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Medikamentenresistente Tuberkulose

Epidemiologie, Diagnostik, Therapie

Drug-resistant tuberculosis

Epidemiology, diagnostics and therapy

  • Schwerpunkt: Tuberkulose
  • Published:
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Zusammenfassung

Die medikamentenresistente Tuberkulose („drug-resistant tuberculosis“ [DR-TB]) ist auf globalem Niveau eines der größten Probleme bei der effektiven Bekämpfung der Tuberkulose. Dieser Übersichtsbeitrag beschreibt in Kürze die globale Epidemiologie, Diagnostik und Behandlung der DR-TB. Detailliert wird auf die Situation in Deutschland, der Schweiz und Österreich eingegangen. Eine Vorstellung der aktuellen Forschungsschwerpunkte im Bereich der resistenten Tuberkulose schließt den Beitrag ab.

Abstract

Drug-resistant tuberculosis (DR-TB) is one of the serious problems in the fight against tuberculosis on a global scale. This review article describes in brief the global epidemiology, diagnostics and treatment of DR-TB. The situation in Germany, Switzerland and Austria is addressed in detail. The article concludes with a presentation of current research topics in the field of resistant TB.

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Literatur

  1. Bundesministerium für Gesundheit (2013) Infektionsschutzgesetz vom 20. Juli 2000 (BGBl. I S. 1045), zuletzt geändert durch Artikel 2 Absatz 36 u. Artikel 4 Absatz 21 des Gesetzes vom 7. August 2013 (BGBl. I S. 3154). http://www.bgbl.de/xaver/bgbl/start.xav%3Fstart=%2F%2F*%5B%40attr%5Fid%3D%27bgbl111s1622.pdf%27%5D%23%5F%5Fbgbl%5F%5F%2F%2F*%5B%40attr%5Fid%3D%27bgbl111s1622.pdf%27%5D%5F%5F1444312936681. Zugegriffen: 08.10.2015

    Google Scholar 

  2. Kompetenzzentrum Tuberkulose Lungenliga. www.tbinfo.ch. Zugegriffen: 08.10.2015

  3. Österreichische Agentur für Gesundheit und Ernährungssicherheit (AGES) http://www.ages.at. Zugegriffen: 08.10.2015

  4. Österreichische Agentur für Gesundheit und Ernährungssicherheit (AGES), Institut für medizinische Mikrobiologie und Hygiene Wien, Nationale Referenzzentrale für Tuberkulose Jahresbericht 2013. http://www.ages.at/fileadmin/AGES2015/Themen/Krankheitserreger_Dateien/Tuberkulose/Tuberkulose_Jahresbericht_2013.pdf. Zugegriffen: 08.10.2015

  5. Österreichische Gesellschaft für Antimikrobielle Chemotherapie Infektionen. Meldepflichtige Krankheiten in Österreich. www.infektionsnetz.at/TextExtMeldepflicht.phtml. Zugegriffen: 08.10.2015

  6. Republic of South Africa’s Department of Health (2011) Management of drug-resistant tuberculosis. policy guidelines, august 2011. http://www.hst.org.za/publications/management-drug-resistant-tuberculosis-policy-guidelines. Zugegriffen: 08.10.2015

    Google Scholar 

  7. Robert Koch Institut www.rki.de. Zugegriffen: 08.10.2015

  8. Robert Koch Institut Bericht zur Epidemiologie der Tuberkulose in Deutschland für 2013. http://www.rki.de/DE/Content/InfAZ/T/Tuberkulose/Download/TB2013.pdf?__blob=publicationFile. Zugegriffen: 08.10.2015

  9. Schweizerische Eidgenossenschaft - Bundesamt für Gesundheit BAG www.bag.admin.ch. Zugegriffen: 08.10.2015

  10. Schweizerische Eidgenossenschaft - Der Bundesrat Verordnung über die Meldung übertragbarer Krankheiten des Menschen. https://www.admin.ch/opc/de/classified-compilation/19983529. Zugegriffen: 08.10.2015

  11. World Health Organization Updated interim critical concentrations for first-line and second-line DST (as of may 2012). http://www.stoptb.org/wg/gli/assets/documents/Updated%20critical%20concentration%20table_1st%20and%202nd%20line%20drugs.pdf. Zugegriffen: 08.10.2015

  12. World Health Organization (2014) Companion handbook to the WHO guidelines for the programmatic management of drug-resistant tuberculosis. http://apps.who.int/iris/bitstream/10665/130918/1/9789241548809_eng.pdf. Zugegriffen: 08.10.2015

