Emergence and treatment of multidrug resistant (MDR) and extensively drug-resistant (XDR) tuberculosis in South Africa

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• 作者：Elizabeth M. Streicher^a ; ^{lizma@sun.ac.za} ; Borna Mü ; ller^a ; Violet Chihota^a ; ^b ; Charmaine Mlambo^c ; Marisa Tait^a ; Manormoney Pillay^d ; Andre Trollip^a ; Kim G.P. Hoek^e ; Frederick A. Sirgel^a ; Nicolaas C. Gey van Pittius^a ; Paul D. van Helden^a ; Thomas C. Victor^a ; Robin M. Warren^a
• 关键词：Drug resistance ; Surveillance ; Evolution ; MDR-TB ; XDR-TB
• 刊名：Infection ; Genetics and Evolution
• 出版年：2012
• 期刊代码：119_15671348
• 类别：med
• 出版时间：June, 2012
• 卷：12
• 期：4
• 页码：686-694
• 文件大小：534 K

摘要

Drug resistant tuberculosis (TB) has reached alarming proportions in South Africa, draining valuable resources that are needed to fight drug susceptible TB. It is currently estimated that 9.6%of all TB cases have multi-drug resistant (MDR)-TB, thereby ranking South Africa as one of the highest MDR-TB burden countries in the world. Molecular epidemiological studies have demonstrated the complexity of the epidemic and have clearly shown that the epidemic is driven by transmission as a consequence of low cases detection and diagnostic delay. The latter has in turn fueled the amplification of drug resistance, ultimately leading to the emergence of extensively drug resistant (XDR)-TB. Despite the introduction of new drugs to combat this scourge, culture conversion rates for XDR-TB remain below 20%. Failure to achieve cure may be explained from DNA sequencing results which have demonstrated mutations in 7 genes encoding resistance to at least 8 anti-TB drugs. This review shows how molecular epidemiology has provided novel insights into the MDR-TB epidemic in South Africa and thereby has highlighted the challenges that need to be addressed regarding the diagnosis and treatment of MDR-TB. An important step towards for curbing this epidemic will be collaboration between clinicians, laboratories and researchers to establish scientific knowledge and medical expertise to more efficiently guide public health policy.