[Comparative epidemiological study of the tuberculosis - migrant and native subjects in Guadeloupe from 2006 to 2011]

[Latent tuberculosis infection (LTBI): What happens at 5 years of the 155 LTBI recent contacts of tuberculosis with positive microscopic examination?]

INTRODUCTION

Contacts of individuals with tuberculosis are at risk of latent infection (LTBI), which can progress to active tuberculosis. The aim of the study was to determine the incidence of tuberculosis in contacts and its risk factors in subjects with LTBI.

METHODOLOGY

This retrospective study from the tuberculosis control centre in Guadeloupe identified smear-positive tuberculosis cases and their contacts. We estimated the incidence of tuberculosis at 5 years using the Kaplan Meier method and identified risk factors for tuberculosis occurrence among contacts by a Cox model.

RESULTS

We analysed 292 contacts of 73 individuals with smear-positive tuberculosis between 2008 and 2015. Of these, 155 contacts had LTBI and 8 developed tuberculosis. The risk of developing tuberculosis was 11.5% (CI : 4.3%-23.4%) for untreated subjects and 1.9% (CI: 0.23%-6.8) for treated subjects. Risk factors identified for tuberculosis were: bacillary density of the index case (HR: 9.10, CI: 1.7-48.4), previous BCG (HR: 0.06, CI: 0.01-0.34), and treatment of LTBI (HR: 0.08, CI: 0.01-0.49).

CONCLUSIONS

This study confirms the relevance of treating LTBI in the context of recent contagion but also the benefit of a BCG vaccination.

[Clinical aspects of primary lung cancers in the cancer ward of CHUA-HUJRA Antananarivo]

Le retard de diagnostic des cancers broncho-pulmonaires est l'une des sources du retard de leur prise en charge dans les pays en développement. A notre connaissance, l'aspect clinique des cancers broncho-pulmonaires au Centre Hospitalier Universitaire d'Antananarivo-Hôpital Universitaire Joseph Ravoahangy Andrianavalona (CHUA-HUJRA) n'a jamais été étudié. L'objectif était de décrire les aspects cliniques des cancers broncho-pulmonaires primitifs dans le plus grand centre de cancérologie de Madagascar. C'est une étude rétrospective et descriptive des patients atteints de cancers broncho-pulmonaires primitifs vus au service d'oncologie du CHUA-HUJRA du 1er janvier 2008 au 31 décembre 2013. Nous avons recensé 101 patients (80 hommes et 21 femmes). Les circonstances de découverte sont principalement la toux chronique (n = 29), la dyspnée (n = 16) et l'association d'une hémoptysie à la toux chronique (n = 12). Soixante et onze patients avaient un index de performans status ≥ à 2 au moment du diagnostic. On a retrouvé des bacilles de Koch actives dans le crachat de deux patients. Le délai moyen entre l'apparition des premiers signes et la première consultation était de 11 mois. Le délai moyen entre la première consultation et le diagnostic anatomopathologique était de 3 mois. Le cancer broncho-pulmonaire peut avoir des manifestations cliniques non spécifiques parfois trompeuses qui peuvent retarder leur prise en charge. De ce fait, il doit être recherché devant tout signe respiratoire persistant. Par ailleurs, le délai de prise en charge pré-hospitalière et hospitalière de ces cancers doit être amélioré.

[Resistance to first-line drugs and major genotypic lineages of Mycobacterium tuberculosis in the 3 French Department of the Americas: Profiles, evolution, and trends (1995-2011)]

This is the first overview on resistant and multidrug resistant isolates of Mycobacterium tuberculosis circulating in the French Department of the Americas (Guadeloupe, Martinique, and French Guiana) over 17 years (January 1995-December 2011). A total of 1,239 cases were studied: 1,199 new cases (primary and multidrug resistance of 11.8 and 1.6% respectively), and 40 persistent (defined as cases with a previous history of positive culture over 6 months interval and whose spoligotypes remain unchanged), in which significantly higher proportions of resistance to at least isoniazid (22.5%, P = 0.002), rifampicin (20.0%, P < 0.001), and multidrug resistance (17.5%, P < 0.001) were observed as compared to new cases. The 281 spoligotypes obtained showed the presence of five major lineages, T (29.9%), LAM (23.9%), Haarlem (22.1%), EAI (7.1%), and X (6.7%). Two of these lineages, X and LAM, predominate among resistant and multidrug resistant isolates respectively (X: 10.5% of resistant isolates, P = 0.04; LAM: 42.3% of multidrug resistant isolates, P = 0.02). Four of the 19 major spoligo-profiles, corresponding to SIT 20, 64, 45, and 46, were significantly associated with drug resistance. Among them, genotype SIT 20, associated with monoresistance to isoniazid and multidrug resistance, would be actively and persistently in circulation, since 1999, in French Guiana, department in which one may also observe the presence of strains of M. tuberculosis phylogeographically associated to Guiana and Suriname (SIT 131 and SIT 1340).

