米国における広範囲にわたる薬剤耐性結核,1993年~2007年
N Sarita Shah1, Robert Pratt, Lori Armstrong
1Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, 1600 Clifton Rd, Mailstop E-10, Atlanta, GA 30333, USA.
JAMA
|November 13, 2008
まとめ
米国での広範囲にわたる耐薬性結核 (XDR-TB) の症例は減少したが,依然として懸念事項である. XDR-TB患者,特にHIV感染者は,薬剤耐性TBと比較して,より高い死亡率と長時間の感染期間に直面しました.
科学分野:
- 公衆衛生は公衆衛生である.
- 感染症 感染症は感染症です.
- エピデミオロジー エピデミオロジー
背景:
- 薬剤耐性結核 (XDR-TB) の世界的な増加は,限られた治療選択肢と高い死亡率のため,公衆衛生上の大きな課題となっています.
- XDR-TBの疫学と独特の特徴を理解することは,効果的な制御戦略にとって極めて重要です.
研究 の 目的:
- 米国におけるXDR-TBの流行病学を分析する.
- XDR-TB症例の特徴を,多剤耐性TB (MDR-TB) と薬物感受性TB症例と比較する.
主な方法:
- 1993年から2007年の間に報告された米国の結核症例の記述的分析が行われました.
- XDR-TBは,イソニアジド,リファミシン,フルオロキノロン,および主要な二次線注射薬 (アミカシン,カナミシン,またはカプレオミシン) を含む特定の第一および二次線薬に対する耐性によって定義されました.
主要な成果:
- 1993年から2007年にかけて,米国では83件のXDR-TB症例が報告され,減少傾向が見られた.
- XDR-TB症例は,感染が広がる可能性が高く,感染期間が長く (MDR-TBの平均は183日,MDR-TBの平均は93日) であり,培養物の変換率が低い.
- 死亡率は,MDR-TBおよび薬剤感受性TBと比較してXDR-TB症例 (35%が死亡) で,特にHIV陽性個体 (81%の死亡) の間で著しく高かった.
結論:
- 報告された症例の減少にもかかわらず,XDR-TBは米国で引き続き発生しています.
- 改善された結核とHIV/AIDSの対策は,XDR-TB症例の減少に寄与している可能性がある.
- XDR-TBを効果的に管理するには,継続的な監視と標的化された介入が必要である.
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