耐多药结核病的再认识

结核病目前仍是严重危及全球的公共卫生问题之一。据世界卫生组织(WHO)估计,当前全球约有20亿人受结核分支杆菌感染,我国近5亿人,其中约5000万人感染了耐药性结核分支杆菌,耐药结核病例数明显增多。同时,结核分支杆菌耐药菌株持续增加,尤其是耐多药结核病(MDR—TB)对全球结核病控制造成严重威胁。     

结核分枝杆菌L型生物学特性及其感染现状

结核分枝杆菌L型(MTB-L)即结核分枝杆菌(MTB)细胞壁缺陷型。近年研究发现,耐多药肺结核(MDR-TB)较初治无耐药肺结核MTB-L培养阳性率显著增高,并随着耐药种类的增多而增高[1]。MTB-L感染者结核病复发率显著高于细菌型结核感染者[2-3]。由于不规范的抗结核治疗导致耐药及MDRTB的产生与传播是造成全球结核病严峻形式的主要原因,特别是广泛耐多药结核分枝杆菌(XDR-TB)的出现使得结核病的防控更加棘手[4]。因此,加强对MTB-L感染的认识,普及     

293例耐多药结核可疑者结核分枝杆菌培养及耐药分析

近年来,结核病流行又呈持续上升趋势,结核菌耐药性的增加和天然耐药株的产生是主要原因之一.MDR-TB(耐多药结核)是指肺结核患者感染的结核分枝杆菌至少同时对异烟肼和利福平耐药.结核菌耐药趋势是反映某一地区结核病防治工作实施效果的重要指标.为了了解聊城市耐多药结核可疑者结核分枝杆菌培养及耐药情况,尽可能的发现耐多药结核患者,我们对293例痰涂片抗酸杆菌阳性耐多药结核可疑者,进行分枝杆菌培养及药敏监测,现报告如下.     

耐多药结核患者生存质量的研究进展

正耐多药结核病(MDR-TB)是指结核病患者感染的结核分枝杆菌体外细菌耐药的药敏试验(DST)证实至少同时对异烟肼和利福平耐药的结核病[1]。流行病学资料显示全球每年新增900万个结核患者中有5%为耐多药结核[2],一些"热点"地区,包括多米尼加、印度等每年新增耐多药患者比例大于3%[3]。2010年我国的流行病学抽样调查结果显示,耐多药率为6.8%。我国每年新发MDR-TB病例占全球每年新     

耐多药结核病59例临床护理

耐多药结核病(MDR-TB)是指至少同时耐异烟肼、利福平二种药物的结核病。全球有5000多万人受耐药结核分枝杆菌感染,约2/3的结核病人处于发生耐多药的危险之中。据世卫组织估算,平均每个耐多药结核患者可传染15名健康人,健康人与之密切接触后会直接患上耐多药结核病,对个人、家庭和社会危害极大。我院是第七轮全球基金中国耐多     

耐多药肺结核的成因及治疗

耐多药肺结核是指患者排出的结核分支杆菌 ,至少已对异烟肼 (INH)和利福平 (RFP)产生耐药的结核病。随着发生率的不断增高和传播的日益扩大 ,特别是国外伴人类免疫缺陷病毒(HIV)感染的耐多药肺结核爆发流行以来 ,对全球结核病控制构成了严重威胁。为了进一步研究耐多药肺结核的病情 ,我们分析了 36例耐多药肺结核的成因和治疗结果 ,以便正确的诊断和制订控制策略。1　材料和方法1 .1　研究对象　经过 HRZS/HRE方案连续治疗 6个月以上 ,痰结核分支杆菌仍然阳性 ,至少对 HR耐药 ,X线胸片病变仍然进展者。年龄 1 8～ 60岁 ,非孕妇 ,未…     

复治耐多药肺结核耐药情况分析及疗效评价

耐多药结核病(MDR-TB)给结核病控制规程的实现构成严重的威胁,WHO估计当今有三分之二的结核病人处于发生耐多药的危险中.MDR-TB是指致病结核菌至少同时耐异烟肼(INH)和利福平(RFP).第四次全国结核病流行病学抽样调查结果显示,我国初始耐多药率为7.6%,获得性耐多药率高达17.1%,属于较严重的国家.作者回顾性分析复治耐多药肺结核25例的耐药情况和治疗效果,旨在为MDR-TB的化学治疗提供参考.     

