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Ndanga MED, Abdul JBPAA, Edoa JR, Ibinda GARM, Adegbite BR, Mevyann RC, Biyogho CM, Mahoumbou J, Manguinga S, Roguet NM, Lell B, Kremsner PG, Alabi AS, Grobusch MP, Adegnika AA. Species identification and drug susceptibility testing of non-tuberculous mycobacteria by Line Probe Assay in Lambaréné, Gabon-a cross-sectional study. BMC Infect Dis 2023; 23:651. [PMID: 37789292 PMCID: PMC10548664 DOI: 10.1186/s12879-023-08617-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 09/18/2023] [Indexed: 10/05/2023] Open
Abstract
BACKGROUND Non-tuberculous mycobacteria (NTM) are a group of bacteria that cause rare lung infections and are increasingly recognized as causative agents of opportunistic and device-associated infections in humans. In Gabon, there is a lack of data on NTM species identification and drug susceptibility. The aim of this study was to identify the frequency of NTM species and their genotypic susceptibility pattern to commonly used antibiotics for NTM infections in Gabon. METHODS A cross-sectional study was conducted at the CERMEL TB laboratory from January 2020 to December 2022, NTM subspecies identification and drug susceptibility testing to macrolides and aminoglycosides were performed using the genotype NTM-DR kit. RESULTS The study found that out of 524 culture-positive specimens, 146 (28%) were NTM, with the predominant group being Mycobacterium avium complex (MAC) and Mycobacterium abscessus complex (MABC). All MAC isolates were fully susceptible to macrolides and aminoglycosides, while five MABC isolates carried mutations indicative of reduced susceptibility to macrolide and aminoglycoside drugs. CONCLUSIONS These findings suggest that clinicians may use macrolides and aminoglycosides to manage NTM infections caused by MAC, but further investigation is required to determine MABC drug susceptibility.
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Affiliation(s)
- Micheska Epola Dibamba Ndanga
- Centre de Recherches Médicales de Lambaréné (CERMEL), Lambaréné, Gabon
- Ecole Doctorale d'infectiologie Tropicale de Franceville, Franceville, Gabon
| | | | - Jean Ronald Edoa
- Centre de Recherches Médicales de Lambaréné (CERMEL), Lambaréné, Gabon
| | | | - Bayodé Romeo Adegbite
- Centre de Recherches Médicales de Lambaréné (CERMEL), Lambaréné, Gabon
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam University Medical Centers, Location University of Amsterdam, Amsterdam Infection & Immunity, Amsterdam Public Health, University of Amsterdam, Amsterdam, The Netherlands
| | | | | | - Jocelyn Mahoumbou
- Programme National de Lutte Contre La Tuberculose, Libreville, Gabon
| | | | | | - Bertrand Lell
- Centre de Recherches Médicales de Lambaréné (CERMEL), Lambaréné, Gabon
- Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Vienna, Austria
| | - Peter Gottfried Kremsner
- Centre de Recherches Médicales de Lambaréné (CERMEL), Lambaréné, Gabon
- German Center for Infection Research, Tübingen, Germany
- Institut Für Tropenmedizin, Universität Tübingen, Tübingen, Germany
| | - Abraham Sunday Alabi
- Centre de Recherches Médicales de Lambaréné (CERMEL), Lambaréné, Gabon
- Health Focus GmbH, Potsdam, Germany
| | - Martin Peter Grobusch
- Centre de Recherches Médicales de Lambaréné (CERMEL), Lambaréné, Gabon.
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam University Medical Centers, Location University of Amsterdam, Amsterdam Infection & Immunity, Amsterdam Public Health, University of Amsterdam, Amsterdam, The Netherlands.
- Institut Für Tropenmedizin, Universität Tübingen, Tübingen, Germany.
- Masanga Medical Research Unit (MMRU), Masanga, Sierra Leone.
- Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town, South Africa.
| | - Ayola Akim Adegnika
- Centre de Recherches Médicales de Lambaréné (CERMEL), Lambaréné, Gabon
- German Center for Infection Research, Tübingen, Germany
- Institut Für Tropenmedizin, Universität Tübingen, Tübingen, Germany
- Fondation Pour La Recherche Scientifique, Cotonou, Bénin
- Department of Parasitology, Leiden University Medical Center, Leiden, The Netherlands
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Adegbite BR, Edoa JR, Agbo Achimi Abdul JBP, Epola M, Mevyann C, Dejon-Agobé JC, Zinsou JF, Honkpehedji YJ, Mpagama SG, Alabi AS, Kremsner PG, Klipstein-Grobusch K, Adegnika AA, Grobusch MP. Non-communicable disease co-morbidity and associated factors in tuberculosis patients: A cross-sectional study in Gabon. EClinicalMedicine 2022; 45:101316. [PMID: 35243277 PMCID: PMC8885570 DOI: 10.1016/j.eclinm.2022.101316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 01/31/2022] [Accepted: 02/09/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND There are only limited data from resource-limited settings available on the prevalence of non-communicable diseases and associated risk factors of tuberculosis patients. This study investigated non-communicable disease co-morbidity in tuberculosis patients from Moyen Ogooué Province, Gabon. METHODS All patients aged 18 years or older consulting for tuberculosis (TB) symptoms in Gabon's Moyen Ogooué province and neighbouring provinces from November 2018 to November 2020 were screened for diabetes mellitus, hypertension, and risk factors thereof (obesity, dyslipidaemia, smoking and alcohol consumption). Logistic regression was performed to identify factors associated with TB-diabetes and TB-hypertension co-morbidities. FINDINGS Of 583 patients included, 227 (39%) were diagnosed with tuberculosis. In tuberculosis-confirmed patients, the prevalences of hypertension and diabetes were 16·3% and 12·8%, respectively. The prevalence of diabetes was twice as high in tuberculosis patients compared to non-tuberculosis patients. Factors independently associated with hypertension-tuberculosis co-morbidity were age >55 years (aOR=8·5, 95% CI 2·43, 32·6), age 45-54 years (aOR=4.9, 95%CI 1.3-19.8), and moderate alcohol consumption (aOR=2·4; 95% CI 1·02- 5·9), respectively. For diabetes-tuberculosis co-morbidity, age >55 years was positively (aOR=9·13; 95% CI 2·4-39·15), and moderate alcohol consumption inversely associated (aOR=0·26, 95% CI 0·08- 0·73). One-hundred-and-four (46%) of the tuberculosis patients had at least either dyslipidaemia, hypertension, diabetes, or obesity with a majority of newly-diagnosed hypertension and diabetes. INTERPRETATION Integration of screening of non-communicable diseases and their risk factors during TB assessment for early diagnosis, treatment initiation and chronic care management for better health outcomes should be implemented in all tuberculosis healthcare facilities. FUNDING This study was supported by WHO AFRO/TDR/EDCTP (2019/893,805) and Deutsches Zentrum für Infektiologie (DZIF/ TTU 02.812).
