BACKGROUND: Very few studies have been devoted to extensively drug-resistant (XDR) strains of Mycobacterium tuberculosis (TB) in Gabon.
OBJECTIVE: The aim of the present study is to present the epidemiology of pre-XDR and XDR TB and the evolution over time of patients with multidrug-resistant TB.
METHODS: This retrospective study covered the activities from 2019 to 2022 of the Nkembo anti-tuberculosis center.
RESULTS: Fifteen patients were eligible, including 11 (73.3%) pre-XDR patients and 4 (26.7%) XDR-TB patients. Three (20.0%) patients had HIV/TB co-infection. The sample consisted of 7 men (46.7%) and 8 women (53.3%), a sex ratio (M/F) of 0.87. The average age was 35.6 years, and the median 34 years, with extremes of 23 and 60 years. Eight patients (53.3%) represented new cases of pre-XDR or XDR-TB tuberculosis. The majority (60%; n=9) came from deprived neighborhoods with widespread promiscuity. The therapeutic success rate among pre-XDR patients was 4 (36.4%) versus 2 (50.0%) among XDR-TB patients. Reported mortality occurred 5 (33.3%) patients during treatment, including 3 pre-XDR and 2 XDR-TB patients. In all cases, they died before the end of the first trimester of follow-up.
CONCLUSIONS: The high frequency of primary pre-extensively drug-resistant tuberculosis underscores the pervasiveness of resistance to anti-tuberculosis drugs and underlines a pressing need for detection of contact cases and early treatment.

暂无摘要。

Chronic constrictive pericarditis is a rare condition characterized by clinical signs of right heart failure, due to the symphysis of the two pericardial leaflets. Our study focused on a retrospective analysis of 43 CCP surgery observations collected over an 11-year period (2003-2013). The mean age of the patients was 32 years; 65% were male; exercise dyspnea (95%) was the most frequent sign. Two main etiologies were observed: tuberculosis 58% and idiopathic causes 42%. All of our patients received a subtotal pericardectomy per median sternotomy, of which 95% had no cardiopulmonary bypass.

We report the case of a 32-year-old man presentedwithleftpre-auricularswellingthathad been evolving for twomonths. Physical examination found a fixed inflammatory parotid mass. Ultrasound of the parotid region found a mixed parotid nodule with liquid redominance. The swelling was drained. Histological examination of a biopsy specimen of the parotid gland revealed an epithelioid granuloma with caseous necrosis. The patient is then treated with anti-tuberculosis with a favorable result.
Nous rapportons le cas d\'un homme de 32 ans venu pour tuméfaction pré-auriculaire gauche évoluant depuis deux mois. L\'examen physique a retrouvé une masse parotidienne fixe inflammatoire. L\'échographie de la région parotidienne a retrouvé un nodule parotidien mixte à prédominance liquidienne. Un drainage de la tuméfaction a été fait. L\'examen anatomopathologique d\'une pièce biopsique de la glande parotide a retrouvé un granulome épithelioïde avec nécrose caséeuse. Le patient est ensuite traité par anti-tuberculeux avec un résultat favorable.

OBJECTIVE: We studied the socio-demographic and paraclinicalcharacteristics of tuberculosis patients to identify the factors associated with their deaths in Bamako.
METHODS: A retrospective cohort study was carried out on tuberculosis patients registered in Bamako from October 1, 2017 to September 30, 2018. Quantitative variables were presented by their mean, qualitative ones by their proportions. Analysis was performed with R version 3.5.0.
RESULTS: Out of 2396 patients enrolled, 25 to 45-year olds represented 50.3% and children 4.51%; the average age 37.3 years; the sex ratio M/F 1.94 and co-infected TB/HIV 8.64%. 25 to 45 year olds (HR=2.58; 95% CI [1.35-4.92]; p=0,0042) and those ≥ 46 years (HR=4.64; 95% CI [2.39-9.01] ; p=5.69e-06) and positive HIV status (HR= 5.87 ; 95% CI [2.24-15.41] ; p= 0.0003) were associated with an increased risk of patient death.
CONCLUSIONS: Tuberculosis affects young and old males. The risks of death identified were the patient\'s age and positive HIV status. We recommend specific monitoring of patients aged 25 to 45 and 46 and over and those with positive HIV status.
UNASSIGNED: Nous avons étudié les caractéristiques sociodémographiques et paracliniques des tuberculeux pour identifier les facteurs associés à leurs décès à Bamako.
UNASSIGNED: Une étude de cohorte rétrospective a été menée portant sur les tuberculeuxenregistrés à Bamako du 1er octobre 2017 au 30 septembre 2018. Les variables quantitatives étaient présentées par leur moyenne et celles qualitatives par leurs proportions. L\'analyse a été effectuée avec R version 3.5.0.
UNASSIGNED: Sur 2396 patients enrôlés, les25 à 45 ansreprésentaient 50,3 % et les enfants 4,51% ; l\'âge moyen 37,3 ans ;le sex-ratio H/F 1,94 etles coinfectés TB/VIH 8,64%. Les25 à 45 ans (HR=2,58 ; IC95% [1,35-4,92] ; p=0,0042) et ceux ≥46 ans (HR=4,64 ; IC95% [2,39-9,01] ; p=5,69e-06) et le statut VIH positif (HR= 5,87 ; IC95% [2,24-15,41] ; p= 0,0003) étaient associés à une augmentation du risque de décès des patients.
CONCLUSIONS: La tuberculose affecte les jeunes et les personnes âgées de sexe masculin. Les risque de décès identifiés étaient l\'âge et le statut VIH positifdu patient.Nous recommandons une surveillance spécifique des patients de 25 à 45 ans et 46 ans et plus et ceux avec statut VIH positif.

