中国结核感染现状.ppt

LatentInfectionofTuberculosisinChinaHUASHANHOSPITAL,FUDANUNIVERSITY,Shanghai,ChinaWenhongZhang,M.DPhD.

TB:Aleadinginfectiouskiller

-top3infectiouskillerTBkillsabout2millionpeopleeachyear8millionpeoplebecomesickwithTBeachyearTBistheleadingkillerofHIV/AIDSpatients50millionpeopleinfectedwithdrug-resistantTB

TheNewTuberculosisHIVandDrug-resistantTB–AlethalcombinationandamajorthreattoTBcontrolWHOdeclaredTBaglobalemergencyin1993

TBChemotherapy:

THEEffectiveTBControlPre-antibioticera:before1940s(e.g.,codliveroils,bedrest,freshair)DrugsusedtotreatTB:StreptomycinfirstTBdrug(1944),followedbyPAS(1946),isoniazid(1952),pyrazinamide(1952),rifampin(1963) (a)Front-lineDrugs:isoniazid(INH)rifampicin(RMP),pyrazinamide(PZA),streptomycin,ethambutol. (b)Second-lineDrugs:PAS,kanamycin,cycloserine,ethionamide,thiacetazone,ciprofloxacin/ofloxacin,rifapentine,amikacin,viomycin,capreomycin.

DOTS-TheBestTBTherapy

since1991DOTS:6monththerapy-ThebesttherapyagainstTB(78%-96%curerate).Initialphase(daily,2months)with4drugs:INH,RMP,PZA,Ethambutol.Continuationphase(3timesaweek,4months)with2drugs:INHandRMP.

DOTS-PlusDOTS+second-lineTBdrugs(PAS,ethionamide,cycloserine,kanamycin,amikacinetc.)Tooexpensive(TBcase:$11to$100,costoftreatinganMDR-TBcase:$150,000)MDR-TBrequiresextensivechemotherapy(alsomoretoxictopatients-sideeffects)foruptotwoyears??DOTS-PlusworksasasupplementtotheDOTS,toaddressbothdrug-susceptibleandMDR-TBinareaswithsignificantMDR-TB.

DiseaseBurdenofTuberculosisinChina,2000dataPrevalenceofactivepulmonarydiseasesis367／100,000PrevalenceofSearpositivepulmonarydiseasesis122／100,000130,000patientsdiefromtuberculosiseveryyearNodataoflatenttuberculosisinChinauptonowChinaCDC2006

PrevalenceofSmearPositiveTuberculosisi