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Affiliation(s)
- BR Adegbite
- German Center for Infection Research, Centre de Recherches Médicales de Lambaréné and African Partner Institution, Lambaréné, Gabon
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, location AMC, Amsterdam Public Health, Amsterdam Infection and Immunity, University of Amsterdam, Amsterdam University Medical Centers, location AMC, Meibergdreef 9, Amsterdam 1105 AZ, the Netherlands
- Universität Tübingen and German Center for Infection Research, Institut für Tropenmedizin, Tübingen, Germany
| | - JR Edoa
- German Center for Infection Research, Centre de Recherches Médicales de Lambaréné and African Partner Institution, Lambaréné, Gabon
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, location AMC, Amsterdam Public Health, Amsterdam Infection and Immunity, University of Amsterdam, Amsterdam University Medical Centers, location AMC, Meibergdreef 9, Amsterdam 1105 AZ, the Netherlands
- Universität Tübingen and German Center for Infection Research, Institut für Tropenmedizin, Tübingen, Germany
| | - JBP Agbo Achimi Abdul
- German Center for Infection Research, Centre de Recherches Médicales de Lambaréné and African Partner Institution, Lambaréné, Gabon
| | - M Epola
- German Center for Infection Research, Centre de Recherches Médicales de Lambaréné and African Partner Institution, Lambaréné, Gabon
| | - C Mevyann
- German Center for Infection Research, Centre de Recherches Médicales de Lambaréné and African Partner Institution, Lambaréné, Gabon
| | - JC Dejon-Agobé
- German Center for Infection Research, Centre de Recherches Médicales de Lambaréné and African Partner Institution, Lambaréné, Gabon
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, location AMC, Amsterdam Public Health, Amsterdam Infection and Immunity, University of Amsterdam, Amsterdam University Medical Centers, location AMC, Meibergdreef 9, Amsterdam 1105 AZ, the Netherlands
- Universität Tübingen and German Center for Infection Research, Institut für Tropenmedizin, Tübingen, Germany
| | - JF Zinsou
- German Center for Infection Research, Centre de Recherches Médicales de Lambaréné and African Partner Institution, Lambaréné, Gabon
- Universität Tübingen and German Center for Infection Research, Institut für Tropenmedizin, Tübingen, Germany
- Department of Parasitology, Leiden University Medical Center, Leiden, the Netherlands
| | - YJ Honkpehedji
- German Center for Infection Research, Centre de Recherches Médicales de Lambaréné and African Partner Institution, Lambaréné, Gabon
- Universität Tübingen and German Center for Infection Research, Institut für Tropenmedizin, Tübingen, Germany
- Department of Parasitology, Leiden University Medical Center, Leiden, the Netherlands
| | - SG Mpagama
- Kibong'oto Infectious Diseases Hospital - Sanya Juu Siha/Kilimanjaro Clinical Research Institute Kilimanjaro Tanzania, Mae Street, Lomakaa Road, Siha Kilimanjaro, Tanzania
| | - AS Alabi
- German Center for Infection Research, Centre de Recherches Médicales de Lambaréné and African Partner Institution, Lambaréné, Gabon
- Universität Tübingen and German Center for Infection Research, Institut für Tropenmedizin, Tübingen, Germany
| | - PG Kremsner
- German Center for Infection Research, Centre de Recherches Médicales de Lambaréné and African Partner Institution, Lambaréné, Gabon
- Universität Tübingen and German Center for Infection Research, Institut für Tropenmedizin, Tübingen, Germany
| | - K Klipstein-Grobusch
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - AA Adegnika
- German Center for Infection Research, Centre de Recherches Médicales de Lambaréné and African Partner Institution, Lambaréné, Gabon
- Universität Tübingen and German Center for Infection Research, Institut für Tropenmedizin, Tübingen, Germany
- Department of Parasitology, Leiden University Medical Center, Leiden, the Netherlands
| | - MP Grobusch
- German Center for Infection Research, Centre de Recherches Médicales de Lambaréné and African Partner Institution, Lambaréné, Gabon
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, location AMC, Amsterdam Public Health, Amsterdam Infection and Immunity, University of Amsterdam, Amsterdam University Medical Centers, location AMC, Meibergdreef 9, Amsterdam 1105 AZ, the Netherlands
- Universität Tübingen and German Center for Infection Research, Institut für Tropenmedizin, Tübingen, Germany
- Masanga Medical Research Unit (MMRU), Masanga, Sierra Leone
- Institute of Infectious Diseases and Molecular Medicine (IDM), University of Cape Town, Cape Town, South Africa
- Corresponding author at: Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, location AMC, Amsterdam Public Health, Amsterdam Infection and Immunity, University of Amsterdam, Amsterdam University Medical Centers, location AMC, Meibergdreef 9, Amsterdam 1105 AZ, the Netherlands.