BACKGROUND: The Xpert MTB / RIF assay has a dual advantage on the one hand, the rapid diagnosis of even difficult cases by the standard technique of direct microscopic examination and on the other hand by the detection of resistance to rifampicin. Our objective was to determine the contribution of the Xpert test in the diagnosis of tuberculosis of all forms.
METHODS: retrospective, descriptive and analytical study carried out in the Pneumophtisiology department of the CHRU of Saint-Louis. All suspected tuberculosis cases who had received an Xpert test from 2018 to 2020 were included. The parameters studied were socio-demographic, clinical and biological data.
RESULTS: 524 patient records included in the study with a sex ratio of 1.3. The mean age of the patients was 37 +/-15 years. There were 285 positive GeneXpert samples, of which 224 were of pulmonary origin and 61 of extra-pulmonary origin. The number of rifampicin resistant samples was five, all of respiratory origin.
CONCLUSIONS: the Xpert test is a new molecular technique recommended by the WHO in the diagnosis of pulmonary tuberculosis.
BACKGROUND: le test Xpert MTB/RIF présente un double avantage d\'une part le diagnostic rapide des cas mêmes difficiles par la technique standard de l\'examen direct à la microscopie et d\'autre part par la détection de la résistance à la rifampicine. Notre objectif était de déterminer l\'apport du test Xpert dans le diagnostic de la tuberculose toutes formes confondues.
UNASSIGNED: étude transversale, descriptive à collecte rétrospective menée dans le service de Pneumophtisiologie de CHRU de Saint-Louis. Tous les cas suspects de tuberculose qui avaient bénéficié d\'un test Xpert de 2018 à 2020avec un dossier médical accessible et exploitable ont été inclus. Les paramètres étudiés étaient les données sociodémographiques, cliniques et biologiques.
UNASSIGNED: Nous avions colligés 524dossiers de malades avec un sex-ratio de 1,3. L\'âge moyen des patients était de 37 ans+/-15 ans. Il y\'avait 285 prélèvements positifs au GeneXpert dont 224 d\'origine pulmonaire et 61d\'origine extra pulmonaire. Le nombre d\'échantillons résistants à la rifampicine était de cinq, tous d\'origine respiratoire.
CONCLUSIONS: le test Xpert est une nouvelle technique moléculaire recommandée par l\'OMS dans le diagnostic de la tuberculose pulmonaire. Toutefois il doit être évaluer dans le diagnostic de la tuberculose extra pulmonaire.

BACKGROUND: Pericarditis is a commun cause of hospitalisation in cardiology and internal medicine wards.
OBJECTIVE: We aimed to describe the epidemiological profile of effusive pericarditis at the Department of cardiology of the National Referral Teaching Hospital of N\'Djamena, Chad.
METHODS: We undertook a descriptive cross-sectional study from January 2017 to December 2019. Patients presenting with effusive pericarditis and who consent to participate were consecutively enrolled during the study period.
RESULTS: Overall, 1805 patients were hospitalized at the department of cardiology during the study period with effusive pericarditis accounting for 4.3% of all cases (n = 78). Patients\' mean age was 35.84 ± 14 years, [range 16 and 73 years]. The sex ratio was 0.89. Exertional dyspnea, chest pain, poor general condition and fever were main symptoms reported in 90%, 89%, 81% and 51% of the cases respectively. Pericardial rub was found in 51% of the study patients. Eighteen patients (26%) were HIV positive and 97% of the study patients had cardiomegaly. ECG demonstrated low QRS voltage (97%) and diffuse abnormalities of repolarisation (96%). Pericardial effusion was found abundant in 57% of the cases. Etiologies of effusive pericarditis were mainly tuberculosis (47%), idiopathic (21%) and HIV infection (13%). Thirty patients (43%) benefited from pericardiocentesis. The in-hospital mortality rate of the disease was 17%.
CONCLUSIONS: Effusive pericarditis is frequent and associated with poor outcome. Treatment depends on etiology dominated by tuberculosis in Chad.
BACKGROUND: Les péricardites représentent une cause fréquente d\'hospitalisation en cardiologie et en médecine interne.
OBJECTIVE: Décrire les caractéristiques épidémiologiques et étiologiques des péricardites liquidiennes dans le service de cardiologie du Centre Hospitalier Universitaire la Référence Nationale (CHU-RN).
UNASSIGNED: Il s\'est agi d\'une étude transversale descriptive menée de Janvier 2017 à Décembre 2019 sur une série consécutive des patients hospitalisés pour péricardite liquidienne dans le service de cardiologie du Centre Hospitalier Universitaire la Référence Nationale de N\'Djamena.
UNASSIGNED: Durant la période d\'étude, 1805 patients étaient hospitalisés dans le service de cardiologie dont 78 pour une péricardite liquidienne ; soit une prévalence de 4,3%. L\'âge moyen était de 35,84 ± 14 ans, [extrêmes 16 et 73 ans]. Le sex-ratio était de 0,89. La dyspnée d\'effort, la douleur thoracique, l\'altération de l\'état général et la fièvre étaient les maitres symptômes dans respectivement 90%, 89%, 81% et 51% des cas. Le frottement péricardique a été retrouvé chez 51% des patients. La sérologie VIH était positive chez 18 patients (26%) et 97% des patients avaient une cardiomégalie. A l\'ECG, on retrouvait un micro voltage et des troubles diffus de la repolarisation dans respectivement 97% et 96% des cas. L\'épanchement péricardique était majoritairement (57%) de grande abondance à l\'échocardiographie. Les étiologies prédominantes étaient la tuberculose dans 47% des cas, une cause idiopathique dans 21% et une infection virale (VIH) dans 13%. Trente patients (43%) avaient bénéficié d\'une ponction péricardique. Le taux de mortalité de la péricardite liquidienne était de 17%.
CONCLUSIONS: la péricardite liquidienne est une pathologie fréquente, grave et mortelle au Tchad. Le traitement dépend de l\'étiologie qui est dominée par la tuberculose.

