Ülevaade tuberkuloosi haigestumise hetkeseisust Eestis

Maailma Terviseorganisatsiooni (WHO) andmetel on tuberkuloosi nakatunud 1/3 maailma rahvastikust, nakatunuist haigestub elu jooksul 5–10%. Piltlikult nakatub maailmas igas sekundis keegi tuberkuloosi ja igal aastal haigestub kogu maailmas tuberkuloosi (TB) üle 8 miljoni inimese. Aastatel 1993–1996 suurenes TB-haigestumus maailmas 13%. Eesti Arst 2005; 84 (1): 42-4

Tuberkuloosne spondüliit. Haigusjuhu kirjeldus

64aastane naine haigestus nimmevaluga. Ravi mittesteroidsete põletikuvastaste ainetega (NSAID) oli ebaefektiivne. Kompuutertomograafilisel (KT) uuringul ilmnesid spodülodistsiidi nähud, mida kinnitas ka magnetresonantstomograafiline (MRT) uuring. Haige hospitaliseeriti ja 3 nädala vältel raviti teda tseftasidiimi ja tsefepiimiga. Haige seisund halvenes ja ta viidi üle ülikoolihaiglasse. 6 nädala möödudes haigestumisest tehtud MRT-uuringul ilmnes L5 ja S1 lüli destruktsioon. Tuberkuloosse protsessi kahtluse tõttu tehtud test, millega mõõdetakse gammainterferooni eritumist, osutus positiivseks ja haigel alustati antituberkuloosset ravi. Ordineeriti 4 ravimit: isoniasiid, levofloksatsiin, etambutool ja pürasiinamiid. Kliiniliselt haige seisund paranes ning MRT-uuring, mis tehti 4 kuud pärast haigestumist, tõi esile positiivse dünaamika.Eesti Arst 2015; 94(3):153–15

Multidrug-resistant Tuberculosis Management in Resource-limited Settings

Managing MDRTB through national programs can yield results similar to those seen in wealthier settings

Availability and costs of medicines for the treatment of tuberculosis in Europe

To evaluate the access to comprehensive diagnostics and novel antituberculosis medicines in European countries. We investigated the access to genotypic and phenotypic Mycobacterium tuberculosis drug susceptibility testing and the availability of antituberculosis drugs and calculated the cost of drugs and treatment regimens at major tuberculosis treatment centres in countries of the WHO European region where rates of drug-resistant tuberculosis are the highest among all WHO regions. Results were stratified by middle-income and high-income countries. Overall, 43 treatment centres from 43 countries participated in the study. For WHO group A drugs, the frequency of countries with the availability of phenotypic drug susceptibility testing was as follows: (a) 75% (30/40) for levofloxacin, (b) 82% (33/40) for moxifloxacin, (c) 48% (19/40) for bedaquiline, and (d) 72% (29/40) for linezolid. Overall, of the 43 countries, 36 (84%) and 24 (56%) countries had access to bedaquiline and delamanid, respectively, whereas only 6 (14%) countries had access to rifapentine. The treatment of patients with extensively drug-resistant tuberculosis with a regimen including a carbapenem was available only in 17 (40%) of the 43 countries. The median cost of regimens for drug-susceptible tuberculosis, multidrug-resistant/rifampicin-resistant tuberculosis (shorter regimen, including bedaquiline for 6 months), and extensively drug-resistant tuberculosis (including bedaquiline, delamanid, and a carbapenem) were €44 (minimum-maximum, €15-152), €764 (minimum-maximum, €542-15152), and €8709 (minimum-maximum, €7965-11759) in middle-income countries (n = 12) and €280 (minimum-maximum, €78-1084), €29765 (minimum-maximum, €11116-40584), and €217591 (minimum-maximum, €82827-320146) in high-income countries (n = 29), respectively. In countries of the WHO European region, there is a widespread lack of drug susceptibility testing capacity to new and repurposed antituberculosis drugs, lack of access to essential medications in several countries, and a high cost for the treatment of drug-resistant tuberculosis

Spread of Drug-Resistant Pulmonary Tuberculosis in Estonia

ABSTRACT Restriction fragment length polymorphism (RFLP) analysis of 209 Mycobacterium tuberculosis clinical isolates obtained from newly detected pulmonary tuberculosis patients (151 male and 58 female; mean age, 41 years) in Estonia during 1994 showed that 61 isolates (29%) belonged to a genetically closely related group of isolates, family A, with a predominant IS 6110 banding pattern. These strains shared the majority of their IS 6110 DNA-containing restriction fragments, representing a predominant banding pattern (similarity, &gt;65%). This family A comprised 12 clusters of identical isolates, and the largest cluster comprised 10 strains. The majority (87.5%) of all multidrug-resistant (MDR) isolates, 67.2% of all isolates with any drug resistance, but only 12% of the fully susceptible isolates of M. tuberculosis belonged to family A. These strains were confirmed by spoligotyping as members of the Beijing genotype family. The spread of Beijing genotype MDR M. tuberculosis strains was also frequently seen in 1997 to 1999. The members of this homogenous group of drug-resistant M. tuberculosis strains have contributed substantially to the continual emergence of drug-resistant tuberculosis all over Estonia. </jats:p

Safety and immunogenicity of the M72/AS01E candidate tuberculosis vaccine in adults with tuberculosis: A phase II randomised study

SummaryPrevious studies have shown that the M72/AS01E candidate tuberculosis vaccine is immunogenic with a clinically acceptable safety profile in healthy and Mycobacterium tuberculosis-infected adults. This phase II, observer-blind, randomised study compared the safety, reactogenicity, and immunogenicity of M72/AS01E in 3 cohorts: tuberculosis-naïve adults (n = 80), adults previously treated for tuberculosis (n = 49), and adults who have completed the intensive phase of tuberculosis treatment (n = 13).In each cohort, 18–59-year-old adults were randomised (1:1) to receive two doses of M72/AS01E (n = 71) or placebo (n = 71) and followed-up until six months post-dose 2. Safety and reactogenicity were assessed as primary objective.Recruitment in the study ended prematurely because of a high incidence of large injection site redness/swelling reactions in M72/AS01E-vaccinated adults undergoing tuberculosis treatment. No additional clinically relevant adverse events were observed, except one possibly vaccine-related serious adverse event (hypersensitivity in a tuberculosis-treated-M72/AS01E participant). Robust and persistent M72-specific humoral and polyfunctional CD4+ T-cell-mediated immune responses were observed post-M72/AS01E vaccination in each cohort. In conclusion, the M72/AS01E vaccine was immunogenic in adults previously or currently treated for tuberculosis, but further analyses are needed to explain the high local reactogenicity in adults undergoing tuberculosis treatment.ClinicalTrials.gov: NCT0142450