{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T22:59:47Z","timestamp":1791845987124,"version":"4.3.4"},"reference-count":36,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2016,8,3]]},"abstract":"<jats:p>Despite overall global progress in tuberculosis (TB) control, TB remains one of the deadliest communicable diseases. This study prospectively assessed TB epidemiology in Lambar\u00e9n\u00e9, Gabon, a Central African country ranking 10th in terms of TB incidence rate in the 2014 World Health Organization TB report. In Lambar\u00e9n\u00e9, between 2012 and 2014, 201 adult and pediatric TB patients were enrolled and followed up; 66% had bacteriologically confirmed TB and 95% had pulmonary TB. The human immunodeficiency virus (HIV) coinfection rate was 42% in adults and 16% in children. <jats:italic>Mycobacterium tuberculosis<\/jats:italic> and <jats:italic>Mycobacterium africanum<\/jats:italic> were identified in 82% and 16% of 108 culture-confirmed TB cases, respectively. Isoniazid (INH) and streptomycin yielded the highest resistance rates (13% and 12%, respectively). The multidrug resistant TB (MDR-TB) rate was 4\/91 (4%) and 4\/13 (31%) in new and retreatment TB cases, respectively. Treatment success was achieved in 53% of patients. In TB\/HIV coinfected patients, mortality rate was 25%. In this setting, TB epidemiology is characterized by a high rate of TB\/HIV coinfection and low treatment success rates. MDR-TB is a major public health concern; the need to step-up in-country diagnostic capacity for culture and drug susceptibility testing as well as access to second-line TB drugs urgently requires action.<\/jats:p>","DOI":"10.4269\/ajtmh.15-0668","type":"journal-article","created":{"date-parts":[[2016,6,29]],"date-time":"2016-06-29T17:10:39Z","timestamp":1467220239000},"page":"472-480","source":"Crossref","is-referenced-by-count":24,"title":["Tuberculosis Treatment Outcome and Drug Resistance in Lambar\u00e9n\u00e9, Gabon: A Prospective Cohort Study"],"prefix":"10.4269","volume":"95","author":[{"given":"Sabine","family":"B\u00e9lard","sequence":"first","affiliation":[{"name":"1Centre de Recherches M\u00e9dicales de Lambar\u00e9n\u00e9, H\u00f4pital Albert Schweitzer, Lambar\u00e9n\u00e9, Gabon."},{"name":"2Institut f\u00fcr Tropenmedizin, Universit\u00e4tsklinikum T\u00fcbingen, Eberhard Karls Universit\u00e4t, T\u00fcbingen, Germany."},{"name":"3Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands."},{"name":"4Department of Pediatric Pneumology and Immunology, Charit\u00e9 Universit\u00e4tsmedizin Berlin, Berlin, Germany."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan","family":"Remppis","sequence":"additional","affiliation":[{"name":"1Centre de Recherches M\u00e9dicales de Lambar\u00e9n\u00e9, H\u00f4pital Albert Schweitzer, Lambar\u00e9n\u00e9, Gabon."},{"name":"2Institut f\u00fcr Tropenmedizin, Universit\u00e4tsklinikum T\u00fcbingen, Eberhard Karls Universit\u00e4t, T\u00fcbingen, Germany."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sanne","family":"Bootsma","sequence":"additional","affiliation":[{"name":"1Centre de Recherches M\u00e9dicales de Lambar\u00e9n\u00e9, H\u00f4pital Albert Schweitzer, Lambar\u00e9n\u00e9, Gabon."},{"name":"3Center of Tropical Medicine and Travel 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Gabon."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Justin O.","family":"Beyeme","sequence":"additional","affiliation":[{"name":"6H\u00f4pital Albert Schweitzer de Lambar\u00e9n\u00e9, Lambar\u00e9n\u00e9, Gabon."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elie G.","family":"Rossatanga","sequence":"additional","affiliation":[{"name":"7Centre de Traitement Ambulatoire Lambar\u00e9n\u00e9, Lambar\u00e9n\u00e9, Gabon."