This case report presents a 63-year-old male patient with a history of TB 20 years prior, who developed chronic cor pulmonale, right heart failure, and eventually died. The report emphasizes the serious long-term effe...This case report presents a 63-year-old male patient with a history of TB 20 years prior, who developed chronic cor pulmonale, right heart failure, and eventually died. The report emphasizes the serious long-term effects of post-TB sequelae, highlighting diagnostic challenges, clinical progression, and management strategies. The case report addresses a significant and often overlooked aspect of TB management: the long-term complications following TB treatment, known as post-TB sequelae.展开更多
<i>Setting</i>: Kinshasa, capital of Democratic Republic of Congo, has the high rate of multidrug resistant tuberculosis (MDR-TB) which is associated with poor treatment outcomes until 2013. A new approach...<i>Setting</i>: Kinshasa, capital of Democratic Republic of Congo, has the high rate of multidrug resistant tuberculosis (MDR-TB) which is associated with poor treatment outcomes until 2013. A new approach was needed. <i>Objectives</i>: To implement a new strategy in order to improve treatment outcomes. <i>Design</i>: A retrospective cohort study reviewing all the patients diagnosed MDR Tuberculosis between 2014 and 2017. The study was conducted in the National Tuberculosis Program (NTP) framework comparing the short regimen and the WHO standard regimen. <i>Results</i>: From 1246 patients diagnosed RR/TB, 1073 were included in the analysis: 948 on shorter regimen, and 125 on WHO standard regimen. The strategy was based on patient-centered care. In the short regimen group, 62.7% were male, 61.4% were age 25 - 44 years, 52.6% had previous history of TB, 39.3% underweight, 12.5% HIV positive. The median time from diagnosis to treatment was 19 days (0 - 163). In the long regimen group, 75% were male, 37.6% were age 14 - 44 years, 61.6% underweight, 18.4% HIV positive. The median time from diagnosis to treatment was 19 days (0 - 114). Favorable outcomes represented 81.9% in the short regimen group versus 72% in the long regimen group. Death and loss to follow-up were more observed in long regimen group (27.2% versus 15.4%). Factors associated with unfavorable outcomes in the short regimen group included sex, age ≥ 45 years, previous TB history, HIV status, delay to begin treatment. For the long regimen, the factors age and delay emerged, underweight and HIV were borderline. Drug adverse events were reported respectively in 43.5% and 42.4% for short and long regimen;with gastrointestinal disturbances, vestibular troubles, ototoxicity, arthralgia and anemia as the most common in the 2 groups. <i>Conclusion: </i>The new approach improved favorable outcomes. Both short and long regimens reached a high level of favorable outcome compared to the previous study. The short regimen, well supervised seems to be superior to the long regimen in term of Death rate and loss to follow up (LTFU).展开更多
Context: Multidrug-resistant tuberculosis (MDR-TB) remains a major public health problem in developing countries such as the Democratic Republic of Congo (DRC), which continues to face the emergence of MDR-TB cases. B...Context: Multidrug-resistant tuberculosis (MDR-TB) remains a major public health problem in developing countries such as the Democratic Republic of Congo (DRC), which continues to face the emergence of MDR-TB cases. Because of the ototoxic effects of AGs, the World Health Organization (WHO) has recommended the introduction of the bedaquiline regimen. However, very few data are available regarding the susceptibility of bedaquiline to induce hearing loss, hence the present study set out to compare the AG-based regimen and the bedaquiline-based regimen in the occurrence of hearing loss in MDR-TB patients. Methods: This is a prospective multicenter cohort study that included 335 MDR-TB patients, performed in Kinshasa (DRC) during the period from January 2020 to January 2021. Sociodemographic, clinical, biological and audiometric data were analyzed using Stata 17. Repeated-measures analysis of variance was used to compare changes in the degree of hearing loss over time between the two groups of patients on AG and bedaquiline regimens. The double-difference method was estimated using regression with fixed-effects. A p value < 0.05 was considered the threshold for statistical significance. Results: The degree of hearing loss was similar between the two groups at the first month [AGs (28 dB) vs BDQ (30 dB);p = 0.298]. At six months, the mean degree of hearing loss was significantly greater in the aminoglycoside regimen group [AGs (60.5 dB) vs BDQ (44 dB);p < 0.001]. The double difference was significant, with a greater increase in hearing loss in the AGs group (diff-in-diff 18.3;p < 0.001). After adjustment for age and serum albumin, the group receiving the AG-based regimen had a 2-point greater worsening than those with bedaquiline at the sixth month (diff-in-diff 19.8;p Conclusion: Hearing loss is frequent with both treatment regimens, but more marked with the Aminoglycoside-based regimen. Thus, bedaquiline should also benefit for audiometric monitoring in future MDR-TB patients.展开更多
