西非广泛耐药前结核病的新出现威胁：为大规模结核病研究和耐药监测做准备。
The emerging threat of pre-extensively drug-resistant tuberculosis in West Africa: preparing for large-scale tuberculosis research and drug resistance surveillance.
作者信息
Gehre Florian, Otu Jacob, Kendall Lindsay, Forson Audrey, Kwara Awewura, Kudzawu Samuel, Kehinde Aderemi O, Adebiyi Oludele, Salako Kayode, Baldeh Ignatius, Jallow Aisha, Jallow Mamadou, Dagnra Anoumou, Dissé Kodjo, Kadanga Essosimna A, Idigbe Emmanuel Oni, Onubogu Catherine, Onyejepu Nneka, Gaye-Diallo Aissatou, Ba-Diallo Awa, Rabna Paulo, Mane Morto, Sanogo Moumine, Diarra Bassirou, Dezemon Zingue, Sanou Adama, Senghore Madikay, Kwambana-Adams Brenda A, Demba Edward, Faal-Jawara Tutty, Kumar Samrat, Tientcheu Leopold D, Jallow Adama, Ceesay Samba, Adetifa Ifedayo, Jaye Assan, Pallen Mark J, D'Alessandro Umberto, Kampmann Beate, Adegbola Richard A, Mboup Souleymane, Corrah Tumani, de Jong Bouke C, Antonio Martin
机构信息
Vaccines and Immunity Theme, Medical Research Council Unit The Gambia, Banjul, The Gambia.
Institute of Tropical Medicine, Antwerp, Belgium.
出版信息
BMC Med. 2016 Nov 3;14(1):160. doi: 10.1186/s12916-016-0704-5.
BACKGROUND
Drug-resistant tuberculosis (TB) is a global public health problem. Adequate management requires baseline drug-resistance prevalence data. In West Africa, due to a poor laboratory infrastructure and inadequate capacity, such data are scarce. Therefore, the true extent of drug-resistant TB was hitherto undetermined. In 2008, a new research network, the West African Network of Excellence for Tuberculosis, AIDS and Malaria (WANETAM), was founded, comprising nine study sites from eight West African countries (Burkina Faso, The Gambia, Ghana, Guinea-Bissau, Mali, Nigeria, Senegal and Togo). The goal was to establish Good Clinical Laboratory Practice (GCLP) principles and build capacity in standardised smear microscopy and mycobacterial culture across partnering laboratories to generate the first comprehensive West African drug-resistance data.
METHODS
Following GCLP and laboratory training sessions, TB isolates were collected at sentinel referral sites between 2009-2013 and tested for first- and second-line drug resistance.
RESULTS
From the analysis of 974 isolates, an unexpectedly high prevalence of multi-drug-resistant (MDR) strains was found in new (6 %) and retreatment patients (35 %) across all sentinel sites, with the highest prevalence amongst retreatment patients in Bamako, Mali (59 %) and the two Nigerian sites in Ibadan and Lagos (39 % and 66 %). In Lagos, MDR is already spreading actively amongst 32 % of new patients. Pre-extensively drug-resistant (pre-XDR) isolates are present in all sites, with Ghana showing the highest proportion (35 % of MDR). In Ghana and Togo, pre-XDR isolates are circulating amongst new patients.
CONCLUSIONS
West African drug-resistance prevalence poses a previously underestimated, yet serious public health threat, and our estimates obtained differ significantly from previous World Health Organisation (WHO) estimates. Therefore, our data are reshaping current concepts and are essential in informing WHO and public health strategists to implement urgently needed surveillance and control interventions in West Africa.
背景
耐多药结核病是一个全球性的公共卫生问题。妥善管理需要基线耐药率数据。在西非，由于实验室基础设施薄弱和能力不足，此类数据稀缺。因此，耐多药结核病的实际程度迄今尚未确定。2008年，一个新的研究网络——西非结核病、艾滋病和疟疾卓越网络（WANETAM）成立，由来自八个西非国家（布基纳法索、冈比亚、加纳、几内亚比绍、马里、尼日利亚、塞内加尔和多哥）的九个研究地点组成。目标是确立良好临床实验室规范（GCLP）原则，并在各合作实验室建立标准化涂片显微镜检查和分枝杆菌培养的能力，以生成首份全面的西非耐药数据。
方法
遵循GCLP并开展实验室培训课程后，于2009年至2013年在定点转诊地点收集结核分枝杆菌分离株，并检测一线和二线耐药情况。
结果
通过对974株分离株进行分析，发现在所有定点地点的新患者（6%）和复治患者（35%）中，耐多药（MDR）菌株的患病率出乎意料地高，在马里巴马科的复治患者中患病率最高（59%），在尼日利亚伊巴丹和拉各斯的两个地点（39%和66%）也较高。在拉各斯，耐多药已在32%的新患者中积极传播。所有地点均存在广泛耐药前（pre-XDR）分离株，加纳的比例最高（占耐多药分离株的35%）。在加纳和多哥，广泛耐药前分离株在新患者中传播。
结论
西非的耐药患病率构成了一个此前被低估但严重的公共卫生威胁，我们获得的估计值与世界卫生组织（WHO）此前的估计值有显著差异。因此，我们的数据正在重塑当前的概念，对于告知WHO和公共卫生战略家在西非实施急需的监测和控制干预措施至关重要。
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