Global control of tuberculosis: from extensively drug-resistant to untreatable tuberculosis.
Global control of tuberculosis: from extensively drug-resistant to untreatable tuberculosis.
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DOI：
10.1016/s2213-2600(14)70031-1
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发表时间：
2014-04
期刊：
影响因子：
--
通讯作者：
Warren R
中科院分区：
文献类型：
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作者：
Dheda K;Gumbo T;Gandhi NR;Murray M;Theron G;Udwadia Z;Migliori GB;Warren R
广泛耐药结核病是一种新兴的全球健康危机，主要影响从事经济活动的年轻人，无论是否感染艾滋病毒，其死亡率都很高。在南非等一些国家，耐药结核病占所有病例的比例不到3%，但却消耗了国家结核病总预算的三分之一以上，这是不可持续的，并有可能破坏国家结核病规划的稳定。然而，对耐药结核病的关注已被对完全和极端耐药结核病的关注所掩盖，即对所有或几乎所有常规一线和二线抗结核药物的耐药性。在这篇综述中，我们讨论了广泛耐药结核病和其他耐药菌株的流行病学、发病机制、诊断、管理、对卫生保健工作者的影响以及伦理和医学法律方面的问题。最后，我们讨论了功能上无法治疗的结核病的新问题，以及它对公共卫生和临床实践构成的问题和挑战。高度耐药结核病菌株的出现和增长使得开发新的结核病药物和快速诊断方法以及增加资金以加强全球控制工作、研究和宣传变得更加紧迫。
Extensively drug-resistant tuberculosis is a burgeoning global health crisis mainly affecting economically active young adults, and has high mortality irrespective of HIV status. In some countries such as South Africa, drug-resistant tuberculosis represents less than 3% of all cases but consumes more than a third of the total national budget for tuberculosis, which is unsustainable and threatens to destabilise national tuberculosis programmes. However, concern about drug-resistant tuberculosis has been eclipsed by that of totally and extremely drug-resistant tuberculosis—ie, resistance to all or nearly all conventional first-line and second-line antituberculosis drugs. In this Review, we discuss the epidemiology, pathogenesis, diagnosis, management, implications for health-care workers, and ethical and medicolegal aspects of extensively drug-resistant tuberculosis and other resistant strains. Finally, we discuss the emerging problem of functionally untreatable tuberculosis, and the issues and challenges that it poses to public health and clinical practice. The emergence and growth of highly resistant strains of tuberculosis make the development of new drugs and rapid diagnostics for tuberculosis—and increased funding to strengthen global control efforts, research, and advocacy—even more pressing.