A systematic follow-up of Mycobacterium tuberculosis drug-resistance and associated genotypic lineages in the French Departments of the Americas over a seventeen-year period

The population of the French Departments of the Americas (FDA) is highly influenced by the intense migratory flows with mainland France and surrounding countries of the Caribbean and Latin America, some of which have high incidence rates of tuberculosis (Haiti: 230/100,000; Guyana: 111/100,000; and Suriname: 145/100,000) and drug resistance. Since the development of drug resistance to conventional antituberculous drugs has a major impact on the treatment success of tuberculosis, we therefore decided to review carefully Mycobacterium tuberculosis drug resistance and associated genotypic lineages in the FDA over a seventeen-year period (January 1995–December 2011). A total of 1239 cases were studied, including 153 drug-resistant and 26 multidrug-resistant- (MDR-) TB cases, representing 12.3% and 2.1% of the TB cases in our study setting. A significantly higher proportion of M. tuberculosis isolates among relapse cases showed drug resistance to isoniazid (22.5%, P = 0.002), rifampicin (20.0%, P < 0.001), or both (MDR-TB, 17.5%; P < 0.001). Determination of spoligotyping based phylogenetic clades showed that among the five major lineages observed—T family (30.1%); Latin-American and Mediterranean (LAM, 23.7%); Haarlem (H, 22.2%); East-African Indian (EAI, 7.2%); and X family (6.5%)—two lineages, X and LAM, were overrepresented in drug-resistant and MDR-TB cases, respectively. Finally, 19 predominant spoligotypes were identified for the 1239 isolates of M. tuberculosis in our study among which 4 were significantly associated with drug resistance corresponding to SIT20/LAM1, SIT64/LAM6, SIT45/H1, and SIT46/undefined lineage.

Use of genotyping based clustering to quantify recent tuberculosis transmission in Guadeloupe during a seven years period: analysis of risk factors and access to health care

BACKGROUND

The present study aimed to characterize Mycobacterium tuberculosis population structure and to identify transmission chains and risk factors by prospective molecular typing in conjunction with conventional epidemiological investigations in the French overseas department of Guadeloupe.

METHODS

The study included all the culture-positive TB cases (1 clinical isolate per patient; n = 129) diagnosed between a seven year period (April 4th, 1999 to December 31st, 2005). Prospective molecular typing was performed using spoligotyping and VNTRs, and a subset of 44 M. tuberculosis isolates found to be clustered was retrospectively typed using 12-loci MIRUs. Data were compared using the SITVIT2 database, followed by analysis of risk factors in function of clustering of the isolates and available demographic and socioeconomic data.

RESULTS

The study sample was characterized by a majority of new cases (87.4%); a moderate proportion of drug-resistance (7.8%); a high level of immigration (51.2% foreign-born) originating from high TB/HIV incidence neighboring islands such as Haiti or Dominican Republic; lower socioeconomic conditions (70.7% of jobless, average income 824 EUR/month); and a significantly higher proportion of TB/HIV co-infected cases (38.2% vs. 8.5%; p < 0.001), and extrapulmonary disease (18.2% vs. 4.8%; p < 0.02) among migrants as compared to French patients. The study revealed an important delay in access to healthcare with a median delay of 74.5 days between the 1st symptoms and clinical suspicion of TB. Prospective molecular typing based on spoligotyping and 5-loci VNTRs showed that evolutionary recent Euro-American lineages predominated in Guadeloupe (91.5% of isolates). In conjunction with epidemiological data, it allowed to estimate a recent transmission rate of 18.6%, which was close to the rate of 16.7% estimated using retrospective 12-loci MIRU typing. Although a higher proportion of cases in older age-group were apparently linked to reactivation; univariate analysis of risk factors did not allow pinpointing specific risk factors for a patient to belong to a TB transmission group.

CONCLUSIONS

Ongoing TB transmission in the insular, low TB-incidence setting of Guadeloupe can be defined as follows: (i) a significant proportion of imported cases of the disease from neighboring islands; (ii) significantly higher TB/HIV coinfection among foreign-born cases; and, (iii) a higher proportion of cases affecting older age-group among French patients due to reactivation. This study emphasizes the need for universal typing using spoligotyping and 15-loci MIRUs in prospective studies.

[Epidemiology and incidence of primary lung cancer in a region with low tobacco consumption: Guadeloupe (French West Indies). Data from the cancer registry 2008-2009]

INTRODUCTION

Few data are available about primary lung cancer in the Caribbean. The purpose of this study was to provide, for the first time, the epidemiological and clinical characteristics of primary lung cancer in the archipelago of Guadeloupe (French West Indies).

METHODS

From the cancer registry, we identified in this retrospective study, all incident cases of primary lung cancer that had occurred between 1st January 2008 and 31st December 2009 in Guadeloupe.

RESULTS

Over the period from 2008 to 2009, 106 patients with primary lung cancer were identified. Males accounted for 72.6% and the women for 27.4%. Mean incidence rate over the 2 years was estimated at 13.4/100000 persons-years (95% CI: [6.0-20.8]) in men (world standardized) and 4.2/100000 persons-years (95% CI: [0.3-8.1]) in women. The median age at initial diagnosis was 65 years for men and 66 years for women. We noted a proportion of 61.3% of current smokers, 4.7% of passive smokers and 34% of non-smokers. The comorbidities were present in 41% of patients. Non-small cell lung cancer (NSCLC) accounted for 88.7% of lung cancers and small cell lung cancer for 7.5%. The most common histological type was adenocarcinoma (43%) followed by squamous cell (24%). Stage III and IV patients accounted for 64.1% of individuals with NSCLC.

CONCLUSION

The incidence of primary lung cancer in Guadeloupe is relatively low compared to metropolitan France. Guadeloupe is also a French department where the rate of tobacco consumption is one of the lowest.