Resistance aux anti-tuberculeux usuels dans les reprises de traitement a Kinshasa

Cette etude vise a situer le niveau actuel de resistance aux anti-tuberculeux retenus par le programme national de lutte anti-tuberculeux pour les reprises de traitement et a identifier des facteurs susceptibles de l'influencer. Les auteurs ont ainsi analyse retrospectivement la sensibilite a l'isoniazide; l'ethambutol; la rifampicine; la streptomycine et la thiacetasone des souches de Bacilles de Koch (BK) isoles chez 73 patients suivis dans 2 centres de Kinshasa au regard des parametres age; sexe; traitement anterieur; infection VIH; et l'evolution des patients sous traitement. De toutes les souches de BK isolees; seules 8;2 pour cent sont sensibles aux medicaments testes. Pour les autres; 84;9 pour cent resistent a l'Izoniazides; 27;4 pour cent a la Rifampicine; 26;8 pour cent a la Thiacestasone; 9;6 pour cent a la Steptomycine; 5;5 pour cent a l'Ethambutol. Aucune difference significative n'est relevee en fonction du status VIH; seul le regime long semble influencer la multiresistance. Enfin; le traitement par le regime de la categorie II/OMS guerit 71;9 pour cent des cas. Ils concluent que le niveau actuel de la resistance aux differents antituberculeux est eleve pour les cas de reprise de traitement; qu'il n'est pas le statut VIH; et que le regime de traitement preconise par l'OMS donne de bons resultats

[Etiologic aspects of low back pain in rheumatic patients in Kinshasa (Zaire). Apropos of 169 cases]. / Quelques aspects étiologiques des lombalgies chez des rhumatisants consultants a Kinshasa (Zaïre). A propos de 169 cas.

A study over a period of 27 consecutive months showed that among patients seen in a Kinshasa hospital outpatient clinic for rheumatologic diseases, 46.5% sought medical advice for lower back pain. Lumbar arthrosis (74.5%), spondylodiscitis (9.5%) and unilateral sacroiliitis (9%) were the main causes of this complaint. A single patient had osteoporosis and no cases of ankylosing spondylarthritis were seen. Lumbar arthrosis was prevalent among females. Mean age of patients with disk disease was fairly low (43 years). Infectious spondylodiscitis and unilateral sacroiliitis, presumably reactive or infectious in origin, were also more common in women. HIV-infection was found in 44% of patients with spondylodiscitis and in 53% of patients with sacroiliitis. Age of HIV-infected individuals ranged from 21 to 40 years. Bacteriologic studies proved indispensable for determining the cause of these conditions in which leukocyte courts failed to rise. In young individuals in Kinshasa with spondylodiscitis or unilateral sacroiliitis, routine HIV testing is warranted.

HIV infection in patients with tuberculosis in Kinshasa, Zaire.

To better define the interrelationship of infection with human immunodeficiency virus (HIV) and tuberculosis (TB), we conducted three HIV serosurveys of inpatients and outpatients with confirmed or suspected TB in Kinshasa, Zaire. HIV seroprevalence in hospitalized sanatorium patients did not change significantly in serosurveys conducted in 1985 and 1987 (92/231 [40%] versus 85/234 [36%]). These proportions were significantly higher than the 17% HIV seroprevalence observed in a 1987 serosurvey of 509 consecutive patients with an initial diagnosis of pulmonary TB seen at an outpatient TB diagnostic center in Kinshasa (p less than 0.001). HIV seroprevalence was higher in sanatorium patients with extrapulmonary TB (22/46 [48%]) and suspected pulmonary TB (60/132 [45%]) than in patients with bacteriologically confirmed pulmonary TB (94/287 [33%]) (p less than 0.02). Mycobacterium sputum isolation rates were similar in HIV-seropositive (28/34 [82%]) and HIV-seronegative patients (135/159 [85%]). All isolates were Mycobacterium tuberculosis. Eighteen (21%) of 84 HIV-seropositive sanatorium patients in 1987, who were followed for two months after admission, had died, compared with 11 (9%) of 128 HIV-seronegative patients (p less than 0.01). However, clearance rates of acid-fast bacilli from sputum after standard therapy were equally good in HIV-seropositive and HIV-seronegative survivors. With the growing AIDS problem, the serious TB burden in sub-Saharan Africa may become even more onerous and may critically overload the stressed African health care systems.