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Over a 3-year follow-up, 30 out of the 318 unique Mycobacterium tuberculosis complex isolates recovered in the Republic of Djibouti had a smooth-type morphology and were Niacine-negative, the characteristics of 'Mycobacterium canettii' strains. Unlike M. tuberculosis, 'M. canettii' grew on nutrient-poor media at 30°C, and possessed characteristic lipids. They were isolated from respiratory and extra-respiratory sites from patients with typical forms of tuberculosis. Most cases resolved with antibiotic therapy but in two human immunodeficiency virus-positive patients 'M. canettii' infection led to septicaemia and death. No cases of human-to-human transmission were observed. The proportion of tuberculosis cases caused by 'M. canettii' was higher among French patients than among Djiboutian patients. Patients with 'M. canettii' were significantly younger than those with tuberculosis caused by other M. tuberculosis complex strains. Smooth tubercle bacilli could be misidentified as non-tuberculous mycobacteria and appear to be limited to the Horn of Africa. Their characteristics are consistent with the existence of non-human sources of infection., (© 2010 The Authors. Clinical Microbiology and Infection © 2010 European Society of Clinical Microbiology and Infectious Diseases.)

The purpose of the survey was the routine assessment of the MTBDRplus(®) kit performance in the determination and characterization of Mycobacterium tuberculosis resistance to rifampicin. The survey was carried out on a collection of 144 strains (126 of which were resistant to rifampicin) isolated on patients from 15 countries. Sensitivity to antituberculosis drugs was determined by a liquid culture system and the reference method was the amplification and sequencing of a target region of the rpoB gene whose mutations are responsible for rifampicin resistance (codons 507 to 533). The assessed kit was based on a reverse hybridization technique using eight overlapping probes covering the target region and four probes representing the most-frequently observed mutations. The assay performance was found excellent, specificity: 100%, sensitivity: 99.2%; 17 mutations affecting 10 codons were reported, two of which were newly identified., (Copyright © 2010 Elsevier Masson SAS. All rights reserved.)

We performed drug susceptibility testing among chronic patients hospitalised in the tuberculosis (TB) referral centre of the capital of Djibouti. Among 36 patients tested, 27 had multidrug-resistant TB and four had extensively drug-resistant TB. National guidelines must be revised urgently and the administration of second-line TB medications strictly controlled.

Aim of This Study: The aim of this study was to compare the mycobacteria growth indicator tube and solid culture for recovery of complex tuberculosis mycobacteria from blood., Patients and Methods: One hundred and twenty-five specimens from 67 Djiboutian patients with a positive serologic diagnosis of HIV and fever were collected in an Isolator tube. After centrifugation and washing with phosphate-buffer, smears were prepared from the pellet for auramin staining. The remaining sediment was suspended in 1 ml of buffer. One half was inoculated into two MGIT (incubation at 30 and 37 degrees C into Bactec 960) and the other onto two Loewenstein-Jensen and two Coletsos medium (incubation at 30 and 37 degrees C)., Results: Eight cultures were contaminated: three on solid medium and MGIT simultaneously, five in MGIT only (three coagulase negative staphylococci, five enterobacteria). Fourteen strains of M. tuberculosis (six patients) and three M. canettii (two patients) (12 on solid media and MGIT, five in MGIT only) were recovered. The mean time to detection was 32.8 days for solid medium and 20.4 days for MGIT. Of a total of 25 patients with culture-proven tuberculosis, two patients had a positive blood culture only, six had blood and other specimens positive culture, 17 had a non blood specimens positive culture only., Conclusion: MGIT processed into Bactec 960 is a viable tool for the detection of complexe tuberculosis mycobacteria from blood and the high-frequency of these mycobacteremia in HIV infected patients from country where the prevalence of tuberculosis is high is confirmed. However, the cost/benefit ratio of this bacteriologic diagnosis had to be evaluated in developping country.

The purpose of this report was to describe a tuberculin survey conducted in 2001 to assess the trend in the annual risk for tuberculosis infection in Djibouti and compare resulting data with those obtained in a previous survey conducted in 1994. In 2001 cluster sampling allowed selection of 5599 school children between the ages of 6 and 10 years including 31.2% (1747/5599) without BCG vaccination scar. In this sample the annual risk of infection (ARI) estimated using cutoff points of 6 mm, 10 mm, and 14 mm corrected by a factor of 1/0.82 and a mode value (18 mm) determined according to the "mirror" method were 4.67%, 3.64%, 3.19% and 2.66% respectively. The distribution of positive tuberculin skin reaction size was significantly different from the normal law. In 1994 a total of 5257 children were selected using the same method. The distribution of positive reactions was not significantly different from the gaussian distribution and 28.6% (1505/5257) did not have a BCG scar. The ARI estimated using cutoff points of 6 mm, 10 mm, and 14 mm corrected by a factor of 1/0.82 and a mode value (17 mm) determined according to the "mirror" method were 2.68%, 2.52%, 2.75% and 3.32 respectively. Tuberculin skin reaction size among positive skin test reactors was correlated with the presence of a BCG scar, and its mean was significantly higher among children with BCG scar. The proportion of positive skin test reactors was also higher in the BCG scar group regardless of the cutoff point selected. Comparison of prevalence rates and ARI values did not allow any clear conclusion to be drawn, mainly because of a drastic difference in the positive reaction distribution profiles between the two studies. The distribution of the skin test reaction's size 1994 study could be modelized by a gaussian distribution while it could not in 2001. A partial explanation for the positive reaction distribution observed in the 2001 study might be the existence of cross-reactions with environmental mycobacteria.

Setting: Djibouti, 1994 and 2001., Objective: To estimate the prevalence of tuberculosis (TB) and average annual risk of TB infection (ARTI) and trends, and to test a new method for calculations., Methods: Tuberculin surveys among schoolchildren and sputum smear-positive TB patients. Prevalence of infection was calculated using cut-off points, the mirror image technique, mixture analysis, and a new method based on the operating characteristics of the tuberculin test. Test sensitivity was derived from tuberculin reactions among TB patients and test specificity from a comparison of reaction size distributions among children with and without a BCG scar., Results: The ARTI was estimated to lie between 2.6% and 3.1%, with no significant changes between 1994 and 2001. The close match of the distributions between children tested in 1994 and patients justifies the utilisation of the latter to determine test sensitivity. This new method gave very consistent estimates of prevalence of infection for any induration for values between 15 and 20 mm. Specificity was successfully determined for 1994, but not for 2001. Mixture analysis confirmed the estimates obtained with the new method., Conclusion: Djibouti has a high ARTI, and no apparent change over the observation time was found. Using operating test characteristics to estimate prevalence of infection looks promising.