Search

Paradoxical reactions (PR) during tuberculosis treatment are rare in HIV negative subjects and result in polymorphic clinical presentations which could sometimes lead to confusion. We report the case of a postpartum mother, HIV negative who was placed on treatment for pulmonary tuberculosis. She experienced transient clinical improvement and developed PR which mimicked lung malignancy. This is a rare phenomenon and may result in diagnostic and therapeutic dilemma in resource poor settings.

Over the past 15 years, and despite many difficulties, significant progress has been made to advance child and adolescent tuberculosis (TB) care. Despite increasing availability of safe and effective treatment and prevention options, TB remains a global health priority as a major cause of child and adolescent morbidity and mortality—over one and a half million children and adolescents develop TB each year. A history of the global public health perspective on child and adolescent TB is followed by 12 narratives detailing challenges and progress in 19 TB endemic low and middle-income countries. Overarching challenges include: under-detection and under-reporting of child and adolescent TB; poor implementation and reporting of contact investigation and TB preventive treatment services; the need for health systems strengthening to deliver effective, decentralized services; and lack of integration between TB programs and child health services. The COVID-19 pandemic has had a significant negative impact on case detection and treatment outcomes. Child and adolescent TB working groups can address country-specific challenges to close the policy–practice gaps by developing and supporting decentral ized models of care, strengthening clinical and laboratory diagnosis, including of multidrug-resistant TB, providing recommended options for treatment of disease and infection, and forging strong collaborations across relevant health sectors.

Data on the prevalence of sleep-disordered breathing (SDB) in the African general population are scarce, and a better understanding is urgently needed. Our study aimed to objectively determine the prevalence of, and factors associated with, SDB in a large sample in Benin, west Africa.In the Benin Society and Sleep (BeSAS) cross-sectional study, participants aged 25 years and older were recruited from both urban and rural areas. Rural participants were recruited from Tanve, a village located 200 km north of Cotonou, and urban participants were recruited from Cotonou. The participants underwent respiratory polygraphy at home using a type-3 device that measures airflow through a nasal pressure sensor, respiratory effort (thoracic movement), and pulse oximetry. Clinical and morphometric data were also collected. SDB severity categories were defined according to the apnoea-hypopnoea index (AHI), with mild-to-severe SDB (AHI ≥5/h), moderate-to-severe SDB (AHI ≥15/h), and severe SDB (AHI ≥30/h).The study was completed from April 4, 2018 to Jan 15, 2021. Of 2909 participants recruited in the BeSAS study, 2168 (74·5%) underwent respiratory polygraphy. For the 1810 participants with complete polygraphic data (mean age 46 years, SD 15; 1163 [64·2%] women), the prevalence of mild-to-severe SDB (AHI ≥5/h) was 43·2% (95% CI 40·9-45·5), of moderate-to-severe SDB (AHI ≥15/h) was 11·6% (10·2-13·1), and of severe SDB (AHI ≥30/h) was 2·7% (2·0-3·5). Factors independently associated with SDB were advanced age, male sex, large neck circumference, abdominal obesity, overweight or obesity, and snoring. After multivariable adjustment, severe SDB was independently associated with hypertension in women (odds ratio 3·99, 95% CI 1·04-15·33; pThe BeSAS study provides the first large-scale objective evaluation of SDB prevalence and associated factors in Africa. The high prevalence of SDB identified should stimulate the development of public health policies to prevent and treat this condition in African countries.Ligue Pulmonaire Vaudoise, Switzerland.

BackgroundThe COVID-19 pandemic has caused major disruption to healthcare services globally and has impacted on tuberculosis (TB) patients and TB diagnosis and treatment services both in low- and high-income countries. We therefore explored the perspectives of members of regional and international TB control and research networks to further understand TB service disruptions and compared the experiences of members from West African and European countries.MethodsThis cross-sectional, explorative descriptive study was conducted from May to July 2020 using an open online survey with target respondents from both West African and European countries. The survey comprised discrete questions exploring challenges faced with TB screening, diagnosis, treatment, prevention, and changes implemented. Additionally, respondents were asked to provide recommendations for remedial actions.ResultsWe analysed responses from 124 respondents based in 29 countries located in Europe and West Africa. About half of the respondents reported challenges in delivering routine TB services during the COVID-19 pandemic, with over one third reporting having some form of guidance issued regarding maintaining delivery of routine TB services. Respondents emphasised the need for strengthening TB services especially in light of COVID-19 pandemic. Considerable similarities were found between the challenges experienced by TB professionals in both West African and European settings. Responses also highlighted the hidden challenges faced in some countries prior to the COVID-19 pandemic, especially in some West African settings where staff shortages and laboratory issues predated COVID-19.ConclusionsTB control and research professionals in West African and European settings experienced similar challenges to the delivery of TB diagnosis and treatment services due to the COVID-19 pandemic, and highlighted the need for clear communication of guidelines, prioritisation of routine TB service delivery, ongoing health education, and possible integration of TB and COVID-19 services to ensure that TB services are more resilient against the impact of the pandemic.

