Pulmonary tuberculosis is still a global scourge, especially in developing countries, despite the control measures that have been in place for decades. The aim of this work was to describe the epidemiological, clinical radiological and evolutionary aspects of PMPT at the Saint-Louis Regional Hospital Center. This was a retrospective descriptive study on 191 PMPT files, hospitalized in the medical department from January 1, 2016 to December 31, 2017.
METHODS: Were included in the study, all cases of pulmonary tuberculosis proved by the presence of bacillus Koch on direct examination of sputum. Were excluded from the study, cases of pulmonary tuberculosis with negative microscopy and cases of pulmonary tuberculosis in patients younger than 14 years.
RESULTS: Of 1417 hospitalizations, 191 patients had a PTPM. The average age was 36.5 years with extremes of 14 to 81 years. The sex ratio was 2.2 in favor the male. Fishermen were the most affected with 34% of cases. A family tuberculosis was noted in 61 patients. One hundred and forty-six new PMPT cases were noted.
CONCLUSIONS: Positive microscopy pulmonary tuberculosis remains a public health problem in Senegal. Much work remains to be done in Saint-Louis, which a region with a high burden of tuberculosis.
BACKGROUND: la tuberculose pulmonaire demeure encore un fléau mondial en progression surtout dans les pays en voie de développement, malgré les actions de lutte mises en place depuis des décennies. Le but de ce travail était de décrire les aspects épidémiologiques, cliniques radiologiques et évolutifs de la TPM (+) au centre hospitalier régional de Saint-Louis. Il s\'agissait d\'étude descriptive rétrospective portant sur 191 dossiers de TPM+, hospitalisés au service de médecine du 1er Janvier 2016 au 31 Décembre 2017. Étaient inclus dans l\'étude, tous les cas de TPM+ prouvée par la présence de BAAR à l\'examen direct des crachats. Étaient exclus de l\'étude les patients de moins de 14 ans, les cas de TPM(-) Résultats : Sur 1417 hospitalisations, 191 patients avaient une TPM+. L\'âge moyen était de 36,5 ans avec des extrêmes de 14 à 81 ans. Sex-ratio de 2,2. Les pêcheurs étaient les plus touchés avec 34 % des cas. Un contage tuberculeux familial était noté chez 61 malades. Cent quarante six nouveaux cas de TPM(+) ont été notés. Conclusion : la TPM(+) demeure un problème de Santé Publique au Sénégal. Beaucoup d\'efforts restent à faire dans la région de Saint-Louis à forte charge de tuberculose.

To estimate whether WHO\'s End TB Strategy targets can be achieved by analysing the incidence trend of pulmonary tuberculosis in Shanghai during 1992-2016.
The age-adjusted annual incidence of tuberculosis (TB) was calculated based on data from the national TB registration system. Linear regression was applied to analyse the trend of the epidemic, together with the statistical indicator of annual percent change (APC).
The overall age-standardised rate decreased from 34.8/100 000 in 1992 to 21.2/100 000 in 2016, or by 2.15% (t = -13.258, P < 0.05) annually. After rapidly declining between 1999 and 2003 (-5.4% p.a.), the epidemic remained at a stable level with a lower annual declining rate (-1.1% p.a). In 2035, the estimated incidence will be 17.2/100 000 based on the APC in 2004-2016. There were two peaks in average incidence of the total population, 30.9/100 000 in the 20-24 age group and 66.4/100 000 in the 70-74 age group. Overall, the ratio of new to retreated cases continually rose and eventually reached 8.36:1 in 2016. The constituent ratio of smear-positive cases ranged from 35.9% to 47.8% without rising or decreasing trend (P = 0.065).
The epidemic of TB in Shanghai has steadily declined during last two decades. A new strategy should be developed to rapidly reduce the incidence rate to achieve the WHO Goals in 2035.

BACKGROUND: Bronchial mould infection or plastic bronchitis is a rare condition, encountered at any age, but with a predilection for childhood. The clinical diagnosis is made easy by the demonstration of solid, branched expectorations. However, the aetiology is not easy to determine and investigation does not often lead to a pathological diagnosis.
METHODS: We report the case of a 24 year-old patient, with a history of pulmonary tuberculosis in January 2016, who had had chronic, persistent, solid and branched expectorations since January 2015. Fibreoptic bronchoscopy revealed thick white secretions plugging the bronchi. Pathological examination of the bronchial plugs showed fibrous tissue infiltrated with predominantly lymphoplasmocytic and histiocytic inflammatory cells. Investigations carried out on the pleura did not establish the aetiological diagnosis. The diagnosis of bronchial mould disease of tuberculous origin complicated by pleurisy was established. Corticosteroid therapy led to a complete regression of the moulds within six weeks.
CONCLUSIONS: The presence of solid and branched sputum should suggest fungal bronchitis and is an indication for bronchoscopy for diagnostic and therapeutic purposes. Early management is important to avoid complications.

