Treatment of pulmonary tuberculosis

The treatment of tuberculosis is important both to preserve the health of the patient and to prevent the spread of the disease amongst the population. Its bacteriological bases are found in the high number of bacillae existing in the majority of human TB lesions and the capacity to mutate of Mycobacterium tuberculosis when it achieves a high number of divisions; this makes it essential to associate drugs that avoid the selection of resistant mutants. In our setting the pharmacological therapy that has shown greatest efficacy consists in the association during two months of isoniacide, rifampicine and pyrazinamide followed by four additional months with the first two drugs. In general the first choice tuberculostatic drugs are well tolerated, but they can produce potentially serious secondary effects that it is necessary to understand and know how to manage. This article also describes how to act from the therapeutic point of view facing certain special situations and when the initial treatments have been abandoned or have failed. In the last five years in Navarre, there has been a significant increase in the presence of immigrants proceeding from developing countries with high rates of tuberculosis and primary resistances. Because of its specific socio-economic conditions and its cultural idiosyncrasy, this group frequently generates difficulties with respect to complying with the treatment, as well in follow-up and control. The treatment of tuberculosis must always be carried out by expert doctors.     

Treatment Outcome of Multidrug-Resistant Mycobacterium tuberculosis in Nepal

The purpose of this study was to examine factors associated with treatment outcome of multidrug-resistant tuberculosis (MDR-TB) cases in Nepal. A retrospective analysis of MDR-TB cases by demographic determinants and treatment was conducted. A total of 494 MDR-TB cases were registered from 2005 to 2008, with data obtained from the National Tuberculosis Center. Chi-squared tests were used to assess statistically the association between smear and culture conversion and treatment outcome. Determinants were analyzed with the use of Kaplan-Meier curves and Cox proportional hazards models to generate estimates of the associations with the time to treatment outcome. Sputum conversion status and culture conversion status were positively associated with treatment outcome for MDR-TB. In a multiple Cox proportional hazards regression model, no determinants were found to be associated with time to cure.     

复发性胸壁结核局部病灶的相关处理措施分析

目的 总结分析复发性胸壁结核局部病灶的相关处理措施,以提高其治疗效果.方法 随机选取2007年8月-2011年10月胸外科收治的术后复发性胸壁结核患者95例,回顾性分析患者所接受的处理措施及治疗效果.结果 经手术彻底清除病灶并辅以术后正规抗痨治疗后,95例患者中切口甲级愈合87例,延期愈合6例,未愈合2例;随访1年原切口结核局部复发3例,无非切口部位复发病例;切口未愈及复发患者经再次手术及抗痨治疗后均治愈.结论 对于复发性胸壁结核局部病灶的治疗,手术彻底清除病灶、消灭死腔、通畅引流并辅以术后正规抗痨等处理措施,可达到较好的治疗效果.     

Treatment of tuberculosis: present status and future prospects

Over recent years, tuberculosis (TB) and disease caused by human immunodeficiency virus (HIV) have merged in a synergistic pandemic. The number of new cases of TB is stabilizing and declining, except in countries with a high prevalence of HIV infection. In these countries, where HIV is driving an increase in the TB burden, the capacity of the current tools and strategies to reduce the burden has been exceeded. This paper summarizes the current status of TB management and describes recent thinking and strategy adjustments required for the control of TB in settings of high HIV prevalence. We review the information on anti-TB drugs that is available in the public domain and highlight the need for continued and concerted efforts (including financial, human and infrastructural investments) for the development of new strategies and anti-TB agents.     

结核分枝杆菌在临床治疗中的耐药变迁

目的 了解海盐县自肺结核患者分离出的结核分枝杆菌在治疗过程中耐药的变迁情况,以利于抗结核治疗中抗菌药物的合理调整与选用.方法 对痰涂片阳性的新发初治肺结核患者,行痰结核分枝杆菌培养,阳性菌株采用高、低两药物浓度进行4种抗结核药物耐药性测试,同时用实时PCR法对结核分枝杆菌的耐药基因rpoB和katG突变进行检测,同时观察治疗2个月后分离菌株的耐药性检测.结果 131例痰培养阳性肺结核患者初始耐药率14.5%,经治疗2个月后分离菌株性耐药率37.8%;初始分离株rpoB和katG的突变率为14.5%和8.4%,耐药基因总携带率16.8%;治疗2个月后分离株rpoB和katG的突变率为39.2%和25.7%,耐药基因总携带率44.6%.结论 结核病患者分离出的结核分枝杆菌在初始治疗时已存在有耐药性,而治疗过程有可能使其耐药性增加;在抗结核治疗前及在治疗过程中对结核分枝杆菌进行耐药性及耐药基因检测很有意义.     

