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[迁移与结核病]

[Migration and Tuberculosis].

作者信息

Othmer J T, Schönfeld N, Häcker B, Otto-Knapp R, Bauer T T

出版信息

Pneumologie. 2018 Sep;72(9):644-659. doi: 10.1055/s-0043-118435. Epub 2018 Aug 30.

Abstract

The majority of the people suffering from tuberculosis in Germany are migrants. The treatment of this demographic still presents certain challenges. Only up to a quarter to a fifth of tuberculosis cases in migrants is being diagnosed by the screening methods that were implemented by The German Protection against Infection Act (Infektionsschutzgesetz, IfSG). Reactivation of latent tuberculosis is the most common cause for tuberculosis in migrants. Easy access to health care is vital for the testing and treatment of latent tuberculosis in people with a high risk of reactivation. The level of infection risk, comorbidities and presentation of disease vary depending on the country of origin. Especially during migration people are more susceptible to somatic and mental maladies. Extrapulmonary tuberculosis is frequent in migrants and requires specific diagnostic approaches. Where risk factors for a multi-drug-resistant tuberculosis are present, this condition has to be actively excluded. To facilitate diagnosis and therapy of tuberculosis in migrants a high level of trust has to be established in the doctor-patient relationship. Therefore and despite of cultural and linguistic differences empathy and time are key. Patients need to be encouraged to complete their treatment rather than terminate it prematurely. To that end comorbidities have also to be diagnosed and treated, social and legal aspects have to be considered.

摘要

德国大多数结核病患者是移民。对这一人群的治疗仍然存在一定挑战。在移民的结核病病例中,只有四分之一到五分之一是通过德国《感染保护法》(Infektionsschutzgesetz, IfSG)实施的筛查方法诊断出来的。潜伏性结核病的复发是移民患结核病最常见的原因。对于有复发高风险的人来说,方便获得医疗保健对于潜伏性结核病的检测和治疗至关重要。感染风险水平、合并症和疾病表现因原籍国而异。特别是在移民期间,人们更容易患躯体和精神疾病。肺外结核在移民中很常见,需要特定的诊断方法。如果存在耐多药结核病的风险因素,则必须积极排除这种情况。为了促进对移民结核病的诊断和治疗,必须在医患关系中建立高度信任。因此,尽管存在文化和语言差异,但同理心和时间是关键。需要鼓励患者完成治疗,而不是过早终止治疗。为此,还必须诊断和治疗合并症,必须考虑社会和法律方面的问题。

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