Pulmonoloogia. Uued suunad ravimiresistentse tuberkuloosi ravis

Eesti Arst 2019; 98(4):233–23

Kopsuväline tuberkuloos Eestis

Kuigi tuberkuloosi peamiseks paikmeks on kopsud, võib ta esineda ka paljudes teistes organsüsteemides, põhjustades raskusi nii diagnoosimisel kui ravi korraldamisel. Artiklis on tutvustatud kopsuvälise ehk ekstrapulmonaalse tuberkuloosi (EPTB, extrapulmonary tuberculosis) epidemioloogilisi uuringuid Eestis, analüüsitud diagnoosimise võimalusi ning erinevate erialaarstide koostööd EPTB diagnostika ja ravi alal. Eesti Arst 2003; 82 (10): 686–69

Multiresistentse tuberkuloosi ravi kulutulusus ja ravitulemused erinevate ravistrateegiate rakendamisel

Järjest laialdasemalt rakendatakse multiresistentse tuberkuloosi haigete raviks DOTS-Plus strateegiat, kasutades teise rea ravimeid, kuid teadmised nende efektiivsuse ja kulutulususe kohta on vähesed. Uuringus hinnati alates 2001. a augustist Eestis rakendatud DOTS-Plus strateegia tõhusust, maksumust ja kulutulusust võrreldes 3 alternatiivset ravi strateegiat: DOTS-Plus strateegia, pre-DOTS-plus strateegia ja DOTS-strateegia. Kulud arvutati 2002. a kehtinud hindades, tõhususe näitajateks olid tuberkuloosist põhjustatud surmade arv, kaotatud haiguskoormus ja kulutulususe näitajaks säästetud haiguskoormuse maksumus. Saadud andmete alusel võib väita, et kasutades DOTS-Plus strateegiat, on võimalik oluliselt paran dada multiresistentse tuberkuloosi haigete ravitulemusi ning võrreldes teiste võimalustega on see kulutulusaim. Eesti Arst 2006; 85 (3): 148–15

Multidrug-resistant Tuberculosis Management in Resource-limited Settings

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

Isoniazid (INH) mono-resistance and tuberculosis (TB) treatment success: analysis of European surveillance data, 2002 to 2014

Introduction: Isoniazid (INH) is an essential drug for tuberculosis (TB) treatment. Resistance to INH may increase the likelihood of negative treatment outcome. Aim: We aimed to determine the impact of INH mono-resistance on TB treatment outcome in the European Union/ European Economic Area and to identify risk factors for unsuccessful outcome in cases with INH mono-resistant TB. Methods: In this observational study, we retrospectively analysed TB cases that were diagnosed in 2002–14 and included in the European Surveillance System (TESSy). Multilevel logistic regression models were applied to identify risk factors and correct for clustering of cases within countries. Results: A total of 187,370 susceptible and 7,578 INH mono-resistant TB cases from 24 countries were included in the outcome analysis. Treatment was successful in 74.0% of INH mono-resistant and 77.4% of susceptible TB cases. In the final model, treatment success was lower among INH mono-resistant cases (Odds ratio (OR): 0.7; 95% confidence interval (CI): 0.6–0.9; adjusted absolute difference in treatment success: 5.3%). Among INH mono-resistant TB cases, unsuccessful treatment outcome was associated with age above median (OR: 1.3; 95% CI: 1.2–1.5), male sex (OR: 1.3; 95% CI: 1.1–1.4), positive smear microscopy (OR: 1.3; 95% CI: 1.1–1.4), positive HIV status (OR: 3.3; 95% CI: 1.6–6.5) and a prior TB history (OR: 1.8; 95% CI: 1.5–2.2). Conclusions: This study provides evidence for an association between INH mono-resistance and a lower likelihood of TB treatment success. Increased attention should be paid to timely detection and management of INH mono-resistant TB

Determinants of site of tuberculosis disease: An analysis of European surveillance data from 2003 to 2014.

We explored host-related factors associated with the site of tuberculosis (TB) disease using variables routinely collected by the 31 EU/EEA countries for national surveillance.Logistic regression models were fitted to case-based surveillance data reported to the European Centre for Disease Prevention and Control for TB cases notified from 2003 to 2014. Missing data on HIV infection and on susceptibility to isoniazid and rifampicin for many patients precluded the inclusion of these variables in the analysis. Records from Finland, Lithuania, Spain and the United Kingdom were excluded for lack of exact details of disease localisation; other records without one or more variable (e.g. previous treatment history, geographical origin) or who had mixed pulmonary and extrapulmonary disease or more than one form of extrapulmonary disease were also removed (total exclusion = 38% of 913,637 notifications).564,916 TB cases reported by 27 EU/EEA countries had exclusive pulmonary (PTB; 83%) or extrapulmonary (EPTB; 17%) disease. EPTB was associated with age 3.7), and age <15 years with lymphatic (aOR: 17.96) and central nervous system disease (aOR: 11.41).Awareness of host-related determinants of site of TB is useful for diagnosis. The predilection for EPTB among patients originating from countries outside Europe may reflect strain preferences for disease localization, geographic/ethnic differences in disease manifestation and other factors, like HIV

Isoniazid (INH) mono-resistance and tuberculosis (TB) treatment success: analysis of European surveillance data, 2002 to 2014

Introduction: Isoniazid (INH) is an essential drug for tuberculosis (TB) treatment. Resistance to INH may increase the likelihood of negative treatment outcome. Aim: We aimed to determine the impact of INH mono-resistance on TB treatment outcome in the European Union/European Economic Area and to identify risk factors for unsuccessful outcome in cases with INH mono-resistant TB. Methods: In this observational study, we retrospectively analysed TB cases that were diagnosed in 2002–14 and included in the European Surveillance System (TESSy). Multilevel logistic regression models were applied to identify risk factors and correct for clustering of cases within countries. Results: A total of 187,370 susceptible and 7,578 INH mono-resistant TB cases from 24 countries were included in the outcome analysis. Treatment was successful in 74.0% of INH mono-resistant and 77.4% of susceptible TB cases. In the final model, treatment success was lower among INH mono-resistant cases (Odds ratio (OR): 0.7; 95% confidence interval (CI): 0.6–0.9; adjusted absolute difference in treatment success: 5.3%). Among INH mono-resistant TB cases, unsuccessful treatment outcome was associated with age above median (OR: 1.3; 95% CI: 1.2–1.5), male sex (OR: 1.3; 95% CI: 1.1–1.4), positive smear microscopy (OR: 1.3; 95% CI: 1.1–1.4), positive HIV status (OR: 3.3; 95% CI: 1.6–6.5) and a prior TB history (OR: 1.8; 95% CI: 1.5–2.2). Conclusions: This study provides evidence for an association between INH mono-resistance and a lower likelihood of TB treatment success. Increased attention should be paid to timely detection and management of INH mono-resistant TB.Peer Reviewe

Demographic and clinical characteristics of tuberculosis cases notified in 31 European Union and European Economic Area countries, by site of disease, 2003–2014.

<p>Demographic and clinical characteristics of tuberculosis cases notified in 31 European Union and European Economic Area countries, by site of disease, 2003–2014.</p