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Epola Dibamba Ndanga M, Babatundé Pacome Achimi Agbo Abdul J, Ronald Edoa J, Chester Mevyann R, Romeo Adegbite B, Mfoumbi A, Mebiame Biyogho C, Beh Mba R, Mahoumbou J, McCall MBB, Peter Grobusch M, Akim Adegnika A, Sunday Alabi A. Non-tuberculous mycobacteria isolation from presumptive tuberculosis patients in Lambaréné, Gabon. Trop Med Int Health 2022; 27:438-444. [PMID: 35167171 DOI: 10.1111/tmi.13736] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The prevalence of clinical cases of pulmonary non-tuberculous mycobacteria (NTM) is increasing worldwide. The aim of this study was to determine the proportion and the NTM species isolated from presumptive tuberculosis patients in Lambaréné, Gabon. METHOD From January 2018 to December 2020, sputum samples from presumptive TB patients were analysed at the tuberculosis reference laboratory of the Centre de Recherches Médicales de Lambaréné. Two sputum samples were collected per patient, and culture was performed using Bactec MGIT 960. The GenoType Mycobacterium CM/AS was used for NTM isolates confirmation and species differentiation. RESULTS Among 1363 sputum samples analysed, 285 (20.9%) were Auramin acid fast bacilli (AFB) smear-positive. NTM were isolated in 137/1363 (10%) of the samples. The most prevalent NTM species was Mycobacterium intracellulare (n=74; 54%). CONCLUSION These results show the presence of NTM among presumptive TB patients in Gabon, which could potentially complicate TB diagnosis. This presents a new public health challenge, and emphasises the need to consider NTM in planning the prevention and management of tuberculosis control.
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Affiliation(s)
| | | | | | | | - Bayodé Romeo Adegbite
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon.,Center of Tropical Medicine and Travel Medicine, Amsterdam University Medical Centers, University of Amsterdam, The Netherlands
| | - Arnaut Mfoumbi
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
| | | | - Romual Beh Mba
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
| | - Jocelyn Mahoumbou
- Programme National de Lutte contre la Tuberculose, Libreville, Gabon
| | - Matthew B B McCall
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon.,Department of Medical Microbiology, Radboud University Medical Centre, Nijmegen, The Netherlands.,Institut für Tropenmedizin, Universität Tübingen, Tübingen, Germany
| | - Martin Peter Grobusch
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon.,Center of Tropical Medicine and Travel Medicine, Amsterdam University Medical Centers, University of Amsterdam, The Netherlands.,Institut für Tropenmedizin, Universität Tübingen, Tübingen, Germany
| | - Ayola Akim Adegnika
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon.,Programme National de Lutte contre la Tuberculose, Libreville, Gabon.,Institut für Tropenmedizin, Universität Tübingen, Tübingen, Germany.,German Center for Infection Research, Tübingen, Germany.,Department of Parasitology, Leiden University Medical Center, Leiden, The Netherlands.,Fondation pour la Recherche Scientifique, Cotonou, Bénin
| | - Abraham Sunday Alabi
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon.,Health Focus GmbH, Potsdam, Germany
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4
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Vigenschow A, Adegbite BR, Edoa JR, Alabi A, Adegnika AA, Grobusch MP, Massinga-Loembe M. Tuberculosis infection control measures in healthcare facilities in Moyen-Ogooué Province, Gabon. BMC Health Serv Res 2021; 21:1200. [PMID: 34740361 PMCID: PMC8571857 DOI: 10.1186/s12913-021-07236-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 10/27/2021] [Indexed: 11/29/2022] Open
Abstract
Background Healthcare workers (HCW) are at higher risk of tuberculosis (TB) than the general population. We assessed healthcare facilities for their TB infection control standards and priorities. Methods A standardised tool was applied. The assessment was conducted by direct observation, documents review and interviews with the facility heads. Results Twenty healthcare facilities were assessed; 17 dispensaries, an HIV-clinic, a private not-for-profit hospital and a public regional hospital. In both hospitals, outpatient departments, internal medicine wards, paediatric wards, emergency departments; and the MDR-TB unit of the public regional hospital were assessed. In Gabon, there are currently no national guidelines for TB infection control (TBIC) in healthcare settings. Consequently, none of the facilities had an infection control plan or TBIC focal point. In three departments of two facilities (2/20 facilities), TB patients and presumed TB cases were observed to be consistently provided with surgical masks. One structure reported to regularly test some of its personnel for TB. Consultation rooms were adequately ventilated in six primary care level facilities (6/17 dispensaries) and in none of the hospitals, due to the use of air conditioning. Adequate personal protective equipment was not provided regularly by the facilities and was only found to be supplied in the MDR-TB unit and one of the paediatric wards. Conclusions In Moyen-Ogooué province, implementation of TBIC in healthcare settings is generally low. Consequently, HCW are not sufficiently protected and therefore at risk for M. tuberculosis infection. There is an urgent need for national TBIC guidelines and training of health workers to safeguard implementation. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-07236-z.