    Google Scholar 

  13. World Health Organization (2011) Guidelines for the programmatic management of drug-resistant tuberculosis. http://apps.who.int/iris/bitstream/10665/44597/1/9789241501583_eng.pdf. Zugegriffen: 08.10.2015

    Google Scholar 

  14. Aung KJ, Van Deun A, Declercq E, Sarker MR, Das PK, Hossain MA, Rieder HL (2014) Successful ‚9-month Bangladesh regimen‘ for multidrug-resistant tuberculosis among over 500 consecutive patients. Int J Tuberc Lung Dis 18:1180–1187

    Article  CAS  PubMed  Google Scholar 

  15. Belard S, Heuvelings CC, Janssen S, Grobusch MP (2015) Bedaquiline for the treatment of drug-resistant tuberculosis. Expert Rev Anti Infect Ther 13:535–553

    Article  CAS  PubMed  Google Scholar 

  16. Belard S, Janssen S, Osbak KK, Adegnika AA, Ondounda M, Grobusch MP (2015) Limited access to drugs for resistant tuberculosis: a call to action. J Public Health 37(4):691–693

    Google Scholar 

  17. Borgdorff MW, van Soolingen D (2013) The re-emergence of tuberculosis: what have we learnt from molecular epidemiology? Clin Microbiol Infect 19:889–901

    Article  CAS  PubMed  Google Scholar 

  18. Brown M, Varia H, Bassett P, Davidson RN, Wall R, Pasvol G (2007) Prospective study of sputum induction, gastric washing, and bronchoalveolar lavage for the diagnosis of pulmonary tuberculosis in patients who are unable to expectorate. Clin Infect Dis 44:1415–1420

    Article  PubMed  Google Scholar 

  19. Cremers AL, de Laat MM, Kapata N, Gerrets R, Klipstein-Grobusch K, Grobusch MP (2015) Assessing the consequences of stigma for tuberculosis patients in urban Zambia. PLOS One 10:e0119861

    Article  PubMed Central  PubMed  Google Scholar 

  20. Diacon AH, Pym A, Grobusch MP, de Los Rios JM, Gotuzzo E, Vasilyeva I, Leimane V, Andries K, Bakare N, De Marez T, Haxaire-Theeuwes M, Lounis N, Meyvisch P, De Paepe E, van Heeswijk RP, Dannemann B (2014) Multidrug-resistant tuberculosis and culture conversion with bedaquiline. N Engl J Med 371:723–732

    Article  PubMed  Google Scholar 

  21. Diel R, Nienhaus A, Lampenius N, Rusch-Gerdes S, Richter E (2014) Cost of multi drug resistance tuberculosis in Germany. Respir Med 108:1677–1687

    Article  CAS  PubMed  Google Scholar 

  22. Drobniewski F, Cooke M, Jordan J, Casali N, Mugwagwa T, Broda A, Townsend C, Sivaramakrishnan A, Green N, Jit M, Lipman M, Lord J, White PJ, Abubakar I (2015) Systematic review, meta-analysis and economic modelling of molecular diagnostic tests for antibiotic resistance in tuberculosis. Health Technol Assess 19:1–188

    Article  PubMed  Google Scholar 

  23. Gimmi R, Pfyffer GE, Brändli O (2003) Multiresistente Tuberkulose – in der Schweiz heilbar. Schweiz Med Forum 4:80–90

    Google Scholar 

  24. Gler MT, Skripconoka V, Sanchez-Garavito E, Xiao H, Cabrera-Rivero JL, Vargas-Vasquez DE, Gao M, Awad M, Park SK, Shim TS, Suh GY, Danilovits M, Ogata H, Kurve A, Chang J, Suzuki K, Tupasi T, Koh WJ, Seaworth B, Geiter LJ, Wells CD (2012) Delamanid for multidrug-resistant pulmonary tuberculosis. N Engl J Med 366:2151–2160

    Article  CAS  PubMed  Google Scholar 

  25. Lawn SD, Meintjes G, McIlleron H, Harries AD, Wood R (2013) Management of HIV-associated tuberculosis in resource-limited settings: a state-of-the-art review. BMC Med 11:253

    Article  PubMed Central  PubMed  Google Scholar 

  26. Lewis JM, Sloan DJ (2015) The role of delamanid in the treatment of drug-resistant tuberculosis. Ther Clin Risk Manag 11:779–791

    PubMed Central  PubMed  Google Scholar 

  27. Madansein R, Parida S, Padayatchi N, Singh N, Master I, Naidu K, Zumla A, Maeurer M (2015) Surgical treatment of complications of pulmonary tuberculosis, including drug-resistant tuberculosis. Int J Infect Dis 32:61–67

