Prise en Charge de la Tuberculose Multirésistante À Brazzaville

RESUME Introduction. L’emergence des formes pharmaco resistantes de tuberculose pose un probleme de la prise en charge a Brazzaville. Le but de notre travail est de decrire les aspects cliniques, paracliniques et evolutifs de la tuberculose multiresistante (TB-MR) au centre antituberculeux de Brazzaville. Patients et methodes. Il s’agit d’une etude transversale, prospective et analytique allant du 1er septembre 2015 au 31 octobre 2017, menee au centre antituberculeux de Brazzaville. Les cultures et les tests de sensibilites etaient effectues a Kinshasa au laboratoire national de reference du programme national de lutte contre la tuberculose de la Republique Democratique du Congo. Resultats. Parmi 115 patients TB-RR (tuberculose resistante a la rifampicine) enregistres au centre antituberculeux de Brazzaville, 88 ont ete inclus dans notre etude. Treize patients (14%) ont beneficie des cultures, des tests de sensibilite et ont ete diagnostiques multiresistants, alors que 75 patients n’avaient pas realise ces examens. La frequence relative de la TB-RR/TB-MR etait de 2,7%. L’âge moyen des patients etait de 31,7 ans ± 10,7 ans pour les patients TB-RR et de 28,8 ans ±7,4 ans pour les patients TB-MR (tuberculose multiresistante).  Les patients TB-RR etaient de sexe masculin  dans 51,1% des cas alors que 53,8% des patients TB-MR etaient de sexe feminin. Les 13 patients TB-MR ont recu un traitement de 2eme  ligne  pendant 24 mois  avec un taux de guerison de 61,5%. A l’oppose, les 75 autres patients etaient toujours en attente pour la prise en charge therapeutique. Conclusion. Le Xpert MTB/RIF nous a permis de depister les cas TB-RR et non de TB-MR. Moins de 25% ont beneficie d’une culture et d’un traitement de 2eme ligne. Les examens complementaires comme les cultures et les tests de sensibilite dans notre pays deviennent necessaires. ABSTRACT Introduction. The emergence of pharmaco-resistant tuberculosis creates new challenges in the management of tuberculosis (TB) in Brazzaville. The aim of this work is to determine the clinical, paraclinical and evolutionary aspects of multidrug resistant tuberculosis (TB-MR) patients treated at the tuberculosis center in Brazzaville. Patients and methods. This was a cross-sectional descriptive  prospective study covering the period from September 1, 2015 to October 31, 2017. The stud took place at the tuberculosis center in Brazzaville. The sensivity tests were performed in the Kinshasa National reference Lab of the national TB program of Democratic Republic of Congo. Results.  Among the rifampicin resistant – tuberculosis (TB-RR) patients registered at the TB center of Brazzaville, 88 were included in this study. Thirteen patients (14%), after bacilli cultures and sensitivity tests were diagnosed multiresistant. However 75 patients, did not perform these procedures. The relative frequency of RR-TB / MDR-TB was 2.7%. The mean age of patients was 31.7 years ± 10.7 years for RR-RR patients and 28.8 years ± 7.4 years for MDR-TB patients. 51.1% of TB-RR patients were male while 53.8% of MDR-TB patients were female. All thirteen MDR-TB patients received second line treatment for 24 months with a cure rate of 61.5%. On the other hand, 75 patients were still waiting for their treatment. Conclusion. Xpert MTB / RIF allowed us to detect TB-RR cases and not MDR-TB cases. Less than 25% of our patients benefited from a 2nd line culture and treatment. Additional exams like cultures and sensitivity tests in our country become necessary.