Centre for Lung Infection and Immunity, Division of Pulmonology, Department of Medicine and UCT Lung Institute & South African MRC/UCT Centre for the Study of Antimicrobial Resistance, University of Cape Town, Cape Town, South Africa.
Faculty of Infectious and Tropical Diseases, Department of Immunology and Infection, London School of Hygiene and Tropical Medicine, London, UK.
Nat Rev Dis Primers. 2024 Mar 24;10(1):22. doi: 10.1038/s41572-024-00504-2.
Tuberculosis (TB) remains the foremost cause of death by an infectious disease globally. Multidrug-resistant or rifampicin-resistant TB (MDR/RR-TB; resistance to rifampicin and isoniazid, or rifampicin alone) is a burgeoning public health challenge in several parts of the world, and especially Eastern Europe, Russia, Asia and sub-Saharan Africa. Pre-extensively drug-resistant TB (pre-XDR-TB) refers to MDR/RR-TB that is also resistant to a fluoroquinolone, and extensively drug-resistant TB (XDR-TB) isolates are additionally resistant to other key drugs such as bedaquiline and/or linezolid. Collectively, these subgroups are referred to as drug-resistant TB (DR-TB). All forms of DR-TB can be as transmissible as rifampicin-susceptible TB; however, it is more difficult to diagnose, is associated with higher mortality and morbidity, and higher rates of post-TB lung damage. The various forms of DR-TB often consume >50% of national TB budgets despite comprising <5-10% of the total TB case-load. The past decade has seen a dramatic change in the DR-TB treatment landscape with the introduction of new diagnostics and therapeutic agents. However, there is limited guidance on understanding and managing various aspects of this complex entity, including the pathogenesis, transmission, diagnosis, management and prevention of MDR-TB and XDR-TB, especially at the primary care physician level.
结核病（TB）仍然是全球传染病死亡的首要原因。耐多药或利福平耐药结核病（MDR/RR-TB；对利福平、异烟肼耐药，或仅对利福平耐药）是世界上一些地区，特别是东欧、俄罗斯、亚洲和撒哈拉以南非洲的新兴公共卫生挑战。预广泛耐药结核病（pre-XDR-TB）是指对氟喹诺酮类药物也耐药的 MDR/RR-TB，而广泛耐药结核病（XDR-TB）分离株还对其他关键药物如贝达喹啉和/或利奈唑胺耐药。这些亚组统称为耐药结核病（DR-TB）。所有形式的 DR-TB 都像利福平敏感结核病一样具有传染性；然而，它更难诊断，与更高的死亡率和发病率以及更高的 post-TB 肺损伤发生率相关。尽管占总结核病病例负荷的<5-10%，但各种形式的 DR-TB 往往消耗了>50%的国家结核病预算。过去十年，随着新诊断和治疗药物的引入，DR-TB 治疗领域发生了巨大变化。然而，对于理解和管理这个复杂实体的各个方面，包括 MDR-TB 和 XDR-TB 的发病机制、传播、诊断、管理和预防，尤其是在初级保健医生层面，仍然缺乏指导。