Tuberculosis and smoking are responsible for significant mortality worldwide. Smoking is spreading in emerging countries, and its prevalence is high in developed countries among socially disadvantaged populations; it could be the source of a resurgence of tuberculosis in future years. The aim of this review is to clarify the consequences of the association between smoking and tuberculosis, and the benefits of smoking cessation for smokers with tuberculosis.

UNASSIGNED: Tuberculous (TB) spondylitis is a hazardous infectious disease causing significant spinal deformity. Increased toll-like receptor-4 (TLR-4) activity promotes more extensive infections in patients with TB spondylitis, so it has the potential to be used as a biomarker to predict the severity. This study aims to determine the relationship between TLR-4 levels and the degree of vertebral destruction in TB spondylitis patients.
UNASSIGNED: A cross-sectional study was conducted from May to October 2023. A total of 27 TB spondylitis samples were then measured for TLR-4 serum levels. Vertebral destruction is assessed based on the Spine At Risk Signs (SARS) criteria on X-ray and MRI examinations. Moreover, the degree of sensory and motor impairment was also assessed in this study. The Spearman correlation test assessed the correlation between TLR-4 levels and vertebral destruction.
UNASSIGNED: Most of the samples in this study were less than 30 years old (10 people, 37%), female (14 people, 51.9%), had spinal destruction at 1 level (11 people, 40.7%), had paraplegia (8 people, 29.6%), and had hypoesthesia (11 people, 40.7%). TLR-4 levels had a mean value of 8254.1±1076.1 ng/ml. TLR-4 levels were positively correlated with the degree of vertebral destruction (r=0.599, P=0.001), motor disorders (r=0.632.x, P=0.000), and sensory disorders (r=0.574, P=0.002).
UNASSIGNED: TLR-4 levels are associated with the severity of vertebral destruction in TB spondylitis, so it has the potential to be used as a prognostic biomarker.

BACKGROUND: Tuberculosis remains a major public health problem in developing countries. Thyroid localization is very rare, and often the cause of misdiagnosis. Pathological anatomy plays an important role in the diagnosis of certainty. The authors report a case of primary thyroid tuberculosis in a 22-year-old patient. We highlight the epidemiological particularities of this case, and discuss diagnostic methods and the contribution of pathological anatomy.
METHODS: A 22 year-old male patient, with no reported pathological history, was seen in the clinic for the management of an isolated anterior cervical swelling that had been evolving for two months. Clinical examination revealed only a small thyroid nodule, with no inflammatory or vascular features. Biological tests were unremarkable. Ultrasound revealed a 2.4cm hypoechoic, homogeneous, poorly vascularized tissue mass in the left lobe, classified as EU-TIRADS 3. Fine needle aspiration with cytopathological study revealed a necrotizing granulomatous lesion suggestive of tuberculosis. A lobo-isthmectomy was performed, and histopathology revealed thyroid parenchyma destroyed by tubercular granulomas. The postoperative course was straightforward, with an exeat on postoperative day 6. Anti-tuberculosis treatment was instituted for 6 months. Three- and six-month follow-up examinations were unremarkable. The evolution was favorable, with recovery after treatment.
CONCLUSIONS: Primary thyroid tuberculosis is rare. Cytology is important for orientation, and often helps to avoid misdiagnosis. The diagnosis should be considered in the presence of any thyroid mass in a patient from a tuberculosis-endemic region.