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. 2024 Feb 5;4(1):mtsi.v4i1.2024.298.
doi: 10.48327/mtsi.v4i1.2024.298. eCollection 2024 Mar 31.

[Contribution of qPCR to the diagnosis of cervico-vaginal infections at the Hôpital Principal de Dakar, Senegal]

[Article in French]
Aminata Sarif Diallo  1   2 , Mor Ngom  2 , Sokhna Moumy Mbacké Daffe  2 , Hubert Bassène  3 , Masse Sambou  3 , Yakhya Dieye  4 , Bécaye Fall  2 , Cheikh Sokhna  3
Affiliations

[Contribution of qPCR to the diagnosis of cervico-vaginal infections at the Hôpital Principal de Dakar, Senegal]

[Article in French]
Aminata Sarif Diallo et al. Med Trop Sante Int. .

Abstract
in English, French

Objective: To determine the etiology of cervico-vaginal infections by cytobacteriology and the efficacy of qPCR for the diagnosis of sensitive strains such as Streptococcus agalactiae, Borrelia crocidurae, Chlamydia trachomatis, Neisseria gonorrhoeae and Treponema pallidum.

Methodology: This prospective cross-sectional study was performed between January and September 2021 in 346 women who were examined for cervico-vaginal infection at the Hôpital Principal de Dakar (HPD). Cytobacteriological (direct examination, agar culture) and molecular analyses were performed.

Results: Vaginal flora imbalances predominated, with a rate of 72.3%. The proportion of type IV vaginal flora was 46.5%. Of the 199 germs isolated, Candida albicans (25.1%), Ureaplasma urealyticum (17.6%), S. agalactiae (7.8%), Gardnerella vaginalis (6.6%) and nonalbicans Candida (5.5%) were the main pathogens responsible for cervico-vaginal infections in patients. Among women tested for mycoplasma, U. urealyticum was identified in 43.3% of patients. Among those tested for C. trachomatis, the proportion of infected women was low (4%). The prevalence of C. albicans was higher in pregnant women (38.3%) than in nonpregnant women (19.2%). S. agalactiae strains showed high resistance to certain beta-lactam antibiotics (pristinamycin 100%, gentamycin 100%, ampicillin 92.5% and cefalotin 85.2%) and to a glycopeptide antibiotic (vancomycin 100%). The Staphylococcus aureus strain had good sensitivity to antibiotics except gentamycin (100%) and kanamycin (100%). The enterobacteria tested were all sensitive to phenicols, carbapenems, cephalosporins and aminoglycosides. However, E. coli showed high resistance to tetracycline. The different methods showed low prevalences of C. trachomatis and N. gonorrhoeae, so comparisons Test RapidChlamydia/qPCR for C. trachomatis and culture/qPCR for N. gonorrhoeae were not possible. For S. agalactiae, on the other hand, qPCR was more advantageous than culture. The χ2 test showed a significant difference (Yates χ2 = 33.77 and p = 1-7) for the diagnosis of S. agalactiae. S. agalactiae qPCR had a sensitivity of 40.7%, a specificity of 94%, and positive and negative predictive values of 36.7% and 94.9% respectively, as well as a kappa = 0.33.

Conclusion: The methods applied enabled us to identify the pathogens that cause cervicovaginal infections. The results suggest that qPCR may be an alternative, at least for the diagnosis of S. agalactiae. However, culture remains indispensable for studying antibiotic sensitivity. In order to improve patient care, molecular techniques need to be integrated into the HPD testing toolbox. To broaden the repertoire of pathogens to be diagnosed by qPCR, targeted comparison studies will be needed to increase the probability of encountering infected individuals.

Objectif: Déterminer l’étiologie des infections cervico-vaginales par la cytobactériologie et l'efficacité de la qPCR pour le diagnostic des souches sensibles telles que Streptococcus agalactiae, Borrelia crocidurae, Chlamydia trachomatis, Neisseria gonorrhoeae et Treponema pallidum.

Méthodologie: Étude prospective transversale effectuée entre janvier et septembre 2021 chez 346 femmes reçues à l'Hôpital Principal de Dakar pour une infection cervico-vaginale. Des analyses cytobactériologiques et moléculaires ont été réalisées.

Résultats: Les déséquilibres de la flore vaginale ont été prédominants, avec un taux de 72,3 %. La proportion des flores vaginales de type IV a été de 46,5 %. Sur les 199 germes isolés, Candida albicans (25,1 %), Ureaplasma urealyticum (17,6 %), S. agalactiae (7,8 %), Gardnerella vaginalis (6,6 %) et Candida non-albicans (5,5 %) ont été les principaux pathogènes responsables des infections cervico-vaginales chez les patientes. Chez les femmes concernées par une recherche de mycoplasmes, U. urealyticum a été identifié chez 43,3 % des patientes. Chez celles qui étaient concernées par une recherche de C. trachomatis, la proportion de femmes infectées a été faible (4 %). Les différentes méthodes ayant montré de faibles prévalences de C. trachomatis et de N. gonorrhoeae, les comparaisons Test RapidChlamydia/qPCR pour C. trachomatis et culture/qPCR pour N. gonorrhoeae n'ont pas été possibles. Par contre, pour S. agalactiae, la qPCR a été plus avantageuse que la culture. Les isolats de S. agalactiae et d'entérobactéries présentaient successivement une résistance élevée à l'acide nalidixique et à l'ampicilline.

Conclusion: Les méthodes appliquées ont permis d'identifier les pathogènes qui sont à l'origine des infections cervico-vaginales. Les résultats suggèrent que la qPCR peut être une alternative au moins pour le diagnostic de S. agalactiae. Cependant la culture reste indispensable pour étudier la sensibilité aux antibiotiques. Dans un souci d'amélioration de la prise en charge des patientes, les techniques moléculaires doivent être intégrées dans la panoplie des tests à l'Hôpital Principal de Dakar (HPD).

Keywords: Cervico-vaginal infections; Cytobacteriology; Dakar; Hospital; Senegal; Sub-Saharan Africa; qPCR.

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