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Low Detection Rate of Multidrug-Resistant and Rifampicin-Resistant Tuberculosis in the Democratic Republic of Congo: Trend Analysis 2013-2017

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Journal of Tuberculosis Research 2019年第4期7卷 212-219页

作者： Innocent kashongwe Murhula Fina Mawete Lay Ofali Michel Kaswa Francois Lepira Bompeka Jean Marie Kayembe Ntumba zacharie kashongwe Munogolo School of Medicine Kinshasa University Hospital Kinshasa Democratic Republic of Congo National Tuberculosis Program Kinshasa Democratic Republic of Congo

The Democratic Republic of Congo is one of the countries with a high preva-lence of multidrug-resistant tuberculosis (MDR-TB) in Africa and worldwide. This study aims to describe the trends and level of screening since 2013. This is a retrospective descriptive study based on quarterly reports from the provinces. The number of cases, past histories, age, sex and HIV Co-infection was identi-fied. It emerges that the number of cases increases significantly but does not reach the forecasts yet (912 cases of MDR/RR and XDR diagnosed in 2017 out of 3948 cases expected with a gap of 77%). Patients with a history of TB pre-dominate (63.5% in 2017);but the proportion of patients with no history of TB increases (36.5% in 2017). This suggests high rates among contacts. Women (37.8%) and children under 15 (2.7%) are less represented. TB/HIV Co-infection is 12% as for sensitive cases. Efforts still need to be made to improve screening.

关键词： MDR-RR TB Trends Screening DRC

Trends in Tuberculosis Epidemiology among Children in the Democratic Republic of Congo

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Journal of Tuberculosis Research 2016年第4期4卷 235-248页

作者： Aketi Loukia Shiku Diayisu Joseph kashongwe zacharie Lay Gertrude Kibadi Kapay Kayembe Kalambay Patrick Department of Pediatrics University Hospital of Kinshasa Kinshasa Democratic Republic of Congo Department of Internal Medicine University Hospital of Kinshasa Kinshasa Democratic Republic of Congo National Tuberculosis Program Kinshasa Democratic Republic of Congo Department of Surgery University Hospital of Kinshasa Kinshasa Democratic Republic of Congo National Program of Buruli Ulcer Surveillance Kinshasa Democratic Republic of Congo Epidemiology and Biostatistics Department Public Health School University of Kinshasa Kinshasa Democratic Republic of Congo

Setting: The epidemiology of tuberculosis (TB) among children in the Democratic Republic of Congo (DRC) is not well known. Objective: This study aimed to describe the trends in TB epidemiology among children in the DRC and to compare these trends in children and adults. Design: Data from the National TB program, the WHO Global TB Report, and a demographic survey of health in the DRC were retrospectively analyzed. The study period was from 1995 to 2014. The notification rate, absolute incidence and incidence rate of TB per 100,000 population were reported. Results: In 2014, 12,785 (12.6% of adult cases) TB cases were reported in children and 101,303 in adults. Among children, 3438 (26.89%) had PTB+;2828 (22.11%) had PTB–;and 6519 (50.98%) had extrapulmonary TB (EPTB). Children under 5 years had a lower reported prevalence of TB (184 cases). The incidence rate per 100,000 population was 10 in children and 181 in adults. The TB incidence decreased between 2010 (11.47) and 2014 (10.46). The proportion of children in overall cases of PTB+ was 4% to 5% in all districts. Conclusion: Caring for childhood TB remains a challenge in the DRC. Improved diagnostic procedures and effective training of providers who care for childhood TB are needed.

关键词： Childhood Tuberculosis Epidemiology Africa

Maternal Knowledge of Tuberculosis and Bacillus Calmette Guerin Vaccination in Pediatric Health Services in Kinshasa

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Journal of Tuberculosis Research 2017年第1期5卷 30-43页

作者： Loukia Aketi Joseph Shiku Diayisu zacharie kashongwe Grace Nkabikueni Patrick Kayembe Kalambay Jean-Marie Kayembe Cardio-Pulmonary and Infectious Diseases Unit Department of Pediatrics University Hospital of Kinshasa University of Kinshasa Kinshasa Democratic Republic of Congo Pneumology Service Department of Internal Medicine University Hospital of Kinshasa University of Kinshasa Kinshasa Democratic Republic of Congo Epidemiology and Biostatistics Public Health School University of Kinshasa Kinshasa Democratic Republic of Congo