结核分支杆菌的实验诊断新技术

结核分支杆菌引起的感染和死亡 ,随着抗结核药物的开发和应用曾一度得到有效的控制 ,但从 2 0世纪 80年代以来 ,结核病出现疫情回潮现象。其主要原因是耐多药结核病(ｍｕｌｔｉｄｒｕｇｒｅｓｉｓｔａｎｃｅｔｕｂｅｒｃｌｅｂａｃｉｌｌｕｓ ,ＭＤＲ ＴＢ)的流行、人类免疫缺陷病毒 (ｈｕｍａｎｉｍｍｕｎｏｄｅｆｉｃｉｅｎｃｙｖｉｒｕｓ ,ＨＩＶ)感染、器官移植、免疫抑制剂使用等所致免疫损害宿主 (ＩＣＨ)增多和高龄人口中机体免疫力低下等因素 ,使结核分支杆菌感染难以控制 ,发展为难治倾向。要想从根本上控制结核病的流行 ,诊断是所…     

雾化吸入抗结核药物治疗耐多药肺结核的疗效观察

经菌型鉴定和药敏试验证实 ,对包括异烟肼 (ＩＮＨ)和利福平 (ＲＦＰ)在内的两种或两种以上抗结核药物耐药的结核分支杆菌 ,为耐多药结核分支杆菌 (ＭＤＲ ＭＴ) ,由ＭＤＲ ＭＴ所致的结核病为耐多药结核病 (ＭＤＲ ＴＢ)。有资料显示 ,全球可能有 5 0 0 0万人感杂ＭＤＲ ＭＴ ,约 2 / 3的结核患者处于耐多药的危险之中 ,尤其是复治结核患者其耐多药的发生率可高达 72 .0 9% [1] 。由于ＭＤＲ ＴＢ具有治疗费用高、疗效差和病死率高的特点而倍受关注。为了提高耐多药肺结核病的治愈率 ,我院自 1999年以来对 34例耐多药肺结核患者 ,在使用第…     

耐多药结核病病人的医院感染管理对策探讨

[目的]探讨耐多药结核病(MDR-TB)的医院感染管理对策。[方法]加强组织管理与制度建设,规范病房管理及病人安置,严格消毒隔离和职业防护,加大健康教育与用药指导。[结果]加强耐多药结核病人的管理,确保了医疗安全,未发生医院感染。[结论]采取综合措施加强科学管理,严格环境控制,可防止MDR-TB的传播,减少MDR-TB对社会的危害。     

Testicular tuberculosis in multidrug-resistant pulmonary tuberculosis

We report a rare case of multidrug-resistant pulmonary and testicular tuberculosis (TB) in a 25-year-old immunocompetent patient. The patient was suspected to have a testicular cancer. He underwent radical orchiectomy, and surgical pathology revealed a granuloma containing acid-fast bacilli in the testis. Bronchial washing fluid culture grew Mycobacterium tuberculosis resistant to isoniazid, rifampin, and ethambutol. To our knowledge, this patient represents the first case of testicular TB in multidrug-resistant pulmonary TB.     

Gastrointestinal tuberculosis in patients with pulmonary tuberculosis

Proven or suspected intestinal tuberculosis was diagnosed in 23 (46 per cent) of 50 patients with smear-positive, cavitating pulmonary tuberculosis. The diagnosis was regarded as proven in 14 patients and suspected in the remaining nine. The frequency of proven gastrointestinal disease increased with the severity of the pulmonary tuberculosis. Small intestinal disease was encountered in only two patients. Small mucosal lesions in the caecum were the most commonly detected pathological features. Colonoscopy was of particular value in establishing the diagnosis, which could not be predicted from the patients' abdominal signs or gastrointestinal symptoms.     

Osteoarticular tuberculosis

As the incidence of tuberculosis in Japan decreases, osteoarticular tuberculosis becomes relatively rare. Therefore, it is often overlooked or misdiagnosed that leads to cryptic aggravation of the disease. On the other hand, because of population aging in Japan, degenerative conditions such as compression vertebral fracture or osteoarthritis should be considered as differential diagnoses of osteoarticular tuberculosis. In addition, we should beware of extra-pulmonary tuberculosis in the patients who undergo biological agent therapy for rheumatoid arthritis that has been advanced drastically in recent years. Surgical treatment for osteoarticular tuberculosis is still an essential part of its treatment in order to achieve early rehabilitation and rapid healing of the lesion.     

Endobronchial tuberculosis

Endobronchial tuberculosis is defined as tuberculous infection of the tracheobronchial tree. Although clinical features differ between various types and stages of endobronchial tuberculosis, common symptoms are cough, hemoptysis, sputum production, wheezing, chest pain, fever and dyspnea. Endobronchial tuberculosis is difficult to diagnose, because the lesion is not evident in the chest radiograph. Computerized tomography is very useful in evaluating bronchial lesions such as stenosis or obstruction. The most important goal of treatment in active endobronchial tuberculosis is the eradication of tubercle bacilli. The second most important goal is prevention of bronchial stenosis. Corticosteroid therapy for prevention of bronchial stenosis in endobronchial tuberculosis remains controversial, but the best results are associated with minimal delay in the initiation of steroid treatment. In inactive disease, treatment to restore full patency is appropriate. As steroids or other medication are unable to reverse stenosis from fibrous disease, airway patency must be restored mechanically by surgery or endobronchial intervention. Aerosol therapy with streptomycin and corticosteroids is useful in treatment against active endobronchial tuberculosis. Time to healing of ulcerous lesions is shorter, and bronchial stenosis is less severe in patients on aerosol therapy. Progression to bronchial stenosis may be prevented if the therapy is initiated as soon as possible.