Little is known about the respiratory health damage related to household air pollution (HAP) in survivors of pulmonary tuberculosis (PTB). In a population-based cross-sectional study, we determined the prevalence and associated predictors of chronic cough and hemoptysis in 441 randomly selected PTB survivors living in 13 remote health zones with high TB burden in the South Kivu province of the Democratic Republic of Congo (DRC). Trained community and health-care workers administered a validated questionnaire. In a multivariate logistic regression, chronic cough was independently associated with HAP (adjusted odds ratios (aOR) 2.10, 95% CI: 1.10–4.00) and PTB treatment >6 months (aOR 3.80, 95% CI: 1.62–8.96). Among women, chronic cough was associated with cooking ≥3 h daily (aOR 2.74, 95% CI: 1.25–6.07) and with HAP (aOR 3.93, 95% CI: 1.15–13.43). Independent predictors of hemoptysis were PTB retreatment (aOR 3.04, 95% CI: 1.04–5.09) and ignorance of treatment outcome (aOR 2.24, 95% CI: 1.09–4.58) but not HAP (aOR 1.86, 95% CI: 0.61–5.62). Exposure to HAP proved a major risk factor for chronic cough in PTB survivors, especially in women. This factor is amenable to intervention.

Partial artemisinin resistance has emerged in East Africa, posing a threat to malaria control across the continent. The Democratic Republic of the Congo carries one of the heaviest malaria burdens globally, and the South Kivu province directly borders current artemisinin resistance hot spots, but indications of such resistance have not been observed so far. We assessed molecular markers of antimalarial drug resistance in 256 Plasmodium falciparum isolates collected in 2022 in South Kivu, Democratic Republic of the Congo. One isolate carried the P. falciparum Kelch-13 469Y variant, a marker associated with partial artemisinin resistance and decreased lumefantrine susceptibility in Uganda. In addition, the multidrug resistance-1 mutation pattern suggested increased lumefantrine tolerance.

Background: The Xpert assay has revolutionized the rapid detection of resistance to rifampicin. However, Xpert has its pitfalls. We explored potential determinants of false-positive rifampicin resistance when using Xpert, aiming to refine the precision of tuberculosis diagnostics and subsequently contribute to better patient outcomes. Methods: This is a retrospective cross-sectional analysis of archived Xpert files from the South Kivu province, used to diagnose Mycobacterium tuberculosis (MTB) between 2013 and 2018. Xpert cycle threshold was extracted for each molecular beacon probe, and ΔCt was calculated. We used the MTBDRplus line-probe assay, which covers the same 81-bp RRDR, as a reference test. Results: Of 1900 samples positive for MTB, 220 (11.2%) were rifampicin resistant. Of the 141 patients' sputum samples that had results for both Xpert and MTBDRplus, 45 (31.9%) showed discordant results with Xpert, indicating rifampicin resistance while MTBDRplus indicated rifampicin susceptibility, suggesting false-positive rifampicin resistance detection by Xpert, predominantly in samples with very low (Ct > 28, odds ratio [OR] = 2.23, 95% CI: 1.30–3.82) or low (Ct 22–28, OR = 1.81, 95% CI: 1.21–2.71) bacterial loads. Probe E was the most frequently missed probe, followed by multiple probe dropouts or absence of probe binding (OR = 1.5, 95% CI: .731–3.076). Conclusions: Our findings indicate that low and very low MTB bacterial loads in sputum are strongly associated with discordant rifampicin resistance results when using Xpert. Further research into underlying mechanisms is needed to establish causality definitively.

The emergence of resistance is of great concern in the control of TB, especially to the new and repurposed drugs needed for the treatment of rifampicin resistance. We report a patient from South Kivu in the Eastern Democratic Republic of the Congo with primary resistance to delamanid and linezolid without treatment experience with these drugs. The identification of novel resistance mutations raises concerns about the potential global spread and poor outcomes of the WHO-recommended oral treatment regimens, highlighting the need for the urgent rollout of DST.

Background: Lineage 8 (L8) occupies a unique phylogenetic position as a sister clade to all other known Mycobacterium tuberculosis complex (MTBC) lineages. Although the initial identification of L8 strains was limited to Rwanda and Uganda, the complete geographical distribution of this lineage remains undetermined due to limited genomic surveillance across eastern and central Africa. Methods: We performed whole genome sequencing (WGS) on MTBC isolates from rifampicin-resistant tuberculosis (TB) patients’ sputum in Bukavu, South Kivu province, eastern Democratic Republic of Congo (DRC). Lineage assignment was performed using TBProfiler with classification based on single nucleotide polymporphisms (SNPs). Phylogenetic reconstruction was conducted using maximum likelihood analysis against publicly available L8 reference genomes from Rwanda and Uganda. Drug-resistance profiles were determined through both genotypic prediction from WGS data and phenotypic drug-susceptibility testing. Clinical and epidemiologic data were extracted from programmatic records. Results: We identified three clinical isolates belonging to MTBC L8 among fifteen sequenced isolates collected in Bukavu between January and December 2023 enriched for rifampicin resistant TB as determined by Xpert Ultra. Phylogenetic analysis confirmed placement within the L8 clade while revealing unique SNP profiles distinct from previously published Rwandan and Ugandan L8 strains by 16–20 to >200 SNPs, respectively, consistent with local diversification rather than recent cross-border importation. Ancestral genomic features characteristic of L8 were preserved, including the intact cobF region and complete pks8 gene. Drug-resistance prediction from genomic data indicated multidrug-resistant and pre-extensively-resistant TB. Conclusions: This report extends the known geographic distribution of MTBC L8 to eastern DRC, supporting the hypothesis that the African Great Lakes region harbors under-characterized ancestral diversity of the tubercle bacillus. Systematic genomic surveillance across the DRC-Uganda-Rwanda-Burundi corridor, including rifampicin-susceptible isolates, is needed to determine whether L8 represents a rare relict lineage or an under-detected endemic variant circulating through regional transmission networks.