OBJECTIVE: To describe the residual broncho-pulmonary lesions and evaluate the role of CT scanning at the end of treatment of pulmonary tuberculosis.
METHODS: Analysis of the initial and end of treatment CT scans of 56 patients with pulmonary tuberculosis according to a reading grid including parenchymatous and airways lesions. The CT data at the end of treatment were analysed in relation to the clinical and microbiological data, and the original CT scan.
RESULTS: Active lesions (thick walled cavities and/or centrilobular micronodules) persisted in 24 patients (43%) after a mean treatment period of 7 months. The persistence of these signs of activity was correlated with the initial presence of a cavitary syndrome (p=0.027), with predominant sub-segmentary bronchial involvement, with extensive micronodular spread (p=0.024) and with bronchiectasis (p=0.04). These residual lesions were not associated with an increased risk of relapse.
CONCLUSIONS: The persistence of signs of activity on the CT scan at the end of treatment of tuberculosis do not necessarily correspond to an absence of cure but to a radiological delay. This imaging is nevertheless useful to make an assessment of any subsequent changes in the bronchial tree and to estimate the risk of later complications.

Papua New Guinea (PNG) has an emerging tuberculosis (TB) epidemic which has become a national public health priority. In Western Province, there are few data about TB outside Daru and the South Fly District. This study describes the epidemiology of TB diagnosed at Balimo District Hospital (BDH) in the Middle Fly District of Western Province, PNG.
All patients (n = 1614) diagnosed with TB at BDH from April 2013 to February 2017 were recorded. Incidence of reported new cases was calculated for the combined Balimo Urban and Gogodala Rural local level government areas. Analyses investigated patient demographic and clinical information, differences between pulmonary and extrapulmonary TB patients, and predictors of treatment failure.
The average case notification rate (2014-2016) was 727 TB cases per 100 000 people per year. One-quarter of TB cases were in children, and 77.1% of all cases had an extrapulmonary TB diagnosis. There was a 1:1.1 ratio of female to male TB cases. When comparing pulmonary and extrapulmonary TB patients, extrapulmonary TB was more likely in those aged up to 14 years and over 54 years. Extrapulmonary TB was more likely in new patients, and pulmonary TB more likely in previously treated patients. Residence in rural regions was associated with treatment failure.
There is a high burden of TB in the Balimo region, including a very high proportion of extrapulmonary TB. These factors emphasise the importance of BDH as the primary hospital for TB cases in the Balimo region and the Middle Fly District, and the need for resources and staff to manage both drug-susceptible and drug-resistant TB cases.

BACKGROUND: Tobacco smoke alters lung defense mechanisms against infections and so increases the risk of mycobacterium tuberculosis infection.
OBJECTIVE: To determine the particular clinical features of tuberculosis in smokers and identify risk factors.
METHODS: We conducted a prospective, cross-sectional study over a period of nine months in Dakar, Senegal. The Chi-square test and multiple logistic regression were used to identify differences between smokers and non-smokers and to identify factors associated with clinical outcomes.
RESULTS: We included 165 patients with active pulmonary tuberculosis (59 smokers versus 106 never-smokers). The average age of smokers was 43.8±12.7 versus 32.1±13.1 years (P<0.0001). Smokers were overwhelmingly male (98.3% versus 1.8%, P<0.0001). The average delay to consultation was longer among smokers (90 days [30-120] versus 60 days [30-90] ; P<0.0001). In multivariate analysis, alcohol abuse, increasing age, male sex, and an unknown retroviral status were independent risk factors for pulmonary tuberculosis. Haemoptysis was observed more frequently in smokers (49.1% versus 31.1%, P=0.017). With regards to chest X-ray features, smokers presented with more advanced, bilateral and cavitating lung lesions.
CONCLUSIONS: Diagnostic delay and haemoptysis are important characteristics of the pulmonary tuberculosis in tobacco smokers.

