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Background: MDR-TB is a major threat to global TB control. In 2015, 580,000 were treated for MDR-TB worldwide. The worldwide roll-out of GeneXpert MTB/RIF® has improved diagnosis of MDR-TB; however, in many countries laboratories are unable to assess drug resistance and clinical predictors of MDR-TB could help target suspected patients. In this study, we aimed to determine the clinical factors associated with MDR-TB in Bamako, Mali. Methods: We performed a cross-sectional study of 214 patients with presumed MDR-TB admitted to University of Bamako Teaching Hospital, Point-G between 2007 and 2016. We calculated crude and adjusted odds ratios for MDR-TB disease diagnosis using SPSS. Results: We found that age ≤40 years (OR = 2.56. 95% CI: 1.44–4.55), two courses of prior TB treatment (OR = 3.25, 95% CI: 1.44–7.30), TB treatment failure (OR = 3.82, 95% CI 1.82–7.79), sputum microscopy with 3+ bacilli load (OR = 1.98, 95% CI: 1.13–3.48) and a history of contact with a TB patient (OR = 2.48, 95% CI: 1.11–5.50) were significantly associated with confirmation of MDR-TB disease. HIV was not a risk factor for MDR-TB (aOR = 0.88, 95% CI: 0.34–1.94). Conclusion: We identified several risk factors that could be used to identify MDR-TB suspects and prioritize them for laboratory confirmation. Prospective studies are needed to understand factors associated with TB incidence and clinical outcomes of TB treatment and disease. Keywords: Multi-Drug Resistant Tuberculosis, Risk factors, Mali

Abstract Background Drug resistant tuberculosis presents a major public health challenge. Case presentation We present here the first two patients diagnosed with extensively drug resistant tuberculosis in Bamako, Mali. Genotypic findings suggest possible nosocomial transmission from the first patient to the second one, resulting in superinfection of the second patient. After being diagnosed with extensively drug resistant tuberculosis in August 2016, the patients only started receiving appropriate treatment 10 months later. Conclusion The identification of these patients highlights the need for improved diagnostic and treatment algorithms for better surveillance and management of drug resistance in Mali. In the interest of these as well as future patients suffering from resistant tuberculosis, all steps recommended for programmatic management of drug resistant tuberculosis must be urgently prioritized in order to strengthen the multidrug resistant tuberculosis program.

Background The incidence of nontuberculous mycobacteria is increasing, among them Mycobacterium avium complex (MAC) strains are the most frequently isolated. In countries endemic for tuberculosis, these infections pose a differential diagnosis challenge due to their clinical similarities. Patients and methods The main goal of this study was to describe the epidemiological, clinical aspects, and outcome of patients infected with MAC who met the American thoracic society (ATS) 2007 criteria for MTN disease’s definition. We conducted a 4-year retrospective evaluation from January 2009 to December 2012 at the Pneumophtisiology Department of the Point G University Teaching Hospital in Bamako. Results A total of 17 patients met the criteria for MAC disease, 16 men and one woman with a mean age of 50.4 years. All patients had at least two antituberculosis treatment courses without success. The signs and symptoms were a febrile alteration of physical condition in 41.7% (seven cases), chronic cough in 94.1% (16 cases), dyspnea in 68.7% (11 cases), and hemoptysis in 11.7% (two cases). The sputum smear was positive in 94.1% (16 cases) and the chest radiography showed constant cavitary images associated with nodular lesions in 52.9% (nine cases) or pleurisy in 11.7% (two cases). The evolution was marked by six deaths occurred within an average of 10 months and 10 were loss to follow-up. Conclusion The occurrence of MAC pulmonary disease poses diagnosis and treatment problems with less favorable outcome. Availability of early diagnosis with sputum culture will allow an accurate treatment regimen, which will improve patient outcomes.

La tuberculose reste un problème de santé publique au Mali malgré les bons scores enregistrés ces dernières années aussi bien dans la lutte que dans la recherche contre la maladie. Le nombre de cas est resté globalement stable au cours des dernières années, mais l’augmentation des cas de résistances attire de plus en plus l’attention et demande une réponse plus rigoureuse de la part des décideurs. Les recherches menées ont permis d’identifier les souches tuberculeuses circulantes au Mali, les profils de résistances et les mycobactérioses atypiques qui posent un problème de diagnostic différentiel avec la tuberculose. Les recherches ont permis aussi de mieux comprendre l’immunologie de la maladie, notamment le rôle des cellules lymphocytaires au cours de la coinfection avec le VIH et du traitement antituberculeux. Tous ces efforts doivent être renforcés pour le long terme afin de venir à bout de la maladie.

la tuberculose reste