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Affiliation(s)
- Anja Vigenschow
- Centre de Recherches Médicales de Lambaréné and African Partner Institution, German Center for Infection Research (CERMEL), Lambaréné, Gabon.,Institut für Tropenmedizin, Universität Tübingen and German Center for Infection Research, Tübingen, Germany
| | - Bayodé Romeo Adegbite
- Centre de Recherches Médicales de Lambaréné and African Partner Institution, German Center for Infection Research (CERMEL), Lambaréné, Gabon.,Institut für Tropenmedizin, Universität Tübingen and German Center for Infection Research, Tübingen, Germany.,Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam Public Health, Amsterdam University Medical Centers, location Amsterdam, Amsterdam Infection & Immunity, University of Amsterdam, Amsterdam, The Netherlands
| | - Jean-Ronald Edoa
- Centre de Recherches Médicales de Lambaréné and African Partner Institution, German Center for Infection Research (CERMEL), Lambaréné, Gabon.,Institut für Tropenmedizin, Universität Tübingen and German Center for Infection Research, Tübingen, Germany
| | - Abraham Alabi
- Centre de Recherches Médicales de Lambaréné and African Partner Institution, German Center for Infection Research (CERMEL), Lambaréné, Gabon
| | - Akim A Adegnika
- Centre de Recherches Médicales de Lambaréné and African Partner Institution, German Center for Infection Research (CERMEL), Lambaréné, Gabon.,Institut für Tropenmedizin, Universität Tübingen and German Center for Infection Research, Tübingen, Germany
| | - Martin P Grobusch
- Centre de Recherches Médicales de Lambaréné and African Partner Institution, German Center for Infection Research (CERMEL), Lambaréné, Gabon. .,Institut für Tropenmedizin, Universität Tübingen and German Center for Infection Research, Tübingen, Germany. .,Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam Public Health, Amsterdam University Medical Centers, location Amsterdam, Amsterdam Infection & Immunity, University of Amsterdam, Amsterdam, The Netherlands. .,Masanga Medical Research Unit, Masanga, Sierra Leone. .,Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town, South Africa.
| | - Marguerite Massinga-Loembe
- Centre de Recherches Médicales de Lambaréné and African Partner Institution, German Center for Infection Research (CERMEL), Lambaréné, Gabon.,Institut für Tropenmedizin, Universität Tübingen and German Center for Infection Research, Tübingen, Germany
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5
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Ateba-Ngoa U, Edoa JR, Adegbite BR, Rossatanga EG, Madiou D, Mfoumbi A, Mevyann C, Achimi Agbo P, Mahoumbou J, Gould S, Lell B, Adegnika AA, Köhler C, Kremsner PG, Massinga-Loembe M, Alabi A, Grobusch MP. Implementation of multidrug-resistant tuberculosis (MDR-TB) treatment in Gabon: lessons learnt from the field. Infection 2019; 47:811-816. [PMID: 31073710 DOI: 10.1007/s15010-019-01314-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 04/30/2019] [Indexed: 02/07/2023]
Abstract
PURPOSE Since May 2016, WHO recommended a 9-12 month short-treatment regimen for multidrug-resistant tuberculosis (MDR-TB) treatment known as the 'Bangladesh Regimen'. However, limited data exist on the appropriateness thereof, and its implementation in low- and middle-income countries (LMIC). We report here on the pilot phase of the evaluation of the Bangladesh regimen in Gabon, prior to its endorsement by the WHO. METHODS This ongoing observational study started in September 2015. Intensive training of hospital health workers as well as community information and education were conducted. GeneXpert-confirmed MDR-TB patients received the second-line anti-tuberculosis drugs (4KmMfxPtoHCfzEZ/5MfxCfzEZ). Sputum smears and cultures were done monthly. Adverse events were monitored daily. RESULTS Eleven patients have been treated for MDR-TB piloting the short regimen. All were HIV-negative and presented in poor health with extensive pulmonary lesions. The overall sputum culture conversion rate was 64% after 4 months of treatment. Three patients developed marked hearing loss; one a transient cutaneous rash. Of 11 patients in our continuous care, 7 (63.6%) significantly improved clinically and bacteriologically. One (9.1%) patient experienced a treatment failure, two (18.2%) died, and one (9.1%) was lost to follow up. CONCLUSIONS Our pioneering data on systematic MDR-TB treatment in Gabon, with currently almost total absence of resistance against the second-line drugs, demonstrate that a 9-month regimen has the capacity to facilitate early culture negativity and sustained clinical improvement. Close adverse events monitoring and continuous care are vital to success.
