Tuberculosis: An Update for the Clinician.

IF 6.6 2区 医学 Q1 RESPIRATORY SYSTEM
Respirology Pub Date : 2025-03-01 Epub Date: 2025-01-31 DOI:10.1111/resp.14887
Saskia Janssen, Melissa Murphy, Caryn Upton, Brian Allwood, Andreas H Diacon
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引用次数: 0

Abstract

Tuberculosis (TB) remains a significant global health threat with high mortality and efforts to meet WHO End TB Strategy milestones are off-track. It has become clear that TB is not a dichotomous infection with latent and active forms but presents along a disease spectrum. Subclinical TB plays a larger role in transmission than previously thought. Aerosol studies have shown that undiagnosed TB patients, even with paucibacillary disease, can be highly infectious and significantly contribute to TB spread. Encouraging clinical results have been seen with the M72/AS01E vaccine. If preliminary results can be confirmed in ongoing larger trials, modelling shows the vaccine can positively impact the epidemic. TB preventive therapy (TPT), especially for high-risk groups like people living with HIV and household contacts of drug-resistant TB patients, has shown efficacy but implementation is resource intensive. Treatment options for infectious patients have grown rapidly. New shorter, all-oral treatment regimens represent a breakthrough, but progress is threatened by rising resistance to bedaquiline. Many new chemical entities are entering clinical trials and raise hopes for all-new regimens that could overcome rising resistance rates to conventional agents. More research is needed on the management of complex cases, such as central nervous system TB and severe HIV-associated TB. Post-TB lung disease (PTLD) is an under-recognised but growing concern, affecting millions of survivors with lasting respiratory impairment and increased mortality. Continued investment in development of TB vaccines and therapeutics, treatment shortening, and management of TB sequelae is critical to combat this ongoing public health challenge.

结核病:临床医生的最新进展。
结核病仍然是一个重大的全球健康威胁,死亡率高,实现世卫组织终止结核病战略里程碑的努力偏离了轨道。很明显,结核病并不是一种潜伏型和活动性的两种感染,而是沿着疾病谱系呈现的。亚临床结核在传播中的作用比以前认为的要大。气雾剂研究表明,未确诊的结核病患者,即使患有少杆菌病,也可能具有高度传染性,并显著促进结核病的传播。M72/AS01E疫苗的临床结果令人鼓舞。如果初步结果可以在正在进行的更大规模试验中得到证实,模型显示疫苗可以对流行病产生积极影响。结核病预防治疗(TPT),特别是对艾滋病毒感染者和耐药结核病患者家庭接触者等高危人群,已显示出疗效,但实施需要耗费大量资源。传染病患者的治疗选择迅速增加。新的更短的全口服治疗方案是一项突破,但对贝达喹啉的耐药性上升威胁着这一进展。许多新的化学实体正在进入临床试验阶段,这让人们对全新的治疗方案产生了希望,这些方案可能克服对传统药物日益上升的耐药性。需要对复杂病例的管理进行更多的研究,例如中枢神经系统结核病和与艾滋病毒相关的严重结核病。结核病后肺病(PTLD)是一个未得到充分认识但日益引起关注的问题,它影响着数百万幸存者,造成持续呼吸障碍和死亡率增加。继续投资开发结核病疫苗和治疗药物、缩短治疗时间和管理结核病后遗症,对于应对这一持续的公共卫生挑战至关重要。
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来源期刊
Respirology
Respirology 医学-呼吸系统
CiteScore
10.60
自引率
5.80%
发文量
225
审稿时长
1 months
期刊介绍: Respirology is a journal of international standing, publishing peer-reviewed articles of scientific excellence in clinical and clinically-relevant experimental respiratory biology and disease. Fields of research include immunology, intensive and critical care, epidemiology, cell and molecular biology, pathology, pharmacology, physiology, paediatric respiratory medicine, clinical trials, interventional pulmonology and thoracic surgery. The Journal aims to encourage the international exchange of results and publishes papers in the following categories: Original Articles, Editorials, Reviews, and Correspondences. Respirology is the preferred journal of the Thoracic Society of Australia and New Zealand, has been adopted as the preferred English journal of the Japanese Respiratory Society and the Taiwan Society of Pulmonary and Critical Care Medicine and is an official journal of the World Association for Bronchology and Interventional Pulmonology.
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