Mpox-Tuberculosis coinfection in a high density military setting in Kinshasa, DRC, June 2024 - January 2026: epidemiological context and two sentinel clinical cases

Abstract

Background: Since 2022, the Democratic Republic of the Congo (DRC) has experienced a marked resurgence of Mpox, while tuberculosis (TB) remains highly endemic. The Kokolo Military Health Zone, characterized by overcrowding and high population mobility, represents a setting conducive to the transmission of respiratory and cutaneous infections. Although Mpox-TB co infection has not yet been documented, its biological plausibility is considerable. The objective of this study is to describe Mpox epidemiology in the Kokolo Military Health Zone between June 2024 and January 2026 and to report two plausible Mpox-TB coinfection cases.
Methods: Descriptive study combining local surveillance data, clinical records from the Kokolo Mpox Treatment Centre, and a literature review. Two plausible co infection cases were confirmed using Mpox PCR and TB GeneXpert MTB/RIF.
Results: Among 1,702 samples tested, 24.8% were positive for Mpox. Mpox-HIV coinfection accounted for 9.2% of confirmed cases. Two patients presented concurrent Mpox and active TB one pulmonary, one lymph node with prolonged and atypical clinical courses.
Conclusion: In this high density military environment in Kinshasa, Mpox circulated with a high positivity rate and a non negligible burden of Mpox-HIV coinfection. Within this context, we identified two Mpox-TB coinfection cases one pulmonary and one lymph node confirmed by PCR and GeneXpert. Although rare and exploratory, these observations support the biological and epidemiological plausibility of Mpox-TB coinfection and argue for integrated Mpox-TB-HIV screening in Mpox patients with prolonged or atypical evolution, particularly in military and other congregate settings.