Aim of study: To describe the clinical, therapeutic and evolutionary profile of patients followed for rifampicin-resistant pulmonary tuberculosis (RR-TB) at the Regional Hospital Centre (RHC) of Maradi (Niger) from 2014 to 2018.
Methods: We conducted a retrospective and descriptive study based on the records of patients followed for Multidrug-resistant tuberculosis (MDR-TB) between January 1, 2014 and June 30, 2018 at the resistant tuberculosis management unit in Maradi (Niger). This unit is located within the RHC of Maradi and has a capacity of 20 beds in 4 wards. It receives patients with tuberculosis resistant to first-line anti-tuberculosis drugs. In this study, patients diagnosed with RR-TB by genotypic (GeneXpert MTB/RIF) or phenotypic (culture) testing were included. We excluded from this study: patients previously treated for more than 1 month with second-line anti-TB drugs; patients with resistance to second-line injectables (SLI) and/or fluoroquinolones (FQ); patients with an electrocardiogram QTc greater than 500 ms (the corrected QT (QTc) estimates the QT interval at a rate of 60 beats per second); cases of atypical mycobacteriosis detected by phenotypic testing.Patients were previously on 2RHZE/4RH prior to the discovery of resistance. The treatment protocol for resistant TB was as follows: 4KmMfxPtoCfzHZE/5MfxCfzZE (The second-line injectable was replaced by Lzd in case of initial or treatment-emergent deafness). HIV co-infected patients received, in addition to anti-tuberculosis drugs, antiretrovirals and cotrimoxazole in preventive doses.
Results: A total of 80 patients were included in the present study (70 males and 10 females, mean age 34.4 years with extremes ranging from 18 to 71 years). Patients aged 18-35 years accounted for more than half. Patients with primary treatment failure were the most frequent type (36%) followed by patients with retreatment failure (24%) and patients with retreatment relapse (17%). It should be noted that 77 patients (96%) were previously treated for TB and only 3 patients (4%) were new cases. The majority of patients (70%) had a Body mass index of less than 18 kg/m2. 7.5% of patients were HIV positive, one was diabetic, 52% of the patients had grade 2 radiological lesions. Grade 1 deafness was noted at the beginning of treatment in 3%. A third of patients (36%) were primary treatment failures. The treatment protocol was as follows: 4KmMfxPtoCfzHZE/5MfxCfzZE. Only 1 patient had a positive culture at the end of the 4th month of treatment. Most of the patients had experienced adverse events, mainly digestive, with vomiting being the most common. The therapeutic success rate was 88%. We noted 10% of deaths, 1% of therapeutic failure and 1% of lost to follow-up.Six months after treatment, 48 patients (60%) were smear negative and 43 (54%) were culture negative. In 32 patients (40%), the smear was not performed and culture was not performed in 37.
Conclusion: The short treatment regime gives satisfactory results in the absence of resistance to fluoroquinolones, with rare adverse effects. In Niger, further efforts should be made to minimize the delay in diagnosis which is responsible for most deaths during treatment. A centre could usefully be designated to organize "TB consiliums" allowing any practitioner to submit difficult cases of MDR-TB.
Objectif: Décrire le profil clinique, thérapeutique et évolutif des patients suivis pour tuberculose résistante à la rifampicine (TB-RR) au Centre hospitalier régional (CHR) de Maradi (Niger) de 2014 à 2018.
Méthodes: Nous avons mené une étude rétrospective et descriptive à partir des dossiers des patients suivis pour tuberculose multirésistante (TB-MR) entre le 1er janvier 2014 et le 30 juin 2018 à l'unité de prise en charge de la tuberculose résistante de Maradi (Niger). Ont été retenus dans cette étude, les patients chez qui le diagnostic de TB-RR était posé.
Résultats: Au total, 80 patients ont été inclus dans la présente étude (70 hommes et 10 femmes, âge moyen: 34,4 ans avec des extrêmes allant de 18 à 71 ans). La majorité des patients, 70%, avaient un IMC inférieur à 18 kg/m2. 7% des patients étaient séropositifs pour le VIH. Un patient était diabétique, 52% avaient des lésions radiologiques de degré 2. On notait une surdité de degré 1 au début du traitement chez 3% de nos patients et 96% étaient des cas précédemment traités pour la tuberculose. Un tiers des patients (36%) étaient des échecs de primo-traitement. Le protocole thérapeutique était le suivant: 4KmMfxPtoCfzHZE/5MfxCfzZE. Un seul patient avait une culture positive à la fin du 4e mois de traitement. La plupart des patients avaient présenté des effets indésirables digestifs, surtout des vomissements. Le succès thérapeutique était de 88% avec 10% de décès, 1% d’échec thérapeutique et 1% de perdu de vue. Conclusion. Le régime thérapeutique court donne des résultats très satisfaisants avec des effets secondaires moindres.
Motsclés: Tuberculose multirésistante, VIH, Échec thérapeutique, Traitement, Maradi, Niger, Afrique subsaharienne
Keywords: HIV; Maradi; Multidrug-resistant tuberculosis; Niger; Sub-Saharan Africa; Therapeutic failure; Treatment.
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