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Genexpert Contribution in the Diagnosis of Tuberculosis and Resistance to Rifampicin in the Haute Matsiatra Region of Madagascar
Published onJun 13, 2023
Genexpert Contribution in the Diagnosis of Tuberculosis and Resistance to Rifampicin in the Haute Matsiatra Region of Madagascar
Aims: In Madagascar, the methods for diagnosing tuberculosis are insufficient and are essentially based on microscopy which has low sensitivity and constitute a real obstacle to the control of tuberculosis. GeneXpert is a molecular test that allows the rapid detection of Mycobacterium tuberculosis and resistance to rifampicin. It is recommended by the WHO as an alternative to microscopy and culture. This study aimed to determine the contribution of GeneXpert in the diagnosis of tuberculosis in the region of Haute Matsiatra Fianarantsoa
Methods : In this descriptive cross-sectional study, from January 2017 to December 2019, pulmonary and extra-pulmonary samples from suspected tuberculosis patients were enrolled and screened for M. tuberculosis using GeneXpert MTB/RIF, Ziehl–Neelsen stain and mycobacterial culture (gold standard).
Result : A total of 1017 cases of suspected tuberculosis were collected. Patients belonged to the age group of 0 to 20 years in 33.92% of cases with a sex ratio of 1, 66. GeneXpert prescriptions came from hospitalized patients in 69.81% of cases, dominated by pediatrics (37.75%) and pulmonology (32.96%) units. Most of the analyzed samples were represented by sputum (73.84%). The GeneXpert positivity rate for tuberculosis was 41.49% (general result), it was variable depending on the type of sample.The majority of samples positive for GeneXpert were of pulmonary location (38.25%). The frequency of rifampicin resistance was 8.29%. Sensitivity and specificity of GeneXpert was 96,01% compared with mycobacterial culture as gold standard. Five GeneXpert positive cases were not detected by Ziehl-Neelsen staining microscopy.
Conclusion : GeneXpert is a quick and helpful method for the early diagnosis of tuberculosis and rifampicin-resistance in regions with high rates of multidrug resistance. GeneXpert was a great contribution to the diagnosis of pulmonary and extrapulmonary tuberculosis but do not replace bacilloscopy and culture.
