Background The Central African Republic (CAR) has one of the heaviest burdens of tuberculosis (TB) in the world, with an incidence of 423 cases per 100 000 population. Surveillance of resistance to rifampicin with GeneXpert MTB/RIF was instituted in the National TB Reference Laboratory in 2015. The aim of this study was to evaluate, after 3 years, resistance to rifampicin, the most effective firstline drug against TB. Methods The surveillance database on cases of rifampicin resistance was retrospectively analyzed. The populations targeted by the National TB Programme were failure, relapse, default, and contacts of multidrug-resistant TB (MDR-TB). Statistical analyses were performed with Stata software, version 14, using chi-square tests and odds ratios. Results Six hundred seventeen cases were registered; 63.7% were male, 36.3% were female, and the mean age was 35.5 years (range from 2 to 81). GeneXpert MTB/RIF tests were positive in 79.1% (488/617), and resistance to rifampicin was positive in 42.2% (206/488), with 49.1% (56/114) in 2015, 34.7% (57/164) in 2016, and 44.3% (93/210) in 2017. Failure cases had the highest rate of resistance (70.4%), with a significant difference (P < .0001; odds ratio, 9.5; 95% confidence interval, 4.4–20.5). Resistance was observed in 40% of contacts of MDR-TB, 28.2% of the relapses and 20% of the defaults without significant difference. Conclusions Resistance to rifampicin is still high in the CAR and is most strongly associated with treatment failure. The Ministry of Health must to deploy GeneXpert MTB/RIF tests in the provinces to evaluate resistance to TB drugs in the country.

We investigated multidrug-resistant (MDR) Mycobacterium tuberculosis strains in Bangui, Central African Republic. We found 39.6% with the same spoligotype and synonymous single nucleotide polymorphism in the mutT1 gene. However, strains had different rpoB mutations responsible for rifampin resistance. MDR strains in Bangui may emerge preferentially from a single, MDR-prone family.

We assessed the performance of a serological test for tuberculosis (SDHO Laboratories Inc., Canada) in our setting. Among 68 of 99 suspected pulmonary tuberculosis patients who were scored as having tuberculosis on the basis of Mycobacterium tuberculosis-positive culture, the sensitivity of the serological test was lower than that of sputum smear microscopic examination (20.6% versus 80.9%, respectively; P < 0.000001).Tuberculosis (TB) remains a major health problem, with an estimated 8 million new cases and 2 million deaths due to this disease every year worldwide (4). Microscopic examination of sputum smears is still the only rapid, technically simple, and inexpensive test available for the routine diagnosis of TB in most developing countries. However, its sensitivity for pulmonary tuberculosis (PTB), even in good centers, is only about 60 to 70% with reference to sputum culture. Various antibodybased serological tests have been developed. Unfortunately, most do not perform sufficiently well to be used as routine field diagnostic tests (6,9,11,12). Here, we assessed the diagnostic performance of the SDHO MTB test (SDHO Laboratories Inc., Canada), a novel and commercially available serological test for the detection of PTB, in the Central African Republic, which is a setting with high prevalences of both TB (13) and human immunodeficiency virus (HIV) infection (1, 7).Study participants were recruited from the Department of Medicine at Bangui Community Hospital and from the Chest Clinic at National Teaching Hospital in Bangui, Central African Republic, between 12 July and 1 September 2004. Eligible participants were suspected PTB cases, defined as patients who had a history of cough lasting Ն3 weeks and who were identified by a physician as needing an evaluation for TB. Giving of informed consent, age of Ն18 years, and either sex were considered inclusion criteria for the study. All consecutive suspected PTB patients who fulfilled the inclusion criteria were enrolled and underwent an evaluation that is considered routine for suspected PTB in the Central African Republic. This consisted of providing three sputum specimens for acid-fast bacillus smearing within 48 h of enrollment. In addition, these same sputum specimens and blood samples were processed for mycobacterial culture (3, 5). Blood samples were also used for HIV testing as described elsewhere (8).The SDHO MTB test (SDHO Laboratories Inc., Canada) utilizes the principle of immunochromatography and is a unique two-site immunoassay on a membrane. As the test sample flows through the membrane assembly of the device, a colored recombinant TB antigen-colloidal gold conjugate complexes with anti-TB antibodies in the sample. This complex moves through the membrane to the test region, where it is immobilized by the recombinant TB antigen coating of the membrane, leading to formation of a colored band which confirms a positive test result. The absence of this colored band in the test region indicates a negative test result. The unreacted conjugate and unbound com...

Our study indicates that primary drug resistance levels in urban settings of CAR are similar to or lower than in other African cities, and that the spread of multidrug-resistant TB in this population is limited. Extended nationwide monitoring of drug resistance remains important, especially in view of the planned introduction of a new treatment regimen (2HRZE/4HR [Z = pyrazinamide]).

BackgroundTuberculosis (TB) is a major cause of childhood morbidity and mortality in developing countries. One of the main difficulties is obtaining adequate specimens for bacteriological confirmation of the disease in children.The aim of this study is to evaluate the adequacy of fine-needle aspiration (FNA) for the diagnosis of TB.MethodsIn a prospective study conducted at the paediatric hospital in Bangui in 2007–2009, we used fine-needle aspiration to obtain samples for diagnosis of TB from 131 children aged 0–17 years with persistent lymphadenitis.ResultsFine-needle aspiration provided samples that could be used for bacteriological confirmation of TB. Ziehl-Neelsen staining for acid-fast bacilli was positive in 42.7% of samples, and culture identified TB in 67.2% of cases. Of 75 samples that were stain-negative, 49 (65.3%) were culture-positive, while 12 stain-positive samples remained culture-negative. Ten of the 12 stain-positive, culture-negative samples were from patients who had received previous antimicrobial therapy. With regard to phenotypic drug susceptibility, 81/88 strains (91.1%) were fully susceptible to isoniazid, rifampicin, ethambutol and streptomycin, six (6.8%) were resistant to one drug, and one multidrug-resistant strain was found.ConclusionsFine-needle aspiration is simple, cost-effective and non-invasive and can be performed by trained staff. Combined with rapid molecular diagnostic tests, fine-needle aspirates could improve the diagnosis of TB and provide valuable information for appropriate treatment and drug resistance.