Mycrobacterium tuberculosis

Notas del editor

• #2: http://www.medicosgeneralescolombianos.com/TBC.htm
• #6: Isoniazida Rifampicina Etambutol Pirazinamida MDRTB
• #7: Cicloserina Etionamida Levofloxacina Moxifloxacina Gatifloxacina Ácido p-Aminosalicílico Estreptomicina Amikacina/kanamicina Capreomicina XDRTB
• #8: 9.27 millones de casos de TB en el 2007 en el mundo De esos, 1.37 millones (14.8%) eran VIH positivo Solo el 6% de los casos de MDR-TB fueron notificados por DST.
• #11: Los países que reportaron datos de DST, solo alcanzaron el 47% del número total de casos nuevos de MDR.TB y el 60% para los casos previamente tratados.
• #12: Años 2004 - 2005
• #13: Colombia reportó su primer caso de XDR TB en el 2007
• #14: Given the large proportion of missing data, it has not been possible to conclude whether an overall association between MDR-TB and HIV epidemics exists. However, based on the current data, HIV-positive TB patients in three Eastern European countries (Estonia, Latvia and the Republic of Moldova) appear to be more at risk of harbouring MDR-TB strains. This finding concurs with the results of the earlier reported survey conducted in Ukraine (6). Furthermore, in Lithuania – where drug resistance data could not be disaggregated by HIV-negative and unknown HIV status – HIV-positive TB patients had a 8.4 (95% CI: 2.7– 28.2) times higher odds of harbouring MDR-TB strains than TB patients for whom HIV status was unknown, indicating a possible association of the two epidemics. In addition, preliminary results of a survey conducted in Mozambique in 2007 have also found a significant association. Lack of an association between HIV status and MDR-TB in some settings can be due to low numbers of HIV-positive TB patients or patients with MDR-TB and consequent insufficient power in analysis. This may be a result of lack of testing of patients or of incomplete reporting of results. There are several reasons why drug-resistant TB may be associated with HIV. Firstly, people living with HIV in Eastern Europe – particularly those infected earlier in the epidemic and whose weakened immune systems have since left them vulnerable to TB – frequently come from socially vulnerable populations, including injecting drug users. Socio-behavioural problems and/or lack of access to proper care may make these populations, as TB patients, vulnerable to developing drug resistance as a result of poor adherence to treatment or suboptimal treatment. Furthermore, people living with HIV may also be more likely to be exposed to MDR-TB patients, due either to increased hospitalizations in settings with poor infection control or association with peers who may have MDR-TB, including in penitentiary settings. In addition, acquisition of rifampicin resistance among people living with HIV under treatment for TB may also be the result of anti-TB drug malabsorption, which has been documented in patient cohorts in settings of high HIV prevalence. The epidemiological impact of HIV infection on the transmission of MDR-TB is still unclear and may depend on several factors. HIV-positive TB cases are more likely to be sputum smear negative, and therefore less likely to transmit TB. In addition, delayed diagnosis of drug resistance and unavailability of treatment (particularly in previous years) have led to high death rates in people living with HIV, which may also result in a lower rate of TB transmission. On the other hand, people living with HIV progress more rapidly to TB disease, and in settings where MDR-TB is prevalent (either among the general population or in a specific population such as a hospital or a district), this may lead to rapid development of a pool of drug-resistant TB patients. Although there appears to be an association between drug-resistant TB and HIV infection in some Eastern European countries, the data are still limited to be able to determine whether there is an overlap between the MDR-TB and HIV epidemics worldwide. Unfortunately, the continuous surveillance data in this report come only from two regions, the European Region and the Region of the Americas, and no data are reported from countries with the highest prevalence of HIV infection. It is critical to include HIV testing in drug resistance surveys and in routine surveillance efforts in order to better understand the relationship between the two epidemics, which is key for optimal care of patients
• #15: Factores de Riesgo