[Factors associated with non-conversion of the direct smear after the initial phase of anti-tuberculous treatment. A study undertaken in three tuberculosis management centres in South Benin]. / Facteurs associés à la non-conversion de la bacilloscopie après la phase d'attaque du traitement antituberculeux. Étude réalisée dans trois centres de prise en charge de la tuberculose au Sud Bénin.

The objective of this work was to describe the profile of routinely managed tuberculosis patients whose sputum smear did not become negative after the initial phase of anti-tuberculous treatment and to analyze the factors associated with this. With this aim a cross-sectional, retrospective, descriptive and analytical study was carried out in a population of adults with pulmonary tuberculosis (PTB) between 2013 and 2014 in three cities in southern Benin (Cotonou, Porto-Novo and Abomey). The data of the patients who did not convert (PTB +) were compared with those who did (PTB-). A multivariate logistic regression analysis was performed. In 1989 (94%) of the cases, 305 (15.3%) were TPB+ with significant differences between the cities. The mean age was 38±13 years vs 34±12 years, respectively, for PTB+and PTB -, P=0.091. At the end of the multivariate analysis, the factors associated with non-conversion were: high bacillary load (≥10 AFB/microscopic field) at diagnosis, HIV+status, and adverse outcome at the end of anti-tuberculous treatment. These patients should be monitored carefully.

Treatment outcome with a short multidrug-resistant tuberculosis regimen in nine African countries.

SETTING: Nine countries in West and Central Africa. OBJECTIVE: To assess outcomes and adverse drug events of a standardised 9-month treatment regimen for multidrug-resistant tuberculosis (MDR-TB) among patients never previously treated with second-line drugs. DESIGN: Prospective observational study of MDR-TB patients treated with a standardised 9-month regimen including moxifloxacin, clofazimine, ethambutol (EMB) and pyrazinamide (PZA) throughout, supplemented by kanamycin, prothionamide and high-dose isoniazid during an intensive phase of a minimum of 4 to a maximum of 6 months. RESULTS: Among the 1006 MDR-TB patients included in the study, 200 (19.9%) were infected with the human immunodeficiency virus (HIV). Outcomes were as follows: 728 (72.4%) cured, 93 (9.2%) treatment completed (81.6% success), 59 (5.9%) failures, 78 (7.8%) deaths, 48 (4.8%) lost to follow-up. The proportion of deaths was much higher among HIV-infected patients (19.0% vs. 5.0%). Treatment success did not differ by HIV status among survivors. Fluoroquinolone resistance was the main cause of failure, while resistance to PZA, ethionamide or EMB did not influence bacteriological outcome. The most important adverse drug event was hearing impairment (11.4% severe deterioration after 4 months). CONCLUSIONS: The study results support the use of the short regimen recently recommended by the World Health Organization. Its high level of success even among HIV-positive patients promises substantial improvements in TB control.

[Tuberculoma of the cerebellar tonsils: a case study]. / Tuberculome de l'amygdale cerebelleux: a propos d'un cas.

Tuberculoma of the cerebellum is a rare presentation of human tuberculosis and the presence of this disease in central nervous system in particular. We report the case of an immunocompetent 53 year old man who initially had an instability when walking, bitemporo-occipital headaches and insomnia, secondarily complicated state of agitation accepted into psychiatric care. The diagnosis was possible with MRI that revealed a mass in the cerebellar tonsil, not taking the contrast after gadolinium injection. The evolution under treatment for tuberculosis was positive. The control MRI performed at 15 months showed no more damage.

Le Tuberculome du cervelet est une présentation rarissime de la tuberculose humaine en général et de l'atteinte par cette maladie du système nerveux central en particulier. Nous rapportons le cas d'un homme de 53 ans immunocompétent qui présentait initialement une instabilité à la marche, des céphalées bitemporo-occipitales et une insomnie, compliquée secondairement d'état d'agitation prise en charge en psychiatrie. Le diagnostic a été possible grâce à l'IRM qui a mis en évidence une masse de l'amygdale cérébelleux, ne prenant pas le contraste après l'injection de gadolinium. L'évolution sous traitement antituberculeux a été favorable. L'IRM de contrôle réalisée à 15 mois ne montrait plus de lésion.

