title: Tuberculosis Treatment Outcome and Drug Resistance in Lambaréné, Gabon: A Prospective Cohort Study.
abstract: 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.
authors.affiliation: 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.
authors.forename: Sabine
authors.initials: S
authors.lastname: Bélard
authors.affiliation: Centre de Recherches Médicales de Lambaréné, Hôpital Albert Schweitzer, Lambaréné, Gabon. Institut für Tropenmedizin, Universitätsklinikum Tübingen, Eberhard Karls Universität, Tübingen, Germany.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Remppis
authors.affiliation: 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.
authors.forename: Sanne
authors.initials: S
authors.lastname: Bootsma
authors.affiliation: 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.
authors.forename: Saskia
authors.initials: S
authors.lastname: Janssen
authors.affiliation: Centre de Recherches Médicales de Lambaréné, Hôpital Albert Schweitzer, Lambaréné, Gabon.
authors.forename: Davy U
authors.initials: DU
authors.lastname: Kombila
authors.affiliation: Hôpital Albert Schweitzer de Lambaréné, Lambaréné, Gabon.
authors.forename: Justin O
authors.initials: JO
authors.lastname: Beyeme
authors.affiliation: Centre de Traitement Ambulatoire Lambaréné, Lambaréné, Gabon.
authors.forename: Elie G
authors.initials: EG
authors.lastname: Rossatanga
authors.affiliation: Hôpital Albert Schweitzer de Lambaréné, Lambaréné, Gabon.
authors.forename: Cosme
authors.initials: C
authors.lastname: Kokou
authors.affiliation: 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.
authors.forename: Kara K
authors.initials: KK
authors.lastname: Osbak
authors.affiliation: Centre de Recherches Médicales de Lambaréné, Hôpital Albert Schweitzer, Lambaréné, Gabon.
authors.forename: Régis M
authors.initials: RM
authors.lastname: Obiang Mba
authors.affiliation: Centre de Recherches Médicales de Lambaréné, Hôpital Albert Schweitzer, Lambaréné, Gabon.
authors.forename: Harry M
authors.initials: HM
authors.lastname: Kaba
authors.affiliation: Centre de Recherches Médicales de Lambaréné, Hôpital Albert Schweitzer, Lambaréné, Gabon. Microbiology Department, University of Venda, Thohoyandou, South Africa.
authors.forename: Afsatou N
authors.initials: AN
authors.lastname: Traoré
authors.affiliation: Centre de Recherches Médicales de Lambaréné, Hôpital Albert Schweitzer, Lambaréné, Gabon. Institut für Tropenmedizin, Universitätsklinikum Tübingen, Eberhard Karls Universität, Tübingen, Germany.
authors.forename: Jonas
authors.initials: J
authors.lastname: Ehrhardt
authors.affiliation: Centre de Recherches Médicales de Lambaréné, Hôpital Albert Schweitzer, Lambaréné, Gabon.
authors.forename: Emmanuel B
authors.initials: EB
authors.lastname: Bache
authors.affiliation: Centre de Recherches Médicales de Lambaréné, Hôpital Albert Schweitzer, Lambaréné, Gabon.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Flamen
authors.affiliation: National Reference Center for Mycobacteria, Forschungszentrum Borstel, Borstel, Germany.
authors.forename: Sabine
authors.initials: S
authors.lastname: Rüsch-Gerdes
authors.affiliation: 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.
authors.forename: Matthias
authors.initials: M
authors.lastname: Frank
authors.affiliation: 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.
authors.forename: Ayôla A
authors.initials: AA
authors.lastname: Adegnika
authors.affiliation: 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.
authors.forename: Bertrand
authors.initials: B
authors.lastname: Lell
authors.affiliation: National Reference Center for Mycobacteria, Forschungszentrum Borstel, Borstel, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Niemann
authors.affiliation: 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.
authors.forename: Peter G
authors.initials: PG
authors.lastname: Kremsner
authors.affiliation: 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.
authors.forename: Marguerite M
authors.initials: MM
authors.lastname: Loembé
authors.affiliation: Centre de Recherches Médicales de Lambaréné, Hôpital Albert Schweitzer, Lambaréné, Gabon. Institut für Tropenmedizin, Universitätsklinikum Tübingen, Eberhard Karls Universität, Tübingen, Germany.
authors.forename: Abraham S
authors.initials: AS
authors.lastname: Alabi
authors.affiliation: 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. m.p.grobusch@amc.uva.nl.
authors.forename: Martin P
authors.initials: MP
authors.lastname: Grobusch
mesh_terms: D000293:Adolescent; D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D060085:Coinfection; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D005681:Gabon / Q000453:epidemiology; D006678:HIV / Q000302:isolation & purification* / Q000502:physiology; D015658:HIV Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000821:virology; D006801:Humans; D015994:Incidence; D007223:Infant; D007538:Isoniazid / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000187:drug effects / Q000254:growth & development / Q000302:isolation & purification*; D011446:Prospective Studies; D013307:Streptomycin / Q000627:therapeutic use; D016019:Survival Analysis; D018088:Tuberculosis, Multidrug-Resistant / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology
chemical_list: D000995:Antitubercular Agents; D007538:Isoniazid; D013307:Streptomycin