f Fluoroquinolones are the core drugs for the management of multidrug-resistant tuberculosis (MDR-TB). Molecular drug susceptibility testing methods provide considerable advantages for scaling up programmatic management and surveillance of drugresistant TB. We describe here the misidentification of fluoroquinolone resistance by the GenoType MTBDRsl (MTBDRsl) (Hain Lifescience GmbH, Nehren, Germany) line probe assay (LPA) encountered during a feasibility and validation study for the introduction of this rapid drug susceptibility test in Kinshasa, Democratic Republic of Congo. The double gyrA mutation 80Ala and 90Gly represented 57% of all fluoroquinolone mutations identified from MDR-TB patient sputum samples, as confirmed by DNA sequencing. This double mutation was previously found to be associated with susceptibility to fluoroquinolones, yet it leads to absent hybridization of a wild-type band in the MTBDRsl and is thus falsely scored as resistance. Our findings suggest that MTBDRsl results must be interpreted with caution when the interpretation is based solely on the absence of a wild-type band without confirmation by visualization of a mutant band. Performance of the MTBDRsl LPA might be improved by replacing the gyrA wild-type probes by additional probes specific for well-documented gyrA mutations that confer clinically relevant resistance.

After an alert regarding ≈31 tuberculosis (TB) cases, 3 of which were rifampin-resistant TB cases, in Mbuji-Mayi Central Prison, Democratic Republic of the Congo, we conducted an outbreak investigation in January 2015. We analyzed sputum of presumptive TB patients by using the Xpert MTB/RIF assay. We also assessed the Mycobacterium tuberculosis isolates’ drug-susceptibility patterns and risk factors for TB infection. Among a prison population of 918 inmates, 29 TB case-patients were already undergoing treatment. We found an additional 475 presumptive TB case-patients and confirmed TB in 170 of them. In March 2015, the prevalence rate of confirmed TB was 21.7% (199/918 inmates). We detected an additional 14 cases of rifampin-resistant TB and initiated treatment in all 14 of these case-patients. Overcrowded living conditions and poor nutrition appeared to be the driving factors behind the high TB incidence in this prison.

Introduction  Multi-resistant tuberculosis is a major problem of public health concern and an endless cycle that ravages the population, particularly children because of the difficulty of controlling the disease. Thus, early detection of cases helps ensure adequate treatment and prevent the spread of the strain in the community.  Methods We present here the case of a child with multidrug-resistant tuberculosis monitored at the Medical Center of Medical Center of the company RVA. Results It is a case of 4-year-old patient with general signs and had an aunt who died of multidrug-resistant tuberculosis. On admission, the child was in good general condition, weighing 14 kg and 90 Cm height. The clinical examination noted crackling rales at the level of two pulmonary bases and the chest x-ray showed multiple confluent nodular opacities in places with excavations. Laboratory workup showed 8.5 mg% microcytic hypochromic anemia and inflammatory syndrome. Sputum was tested for Koch's Bacillus on direct examination and both smears were positive. The Mycobacterium tuberculosis strain was isolated on Lowenstein Jenssen's medium. The Gen-Xpert MTB / RIF detected resistance to rifampicin and the Hain test performed showed resistance to rifampicin and Isoniazid. The child was put on ethambutol, ciprofloxacin, kanamycin, ethionamide, cycloserine, pyrazinamide and Vitamin B6 with good tolerability. The course was marked by weight gain (2 kg) and BK negativation in the second month of treatment. Conclusion Early detection of tuberculosis, especially multidrug-resistant tuberculosis is a crucial element in ensuring adequate treatment of cases and preventing the spread of germs in the population.

Background: Buruli ulcer (BU) is endemic in more than 30 countries worldwide. Africa is the most affected continent with 16 confirmed endemic countries and 7 suspected or potential endemic countries. In the Democratic Republic of the Congo, a survey in 2004 showed the presence of suspected cases of BU in five of the country's 11 provinces. The current survey was carried out in 2010 to confirm the endemicity of BU is the southern part of the Maniema Province and to provide support for case management and control measures if necessary. Method: The method of the survey was based on the protocol of rapid prevalence assessment survey (RPAS), proposed by the Buruli ulcer control Program of the World Health Organization (WHO) Regional Office for Africa to confirm BU endemic in countries. It included: awareness campaign and sensitization of health workers and communities in suspected endemic areas, followed by clinical screening of patients with suspected BU lesions and sampling of suspicious lesions by swab or fine needle aspiration (FNA) for laboratory confirmation of diagnosis, mainly by PCR. WHO-recommended treatment is proposed for cases which clinical features were in favor of the diagnosis of Buruli ulcer. Results: The survey in the Southern part of Maniema province targeted six of the nine health zones of Kasongo district. The three other health zones in the district were not be visited for accessibility and security reasons. A total of 66 suspected cases of Buruli ulcer were found at the Hospital of Kindu and in the six visited health zones. The lab tests with Ziehl-Nielsen (ZN) technique have confirmed 9 cases of BU. PCR tests confirmed eight cases of BU, including three who were not positive to the ZN tests. This makes a total of 12 BU patients confirmed by ZN and/or PCR and gives a proportion of laboratory confirmation of 18%. Discussions: Based on the results of this survey all health zones in South Maniema were classified as Buruli ulcer endemic areas, because of the same geo-climatic features that characterize all of them. These findings are similar to those of previous studies in the same province. The low confirmation rate of BU suspected cases by laboratory tests (18%) could be explained by the fact that many of the suspicious lesions which were sampled were very old wounds and had been evolving for several years. The WHO Regional Office for Africa has developed a plan of surveys, using the same rapid assessment protocol to confirm the endemicity of Buruli ulcer in other suspected endemic provinces of the DRC and in other member states of WHO African Region.