Drug-Resistant Tuberculosis-Current Dilemmas, Unanswered Questions, Challenges, and Priority Needs

被引：126

作者：

Zumla, Alimuddin ^{[1
]}

Abubakar, Ibrahim ^{[2
]}

Raviglione, Mario ^{[3
]}

Hoelscher, Michael ^{[4
]}

Ditiu, Lucica ^{[5
]}

Mchugh, Timothy D.

Squire, S. Bertel ^{[6
]}

Cox, Helen ^{[7
]}

Ford, Nathan ^{[8
,9
]}

McNerney, Ruth ^{[10
]}

Marais, Ben ^{[11
,12
]}

Grobusch, Martin ^{[13
]}

Lawn, Stephen D. ^{[14
,15
]}

Migliori, Giovanni-Battista ^{[16
]}

Mwaba, Peter ^{[17
,18
,19
]}

O'Grady, Justin

Pletschette, Michel ^{[20
,21
]}

Ramsay, Andrew ^{[22
]}

Chakaya, Jeremiah ^{[23
,24
]}

Schito, Marco ^{[25
,26
]}

Swaminathan, Soumya ^{[27
]}

Memish, Ziad ^{[28
,29
]}

Maeurer, Markus ^{[30
,31
]}

Atun, Rifat ^{[32
,33
]}

机构：

[1] Royal Free Hosp, Univ Coll London, Sch Med, Ctr Clin Microbiol,Div Infect & Immun, London NW3 2PF, England

[2] Hlth Protect Agcy, Hlth Protect Serv, London, England

[3] WHO, STOP TB Dept, CH-1211 Geneva, Switzerland

[4] Univ Munich, Dept Infect Dis & Trop Med, Munich, Germany

[5] WHO, STOP TB Partnership, CH-1211 Geneva, Switzerland

[6] Univ Liverpool, Liverpool Sch Trop Med, Liverpool L3 5QA, Merseyside, England

[7] Med Sans Frontieres, Cape Town, South Africa

[8] Med Sans Frontieres, Geneva, Switzerland

[9] Univ Cape Town, Ctr Infect Dis Epidemiol & Res, ZA-7700 Rondebosch, South Africa

[10] London Sch Hyg & Trop Med, Dept Pathogen Mol Biol, Fac Infect & Trop Dis, London, England

[11] Univ Sydney, Sydney Med Sch, Childrens Hosp Westmead, Sydney, NSW 2006, Australia

[12] Univ Sydney, Sydney Emerging Infect Dis & Biosecur Inst, Sydney, NSW 2006, Australia

[13] Univ Amsterdam, Acad Med Ctr, Div Internal Med, Dept Infect Dis, NL-1012 WX Amsterdam, Netherlands

[14] Univ Cape Town, Inst Infect Dis & Mol Med, Desmond Tutu HIV Ctr, ZA-7925 Cape Town, South Africa

[15] London Sch Hyg & Trop Med, Fac Infect & Trop Dis, London, England

[16] Fdn S Maugeri Care & Res Inst, WHO Collaborating Ctr TB & Lung Dis, Tradate, Italy

[17] Minist Hlth, Lusaka, Zambia

[18] Univ Zambia, Lusaka, Zambia

[19] Univ Coll London, Med R&D Project, Lusaka, Zambia

[20] Commiss European Communities, Unit Evaluat, B-1049 Brussels, Belgium

[21] Commiss European Communities, Audit Directorate Publ Hlth, B-1049 Brussels, Belgium

[22] WHO, UNICEF, UNDP, World Bank,WHO Special Programme Res & Training T, CH-1211 Geneva, Switzerland

[23] Kenya Govt Med Res Ctr, Ctr Resp Dis Res, Nairobi, Kenya

[24] Minist Hlth, Natl TB Programme, Nairobi, Kenya

[25] NIAID, Vaccine Clin Res Branch, Div Acquired Immunodeficiency Syndrome, NIH, Bethesda, MD USA

[26] Henry M Jackson Fdn Adv Mil Med Bethesda, Bethesda, MD USA

[27] Natl Inst Res TB, Madras, Tamil Nadu, India

[28] Alfaisal Univ, Coll Med, Riyadh, Saudi Arabia

[29] Alfaisal Univ, Minist Hlth, Riyadh, Saudi Arabia

[30] Karolinska Inst, Dept Microbiol Tumor & Cell Biol, Stockholm, Sweden

[31] Karolinska Inst, Dept Lab Med, Ctr Allogene Stem Cell Transplantat CAST, Stockholm, Sweden

[32] Global Fund Fight AIDS TB & Malaria, Geneva, Switzerland

[33] Univ London Imperial Coll Sci Technol & Med, London, England

来源：

JOURNAL OF INFECTIOUS DISEASES | 2012年 / 205卷

关键词：

MYCOBACTERIUM-TUBERCULOSIS; TREATMENT OUTCOMES; SOUTH-AFRICA; CHILDHOOD TUBERCULOSIS; CHILDREN; DIAGNOSIS; TB; MANAGEMENT; CLARITHROMYCIN; IMPLEMENTATION;

D O I：

10.1093/infdis/jir858

中图分类号：

R392 [医学免疫学]; Q939.91 [免疫学];

学科分类号：

071005 [微生物学]; 100108 [医学免疫学];

摘要：

Tuberculosis was declared a global emergency by the World Health Organization (WHO) in 1993. Following the declaration and the promotion in 1995 of directly observed treatment short course (DOTS), a cost-effective strategy to contain the tuberculosis epidemic, nearly 7 million lives have been saved compared with the pre-DOTS era, high cure rates have been achieved in most countries worldwide, and the global incidence of tuberculosis has been in a slow decline since the early 2000s. However, the emergence and spread of multidrug-resistant (MDR) tuberculosis, extensively drug-resistant (XDR) tuberculosis, and more recently, totally drug-resistant tuberculosis pose a threat to global tuberculosis control. Multidrug-resistant tuberculosis is a man-made problem. Laboratory facilities for drug susceptibility testing are inadequate in most tuberculosis-endemic countries, especially in Africa; thus diagnosis is missed, routine surveillance is not implemented, and the actual numbers of global drug-resistant tuberculosis cases have yet to be estimated. This exposes an ominous situation and reveals an urgent need for commitment by national programs to health system improvement because the response to MDR tuberculosis requires strong health services in general. Multidrug-resistant tuberculosis and XDR tuberculosis greatly complicate patient management within resource-poor national tuberculosis programs, reducing treatment efficacy and increasing the cost of treatment to the extent that it could bankrupt healthcare financing in tuberculosis-endemic areas. Why, despite nearly 20 years of WHO-promoted activity and > 12 years of MDR tuberculosis-specific activity, has the country response to the drug-resistant tuberculosis epidemic been so ineffectual? The current dilemmas, unanswered questions, operational issues, challenges, and priority needs for global drug resistance screening and surveillance, improved treatment regimens, and management of outcomes and prevention of DR tuberculosis are discussed.

引用

页码：S228 / S240

页数：13

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