TB or not TB: a disease forgotten, but not gone.
TB or not TB: a disease forgotten, but not gone.
复制标题
结核病或非结核病：一种被遗忘的疾病，但并未消失。
DOI：
10.1111/j.1865-1682.2009.01084.x
复制
发表时间：
2009
影响因子：
4.3
通讯作者：
Coffey TJ
中科院分区：
文献类型：
--
作者：
Coffey TJ
作为一个健康问题，结核病并不像人类免疫缺陷病毒（艾滋病毒）/获得性免疫缺陷综合症（艾滋病）那样引人注目。人类结核病，主要由结核分枝杆菌引起，通常表现在肺（肺），但也可以影响身体的其他部位（肺外）。全世界每年有900万新发结核病病例，近200万人死于结核病，结核病是可治愈的传染病中的主要死因。与艾滋病毒合并感染和多重耐药菌株的出现导致结核病仍然是一个全球性挑战。尽管世界卫生组织（世卫组织）推荐的一种高效、低成本的技术治疗方法--直接观察短期治疗（DOTS）已帮助治愈了约2000万患者，但自1990年以来，在21个艾滋病毒感染率高的非洲国家，艾滋病的发病率增加了两倍。在非洲，结核病病例每年以3%至4%的速度增加，给长期贫穷和不足的卫生设施带来了进一步的压力。我们需要做些什么来应对结核病流行的上升？卫生专家列出了一些他们认为将大大有助于应对这种日益致命的疾病的措施。这些措施包括改进诊断检测，开发新的疫苗、药物和治疗制度，开展社会研究以降低疾病风险，解决贫困问题，以及更严格地审查结核病和艾滋病毒合并感染以及耐多药结核病的传播。显然，上述所有措施，尽管绝不是详尽无遗的，但对于应对结核病死灰复燃构成的重大全球卫生挑战至关重要，特别是在非洲。然而，这些措施中的许多措施并不限于人类结核病，但也可以直接转移到牛结核病。人类结核病不一定仅由结核分枝杆菌引起，这一事实加剧了非洲的情况。牛M.牛，可能代表未被认识的发病和死亡原因。虽然大多数病例是由M.由于结核病，目前尚无关于结核杆菌引起的人类疾病发病率的可靠信息。牛传染性疾病，特别是在发展中国家，诊断基于显微镜检查，区分这两种生物的技术并不普及。牛分枝杆菌感染在19世纪末和20世纪初是重要的，并且占欧洲人类TB的很大一部分。随着牛和人类更好的住房，巴氏杀菌和牛的根除计划的实施，人类M。牛感染率下降。M.现在估计牛占大多数工业化国家人类结核病的< 1%，但被认为在特定地区和人群中更普遍。近年来，M.野生动物体内的牛支原体是这种疾病的宿主，这阻碍了M.从牛身上分离出来。在英国，獾可能作为感染的宿主发挥重要作用，而其他动物，如鹿和负鼠在其他国家可能作为宿主，导致感染M的牛群被屠宰、检疫和灭绝。牛、失去宝贵的血统以及限制宝贵的育种动物和精液的国际出口。M的重要性。在许多国家的野生动物种群中，牛的感染已被记录，但在许多发展中国家，关于M.家畜或野生种属的牛感染。巴氏杀菌法通常是…
As a health problem, tuberculosis (TB) does not attract the same high profile of human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS). Human TB, caused primarily by Mycobacterium tuberculosis, usually manifests in the lungs (pulmonary), but can also affect other parts of the body (extra-pulmonary). With 9 million new cases of TB and nearly 2 million deaths from TB around the world every year, it is the leading cause of death among curable infectious diseases. Co-infection with HIV and the emergence of multidrug resistant strains has contributed to TB remaining a global challenge. While the Directly Observed Treatment Short course (DOTS), a highly effective low cost technology treatment recommended by the World Health Organization (WHO), has helped to cure about 20 million patients, incidence of the disease has tripled since 1990 in 21 African countries with high levels of HIV. Tuberculosis cases are increasing at rates of between 3% and 4% per annum in Africa, putting further pressure on chronically poor and inadequate health facilities. What needs to be done to combat the rising epidemic of TB? Health experts have listed a number of measures they believe will go a long way towards tackling this increasingly deadly disease. These include improving diagnostic testing, developing new vaccines, drugs and treatment regimes, conducting social research to reduce the risk of the disease, addressing the issue of poverty and examining more critically the spread of TB and HIV co-infection and multidrug resistant TB. Clearly all the above, although they are by no means exhaustive, are crucial for meeting the big global health challenges posed by a resurgent TB, particularly in Africa. However, many of these measures are not exclusive for human TB, but can directly be transferred to bovine TB as well. The situation in Africa is exacerbated by the fact that human TB may not necessarily be caused by Mycobacterium tuberculosis alone. Its bovine counterpart, M. bovis, may represent an unrecognized cause of morbidity and mortality. Although most cases are caused by M. tuberculosis, reliable information is not generally available on the incidence of human disease caused by M. bovis, especially in developing countries, where diagnosis is based on microscopic examination and techniques for differentiating the two organisms are not widely accessible. Mycobacterium bovis infection in humans was important in the late 19th and early 20th centuries, and accounted for a substantial portion of human TB in Europe. With the implementation of better housing for cattle and humans, pasteurization and the development of eradication programmes in cattle, reports of human M. bovis infection decreased. M. bovis is now estimated to account for< 1% of human TB in most industrialized countries, but is thought be more prevalent in particular areas and populations. Recently, outbreaks of M. bovis in wild animals, which act as a reservoir for the disease, have frustrated the eradication of M. bovis from cattle. Whereas in the UK, badgers may play an important role as a reservoir for infection, other animals, such as cervids (deer) and possums may act as reservoirs in other nations, resulting in the slaughter, quarantine and depopulation of cattle herds infected with M. bovis, loss of valuable blood lines, and limitations on the international export of valuable breeding animals and semen. The importance of M. bovis infections in wild animal populations in many countries has been documented, but in many developing countries no definitive information is available about the scale of M. bovis infection in domestic or wild species. Pasteurization is often …