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Étude de la résistance de Mycobacterium tuberculosis chez les patients bacillifères au Tchad

Drug resistance testing of Mycobacterium tuberculosis isolates from sputum in Chad

Bulletin de la Société de pathologie exotique volume 105, pages 16–22 (2012)Cite this article

Résumé

À partir d’expectorations positives à bacilles acidoalcoolorésistants (BAAR), provenant de patients suivis dans un hôpital national, régional ou de district, une culture et une recherche de résistance aux antituberculeux de première ligne ont été pratiquées. À partir de 232 crachats positifs à BAAR par la coloration de Ziehl, 135 souches provenant de patients différents (46 femmes, 89 hommes, âge moyen de 34 ans) ont pu être isolées et testées. Tous les patients, sauf un, présentaient de nouveaux cas de tuberculose. Vingt-sept souches (20 %) avaient au moins une résistance à un antituberculeux. La résistance à l’isoniazide était la plus fréquente avec 18 souches (13 %) qui présentaient au moins cette résistance. Trois souches (2,2 %) étaient résistantes à l’isoniazide et à la rifampicine (MDR) dont une souche également résistante à la streptomycine et à l’éthambutol. Le taux de résistance différait selon la structure de santé, avec une plus forte résistance retrouvée à l’hôpital régional (33 %), alors que ce taux était de 16 et 14 % respectivement à l’hôpital national et de district. La sérologie pour le VIH était connue chez 81 patients et s’avérait positive pour 20 (25 %) d’entre eux. Cette étude est la première à mettre en évidence des souches multirésistantes (MDR) au Tchad. Elle souligne l’urgence de mettre en place des actions pour limiter la propagation de cette résistance. Pour citer cette revue: Bull. Soc. Pathol. Exot. 105 (2012).

Abstract

Culture and resistance testing of Mycobacterium tuberculosis are not regularly performed in Chad. Sputa were obtained from three different categories of hospitals (district, regional and national) in Chad. All examined sputa were smear-positive and were investigated by culture and drug resistance testing for first-line antituberculosis drugs. From 232 sputa positive for acid-fast bacilli, 135 isolates of M. tuberculosis from different patients (46 women, 89 men, mean age 34 years) were analyzed. All the patients except one corresponded to new cases of tuberculosis. In total, 27 out of 135 isolates (20%) were resistant to at least one major antituberculosis drug. Resistance to isoniazid was the most frequent resistance observed, with 18 isolates (13%) presenting at least this resistance. Three isolates (2.2%) were resistant to isoniazid and rifampicin (multidrug resistance MDR) including one isolate being concomitantly resistant to streptomycin and ethambutol. The resistance rate differed in relation to the category of the hospital; the most important resistance rate was observed in regional hospitals (33%), while it was 16% and 14% in the national and district hospitals, respectively. HIV serology was performed in 81 patients, among whom 20 (25%) were positive. This is the first study that shows that drug resistance of M. tuberculosis is present in Chad. Besides single drug-resistant isolates, multidrug-resistant strains of M. tuberculosis could also be identified. This result highlights the urgency of initiating actions to detect drug resistance and limit the spread of drug-resistant strains.

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Author information

Affiliations

  1. Programme national de lutte contre la tuberculose, N’Djaména, Tchad

    O. Abdelhadi & J. Ndokaïn

  2. Conseil national de lutte contre le sida, N’Djaména, Tchad

    M. Moussa Ali

  3. Service de microbiologie-hygiène, CHU Ambroise-Paré, AP-HP, faculté de médecine, université de Versailles-Saint-Quentin-en-Yvelines, 9, avenue Charles-de-Gaulle, F-92100, Boulogne-Billancourt, France

    V. Friocourt & B. Heym

  4. Entraide Santé 92, 23, rue des Jardins, F-92420, Vaucresson, France

    E. Mortier

Authors
  1. O. Abdelhadi
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  2. J. Ndokaïn
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  3. M. Moussa Ali
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  4. V. Friocourt
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  5. E. Mortier
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  6. B. Heym
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Corresponding author

Correspondence to E. Mortier.

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Abdelhadi, O., Ndokaïn, J., Ali, M.M. et al. Étude de la résistance de Mycobacterium tuberculosis chez les patients bacillifères au Tchad. Bull. Soc. Pathol. Exot. 105, 16–22 (2012). https://doi.org/10.1007/s13149-011-0186-9

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  • DOI: https://doi.org/10.1007/s13149-011-0186-9

Mots clés

  • Tuberculose
  • Multirésistance
  • VIH
  • Mycobacterium tuberculosis
  • Tuberculose pulmonaire
  • Tuberculose bacillifère
  • Hôpital
  • Ndjaména
  • Moundou
  • Bebalem
  • Tchad
  • Afrique intertropicale

Keywords

  • Tuberculosis
  • Mycobacterium tuberculosis
  • Multidrug resistance
  • HIV
  • Pulmonary tuberculosis
  • Bacilliferous tuberculosis
  • Hospital
  • Ndjaména
  • Moundou
  • Bebalem
  • Chad
  • Sub-Saharan Africa