Tsuyuguchi K
Department of Infection and Inflammation, Graduate School of Medicine, Kyoto University, Japan.
Kekkaku. 1998 Nov;73(11):687-90.
Primary drug resistance is defined as the presence of resistant strains of Mycobacterium tuberculosis in a patient with no history of prior anti-tuberculosis chemotherapy. In Japan, a recent study shows that the prevalence of primary resistance has been stable for two decades and that primary multidrug-resistant tuberculosis (MDR-TB) is rare, which suggests the effectiveness of tuberculosis control. We presented four cases of primary MDR-TB that we had experienced from 1984 to 1997, and discussed an issue about diagnosis and treatment of primary MDR-TB. Of the four patients, two young men received surgical resection, which has resulted in a favorable outcome. Of the other two patients, one responded to long-term chemotherapy with ethambutol, ofloxacin and enviomycin. There have been no recurrence so far in the three cases. The rest case died due to progression of tuberculosis. Two of the four patients had been in contact with relatives who had died of MDR-TB. In conclusion, all the tuberculosis patients should be suspected to be primary MDR-TB when they had a history of a contact with a tuberculosis patient in whom chemotherapy had not been successful, and once patients are diagnosed as MDR-TB, surgical intervention should be considered as an adjunctive treatment. To prevent the emergence of primary MDR-TB, it is important to treat MDR-TB patients appropriately and to implement the infection control program.
原发性耐药被定义为在既往无抗结核化疗史的患者中存在结核分枝杆菌耐药菌株。在日本，最近一项研究表明，原发性耐药的流行率在二十年里一直保持稳定，并且原发性耐多药结核病（MDR-TB）很罕见，这表明结核病控制是有效的。我们报告了1984年至1997年间我们所遇到的4例原发性MDR-TB病例，并讨论了原发性MDR-TB的诊断和治疗问题。在这4例患者中，2名年轻男性接受了手术切除，结果良好。在另外2例患者中，1例对乙胺丁醇、氧氟沙星和恩维霉素的长期化疗有反应。到目前为止，这3例均无复发。其余1例因结核病进展而死亡。4例患者中有2例曾与死于MDR-TB的亲属有过接触。总之，所有结核病患者如果有与化疗未成功的结核病患者接触史，都应怀疑为原发性MDR-TB，一旦患者被诊断为MDR-TB，应考虑将手术干预作为辅助治疗。为防止原发性MDR-TB的出现，恰当治疗MDR-TB患者并实施感染控制计划很重要。
