Volume 95, Issue 2
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



Despite overall global progress in tuberculosis (TB) control, TB remains one of the deadliest communicable diseases. This study prospectively assessed TB epidemiology in Lambaréné, Gabon, a Central African country ranking 10th in terms of TB incidence rate in the 2014 World Health Organization TB report. In Lambaréné, between 2012 and 2014, 201 adult and pediatric TB patients were enrolled and followed up; 66% had bacteriologically confirmed TB and 95% had pulmonary TB. The human immunodeficiency virus (HIV) coinfection rate was 42% in adults and 16% in children. and were identified in 82% and 16% of 108 culture-confirmed TB cases, respectively. Isoniazid (INH) and streptomycin yielded the highest resistance rates (13% and 12%, respectively). The multidrug resistant TB (MDR-TB) rate was 4/91 (4%) and 4/13 (31%) in new and retreatment TB cases, respectively. Treatment success was achieved in 53% of patients. In TB/HIV coinfected patients, mortality rate was 25%. In this setting, TB epidemiology is characterized by a high rate of TB/HIV coinfection and low treatment success rates. MDR-TB is a major public health concern; the need to step-up in-country diagnostic capacity for culture and drug susceptibility testing as well as access to second-line TB drugs urgently requires action.


Article metrics loading...

The graphs shown below represent data from March 2017
Loading full text...

Full text loading...



