APPORT DU GENEXPERT MTB/RIF DANS LA DETECTION DE L’INFECTION A MYCOBACTERIUM TUBERCULOSIS ET LA RESISTANCE A LA RIFAMPICINE A L’HOPITAL GENERAL DE REFERENCE DE KIRUNGU-MOBA, SUD-EST DE LA REPUBLIQUE DEMOCRATIQUE DU CONGO
Résumé
Introduction : La tuberculose pharmaco-résistante est une menace réelle sur notre capacité d’élimination de la tuberculose comme problème de santé publique. La prévention et le contrôle de la résistance à la rifampicine et isoniazide demeure notre priorité. Cette étude vise à déterminer les facteurs associés à la TB-RR.
Méthodes : Il s’agissait d’une étude transversale à visée analytique des échantillons de crachats envoyés au GeneXpert/RIF à l’hôpital général de référence de Kirungu-Moba de 2019 à 2022. Les données ont été collectées à l’aide de Kobocollect à partir des registres des tuberculeux et des analyses biologiques au GeneXpert. L’analyse statique au seuil de 0,05 a été effectuée avec Epi Info 7.2
Résultats : Des 1589 échantillons des crachats analysés au GeneXpert, 31,3% (497) étaient positifs au Mycobacterium tuberculosis et 4,0% (20 cas) de Tuberculose résistante à la rifampicine (TB-RR). L’âge moyen des cas de tuberculose pulmonaire est de 37,35 ± 16,7 ans avec les extrêmes de 6 à 78 ans, sex ratio de 1,4 en faveurs des hommes. La durée moyenne de transport entre le site de prélèvement et l’analyse au GeneXpert est de 5,8 jours (2 – 17 jours). La durée de conservation des échantillons en moins de huit jours est en liaison avec le risque d’obtenir les résultats MTB-positif (OR 4,49 ; IC95% 2,94 – 6,85 ; p 0,0000), mais n’influe pas sur le risque de TB-RR (OR 0,41 ; IC95% 0,158 – 1,092 ; p 0,1276). L’âge inférieur ou égal à 30 ans (OR 1,36 ; IC95% 1,09-1,070 ; p 0,007), le sexe masculin (OR 1,30 ; IC95% 1,05-1,61 ; p 0,017) et la zone de santé de Moba (OR 1,69 ; IC95% 1,28-2,26 ; p 0,0003) sont des facteurs de risque liés au développement de la tuberculose. Les facteurs associés à la TB-RR sont les tests Xperts indiqués chez les présumés MDR (RR 239 ; IC95% 60,07-954,88 ; p 0,0000) et le sexe masculin (OR 14,89 ; IC95% 2,698-115,08 ; p 0,0012).
Conclusion : La proportion des échantillons envoyés au GeneXpert demeure encore faible. Il faut renforcer les activités de la stratégie DOTS et la surveillance pharmacologique des médicaments antituberculeux.
Mots-clés : Mycobacterium tuberculosis, Rifampicine, GeneXpert, Tuberculose, RDC
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Khan AS, Phelan JE, Khan MT, Ali S, Qasim M, Napier G, et al. Characterization of rifampicin-resistant Mycobacterium tuberculosis in Khyber Pakhtunkhwa, Pakistan. Sci Rep., 2021;11(1):14194.
Qin L, Huo F, Ren W, Shang Y, Yao C, Zhang X, et al. Dependence of Xpert MTB/RIF Accuracy for Detecting Rifampin Resistance in Bronchoalveolar Lavage Fluid on Bacterial Load: A Retrospective Study in Beijing, China DR. Infection and Drug Resistance, 2021;14:2429‑35.
OMS. Lèpre : Principaux faits, du 11 janvier 2022 In https://www.who.int/fr/news-room/fact-sheets/detail/leprosy.
Hajissa K, Marzan M, Idriss MI, Islam MA. Prevalence of Drug-Resistant Tuberculosis in Sudan: A Systematic Review and Meta-Analysis. Antibiotics, 2021;10(8):932.
Gibson J, Donnan E, Eather G. Management of rifampicin mono‐resistant tuberculosis in Queensland, Australia: a retrospective case series. Respirol Case Rep., 2018;6(8):e00366.
Mollel E, Lekule I, Lynen L, Decroo T. Effect of reliance on Xpert MTB/RIF on time to treatment and multidrug-resistant tuberculosis treatment outcomes in Tanzania: a retrospective cohort study. International Health, 2019;11(6):520‑7.
