Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA.
Division of Medical Microbiology and the Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa.
Lancet. 2019 Apr 20;393(10181):1642-1656. doi: 10.1016/S0140-6736(19)30308-3. Epub 2019 Mar 20.
Tuberculosis remains the leading cause of death from an infectious disease among adults worldwide, with more than 10 million people becoming newly sick from tuberculosis each year. Advances in diagnosis, including the use of rapid molecular testing and whole-genome sequencing in both sputum and non-sputum samples, could change this situation. Although little has changed in the treatment of drug-susceptible tuberculosis, data on increased efficacy with new and repurposed drugs have led WHO to recommend all-oral therapy for drug-resistant tuberculosis for the first time ever in 2018. Studies have shown that shorter latent tuberculosis prevention regimens containing rifampicin or rifapentine are as effective as longer, isoniazid-based regimens, and there is a promising vaccine candidate to prevent the progression of infection to the disease. But new tools alone are not sufficient. Advances must be made in providing high-quality, people-centred care for tuberculosis. Renewed political will, coupled with improved access to quality care, could relegate the morbidity, mortality, and stigma long associated with tuberculosis, to the past.
结核病仍然是全球成年人因传染病导致死亡的主要原因,每年有超过 1000 万人新患结核病。在诊断方面的进展,包括在痰和非痰样本中使用快速分子检测和全基因组测序,可以改变这种情况。虽然耐多药结核病的治疗方法几乎没有改变,但新的和重新利用的药物疗效增加的数据促使世卫组织在 2018 年首次建议对耐药结核病进行全口服治疗。研究表明,含有利福平或利福喷汀的更短潜伏结核病预防方案与更长的基于异烟肼的方案同样有效,并且有一个有前途的疫苗候选物可预防感染进展为疾病。但仅靠新工具是不够的。必须在提供高质量、以患者为中心的结核病护理方面取得进展。重新焕发的政治意愿,加上获得优质护理的机会增加,可能会使结核病长期以来与发病率、死亡率和耻辱感相关的问题成为过去。