Department of Medicine, East Tennessee State University, James H. Quillen College of Medicine, Johnson City, TN 37614.
Department of Medicine, Meharry Medical College, Nashville, TN 37208.
Microbiol Spectr. 2016 Dec;4(6). doi: 10.1128/microbiolspec.TNMI7-0018-2016.
In 2014, WHO reported approximately 9.6 million new cases of tuberculosis (TB) in the world, more than half of which are contributed by developing countries in Asia and Africa. Lack of modern diagnostic tools, underreporting of the new cases and underutilization of directly observed therapy (DOT) remain a concern in developing countries. Transient resurgence of TB during the HIV epidemic has subsided and the annual decline has resumed in developed countries including the USA. In 2014 though, the rate of decline has slowed down resulting in leveling of TB incidence in the USA. In developed countries like the USA, the incidence of TB remains high in those with certain risk factors for TB. This group includes immunocompromised patients, particularly those with positive HIV infection. Others at high risk include those with diabetes, cancer, those taking immunosuppressive drugs, and those with other medical conditions that reduce host immunity. If we look at age and ethnicity, elderly patients are at higher risk of developing TB. African-American, foreign-born, and homeless populations are also at higher risk of developing tuberculosis. Virulence of the mycobacteria, and immunological and genetically mediated factors are also mentioned, but these topics are not the primary goal of this article. This review, thus discusses the epidemiology, host factors, and those at high risk for developing active TB. A brief review of the current trends in drug resistance of mycobacteria is also presented.
2014 年，世卫组织报告称，全球约有 960 万例新结核病（TB）病例，其中一半以上来自亚洲和非洲的发展中国家。发展中国家仍然存在现代诊断工具缺乏、新发病例漏报和直接观察治疗（DOT）利用不足等问题。在包括美国在内的发达国家，艾滋病毒流行期间结核病的短暂死灰复燃已经平息，发病率呈年度下降趋势。然而，2014 年，下降速度有所放缓，导致美国结核病发病率持平。在美国等发达国家，具有某些结核病风险因素的人群中，结核病发病率仍然很高。这包括免疫功能低下的患者，特别是 HIV 感染阳性者。其他高危人群包括糖尿病患者、癌症患者、正在服用免疫抑制剂的患者以及其他降低宿主免疫力的疾病患者。如果我们考虑年龄和种族，老年患者患结核病的风险更高。非裔美国人、外国出生者和无家可归者也面临更高的结核病发病风险。分枝杆菌的毒力以及免疫和遗传介导的因素也有提及，但这些不是本文的主要目标。因此，本文讨论了活动性结核病的流行病学、宿主因素和高危人群。本文还简要回顾了分枝杆菌耐药性的当前趋势。