Introduction: To participate effectively in the fight against tuberculosis (TB), mothers need to have a good knowledge of TB and its prevention. The objective of this study was to evaluate the knowledge of mothers about TB and Bacillus Calmette Guérin (BCG). Methods: This was a cross-sectional survey performed from September to December 2015 in 4 health care facilities of Kinshasa. It concerned mothers of children who received BCG vaccine. The frequencies and chi-square of Pearson were used to report results. Results: A total of 380 couples of the children and their mothers were recruited. The median age of children was 16 months (ranges: 6 days to 59 months);224 (58.9%) of them received BCG during the period recommended;62 (16.3%) experienced a side effect. There was a significant association (p = 0.00) between sides effects and the delayed vaccination. The average age of the mothers was 29.3 ± 6.4 years;352 (92.6%) had heard about TB;28 (7.4%) never heard about it;168 (44.2%) knew that TB is a contagious disease;only 111 (29.2%) knew the mode of transmission;87 (22.9%) did not know any signs of TB, and 54 (14.2%) knew about prevention with the BCG vaccine. Factors significantly associated with the mothers’ lack of knowledge were a low level of education (p = 0.01), young age (p = 0.02), and place of residence (p = 0.04). Conclusion: There is an urgent need to improve the education of the population, particularly those who lives in poor conditions and who are uneducated.

关键词： Maternal Knowledge Tuberculosis BCG Children

Factors Associated with Mortality among Multidrug Resistant Tuberculosis MDR/RR-TB Patients in Democratic Republic of Congo

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Journal of Tuberculosis Research 2017年第4期5卷 276-291页

作者： Murhula Innocent kashongwe Leopoldine Mbulula Pierre Umba Francois Bompeka Lepira Michel Kaswa zacharie Munogolo kashongwe Lung disease Unit Department of Internal medicine Faculty of Medicine University of Kinshasa Hospital University of Kinshasa Kinshasa Democratic Republic of Congo Centre d’excellence Damien (CEDA) Action Damien DR Congo Nephrology Unit Department of Internal Medicine Faculty of Medicine University of Kinshasa Hospital University of Kinshasa Kinshasa Democratic Republic of Congo National Tuberculosis Program of DR Congo (NTP) DR Congo

Background: Tuberculosis remains a very common infectious disease in Democratic Republic of Congo (DRC). The resistance to drugs worsens the prognosis and the outcome of patients affected tuberculosis and increase their mortality. Objective: To identify factors associated with death among Multidrugs resistant tuberculosis (MDR/RR TB) patients referred to the referential hospital, Centre d’Excellence Damien (CEDA). Materials and Methods: A retrospective cohort study of patients attending health care to the Center CEDA, a referral center for management of MDR/RR-TB in DR Congo. This study included all MDR/RR-TB patients referred from February 1st, 2015 to February 29th, 2017. A multivariate COX regression was performed to identify factors associated with mortality in the target population. Kaplan Meier method described the survival of patients and the comparison of curves was performed by the test of log Rank. Results: 199 patients were included in our study. Male gender was predominant with a sex ratio of 1.3. The mean age of patients was 35.8 ± 13.9 years. Among them, 18 (15.1%) were died. The major complications were Chronicles pulmonary Heart failure (p = 0.035), Chronic respiratory insufficiency (p = 0.004), depression (p = 0.044), undernutrition (p = 0.033), alcohol addiction (p = 0.006) and high smoking (p = 0.019). In multivariated analysis, factors associated to the death were alcohol addiction (HRa = 12.64, 95% CI 2.36 - 14.55, p = 0.003), asthenia (HRa = 4.75, 95% CI 1.56 - 14.50, p < 0.001), pulmonary consolidation (HRa = 10.01 95% CI 2.34 - 12.86, p = 0.02), some chest X-ray abnormalities such as signs of pulmonary fibrosis (HR = 4.7, 95% CI 2.78 - 28.94, p = 0.002) and the Chronic respiratory insufficiency (HRa = 3.77, 95% CI 1.37 - 10.43, p = 0.010). Conclusion: The present retrospective cohort study revealed that structural and functional pulmonary alteration emerged as the main factors associated with mortality among MDR/RR TB patients in Kinshasa. Na

