Les facteurs de mortalité de la tuberculose pulmonaire à bacilloscopie positive (TPM+) vus à l’USFR de Pneumologie de Befelatanana.

Introduction : Over 95% of the mortality and morbidity of tuberculosis occur in developing countries. In Madagascar this mortality is 46/100.000. The aim of our study was to identify factors of mortality in patients with smear-positive pulmonary tuberculosis.  Methods : It is retrospective, comparative "control cases" studies, performed at the service of USFR Pneumology CHU Befelatanana during the period of February 2012 to February 2014. Were included the patients hospitalized for a smear-positive pulmonary tuberculosis. Results : During the study period 153 patients with smear-positive pulmonary tuberculosis were collected. Fifty-three cases were excluded cause of the unavailability of quantifying the concentration in sputum bacillary and or chest radiography. We selected 100 cases including 26 deaths and 74 alive. All patients had a negative HIV serology. The following have been associated with patient mortality: the presence of asthenia (p: 0.035, OR: 2.99, CI: [1.07 to 8.29]), lymphocytes (p= 0,003, OR : 3,50 IC : [1,53-7,99]), the number of lobes involved with chest radiographic (p: 0.001, OR: 4.67, CI: [1.83 to 11.92]) and the presence of a cellular syndrome (p: 0.006, OR: 5.85, CI: [1.65 to 20,73]).  The urban population has less mortality compared to the rural population (p: 0.017, OR: 0.15, CI: [0.03-0.71]). The concentration of tuberculosis in smear test was not associated with mortality (p: 0,1261, OR : 1,69, IC : [0,8614-3,3511]) Conclusion: A management and stricter monitoring of these patients would reduce mortality of smear-positive pulmonary tuberculosis in Madagascar. Mots cles: TPM+, facteurs de mortalite, Antananarivo, Madagascar.