Extensively Drug-resistant Tuberculosis: Epidemiology and Management Challenges

被引：44

作者：

Dheda, Keertan ^{[1
,2
,3
,4
]}

Warren, Robin M. ^{[5
]}

Zumla, Alimuddin ^{[4
]}

Grobusch, Martin P. ^{[6
,7
]}

机构：

[1] Univ Cape Town, Dept Med, UCT Lung Inst, ZA-7925 Cape Town, South Africa

[2] Univ Cape Town, Dept Med, Lung Infect & Immun Unit, Div Pulmonol & Clin Immunol, ZA-7925 Cape Town, South Africa

[3] Univ Cape Town, Inst Infect Dis & Mol Med, ZA-7925 Cape Town, South Africa

[4] UCL Med Sch, Dept Infect, Ctr Infect Dis & Int Hlth, Windeyer Inst Med Sci, London W1T 4JF, England

[5] Univ Stellenbosch, DST NRF Ctr Excellence Biomed TB Res MRC, Ctr Mol & Cellular Biol, Div Mol Biol & Human Genet,Fac Hlth Sci, ZA-7505 Tygerberg, South Africa

[6] Univ Amsterdam, Amsterdam Med Ctr, Amsterdam, Netherlands

[7] Albert Schweitzer Hosp, Med Res Unit, Lambarene, Gabon

来源：

INFECTIOUS DISEASE CLINICS OF NORTH AMERICA | 2010年 / 24卷 / 03期

基金：

英国医学研究理事会; 新加坡国家研究基金会;

关键词：

Extensively drug-resistant tuberculosis; Human; Epidemiology; Survival; HIV; MULTICENTER LABORATORY VALIDATION; MYCOBACTERIUM-TUBERCULOSIS; MULTIDRUG-RESISTANT; XDR-TB; NOSOCOMIAL TRANSMISSION; EXOGENOUS REINFECTION; ANTIBIOTIC-RESISTANCE; POPULATION-STRUCTURE; ANTIMICROBIAL DRUGS; CLASSICAL; 2ND-LINE;

D O I：

10.1016/j.idc.2010.05.001

中图分类号：

R392 [医学免疫学]; Q939.91 [免疫学];

学科分类号：

100102 ;

摘要：

Widespread global use of rifampin for 2 decades preceded the emergence of clinically significant multidrug-resistant tuberculosis (MDR-TB) in the early 1990s. The prevalence of MDR-TB has gradually increased such that it accounts for similar to 5% of the global case burden of disease (approximately half a million cases in 2007). Eclipsing this worrying trend is the widespread emergence of extensively drug-resistant TB (XDR-TB). This article reviews the insights provided by clinical and molecular epidemiology regarding global trends and transmission dynamics of XDR-TB, and the challenges clinicians have to face in diagnosing and managing cases of XDR-TB. The ethical and management dilemmas posed by recurrent defaulters, XDR-TB treatment failures, and isolation of incurable patients are also discussed. Given the past global trends in MDR-TB, if aggressive preventive and management strategies are not implemented, XDR-TB has the potential to severely cripple global control efforts of TB.

引用

页码：705 / +

页数：23

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