    Article  PubMed  Google Scholar 

  28. Marais BJ, Mlambo CK, Rastogi N, Zozio T, Duse AG, Victor TC, Marais E, Warren RM (2013) Epidemic spread of multidrug-resistant tuberculosis in Johannesburg, South Africa. J Clin Microbiol 51:1818–1825

    Article  PubMed Central  PubMed  Google Scholar 

  29. Marais E, Mlambo CK, Lewis JJ, Rastogi N, Zozio T, Grobusch MP, Duse A, Victor T, Warren RW (2014) Treatment outcomes of multidrug-resistant tuberculosis patients in Gauteng, South Africa. Infection 42:405–413

    Article  CAS  PubMed  Google Scholar 

  30. McNerney R, Maeurer M, Abubakar I, Marais B, McHugh TD, Ford N, Weyer K, Lawn S, Grobusch MP, Memish Z, Squire SB, Pantaleo G, Chakaya J, Casenghi M, Migliori GB, Mwaba P, Zijenah L, Hoelscher M, Cox H, Swaminathan S, Kim PS, Schito M, Harari A, Bates M, Schwank S, O’Grady J, Pletschette M, Ditui L, Atun R, Zumla A (2012) Tuberculosis diagnostics and biomarkers: needs, challenges, recent advances, and opportunities. J Infect Dis 205(Suppl 2):S147–S158

    Article  PubMed  Google Scholar 

  31. Nkosi D, Janssen S, Padanilam X, Louw R, Menezes CN, Grobusch MP (2013) Factors influencing specialist care referral of multidrug- and extensively drug-resistant tuberculosis patients in Gauteng/South Africa: a descriptive questionnaire-based study. BMC Health Serv Res 13:268

    Article  PubMed Central  PubMed  Google Scholar 

  32. Nunn AJ, Rusen ID, Van Deun A, Torrea G, Phillips PP, Chiang CY, Squire SB, Madan J, Meredith SK (2014) Evaluation of a standardized treatment regimen of anti-tuberculosis drugs for patients with multi-drug-resistant tuberculosis (STREAM): study protocol for a randomized controlled trial. Trials 15:353

    Article  PubMed Central  PubMed  Google Scholar 

  33. Pai M, Denkinger CM, Kik SV, Rangaka MX, Zwerling A, Oxlade O, Metcalfe JZ, Cattamanchi A, Dowdy DW, Dheda K, Banaei N (2014) Gamma interferon release assays for detection of Mycobacterium tuberculosis infection. Clin Microbiol Rev 27:3–20

    Article  PubMed Central  PubMed  Google Scholar 

  34. Parida SK, Axelsson-Robertson R, Rao MV, Singh N, Master I, Lutckii A, Keshavjee S, Andersson J, Zumla A, Maeurer M (2015) Totally drug-resistant tuberculosis and adjunct therapies. J Intern Med 277:388–405

    Article  CAS  PubMed  Google Scholar 

  35. Richter E, Rusch-Gerdes S, Hillemann D (2009) Drug-susceptibility testing in TB: current status and future prospects. Expert Rev Respir Med 3:497–510

    Article  CAS  PubMed  Google Scholar 

  36. Steingart KR, Jotblad S, Robsky K, Deck D, Hopewell PC, Huang D, Nahid P (2011) Higher-dose rifampin for the treatment of pulmonary tuberculosis: a systematic review. Int J Tuberc Lung Dis 15:305–316

    CAS  PubMed  Google Scholar 

  37. van Altena R, de Vries G, Haar CH, de Lange WC, Magis-Escurra C, van den Hof S, van Soolingen D, Boeree MJ, van der Werf TS (2015) Highly successful treatment outcome of multidrug-resistant tuberculosis in the Netherlands, 2000–2009. Int J Tuberc Lung Dis 19:406–412

    Article  PubMed  Google Scholar 

  38. Van Deun A, Maug AK, Salim MA, Das PK, Sarker MR, Daru P, Rieder HL (2010) Short, highly effective, and inexpensive standardized treatment of multidrug-resistant tuberculosis. Am J Respir Crit Care Med 182:684–692

    Article  PubMed  Google Scholar 

  39. Wallis RS, Kim P, Cole S, Hanna D, Andrade BB, Maeurer M, Schito M, Zumla A (2013) Tuberculosis biomarkers discovery: developments, needs, and challenges. Lancet 13:362–372

    Article  PubMed  Google Scholar 

  40. Walzl G, Haks MC, Joosten SA, Kleynhans L, Ronacher K, Ottenhoff TH (2014) Clinical immunology and multiplex biomarkers of human tuberculosis. Cold Spring Harb Perspect Med 5(4). doi:10.1101/cshperspect.a018515