[Sensitisation profile to airborne allergens of patients followed for asthma in Cotonou, Benin. A cross-sectional study using prick-tests]. / Profil de sensibilisation aux pneumallergènes des patients suivis pour asthme à Cotonou, Bénin : étude transversale par prick-tests.

RATIONALE: The sensitisation profile to airborne allergens of asthma patients followed in Benin is not known. PATIENTS AND METHODS: A descriptive cross-sectional study was conducted from April to June 2013 at the hospital reference centre. A prick-test was performed in all adults with asthma consulting during this period. The standardized allergenic extracts tested were: mites (Dermatophagoides pteronyssinus [DP], Dermatophagoides farinae [DF] and Blomia tropicalis [BT]), cockroaches, 5 different grasses, Alternaria, dogs and cats. The test was positive when the diameter of the wheal was more than half that of the positive control and/or when the diameter of the wheal was ≥3mm than the negative control. RESULTS: Of the 253 asthmatics tested, 247 (97.6%) had at least one positive skin reaction. The average age was 44 years, the sex ratio was 0.81. Sensitization to mites was the most frequent (99.6%), followed by cockroaches (71.3%), 5 grasses (71.3%), Alternaria (71%), dog (68%) and cat (63.6%). The average number of sensitivities was 5±2. CONCLUSION: Asthmatics monitored in Cotonou have multiple sensitisations dominated by mites.

[Evaluation of tuberculous patients' management when re-treated in Cotonou, Benin]. / Évaluation de la prise en charge des patients admis au régime de retraitement à Cotonou, Bénin.

Retreatment of tuberculosis is the leading risk factor for drug resistance if the management is not adequate and complete. The objective of this study was to evaluate the management of cases of retreatment in Cotonou. This was a retrospective, descriptive cross type which covered a period of 5 years. Outcomes of retreatment cases were compared against those for new cases that were registered during the same period. We analyzed the cases of 389 retreatment patients and 4542 new cases. The success rates of treatment were generally satisfactory (80% vs. 86%, P=0.0001). Of adverse outcomes, the rate of loss of sight of was 12% versus 7%, P=0.26, the rate was 23% for cases of occasions. The failure rate was low and similar in both populations (2%). The retreatment regimen for patients with TB in Cotonou appears to give generally satisfactory results. The high loss to follow-up in case of retreatment means that a personalized therapeutic approach for such patients is needed in general and in particular in the case of defaulters.

Integrating HIV testing and care into tuberculosis services in Benin: programmatic aspects.

SETTING: Between 2005 and 2008, the diagnosis and care of human immunodeficiency virus (HIV) infection and tuberculosis (TB) services were integrated in Benin. RESULTS: The appointment of a TB-HIV Coordinator by the National Tuberculosis Control Programme and quarterly supervisory visits to TB clinics have bolstered the implementation of integrated HIV-TB activities. HIV testing and cotrimoxazole preventive therapy were integrated smoothly into the TB services. The strategy chosen to facilitate access of HIV-positive TB patients to antiretroviral treatment contributed to greater integration over time, but perpetuated, for some, the burden of attending two facilities. CONCLUSION: The integration and decentralisation of TB and HIV care services at national level in Benin resulted in a high uptake of HIV services among TB patients.

Results of rapid and successful integration of HIV diagnosis and care into tuberculosis services in Benin.

SETTING: Benin, where 20 of 54 tuberculosis (TB) clinics caring for 80% of all TB patients began providing integrated human immunodeficiency virus (HIV) care in 2005. OBJECTIVE: To describe the characteristics and TB treatment outcomes of the first cohorts of TB-HIV patients, and to assess programmatic outcomes. METHODS: Retrospective cohort study using data from the TB register and the register of co-infected patients. RESULTS: During the study period, 8368 TB patients were registered, 7787 (93%) were tested for HIV and 1255 (16%) were HIV-positive, including 385 (32%) who already knew their positive status. Most patients (88%) were tested within 15 days of TB diagnosis. Female and young patients were overrepresented among the co-infected. Cotrimoxazole preventive therapy was administered to 1152 patients (95%) during anti-tuberculosis treatment, and antiretroviral treatment (ART) to 469 (42%). The likelihood of receiving ART increased as initial CD4 lymphocyte counts decreased. Fifteen per cent of TB-HIV patients died during anti-tuberculosis treatment. Patients already on ART prior to anti-tuberculosis treatment experienced the worst outcomes. Patients who initiated ART early during anti-tuberculosis treatment or in the timeframe recommended by the guidelines fared the best. CONCLUSION: HIV care has been successfully and sustainably integrated into TB services in Benin. However, ensuring the access of co-infected patients to more favourable treatment outcomes still represents significant challenges.

