儿童耐多药结核病:关于流行病学、诊断、治疗和预防的最新实用信息

IF 1.9 Q3 INFECTIOUS DISEASES
James T. Gaensbauer , Nabaneeta Dash , Sanjay Verma , DJ Hall , Felice C. Adler-Shohet , Guyu Li , Grace Lee , Laura Dinnes , Kristen Wendorf
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引用次数: 0

摘要

小儿耐多药结核病(MDR-TB)仍然是一个严重的全球性问题,有许多障碍阻碍着对耐多药结核病患儿的识别、微生物学检测的确认以及安全、实用和有效的治疗方案。然而,诊断和治疗方案的最新进展有望改善 MDR-TB 儿童的治疗效果。我们通过两个病例来介绍这篇综述,这两个病例既体现了儿童 MDR-TB 管理方面的挑战,也体现了取得积极疗效的潜力。据信,每年有 3 万多例 MDR-TB 病例发生在儿童身上,但经微生物学确诊的病例不到 5%,这导致了较差的治疗效果和过高的死亡率。提供利福平敏感性信息的基于分子的快速检测在全球范围内越来越普及,并被推荐用于所有疑似结核病患儿--但仍受限于获取适当样本的困难和大多数儿童结核病的贫血病性质。目前正在出现更复杂的检测方法,可以更好地确定耐药分离株的特征。对于确诊为 MDR-TB 的儿童,传统的治疗方案疗程较长,使用多种药物,尤其是注射药物,副作用较大。现在,包括贝达喹啉、地拉马尼、氯法齐明和利奈唑胺在内的几种新药或重新设计用途的药物可以缩短大多数治疗方案的疗程,而且可以全口服。然而,目前支持针对幼儿的短程、全口服、含有前马尼肽的新型治疗方案的数据仍然不足,因此亟需对有前景的治疗药物和 MDR-TB 治疗方案进行儿科试验。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Multidrug-resistant tuberculosis in children: A practical update on epidemiology, diagnosis, treatment and prevention

Pediatric multidrug-resistant tuberculosis (MDR-TB) remains a significant global problem, and there are numerous barriers preventing children with MDR-TB from being identified, confirmed with microbiologic tests, and treated with a safe, practical, and effective regimen. However, several recent advances in diagnostics and treatment regimens have the promise to improve outcomes for children with MDR-TB. We introduce this review with two cases that exemplify both the challenges in management of MDR-TB in children, but also the potential to achieve a positive outcome. More than 30,000 cases of MDR-TB per year are believed to occur in children but less than 5% are confirmed microbiologically, contributing to poorer outcomes and excess mortality. Rapid molecular-based testing that provides information on rifampin susceptibility is increasingly globally available and recommended for all children suspected of TB disease--but remains limited by challenges obtaining appropriate samples and the paucibacillary nature of most pediatric TB. More complex assays allowing better characterization of drug-resistant isolates are emerging. For children diagnosed with MDR-TB, treatment regimens have traditionally been long and utilize multiple drugs associated with significant side effects, particularly injectable agents. Several new or repurposed drugs including bedaquiline, delamanid, clofazimine and linezolid now allow most treatment regimens to be shorter and all-oral. Yet data to support short, all-oral, novel regimens for young children containing pretomanid remain insufficient at present, and there is a compelling need to conduct pediatric trials of promising therapeutics and MDR-TB treatment regimens.

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来源期刊
Journal of Clinical Tuberculosis and Other Mycobacterial Diseases
Journal of Clinical Tuberculosis and Other Mycobacterial Diseases Medicine-Pulmonary and Respiratory Medicine
CiteScore
4.00
自引率
5.00%
发文量
44
审稿时长
30 weeks
期刊介绍: Journal of Clinical Tuberculosis and Mycobacterial Diseases aims to provide a forum for clinically relevant articles on all aspects of tuberculosis and other mycobacterial infections, including (but not limited to) epidemiology, clinical investigation, transmission, diagnosis, treatment, drug-resistance and public policy, and encourages the submission of clinical studies, thematic reviews and case reports. Journal of Clinical Tuberculosis and Mycobacterial Diseases is an Open Access publication.
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