Tuberculosis Treatment Outcome and Drug Resistance in Lambaréné, Gabon: A Prospective Cohort Study

Sabine Bélard Centre de Recherches Médicales de Lambaréné, Hôpital Albert Schweitzer, Lambaréné, Gabon.
Institut für Tropenmedizin, Universitätsklinikum Tübingen, Eberhard Karls Universität, Tübingen, Germany.
Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
Department of Pediatric Pneumology and Immunology, Charité Universitätsmedizin Berlin, Berlin, Germany.

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Jonathan Remppis Centre de Recherches Médicales de Lambaréné, Hôpital Albert Schweitzer, Lambaréné, Gabon.
Institut für Tropenmedizin, Universitätsklinikum Tübingen, Eberhard Karls Universität, Tübingen, Germany.

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Sanne Bootsma Centre de Recherches Médicales de Lambaréné, Hôpital Albert Schweitzer, Lambaréné, Gabon.
Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.

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Saskia Janssen Centre de Recherches Médicales de Lambaréné, Hôpital Albert Schweitzer, Lambaréné, Gabon.
Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town, South Africa.

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Davy U. Kombila Centre de Recherches Médicales de Lambaréné, Hôpital Albert Schweitzer, Lambaréné, Gabon.

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Justin O. Beyeme Hôpital Albert Schweitzer de Lambaréné, Lambaréné, Gabon.

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Elie G. Rossatanga Centre de Traitement Ambulatoire Lambaréné, Lambaréné, Gabon.

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Cosme Kokou Hôpital Albert Schweitzer de Lambaréné, Lambaréné, Gabon.

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Kara K. Osbak Centre de Recherches Médicales de Lambaréné, Hôpital Albert Schweitzer, Lambaréné, Gabon.
Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.

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Régis M. Obiang Mba Centre de Recherches Médicales de Lambaréné, Hôpital Albert Schweitzer, Lambaréné, Gabon.

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Harry M. Kaba Centre de Recherches Médicales de Lambaréné, Hôpital Albert Schweitzer, Lambaréné, Gabon.

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Afsatou N. Traoré Centre de Recherches Médicales de Lambaréné, Hôpital Albert Schweitzer, Lambaréné, Gabon.
Microbiology Department, University of Venda, Thohoyandou, South Africa.

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Jonas Ehrhardt Centre de Recherches Médicales de Lambaréné, Hôpital Albert Schweitzer, Lambaréné, Gabon.
Institut für Tropenmedizin, Universitätsklinikum Tübingen, Eberhard Karls Universität, Tübingen, Germany.

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Emmanuel B. Bache Centre de Recherches Médicales de Lambaréné, Hôpital Albert Schweitzer, Lambaréné, Gabon.

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Arnaud Flamen Centre de Recherches Médicales de Lambaréné, Hôpital Albert Schweitzer, Lambaréné, Gabon.

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Sabine Rüsch-Gerdes National Reference Center for Mycobacteria, Forschungszentrum Borstel, Borstel, Germany.

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Matthias Frank Centre de Recherches Médicales de Lambaréné, Hôpital Albert Schweitzer, Lambaréné, Gabon.
Institut für Tropenmedizin, Universitätsklinikum Tübingen, Eberhard Karls Universität, Tübingen, Germany.
German Centre for Infection Research (DZIF), Partner Site Tübingen, Germany.

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Ayôla A. Adegnika Centre de Recherches Médicales de Lambaréné, Hôpital Albert Schweitzer, Lambaréné, Gabon.
Institut für Tropenmedizin, Universitätsklinikum Tübingen, Eberhard Karls Universität, Tübingen, Germany.
German Centre for Infection Research (DZIF), Partner Site Tübingen, Germany.

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Bertrand Lell Centre de Recherches Médicales de Lambaréné, Hôpital Albert Schweitzer, Lambaréné, Gabon.
Institut für Tropenmedizin, Universitätsklinikum Tübingen, Eberhard Karls Universität, Tübingen, Germany.
German Centre for Infection Research (DZIF), Partner Site Tübingen, Germany.

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Stefan Niemann National Reference Center for Mycobacteria, Forschungszentrum Borstel, Borstel, Germany.

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Peter G. Kremsner Centre de Recherches Médicales de Lambaréné, Hôpital Albert Schweitzer, Lambaréné, Gabon.
Institut für Tropenmedizin, Universitätsklinikum Tübingen, Eberhard Karls Universität, Tübingen, Germany.
German Centre for Infection Research (DZIF), Partner Site Tübingen, Germany.