The burden and outcomes of childhood tuberculosis in Cotonou, Benin.

SETTING: The National Tuberculosis Programme (NTP) and the paediatric ward of the General Hospital (GH), Cotonou, Benin. OBJECTIVE: To describe the burden of tuberculosis (TB), characteristics and outcomes among children treated in Cotonou from 2009 to 2011. DESIGN: Cross-sectional cohort study consisting of a retrospective record review of all children with TB aged <15 years. RESULTS: From 2009 to 2011, 182 children with TB were diagnosed and treated (4.5% of total cases), 153 (84%) by the NTP and 29 (16%) by the GH; the latter were not notified to the NTP. The incidence rate of notified TB cases was between 8 and 13 per 100 000 population, and was higher in children aged >5 years. Of 167 children tested, 29% were HIV-positive. Treatment success was 72% overall, with success rates of 86%, 62% and 74%, respectively, among sputum smear-positive, sputum smear-negative and extra-pulmonary patients. Treatment success rates were lower in children with sputum smear-negative TB (62%) and those with HIV infection (58%). CONCLUSION: The number of children being treated for TB is low, and younger children in particular are underdiagnosed. There is a need to improve the diagnosis of childhood TB, especially among younger children, and to improve treatment outcomes among HIV-TB infected children, with better follow-up and monitoring.

Management of asthma in Benin: the challenge of loss to follow-up.

SETTING: An asthma pilot project in Benin. OBJECTIVE: To assess the implementation of standard case management of asthma at three referral centres and three primary care centres. METHODS: The project began with local adaptation of international asthma guidelines, followed by situation analysis, pre-intervention, training and intervention. The initial dosage of inhaled beclometasone was determined by asthma severity. Outcome of treatment was assessed annually, starting from one year after enrolment. RESULTS: Of 103 asthma patients identified during situation analysis, only 11 (11%) were prescribed inhaled corticosteroids. After health worker training, a total of 430 asthma patients were identified in 2008, of whom 273 (63.5%) returned after initial management with 7-day oral prednisolone. Of the 273 patients, 261 (95.6%) had persistent asthma, 231 (86.2%) had peak flow measurement variability of ≥20%, and 155 (56.8%) had had one or more unplanned visits to health facilities in the previous year. Outcome at one year evaluation was as follows: 63 (24.1%) had improved, 48 (18.4%) remained stable, 14 (5.4%) were worse and 136 (52.4%) were lost to follow-up. CONCLUSION: It is feasible to train health workers to manage asthma patients in a standardised manner. However, a high proportion of patients were lost to follow-up during treatment.

MDR-TB treatment needs in patients previously treated for TB in Cotonou, Benin.

SETTING: Centre National Hospitalier de Pneumo-Phtisi-ologie, Cotonou, Benin. OBJECTIVE: To determine the proportion of individuals needing treatment for multidrug-resistant tuberculosis (MDR-TB) among patients previously treated for TB. DESIGN: A retrospective cross-sectional study of all patients previously treated for TB in Cotonou from 2003 to 2011. RESULTS: Of 956 patients on retreatment, 897 (94%) underwent culture and/or a line-probe assay. For different reasons, 594 (66%) underwent drug susceptibility testing for rifampicin (RMP), of whom 95 (16%) had RMP resistance (68 multidrug-resistance [MDR] and 27 other RMP resistance) and therefore needed treatment for MDR-TB. These represent 39% of patients who failed/relapsed after standardised retreatment, and 20% of those who failed, 19% of defaulters and 11% of relapses after first-line treatment. Residence outside of Benin was associated with a higher risk of RMP resistance (RR 3.13, 95%CI 2.19-4.48, P < 0.01). From 2003 to 2011, the prevalence of RMP resistance decreased from 25% to 5% among patients living in Benin. Human immunodeficiency virus (HIV) prevalence was 25%; no association was found between HIV and RMP resistance. Of patients failing treatment, 48% were fully susceptible, 22% were monoresistant and 8% polyresistant. CONCLUSION: The majority of patients who fail retreatment or first-line treatment in Cotonou do not require empirical treatment for MDR-TB.

