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Master Thesis

Épidémiologie des infections à mycobactéries non tuberculeuses d’expression respiratoire en Guyane française, étude rétrospective 2008-2018

Abstract : Introduction: In French Guiana, the epidemiology of respiratory infections caused by pulmonary nontuberculous mycobacteria (PNTM) has been little studied. The main objective of this study was to determine the characteristics of the patients infected by PNTM in French Guiana. Secondary objectives were to determine the incidence of these infections, to study microbiological diversity, and to enhance factors associated with NTM pulmonary disease (NTM-PD), specific characteristics of patients infected with Mycobacterium avium complex (MAC) or M. abscessus and those with patients infected with HIV. Methods: This is a retrospective, observational analysis of patients who had at least one NTM-PD positive breath test culture between 2008 and 2018, performed in all hospitals in French Guiana. Patients were classified as healthy carriers or with NTM-PD according to the clinical, radiological and microbiological criteria defined by the American Thoracic Society / Infectious Disease Society of America (ATS / IDSA) in 2007. Results: On the study period, 178 cases were included, of which 147 were healthy carriers and 31 real diseases. Patients were more likely to be male (61%), rather young (median age 49 years), living in precariousness (64%), with respiratory co-morbidities (33%), or immunosuppression due to HIV with CD4 <50 / mm3 in 39% of the 46% of HIV-positive patients. MAC followed by M. fortuitum and M. abscessus were the most frequent evidenced species (38%, 19% and 6% respectively). The average annual incidence rate of isolates was 6.17 / 100,000 population per year, while the mean NTM–PD rate was 1.07 / 100,000 per year. NTM-PD was significantly associated with HIV infection, undernutrition, and MAC and M. abscessus species, which represented 81% and 16%, respectively, of PNTM lung diseases. One-year all-cause mortality was 29% in proven patients. Discussion/Conclusion: This is the first study conducted on PNTM infection in French Guiana, and there are few studies of this magnitude in Latin America. The epidemiology of PNTM in French Guiana is specific with a population different from that of metropolitan France. MAC and M. abscessus are the species responsible for respiratory diseases favored by HIV infection, or by respiratory co-morbidities and undernutrition, respectively. HIV characteristics are different and the ATS / IDSA criteria are not extrapolable, making diagnosis difficult. Particular attention should be paid to the management of these infections because of mortality more important than in metropolitan France.
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Milène Chaptal. Épidémiologie des infections à mycobactéries non tuberculeuses d’expression respiratoire en Guyane française, étude rétrospective 2008-2018. Pneumologie et système respiratoire. 2019. ⟨dumas-02872475⟩

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