  1. WHO, 2014. Global Tuberculosis Report 2014. Available at: http://apps.who.int/iris/bitstream/10665/137094/1/9789241564809_eng.pdf?ua=1. Accessed August 5, 2015. [Google Scholar]
  2. Bélard S, Janssen S, Osbak KK, Adegnika AA, Ondounda M, Grobusch MP, , 2014. Limited access to drugs for resistant tuberculosis: a call to action. J Public Health (Oxf) 37: 691693. [Google Scholar]
  3. Janssen S, Huson MA, Belard S, Stolp S, Kapata N, Bates M, van Vugt M, Grobusch MP, , 2014. TB and HIV in the Central African region: current knowledge and knowledge gaps. Infection 42: 281294.[Crossref] [Google Scholar]
  4. Direction Générale de la Statistique (DGS) du Gabon et ICF International, 2012. Enquête Démographique et de Santé du Gabon 2012: Rapport de synthèse. Calverton, MD: DGS et ICF International. [Google Scholar]
  5. WHO, 2013. Tuberculosis Country Profile Gabon. Available at: https://extranet.who.int/sree/Reports?op=Replet&name=%2FWHO_HQ_Reports%2FG2%2FPROD%2FEXT%2FTBCountryProfile&ISO2=GA&LAN=EN&outtype=html. Accessed May 18, 2015. [Google Scholar]
  6. Ramharter M, Adegnika AA, Agnandji ST, Matsiegui PB, Grobusch MP, Winkler S, Graninger W, Krishna S, Yazdanbakhsh M, Mordmüller B, Lell B, Missinou MA, Mavoungou E, Issifou S, Kremsner PG, , 2007. History and perspectives of medical research at the Albert Schweitzer Hospital in Lambarene, Gabon. Wien Klin Wochenschr 119 (19–20 Suppl 3): 812.[Crossref] [Google Scholar]
  7. Ministre de la Santé, des Affaires Sociales, de la Solidarité et de la Famille. 2010. Guide Technique National, 4th edition. Gabon: Programme National de Lutte Contre la Tuberculose. [Google Scholar]
  8. International Union Against Tuberculosis and Lung Disease (IUATLD), 2000. Sputum Examination for Tuberculosis by Direct Microscopy in Low Income Countries—Technical Guide, 5th edition. Available at: http://www.uphs.upenn.edu/bugdrug/antibiotic_manual/IUATLD_afb%20microscopy_guide.pdf. Accessed August 5, 2015. [Google Scholar]
  9. WHO, 2013. Definitions and Reporting Framework for Tuberculosis—2013 Revision. Available at: http://apps.who.int/iris/bitstream/10665/79199/1/9789241505345_eng.pdf. Accessed August 5, 2015. [Google Scholar]
  10. Graham SM, Ahmed T, Amanullah F, Browning R, Cardenas V, Casenghi M, Cuevas LE, Gale M, Gie RP, Grzemska M, Handelsman E, Hatherill M, Hesseling AC, Jean-Philippe P, Kampmann B, Kabra SK, Lienhardt C, Lighter-Fisher J, Madhi S, Makhene M, Marais BJ, McNeeley DF, Menzies H, Mitchell C, Modi S, Mofenson L, Musoke P, Nachman S, Powell C, Rigaud M, Rouzier V, Starke JR, Swaminathan S, Wingfield C, , 2012. Evaluation of tuberculosis diagnostics in children: 1. Proposed clinical case definitions for classification of intrathoracic tuberculosis disease. Consensus from an expert panel. J Infect Dis 205 (Suppl 2): S199S208.[Crossref] [Google Scholar]
  11. Programme National de Lutte contre la Tuberculose (PNLT), 2014 Profil Epidemiologique de la Tuberculose au Gabon 2003—2013. Libreville, Gabon: Ministère de la Santé et de la Prévoyance Sociale. [Google Scholar]
  12. Nkoghe D, Toung Mve M, Nnegue S, Okome Nkoume M, Iba BJ, Hypolite J, Leonard P, Kendjo E, , 2005. HIV seroprevalence among tuberculosis patients in Nkembo Hospital, Libreville, Gabon. Short note [in French]. Bull Soc Pathol Exot 98: 121122. [Google Scholar]
  13. Stolp SM, Huson MA, Janssen S, Beyeme JO, Grobusch MP, , 2013. Tuberculosis patients hospitalized in the Albert Schweitzer Hospital, Lambarene, Gabon—a retrospective observational study. Clin Microbiol Infect 19: E499E501.[Crossref] [Google Scholar]
  14. Kombila DU, Moussavou-Kombila JB, Grobusch MP, Lell B, , 2013. Clinical and laboratory features of tuberculosis within a hospital population in Libreville, Gabon. Infection 41: 737739.[Crossref] [Google Scholar]
  15. Ondounda M, Ilozue C, Mounguengui D, Magne C, Nzenze JR, , 2011. Clinical and radiological features of tuberculosis during HIV infection in Libreville, Gabon [in French]. Med Trop (Mars) 71: 253256. [Google Scholar]
  16. Agbor AA, Bigna JJ, Plottel CS, Billong SC, Tejiokem MC, Ekali GL, Noubiap JJ, Toby R, Abessolo H, Koulla-Shiro S, , 2015. Characteristics of patients co-infected with HIV at the time of inpatient tuberculosis treatment initiation in Yaounde, Cameroon: a tertiary care hospital-based cross-sectional study. Arch Public Health 73: 24.[Crossref] [Google Scholar]
  17. WHO, 2010. Treatment of Tuberculosis Guidelines, 4th edition. Available at: http://apps.who.int/iris/bitstream/10665/44165/1/9789241547833_eng.pdf?ua=1&ua=1. Accessed July 14, 2015. [Google Scholar]