Management of tuberculosis and HIV co-infection in Cotonou, Benin.

OBJECTIVES: The authors had for aim to assess the management of tuberculosis and HIV co-infection in Cotonou, Benin. PATIENTS AND METHODS: We made a cross-sectional, retrospective, and descriptive study comparing the clinical presentation and outcome of patients with tuberculosis and HIV co-infection versus patients with tuberculosis alone, all managed at the National Pneumophtisiology Center in Cotonou, Benin, in 2009. RESULTS: The rate of HIV screening in TB patients was 99%. One thousand and eighty-six TB patients were included and 259 were HIV positive. The mean age of co-infected patients was 36 years, versus 34 for TB mono-infected patients. The sex ratio among co-infected was 1.15 versus 2.25 among TB patients. Positive pulmonary sputum was less frequent with co-infection. Two hundred and fifty-seven over 259 patients were treated with cotrimoxazole. One hundred and eighty-five over 234 (79.05%) had CD4 counts<350. Eighty-five (46%) of the 185 patients with CD4<350, were given antiretroviral therapy. Treatment success rate was lower for co-infected (75%) than for patients with TB alone (86%), and death rates were higher in co-infected patients (10% vs. 3%). CONCLUSION: High death rate and high rate of lost to follow-up are arguments for systematic antiretroviral treatment of co-infected patients. Early screening for TB and HIV, and reviewing the current national recommendations, as well as an increased governmental effort to provide medicines to all patients in need of ARV are mandatory.

[Bronchoconstriction induced by exercise in the black African athlete]. / L'Asthme Induit Par L'Exercice De L'Athlete En Climat Chaud Et Humide.

INTRODUCTION: The bronchoconstriction induced by exercise (BIE) in urban black Africans is poorly known. The warm moist air would be a mitigating factor for its occurrence. The objective of this study was to measure the prevalence and determine the associated factors. SUBJECTS AND METHODS: A prospective descriptive and analytical involving 40 student-athletes was conducted from September 12 to 24, 2010. The test was considered positive when the percentage fall in FEV from baseline in pre-test and the smallest value in post-test exceeded 10%. RESULTS: The prevalence of bronchoconstriction induced by exercise was 40% CI (26.3-55.4). The presence of symptoms of atopy was higher in athletes with an BIE than in those without (66% vs. 33.33% p NS). CONCLUSION: The proportion of the BIE in the middle of the black African athlete is as important as that observed in other countries, highlighting the weak influence of climate on its occurrence.

[Air pollution and respiratory disease in a tropical urban setting in Cotonou, Benin]. / Pollution atmosphérique et pathologie respiratoire en milieu urbain et tropical a Cotonou, Bénin.

PURPOSE: To assess the impact of air pollution inside and outside housing on respiratory function in people living around traffic intersections. METHODS: A descriptive analytical study was carried out from February 5 to July 5, 2006. Carbon monoxide (CO), sulfur dioxide (SO2), and nitric dioxide (NO2) were measured over an 8-hour period inside and outside 60 houses near intersections during periods of heavy and light traffic. Spirometry was performed on residents of the same houses. RESULTS: CO levels were higher during heavy than light traffic both inside houses: 65 ppm vs. 43.2 ppm and outside houses: 160 ppm vs. 115 ppm. Similar results were observed for SO2, i.e., 2.8 ppm vs. 0.49 ppm inside houses and 4.3 ppm vs. 0.83 ppm outside houses. Measurements for NO2 were consistently nil. Respiratory symptoms were more frequent during heavy than light traffic: p = 0.0001; odds ratio (OR), 4.73; confidence interval (CI), 2.13-10.51. The frequency of spirometric abnormalities was higher in heavy than light traffic: p = 0.004; OR, 5.78; CI, 1.43-27.10. CONCLUSION: Indoor pollution level is higher during heavy traffic than light traffic. Respiratory symptoms were greater during heavy than light traffic.