Background: There are currently no data on the prevalence of sleep-disordered breathing (SDB) in the African general population. This study aimed to objectively determine the prevalence of, and factors associated with, SDB in a large population-based sample in Benin, West Africa. Methods: The Benin Society and Sleep (BeSAS) population-based study was conducted from April 2018 to January 2021. Participants were recruited from both urban and rural areas. Subjects underwent polygraphy at home using a type III device. Clinical and morphometric data were also collected. SBD severity categories were defined according to apnoea-hypopnoea index (AHI): mild-to-severe (AHI ≥5/h, moderate-to-severe (AHI ≥15/h) or severe (AHI ≥30/h). Findings: For the 1810 participants with complete polygraphic data (age 46±15 years, 64·2% women), the prevalence (95% confidence interval [CI]) of mild-to-severe SDB (AHI ≥5/h) was 43·2% (40·9–45·5), of moderate-to-severe SDB (AHI ≥15/h) was 11·6% (10·2–13·1), and of severe SDB (AHI ≥30/h) was 2·7% (2·0-3·5). Factors independently associated with SBD were advanced age, large neck circumference, and snoring in both sexes. After multivariable adjustment, severe SDB was independently associated with hypertension (odds ratio 3·99 [95% CI 1·04–15·33]; p trend =0·044) in women but not in men. Interpretation: The BeSAS study provides the first objective evaluation of SDB prevalence and associated factors in Africa. The high prevalence of SDB identified should stimulate the development of public health policies to prevent and treat this condition in African countries. Funding Information: Ligue Pulmonaire Vaudoise, Switzerland. Declaration of Interests: RH is member of the medical advisory board of Dreem and Nightbalance (Philips) and received honorariums, grants or speakers’ fees from ResMed, Jazz, Inspire, Philips and Dreem. All the other authors have no conflict of interest to disclose. Ethics Approval Statement: The study was approved by the National Ethics Committee of Benin (reference No. 45, 25 October 2017) with regular annual approval renewal throughout the course of the research project. Participants were enrolled on a voluntary basis and provided written informed consent. If a subject was unable to read or write, a family member able to read was asked to assist with providing information.

Resume Introduction L’incidence des infections a mycobacteries atypiques est estimee en Europe a un cas pour 100 000 personnes/annee. Malgre la rarete des infections mycobacteriennes non tuberculeuses, le Mycobacterium avium peut realiser une lesion nodulaire donnant le change avec un cancer pulmonaire. Nous rapportons un cas de mycobacteriose atypique pulmonaire, ayant conduit a la lobectomie. Observation Il s’agit d’un nodule pulmonaire droit decouvert chez un patient de 63 ans, BPCO, partiellement nephrectomise pour carcinome renal, hebdomadairement sous methotrexate pour polyarthrite rhumatoide. A la tomographie par emission de positron (TEP scan), la lesion etait faiblement hypermetabolique, avec des micronodules non hypermetaboliques de la petite scissure. La bronchoscopie ne retrouvait pas de lesions endoluminales. L’examen cytobacteriologique etait non contributif. L’examen histopathologique du nodule pulmonaire apical, obtenu par biopsie transthoracique revelait un adenocarcinome bronchique au stade T1(a)N0M0. Le patient beneficia alors d’une lobectomie superieure avec curage ganglionnaire. L’analyse anatomopathologique a retrouve des nodules granulomateux necrosant entoures de cellules geantes evoquant un tuberculome. La culture mycobacterienne des echantillons de lavage bronchique s’est revelee positive a Mycobacterium avium apres 7 semaines. Conclusion Dans les formes pseudoneoplasiques des mycobacterioses atypiques, la presence d’anomalies cytonucleaires alveolaires inflammatoires peut mimer un adenocarcinome. Faire la difference entre les anomalies cytonucleaires d’origine reactionnelles ou d’origine neoplasique reste donc une difficulte journaliere en histopathologie.