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.
Références
Ben Amor Y, Nemser B, Singh A, et al (2008) Underreported threat of multidrug-resistant tuberculosis in Africa. Emerg Infect Dis 14(9):1345–1352
Bwanga F, Hoffner S, Haile M, Joloba ML (2009) Direct susceptibility testing for multidrug resistant tuberculosis: a metaanalysis. BMC Infect Dis 9:67
Diguimbaye C, Hilty M, Ngandolo R, et al (2006) Molecular characterization and drug resistance testing of Mycobacterium tuberculosis isolates from Chad. J Clin Microbiol 44(4): 1575–1577
Gandhi NR, Nunn P, Dheda K, et al (2010) Multidrug-resistant and extensively drug-resistant tuberculosis: a threat to global control of tuberculosis. Lancet 375(9728):1830–1843
Kubica GP, Dye WE, Cohn ML, Middlebrook G (1963) Sputum digestion and decontamination with N-acetyl-L-cysteine-sodium hydroxide for culture of mycobacteria. Am Rev Respir Dis 87:775–779
Minime-Lingoupou F, Pierre-Audigier C, Kassa-Kélémbho E, et al (2010) Rapid identification of multidrug-resistant tuberculosis isolates in treatment failure or relapse patients in Bangui, Central African Republic. Int J Tuberc Lung Dis 14(6):782–785
Naidoo S, Jinabhai CC (2006) TB in health care workers in KwaZulu-Natal, South Africa. Int J Tuberc Lung Dis 10(6):676–682
Nathanson E, Nunn P, Uplekar M, et al (2010) MDR tuberculosis-Critical Steps for Prevention and Control. N Engl J Med 363(11): 1050–1058
Nodieva A, Jansone I, Broka L, et al (2010) Recent nosocomial transmission and genotypes of multidrug-resistant Mycobacterium tuberculosis. Int J Tuberc Lung Dis 14(4):427–433
OMS (2003) Le traitement de la tuberculose. Principe à l’intention des programmes nationaux. 3e édition. 2003. WHO/CDS/TB/2003.313
OMS (2009) Natural ventilation for infection control in healthcare settings. Guidelines 2009
OMS (2010) Statistiques sanitaires mondiales http://www.who.int/whosis/whostat/FR_WHS10_Full.pdf
OMS (2011) Automated automated real-time nucleic acid amplification technology for rapid and simultaneous detection of tuberculosis and rifampicin resistance: Xpert MTB/RIF System. Policy Statement. http://whqlibdoc.who.int/publications/2011/9789241501545_eng.pdf
Ringuet H, Akoua-Koffi C, Honore S, et al (1999) Hsp65 sequencing for identification of rapidly growing mycobacteria. J Clin Microbiol 37:852–857
Schaaf HS, Moll AP, Dheda K (2009) Multidrug and extensively drug-resistant tuberculosis in Africa and South America: epidemiology, diagnosis and management in adults and children. Clin Chest Med 30(4):667–683
Shah NS, Moodley P, Babaria P, et al (2011) Rapid diagnosis of tuberculosis and multidrug resistance by the microscopicobservation drug-susceptibility assay. Am J Respir Crit Care Med 183(10):1427–1433. Epub 2011 Feb 4
Skodric-Trifunovic V, Markovic-Denic L, Nagorni-Obradovic L, et al (2009) The risk of occupational tuberculosis in Serbian health care workers. Int J Tuberc Lung Dis 1(5):640–644
Sotgiu G, Ferrara G, Matteelli A, et al (2009) Epidemiology and clinical management of XDR-TB: a systematic review by TBNET. Eur Respir J 33(4):871–881. Epub 2009 Feb 27
Author information
Authors and Affiliations
Corresponding author
About this article
Cite this article
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
Received:
Accepted:
Published:
Issue Date:
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