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REACTION IMMUNOALLERGIQUE A LETHAMBUTOL : A PROPOS DE 2 CAS

Authors: F. Ait Ahmed, N. Elkhamlichi;

REACTION IMMUNOALLERGIQUE A LETHAMBUTOL : A PROPOS DE 2 CAS

Abstract

La tuberculose represente un probleme majeur de sante publique a travers le monde, enparticulier dans les pays en voie de developpement. La strategie therapeutique est bien standardisee et fait appel a 4 antibiotiques majeurs : LIsoniazide (H), la Rifampicine (R), la Pyrazinamide (Z) et lEthambutol (E). Dautres medicaments peuvent etre utilises en cas de tuberculose multi-resistante ou ultra-resistante ou en cas dintolerance aux medicaments usuels. Ces medicaments peuvent induire de nombreux effets indesirables, parmi lesquels les reactions immunoallergiques qui surviennent dans 5% des cas et pose un reel probleme de prise en charge. Tous les antituberculeux majeurs sont concernes, avec par ordre de frequence la Rifampicine, la Pyrazinamide, lIsoniazide et lEthambutol.Cette reaction allergique peut se manifester par des signes cutanes, hematologiques ou generaux, durant les deux premiers mois du traitement. En fonction du degre de gravite des reactions allergiques, certaines peuvent aboutir a un arret du traitement, les antituberculeux responsables doivent etre identifies afin, si possible, induire une immunotolerance permettant une reprise du traitement en cause. LEthambutol est lantibacillaire le mieux tolere en dehors des atteintes oculaires, les lesions cutanees les plus frequentes sont comparables a celles decrites pour les autres antituberculeux, il peut sagir dun prurit, un rash cutane le plus souvent, avec possibilite de forme grave notamment le Syndrome de Stevens-Johnson.La desensibilisation au traitement antibacillaire consiste a induire une tolerance temporaire aux medicaments responsables de la reaction immunoallergique en introduisant des dosescroissantes de la molecule en question sur une courte periode de temps jusqua ce que la dose cumulative therapeutique soit atteinte et toleree.Nous rapportons 2 cas de reactions immunoallergiques a lEthambutol colliges auservice dePneumo-phtisiologie de lHopital Moulay Youssef, centre hospitalier Ibn Sina de Rabat, Maroc. Un protocole de desensibilisation a la molecule responsable a ete instaure chez lune de nos patientes mais arrete devant la reapparition des meme lesions cutanees a la dose de 15 mg, notre 2 eme patiente presentait une forme de tuberculose pauci bacillaire, nous avons decide darreter definitivement lEthmabutol pour les deux patientes et de prolonger le traitement de 3 mois selon le schema 2RHZ/7RH.

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Keywords

Tuberculose Traitement Antibacillaire Reaction Immunoallergique Ethambutol Desensibilisation

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popularity
This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.
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influence
This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
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