Emergence and treatment of multidrug resistant (MDR) and extensively drug-resistant (XDR) tuberculosis in South Africa
| Autor: | Kim G. P. Hoek, Paul D. van Helden, Frederick A. Sirgel, Thomas C. Victor, Manormoney Pillay, Andre Trollip, Marisa Tait, Elizabeth M. Streicher, Nicolaas C. Gey van Pittius, Robin M. Warren, Charmaine K. Mlambo, Borna Müller, Violet N. Chihota |
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| Rok vydání: | 2012 |
| Předmět: |
Microbiology (medical)
Drug medicine.medical_specialty Delayed Diagnosis Tuberculosis Genotype Extensively Drug-Resistant Tuberculosis media_common.quotation_subject Antitubercular Agents Drug resistance Biology Microbiology South Africa Drug Resistance Multiple Bacterial Tuberculosis Multidrug-Resistant Epidemiology Genetics medicine Culture conversion Humans Intensive care medicine Molecular Biology Ecology Evolution Behavior and Systematics media_common Molecular epidemiology business.industry Transmission (medicine) Mycobacterium tuberculosis medicine.disease Biotechnology Multiple drug resistance Phylogeography Infectious Diseases Practice Guidelines as Topic business |
| Zdroj: | Infection, Genetics and Evolution. 12:686-694 |
| ISSN: | 1567-1348 |
| DOI: | 10.1016/j.meegid.2011.07.019 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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