing perturbations in the immune response to tuberculosis in HIV can develop insights into the pathogenesis of coinfection. HIV+ TB+ and TB monoinfected (TB+) subjects recruited from clinics in Bamako prior to initiation of TB treatment were evaluated at time-points following initiation of therapy. Flow cytometry assessed CD4+/CD8+ T cell subsets and activation markers CD38/HLA-DR. Antigen specific responses to TB proteins were assessed by intracellular cytokine detection and proliferation. HIV+ TB+ subjects had significantly higher markers of immune activation in the CD4+ and CD8+ T cells compared to TB+ subjects. HIV+ TB+ had lower numbers of TB-specific CD4+ T cells at baseline. Plasma IFNγ levels were similar between HIV+ TB+ and TB+ subjects. No differences were observed in in-vitro proliferative capacity to TB antigens between HIV+ TB+ and TB+ subjects. Subjects with HIV+ TB+ coinfection demonstrate in vivo expansion of TB-specific CD4+ T cells. Immunodeficiency associated with CD4+ T cell depletion may be less significant compared to immunosuppression associated with HIV viremia or untreated TB infection.

[Epidemiologic aspects of pulmonary tuberculosis with positive bacilloscopy in the decade of 1995-2004]. / Aspects epidemiologiques de la tuberculose pulmonaire a bacilloscopie positive au Mali pendant la decennie 1995-2004.

The purpose of this study is to make an epidemiological description of pulmonary tuberculosis with sputum smear positive in Mali. This is a retrospective study conducted from January 1st, 1995 to December 31st, 2004 by the National Program for fighting against tuberculosis (located at the National Department of health), and where data were centralized. From this ten years period, 33,000 cases of tuberculosis (all forms of TB) have been notified in Mali, which represented an annual rate of 2750. Of those, 22,275 cases (67.5%) were sputum smear positive (with Ziehl Nielsen), this represented 1856 as annual rate. The prevalence of pulmonary TB with sputum smear positive is 185/100,000. During the study period a total of 13,638 (61.22%) cases of 22,275 cases of pulmonary TB with sputum smear positive have been given ant tuberculosis drugs; From these patients under therapy 2371 cases (17.38% ) disappear before the end of treatment.; 5851 cases (42.90%) have been considered as cured; 161 (1.18%) cases of treatment failure and 523 (3.93%) cases of death. The sex-ratio was 3.57 with young adults representing the majority of cases. Pulmonary TB with sputum smear positive treatment remains a challenge for National Programs for fighting against TB as well as its prevention.

Aspects épidémiologiques de la tuberculose pulmonaire à bacilloscopie positive au Mali à la décennie 1995-2004

Dans le but de decrire l'epidemiologie de la tuberculose pulmonaire a bacilloscopie positive (TPM+) au Mali; une etude retrospective sur dix ans du 1er janvier 1995 au 31 decembre 2004; a ete menee au Programme National de Lutte contre la Tuberculose (TB) sis a la direction nationale de la Sante. Toutes les donnees de l'etendue du pays sont centralisees au niveau de ce programme. Durant cette periode de dix ans; 33 000 cas de TB toutes formes confondues ont ete notifies sur le territoire de la republique du Mali; soit 2750 cas de TB en moyenne par an ; et 22.275 cas (67;5) avaient une microscopie positive des crachats pour le BAAR soit 1856 cas de TPM+ en moyenne par an. Cette prevalence annuelle de TPM+ par rapport a la population nationale represente 185 cas pour 100.000 habitants par an. Au total pendant la periode d'etude 13.638 TPM+ sur 22275 cas au total (soit 61;22) ont ete soumis au traitement antituberculeux. Parmi ces patients sous traitements antituberculeux 2371 cas (17;38) ont ete perdus de vue pendant le suivi; 5851 ont ete declares gueris (42;90) ;161(1;18) en situation d'echec therapeutique et 523 (3;93) cas de deces. Avec un sex-ratio de 3;57 les adultes jeunes etaient majoritairement represente.La TPM+ reste la pierre angulaire de tout programme national de lutte anti-tuberculeux tant pour le traitement que la prevention