Harvard Medical School, Harvard University, Boston, USA.
Brigham and Women's Hospital, Boston, USA.
Epidemiol Infect. 2020 Sep 30;148:e253. doi: 10.1017/S0950268820002307.
Tuberculosis (TB) is one of the top 10 leading causes of morbidity and mortality worldwide [1]. In 2017, approximately 10 million people were infected with TB and 1.3 million patients faced mortality [1]. Patients with active TB can infect up to 10-15 people over a year. There is a greater risk of transmission in overcrowded areas with limited air ventilation including large family units, prisons and slums [1, 2]. Without proper diagnosis and treatment, roughly 45% of non-HIV positive TB patients face mortality [1]. With the help of global organizations and national TB treatment and control programmes, the global incidence of TB is declining by approximately 2% each year [1]. The World Health Organization (WHO) TB-strategy aims to end the TB epidemic and encourages partners to fund national TB programmes to improve diagnosis and treatment of TB. The goal is to ultimately decrease death rates by 90% and decrease incidence rates by 80% [1]. To achieve these goals, the decline in TB incidence needs to reach approximately 4-5% per year [1]. The WHO 2018 TB report identified multidrug resistant TB (MDR-TB) as the leading factor hindering that goal [1]. The incidence and spread of MDR-TB has drastically increased, where approximately 558 000 new cases of MDR-TB were diagnosed in 2017 causing more than 230 000 deaths globally [1]. MDR-TB is identified by resistance to the two most powerful anti-TB treatment drugs including isoniazid and rifampicin [3]. Patients with MDR-TB are required to start second-line anti-TB drugs (SLDs), which are limited, expensive, less effective and more toxic [1,2]. Therapy duration is one of the major limitations of second-line treatments, which may require up to two years of consistent use. Since TB affects mostly developing countries, long treatment durations and associated costs become a major challenge. In 2015, 15% of new TB cases were reported as MDR-TB, which drastically increased to 24% by 2017 [1]. Even with significant improvements in molecular tests and diagnostic methods, MDR-TB is still on the rise where the success rate of treatments is between 50 and 60% [1]. Additional characteristics including socioeconomic and sociocultural factors need to be considered when targeting and treating patients with MDR-TB.
结核病（TB）是全球导致发病率和死亡率的十大原因之一[1]。2017 年，约有 1000 万人感染结核病，130 万人面临死亡[1]。活动性结核病患者在一年内可能感染多达 10-15 人。在拥挤且通风不良的区域，包括大家庭、监狱和贫民窟，传播的风险更大[1,2]。如果没有适当的诊断和治疗，大约 45%的非艾滋病毒阳性结核病患者会面临死亡[1]。在全球组织和国家结核病治疗和控制规划的帮助下，全球结核病发病率每年下降约 2%[1]。世界卫生组织（WHO）结核病战略旨在结束结核病流行，并鼓励合作伙伴为国家结核病规划提供资金，以改善结核病的诊断和治疗。目标是最终将死亡率降低 90%，发病率降低 80%[1]。为了实现这些目标，结核病发病率的下降需要达到每年 4-5%左右[1]。世卫组织 2018 年结核病报告将耐多药结核病（MDR-TB）确定为阻碍这一目标的主要因素[1]。耐多药结核病的发病率和传播率急剧上升，2017 年约有 55.8 万例新的耐多药结核病病例，导致全球超过 23 万人死亡[1]。耐多药结核病是通过对异烟肼和利福平这两种最有效的抗结核药物的耐药性来确定的[3]。耐多药结核病患者需要开始使用二线抗结核药物（SLD），这些药物有限、昂贵、效果较差且毒性更大[1,2]。治疗持续时间是二线治疗的主要限制之一，可能需要长达两年的持续使用。由于结核病主要影响发展中国家，因此治疗时间长和相关费用成为一个主要挑战。2015 年，新结核病病例中有 15%报告为耐多药结核病，到 2017 年，这一比例急剧上升至 24%[1]。尽管分子检测和诊断方法有了显著改进，但耐多药结核病仍在上升，治疗成功率在 50%至 60%之间[1]。在针对和治疗耐多药结核病患者时，还需要考虑社会经济和社会文化等特征。
