Lung Infection and Immunity Unit, Division of Pulmonology and UCT Lung Institute, Department of Medicine, University of Cape Town, Cape Town, South Africa; Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town, South Africa.
Office of Global Health and Department of Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Lancet Respir Med. 2014 Apr;2(4):321-38. doi: 10.1016/S2213-2600(14)70031-1. Epub 2014 Mar 24.
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.
广泛耐药结核病是一种正在迅速蔓延的全球卫生危机，主要影响经济活跃的年轻成年人，无论 HIV 状况如何，其死亡率都很高。在南非等一些国家，耐药结核病不到所有病例的 3%，但却消耗了全国结核病预算的三分之一以上，这种情况不可持续，有可能破坏国家结核病规划的稳定。然而，人们对广泛耐药结核病的关注已经被完全和极端耐药结核病所掩盖，即对所有或几乎所有传统一线和二线抗结核药物都产生耐药性。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、治疗、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这一新兴问题，以及它对公共卫生和临床实践带来的问题和挑战。结核病高度耐药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。