Despite the availability of potent drugs and the availability of vaccine, tuberculosis remains until today one of the most worrying infectious diseases because of both its morbidity and mortality. This serious health problem is further complicated by the emergence of multidrug-resistant (MDR) or extensively drug-resistant strains (XDR). The number of MDR and XDR strains has continued to increase in recent years. Therefore, it is necessary to determine the risk factors leading to the emergence of MDR-TB strains to improve its overall management. Most studies indicate that the irregular previous treatment of tuberculosis with poor adherence is the main risk factor found. Other risk factors such as digestive issues, age, sex, and immunosuppression have been reported by several studies. In Tunisia, MDR-TB prevalence remains low with 0.8% among new cases and 12% among the restatements but control of this disease is necessary and remains essentially preventive. It is based on real preventive strategies planned according to local and updated regional data.

OBJECTIVE: Eight of 17 districts of Shanghai have offered transportation and living allowances subsidies to patients with tuberculosis (TB) among the migrant population. The study aimed to assess the impact of the subsidising initiative on the treatment success rate (TSR) and identify the social determinants of treatment outcomes.
METHODS: The participants included 7072 residents and 5703 migrants who were registered in the TB Information Management System with smear-positive pulmonary TB from January 2006 to December 2010. The Cochran-Armitage test was employed to test the trends of TSR and logistic regressions to identify the factors associated with treatment outcome.
RESULTS: Without subsidies, migrant TB cases had lower odds of successful treatment [OR = 0.20 (95% CI 0.18-0.23)] than resident cases. Subsidisation was associated with a 65% increased odds ratio of success [1.65 (1.40-1.95)] among migrant cases. The TSR has stabilised at 87% for both permanent residents and temporary migrants since 2009. Living in districts with a population density ≥20,000/km(2) was associated with a low odds ratio [0.42 (0.26-0.68)] among resident cases, whereas among migrant cases those living in districts out of central downtown had a higher odds ratio of treatment success [peripheral downtown: 1.73 (1.36-2.20), suburban: 1.69 (1.16-2.46)]. The TB cases in districts with 2.0-2.9 TB specialists/100 cases had a higher odds ratio [2.99 (1.91-4.69)] of successful treatment than cases from districts with fewer specialists.
CONCLUSIONS: Besides free medical services, transport and living allowance subsidies to migrant patients with TB improved the treatment outcome significantly.

BACKGROUND: Immunodepression induced by the human immunodeficiency virus (HIV) modifies the clinical, radiological and microbiological manifestations of pulmonary tuberculosis; leading to similarities between pulmonary tuberculosis and acute community-acquired bacterial pneumonia. A consequence is the high proportion of discordant pre- and post-mortem diagnoses of pneumonia. The aim of our study was to contribute to the improvement in the diagnosis of acute bacterial pneumonia in HIV positive patients in areas where tuberculosis is endemic.
METHODS: This retrospective study in HIV positive patients has compared 94 cases of positive smear cases pulmonary tuberculosis and 78 cases of acute community-acquired bacterial pneumonia.
RESULTS: Using logistic regression, the following features were positively associated with bacterial pneumonia: the sudden onset of signs (OR=8.48 [CI 95% 2.50-28.74]), a delay in the evolution of symptoms of less than 15 days (OR=3.70 [CI 95% 1.11-12.35]), chest pain (OR=2.81 [CI 95% 1.10-7.18]), radiological alveolar shadowing (OR=12.98 [CI 95% 4.66-36.12) and high leukocytosis (OR=3.52 [CI 95% 1.19-10.44]). These five variables allowed us to establish a diagnostic score for bacterial pneumonia ranging from 0 to 5. The area under the ROC curve was 0.886 [CI 95% 0.84-0.94, P<0.001]). Its specificity was >96.8% for a score of greater than or equal to 4.
CONCLUSIONS: The diagnostic score for acute community-acquired pneumonia may improve the management of bacterial pneumonia in areas where tuberculosis is endemic.

Tuberculosis (TB) is still being endemic in our country. Time until management determines both evolution and prognosis of this condition. The aim of this work is to evaluate the delay in diagnosis of TB in a respiratory unit from a university hospital series. The authors conducted a cross-sectional study including patients with pulmonary TBC and/or pleural. An evaluation of time management was conducted from the beginning of symptoms and various consultations with reference to the date of hospitalization and treatment set up. One hundred patients were included (pulmonary TB: 68 cases, pleural TB 23 cases, miliary pulmonary TB: 4 cases, pulmonary TB associated with other extrathoracic locations: 5 cases). The mean time of patient delay and total delay institution were respectively 43.6, 25.7 and 69.3 days. Variables responsible for long delays were: number of consultations more than 3 before hospitalization, empirical antibiotic therapy, of a regional hospital first consultation and the presence of extra-respiratory impairment. The patient delay was considered long. A reorganization of the TB control program, in particular by partial decentralization of care and health education is imperative in order to improve the quality of tuberculosis management in our country.