Shea J, Halse TA, Kohlerschmidt D, Lapierre P, Modestil HA, Kearns CH, et al. Low-Level Rifampin Resistance and rpoB Mutations in Mycobacterium tuberculosis: an Analysis of Whole-Genome Sequencing and Drug Susceptibility Test Data in New York. Journal of Clinical Microbiology, 2021;59(4):e01885-20.
Iradukunda A, Ndayishimiye GP, Sinarinzi D, Odjidja EN, Ntakaburimvo N, Nshimirimana I, Izere C. Key factors influencing multidrug-resistant tuberculosis in patients under anti-tuberculosis treatment in two centres in Burundi: a mixed effect modelling study. BMC Public Health. 2021 Nov 23;21(1):2142. doi: 10.1186/s12889-021-12233-2
Xu G, Liu H, Jia X, Wang X, Xu P. Mechanisms and detection methods of Mycobacterium tuberculosis rifampicin resistance: The phenomenon of drug resistance is complex. Tuberculosis, 2021;128:102083.
Veziris N, Robert J. Tuberculose multirésistante : prise en charge. La Lettre de l’Infectiologue, 2003;XVIII(5):186‑92.
Veziris N, Robert J. Résistance aux antituberculeux et impasse thérapeutique. Med Sci (Paris), 2010;26(11):976‑80.
Thirumurugan R, Kathirvel M, Vallayyachari K, Surendar K, Samrot AV, Muthaiah M. Molecular analysis of rpoB gene mutations in rifampicin resistant Mycobacterium tuberculosis isolates by multiple allele specific polymerase chain reaction in Puducherry, South India. Journal of Infection and Public Health. 1 nov 2015;8(6):619‑25.
Dorman SE, Schumacher SG, Alland D, Nabeta P, Armstrong DT, King B, et al. Xpert MTB/RIF Ultra for detection of Mycobacterium tuberculosis and rifampicin resistance: a prospective multicentre diagnostic accuracy study. Lancet Infect Dis. janv 2018;18(1):76‑84.
Rossetti ML, Almeida da Silva PE, Salvato RS, Reis AJ, Schiefelbein SH, von Groll A, et al. A highly rifampicin resistant Mycobacterium tuberculosis strain emerging in Southern Brazil. Tuberculosis (Edinb). déc 2020;125:102015.
de Castro N, Méchai F, Bachelet D, Canestri A, Joly V, Vandenhende M, et al. Détection précoce de la résistance isoniazide/rifampicine pour l’allègement du traitement initial de la tuberculose : les résultats de l’étude randomisée Fast-TB. Infectious Diseases Now. 1 août 2021;51(5, Supplement):S10.
Bisimwa BC, Nachega JB, Warren RM, Theron G, Metcalfe JZ, Shah M, et al. Xpert Mycobacterium tuberculosis/Rifampicin-Detected Rifampicin Resistance is a Suboptimal Surrogate for Multidrug-resistant Tuberculosis in Eastern Democratic Republic of the Congo: Diagnostic and Clinical Implications. Clin Infect Dis. 15 juill 2021;73(2):e362‑70.
Farra A, Manirakiza A, Yambiyo BM, Zandanga G, Lokoti B, Berlioz-Arthaud A, et al. Surveillance of Rifampicin Resistance With GeneXpert MTB/RIF in the National Reference Laboratory for Tuberculosis at the Institut Pasteur in Bangui, 2015-2017. Open Forum Infect Dis. mars 2019;6(3):ofz075.
Guled AY, Elmi AH, Abdi BM, Ali Rage AM, Ali FM, Abdinur AH, et al. Prevalence of Rifampicin Resistance and Associated Risk Factors among Suspected Multidrug Resistant Tuberculosis Cases in TB Centers Mogadishu-Somalia: Descriptive Study. Open Journal of Respiratory Diseases-OJRD. 2016;06(02):15‑24.
Kouemo Motse FD, Nsagha DS, Teyim PM, Adiogo D, Kojom Foko LP, Kedy Koum DC, et al. Rifampicin resistance among Mycobacterium tuberculosis-infected individuals using GeneXpert MTB/RIF ultra: a hospital-based study. Trop Med Int Health. févr 2021;26(2):159‑65.
