Facteurs de risque de la tuberculose pulmonaire multirésistante à Bangui / Risk factors of multidrug-resistant pulmonary tuberculosis in Bangui

ntroduction.. La prévalence de la tuberculose pulmonaire multirésistante est passé de 0,4% en 2011 à 3,8% en 2021 soit 9,5 fois plus. L'objectif de notre étude était de déterminer les principaux facteurs de risque associés à la survenue de la tuberculose pulmonaire multi résistante (TBMR) chez les patients hospitalisés pour tuberculose au Centre National Hospitalier Universitaire de Bangui (CNHUB). Méthodologie. Il s'agissait d'une étude rétrospective allant du 1 er janvier 2019 au 30 juin 2021. Les cas étaient les patients atteints de tuberculose pulmonaire multi-résistante. Les témoins étaient ceux atteints de tuberculose pulmonaire pharmaco-sensible.Résultats.Nous avons inclus 210 patients dont 70 cas et 140 témoins avec une moyenne d'âge de 35 ans (± 14,09) pour un sex ratio de 1,6. Les ouvriers étaient la classe professionnelle la plus retrouvée(41,43% des cas et 32,85% des témoins). Les patients avaient pour la plupart un revenu mensuel faible (92,86% des cas et 77,14% des témoins). L'antécédent de tuberculose pulmonaire était retrouvé chez 61,42% des cas et 17,85% destémoins. La notion de tuberculose multi-résistante dans lafamille était présente chez 10%cas. Les facteurs significativement associés à la survenue de la tuberculose multi résistante étaient: le faible niveau de revenu (0R=3.8 [1,42-10,38] p=0,004), la consommation de tabac (OR=2 [1,06-3,72] p=0,03), un antécédent de Tuberculose (0R=7.84 [3,83-13,99] p<0,000), et la notion de tuberculose multi résistante dans la famille (0R=15.44 [1,86-128,20] p=0,001).Conclusion.Le niveau de revenu faible, la consommation de tabac, un antécédent de tuberculose, et une notion de tuberculose multi résistante dans la famille étaient les principaux facteurs de risques à la survenue de TBMR. L'émergence de cette forme de tuberculose peut être minimisée par le renforcement des stratégies de lutte

ntroduction.The prevalence of multidrug-resistant pulmonary tuberculosis has increased from 0.4% in 2011 to 3.8% in 2021, which is 9.5 times more. The aim of our study was to determine the main risk factors associated with the occurrence of multidrug-resistant pulmonary tuberculosis (MDR-TB) in patients hospitalized for tuberculosis at the Bangui National University Hospital Center (CNHUB). Methodology.This was a retrospective study from January 1, 2019 to June 30, 2021. The cases were patients with multidrug-resistant pulmonary tuberculosis. The controls were those with drug-sensitive pulmonary tuberculosis. Results.We included 210 patients, of which 70 cases and 140 controls, with a mean age of 35 years (± 14.09) and a sex ratio of 1.6. Workers were the most represented professional class (41.43% of cases and 32.85% of controls). Most patients had a low monthly income (92.86% of cases and 77.14% of controls). A history of pulmonary tuberculosis was found in 61.42% of cases and 17.85% of controls. The presence of multidrug-resistant tuberculosis in the family was present in 10% of cases. Factors significantly associated with the occurrence of multidrug-resistant tuberculosis were: low income level (OR=3.8 [1.42-10.38] p=0.004), tobacco consumption (OR=2 [1.06-3.72] p=0.03), history of tuberculosis (OR=7.84 [3.83-13.99] p<0.000), and the presence of multidrug-resistant tuberculosis in the family (OR=15.44 [1.86-128.20] p=0.001). Conclusion.Low income level, tobacco consumption, history of tuberculosis, and the presence of multidrug-resistant tuberculosis in the family were the main risk factors for the occurrence ofMDR-TB. The emergence of this form of tuberculosis can be minimized by strengthening control strategies.

Surveillance of Rifampicin Resistance With GeneXpert MTB/RIF in the National Reference Laboratory for Tuberculosis at the Institut Pasteur in Bangui, 2015-2017.

BACKGROUND: The Central African Republic (CAR) has one of the heaviest burdens of tuberculosis (TB) in the world, with an incidence of 423 cases per 100 000 population. Surveillance of resistance to rifampicin with GeneXpert MTB/RIF was instituted in the National TB Reference Laboratory in 2015. The aim of this study was to evaluate, after 3 years, resistance to rifampicin, the most effective firstline drug against TB. METHODS: The surveillance database on cases of rifampicin resistance was retrospectively analyzed. The populations targeted by the National TB Programme were failure, relapse, default, and contacts of multidrug-resistant TB (MDR-TB). Statistical analyses were performed with Stata software, version 14, using chi-square tests and odds ratios. RESULTS: Six hundred seventeen cases were registered; 63.7% were male, 36.3% were female, and the mean age was 35.5 years (range from 2 to 81). GeneXpert MTB/RIF tests were positive in 79.1% (488/617), and resistance to rifampicin was positive in 42.2% (206/488), with 49.1% (56/114) in 2015, 34.7% (57/164) in 2016, and 44.3% (93/210) in 2017. Failure cases had the highest rate of resistance (70.4%), with a significant difference (P < .0001; odds ratio, 9.5; 95% confidence interval, 4.4-20.5). Resistance was observed in 40% of contacts of MDR-TB, 28.2% of the relapses and 20% of the defaults without significant difference. CONCLUSIONS: Resistance to rifampicin is still high in the CAR and is most strongly associated with treatment failure. The Ministry of Health must to deploy GeneXpert MTB/RIF tests in the provinces to evaluate resistance to TB drugs in the country.

Poor performance of a novel serological test for diagnosis of pulmonary tuberculosis in Bangui, Central African Republic.

We assessed the performance of a serological test for tuberculosis (SDHO Laboratories Inc., Canada) in our setting. Among 68 of 99 suspected pulmonary tuberculosis patients who were scored as having tuberculosis on the basis of Mycobacterium tuberculosis-positive culture, the sensitivity of the serological test was lower than that of sputum smear microscopic examination (20.6% versus 80.9%, respectively; P < 0.000001).