提示: 手机请竖屏浏览!

广泛耐药性结核病在南非的传播
Transmission of Extensively Drug-Resistant Tuberculosis in South Africa


N. Sarita Shah ... 呼吸系统疾病 其他 • 2017.01.19
相关阅读
• 潜伏性结核的治疗 • 纳米微粒可能改善结核分枝杆菌感染的诊断

《广泛耐药性结核病在南非的传播》给我们的启示


赵雁林,王宇*

中国疾病预防控制中心

* 通讯作者


多药耐药结核病(MDR-TB)是指同时耐利福平和异烟肼(两个主要的抗结核药物)的结核病,广泛耐药性结核病(XDR-TB)是指在MDR-TB的基础上,又增加对其他两类主要抗结核药物氟喹诺酮类以及二线注射药物的耐受。结核病每年导致180万人死亡,其致死数量比艾滋病和疟疾致死总数还高1

查看更多

摘要


背景

耐药性结核病威胁着全世界结核病和人类免疫缺陷病毒(HIV)感染治疗的新进成果。在南非,广泛耐药性(XDR)结核病大规模流行,自2002年以来病例数大幅增加。科研人员尚未完全阐明病例快速增加的驱动因素,但是需要知晓这类信息以指导公共卫生干预措施。


方法

我们进行的一项前瞻性研究包括了在南非夸祖鲁-纳塔尔省(KwaZulu-Natal),自2011年至2014年间被确诊为XDR结核病的404名参与者。我们通过访谈和查阅病历的方式获取参与者的结核病和HIV感染、住院和社交网络的历史信息。我们对结核分枝杆菌分离株进行了插入序列(IS)6110限制性片段长度多态性分析、靶向基因测序和全基因组测序。我们使用临床和基因型病例定义来计算比较以下两类病例的比例:由于对多药耐药(MDR)结核病(即获得性耐药)治疗不足而引起的XDR结核病与由于传播(即传播耐药性)而引起的XDR结核病。我们使用社交网络分析法来识别社区和医院的传播地点。


结果

在404名参与者中,311名(77%)患HIV感染;中位CD4+计数为340个细胞/mm3(四分位距为117~431)。共有280名参与者(69%)从未接受过MDR结核病治疗。386名参与者的基因型分析显示323(84%)名属于31个簇中的1个。各簇包含2~14名参与者,唯一例外是感染LAM4/KZN菌株的212名参与者(55%)组成的一个大簇。在404名参与者中有123名(30%)确定了人与人或医院内的流行病学联系。


结论

在结核病负担高的南非夸祖鲁-纳塔尔省,大多数XDR结核病例可能是由于传播,而不是由于对MDR结核病的治疗不足。这些数据提示,我们需要更加重视阻断传播来控制耐药性结核病的流行(由美国国立过敏和传染病研究所[National Institute of Allergy and Infectious Diseases]等资助)。





作者信息

N. Sarita Shah, M.D., M.P.H., Sara C. Auld, M.D., James C.M. Brust, M.D., Barun Mathema, Ph.D., Nazir Ismail, Ph.D., Pravi Moodley, M.D., Koleka Mlisana, M.D., Ph.D., Salim Allana, M.B., B.S., M.D., Angela Campbell, M.A., Thuli Mthiyane, M.Sc., Natashia Morris, M.Sc., Primrose Mpangase, B.A., Hermina van der Meulen, Shaheed V. Omar, Ph.D., Tyler S. Brown, M.D., Apurva Narechania, M.A., Elena Shaskina, Ph.D., Thandi Kapwata, M.Sc., Barry Kreiswirth, Ph.D., and Neel R. Gandhi, M.D.
From the Emory University Rollins School of Public Health and School of Medicine (N.S.S., S.C.A., S.A., A.C., N.R.G.) and the Centers for Disease Control and Prevention (N.S.S.) — both in Atlanta; Albert Einstein College of Medicine and Montefiore Medical Center (N.S.S., J.C.M.B., N.R.G.), Columbia University Mailman School of Public Health (B.M., T.S.B.), and the American Museum of Natural History (A.N.) — all in New York; the National Institute for Communicable Diseases, Johannesburg (N.I., H.M., S.V.O.), University of KwaZulu-Natal and National Health Laboratory Service, Durban (P. Moodley, K.M., T.M., P. Mpangase), and the South African Medical Research Council, Cape Town (N.M., T.K.) — all in South Africa; and the Public Health Research Institute, New Jersey Medical School–Rutgers University, Newark (E.S., B.K.). Address reprint requests to Dr. Gandhi at the Rollins School of Public Health, Emory University, 1518 Clifton Rd. NE, Claudia Nance Rollins Bldg., Rm. 3031, Atlanta, GA 30322, or at neel.r.gandhi@emory.edu.