Background: The onset of the hearing loss is a major challenge during the treatment of multidrug-resistant tuberculosis (MDR-TB). Aminoglycoside-based regimens, to a lesser extent based on bedaquiline, induce ototoxic...Background: The onset of the hearing loss is a major challenge during the treatment of multidrug-resistant tuberculosis (MDR-TB). Aminoglycoside-based regimens, to a lesser extent based on bedaquiline, induce ototoxic sensorineural hearing loss. Research on risk factors is essential to enable high-risk individuals to benefit from preventive measures in settings with limited resources. Objective: This study aimed to assess the determinants of the hearing loss in patients with MDR-TB. Methods: This prospective multicenter cohort study included 337 patients with MDR-TB. It was performed in Kinshasa (Democratic Republic of the Congo) between January 2020 and January 2021. Sociodemographic, clinical, biological, therapeutic, and audiometric data were exported and analyzed using Stata 17 and MedCalc. The fixed-effect linear regression panel model was used to assess the degree of the hearing loss over time according to the following covariates: therapeutic regimen (aminoglycosides, bedaquiline, or alternate), stage of chronic kidney disease (CKD), age at inclusion, body mass index, serum albumin level, HIV status, alcohol intake, hypertension, and hemoglobin level. The Hausman test was used to select between fixed- and random-effect estimators. The threshold for statistical significance was set at p Result: A total of 236 patients (70%) received an aminoglycoside-based regimen, 61 (18%) received a bedaquiline-based regimen, and 40 (12%) received aminoglycosides relayed by bedaquiline. The frequency of the hearing loss increased from 62% to 96.3% within six months for all therapeutic regimens. The Hearing loss worsened, with moderate (72.4%) and profound (16%) deafness being predominant. An Exposure to the treatment for more than one month (β coeff: 27.695, Se: 0.793, p β coeff: 6.102, Se: 1.779, p β coeff: 5.610, Se: 1.682, p = 0.001), and an eGFR β coeff: 6.730, Se: 2.70, p = 0.013) were the independent risk factors associated with the hearing loss in patients with MDR-TB. Conclusions: The Hearing loss was more prevalent and worsened during the treatment of the patients with MDR-TB. An Exposure for more than one month, AG-based regimens, advanced age, hypoalbuminemia, and CKD have emerged as the main determinants of the worsening of the hearing loss.展开更多
Background: Some national and international strategies for the detection and prevention of emerging infectious diseases have been established across sectors. The capacity to carry out these tasks varies from country t...Background: Some national and international strategies for the detection and prevention of emerging infectious diseases have been established across sectors. The capacity to carry out these tasks varies from country to country, and that remains largely undervalued. The Pasteur Institute of C?te d’Ivoire has created and implemented the capacity of national reference centers to fight against emerging and other infectious diseases. Objective: Show on the one hand the strategies used to develop the National Reference Centers and the IPCI and on the other hand the results obtained by performing these strategies. Method: Datas collection by documentary analysis (published scientific articles and grey literature) was done on Google Scholar, PUBMED and institutional reference documents. The documentary research was carried out to have a better understanding of strategies used to create and develop the NRCs in microbiology of communicable diseases. Results: Seven integrated strategies were launched: 1-training and workforce development;2-investigation of epidemics or public health events;3-strengthening laboratory epidemiological research;4-strengthening surveillance systems;5-improving communication with partners and stakeholders;6-building national and international collaborations;and 7-strengthening technical and technological platforms. In two decades, the number of researchers has risen from 10 in 2004 to ninety (90) in 2021, with 12 senior researchers and 32 junior researchers. A number of health service staff had attended a qualifying training course, 27 investigations into outbreaks and other public health events had been carried out, 18 short-term research projects had been launched, major surveillance programs and epidemiological research efforts on vector-borne, food-borne and nosocomial infections had begun, and several scientific manuscripts had been published or were edited in the writting press. Conclusion: The Ivorian experience shows that, with concerted effort, considerable progress can be made in the development and implementation of an infectious disease control program.展开更多
文摘This case report presents a 63-year-old male patient with a history of TB 20 years prior, who developed chronic cor pulmonale, right heart failure, and eventually died. The report emphasizes the serious long-term effects of post-TB sequelae, highlighting diagnostic challenges, clinical progression, and management strategies. The case report addresses a significant and often overlooked aspect of TB management: the long-term complications following TB treatment, known as post-TB sequelae.
