Esmail Aliasgar, Sabur Natasha F, Okpechi Ikechi, Dheda Keertan
Lung Infection and Immunity Unit, Division of Pulmonology and University of Cape Town Lung Institute, Department of Medicine, University of Cape Town, Cape Town, South Africa.
Division of Respirology, Department of Medicine, St. Michael's Hospital and West Park Healthcare Centre, Toronto, Canada.
J Thorac Dis. 2018 May;10(5):3102-3118. doi: 10.21037/jtd.2018.05.11.
Tuberculosis remains a major problem globally, and is the leading cause of death from an infectious agent. Drug-resistant tuberculosis threatens to marginalise the substantial gains that have recently been made in the fight against tuberculosis. Drug-resistant TB has significant associated morbidity and a high mortality, with only half of all multidrug-resistant TB patients achieving a successful treatment outcome. Patients with drug-resistant TB in resource-poor settings are now gaining access to newer and repurposed anti-tuberculosis drugs such as bedaquiline, delamanid and linezolid. However, with ever increasing rates of co-morbidity, there is little guidance on how to manage complex patients with drug-resistant TB. We address that knowledge gap, and outline principles underpinning the management of drug-resistant TB in special situations including HIV co-infection, pregnancy, renal disease, liver disease, diabetes, and in the critically ill.
结核病在全球范围内仍然是一个重大问题，并且是由传染性病原体导致死亡的首要原因。耐多药结核病有可能使近期在抗击结核病方面取得的重大成果化为泡影。耐多药结核病伴有严重的发病率和高死亡率，所有耐多药结核病患者中只有一半能成功治愈。资源匮乏地区的耐多药结核病患者现在能够获得新型和重新利用的抗结核药物，如贝达喹啉、地拉曼德和利奈唑胺。然而，随着合并症发生率不断上升，对于如何管理复杂的耐多药结核病患者几乎没有指导意见。我们填补了这一知识空白，并概述了在包括艾滋病毒合并感染、妊娠、肾脏疾病、肝脏疾病、糖尿病以及危重症等特殊情况下耐多药结核病管理的基本原则。