 

参考文献

1. Global tuberculosis report. Geneva: World Health Organization, 2015.

2. Pietersen E, Ignatius E, Streicher EM, et al. Long-term outcomes of patients with extensively drug-resistant tuberculosis in South Africa: a cohort study. Lancet 2014;383:1230-1239

3. Liu CH, Li L, Chen Z, et al. Characteristics and treatment outcomes of patients with MDR and XDR tuberculosis in a TB referral hospital in Beijing: a 13-year experience. PLoS One 2011;6:e19399-e19399

4. Shah NS, Pratt R, Armstrong L, Robison V, Castro KG, Cegielski JP. Extensively drug-resistant tuberculosis in the United States, 1993-2007. JAMA 2008;300:2153-2160

5. Falzon D, Gandhi N, Migliori GB, et al. Resistance to fluoroquinolones and second-line injectable drugs: impact on multidrug-resistant TB outcomes. Eur Respir J 2013;42:156-168

6. Gandhi NR, Moll A, Sturm AW, et al. Extensively drug-resistant tuberculosis as a cause of death in patients co-infected with tuberculosis and HIV in a rural area of South Africa. Lancet 2006;368:1575-1580

7. Wells CD, Cegielski JP, Nelson LJ, et al. HIV infection and multidrug-resistant tuberculosis: the perfect storm. J Infect Dis 2007;196:Suppl 1:S86-107

8. Moro ML, Gori A, Errante I, et al. An outbreak of multidrug-resistant tuberculosis involving HIV-infected patients of two hospitals in Milan, Italy. AIDS 1998;12:1095-1102

9. Ritacco V, Di Lonardo M, Reniero A, et al. Nosocomial spread of human immunodeficiency virus-related multidrug-resistant tuberculosis in Buenos Aires. J Infect Dis 1997;176:637-642

10. Gelmanova IY, Keshavjee S, Golubchikova VT, et al. Barriers to successful tuberculosis treatment in Tomsk, Russian Federation: non-adherence, default and the acquisition of multidrug resistance. Bull World Health Organ 2007;85:703-711

11. Pearson ML, Jereb JA, Frieden TR, et al. Nosocomial transmission of multidrug-resistant Mycobacterium tuberculosis: a risk to patients and health care workers. Ann Intern Med 1992;117:191-196

12. Annual tuberculosis report for South Africa, 2012: research, information, monitoring, evaluation and surveillance. Pretoria: National TB Control and Management Cluster, Department of Health, Republic of South Africa, 2016.

13. Shisana O, Rehle T, Simbayi L, et al. South African national HIV prevalence, incidence and behavior survey. Cape Town, South Africa: HSRC Press, 2014.

14. Ndjecka N. Multi-drug resistant tuberculosis: strategic overview on MDR-TB care in South Africa. Pretoria: Department of Health, Republic of South Africa, 2014.

15. Cook VJ, Sun SJ, Tapia J, et al. Transmission network analysis in tuberculosis contact investigations. J Infect Dis 2007;196:1517-1527

16. Clinical policies and protocols. 4th ed. New York: Bureau of Tuberculosis Control, New York City Department of Health and Mental Hygiene, 2008.

17. Gandhi NR, Weissman D, Moodley P, et al. Nosocomial transmission of extensively drug-resistant tuberculosis in a rural hospital in South Africa. J Infect Dis 2013;207:9-17

18. Plus R: a suite of publicly available software programs for collecting and processing cancer registry data. Atlanta: National Center for Chronic Disease Prevention and Health Promotion, 2015.

19. Borgatti SP, Everett MG, Freeman LC. Ucinet 6 for Windows: software for social network analysis. Harvard, MA: Analytic Technologies, 2002.