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cosme","family":"Kokou","sequence":"additional","affiliation":[{"name":"6H\u00f4pital Albert Schweitzer de Lambar\u00e9n\u00e9, Lambar\u00e9n\u00e9, Gabon."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kara K.","family":"Osbak","sequence":"additional","affiliation":[{"name":"1Centre de Recherches M\u00e9dicales de Lambar\u00e9n\u00e9, H\u00f4pital Albert Schweitzer, Lambar\u00e9n\u00e9, Gabon."},{"name":"3Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R\u00e9gis M.","family":"Obiang Mba","sequence":"additional","affiliation":[{"name":"1Centre de Recherches M\u00e9dicales de Lambar\u00e9n\u00e9, H\u00f4pital Albert Schweitzer, Lambar\u00e9n\u00e9, Gabon."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harry M.","family":"Kaba","sequence":"additional","affiliation":[{"name":"1Centre de Recherches M\u00e9dicales de Lambar\u00e9n\u00e9, H\u00f4pital Albert Schweitzer, Lambar\u00e9n\u00e9, Gabon."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Afsatou N.","family":"Traor\u00e9","sequence":"additional","affiliation":[{"name":"1Centre de Recherches M\u00e9dicales de Lambar\u00e9n\u00e9, H\u00f4pital Albert Schweitzer, Lambar\u00e9n\u00e9, Gabon."},{"name":"8Microbiology Department, University of Venda, Thohoyandou, South Africa."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonas","family":"Ehrhardt","sequence":"additional","affiliation":[{"name":"1Centre de Recherches M\u00e9dicales de Lambar\u00e9n\u00e9, H\u00f4pital Albert Schweitzer, Lambar\u00e9n\u00e9, Gabon."},{"name":"2Institut f\u00fcr Tropenmedizin, Universit\u00e4tsklinikum T\u00fcbingen, Eberhard Karls Universit\u00e4t, T\u00fcbingen, Germany."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emmanuel B.","family":"Bache","sequence":"additional","affiliation":[{"name":"1Centre de Recherches M\u00e9dicales de Lambar\u00e9n\u00e9, H\u00f4pital Albert Schweitzer, Lambar\u00e9n\u00e9, Gabon."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arnaud","family":"Flamen","sequence":"additional","affiliation":[{"name":"1Centre de Recherches M\u00e9dicales de Lambar\u00e9n\u00e9, H\u00f4pital Albert Schweitzer, Lambar\u00e9n\u00e9, 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gaps","volume":"42","author":"Janssen","year":"2014"},{"key":"ref4","series-title":"Enqu\u00eate D\u00e9mographique et de Sant\u00e9 du Gabon 2012: Rapport de synth\u00e8se","author":"Direction G\u00e9n\u00e9rale de la Statistique (DGS) du Gabon et ICF International","year":"2012"},{"key":"ref5","series-title":"Tuberculosis Country Profile Gabon","author":"WHO","year":"2013"},{"issue":"(19\u201320 Suppl 3)","key":"ref6","series-title":"Wien Klin Wochenschr","first-page":"8","article-title":"History and perspectives of medical research at the Albert Schweitzer Hospital in Lambarene, Gabon","volume":"119","author":"Ramharter","year":"2007"},{"key":"ref7","series-title":"Guide Technique National","author":"Ministre de la Sant\u00e9, des Affaires Sociales, de la Solidarit\u00e9 et de la Famille","year":"2010"},{"key":"ref8","series-title":"Sputum Examination for Tuberculosis by Direct Microscopy in Low Income Countries\u2014Technical Guide","author":"International Union Against Tuberculosis and Lung Disease (IUATLD)","year":"2000"},{"key":"ref9","series-title":"Definitions and Reporting Framework for Tuberculosis\u20142013 Revision","author":"WHO","year":"2013"},{"issue":"(Suppl 2)","key":"ref10","series-title":"J Infect Dis","first-page":"S199","article-title":"Evaluation of tuberculosis diagnostics in children: 1. Proposed clinical case definitions for classification of