We searched PubMed Central for all studies or reports of lipoarabinomannan for the diagnosis of pulmonary tuberculosis in children. We used search terms "pulmonary tuberculosis" OR "ptb" AND "child" OR "infant" OR "adolescent" AND "lipoarabinomannan" OR "lam" AND "urine", up to Mar 9, 2020. No language restrictions were applied. Our search returned five relevant publications that included children below 15 years undergoing LAM testing of urine for diagnosis of pulmonary tuberculous using AlereLAM. None of the studies used FujiLAM. The sensitivity of LAM, compared with confirmed TB, ranged from 48•3% to 73•2% for all children. Even though the WHO has recommended the use of AlereLAM to aid in the diagnosis of TB in children and adolescents with HIV, the test still shows sub-optimal sensitivity in most studies.When we searched using the search terms "fuji silvamp tb" OR "fujilam" OR "fuji silvamp tb lam", we found two relevant studies, both of which were performed in adults with HIV and found that FujiLAM had a notably higher sensitivity than AlereLAM. No comparison of the two tests in children has been done to date, and the role of FujiLAM in childhood PTB diagnosis remains unknown.

BackgroundDrug resistant tuberculosis presents a major public health challenge.Case presentationWe present here the first two patients diagnosed with extensively drug resistant tuberculosis in Bamako, Mali. Genotypic findings suggest possible nosocomial transmission from the first patient to the second one, resulting in superinfection of the second patient. After being diagnosed with extensively drug resistant tuberculosis in August 2016, the patients only started receiving appropriate treatment 10 months later.ConclusionThe identification of these patients highlights the need for improved diagnostic and treatment algorithms for better surveillance and management of drug resistance in Mali. In the interest of these as well as future patients suffering from resistant tuberculosis, all steps recommended for programmatic management of drug resistant tuberculosis must be urgently prioritized in order to strengthen the multidrug resistant tuberculosis program.

L’enquête a été réalisée dans 36 troupeaux bovins laitiers repartis dans 19 sites localisés dans la zone périurbaine du district de Bamako. Au total 1 087 sujets ont subi le test d’intradermoréaction comparative avec 202 (18,58 p. 100) cas de réaction positive. La prévalence au sein des troupeaux a été évaluée à 94,44 p. 100 (34 troupeaux positifs au test d’intradermoréaction sur 36 testés). Les résultats ont montré que, dans les troupeaux visités, la prévalence intradermo comparative individuelle positive a varié selon l’âge et la race des animaux testés : elle a été plus élevée chez les adultes âgés de plus de 10 ans (44,18 p. 100) et les sujets appartenant aux races bovines importées et ceux issus de croisement (22,42 p. 100).

BACKGROUND: Non-conversion on auramine smear microscopy indicates a lack of treatment response, possibly associated with initial rifampicin-resistant tuberculosis (RR-TB). However, dead bacteria still stain positive and may be detected. Fluorescein diacetate smear microscopy (FDA) shows live mycobacteria only. Therefore, we studied the potential of 2-month (2M) FDA for the identification of initial RR-TB.METHODS: Between 2015 and 2018, we enrolled new smear-positive pulmonary TB patients from five local centres in Bamako, Mali. After baseline screening, sputum samples were collected at 1M, 2M, 5M and 18M. We used rpoB sequencing to identify initial RR-TB.RESULTS: Of 1359 patients enrolled, 1019 (75%) had rpoB sequencing results. Twenty-six (2.6%, 95%CI: 1.7–3.7) had mutations conferring rifampicin resistance. Most frequent rpoB mutations were located at the codons Asp435Val (42.4%) and Ser450Leu (34.7%). Among patients with initial RR-TB, 72.2% were FDA-negative at 2M (P = 0.2). The positive and negative predictive value of 5M FDA for culture-based failure was respectively 20.0% and 94.7%.CONCLUSION: FDA did not identify the majority of patients with initial RR-TB or culture-based failure. As the full spectrum of mutations identified on sequencing was identified using Xpert, our data support its rapid universal implementation in Mali.

Background The End Tuberculosis (TB) Strategy aims to achieve 90% reduction of deaths due to TB by 2030, compared with 2015. Mortality due to tuberculosis in Mali was 13 per 100,000 inhabitants in 2014 and 11 per 100,000 inhabitants in 2017. Risk factors for death are not known. The objective of this study was to determine the time and risk factors for death in pulmonary TB patients with positive microscopy. Methods We conducted a retrospective cohort study from October to December 2016 in Commune VI of Bamako. Smear positive cases pulmonary tuberculosis from 2011 to 2015 were included. We reviewed the treatment registers and collected sociodemographic, clinical, biological and therapeutic data. Median time to death and hazard ratio (HR) were estimated by the Kaplan-Meier method and a Cox regression model, respectively. Results In total, we analysed 1362 smear positive cases of pulmonary TB including 104 (8%) HIV positive and 90 (7%) deaths. The mean age was 36 ± 13 years, the sex ratio of males to females was 2:1. Among the deaths, 48 (53%) occurred during the first 2 months of treatment. Age ≥ 45 years (HR 2.09 95% CI [1.35–3.23]), weight <  40 kg (HR 2.20 95% CI [1.89–5.42]), HIV unknown status (HR 1.96, 95% CI [1.04–3.67]) and HIV-positive (HR 7.10 95% CI [3.53–14.26]) were significantly associated with death. Conclusions The median time to death was 2 months from the start of treatment. Independent risk factors for death were age ≥ 45 years, weight <  40 kg, unknown and positive HIV status. We recommend close monitoring of patients over 45 years, HIV testing in those with unknown status, an adequate care for positive HIV status, as well as a nutritional support for those with weight below 40 kg during the intensive phase of TB treatment.