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Tuberculosis Treatment Outcome and Drug Resistance in Lambaréné, Gabon: A Prospective Cohort Study
Sabine Bélard
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
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
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
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
Davy U. Kombila
Centre de Recherches Médicales de Lambaréné, Hôpital Albert Schweitzer, Lambaréné, Gabon.
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Justin O. Beyeme
Justin O. Beyeme
Hôpital Albert Schweitzer de Lambaréné, Lambaréné, Gabon.
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Elie G. Rossatanga
Elie G. Rossatanga
Centre de Traitement Ambulatoire Lambaréné, Lambaréné, Gabon.
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Cosme Kokou
Cosme Kokou
Hôpital Albert Schweitzer de Lambaréné, Lambaréné, Gabon.
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Kara K. Osbak
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
Régis M. Obiang Mba
Centre de Recherches Médicales de Lambaréné, Hôpital Albert Schweitzer, Lambaréné, Gabon.
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Harry M. Kaba
Harry M. Kaba
Centre de Recherches Médicales de Lambaréné, Hôpital Albert Schweitzer, Lambaréné, Gabon.
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Afsatou N. Traoré
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
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
Emmanuel B. Bache
Centre de Recherches Médicales de Lambaréné, Hôpital Albert Schweitzer, Lambaréné, Gabon.
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Arnaud Flamen
Arnaud Flamen
Centre de Recherches Médicales de Lambaréné, Hôpital Albert Schweitzer, Lambaréné, Gabon.
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Sabine Rüsch-Gerdes
Sabine Rüsch-Gerdes
National Reference Center for Mycobacteria, Forschungszentrum Borstel, Borstel, Germany.
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Matthias Frank
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
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
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
Stefan Niemann
National Reference Center for Mycobacteria, Forschungszentrum Borstel, Borstel, Germany.
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Peter G. Kremsner
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
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
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
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
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.
ProCite
RefWorks
Reference Manager
BibTeX
Zotero
EndNote
-
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.
-
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: 691–693.
-
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: 281–294.
-
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.
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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.
-
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): 8–12.
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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.
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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.
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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.
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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): S199–S208.
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