Treatment outcome of new culture positive pulmonary tuberculosis in Norway

Background  

The key elements in tuberculosis (TB) control are to cure the individual patient, interrupt transmission of TB to others and prevent the tubercle bacilli from becoming drug resistant. Incomplete treatment may result in excretion of bacteria that may also acquire drug resistance and cause increased morbidity and mortality. Treatment outcome results serves as a tool to control the quality of TB treatment provided by the health care system. The aims of this study were to evaluate the treatment outcome for new cases of culture positive pulmonary TB registered in Norway during the period 1996–2002 and to identify factors associated with non-successful treatment.     

胸膜外全肺切除术治疗单侧结核性全肺毁损

目的 总结胸膜外全肺切除术治疗单侧结核性全肺毁损临床经验.方法 回顾性分析30例单侧结核性全肺毁损患者施行全肺切除术的临床资料,术中发现脏、壁层胸膜呈胼胝样粘连,胸膜内分离病肺困难而施行胸膜外全肺切除术.结果 30例手术全部成功,术中出血1300～5300ml,平均(2854±526)ml,术后近期并发症11例(36.7%):急性肺水肿3例,呼吸衰竭4例,脓胸2例,纵隔摆动2例;治愈28例(93.3%),死亡2例(6.7%).结论 对单侧结核性全肺毁损患者施行全肺切除术时,如果术中发现脏、壁层胸膜呈胼胝样粘连,胸膜内分离病肺困难时,应当机立断施行胸膜外全肺切除术,积极防治术后并发症,其并发症发生率、病死率均在可接受范围之内.     

Treatment outcome of extra-pulmonary tuberculosis in Finland: a cohort study

Background  

We investigated the treatments given, the outcome and the patient- and treatment-system dependent factors affecting treatment outcome in a national two-year cohort of culture-verified extra-pulmonary tuberculosis cases in Finland.     

Treatment referral system for tuberculosis patients in Dhaka,Bangladesh

Objective: To evaluate the referral system in an urban DOTS-based programme in Dhaka, Bangladesh, including the peri-urban area, and to identify opportunities to strengthen the system.Design: This was a retrospective cohort study in which diagnosed tuberculosis (TB) patients and health providers from DOTS centres were interviewed. Research tools included pre-tested structured questionnaires and the TB patients'' referral records.Results: Of 4974 TB patients who were referred to the different treatment centres, only 1756 (35%) of the counterfoils of the referral slips were returned. Of 250 patients randomly selected for interview, 165 reported to a DOTS centre, 69 did not and 16 could not be traced. Variations in educational qualification, residence and the identification of DOTS centres after counselling were statistically significant (P < 0.05). Lower monthly income (RR = 7.84, RR = 5.03), distance from the centre (RR = 36.21) and those receiving treatment from pharmacies (RR = 3) or non-governmental organisations (RR = 28.48) have more risk of irregular treatment.Conclusion: A high proportion of referred patients were registered and initiated treatment, but many did not report to the referral treatment centre. Proper counselling and taking into account the patients'' preferences during referral are essential to address access barriers to treatment adherence and improved treatment outcome.     

经纤维支气管镜局部灌注给药治疗耐多药肺结核

目的探讨经纤维支气管镜局部灌注给药对耐多药肺结核患者的治疗价值。方法将纤维支气管镜导管介入至相应的病灶所在段支气管,吸净病灶分泌物后,注入左氧氟沙星(0.4g)和丁胺卡那(0.4g)注射液,辅以全身化疗治疗耐多药肺结核42例,与单纯全身化疗37例进行对照研究。结果经纤维支气管镜介入局部灌注给药组,疗程满9个月时痰菌阴转率为92.9%,病灶吸收有效率为90.5%,均高于单纯全身化疗组的62.2%、59.5%(P<0.01)。结论经纤维支气管镜局部灌注给药辅以全身化疗治疗耐多药肺结核疗效显著优于单纯全身化疗,且未见并发症和明显毒副反应。