Murhula IK, Mawete F, Ofali L, Kaswa M, Bompeka FL, Ntumba JMK, et al. Low Detection Rate of Multidrug-Resistant and Rifampicin-Resistant Tuberculosis in the Democratic Republic of Congo: Trend Analysis 2013-2017. Journal of Tuberculosis Research. 28 oct 2019;7(4):212‑9.
Kabemba Bukasa H. Monitorage épidémiologique des cas de maladie de Hansen à Moba, province du Tanganyika en République Démocratique du Congo (2011-2020). Médecine d’Afrique Noire. 2021;
Bulabula ANH, Nelson JA, Musafiri EM, Machekano R, Sam-Agudu NA, Diacon AH, et al. Prevalence, Predictors, and Successful Treatment Outcomes of Xpert MTB/RIF–identified Rifampicin-resistant Tuberculosis in Post-conflict Eastern Democratic Republic of the Congo, 2012–2017: A Retrospective Province-Wide Cohort Study. Clinical Infectious Diseases. 27 sept 2019;69(8):1278‑87.
Bisuta-Fueza S, Kayembe-Ntumba JM, Kabedi-Bajani MJ, Sabwe PM, Tuma HSN, Simelo JP, et al. Multidrug-Resistant Tuberculosis in the Democratic Republic of Congo: Analysis of Continuous Surveillance Data from 2007 to 2016. JTR. 2019;07(01):25‑44.
Lupande D, Kaishusha D, Mihigo C, Itongwa M, Yenga G, Katchunga P. GeneXpert MTB/RIF dans le dépistage de la tuberculose pulmonaire à l’Hôpital Provincial Général de Référence de Bukavu, à l’Est de la République Démocratique du Congo: quelles leçons tirées après 10 mois d’utilisation? Pan Afr Med J. 2017;27(260):1‑7.
Kabedi MJ, Kayembe JM, Kabengele B, Kashongwe Z, Bola V, Nsingani LP, et al. Profil et évolution de la résistance primaire de Mycobacterium tuberculosis aux antituberculeux dans deux centres de traitement à Kinshasa - Annales africaines de médecine. Annales Africaines de médecine, 2009; 2:2
Céphéide. Notice du test GeneXpert® Xpert® MTB/RIF Assay. Version 301-1404-FR, 2020. https://www.cepheid.com/Package%20Insert%20Files/Xpert-MTB-RIF-FRENCH-Package-Insert-301-1404-FR-Rev-G.pdf.
Alemu A, Tadesse M, Seid G, Mollalign H, Eshetu K, Sinshaw W, et al. Does Xpert® MTB/RIF assay give rifampicin resistance results without identified mutation? Review of cases from Addis Ababa, Ethiopia. BMC Infect Dis., 2020;20(1):87.
Kay AW, González Fernández L, Takwoingi Y, Eisenhut M, Detjen AK, Steingart KR, Mandalakas AM. Xpert MTB/RIF and Xpert MTB/RIF Ultra assays for active tuberculosis and rifampicin resistance in children. Cochrane Database of Systematic Reviews 2020, Issue 8. Art. No.: CD013359. DOI: 10.1002/14651858.CD013359.pub2.
Kakoma LN, Mukesi M, Moyo SR. Effectiveness of GeneXpert Technology in the Diagnosis of Smear-Negative Pulmonary <i>Mycobacterium tuberculosis</i> in HIV Positive Patients in Namibia. Open Journal of Medical Microbiology-OJMM, 2016;06(03):133‑41.
Elfaham ZH, Ibrahim EM, Ahmed EA, Mohammed AE, Nour BYM. Pulmonary Tuberculosis among Suspected Sudanese Patients in Wad Madani Tuberculosis Center. Open Journal of Medical Microbiology, 2021;11(4):298‑307.
RDC/PNLT. Programme Antituberculeux intégré : PATI VI,2022
Zifodya JS, Kreniske JS, Schiller I, Kohli M, Dendukuri N, Schumacher SG, et al. Xpert Ultra versus Xpert MTB/RIF for pulmonary tuberculosis and rifampicin resistance in adults with presumptive pulmonary tuberculosis. Cochrane Database of Systematic Reviews,2023; Disponible sur: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD009593.pub5/full
Donovan J, Thu DDA, Phu NH, Dung VTM, Quang TP, Nghia HDT, et al. Xpert MTB/RIF Ultra versus Xpert MTB/RIF for the diagnosis of tuberculous meningitis: a prospective, randomised, diagnostic accuracy study. Lancet Infect Dis., 2020;20(3):299‑307.
