Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Health Sciences, Stellenbosch University, and Tygerberg Children's Hospital, PO Box 19063, Tygerberg 7505, South Africa.
Clin Chest Med. 2009 Dec;30(4):667-83, vii-viii. doi: 10.1016/j.ccm.2009.08.019.
Available data show that Africa, together with the Americas and western and central Europe, reported the lowest prevalence of multidrug-resistant tuberculosis (MDR-TB). However, sub-Saharan Africa has a high TB incidence and the highest human immunodeficiency virus (HIV) prevalence in the world, and because of the high number of TB cases, Africa still presents 14% of the global burden of new MDR-TB cases. Until recently, Africa and South America were deprived of second-line antituberculosis drugs, preventing the development of extensively drug-resistant TB (XDR-TB). Current efforts, introducing improved laboratory infrastructure and second-line TB treatment in resource-limited countries, need to be carried out with care to minimize the development of MDR/XDR-TB in these countries. Recent diagnostic developments now need evaluation and implementation in resource-limited areas, and delays in diagnosis also need to be addressed. Outcomes for MDR/XDR-TB have improved, but prevention of MDR/XDR-TB by early diagnosis and treatment, improvement of adherence, and proper infection control remains the mainstay for the future.
现有数据表明，非洲与美洲以及西欧和中欧报告的耐多药结核病（MDR-TB）患病率最低。然而，撒哈拉以南非洲的结核病发病率很高，而且是世界上艾滋病毒（HIV）流行率最高的地区，由于结核病病例数量众多，非洲仍然占全球新出现的耐多药结核病病例的 14%。直到最近，非洲和南美洲都缺乏二线抗结核药物，从而阻碍了广泛耐药结核病（XDR-TB）的发展。在资源有限的国家中，目前正在努力引入改进的实验室基础设施和二线结核病治疗，但需要谨慎进行，以尽量减少这些国家中耐多药/广泛耐药结核病的发展。最近的诊断进展现在需要在资源有限的地区进行评估和实施，而且还需要解决诊断延误的问题。耐多药/广泛耐药结核病的治疗结果有所改善，但是早期诊断和治疗、提高治疗依从性以及适当的感染控制仍然是未来的主要措施，以预防耐多药/广泛耐药结核病的发生。
