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 Table of Contents  
ORIGINAL ARTICLE
Year : 2022  |  Volume : 11  |  Issue : 4  |  Page : 412-414

Evaluation of the resistance of Mycobacterium tuberculosis to rifampicin at the regional hospital center of Maradi, Niger Republic


1 Facuty of Health Sciences, Dan Dicko Dankoulodo University, Maradi, Niger
2 Damien Foundation, Maradi, Niger
3 Ministry of Public Health, Population and Social Affairs, Niamey, Niger
4 Maradi Regional Health Directorate

Date of Submission17-Sep-2022
Date of Decision11-Oct-2022
Date of Acceptance25-Nov-2022
Date of Web Publication10-Dec-2022

Correspondence Address:
Ousmane Abdoulaye
Dan Dicko Dankoulodo University, BP: 465, Maradi
Niger
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijmy.ijmy_160_22

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  Abstract 


Background: According to the World Health Organization (WHO) data, 600,000 cases of rifampicin-resistant tuberculosis (TB) have been reported worldwide, including 490,000 cases of multidrug-resistant TB. Thus, through the present study, we proposed to evaluate the resistance of Mycobacterium tuberculosis to rifampicin in the regional hospital of Maradi. Methods: Our study involved 887 sputum samples that were GeneXpert tested from January 2016 to December 2020. These data were collected from the laboratory records of the Maradi Regional Hospital and analyzed with SPSS and Excel 2013 software. Results: In total, more than half of the patients were male, i.e., a sex ratio of 3.03. The average age was 41 years. The rate of detection of M. tuberculosis by GeneXpert was 42% and the frequency of resistance to rifampicin was 20%. However, treatment failure and relapse were associated with this monoresistance in 53.95% and 30.26% of cases, respectively. Conclusion: The present study shows a fairly high prevalence of rifampicin resistance in the Maradi region, corresponding to twice the WHO threshold. The vast majority of these cases presented either a therapeutic failure or a relapse. Urgent and effective actions must be taken to significantly reduce the rates of treatment failure and relapse to decrease the rate of monoresistance and thus avoid the emergence of multidrug-resistant strains.

Keywords: Mycobacterium tuberculosis, resistance, rifampicin, tuberculosis


How to cite this article:
Abdoulaye O, Idi ID, Mahaman Laouali HA, Lawan IM, Boureima H, Mati FG, Biraima A, Maman Bacha BS, Mamane SH, Issa AG. Evaluation of the resistance of Mycobacterium tuberculosis to rifampicin at the regional hospital center of Maradi, Niger Republic. Int J Mycobacteriol 2022;11:412-4

How to cite this URL:
Abdoulaye O, Idi ID, Mahaman Laouali HA, Lawan IM, Boureima H, Mati FG, Biraima A, Maman Bacha BS, Mamane SH, Issa AG. Evaluation of the resistance of Mycobacterium tuberculosis to rifampicin at the regional hospital center of Maradi, Niger Republic. Int J Mycobacteriol [serial online] 2022 [cited 2023 Feb 3];11:412-4. Available from: https://www.ijmyco.org/text.asp?2022/11/4/412/363159




  Introduction Top


Tuberculosis (TB) is an infectious disease of human-to-human transmission, caused by a bacterium called Mycobacterium tuberculosis. According to estimates by the World Health Organization (WHO), it is one of the most deadly infectious diseases worldwide. With nearly 8 million new cases each year and more than 1 million deaths per year, TB still represents a major public health problem.[1] Indeed, it is one of the most deadly infectious diseases in the world, second only to HIV/AIDS. Since 1994, a second serious factor has been added to HIV infection: resistance to antituberculosis drugs, resulting in multidrug-resistant TB (MDR-TB) and ultra-drug-resistant TB.[2] The increase in drug-resistant TB is a real and worrying phenomenon and a concern in many countries. According to the WHO data, 600,000 cases of rifampicin-resistant TB have been reported worldwide, including 490,000 cases of MDR-TB, i.e., TB in which the bacilli are resistant to at least isoniazid and rifampicin, the major anti-TB drugs.[3] In Niger, 10, 165 cases of all forms of TB were recorded in 2016, including 130 cases of treatment failure. The detection rate of MDR-TB was 43% with 12% of TB/HIV coinfection.[2] In view of this worrying situation, we proposed in this study to evaluate the resistance of M. tuberculosis to rifampicin in the regional hospital of Maradi to measure the extent of this phenomenon in this region.


  Methods Top


Study design

We conducted a retrospective descriptive and analytical study based on data collected using a data collection form. The collection concerned the data recorded from January 2016 to December 2020 in the database of the NGO DAMIEN foundation and at the laboratory level of the regional hospital of Maradi.

Study population

The study population consisted of patients in whom the search for Koch's bacillus was requested and in whom the GeneXpert test was performed in case of positive.

Data analysis

Data collected were analyzed and processed with SPSS, Excel and Word 2013 software (Microsoft).

Ethical aspects

This is a study that used data from registers with the authorization of the director of the Regional Hospital of Maradi. Patient anonymity was respected.