Monde N, Munyeme M, Chongwe G, Wensman JJ, Zulu M, Siziya S, et al. First and Second-Line Anti-Tuberculosis Drug-Resistance Patterns in Pulmonary Tuberculosis Patients in Zambia. Antibiotics, 2023;12(1):166.
Toft AL, Dahl VN, Sifna A, Ige OM, Schwoebel V, Souleymane MB, et al. Treatment outcomes for multidrug- and rifampicin-resistant tuberculosis in Central and West Africa: A systematic review and meta-analysis. International Journal of Infectious Diseases. 1 nov 2022;124:S107‑16.
Kayomo MK, Mbula VN, Aloni M, André E, Rigouts L, Boutachkourt F, et al. Targeted next-generation sequencing of sputum for diagnosis of drug-resistant TB: results of a national survey in Democratic Republic of the Congo. Sci Rep., 2020;10(1):10786.
Trauer JM, Cheng AC. Multidrug-resistant tuberculosis in Australia and our region. Med J Aust., 2016;204(7):251‑3.
Misombo-Kalabela A, Nguefack-Tsague G, Kalla GCM, Ze EA, Diangs K, Panda T, et al. Facteurs de risque de la tuberculose multi-résistante dans la ville de Kinshasa en République Démocratique du Congo. The Pan African Medical Journal, 2016;23(157). Disponible sur: https://www.panafrican-med-journal.com/content/article/23/157/full
Kabedi Bajani MJ, Kayembe Ntumba JM, Kayembe Kalambayi P, Kashongwe Munogolo Z, Lunguya Metila O, Mujangi Kadima B, et al. Performance of Antibiogram on Slide in the Diagnosis of Multiresistant Tuberculosis in Kinshasa. Int J Med Res Prof., 2017;3(3):348‑52.
Alame-Emane AK, Pierre-Audigier C, Aboumegone-Biyogo OC, Nzoghe-Mveang A, Cadet-Daniel V, Sola C, et al. Use of GeneXpert Remnants for Drug Resistance Profiling and Molecular Epidemiology of Tuberculosis in Libreville, Gabon. Journal of Clinical Microbiology, 2017;55(7):2105‑15.
Ossoga GW, Ba-Diallo A, Ngandolo R, Camara M, Diop-Ndiaye H, Issifi-Kollo A et al. Résistance aux antituberculeux chez les patients atteints de tuberculose pulmonaire dans sept régions du Tchad. Rev CAMES SANTE, 2014;2(2):18‑24.
Noeske J, Yakam AN, Foe JLA, Nguafack D, Kuaban C. Rifampicin resistance in new bacteriologically confirmed pulmonary tuberculosis patients in Cameroon: a cross-sectional survey. BMC Res Notes. 13 août 2018;11(1):580.
Ogari CO, Nyamache AK, Nonoh J, Amukoye E. Prevalence and detection of drug resistant mutations in Mycobacterium tuberculosis among drug naïve patients in Nairobi, Kenya. BMC Infectious Diseases. 25 mars 2019;19(1):279.
Mutayoba BK, Ershova J, Lyamuya E, Hoelscher M, Heinrich N, Kilale AM, et al. The second national anti-tuberculosis drug resistance survey in Tanzania, 2017–2018. Tropical Medicine & International Health, 2022;27(10):891‑901.
Habimana-Mucyo Y, Dushime A, Migambi P, Habiyambere I, Semuto Ngabonziza JC, Decroo T. Continuous surveillance of drug-resistant TB burden in Rwanda: a retrospective cross-sectional study. International Health, 2022;0(39):1‑8.
Sanders M, Van Deun A, Ntakirutimana D, Masabo JP, Rukundo J, Rigouts L, et al. Rifampicin mono-resistant Mycobacterium tuberculosis in Bujumbura, Burundi: results of a drug resistance survey. The International Journal of Tuberculosis and Lung Disease, 2006;10(2):178‑83.
Kigozi E, Kasule GW, Musisi K, Lukoye D, Kyobe S, Katabazi FA, et al. Prevalence and patterns of rifampicin and isoniazid resistance conferring mutations in Mycobacterium tuberculosis isolates from Uganda. PLoS One, 2018;13(5):e0198091.
