ABSTRACT
Over a 3-year follow-up, 30 out of the 318 unique Mycobacterium tuberculosis complex isolates recovered in the Republic of Djibouti had a smooth-type morphology and were Niacine-negative, the characteristics of 'Mycobacterium canettii' strains. Unlike M. tuberculosis, 'M. canettii' grew on nutrient-poor media at 30°C, and possessed characteristic lipids. They were isolated from respiratory and extra-respiratory sites from patients with typical forms of tuberculosis. Most cases resolved with antibiotic therapy but in two human immunodeficiency virus-positive patients 'M. canettii' infection led to septicaemia and death. No cases of human-to-human transmission were observed. The proportion of tuberculosis cases caused by 'M. canettii' was higher among French patients than among Djiboutian patients. Patients with 'M. canettii' were significantly younger than those with tuberculosis caused by other M. tuberculosis complex strains. Smooth tubercle bacilli could be misidentified as non-tuberculous mycobacteria and appear to be limited to the Horn of Africa. Their characteristics are consistent with the existence of non-human sources of infection.
Subject(s)
Mycobacterium tuberculosis/isolation & purification , Mycobacterium tuberculosis/physiology , Tuberculosis/epidemiology , Tuberculosis/microbiology , Adolescent , Adult , Age Distribution , Antitubercular Agents/administration & dosage , Child , Child, Preschool , Culture Media/chemistry , Djibouti/epidemiology , Ethnicity , Female , Humans , Infant , Lipids/analysis , Male , Middle Aged , Mycobacterium tuberculosis/chemistry , Niacin/metabolism , Temperature , Treatment Outcome , Tuberculosis/mortality , Tuberculosis/transmission , Young AdultABSTRACT
SETTING: Decentralisation of directly observed treatment (DOT) for tuberculosis patients in three public centres in Djibouti city from April 2000. OBJECTIVES: To evaluate decentralisation based on the success rate by site of treatment and according to certain critical variables. METHODS: Comparative evaluation of the success rate of smear-positive patients followed in all treatment centres from 1 May 2000 to 31 March 2001. RESULTS: The success rate was 58% for the main centre, Centre Paul Faure, and 81% for all the peripheral centres together (P < 10.6). It was 80% for the three new centres and 85% for the established centres (P > 0.05). Age under 20 years, female sex and treatment centre were factors linked to success. After stratification, sex was shown to be the confounding variable. Multivariate analysis shows that non-Djibouti nationality is related to treatment success (P = 0.02). In the groups of established and new centres, there is an inverse linear relationship between success rate and workload, with greater capacity in the established centres. CONCLUSIONS: Urban decentralisation of DOT increases the chances of treatment success among smear-positive patients. Another centre for supervised treatment needs to be created in one of the public health centres in Djibouti city.