20. Shah NS, Wright A, Bai G-H, et al. Worldwide emergence of extensively drug-resistant tuberculosis. Emerg Infect Dis 2007;13:380-387

21. World TB Day — March 24, 2016. MMWR Morb Mortal Wkly Rep 2016;65:273-273

22. Farley JE, Tudor C, Mphahlele M, et al. A national infection control evaluation of drug-resistant tuberculosis hospitals in South Africa. Int J Tuberc Lung Dis 2012;16:82-89

23. Tudor C, Van der Walt M, Hill MN, Farley JE. Occupational health policies and practices related to tuberculosis in health care workers in KwaZulu-Natal, South Africa. Public Health Action 2013;3:141-145

24. Walker TM, Lalor MK, Broda A, et al. Assessment of Mycobacterium tuberculosis transmission in Oxfordshire, UK, 2007-12, with whole pathogen genome sequences: an observational study. Lancet Respir Med 2014;2:285-292

25. Guerra-Assunção JA, Crampin AC, Houben RM, et al. Large-scale whole genome sequencing of M. tuberculosis provides insights into transmission in a high prevalence area. Elife 2015;4:4-4

26. Bryant JM, Schürch AC, van Deutekom H, et al. Inferring patient to patient transmission of Mycobacterium tuberculosis from whole genome sequencing data. BMC Infect Dis 2013;13:110-110

27. Glynn JR, Guerra-Assunção JA, Houben RM, et al. Whole genome sequencing shows a low proportion of tuberculosis disease is attributable to known close contacts in rural Malawi. PLoS One 2015;10:e0132840-e0132840

28. Marais BJ, Mlambo CK, Rastogi N, et al. Epidemic spread of multidrug-resistant tuberculosis in Johannesburg, South Africa. J Clin Microbiol 2013;51:1818-1825

29. Becerra MC, Appleton SC, Franke MF, et al. Tuberculosis burden in households of patients with multidrug-resistant and extensively drug-resistant tuberculosis: a retrospective cohort study. Lancet 2011;377:147-152

30. Devaux I, Kremer K, Heersma H, Van Soolingen D. Clusters of multidrug-resistant Mycobacterium tuberculosis cases, Europe. Emerg Infect Dis 2009;15:1052-1060

31. Zhao Y, Xu S, Wang L, et al. National survey of drug-resistant tuberculosis in China. N Engl J Med 2012;366:2161-2170

32. Yang C, Shen X, Peng Y, et al. Transmission of Mycobacterium tuberculosis in China: a population-based molecular epidemiologic study. Clin Infect Dis 2015;61:219-227

33. Li X, Zhang Y, Shen X, et al. Transmission of drug-resistant tuberculosis among treated patients in Shanghai, China. J Infect Dis 2007;195:864-869

34. Said HM, Kock MM, Ismail NA, et al. Molecular characterization and second-line antituberculosis drug resistance patterns of multidrug-resistant Mycobacterium tuberculosis isolates from the northern region of South Africa. J Clin Microbiol 2012;50:2857-2862

35. Basu S, Andrews JR, Poolman EM, et al. Prevention of nosocomial transmission of extensively drug-resistant tuberculosis in rural South African district hospitals: an epidemiological modelling study. Lancet 2007;370:1500-1507

36. Frieden TR, Fujiwara PI, Washko RM, Hamburg MA. Tuberculosis in New York City — turning the tide. N Engl J Med 1995;333:229-233

37. Barrera E, Livchits V, Nardell E. F-A-S-T: a refocused, intensified, administrative tuberculosis transmission control strategy. Int J Tuberc Lung Dis 2015;19:381-384

38. Loveday M, Wallengren K, Brust J, et al. Community-based care vs. centralised hospitalisation for MDR-TB patients, KwaZulu-Natal, South Africa. Int J Tuberc Lung Dis 2015;19:163-171

39. Mitnick C, Bayona J, Palacios E, et al. Community-based therapy for multidrug-resistant tuberculosis in Lima, Peru. N Engl J Med 2003;348:119-128

40. Theron G, Zijenah L, Chanda D, et al. Feasibility, accuracy, and clinical effect of point-of-care Xpert MTB/RIF testing for tuberculosis in primary-care settings in Africa: a multicentre, randomised, controlled trial. Lancet 2014;383:424-435

41. Shah NS, Yuen CM, Heo M, Tolman AW, Becerra MC. Yield of contact investigations in households of patients with drug-resistant tuberculosis: systematic review and meta-analysis. Clin Infect Dis 2014;58:381-391

42. Grandjean L, Gilman RH, Martin L, et al. Transmission of multidrug-resistant and drug-susceptible tuberculosis within households: a prospective cohort study. PLoS Med 2015;12:e1001843-e1001843

43. Andrews JR, Gandhi NR, Moodley P, et al. Exogenous reinfection as a cause of multidrug-resistant and extensively drug-resistant tuberculosis in rural South Africa. J Infect Dis 2008;198:1582-1589

44. Yuen CM, Amanullah F, Dharmadhikari A, et al. Turning off the tap: stopping tuberculosis transmission through active case-finding and prompt effective treatment. Lancet 2015;386:2334-2343

服务条款 | 隐私政策 | 联系我们