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Challenge to treat pre-extensively drug-resistant tuberculosis in a low-income country: A report of 12 cases

Setting: Democratic Republic of the Congo is a high-burden TB country. Its capital, Kinshasa, reports annually about one-third of all MDR-TB cases in the country; thus, pre-XDRTB management is warranted. OBJECTIVES: To describe the main challenges in treating pre- XDR TB in this low resources settin...

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Autores principales: Murhula Kashongwe, Innocent, Mawete, Fina, Anshambi, Nicole, Maingowa, Nadine, Aloni, Murielle, Lukaso L'osenga, Luc, Kaswa, Michel, Munogolo Kashongwe, Zacharie
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7527706/
https://www.ncbi.nlm.nih.gov/pubmed/33024840
http://dx.doi.org/10.1016/j.jctube.2020.100192
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author Murhula Kashongwe, Innocent
Mawete, Fina
Anshambi, Nicole
Maingowa, Nadine
Aloni, Murielle
Lukaso L'osenga, Luc
Kaswa, Michel
Munogolo Kashongwe, Zacharie
author_facet Murhula Kashongwe, Innocent
Mawete, Fina
Anshambi, Nicole
Maingowa, Nadine
Aloni, Murielle
Lukaso L'osenga, Luc
Kaswa, Michel
Munogolo Kashongwe, Zacharie
author_sort Murhula Kashongwe, Innocent
collection PubMed
description Setting: Democratic Republic of the Congo is a high-burden TB country. Its capital, Kinshasa, reports annually about one-third of all MDR-TB cases in the country; thus, pre-XDRTB management is warranted. OBJECTIVES: To describe the main challenges in treating pre- XDR TB in this low resources setting and possible solutions. METHOD: This is a retrospective study of all pre-XDR TB patients diagnosed in Kinshasa in 2018. A personalized regimen was applied according to the clinical profile, drug availability, and the Drug susceptibility testing (DST). Treatment was administered by hospitalization during the intensive phase and in ambulatory care in the continuation phase except in emergencies. Monthly follow up included evaluating clinical and bacteriological features, renal and liver functions, QT interval on ECG, and audiometry for those under aminoglycosides. RESULTS: Among the 236 MDR-TB patients identified in 2018, 14 had pre-XDR. Two died before treatment initiation. Of the remaining 12. 75% were male, 50% were aged 25–44 years, 66.7% had previous anti-tuberculosis treatment, 75% had a body mass index < 18.5 kg/m(2), and 1 patient was HIV positive. On radiography, all the patients had cavities. The median time from the diagnosis to treatment initiation was 48.5 days (range: 14–105). A favorable outcome occurred in 10 cases (83.3%), one patient died, and anotherwas lost to follow up. Nine (75%) patients reported adverse reactions, which were mild or moderate in 6 cases and severe in 2 cases. The severe reactions were psychosis (1 case) and ototoxicity (1 case). CONCLUSION: Successful pre-XDRTB treatment using the new strategy is possible even in a low-income country. The main challenges are diagnosis access, drug availability and follow-up laboratory facilities. These can be included in a global policy review by the NTP to ensure the sustainability of the strategies implemented.
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spelling pubmed-75277062020-10-05 Challenge to treat pre-extensively drug-resistant tuberculosis in a low-income country: A report of 12 cases Murhula Kashongwe, Innocent Mawete, Fina Anshambi, Nicole Maingowa, Nadine Aloni, Murielle Lukaso L'osenga, Luc Kaswa, Michel Munogolo Kashongwe, Zacharie J Clin Tuberc Other Mycobact Dis Article Setting: Democratic Republic of the Congo is a high-burden TB country. Its capital, Kinshasa, reports annually about one-third of all MDR-TB cases in the country; thus, pre-XDRTB management is warranted. OBJECTIVES: To describe the main challenges in treating pre- XDR TB in this low resources setting and possible solutions. METHOD: This is a retrospective study of all pre-XDR TB patients diagnosed in Kinshasa in 2018. A personalized regimen was applied according to the clinical profile, drug availability, and the Drug susceptibility testing (DST). Treatment was administered by hospitalization during the intensive phase and in ambulatory care in the continuation phase except in emergencies. Monthly follow up included evaluating clinical and bacteriological features, renal and liver functions, QT interval on ECG, and audiometry for those under aminoglycosides. RESULTS: Among the 236 MDR-TB patients identified in 2018, 14 had pre-XDR. Two died before treatment initiation. Of the remaining 12. 75% were male, 50% were aged 25–44 years, 66.7% had previous anti-tuberculosis treatment, 75% had a body mass index < 18.5 kg/m(2), and 1 patient was HIV positive. On radiography, all the patients had cavities. The median time from the diagnosis to treatment initiation was 48.5 days (range: 14–105). A favorable outcome occurred in 10 cases (83.3%), one patient died, and anotherwas lost to follow up. Nine (75%) patients reported adverse reactions, which were mild or moderate in 6 cases and severe in 2 cases. The severe reactions were psychosis (1 case) and ototoxicity (1 case). CONCLUSION: Successful pre-XDRTB treatment using the new strategy is possible even in a low-income country. The main challenges are diagnosis access, drug availability and follow-up laboratory facilities. These can be included in a global policy review by the NTP to ensure the sustainability of the strategies implemented. Elsevier 2020-09-22 /pmc/articles/PMC7527706/ /pubmed/33024840 http://dx.doi.org/10.1016/j.jctube.2020.100192 Text en © 2020 The Authors http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Article
Murhula Kashongwe, Innocent
Mawete, Fina
Anshambi, Nicole
Maingowa, Nadine
Aloni, Murielle
Lukaso L'osenga, Luc
Kaswa, Michel
Munogolo Kashongwe, Zacharie
Challenge to treat pre-extensively drug-resistant tuberculosis in a low-income country: A report of 12 cases
title Challenge to treat pre-extensively drug-resistant tuberculosis in a low-income country: A report of 12 cases
title_full Challenge to treat pre-extensively drug-resistant tuberculosis in a low-income country: A report of 12 cases
title_fullStr Challenge to treat pre-extensively drug-resistant tuberculosis in a low-income country: A report of 12 cases
title_full_unstemmed Challenge to treat pre-extensively drug-resistant tuberculosis in a low-income country: A report of 12 cases
title_short Challenge to treat pre-extensively drug-resistant tuberculosis in a low-income country: A report of 12 cases
title_sort challenge to treat pre-extensively drug-resistant tuberculosis in a low-income country: a report of 12 cases
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7527706/
https://www.ncbi.nlm.nih.gov/pubmed/33024840
http://dx.doi.org/10.1016/j.jctube.2020.100192
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