  Results Top


Our study population consisted of 887 patients with a sex ratio (male/female) of 3.03.

The median age was 41 years with extremes of 3 and 90 years.

The most represented age range was 20–40 years, or 51% [Figure 1].
Figure 1: Age distribution of the study population

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GeneXpert results

During our study, out of a total of 887 sputum samples received at the RHC laboratory, 476 (54%) samples were MTB–, 271 (42%) were MTB+, 76 (20%) were MTB+ and rifampicin resistant, and finally, 40 (5%) showed invalid results.

These different results are presented in [Figure 2].
Figure 2: GeneXpert results

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Distribution of rifampicin-resistance cases according to the type of application

It is observed that the resistances were more on the samples of patients in therapeutic failure or relapse with 53.95% and 30.26%, respectively [Figure 3].
Figure 3: Distribution of rifampicin resistance cases by application type. RT: Retreatment; R: Relapse; F: Treatment failure; N: New case; C RR: Contact with a known rifampicin-resistant subject; C+: Positive 2nd-month control

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  Discussion Top


We conducted a retrospective, analytical and descriptive study over 5 years.

This study included 887 patients who were identified based on inclusion criteria.

The male sex was largely predominant in our study with 75.2% of cases and a sex ratio of 3.03. This result is approximately equal to that reported by Mamane et al. who found a sex ratio of 3.5 in a study conducted in Zinder, Niger in 2018.[2]

The male predominance is also much more found in the literature where many authors report a sex ratio in favor of men. This is the case of Ouédraogo et al. in Burkina Faso[4] who found a sex ratio of 1.42. Rakotoson et al. in Madagascar found a sex ratio of 1.54.[5]

This male predominance seems to be related to the differences in exposure between male and female participants in their societal roles.

In our study, the age group most represented was 20–40 years old with 51% of cases.

The average age of the patients was 41 years with extremes of 3 and 90 years. These results are similar to those of Mamane et al. in Zinder (Niger) who found the age group 20–40 years representing 46.7%.[2] However, they are different from those of More et al. in India, who found a predominance of the age group 31–50 years with 41.66%,[6] and also different from those of Elhassan et al. in Saudi Arabia who found 31.8% of the patients belonging to the age group of 45 years and above.[7] This could be explained by the relative youth of the Nigerien population where the under 15 years old represent 51.7%.[8]

GeneXpert results

In our study, MTB was detected in 371 patients out of 887 tested, or 42%. These results were close to those of Mamane et al. who found 49% in their study conducted in Zinder in 2018. A higher rate was reported by Diop et al. in Senegal with 73.40%.[9]

On the other hand, a low rate was reported by Lupande and coll in DRC with 15.9% in their studies on the Xpert MTB/RIF test for pulmonary tuberculosis.[10] This difference could be explained by the variability of the distribution of M. tuberculosis from one country to another.

In our study, we found 76 cases of rifampicin resistance or 20%. These results were high compared to the critical threshold of monoresistance to anti-TB drugs set at 10% by the WHO.[11] Our results were comparable to those reported by Lupand and coll in the Democratic Republic of the Congo with 20.8% of cases of rifampicin resistance.[10]

In contrast, Boakye-Appiah et al. in Ghana and Ngozika et al. in Nigeria reported lower rates of rifampicin resistance, with 14.4% and 13.3%, respectively.[12],[13] Low rates were reported by Kiady et al. in Madagascar at 2.7% and Elhassan et al. in Saudi Arabia at 4%.[7],[14] The discrepancies may be due to differences in sample size and method used.

In our study, we observed that 54% of rifampicin resistance cases were found in patients who had failed treatment. Our results were similar to those of More et al. in India who found 62.8% of rifampicin resistance in patients who had failed treatment.[6] A lower rate was reported by Boakye-Appiah et al. in Ghana, 17%.[12] In contrast, Yahaya et al. in their study in Zinder reported a higher rate of rifampicin resistance in failed patients (92.8%).

From these results, it can easily be said that the failure of anti-TB treatment is a proven predictive factor for the development of drug-resistant tuberculosis.


  Conclusion Top


At the end of our study carried out at the Maradi Regional Hospital, we found a 20% frequency of resistance of M. tuberculosis to rifampicin. This resistance was related to either therapeutic failure or relapse in almost four out of five cases. Young adult males were the most affected. This study not only emphasized the usefulness of culture to identify mycobacteria and determine their susceptibility to antibiotics but also extended the evaluation of resistance to first-line anti-TB drugs. We recommend that further studies be conducted to deeply investigate reasons for treatment failure and frequency of relapses, crosscut with the categories of TB among the study populations.

Limitation of the study

The limits of this study remain the incompleteness of the registers that we had used. Indeed, some information sought was not available at the appropriate time? This is the major drawback of retrospective studies.