Mwanza W, Milimo D, Chilufya MM, Kasese N, Lengwe MC, Munkondya S, et al. Diagnosis of rifampicin-resistant tuberculosis: Discordant results by diagnostic methods. African Journal of Laboratory Medicine, 2018;7(2):1‑4.
Yahaya ML, Abdoulaye O, Lawan O, Mahaman Laouali HA, Amadou O, Ahamadou B, et al. Evaluation de la resistance de mycobacterium tuberculosis à la rifampicine dans la region de Zinder, Niger. Journal de la Société de Biologie Clinique du Bénin, 2019;(31):15‑9.
Bemba ELP, Okombi FO, Bopaka RG, Abacka KO, Koumeka PP, Ayet MI. Profil Clinique et Évolutif de la Tuberculose au Service de Pneumophtisiologie du CHU de Brazzaville. Health Sci Dis., 2020;21(5):47‑51.
Régis GB, Okombi FHO, Bemba ELP, Essango EBN, Ossale-Abacka KB, Koumeka PP, et al. Prise en Charge de la Tuberculose Multirésistante À Brazzaville. Health Sci Dis., 2020;21(6):12‑6.
Okemba Okombi FH, Ikouébé-Atonoboma S, Bemba ELP, Bopaka RG, Ossale Abacka BK. Tuberculose multirésistante et facteurs prédictifs à Brazzaville. Revue des Maladies Respiratoires Actualités, 2020;12(1):160.
Ogwang MO, Imbuga M, Ngugi C, Mutharia L, Magoma G, Diero L. Distribution patterns of drug resistance Mycobacterium tuberculosis among HIV negative and positive tuberculosis patients in Western Kenya. BMC Infectious Diseases, 2021;21(1):1175.
Monde N, Zulu M, Tembo M, Handema R, Munyeme M, Malama S. Drug Resistant Tuberculosis in the Northern Region of Zambia: A Retrospective Study. Frontiers in Tropical Diseases, 2021;2(735028):1‑10.
Elion Assiana DO, Abdul JBPA, Linguissi LSG, Epola M, Vouvoungui JC, Mabiala A, et al. Epidemiological profile of multidrug-resistant and extensively drug-resistant Mycobacterium Tubrculosis among Congolese patients. Ann Clin Microbiol Antimicrob., 2021;20:84.
Abdul JBPAA, Adegbite BR, Ndanga MED, Edoa JR, Mevyann RC, Mfoumbi GRAI, et al. Resistance patterns among drug-resistant tuberculosis patients and trends-over-time analysis of national surveillance data in Gabon, Central Africa. Infection, 2022 [cité 9 avr 2023]; Disponible sur: https://link.springer.com/10.1007/s15010-022-01941-5 https://doi.org/10.1007/s15010-022-01941-5
Abdoulaye O, Idi ID, Mahaman Laouali HA, Lawan IM, Boureima H, Mati FG, Biraima A, Maman Bacha BS, Mamane SH, Issa AG. Evaluation of the resistance of Mycobacterium tuberculosis to rifampicin at the regional hospital center of Maradi, Niger Republic. Int J Mycobacteriol, 022; 11 (4):412-4.
Farra A, Danebera LV, Ngaya G, Yambiyo BM, Manirakiza A, Mossoro-Kpinde CD. The Contribution of the Xpert MTB/RIF Assay to the Surveillance of Drug-Resistant Tuberculosis in the Central African Republic. Journal of Tuberculosis Research, 2023;11(1):23‑32.
Robert BN, Many MR. Multidrug-Resistant Tuberculosis Disease in North-Kivu Province, Democratic Republic of Congo. JTR., 2019;07(02):56‑64.
Baya B, Achenbach CJ, Kone B, Toloba Y, Dabitao DK, Diarra B, et al. Clinical risk factors associated with multidrug-resistant tuberculosis (MDR-TB) in Mali. Int J Infect Dis., 2019;81:149‑55.
Cords O, Martinez L, Warren JL, O’Marr JM, Walter KS, Cohen T, et al. Incidence and prevalence of tuberculosis in incarcerated populations: a systematic review and meta-analysis. Lancet Public Health, 2021;6(5):e300‑8.