关键词： MDR/RR-TB Mortality Kinshasa Factors

Implementing a Short Regimen for Multidrug-Resistant Tuberculosis in Kinshasa, Democratic Republic of Congo: A Cohort Study 2014-2017

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Journal of Tuberculosis Research 2020年第3期8卷 111-126页

作者： Innocent Murhula kashongwe Leopoldine Mbulula Fina Mawete Nicole Anshambi Nadine Maingowa Michel Kaswa Jean Marie Ntumba Kayembe Francois Bompeka Lepira zacharie Munogolo kashongwe Pulmonology Unit Internal Medicine Kinshasa University Hospital Kinshasa Democratic Republic of the Congo Drug Resistant Tuberculosis Unit “Centre Excellence Damien” Damian Foundation Kinshasa Democratic Republic of the Congo National Tuberculosis Program of the Democratic Republic of the Congo Kinshasa Democratic Republic of the Congo Provincial Coordination for Tuberculosis Control Kinshasa Democratic Republic of the Congo

Setting: Kinshasa, capital of Democratic Republic of Congo, has the high rate of multidrug resistant tuberculosis (MDR-TB) which is associated with poor treatment outcomes until 2013. A new approach was needed. Objectives: To implement a new strategy in order to improve treatment outcomes. Design: A retrospective cohort study reviewing all the patients diagnosed MDR Tuberculosis between 2014 and 2017. The study was conducted in the National Tuberculosis Program (NTP) framework comparing the short regimen and the WHO standard regimen. Results: From 1246 patients diagnosed RR/TB, 1073 were included in the analysis: 948 on shorter regimen, and 125 on WHO standard regimen. The strategy was based on patient-centered care. In the short regimen group, 62.7% were male, 61.4% were age 25 - 44 years, 52.6% had previous history of TB, 39.3% underweight, 12.5% HIV positive. The median time from diagnosis to treatment was 19 days (0 - 163). In the long regimen group, 75% were male, 37.6% were age 14 - 44 years, 61.6% underweight, 18.4% HIV positive. The median time from diagnosis to treatment was 19 days (0 - 114). Favorable outcomes represented 81.9% in the short regimen group versus 72% in the long regimen group. Death and loss to follow-up were more observed in long regimen group (27.2% versus 15.4%). Factors associated with unfavorable outcomes in the short regimen group included sex, age ≥ 45 years, previous TB history, HIV status, delay to begin treatment. For the long regimen, the factors age and delay emerged, underweight and HIV were borderline. Drug adverse events were reported respectively in 43.5% and 42.4% for short and long regimen;with gastrointestinal disturbances, vestibular troubles, ototoxicity, arthralgia and anemia as the most common in the 2 groups. Conclusion: The new approach improved favorable outcomes. Both short and long regimens reached a high level of favorable outcome compared to the previous study. The short regim

关键词： MDR-TB Short Regimen Patient Centered Card

First Use of Bedaquiline in Democratic Republic of Congo: Two Case Series of Pre Extensively Drug Resistant Tuberculosis

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Journal of Tuberculosis Research 2018年第2期6卷 125-134页

作者： Murhula Innocent kashongwe Leopoldine Mbulula Brian Bakoko Pamphile Lubamba Murielle Aloni Simon Kutoluka Pierre Umba Luc Lukaso Michel Kaswa Jean Marie Ntumba Kayembe zacharie Munogolo kashongwe Kinshasa University Hospital Kinshasa Democratic Republic of Congo Action Damien Centre d’Excellence Damien Kinshasa Democratic Republic of Congo Coordination Provinciale de Lutte contre la Tuberculose Kinshasa Democratic Republic of Congo National Tuberculosis Program Kinshasa Democratic Republic of Congo

