Augustynowicz-Kopeć Ewa, Zwolska Zofia
Instytut Gruźlicy i Chorób Płuc w Warszawie Zakład Mikrobiologii, Krajowe Referencyjne Laboratorium Pratka Gruźlicy.
Przegl Epidemiol. 2008;62(1):113-21.
At present despite methods of fast recognition of the disease and efficient antituberculosis drugs not only we cannot contain the epidemic but we can see an increase in new cases of tuberculosis including its drug resistant variety. Causes of aggravation of the situation are varied and ought to be examined separately in case of any particular region. One of the major ones are bad programmes of fighting against the disease or their inadequate realization, ignoring a problem of tuberculosis in developed countries, lack of money for treatment in developing countries and coincidence with HIV virus. Among the mentioned factors the phenomenon of drug resistance is considered one of most important reasons of expansion of tuberculosis in the modern world. In epidemiological investigations it is important to determine, apart from drug resistance patterns, what molecular families strains belong to. This allows us to track their transmission routes. Genotyping has given us knowledge of the threats connected with transmission of the infection and made it possible to identify a risk factor which is the cause of MDR (multidrug-resistant), XDR (extensively drug-resistant tuberculosis) strains dissemination as well as strains representing new molecular families. Results of some analyses proved to be surprising. For instance high proportion of genetically similar strains has been shown in countries of low incidence. It proves higher than expected transmission in societies of high economic standard. Analyses of DNA of mycobacteria led to distinguishing several genetic families among which M. tuberculosis Beijing is one of most important.
目前,尽管有疾病快速识别方法和高效抗结核药物,但我们不仅无法遏制这一流行病,而且还看到结核病新病例有所增加,包括耐药性结核病。情况恶化的原因多种多样,在任何特定地区都应分别进行研究。其中一个主要原因是抗击该疾病的方案不佳或实施不力,发达国家忽视结核病问题,发展中国家缺乏治疗资金,以及与艾滋病毒同时感染。在上述因素中,耐药现象被认为是现代世界结核病蔓延的最重要原因之一。在流行病学调查中,除了耐药模式外,确定菌株所属的分子家族也很重要。这使我们能够追踪它们的传播途径。基因分型让我们了解了与感染传播相关的威胁,并使识别一个风险因素成为可能,该风险因素是耐多药、广泛耐药结核菌株传播以及代表新分子家族的菌株传播的原因。一些分析结果令人惊讶。例如,在低发病率国家发现了高比例的基因相似菌株。这证明在高经济水平社会中的传播高于预期。对分枝杆菌DNA的分析导致区分出几个基因家族,其中结核分枝杆菌北京家族是最重要的家族之一。