[Tetanus in Ho Chi Minh City, Vietnam: epidemiological, clinical and outcome features of 389 cases at the Hospital for Tropical Diseases]. / Le tétanos à Hô-Chi-Minh-Ville, Vietnam : épidémiologie, clinique et pronostic, à propos de 389 cas à l'Hôpital des maladies tropicales.

The objective of this study is to describe the different aspects of tetanus during the past recent years in southern Vietnam: epidemiology, clinical picture, management, and death risk factors. It is a retrospective study concerning 389 cases admitted in 2007 and 2008 at the reference Hospital for Tropical Diseases in Ho Chi Minh City. 93% of all cases were generalized tetanus, and 50% were severe cases. A majority of patients were adult males (medium age 43, M/ F sex-ratio 2.9). Half of them underwent tracheotomy and 39% assisted ventilation. Case fatality rate was 6.4%, the lowest reported rate worldwide in the last ten years. Fatalities resulted mainly from neuro-vegetative disorders, essentially cardiogenic shock (28% of all deaths) [OR = 16.95; p < 0.001], sepsis (24%) [OR = 3.25; (p < 0,114], and acute renal failure (16%) [OR = 7,22; p < 0.004]. Age over 60-year [OR = 4.53; p < 0.0001] and a leukocyte count>12.000/mm(3) [OR = 2.32; p < 0.020] were significantly associated with fatal outcome, contrarily to incubation and extension phase durations, or delayed serum administration. Systematic extension of vaccination to all adult males, and improved access to post exposure sero-immunization at all levels of health centres throughout the country may further reduce tetanus burden in Vietnam.

Penicilliosis and AIDS in Haiphong, Vietnam: evolution and predictive factors of death.

OBJECTIVES: The study objective was to assess the lethality rates and the predictive factors for death in AIDS patients infected by Penicillium marneffei (Pm) in Hai Phong, Vietnam. METHODS: A retrospective cohort study was conducted by reviewing 103 medicals records of confirmed cases from June 2006 to August 2009. RESULTS: Penicilliosis-related mortality was very high (33%). The majors risk factors of death were: (i) patient lacking complete treatment, a regimen with both of secondary prophylaxis by itraconazole and HAART (OR=52.2, P<0.001); (ii) patients having received only secondary prophylaxis (OR=21.2, P<0.001); (iii) patients coinfected by hepatitis C (OR=2.3, P=0.02) and tuberculosis (OR=1.97, P=0.04). Penicilliosis occurred in 28 cases after initiation of ART, probably caused by IRIS, with the same signs and symptoms as "common" penicilliosis. However, the diagnosis of IRIS was ruled out because the viral load could not be assessed. CONCLUSIONS: Penicilliosis is very frequent in the North of Vietnam. A good compliance to a complete treatment with healing antifungal (Amphotericin B) then secondary prophylaxis (Itraconazole) associate with ART, prolongs survival, prevents relapse, and also allows discontinuing a secondary prophylaxis in a half of the cases.

Drug resistance and HIV co-infection among pulmonary tuberculosis patients in Haiphong City, Vietnam.

SETTING: Vietnam is one of the 22 countries with the highest burden of tuberculosis (TB). Although its National Tuberculosis Programme (NTP) is effective, there is no ongoing surveillance of drug resistance. OBJECTIVE: To establish the first step of a surveillance programme on anti-tuberculosis drug resistance in Haiphong, the third largest city in Vietnam. DESIGN: A regional survey using proportionate cluster sampling in 2006, and recording patients' characteristics, including human immunodeficiency virus (HIV) co-infection. RESULTS: There was a high prevalence of HIV co-infection (14.2%) among culture-positive pulmonary TB patients. The prevalence of drug resistance was high, and it was much higher among previously treated cases than among new cases (52.5% vs. 25.6%), with resistance to streptomycin being the most prevalent. The prevalence of multidrug resistance was high among new cases (4.4%), but was relatively low among previously treated cases (10%). HIV co-infection was related to resistance to rifampicin alone among new cases, but was not a risk factor for any other resistance pattern. CONCLUSION: These results suggest a high prevalence of anti-tuberculosis drug resistance and of HIV co-infection among TB patients in Haiphong. Ongoing surveillance to assess resistance trends is needed, and the NTP needs to coordinate HIV and TB programmes to address the growing issue of TB and HIV co-infection.

Evaluation of data quality in a laboratory-based surveillance of M. tuberculosis drug resistance and impact on the prevalence of resistance: France, 2004.

In France, surveillance of anti-tuberculosis drug resistance is performed by the Azay-Mycobacteria network, representing 30% of all culture-positive cases. We sought to validate administrative and clinical data gathered by the network in 2004 and to produce corrected resistance rates accounting for the observed misclassification. We reviewed a 10% sample of patients' records diagnosed in 2004 and measured the agreement between controlled data and data collected by the network by using the kappa (kappa) statistic. A re-sampling bootstrap-based method was used to investigate the impact of bias found on resistance rates. Most of data collected by the network, such as demographic data, and country of birth had an excellent agreement (kappa>0.8) with controlled data. The concordance was good (kappa>0.6) for HIV status and tuberculosis site. The only variable slightly discordant with controlled data was prior history of treatment (kappa=0.52). However, after correcting crude resistance rates for the observed misclassification, all estimated rates were within confidence intervals based on reported rates. This validation study is in favour of a good quality of data produced by the network, even though corrected rates are slightly different from observed rates. Therefore, data collected through the network may be used for policy making and tuberculosis programme evaluation. However, improvement in data collection regarding prior history of treatment should be considered.

A 10-year prospective surveillance of Mycobacterium tuberculosis drug resistance in France 1995-2004.

Drug resistance surveillance and trend monitoring resistance rates bring some insights into tuberculosis (TB) control. The current study reports the characteristics of TB and drug resistance during a 10-yr prospective surveillance of culture-positive TB in France. Data for the current study was collected from 1995-2004 via a sentinel network of laboratories from university hospitals that complied with the international recommendations for the surveillance of drug resistance. Susceptibility test results were performed in each individual laboratory. Data on 13,283 patients were collected during the 10-yr period, 49% of whom had been born in France, 10% were HIV co-infected and 8% had previously been treated. As expected, previously treated and HIV co-infected patients were more likely to harbour resistant strains, especially rifampicin (RMP)-resistant strains. Among new patients, the mean resistance rate to at least one drug was 8.8%, and there was an upward trend in resistance to isoniazid and RMP (0.8-1%) related to the increase in the proportion of patients who had been born outside of France (38-53%). Among previously treated patients, the mean resistance rate to one drug was 20.6% and there was no significant time trend in resistance rates. The sentinel network provided valuable data on trends regarding the characteristics of tuberculosis and on drug resistance rates and reinforced the interest of analysing data by country of birth and history of treatment.