    Google Scholar 

  41. Wejse C (2015) Tuberculosis elimination in the post millennium development goals era. Int J Infect Dis 32:152–155

    Article  PubMed  Google Scholar 

  42. Wells WA, Boehme CC, Cobelens FG, Daniels C, Dowdy D, Gardiner E, Gheuens J, Kim P, Kimerling ME, Kreiswirth B, Lienhardt C, Mdluli K, Pai M, Perkins MD, Peter T, Zignol M, Zumla A, Schito M (2013) Alignment of new tuberculosis drug regimens and drug susceptibility testing: a framework for action. Lancet Infect Dis 13:449–458

    Article  PubMed Central  PubMed  Google Scholar 

  43. World Health Organization (2014) WHO Global TB report 2014

    Google Scholar 

  44. Zar HJ, Hanslo D, Apolles P, Swingler G, Hussey G (2005) Induced sputum versus gastric lavage for microbiological confirmation of pulmonary tuberculosis in infants and young children: a prospective study. Lancet 365:130–134

    Article  PubMed  Google Scholar 

  45. Zhang X, Falagas ME, Vardakas KZ, Wang R, Qin R, Wang J, Liu Y (2015) Systematic review and meta-analysis of the efficacy and safety of therapy with linezolid containing regimens in the treatment of multidrug-resistant and extensively drug-resistant tuberculosis. J Thorac Dis 7:603–615

    PubMed Central  PubMed  Google Scholar 

  46. Ziegler R, Just HM, Castell S, Diel R, Gastmeier P, Haas W, Hauer B, Loytved G, Mielke M, Moser I, Nienhaus A, Richter E, Ruden H, Rusch-Gerdes S, Schaberg T, Wischnewski N, Loddenkemper R (2012) Tuberculosis infection control – recommendations of the DZK. Pneumologie 66:269–282

    Article  CAS  PubMed  Google Scholar 

  47. Zumla A, Chakaya J, Centis R, D’Ambrosio L, Mwaba P, Bates M, Kapata N, Nyirenda T, Chanda D, Mfinanga S, Hoelscher M, Maeurer M, Migliori GB (2015) Tuberculosis treatment and management – an update on treatment regimens, trials, new drugs, and adjunct therapies. Lancet 3:220–234

    PubMed  Google Scholar 

  48. Zumla A, Chakaya J, Hoelscher M, Ntoumi F, Rustomjee R, Vilaplana C, Yeboah-Manu D, Rasolof V, Munderi P, Singh N, Aklillu E, Padayatchi N, Macete E, Kapata N, Mulenga M, Kibiki G, Mfinanga S, Nyirenda T, Maboko L, Garcia-Basteiro A, Rakotosamimanana N, Bates M, Mwaba P, Reither K, Gagneux S, Edwards S, Mfinanga E, Abdulla S, Cardona PJ, Russell JB, Gant V, Noursadeghi M, Elkington P, Bonnet M, Menendez C, Dieye TN, Diarra B, Maiga A, Aseffa A, Parida S, Wejse C, Petersen E, Kaleebu P, Oliver M, Craig G, Corrah T, Tientcheu L, Antonio M, Rao M, McHugh TD, Sheikh A, Ippolito G, Ramjee G, Kaufmann SH, Churchyard G, Steyn A, Grobusch M, Sanne I, Martinson N, Madansein R, Wilkinson RJ, Mayosi B, Schito M, Wallis RS, Maeurer M (2015) Towards host-directed therapies for tuberculosis. Nat Rev 14:511–512

    CAS  Google Scholar 

  49. Zumla A, Maeurer M (2015) Host-directed therapies for tackling multi-drug resistant tuberculosis: learning from the pasteur-Bechamp debate. Clin Infect Dis: (Jul 28. pii: civ631. Epub ahead of print)

    Google Scholar 

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Danksagung

Wir danken Herrn Peter Helbling (BAG) und Herrn Prof. Dr. Otto Schoch (Lungenliga Schweiz) für die freundliche Unterstützung bei der Erstellung des Manuskripts.

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Correspondence to M. P. Grobusch.

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Interessenkonflikt

F. Schaumburg, E. Altpeter und S. Bélard geben an, dass kein Interessenkonflikt besteht. M.P. Grobusch weist auf folgende Beziehung hin: M.P. Grobusch ist Mitglied des wissenschaftlichen Beirats für Bedaquilin (Janssen) und Delamanid (Otsuka).

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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B. Salzberger, Regensburg

T. Welte, Hannover

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Grobusch, M.P., Schaumburg, F., Altpeter, E. et al. Medikamentenresistente Tuberkulose. Internist 57, 126–135 (2016). https://doi.org/10.1007/s00108-015-0010-x

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