Ethical statement

The study was authorized by the management of the Regional Hospital Center of Maradi.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Mjid M, Cherif J, Ben Salah N, Toujani S, Ouahchi Y, Zakhama H, et al. Epidemiology of tuberculosis. Rev Pneumol Clin 2015;71:67-72.  Back to cited text no. 1
    
2.
Mamane Y, Abdoulaye O, Ousmane L, Harouna Amadou ML, Oumarou A, et al. Evaluation de la resistance du Mycobacterium tuberculosis a la rifampicine dans la région de Zinder, Niger. J Soc Biol Clin Benin 2019;31;6-2. Available from: https://pesquisa.bvsalud.org/gim/resource/fr/biblio-1264241. [Last accessed on 2022 Dec 08].  Back to cited text no. 2
    
3.
Organisation Mondiale de la Santé (OMS). Rapport Sur la Lutte Contre la Tuberculose Dans le Monde. Organisation Mondiale de la Santé; 2017. p. 1. Available from: Global tuberculosis report 2017. [Last accessed on 2022 Dec 08].  Back to cited text no. 3
    
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Ouedraogo SL, Ouedraogo AR, Birba E, Ouedraogo G, Badoum G, Boncoungou Nikiem K, et al. Tuberculose multirésistante à Bobo-Dioulasso: Aspects épidémiologiques, cliniques, radiographiques et evolutifs. RAFMI 2014;1:30-4. Available from: http://rafmi.org/index.php/rafmi/article/view/58. [Last accessed on 2022 Dec 01].  Back to cited text no. 4
    
5.
Rakotoson JL, Raherimandimby H, Rajaoarifetra J, Zafimahita A, Rakotoson L, Raharimbohitra L, et al. GeneXpert MTB/RIF dans un pays à faible revenu GeneXpert revenu: Expérience du service de pneumo-phtisiologie du chu de Fianarantsoa, Madagascar. Rev Médi Madagascar 2013;3:314-7. Available from: https://rmm.mg/storage/pdfs/RMM10-04.PDF. [Last accessed on 2022 Dec 01].  Back to cited text no. 5
    
6.
More SW, Parande MA, Kamble SW, Kamble MS. Profile of drug-resistant tuberculosis in Western Maharashtra. J Family Med Prim Care 2017;6:29-33.  Back to cited text no. 6
[PUBMED]  [Full text]  
7.
Elhassan MM, Hemeg HA, Elmekki MA, Turkistani KA, Abdul-Aziz AA. Burden of multidrug resistant Mycobacterium tuberculosis among new cases in Al-Madinah Al-Monawarah, Saudi Arabia. Infect Disord Drug Targets 2017;17:14-23.  Back to cited text no. 7
    
8.
National Institute of Statistics-Niger. Etat et Structure de la Population du Niger En 2012. National Institute of Statistics, Ministry of Economy and Finance of Niger; 2015. p. 54. Available from: https://www.stat-niger.org/wp-content/uploads/2020/05/ETAT_STRUCTURE_POPULATION.pdf.  Back to cited text no. 8
    
9.
Diop SA, Massaly A, Ka D, Manga NM, Fortes-Déguénonvo L, Ndour CT, et al. Use of the GeneXpert test for the diagnosis of tuberculosis in the infectious diseases department of the CHNU of Fann. Pan Afr Med J 2016;23:1-5. Available from: https://www.ajol.info/index.php/pamj/article/view/139630. [Last accessed on 2022 Dec 01].  Back to cited text no. 9
    
10.
Lupande D, Kaishusha D, Mihigo C, Itongwa M, Yenga G, Katchunga P. GeneXpert MTB/RIF dans le dépistage de la tuberculose pulmonaire à lHopitale provincial generale de reference de Bukavu, à L'Est de la république démocratique du Congo: Quelles leçons tirées après 10 mois d'utilisation? Pan Afri Med J 2017;27:1-7.  Back to cited text no. 10
    
11.
Organisation Mondiale de la Santé (OMS). Global Tuberculosis Report 2017. Organisation Mondiale de la Santé; WHO document 2017. p. 147. Available from: https://www.who.int/fr/news/item/30-10-2017-who-report-signals-urgent-need-for-greater-political-commitment-to-end-tuberculosis. [Last accessed on 2022 Dec 01].  Back to cited text no. 11
    
12.
Boakye-Appiah JK, Steinmetz AR, Pupulampu P, Ofori-Yirenkyi S, Tetteh I, Frimpong M, et al. High prevalence of multidrug-resistant tuberculosis among patients with rifampicin resistance using GeneXpert Mycobacterium tuberculosis/rifampicin in Ghana. Int J Mycobacteriol 2016;5:226-30.  Back to cited text no. 12
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13.
Ngozika WG, Obioma A, Appollus JN. Investigation of rifampicin resistance outcome among tuberculosis patients visiting two major health facilities in port harcourt in Niger Delta. Int J Med Res Health Sci 2018;7:8-14.  Back to cited text no. 13
    
14.
Kiady R, Davidson RI, Michel TH, Anjara N, Lovaniaina RJ. Profil de résistance du Mycobactrium Tuberculosis DES malades en retraitement dans la région de haute Matsiatra, Madagascar. Eur Sci J 2017;15:461-6.  Back to cited text no. 14
    


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  [Figure 1], [Figure 2], [Figure 3]



 

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