文摘<i>Setting</i>: Kinshasa, capital of Democratic Republic of Congo, has the high rate of multidrug resistant tuberculosis (MDR-TB) which is associated with poor treatment outcomes until 2013. A new approach was needed. <i>Objectives</i>: To implement a new strategy in order to improve treatment outcomes. <i>Design</i>: A retrospective cohort study reviewing all the patients diagnosed MDR Tuberculosis between 2014 and 2017. The study was conducted in the National Tuberculosis Program (NTP) framework comparing the short regimen and the WHO standard regimen. <i>Results</i>: From 1246 patients diagnosed RR/TB, 1073 were included in the analysis: 948 on shorter regimen, and 125 on WHO standard regimen. The strategy was based on patient-centered care. In the short regimen group, 62.7% were male, 61.4% were age 25 - 44 years, 52.6% had previous history of TB, 39.3% underweight, 12.5% HIV positive. The median time from diagnosis to treatment was 19 days (0 - 163). In the long regimen group, 75% were male, 37.6% were age 14 - 44 years, 61.6% underweight, 18.4% HIV positive. The median time from diagnosis to treatment was 19 days (0 - 114). Favorable outcomes represented 81.9% in the short regimen group versus 72% in the long regimen group. Death and loss to follow-up were more observed in long regimen group (27.2% versus 15.4%). Factors associated with unfavorable outcomes in the short regimen group included sex, age ≥ 45 years, previous TB history, HIV status, delay to begin treatment. For the long regimen, the factors age and delay emerged, underweight and HIV were borderline. Drug adverse events were reported respectively in 43.5% and 42.4% for short and long regimen;with gastrointestinal disturbances, vestibular troubles, ototoxicity, arthralgia and anemia as the most common in the 2 groups. <i>Conclusion: </i>The new approach improved favorable outcomes. Both short and long regimens reached a high level of favorable outcome compared to the previous study. The short regimen, well supervised seems to be superior to the long regimen in term of Death rate and loss to follow up (LTFU).
文摘Context: Multidrug-resistant tuberculosis (MDR-TB) remains a major public health problem in developing countries such as the Democratic Republic of Congo (DRC), which continues to face the emergence of MDR-TB cases. Because of the ototoxic effects of AGs, the World Health Organization (WHO) has recommended the introduction of the bedaquiline regimen. However, very few data are available regarding the susceptibility of bedaquiline to induce hearing loss, hence the present study set out to compare the AG-based regimen and the bedaquiline-based regimen in the occurrence of hearing loss in MDR-TB patients. Methods: This is a prospective multicenter cohort study that included 335 MDR-TB patients, performed in Kinshasa (DRC) during the period from January 2020 to January 2021. Sociodemographic, clinical, biological and audiometric data were analyzed using Stata 17. Repeated-measures analysis of variance was used to compare changes in the degree of hearing loss over time between the two groups of patients on AG and bedaquiline regimens. The double-difference method was estimated using regression with fixed-effects. A p value < 0.05 was considered the threshold for statistical significance. Results: The degree of hearing loss was similar between the two groups at the first month [AGs (28 dB) vs BDQ (30 dB);p = 0.298]. At six months, the mean degree of hearing loss was significantly greater in the aminoglycoside regimen group [AGs (60.5 dB) vs BDQ (44 dB);p < 0.001]. The double difference was significant, with a greater increase in hearing loss in the AGs group (diff-in-diff 18.3;p < 0.001). After adjustment for age and serum albumin, the group receiving the AG-based regimen had a 2-point greater worsening than those with bedaquiline at the sixth month (diff-in-diff 19.8;p Conclusion: Hearing loss is frequent with both treatment regimens, but more marked with the Aminoglycoside-based regimen. Thus, bedaquiline should also benefit for audiometric monitoring in future MDR-TB patients.
