RESUMEN
In spite of the growing awareness of emerging drug-resistant Mycobacterium tuberculosis, the extent of inappropriate tuberculosis (TB) case management may be underestimated, even in Europe. We evaluated TB case management in the European Union/European Economic Area countries, with special focus on multidrug-resistant (MDR) and extensively drug-resistant (XDR)-TB, using a purposely developed, standardised survey tool. National reference centres in five countries representing different geographical, socioeconomic and epidemiological patterns of TB in Europe were surveyed. 40 consecutive, original clinical TB case records (30 MDR/XDR-TB cases) were reviewed in each of the five countries. The findings were recorded and, through the survey tool, compared with previously agreed and identified international standards. Deviations from international standards of TB care were observed in the following areas: surveillance (no information available on patient outcomes); infection control (lack of respiratory isolation rooms/procedures and negative-pressure ventilation rooms); clinical management of TB, MDR-TB and HIV co-infection (inadequate bacteriological diagnosis, regimen selection and treatment duration); laboratory support; and diagnostic/treatment algorithms. Gaps between present international standards of care and the management of MDR/XDR-TB patients were identified. Training, increased awareness, promotion of standards and allocation of appropriate resources are necessary to ensure appropriate care and management as well as to prevent further emergence of drug resistance.
Asunto(s)
Encuestas de Atención de la Salud , Tuberculosis Resistente a Múltiples Medicamentos/terapia , Tuberculosis Pulmonar/terapia , Adulto , Antituberculosos/normas , Antituberculosos/uso terapéutico , Coinfección/terapia , Unión Europea , Femenino , Infecciones por VIH/terapia , Humanos , Masculino , Persona de Mediana Edad , Resultado del Tratamiento , Adulto JovenAsunto(s)
Tuberculosis Extensivamente Resistente a Drogas/prevención & control , Tuberculosis Resistente a Múltiples Medicamentos/prevención & control , Recolección de Datos , Europa (Continente)/epidemiología , Unión Europea/estadística & datos numéricos , Tuberculosis Extensivamente Resistente a Drogas/epidemiología , Instituciones de Salud , Humanos , Tuberculosis Resistente a Múltiples Medicamentos/epidemiologíaRESUMEN
The emergence of drug-resistant tuberculosis (TB) is a challenge to TB control in Europe. We evaluated second-line drug susceptibility testing in Mycobacterium tuberculosis isolates from patients with multidrug-resistant, pre-extensively drug-resistant (pre-XDR-TB) and XDR-TB at 23 TBNET sites in 16 European countries. Over 30% of bacilli from patients with pre-XDR-TB showed resistance to any fluoroquinolone and almost 70% to any second-line injectable drug. Respectively >90% and >80% of the XDR-TB strains tested showed phenotypic resistance to pyrazinamide and ethambutol. Resistance to prothionamide/ethionamide was high in bacilli from pre-XDR-TB patients (43%) and XDR-TB patients (49%).
Asunto(s)
Antituberculosos/uso terapéutico , Tuberculosis Extensivamente Resistente a Drogas/tratamiento farmacológico , Mycobacterium tuberculosis/efectos de los fármacos , Adulto , Etambutol/uso terapéutico , Etionamida/uso terapéutico , Europa (Continente) , Femenino , Fluoroquinolonas/uso terapéutico , Humanos , Modelos Logísticos , Masculino , Pruebas de Sensibilidad Microbiana , Pirazinamida/uso terapéuticoRESUMEN
Hypersensitivity pneumonitis (HP) is an interstitial lung disease associated with repeated exposure to a wide range of inhaled organic dusts and related occupational allergens. Immunological phenomena have been reported to play an essential role in initiating and maintaining the disease. Natural history, clinical findings, chest radiography, pulmonary function, immunological investigations, the use of the bronchoalveolar lavage, the prognostic and management of HP are discussed.