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Affiliation(s)
- U Ateba-Ngoa
- Centre des Recherches Médicales de Lambaréné, Lambarene, Gabon
- Institut für Tropenmedizin, Eberhard Karls Universität, Tübingen, Germany
| | - J R Edoa
- Centre des Recherches Médicales de Lambaréné, Lambarene, Gabon
- Institut für Tropenmedizin, Eberhard Karls Universität, Tübingen, Germany
| | - B R Adegbite
- Centre des Recherches Médicales de Lambaréné, Lambarene, Gabon
- Institut für Tropenmedizin, Eberhard Karls Universität, Tübingen, Germany
| | - E G Rossatanga
- Centre Hospitalier Régional Georges Rawiri de Lambaréné, Lambarene, Gabon
| | - D Madiou
- Centre Hospitalier Régional Georges Rawiri de Lambaréné, Lambarene, Gabon
| | - A Mfoumbi
- Centre des Recherches Médicales de Lambaréné, Lambarene, Gabon
| | - C Mevyann
- Centre des Recherches Médicales de Lambaréné, Lambarene, Gabon
| | - P Achimi Agbo
- Centre des Recherches Médicales de Lambaréné, Lambarene, Gabon
| | - J Mahoumbou
- Programme National de Lutte contre la Tuberculose, Ministry of Health, Libreville, Gabon
| | - S Gould
- Centre des Recherches Médicales de Lambaréné, Lambarene, Gabon
| | - B Lell
- Centre des Recherches Médicales de Lambaréné, Lambarene, Gabon
- Institut für Tropenmedizin, Eberhard Karls Universität, Tübingen, Germany
| | - A A Adegnika
- Centre des Recherches Médicales de Lambaréné, Lambarene, Gabon
- Institut für Tropenmedizin, Eberhard Karls Universität, Tübingen, Germany
| | - C Köhler
- Centre des Recherches Médicales de Lambaréné, Lambarene, Gabon
- Institut für Tropenmedizin, Eberhard Karls Universität, Tübingen, Germany
| | - P G Kremsner
- Centre des Recherches Médicales de Lambaréné, Lambarene, Gabon
- Institut für Tropenmedizin, Eberhard Karls Universität, Tübingen, Germany
| | - M Massinga-Loembe
- Centre des Recherches Médicales de Lambaréné, Lambarene, Gabon
- Institut für Tropenmedizin, Eberhard Karls Universität, Tübingen, Germany
| | - A Alabi
- Centre des Recherches Médicales de Lambaréné, Lambarene, Gabon
- Institut für Tropenmedizin, Eberhard Karls Universität, Tübingen, Germany
| | - M P Grobusch
- Centre des Recherches Médicales de Lambaréné, Lambarene, Gabon.
- Institut für Tropenmedizin, Eberhard Karls Universität, Tübingen, Germany.
- Department of Infectious Diseases, Center of Tropical Medicine and Travel Medicine, Amsterdam University Medical Centers, Location AMC, University of Amsterdam, Amsterdam, The Netherlands.
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