Early results of systematic drug susceptibility testing in pulmonary tuberculosis retreatment cases in Cameroon.

BACKGROUND: The number of pulmonary tuberculosis (PTB) patients reported with resistance to first-line anti-tuberculosis drugs after a standardized retreatment regimen in Cameroon is increasing. Hence, the National Tuberculosis Control Program (NTP) implemented, in one of the ten Regions of the country, a pilot programme aimed at performing routine drug susceptibility testing (DST) for previously treated PTB cases. The objectives of the programme were to evaluate the feasibility of monitoring drug resistance among retreatment cases under programme conditions and to measure the presence and magnitude of anti-TB drug resistance in order to inform NTP policies. FINDINGS: This retrospective cohort study was conducted in the Littoral Region of Cameroon in 2009. It included all sputum smear positive (SM+) PTB cases registered for retreatment. TB cases were identified and classified according to World Health Organization (WHO) recommendations for national TB programs. Bacterial susceptibility testing to first-line anti-TB drugs was performed using standard culture methods. In 2009, 5,668 TB cases were reported in the Littoral Region, of which 438 (7.7%) were SM + PTB retreatment cases. DST results were available for 216 (49.4%) patients. Twenty six patients (12%) harbored multi-drug resistant (MDR) strains. Positive treatment outcome rates were particularly low in retreatment patients with MDR-TB (46.2%; 95% CI: 27.1-66.3). Thirteen MDR-TB patients were treated using a standardized MDR treatment regimen. Delivery of laboratory results took on average 17 (12-26) weeks. CONCLUSIONS: WHO-recommended routine DST in retreatment patients seems feasible in Cameroon. However, coverage needs to be improved through better management. Moreover, diagnostic delay should be shortened by introducing more rapid diagnostic tools. The high risk of MDR in standard regimen failure cases virtually rules out the standard retreatment regimen for such patients without prior DST.

High prevalence of HIV and malaria co-infection in urban Douala, Cameroon.

A prospective cohort study was undertaken among 684 adult hospital attendees in Douala, Littoral Province, Cameroon. The objectives were to determine the prevalence of HIV/malaria co-infection and to determine and compare the prevalence of some parasitological, haematological and clinical parameters between co-infection and mono-infection with HIV or malaria in the study population. Information was collected on HIV serostatus, and malaria parasitaemia was assessed from blood smears by microscopy. Haemoglobin concentration was measured using the STANBIO STAT-Site MHgb Test System(®), and CD4 cell counts were obtained using the Partec CyFlow Counter(®). The prevalence of HIV/malaria co-infection in the sample was 29.4%. Geometric mean parasitaemia was significantly higher in co-infected patients than in malaria patients (9 868 parasites/µL blood versus 6 134 parasites/µL blood; F = 3.44, p = 0.018). Anaemia was more prevalent in cases of co-infection (43.3%) than in cases of HIV mono-infection (36.8%) or malaria mono-infection (20.4%) (χ(2) = 12.38, p = 0.006). The mean CD4 cell count between the groups of co-infected and HIV-mono-infected patients was not significantly different (F = 0.004, p = 1.000), but more patients with dual infections had CD4 cell counts corresponding to the chronic and advanced stages of HIV infection. A total of 105 individuals were successfully followed up for six months; twelve deaths were recorded within this period, nine of which were co-infected patients. Our results add to the existing pool of data from similar studies showing that HIV/malaria co-infections have a significant effect on a patient's clinical outcome. The data provide a basis for more elaborate studies with a larger sample size and follow-up of longer duration in the study region.