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