Murhula Kashongwe Innocent, Mawete Fina, Anshambi Nicole, Maingowa Nadine, Aloni Murielle, Lukaso L'osenga Luc, Kaswa Michel, Munogolo Kashongwe Zacharie
Internal Medicine, Pulmonology Unit, Kinshasa University Hospital, Kinshasa, Democratic Republic of the Congo.
Drug-Resistant Tuberculosis Unit 'Centre d'excellence Damien', Damian Foundation, Kinshasa, Democratic Republic of the Congo.
J Clin Tuberc Other Mycobact Dis. 2020 Sep 22;21:100192. doi: 10.1016/j.jctube.2020.100192. eCollection 2020 Dec.
Setting: Democratic Republic of the Congo is a high-burden TB country. Its capital, Kinshasa, reports annually about one-third of all MDR-TB cases in the country; thus, pre-XDRTB management is warranted.
To describe the main challenges in treating pre- XDR TB in this low resources setting and possible solutions.
retrospective study of all pre-XDR TB patients diagnosed in Kinshasa in 2018. A personalized regimen was applied according to the clinical profile, drug availability, and the Drug susceptibility testing (DST). Treatment was administered by hospitalization during the intensive phase and in ambulatory care in the continuation phase except in emergencies. Monthly follow up included evaluating clinical and bacteriological features, renal and liver functions, QT interval on ECG, and audiometry for those under aminoglycosides.
Among the 236 MDR-TB patients identified in 2018, 14 had pre-XDR. Two died before treatment initiation. Of the remaining 12. 75% were male, 50% were aged 25-44 years, 66.7% had previous anti-tuberculosis treatment, 75% had a body mass index < 18.5 kg/m, and 1 patient was HIV positive. On radiography, all the patients had cavities. The median time from the diagnosis to treatment initiation was 48.5 days (range: 14-105). A favorable outcome occurred in 10 cases (83.3%), one patient died, and anotherwas lost to follow up. Nine (75%) patients reported adverse reactions, which were mild or moderate in 6 cases and severe in 2 cases. The severe reactions were psychosis (1 case) and ototoxicity (1 case).
Successful pre-XDRTB treatment using the new strategy is possible even in a low-income country. The main challenges are diagnosis access, drug availability and follow-up laboratory facilities. These can be included in a global policy review by the NTP to ensure the sustainability of the strategies implemented.
背景：刚果民主共和国是结核病高负担国家。其首都金沙萨每年报告该国约三分之一的耐多药结核病病例；因此，对广泛耐药结核病前期进行管理很有必要。
描述在这种资源匮乏环境下治疗广泛耐药结核病前期的主要挑战及可能的解决方案。
对2018年在金沙萨诊断出的所有广泛耐药结核病前期患者进行回顾性研究。根据临床特征、药物可及性和药敏试验（DST）应用个性化治疗方案。强化期住院治疗，继续期门诊治疗，紧急情况除外。每月随访包括评估临床和细菌学特征、肾功能和肝功能、心电图QT间期以及对使用氨基糖苷类药物患者进行听力测定。
在2018年确诊的236例耐多药结核病患者中，14例为广泛耐药结核病前期。2例在开始治疗前死亡。其余12例中，75%为男性，50%年龄在25 - 44岁，66.7%曾接受过抗结核治疗，75%体重指数<18.5kg/m²，1例患者艾滋病毒呈阳性。影像学检查显示，所有患者均有空洞。从诊断到开始治疗的中位时间为48.5天（范围：14 - 105天）。10例（83.3%）治疗结果良好，1例死亡，1例失访。9例（75%）患者报告有不良反应，其中6例为轻度或中度，2例为重度。重度反应为精神病（1例）和耳毒性（1例）。
即使在低收入国家，采用新策略成功治疗广泛耐药结核病前期也是可能的。主要挑战是诊断途径、药物可及性和随访实验室设施。这些可纳入国家结核病规划的全球政策审查，以确保所实施策略的可持续性。
