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Mycrobacterium tuberculosis
- 1. www.themegallery.com LOGO “Mycobacterium tuberculosis: Un guerrero milenario con nuevas armas” Cesar Muñoz Mejía Universidad de Cartagena Octubre 22, 2010
- 2. HISTORIA DE LA TUBERCULOSIS (TB) La TB es una enfermedad antigua identificada (por PCR) como TB espinal en momias egipcias. La historia data de los años 1550 – 1080 A.C.
- 3. Robert Koch
- 4. Selman Abraham Waksman. Premio Nobel en 1952.
- 5. National Institute of Allergy and Infectious Diseases (NIAID)
- 6. National Institute of Allergy and Infectious Diseases (NIAID)
- 7. Panorama Mundial de Resistencia 9.27 millones de casos de TBC en el mundo en el año 2007. 510.545 (5%) casos de MDR-TB. 25 países (17 de los cuales están en el Este de Europa) reportan el 85% de todos los casos. Solo el 6% de los casos de MDR-TB fueron notificados por test de sensibilidad. 40.000 casos anuales de XDR-TB. Global tuberculosis control - epidemiology, strategy, financing; WHO Report 2009.
- 8. MDR-TB en casos nuevos, 1994 - 2009 World Health Organization. Multidrug and extensively drug-resistant TB (M/XDR-TB). 2010 Global Report on Surveillance and Response (WHO/HTM/TB/2010.3). 2010.
- 9. MDR-TB en casos que han sido tratados previamente, 1994 -2009 World Health Organization. Multidrug and extensively drug-resistant TB (M/XDR-TB). 2010 Global Report on Surveillance and Response (WHO/HTM/TB/2010.3). 2010.
- 10. Global tuberculosis control - epidemiology, strategy, financing; WHO Report 2009. Test de susceptibilidad para casos nuevos y retratamiento. (número de países que reportaron datos, porcentaje del total de casos estimados de MDR-TB notificados por los países)
- 11. Resistencia en Colombia. 925 pacientes no tratados presentaron una prevalencia de resistencia global de 11,78% (IC 95%: 9,86-14,02) y una MDR- TB de 2,38% (IC 95%: 1,58-3,57). Los 264 pacientes previamente tratados presentaron una resistencia global de 44,32% (IC 95%: 38,45-50,35) y MDR-TB de 31,44% (IC 95%: 26,14-37,27). MDR-TB en el grupo de pacientes previamente tratados: 50,6% en los fracasos, 25,3% en los abandonos y 19,3% en las recaídas. Biomédica 2008;28:319-26
- 12. Países que han reportado al menos un caso de XDR-TB, Junio 2010 World Health Organization. Multidrug and extensively drug-resistant TB (M/XDR-TB). 2010 Global Report on Surveillance and Response (WHO/HTM/TB/2010.3). 2010.
- 13. Factores de Riesgo Asociación entre MDR-TB en recaídas vs. Casos nuevos en países con vigilancia continua de TB resistente . Recaídas. Sexo? ~ Co-infección con VIH. World Health Organization. Multidrug and extensively drug-resistant TB (M/XDR-TB). 2010 Global Report on Surveillance and Response (WHO/HTM/TB/2010.3). 2010.
- 14. ¿Por qué es importante? Mayor período de tratamiento (24 meses vs. 6-8 meses). Menores tasas de curación. Mayor mortalidad. Mayor uso de fármacos de 2da línea: • Mayor toxicidad. • Mayores costos. Wells CD et al: HIV infection and multidrug-resistant tuberculosis: the perfect storm. J Infect Dis 196 Suppl 1:S86, 2007
- 15. M. tuberculosis silvestre Cepa resistente a algún fármaco Resistencia Adquirida Resistencia Primaria Mutación espontánea Terapia inadecuada, pobre adherencia o suministro de medicamentos. Transmisión: Retraso en el diagnóstico, hacinamiento, control inadecuado, VIH. NATURALEZA HUMANO Lambregts-van Weezenbeek, CSB, Veen J. Control of drug-resistant tuberculosis. Tubercle Lung Dis 1995;76:455-459 Int J tuberc Lung Dis 13(11):1320-1330; 2009 The Union
- 16. National Institute of Allergy and Infectious Diseases
- 18. Baja adherencia Mala prescripción Medicamentos no disponibles RESISTENCIA ADQUIRIDA RESISTENCIA PRIMARIA
- 20. Enferm Infecc Microbiol Clin.2009; 27(08) :474-80
- 21. ¿Tenemos tiempo suficiente para esperar?
