High prevalence of multidrug resistant tuberculosis in Djibouti: a retrospective study

Abstract

Introduction: The Republic of Djibouti is an African country that exhibits one of the highest incidence rate of tuberculosis in the world. The aim of this study was to evaluate the prevalence of multidrug-resistant tuberculosis among new cases. Methodology: We studied retrospectively every tuberculosis case diagnosed over a 12-month period in patients hospitalized at the French Military Hospital of Bouffard. During this period, 1,274 samples from 675 patients were tested. Results: We isolated 266 mycobacteria corresponding to 180 cases of tuberculosis. Thirty-three were fully susceptible and 57% met the tuberculosis criteria, with 46% primary resistance. No extensively-drug-resistant tuberculosis was found. Conclusion: Our results highlight a major concern about the situation in this part of the world.

Extended spectrum of antibiotic susceptibility for tuberculosis, Djibouti

“…These criteria do not provide information on the mycobacterial species causing the tuberculosis and leave scope for the possibility that some patients who are clinically diagnosed with pulmonary tuberculosis are, in fact, infected by other mycobacteria. Accordingly, our prospective study revealed M. canettii in some patients in Djibouti, in line with observations previously reported in Djibouti [3,5]. In addition, we recovered one strain of M. kansasii and one strain of 'M.…”

“…In Djibouti, pulmonary tuberculosis is routinely diagnosed based on clinical data and positive microscopic observation of a sputum smear following Ziehl-Neelsen staining [3]. These criteria do not provide information on the mycobacterial species causing the tuberculosis and leave scope for the possibility that some patients who are clinically diagnosed with pulmonary tuberculosis are, in fact, infected by other mycobacteria.…”

“…The patient reported in this paper had a similar medical history, yet denied having had any contact with Somalia. A few studies identified non-tuberculous mycobacteria as being responsible for pulmonary infection in Djibouti, including Mycobacterium chelonae, Mycobacterium fortuitum and Mycobacterium peregrinum [3].…”

“…The Horn of Africa, comprising Djibouti, Ethiopia, Somalia and Eritrea, is a hotspot for tuberculosis, with a high incidence of 378/ 100 000 inhabitants in Djibouti and 192/100 000 inhabitants in Ethiopia in 2015 [1]. In Djibouti, the high prevalence of tuberculosis has been reported to be partly driven by so-called multidrugresistant (MDR) Mycobacterium tuberculosis isolates [2,3], defined as being resistant to at least isoniazid and rifampicin [4]. Moreover, in Djibouti, tuberculosis is caused not only by M. tuberculosis isolates, but also by Mycobacterium canettii in 3% and up to 6% of cases [3,5].…”

“…In Djibouti, the high prevalence of tuberculosis has been reported to be partly driven by so-called multidrugresistant (MDR) Mycobacterium tuberculosis isolates [2,3], defined as being resistant to at least isoniazid and rifampicin [4]. Moreover, in Djibouti, tuberculosis is caused not only by M. tuberculosis isolates, but also by Mycobacterium canettii in 3% and up to 6% of cases [3,5]. Notably, M. canettii organisms are naturally resistant to pyrazinamide and streptomycin [6].…”