Ogumbo F, Odero R, Odhiambo B, Emojong P, Okumu A, Nonoh J, et al. Isoniazid and Rifampicin Tuberculosis Drug Resistance in HIV Endemic Region of Western Kenya. East Africa Science, 2022;4(1):37‑47.
Ogaro TD, , Githui W, Kikuvi G, Okari J, Wangui E, Asiko V. Anti-tuberculosis drug resistance in Nairobi, Kenya. African journal of health science, 2012; 20 (1-2) : 21-27.
Rahman SMM, Ather MF, Nasrin R, Hoque MA, Khatun R, Rahman T, et al. Performance of WHO-Endorsed Rapid Tests for Detection of Susceptibility to First-Line Drugs in Patients with Pulmonary Tuberculosis in Bangladesh. Diagnostics, 2022; 12(2):410.
Mahomed S, Dlamini-Mvelase NR, Dlamini M, Mlisana K. Failure of BACTECTM MGIT 960TM to detect Mycobacterium tuberculosis complex within a 42-day incubation period. African Journal of Laboratory Medicine, 2017;6(1):3.
Cayci YT, Bilgin K, Coban AY, Birinci A, Durupınar B. An evaluation of false-positive rifampicin resistance on the Xpert MTB/RIF. Mem Inst Oswaldo Cruz., 2017;112(11):756‑9.
Ngabonziza JCS, Decroo T, Migambi P, Habimana YM, Deun AV, Meehan CJ, et al. Prevalence and drivers of false-positive rifampicin-resistant Xpert MTB/RIF results: a prospective observational study in Rwanda. The Lancet Microbe, 2020;1(2):e74‑83.
Nguyen HV, de Haas P, Nguyen HB, Nguyen NV, Cobelens FGJ, Mirtskhulava V, et al. Discordant results of Xpert MTB/Rif assay and BACTEC MGIT 960 liquid culture to detect Mycobacterium tuberculosis in community screening in Vietnam. BMC Infectious Diseases, 2022;22(1):506.
Zetola NM, Shin SS, Tumedi KA, Moeti K, Ncube R, Nicol M, et al. Mixed Mycobacterium tuberculosis Complex Infections and False-Negative Results for Rifampin Resistance by GeneXpert MTB/RIF Are Associated with Poor Clinical Outcomes. Journal of Clinical Microbiology, 2014;52(7):2422‑9.
Beylis N, Ghebrekristos Y, Nicol M. Management of false-positive rifampicin resistant Xpert MTB/RIF. The Lancet Microbe, 2020;1(6):e238.
Liu Y, Zhou J, Cui X li, Lei J yuan, Zhao G lian, Dang L yun. The relationship between false-positive rifampicin resistant results of GeneXpert MTB/RIF and very low bacterial load in the clinical samples. Chinese Journal of Antituberculosis, 2019;41(2):176.
Diallo AB, Kollo AI, Camara M, Lo S, Ossoga GW, Mbow M, et al. Performance du GeneXpert MTB/RIF® dans le diagnostic de la tuberculose extra-pulmonaire à Dakar: 2010-2015. Pan Afr Med J., 2016;25:129.
Hiza H, Doulla B, Sasamalo M, Hella J, Kamwela L, Mhimbira F, et al. Preservation of sputum samples with cetylpyridinium chloride (CPC) for tuberculosis cultures and Xpert MTB/RIF in a low-income country. BMC Infectious Diseases, 2017;17(1):542.
Lumb R, Ardian M, Waramori G, Syahrial H, Tjitra E, Maguire GP, et al. An alternative method for sputum storage and transport for Mycobacterium tuberculosis drug resistance surveys. Int J Tuberc Lung Dis. févr 2006;10(2):172‑7.
Alemayehu WA, Neri S, Dalebout S, Nalikungwi R, Trusov A, Ahmed E, et al. Comparative study of OMNIgene®•SPUTUM reagent versus cold-chain for the transportation of sputum samples to GeneXpert®MTB/RIF testing sites in Malawi. BMC Infectious Diseases, 2019;19(1):424.
Sanoussi CN, de Jong BC, Affolabi D, Meehan CJ, Odoun M, Rigouts L. Storage of Sputum in Cetylpyridinium Chloride, OMNIgene.SPUTUM, and Ethanol Is Compatible with Molecular Tuberculosis Diagnostic Testing. J Clin Microbiol., 2019;57(7):e00275-19.