文摘Background: The onset of the hearing loss is a major challenge during the treatment of multidrug-resistant tuberculosis (MDR-TB). Aminoglycoside-based regimens, to a lesser extent based on bedaquiline, induce ototoxic sensorineural hearing loss. Research on risk factors is essential to enable high-risk individuals to benefit from preventive measures in settings with limited resources. Objective: This study aimed to assess the determinants of the hearing loss in patients with MDR-TB. Methods: This prospective multicenter cohort study included 337 patients with MDR-TB. It was performed in Kinshasa (Democratic Republic of the Congo) between January 2020 and January 2021. Sociodemographic, clinical, biological, therapeutic, and audiometric data were exported and analyzed using Stata 17 and MedCalc. The fixed-effect linear regression panel model was used to assess the degree of the hearing loss over time according to the following covariates: therapeutic regimen (aminoglycosides, bedaquiline, or alternate), stage of chronic kidney disease (CKD), age at inclusion, body mass index, serum albumin level, HIV status, alcohol intake, hypertension, and hemoglobin level. The Hausman test was used to select between fixed- and random-effect estimators. The threshold for statistical significance was set at p Result: A total of 236 patients (70%) received an aminoglycoside-based regimen, 61 (18%) received a bedaquiline-based regimen, and 40 (12%) received aminoglycosides relayed by bedaquiline. The frequency of the hearing loss increased from 62% to 96.3% within six months for all therapeutic regimens. The Hearing loss worsened, with moderate (72.4%) and profound (16%) deafness being predominant. An Exposure to the treatment for more than one month (β coeff: 27.695, Se: 0.793, p β coeff: 6.102, Se: 1.779, p β coeff: 5.610, Se: 1.682, p = 0.001), and an eGFR β coeff: 6.730, Se: 2.70, p = 0.013) were the independent risk factors associated with the hearing loss in patients with MDR-TB. Conclusions: The Hearing loss was more prevalent and worsened during the treatment of the patients with MDR-TB. An Exposure for more than one month, AG-based regimens, advanced age, hypoalbuminemia, and CKD have emerged as the main determinants of the worsening of the hearing loss.
基金This study was funded by the UK Department of Inter-national Development(DFID)withinthe framework of the West African TB Research Initiative(ref Afw9800/255/703/007A),and the Medical Research Council.
文摘Background: Some national and international strategies for the detection and prevention of emerging infectious diseases have been established across sectors. The capacity to carry out these tasks varies from country to country, and that remains largely undervalued. The Pasteur Institute of C?te d’Ivoire has created and implemented the capacity of national reference centers to fight against emerging and other infectious diseases. Objective: Show on the one hand the strategies used to develop the National Reference Centers and the IPCI and on the other hand the results obtained by performing these strategies. Method: Datas collection by documentary analysis (published scientific articles and grey literature) was done on Google Scholar, PUBMED and institutional reference documents. The documentary research was carried out to have a better understanding of strategies used to create and develop the NRCs in microbiology of communicable diseases. Results: Seven integrated strategies were launched: 1-training and workforce development;2-investigation of epidemics or public health events;3-strengthening laboratory epidemiological research;4-strengthening surveillance systems;5-improving communication with partners and stakeholders;6-building national and international collaborations;and 7-strengthening technical and technological platforms. In two decades, the number of researchers has risen from 10 in 2004 to ninety (90) in 2021, with 12 senior researchers and 32 junior researchers. A number of health service staff had attended a qualifying training course, 27 investigations into outbreaks and other public health events had been carried out, 18 short-term research projects had been launched, major surveillance programs and epidemiological research efforts on vector-borne, food-borne and nosocomial infections had begun, and several scientific manuscripts had been published or were edited in the writting press. Conclusion: The Ivorian experience shows that, with concerted effort, considerable progress can be made in the development and implementation of an infectious disease control program.