Epidemiology of tuberculosis in Benin.

SETTING: Benin, West Africa. OBJECTIVE: To describe the epidemiology of tuberculosis (TB) in Benin. DESIGN: Analysis of two tuberculin surveys initiated in 1987 and 1994 and of the quarterly reports of the Basic Management Units to the National Tuberculosis Programme from 1995 to 2007. RESULTS: The average annual risk for a child in Benin of becoming infected with Mycobacterium tuberculosis was around 0.5% in the mid 1980s. The notification rate increased by approximately 1% each year over the observation period and was on average 35 per 100,000 population, with a male-to-female sex ratio of 1.8 and no shift in the age structure of the cases over the observation period. Human immunodeficiency virus prevalence was 14% (97% of the patients were tested). There is a strong gradient of incident notification rates from the north to the south of the country that seems to be related to the population density. CONCLUSION: Both the tuberculin skin test survey results and the notification data suggest that the TB problem in Benin is much smaller than in eastern and southern African countries.

Smear-negative, culture-positive pulmonary tuberculosis among patients with chronic cough in Cotonou, Benin.

SETTING: The main tuberculosis (TB) centre in Benin, West Africa, where only 2% of adult pulmonary TB cases are sputum smear-negative, all other pulmonary cases being smear-positive. OBJECTIVES: To assess the burden of smear-negative, culture-positive pulmonary TB among TB suspects in Cotonou, and to estimate the total number of non-smear-positive TB cases at country level. DESIGN: For 1 year, one morning sputum culture was performed for every TB suspect (cough lasting >3 weeks, as defined in Benin's national guidelines) with three negative sputum smears (fluorescence technique). RESULTS: Of 214 TB suspects for whom culture was performed, only 22 smear-negative, culture-positive cases were identified. During the same period, 831 sputum smear-positive cases were diagnosed. Culture therefore contributed only 2.6% of the total number of bacteriologically proven cases. CONCLUSION: These results show the relatively low input of culture in TB diagnosis among chronic coughers in Cotonou, Benin, and demonstrates that the expected number of non-smear-positive TB cases in Benin is probably much lower than the World Health Organization's current annual estimates.

Exposure to combustion of solid fuel and tuberculosis: a matched case-control study.

The present study was conducted in Benin to ascertain the association between exposure to combustion of solid fuel (coal and biomass) and tuberculosis. Cases were consecutive, sputum smear-positive tuberculosis patients never previously treated for tuberculosis for as long as 1 month. Two controls were selected from the neighbourhood of each case, matched by age and sex by a predefined procedure. A total of 200 new smear-positive cases and 400 neighbourhood controls were enrolled. In univariate analysis, using solid fuel for cooking (OR 1.7, 95% CI 1.1-2.8), ever smoking (OR 5.5, 95% CI 3.1-9.8), male sex (OR 10.5, 95% CI 1.6-71.1), daily use of alcoholic beverages (OR 2.3, 95% CI 1.2-4.2) and having a family member with tuberculosis in the previous 5 yrs (OR 30.5, 95% CI 10.8-85.8) were all significantly associated with tuberculosis cases. When all significant variables were entered into a multivariate conditional logistic regression model, the association between using solid fuel for cooking and tuberculosis cases was no longer statistically significant (adjusted OR 1.4, 95% CI 0.7-2.7). In conclusion, the association between exposure to combustion of solid fuel and tuberculosis was relatively weak and not statistically significant.

[Prevalence of respiratory disorders in women exposed to the smoke from smoking fish in the municipality of Cotonou, Benin]. / Prevalence Des Troubles Respiratoires Chez Les Femmes Exercant Sur Un Site Artisanal De Fumage De Poisson A Cotonou Au Benin.