In this manuscript the authors have studied the first two patients who were successfully treated with the treatment regimen containing Bedaquiline as second-line drug. The patients were diagnosed with pre-extensively drug-resistant tuberculosis (preXDR TB) whose prognosis was fatal in Democratic Republic of Congo (DRC). Bedaquiline is arguably one of the molecules of the future in the management of ultra-resistant tuberculosis. However, a larger cohort study may help to establish its effectiveness. Case report: Patients 1, 29 years old, with a history of multidrug-resistant TB (MDR-TB) one year previously. He showed signs of TB impregnation again 6 months after the last treatment. Bascilloscopy was positive again. The pre-extensively tuberculosis (pre-XDR TB) diagnosis was made by the Hain test (GenoType®MTBDRsl, Hain Lifescience). Patient 2, brother of the first patient, with a history of MDR TB a year before. He had low back pain with right parietal dorso swelling four months after the last treatment. The x-ray of the column showed L4-L5 disc disease. Parietal ultrasound showed a parietal abscess to the right of thoracic vertebrae with fistulization. Surgical biopsy and pus culture confirmed the diagnosis of Pre-XDR Extrapulmonary TB. The treatment regimen was the same for both patients: 6 months with Amikacin (Am) Bedaquiline (Bdq) Prothionamide (Pto) Paraamino Salicylic acid (PAS) Linezolid (Lzd) Cycloserine (Cs) Pyrazinamide (Z) and 14 months with PAS Lzd Cs Z. The side effects were minor. Bacteriological controls (smears and cultures) after 20 months of treatment are negative to date.

关键词： Pre-XDR TB Pott’s Disease Bedaquiline Molecular Technique Loweinstein Culture

Determinants of the Sensorineural Hearing Loss in Patients with Multidrug-Resistant Tuberculosis in Kinshasa (Democratic Republic of the Congo): A Prospective Cohort Study

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International Journal of Otolaryngology and Head & Neck Surgery 2023年第6期12卷 411-425页

作者： Mireille Avilaw Mpwate Eddy Mampuya Mbambu Gabriel Mabuaka Lema Christian Nzanza Matanda Dominique Mayuku Mupepe Michel Kayomo Kaswa Murielle Luengiladio Aloni Nicole Muzutie Anshambi Fabrice Mankangu Matuta Luc Losenga Lukasu Serge Katya Mpwate Pierre Zalagile Akilimali Innocent Murhula kashongwe zacharie Munogolo kashongwe Jean Marie Ntumba Kayembe Richard Nzanza Matanda Department of Otorhinolaryngology University Hospital of Kinshasa Kinshasa 11 University of Kinshasa Kinshasa Democratic Republic of The Congo Division of Cardiology Department of Internal Medicine University Hospital of Kinshasa Kinshasa 11 University of Kinshasa Kinshasa Democratic Republic of The Congo National Tuberculosis Control Program in Democratic Republic of The Congo Kinshasa Democratic Republic of The Congo Provincial Coordination for The Fight against Tuberculosis Kinshasa Democratic Republic of The Congo Multidrug-Resistant Tuberculosis Unit “Centre d’Excellence Damien” Damien Foundation Kinshasa Democratic Republic of The Congo Department of Anatomy-Pathology University Hospital of Kinshasa Kinshasa 11 University of Kinshasa Kinshasa Democratic Republic of The Congo Kinshasa School of Public Health Faculty of Medicine University of Kinshasa Kinshasa Democratic Republic of The Congo Pneumology Unit Department of Internal Medicine University Hospital of Kinshasa Kinshasa 11 University of Kinshasa Kinshasa Democratic Republic of The Congo

Background: The onset of the hearing loss is a major challenge during the treatment of multidrug-resistant tuberculosis (MDR-TB). Aminoglycoside-based regimens, to a lesser extent based on bedaquiline, induce ototoxic sensorineural hearing loss. Research on risk factors is essential to enable high-risk individuals to benefit from preventive measures in settings with limited resources. Objective: This study aimed to assess the determinants of the hearing loss in patients with MDR-TB. Methods: This prospective multicenter cohort study included 337 patients with MDR-TB. It was performed in Kinshasa (Democratic Republic of the Congo) between January 2020 and January 2021. Sociodemographic, clinical, biological, therapeutic, and audiometric data were exported and analyzed using Stata 17 and MedCalc. The fixed-effect linear regression panel model was used to assess the degree of the hearing loss over time according to the following covariates: therapeutic regimen (aminoglycosides, bedaquiline, or alternate), stage of chronic kidney disease (CKD), age at inclusion, body mass index, serum albumin level, HIV status, alcohol intake, hypertension, and hemoglobin level. The Hausman test was used to select between fixed- and random-effect estimators. The threshold for statistical significance was set at p Result: A total of 236 patients (70%) received an aminoglycoside-based regimen, 61 (18%) received a bedaquiline-based regimen, and 40 (12%) received aminoglycosides relayed by bedaquiline. The frequency of the hearing loss increased from 62% to 96.3% within six months for all therapeutic regimens. The Hearing loss worsened, with moderate (72.4%) and profound (16%) deafness being predominant. An Exposure to the treatment for more than one month (β coeff: 27.695, Se: 0.793, p β coeff: 6.102, Se: 1.779, p β coeff: 5.610, Se: 1.682, p = 0.001), and an eGFR β coeff: 6.730, Se: 2.70, p = 0.013) were the independent risk factors associated with the hearing loss in patients with MDR-TB