intrathoracic tuberculosis disease. Consensus from an expert panel","volume":"205","author":"Graham","year":"2012"},{"key":"ref11","series-title":"Profil Epidemiologique de la Tuberculose au Gabon 2003\u20142013","author":"Programme National de Lutte contre la Tuberculose (PNLT)","year":"2014"},{"key":"ref12","series-title":"Bull Soc Pathol Exot","first-page":"121","article-title":"HIV seroprevalence among tuberculosis patients in Nkembo Hospital, Libreville, Gabon. Short note [in French]","volume":"98","author":"Nkoghe","year":"2005"},{"key":"ref13","series-title":"Clin Microbiol Infect","first-page":"E499","article-title":"Tuberculosis patients hospitalized in the Albert Schweitzer Hospital, Lambarene, Gabon\u2014a retrospective observational study","volume":"19","author":"Stolp","year":"2013"},{"key":"ref14","series-title":"Infection","first-page":"737","article-title":"Clinical and laboratory features of tuberculosis within a hospital population in Libreville, Gabon","volume":"41","author":"Kombila","year":"2013"},{"key":"ref15","series-title":"Med Trop (Mars)","first-page":"253","article-title":"Clinical and radiological features of tuberculosis during HIV infection in Libreville, Gabon [in French]","volume":"71","author":"Ondounda","year":"2011"},{"key":"ref16","series-title":"Arch Public Health","first-page":"24","article-title":"Characteristics of patients co-infected with HIV at the time of inpatient tuberculosis treatment initiation in Yaounde, Cameroon: a tertiary care hospital-based cross-sectional study","volume":"73","author":"Agbor","year":"2015"},{"key":"ref17","series-title":"Treatment of Tuberculosis Guidelines","author":"WHO","year":"2010"},{"key":"ref18","series-title":"Public Health Action","first-page":"328","article-title":"Perceptions, health seeking behaviour and implementation of a tuberculosis control programme in Lambar\u00e9n\u00e9, Gabon","volume":"3","author":"Cremers","year":"2013"},{"key":"ref19","series-title":"Int J Tuberc Lung Dis","first-page":"255","article-title":"Delays in diagnosis and treatment of pulmonary tuberculosis in India: a systematic review","volume":"18","author":"Sreeramareddy","year":"2014"},{"key":"ref20","series-title":"Travel Med Infect Dis","first-page":"340","article-title":"Extra-pulmonary paragonimiasis with unusual arthritis and cutaneous features among a tourist returning from Gabon","volume":"4","author":"Malvy","year":"2006"},{"key":"ref21","series-title":"Bull Soc Pathol Exot","first-page":"193","article-title":"A Gabonese case of paragonimiasis in a child [in French]","volume":"74","author":"Petavy","year":"1981"},{"key":"ref22","series-title":"Tropenmed Parasitol","first-page":"105","article-title":"Paragonimus uterobilateralis as the cause of 3 cases of human paragonimiasis in Gabon [in French]","volume":"34","author":"Sachs","year":"1983"},{"key":"ref23","series-title":"Trop Med Parasitol","first-page":"210","article-title":"Morphology of the lung fluke Paragonimus uterobilateralis occurring in Gabon, west Africa","volume":"36","author":"Voelker","year":"1985"},{"key":"ref24","series-title":"Presse Med","first-page":"1084","article-title":"Paragonimus westermani pulmonary distomatosis in Gabon. First case [in French]","volume":"25","author":"Vuong","year":"1996"},{"key":"ref25","series-title":"Pathog Glob Health","first-page":"95","article-title":"Integrated surveillance of pulmonary tuberculosis and paragonimiasis in Zamboanga del Norte, the Philippines","volume":"108","author":"Belizario","year":"2014"},{"key":"ref26","series-title":"Int J Tuberc Lung Dis","first-page":"693","article-title":"Experience in implementing a quality management system in a tuberculosis