- 22. Totally drug-resistant strains (TDR) or super XDR-TB isolates. “MDR-TB strains that are resistant to all second-line drug classes that our laboratory tested (ie, aminoglycosides, cyclic polypeptides, fluoroquinolones, thioamides, serine analogues, and salicylic acid derivatives).” Chest 2009;136;420-425; Prepublished online April 6, 2009.
Notas del editor
- http://www.medicosgeneralescolombianos.com/TBC.htm
- Isoniazida Rifampicina Etambutol Pirazinamida MDRTB
- Cicloserina Etionamida Levofloxacina Moxifloxacina Gatifloxacina Ácido p-Aminosalicílico Estreptomicina Amikacina/kanamicina Capreomicina XDRTB
- 9.27 millones de casos de TB en el 2007 en el mundo De esos, 1.37 millones (14.8%) eran VIH positivo Solo el 6% de los casos de MDR-TB fueron notificados por DST.
- Los países que reportaron datos de DST, solo alcanzaron el 47% del número total de casos nuevos de MDR.TB y el 60% para los casos previamente tratados.
- Años 2004 - 2005
- Colombia reportó su primer caso de XDR TB en el 2007
- Given the large proportion of missing data, it has not been possible to conclude whether an overall association between MDR-TB and HIV epidemics exists. However, based on the current data, HIV-positive TB patients in three Eastern European countries (Estonia, Latvia and the Republic of Moldova) appear to be more at risk of harbouring MDR-TB strains. This finding concurs with the results of the earlier reported survey conducted in Ukraine (6). Furthermore, in Lithuania – where drug resistance data could not be disaggregated by HIV-negative and unknown HIV status – HIV-positive TB patients had a 8.4 (95% CI: 2.7– 28.2) times higher odds of harbouring MDR-TB strains than TB patients for whom HIV status was unknown, indicating a possible association of the two epidemics. In addition, preliminary results of a survey conducted in Mozambique in 2007 have also found a significant association. Lack of an association between HIV status and MDR-TB in some settings can be due to low numbers of HIV-positive TB patients or patients with MDR-TB and consequent insufficient power in analysis. This may be a result of lack of testing of patients or of incomplete reporting of results. There are several reasons why drug-resistant TB may be associated with HIV. Firstly, people living with HIV in Eastern Europe – particularly those infected earlier in the epidemic and whose weakened immune systems have since left them vulnerable to TB – frequently come from socially vulnerable populations, including injecting drug users. Socio-behavioural problems and/or lack of access to proper care may make these populations, as TB patients, vulnerable to developing drug resistance as a result of poor adherence to treatment or suboptimal treatment. Furthermore, people living with HIV may also be more likely to be exposed to MDR-TB patients, due either to increased hospitalizations in settings with poor infection control or association with peers who may have MDR-TB, including in penitentiary settings. In addition, acquisition of rifampicin resistance among people living with HIV under treatment for TB may also be the result of anti-TB drug malabsorption, which has been documented in patient cohorts in settings of high HIV prevalence. The epidemiological impact of HIV infection on the transmission of MDR-TB is still unclear and may depend on several factors. HIV-positive TB cases are more likely to be sputum smear negative, and therefore less likely to transmit TB. In addition, delayed diagnosis of drug resistance and unavailability of treatment (particularly in previous years) have led to high death rates in people living with HIV, which may also result in a lower rate of TB transmission. On the other hand, people living with HIV progress more rapidly to TB disease, and in settings where MDR-TB is prevalent (either among the general population or in a specific population such as a hospital or a district), this may lead to rapid development of a pool of drug-resistant TB patients. Although there appears to be an association between drug-resistant TB and HIV infection in some Eastern European countries, the data are still limited to be able to determine whether there is an overlap between the MDR-TB and HIV epidemics worldwide. Unfortunately, the continuous surveillance data in this report come only from two regions, the European Region and the Region of the Americas, and no data are reported from countries with the highest prevalence of HIV infection. It is critical to include HIV testing in drug resistance surveys and in routine surveillance efforts in order to better understand the relationship between the two epidemics, which is key for optimal care of patients
- Factores de Riesgo