Our study indicates that primary drug resistance levels in urban settings of CAR are similar to or lower than in other African cities, and that the spread of multidrug-resistant TB in this population is limited. Extended nationwide monitoring of drug resistance remains important, especially in view of the planned introduction of a new treatment regimen (2HRZE/4HR [Z = pyrazinamide]).
BackgroundTuberculosis (TB) is a major cause of childhood morbidity and mortality in developing countries. One of the main difficulties is obtaining adequate specimens for bacteriological confirmation of the disease in children.The aim of this study is to evaluate the adequacy of fine-needle aspiration (FNA) for the diagnosis of TB.MethodsIn a prospective study conducted at the paediatric hospital in Bangui in 2007–2009, we used fine-needle aspiration to obtain samples for diagnosis of TB from 131 children aged 0–17 years with persistent lymphadenitis.ResultsFine-needle aspiration provided samples that could be used for bacteriological confirmation of TB. Ziehl-Neelsen staining for acid-fast bacilli was positive in 42.7% of samples, and culture identified TB in 67.2% of cases. Of 75 samples that were stain-negative, 49 (65.3%) were culture-positive, while 12 stain-positive samples remained culture-negative. Ten of the 12 stain-positive, culture-negative samples were from patients who had received previous antimicrobial therapy. With regard to phenotypic drug susceptibility, 81/88 strains (91.1%) were fully susceptible to isoniazid, rifampicin, ethambutol and streptomycin, six (6.8%) were resistant to one drug, and one multidrug-resistant strain was found.ConclusionsFine-needle aspiration is simple, cost-effective and non-invasive and can be performed by trained staff. Combined with rapid molecular diagnostic tests, fine-needle aspirates could improve the diagnosis of TB and provide valuable information for appropriate treatment and drug resistance.
BackgroundThe tuberculin skin test (TST) is the recommended method for screening for Mycobacterium tuberculosis infection in many countries. We used this technique to assess bacillus Calmette-Guérin (BCG) status and to estimate the current prevalence and annual rate of latent tuberculosis infection in schoolchildren in the Central African Republic.MethodsTwo tuberculin units of 0.1 ml purified protein derivative TR23 were injected intradermally into the left forearm of 2710 children attending school in Bangui and Ombella M’Poko. The induration size was interpreted at cut-off points of ≥5 mm, ≥10 mm and ≥15 mm. The annual infection rate was estimated as the average number of infections in the study sample each year between birth and the time of the survey.ResultsOverall, there was no reaction to the TST (no induration) in 71.7 % (95 CI, 68.3–75.3 %) of BCG-vaccinated children and 82.9 % (95 CI, 74.1–91.4 %) of non-vaccinated children. The proportions of children who gave a TST reaction above ≥10 mm and ≥15 mm cut-off was 18.4 % (95 % CI, 16.8–20.1 %) and 8.9 % (95 % CI, 7.8–10.0 %), respectively. The proportions of TST reaction above these cut-offs were 19.6 % (95 % CI, 17.4–21.9 %) and 8.1 % (95 % CI, 6.7–9.6 %), respectively. The annual infection rate was 0.8 % at the cut-off point of ≥15 mm.ConclusionThis study provides updated data on rates of tuberculosis infection in the Central African Republic. It is remarkable that most of the children had negative tuberculin reactivity. More studies are required to understand the factors that determine the low tuberculin reactivity in this population.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.