  18. Cremers AL, Janssen S, Huson MA, Bikene G, Bélard S, Gerrets RPM, Grobusch MP, , 2013. Perceptions, health seeking behaviour and implementation of a tuberculosis control programme in Lambaréné, Gabon. Public Health Action 3: 328332.[Crossref] [Google Scholar]
  19. Sreeramareddy CT, Qin ZZ, Satyanarayana S, Subbaraman R, Pai M, , 2014. Delays in diagnosis and treatment of pulmonary tuberculosis in India: a systematic review. Int J Tuberc Lung Dis 18: 255266.[Crossref] [Google Scholar]
  20. Malvy D, Ezzedine KH, Receveur MC, Pistone T, Mercie P, Longy-Boursier M, , 2006. Extra-pulmonary paragonimiasis with unusual arthritis and cutaneous features among a tourist returning from Gabon. Travel Med Infect Dis 4: 340342.[Crossref] [Google Scholar]
  21. Petavy AF, Cambon M, Demeocq F, Dechelotte P, , 1981. A Gabonese case of paragonimiasis in a child [in French]. Bull Soc Pathol Exot 74: 193197. [Google Scholar]
  22. Sachs R, Kern P, Voelker J, , 1983. Paragonimus uterobilateralis as the cause of 3 cases of human paragonimiasis in Gabon [in French]. Tropenmed Parasitol 34: 105108. [Google Scholar]
  23. Voelker J, Sachs R, , 1985. Morphology of the lung fluke Paragonimus uterobilateralis occurring in Gabon, west Africa. Trop Med Parasitol 36: 210212. [Google Scholar]
  24. Vuong PN, Bayssade-Dufour C, Mabika B, Ogoula-Gerbeix S, Kombila M, , 1996. Paragonimus westermani pulmonary distomatosis in Gabon. First case [in French]. Presse Med 25: 10841085. [Google Scholar]
  25. Belizario V, Jr Totanes FI, Asuncion CA, De Leon W, Jorge M, Ang C, Naig JR, , 2014. Integrated surveillance of pulmonary tuberculosis and paragonimiasis in Zamboanga del Norte, the Philippines. Pathog Glob Health 108: 95102.[Crossref] [Google Scholar]
  26. Musau S, McCarthy K, Okumu A, Shinnick T, Wandiga S, Williamson J, Cain K, , 2015. Experience in implementing a quality management system in a tuberculosis laboratory, Kisumu, Kenya. Int J Tuberc Lung Dis 19: 693695.[Crossref] [Google Scholar]
  27. Mathewos B, Kebede N, Kassa T, Mihret A, Getahun M, , 2015. Characterization of Mycobacterium isolates from pulmonary tuberculosis suspected cases visiting Tuberculosis Reference Laboratory at Ethiopian Health and Nutrition Research Institute, Addis Ababa Ethiopia: a cross sectional study. Asian Pac J Trop Med 8: 3540.[Crossref] [Google Scholar]
  28. Huet M, Rist N, Boube G, Potier D, , 1971. Bacteriological study of tuberculosis in Cameroon [in French]. Rev Tuberc Pneumol (Paris) 35: 413426. [Google Scholar]
  29. Niobe-Eyangoh SN, Kuaban C, Sorlin P, Cunin P, Thonnon J, Sola C, Rastogi N, Vincent V, Gutierrez MC, , 2003. Genetic biodiversity of Mycobacterium tuberculosis complex strains from patients with pulmonary tuberculosis in Cameroon. J Clin Microbiol 41: 25472553.[Crossref] [Google Scholar]
  30. Heller T, Goblirsch S, Bahlas S, Ahmed M, Giordani MT, Wallrauch C, Brunetti E, 2013. Diagnostic value of FASH ultrasound and chest X-ray in HIV-co-infected patients with abdominal tuberculosis. Int J Tuberc Lung Dis 17: 342344.[Crossref] [Google Scholar]
  31. Heller T, Wallrauch C, Goblirsch S, Brunetti E, , 2012. Focused assessment with sonography for HIV-associated tuberculosis (FASH): a short protocol and a pictorial review. Crit Ultrasound J 4: 21.[Crossref] [Google Scholar]
  32. Janssen S, Grobusch MP, Heller T, , 2013. ‘Remote FASH’ tele-sonography—a novel tool to assist diagnosing HIV-associated extrapulmonary tuberculosis in remote areas. Acta Trop 127: 5355.[Crossref] [Google Scholar]
  33. Mounguengui D, Ondounda M, Mandji Lawson JM, Fabre M, Gaudong L, Mangouka L, Magne C, Nzenze JR, L'her P, , 2012. Multi-resistant tuberculosis at the Hâopital d'instruction des Armées de Libreville (Gabon) about 16 cases [in French]. Bull Soc Pathol Exot 105: 14.[Crossref] [Google Scholar]
  34. Menzies D, Benedetti A, Paydar A, Royce S, Madhukar P, Burman W, Vernon A, Lienhardt C, , 2009. Standardized treatment of active tuberculosis in patients with previous treatment and/or with mono-resistance to isoniazid: a systematic review and meta-analysis. PLoS Med 6: e1000150.[Crossref] [Google Scholar]
  35. Machado D, Perdigao J, Ramos J, Couto I, Portugal I, Ritter C, Boettger EC, Viveiros M, , 2013. High-level resistance to isoniazid and ethionamide in multidrug-resistant Mycobacterium tuberculosis of the Lisboa family is associated with inhA double mutations. J Antimicrob Chemother 68: 17281732.[Crossref] [Google Scholar]
  36. Mve MT, Bisvigou U, Barry NC, Ondo CE, Nkoghe D, , 2010. Reasons for stopping and restarting tuberculosis treatment in Libreville (Gabon) [in French]. Sante 20: 3134. [Google Scholar]

Data & Media loading...

  • Received : 13 Sep 2015
  • Accepted : 11 Apr 2016
  • Published online : 03 Aug 2016

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error