INTRODUCTION: Women are constantly exposed to fumes and gases produced by burning wood, however they are poorly studied. The aim of this study was to assess the prevalence of respiratory disorders among women most at risk. SUBJECTS AND METHODS: We conducted a descriptive, transversal and prospective women engaged with the site of artisanal smoked fish Hwlacodji in Cotonou. The survey included a questionnaire exploring the medical history and pathological respiratory events occurred during the last 12 months. All had received spirometry testing. RESULTS: 84 women were included. The average age was 37 ± 12 years, with extremes of 18 and 70 years. More than half of respondents had a tenure of more than 20 years and 61/84 (73%) practiced this profession full time. 70 (83%) had at least one respiratory symptom. The reported symptoms were: rhinitis 77%, 70% cough, dyspnea 65% and 19% have gone out of business last year due to lung disease. Ventilatory abnormalities are found in 49% of respondents. Abnormalities relate to FEV / FVC <0.8: 3 (3.5%), PEF <0, 8: 10 (11.90%), FEV <0.8: 10 (11.90%). CONCLUSION: The respiratory symptoms is quite expressive contrasts with spirometric results. Monitoring over a long period of mostly young women will help lead to meaningful conclusions.

Are the statistical data from Benin's National Tuberculosis Programme reliable?

SETTING: The National Tuberculosis Programme (NTP) of Benin, West Africa. OBJECTIVE: To verify the accuracy of the data published by the NTP in terms of notified cases and treatment results. DESIGN: Purposeful selection of nine basic management units (BMUs) that had declared zero tuberculosis (TB) patients lost to follow-up in the first three quarters of 2006. Retrospective onsite survey by independent teams based on the documents kept at the BMUs, on the data transmitted to and compiled at the central level and on home interviews with patients who had been declared treatment successes. RESULTS: Of the 446 cases evaluated, there was excellent agreement between the TB register and the TB treatment card, between the TB register and the quarterly reports and between the TB register and the laboratory register. Home interviews with 32 patients all confirmed the information contained in the treatment cards and the TB register. CONCLUSION: The results published by the NTP of Benin are remarkably reliable.

Anti-tuberculosis drug resistance among new and previously treated pulmonary tuberculosis patients in Cotonou, Benin.

OBJECTIVES: To assess the current anti-tuberculosis drug resistance situation in Cotonou, at the largest anti-tuberculosis centre of Benin. METHODS: A total of 470 isolates of Mycobacterium tuberculosis complex from pulmonary tuberculosis (TB) patients were analysed: 244 from new cases and 226 from previously treated cases. Drug susceptibility testing of isolates against first-line drugs was performed using the proportion method. RESULTS: Primary multidrug resistance (MDR) depends on the patients' origin: MDR in new cases is relatively high (1.6%) when all patients are considered, but low (0.5%) and comparable to 1994 national survey results when only patients residing in Benin are considered. MDR in previously treated patients (11.1%) remains comparable to the study performed in Benin in 1994. No relation was found between human immunodeficiency virus co-infection and anti-tuberculosis drug resistance. CONCLUSION: This study shows the great importance of correct patient identification in epidemiological surveys, where results may vary according to the population(s) studied.

Outcome of tuberculosis retreatment in routine conditions in Cotonou, Benin.

SETTING: National Tuberculosis Programme (NTP), Cotonou, Benin. OBJECTIVE: To study the patient characteristics and outcome of tuberculosis retreatment cases in a well-functioning NTP. METHODS: A retrospective, register-based study of all smear-positive pulmonary tuberculosis cases put on retreatment (2SERHZ/1ERHZ/5R3H3E3) between 1992 and 2001 in Cotonou. For comparison, information on new smear-positive cases in Cotonou in 1999 was entered and analysed. RESULTS: Of 8103 tuberculosis patients registered, 642 were put on retreatment. The analysis is mainly based on the 236 patients whose initial treatment regimen records were available (113 relapses, 84 failures, 39 returns after default). Most of the relapse (57%) and return after default (72%) cases were put on retreatment within 12 months after stopping their initial treatment. Overall, the retreatment results were satisfactory (78% success) and comparable with those of new cases (82%); the failure rates were low (3%), as were those for initial treatment (1%). There were more defaulters from retreatment among those who had already defaulted from initial treatment (21%). Treatment success rates were better among women than men. CONCLUSION: The standardised retreatment regimen is effective in Cotonou, probably because the NTP is functioning well, there are no drug shortages, drug taking is strictly supervised, and a good treatment plan is followed.