期刊
INFECTIOUS DISEASE CLINICS OF NORTH AMERICA
卷 24, 期 3, 页码 705-+出版社
W B SAUNDERS CO-ELSEVIER INC
DOI: 10.1016/j.idc.2010.05.001
关键词
Extensively drug-resistant tuberculosis; Human; Epidemiology; Survival; HIV
资金
- European Commission (EU)
- European and Developing Countries Clinical Trials Partnership
- South African Medical Research Council
- National Research Foundation
- South African Research Chairs Initiative
Widespread global use of rifampin for 2 decades preceded the emergence of clinically significant multidrug-resistant tuberculosis (MDR-TB) in the early 1990s. The prevalence of MDR-TB has gradually increased such that it accounts for similar to 5% of the global case burden of disease (approximately half a million cases in 2007). Eclipsing this worrying trend is the widespread emergence of extensively drug-resistant TB (XDR-TB). This article reviews the insights provided by clinical and molecular epidemiology regarding global trends and transmission dynamics of XDR-TB, and the challenges clinicians have to face in diagnosing and managing cases of XDR-TB. The ethical and management dilemmas posed by recurrent defaulters, XDR-TB treatment failures, and isolation of incurable patients are also discussed. Given the past global trends in MDR-TB, if aggressive preventive and management strategies are not implemented, XDR-TB has the potential to severely cripple global control efforts of TB.
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