laboratory, Kisumu, Kenya","volume":"19","author":"Musau","year":"2015"},{"key":"ref27","series-title":"Asian Pac J Trop Med","first-page":"35","article-title":"Characterization of Mycobacterium isolates from pulmonary tuberculosis suspected cases visiting Tuberculosis Reference Laboratory at Ethiopian Health and Nutrition Research Institute, Addis Ababa Ethiopia: a cross sectional study","volume":"8","author":"Mathewos","year":"2015"},{"key":"ref28","series-title":"Rev Tuberc Pneumol (Paris)","first-page":"413","article-title":"Bacteriological study of tuberculosis in Cameroon [in French]","volume":"35","author":"Huet","year":"1971"},{"key":"ref29","series-title":"J Clin Microbiol","first-page":"2547","article-title":"Genetic biodiversity of Mycobacterium tuberculosis complex strains from patients with pulmonary tuberculosis in Cameroon","volume":"41","author":"Niobe-Eyangoh","year":"2003"},{"key":"ref30","series-title":"Int J Tuberc Lung Dis","first-page":"342","article-title":"Diagnostic value of FASH ultrasound and chest X-ray in HIV-co-infected patients with abdominal tuberculosis","volume":"17","author":"Heller","year":"2013"},{"key":"ref31","series-title":"Crit Ultrasound J","first-page":"21","article-title":"Focused assessment with sonography for HIV-associated tuberculosis (FASH): a short protocol and a pictorial review","volume":"4","author":"Heller","year":"2012"},{"key":"ref32","series-title":"Acta Trop","first-page":"53","article-title":"\u2018Remote FASH\u2019 tele-sonography\u2014a novel tool to assist diagnosing HIV-associated extrapulmonary tuberculosis in remote areas","volume":"127","author":"Janssen","year":"2013"},{"key":"ref33","series-title":"Bull Soc Pathol Exot","first-page":"1","article-title":"Multi-resistant tuberculosis at the H\u00e2opital d'instruction des Arm\u00e9es de Libreville (Gabon) about 16 cases [in French]","volume":"105","author":"Mounguengui","year":"2012"},{"key":"ref34","series-title":"PLoS Med","first-page":"e1000150","article-title":"Standardized treatment of active tuberculosis in patients with previous treatment and\/or with mono-resistance to isoniazid: a systematic review and meta-analysis","volume":"6","author":"Menzies","year":"2009"},{"key":"ref35","series-title":"J Antimicrob Chemother","first-page":"1728","article-title":"High-level resistance to isoniazid and ethionamide in multidrug-resistant Mycobacterium tuberculosis of the Lisboa family is associated with inhA double mutations","volume":"68","author":"Machado","year":"2013"},{"key":"ref36","series-title":"Sante","first-page":"31","article-title":"Reasons for stopping and restarting tuberculosis treatment in Libreville (Gabon) [in French]","volume":"20","author":"Mve","year":"2010"}],"container-title":["The American Society of Tropical Medicine and Hygiene"],"original-title":[],"link":[{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/95\/2\/article-p472.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.ajtmh.org\/downloadpdf\/journals\/tpmd\/95\/2\/article-p472.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/www.ajtmh.org\/downloadpdf\/journals\/tpmd\/95\/2\/article-p472.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,8,7]],"date-time":"2024-08-07T21:58:45Z","timestamp":1723067925000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/95\/2\/article-p472.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2016,8,3]]},"references-count":36,"journal-issue":{"issue":"2"},"URL":"https:\/\/doi.org\/10.4269\/ajtmh.15-0668","relation":{},"ISSN":["0002-9637","1476-1645"],"issn-type":[{"value":"0002-9637","type":"print"},{"value":"1476-1645","type":"electronic"}],"subject":[],"published":{"date-parts":[[2016,8,3]]}}}