EVALUATION DU TEST GENEXPERT MTB/RIF DANS LA PRISE EN CHARGE DIAGNOSTIQUE DE LA TUBERCULOSE AUX CHU BEFELATANANA ET FENOARIVO
2019
Resume: Introduction: Nous avons realise ce travail pour evaluer l’apport du test GeneXpert MTB/RIF dans le diagnostic de la tuberculose toute localisation confondue, la tuberculose pulmonaire a bacilloscopie negative (TPB-) et la tuberculose pleurale dans deux services de Pneumologie de deux Centres Hospitaliers Universitaires a Antananarivo.
Methodes: Il s’agit d’une etude retrospective transversale descriptive et analytique de Janvier 2016 a Mars 2019 realisee chez des patients suspects de tuberculose dans les deux services.
Resultats: Deux cent vingt-et-un (50.92%) patients ont ete retenus pour l’etude du test GeneXpert MTB/RIF pour la tuberculose toute forme confondue. Les prelevements pulmonaires representaient 81% des prelevements totaux et le reste sont d’origine extra-pulmonaire. La bacilloscopie etait positive dans 60.13% (N=153) des cas aux Centre de Diagnostic et de Traitement (CDT), et dans 72% (N=136) des cas dans les laboratoires de reference. Le test GeneXpert MTB/RIF a trouve 57.72% (N=221) de resultats positifs. Une resistance a la rifampicine a ete retrouvee chez 5 patients. Trente-quatre (75.5%) des 45 resultats de culture colliges etaient positifs. Pour tous les prelevements, le test GeneXpert MTB/RIF a trouve plus de resultats positifs que la bacilloscopie, et ses resultats ont ete tous confirmes par la culture. La valeur de p est significative (<0.05) pour la comparaison des tests des crachats. Cinquante (11.52%) patients ont ete inclus dans l’etude du test GeneXpert MTB/RIF pour la TPB-. Les resultats positifs trouves par une deuxieme bacilloscopie dans les laboratoires de reference et le test GeneXpert MTB/RIF sont respectivement de 12.5% et de 58% chez des patients ayant eu au prealable une bacilloscopie negative aux CDT. Pour l’etude de l’apport du test GeneXpert MTB/RIF dans le diagnostic de la pleuresie tuberculeuse, nous avons trouve les valeurs de la sensibilite, la specificite, la valeur predictive positive (VPP) et la valeur predictive negative (VPN) pour le liquide pleural respectivement de: 20%, 100%, 100% et 62.5%, et pour la piece biopsique pleurale respectivement de : 15%, 100%, 100% et 58.82% en considerant l’examen anatomo-pathologique comme examen de reference.
Conclusion: Le test GeneXpert MTB/RIF est tres performant pour le diagnostic de la tuberculose pulmonaire mais l’est moins pour le diagnostic de la tuberculose extra-pulmonaire.
Mots-cles: GeneXpert MTB/RIF, diagnostic, tuberculose, TPB-, pleuresie tuberculeuse
Abstract: Introduction: We have realied this study to evaluate GeneXpert MTB/RIF’s part in the diagnosis of all areas combined tuberculosis, pulmonary tuberculosis with negative microscopy and pleural tuberculosis in two Pneumology departments of two university hospital centers in Antananarivo.
Methods: It is a descriptive and analytic retrospective cross-sectionnal study from January 2016 to March 2019 done in patients where tuberculosis was suspected in the two departments.
Results: Two hundred and twenty-two (50.92%) patients were selected for GeneXpert MTB/RIF study for all areas combined tuberculosis. The pulmonary samples represented 81% of all samples and the restis from extra-pulmonary origins. The microscopy was positive in 60.13% (N=153) of the cases in the Diagnosis and Treatment Centers, and in 72% (N=136) of the cases in the reference laboratories. The GeneXpert MTB/RIF test has found 57.72% (N=221) positive results. A resistance to rifampicine has been found in 5 patients. Thirty-four (75.5%) of the 45 gathered culture results were positive. For all samples, the GeneXpert MTB/RIF has found more positive results than the microscopy, and its results were all confirmed by the culture. P-value was significant (<0.05) for sputum tests. Fifty (11.52%) patients were included in the GeneXpert MTB/RIF study of negative microscopy pulmonary tuberculosis. The positive results found by a second microscopy in the reference laboratories and the GeneXpert MTB/RIF test were respectively 12.5% and 58% in patients having previously had a negative microscopy in the Diagnostic and Treatment Center. For the GeneXpert MTB/RIF’s contribution in pleural tuberculosis’diagnosis, we have found respectively a sensitivity, a specificity, a positive predictive value, a negative predictive value for pleural fluid of : 20%, 100%, 100% and 62.5% and for pleural biopsy of : 15%, 100%, 100% and 58.82% by considering histology as gold standard.
Conclusion: The GeneXpert MTB/RIF test is a very effective tool for pulmonary tuberculosis diagnosis but less effective for extra-pulmonary tuberculosis diagnosis.
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