关键词： Multidrug-Resistant Tuberculosis Determinants Hearing Loss DRC

Sensorineural Hearing Loss in Multidrug-Resistant Tuberculosis Patients in Kinshasa (Democratic Republic of Congo): Prospective Cohort Study of Therapeutic Regimen with Aminoglycoside versus Bedaquiline

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Journal of Tuberculosis Research 2023年第3期11卷 109-119页

作者： Mireille A. Mpwate Eddy M. Mbambu Christian N. Matanda Gabriel M. Lema Michel K. Kaswa Murielle L. Aloni Nicole M. Anshambi Fabrice M. Matuta Luc L. Lukasu Dominique M. Mupepe Serge K. Mpwate Pierre Z. Akilimali zacharie M. kashongwe Richard N. Matanda Department of Otorhinolaryngology University Clinics of Kinshasa Kinshasa 11 University of Kinshasa Kinshasa Democratic Republic of Congo National Tuberculosis Control Program in the Democratic Republic of Congo Kinshasa Democratic Republic of Congo Provincial Coordination for the Fight against Tuberculosis Kinshasa Democratic Republic of Congo Multidrug-Resistant Tuberculosis Unit “Centre d’Excellence Damien” Damien Foundation Kinshasa Democratic Republic of Congo Division of Cardiology Department of Internal Medicine University Clinics of Kinshasa Kinshasa 11 University of Kinshasa Kinshasa Democratic Republic of Congo Department of Anatomy-Pathology University Clinics of Kinshasa Kinshasa 11 University of Kinshasa Kinshasa Democratic Republic of Congo Kinshasa School of Public Health Faculty of Medicine University of Kinshasa Kinshasa Democratic Republic of Congo Pneumology Unit Department of Internal Medicine University Clinics of Kinshasa Kinshasa 11 University of Kinshasa Kinshasa Democratic Republic of Congo

Context: Multidrug-resistant tuberculosis (MDR-TB) remains a major public health problem in developing countries such as the Democratic Republic of Congo (DRC), which continues to face the emergence of MDR-TB cases. Because of the ototoxic effects of AGs, the World Health Organization (WHO) has recommended the introduction of the bedaquiline regimen. However, very few data are available regarding the susceptibility of bedaquiline to induce hearing loss, hence the present study set out to compare the AG-based regimen and the bedaquiline-based regimen in the occurrence of hearing loss in MDR-TB patients. Methods: This is a prospective multicenter cohort study that included 335 MDR-TB patients, performed in Kinshasa (DRC) during the period from January 2020 to January 2021. Sociodemographic, clinical, biological and audiometric data were analyzed using Stata 17. Repeated-measures analysis of variance was used to compare changes in the degree of hearing loss over time between the two groups of patients on AG and bedaquiline regimens. The double-difference method was estimated using regression with fixed-effects. A p value < 0.05 was considered the threshold for statistical significance. Results: The degree of hearing loss was similar between the two groups at the first month [AGs (28 dB) vs BDQ (30 dB);p = 0.298]. At six months, the mean degree of hearing loss was significantly greater in the aminoglycoside regimen group [AGs (60.5 dB) vs BDQ (44 dB);p < 0.001]. The double difference was significant, with a greater increase in hearing loss in the AGs group (diff-in-diff 18.3;p < 0.001). After adjustment for age and serum albumin, the group receiving the AG-based regimen had a 2-point greater worsening than those with bedaquiline at the sixth month (diff-in-diff 19.8;p Conclusion: Hearing loss is frequent with both treatment regimens, but more marked with the Aminoglycoside-based regimen. Thus, bedaquiline should also benefit for audiometric monitoring in future MDR-TB p

关键词： Multidrug-Resistant Tuberculosis Aminoglycosides Bedaquiline Hearing Loss