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Marguerite M. Loembé Centre de Recherches Médicales de Lambaréné, Hôpital Albert Schweitzer, Lambaréné, Gabon.
Institut für Tropenmedizin, Universitätsklinikum Tübingen, Eberhard Karls Universität, Tübingen, Germany.
German Centre for Infection Research (DZIF), Partner Site Tübingen, Germany.
Bacteriology and Virology Department, Université des Sciences de la Santé, Libreville, Gabon.

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Abraham S. Alabi Centre de Recherches Médicales de Lambaréné, Hôpital Albert Schweitzer, Lambaréné, Gabon.
Institut für Tropenmedizin, Universitätsklinikum Tübingen, Eberhard Karls Universität, Tübingen, Germany.

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Martin P. Grobusch Centre de Recherches Médicales de Lambaréné, Hôpital Albert Schweitzer, Lambaréné, Gabon.
Institut für Tropenmedizin, Universitätsklinikum Tübingen, Eberhard Karls Universität, Tübingen, Germany.
Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town, South Africa.
German Centre for Infection Research (DZIF), Partner Site Tübingen, Germany.

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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. Mycobacterium tuberculosis and Mycobacterium africanum 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.

Author Notes

* Address correspondence to Martin P. Grobusch, Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1100 DE, Amsterdam, The Netherlands. E-mail: m.p.grobusch@amc.uva.nl

Financial support: The study was supported by the European and Developing Countries Clinical Trials Partnership (EDCTP) through a grant to the Pan-African Consortium for the Evaluation of Antituberculosis Antibiotics (PanACEA) Consortium.

Authors' addresses: Sabine Bélard, Department of Pediatric Pneumology and Immunology, Charité-Universitätsmedizin Berlin, Berlin, Germany, E-mail: sabinebelard@yahoo.de. Jonathan Remppis, Davy U. Kombila, Kara K. Osbak, Régis M. Obiang Mba, Harry M. Kaba, Emmanuel B. Bache, Arnaud Flamen, Ayôla A. Adegnika, Bertrand Lell, Marguerite M. Loembé, and Abraham S. Alabi, Centre de Recherches Médicales de Lambaréné, Hôpital Albert Schweitzer, Lambaréné, Gabon, E-mails: jonathan.remppis@posteo.de, ukombila@gmail.com, kosbak@hotmail.com, obianregi@yahoo.fr, kharry3@yahoo.fr, bebache@gmail.com, arnaud.flamen@live.fr, aadegnika@gmail.com, bertrand.lell@gmail.com, mmassingaloembe@lambarene.org, and aalabi02@yahoo.co.uk. Sanne Bootsma, Saskia Janssen, and Martin P. Grobusch, Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands, E-mails: bootsmasanne@gmail.com, s.janssen@amc.uva.nl, and m.p.grobusch@amc.uva.nl. Justin O. Beyeme and Cosme Kokou, Hôpital Albert Schweitzer de Lambaréné, Lambaréné, Gabon, E-mails: justinomva@yahoo.fr and ckokou2002@yahoo.fr. Elie G. Rossatanga, Centre de Traitement Ambulatoire Lambaréné, Lambaréné, Gabon, E-mail: rossatanga@yahoo.fr. Afsatou N. Traoré, Microbiology Department, University of Venda, Thohoyandou, South Africa, E-mail: traoresafi@hotmail.com. Jonas Ehrhardt, Matthias Frank, and Peter G. Kremsner, Institut für Tropenmedizin, Universitätsklinikum Tübingen, Eberhard Karls Universität, Tübingen, Germany, E-mails: jonasehrhardt@yahoo.de, matthias.frank@medizin.uni-tuebingen.de, and peter.kremsner@uni-tuebingen.de. Sabine Rüsch-Gerdes and Stefan Niemann, National Reference Center for Mycobacteria, Forschungszentrum Borstel, Borstel, Germany, E-mails: srueschg@t-online.de and stniemann@yahoo.de.

  • 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.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 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.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 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.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 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.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 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.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 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.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 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.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 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.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 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.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 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.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 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.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 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.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 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.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 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.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 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.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 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.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 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.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 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.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 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.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 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.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 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.

  • 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.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23.

    Voelker J, Sachs R, 1985. Morphology of the lung fluke Paragonimus uterobilateralis occurring in Gabon, west Africa. Trop Med Parasitol 36: 210212.

  • 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.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 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.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 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.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 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.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 28.

    Huet M, Rist N, Boube G, Potier D, 1971. Bacteriological study of tuberculosis in Cameroon [in French]. Rev Tuberc Pneumol (Paris) 35: 413426.

  • 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.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 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.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 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.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 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.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 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.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 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.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 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.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 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.

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