Payen M C, VAN Vooren J P, Vandenberg O, Clumeck N, DE Wit S
Infectious Diseases Department,Saint-Pierre University Hospital, Université Libre de Bruxelles,Brussels,Belgium.
Immunodeficiency Unit,Hôpital Erasme,Brussels,Belgium.
Epidemiol Infect. 2017 May;145(7):1368-1373. doi: 10.1017/S0950268817000267. Epub 2017 Feb 16.
Tuberculosis (TB) remains a threat to public health and is the second cause of death due to a single infectious agent after HIV/AIDS. The worldwide distribution of TB is heterogeneous. The incidence is decreasing in most high-income regions, but the situation remains worrying in many parts of the world. The emergence of Mycobacterium tuberculosis strains resistant to key agents used in treatment (rifampin and isoniazid) contributes to TB transmission around the world. To achieve TB elimination, both high and low endemic countries must upscale their efforts to decrease disease transmission and improve cure rates. Management of drug-resistant TB is of particular importance. In this paper, we discuss the different models of care of multidrug-resistant TB (MDR-TB), the ethical considerations and the specific constraints present in high income countries. The management model chosen by the Belgian TB specialists in accordance with public health authorities as well as building of a specific MDR/XDR-TB isolation unit are also discussed.
结核病（TB）仍然是对公共卫生的一大威胁，是继艾滋病毒/艾滋病之后单一传染源导致死亡的第二大原因。结核病在全球的分布并不均匀。在大多数高收入地区，发病率正在下降，但世界许多地区的情况仍然令人担忧。对治疗中使用的关键药物（利福平和平肼）耐药的结核分枝杆菌菌株的出现，促使结核病在全球传播。为了实现消除结核病的目标，高流行率国家和低流行率国家都必须加大努力，以减少疾病传播并提高治愈率。耐多药结核病的管理尤为重要。在本文中，我们讨论了耐多药结核病（MDR-TB）的不同护理模式、伦理考量以及高收入国家存在的具体限制因素。还讨论了比利时结核病专家根据公共卫生当局选择的管理模式以及一个特定的耐多药/广泛耐药结核病隔离单元的建设情况。
