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Dtsch Med Wochenschr 2023; 148(19): 1227-1235
DOI: 10.1055/a-1937-8337
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Update: Diagnostik und Therapie der pulmonalen Tuberkulose

Update: Diagnostics and treatment of pulmonary tuberculosis
Gunar Günther
,
Martin Kuhns
,
Inna Friesen∗
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Die Diagnostik der Tuberkulose hat große Lücken, worauf u.a. die Abnahme der diagnostizierten Fälle und die Zunahme von Todesfällen in den letzten Jahren hinweist. Viele Infizierte werden nicht identifiziert, da die symptombasierten Screeningverfahren versagen. Neue Ansätze in der Diagnostik und auch Therapie sind dringend erforderlich für die erfolgreiche Eindämmung der Tuberkulose weltweit.

Abstract

Molecular diagnostic tools have changed the approach to the detection of Mycobacterium tuberculosis and associated drug-resistance substantially. PCR-based technologies allow a more rapid detection with higher diagnostic sensitivity in pulmonary and extrapulmonary specimens. However, a real point of care test, which needs minimal technical resources remains missing. Genome sequencing technologies are currently changing tuberculosis drug resistance testing, and for some questions are replacing phenotypic drug resistance testing, based on culture.

New evidence on treatment for drug-sensitive tuberculosis allows shortening of treatment to 4 months, or in selected cases even to 2 months based on the use of fluoroquinolones, high dose rifamycins and newly developed TB medicines.

Such developments will very likely simplify the management of tuberculosis, although prevention remains the most important pillar of any tuberculosis related public health strategy.

Kernaussagen

  • Die NAT-basierte Diagnostik der TB, inklusive Resistenztestung, mindestens für Rifampicin, stellt aktuell das initiale Diagnostikverfahren der TB dar.

  • Die Kultivierung des Mycobacterium tuberculosis bleibt weiterhin der Goldstandard der TB-Diagnostik.

  • Die Genomsequenzierung von Mycobacterium tuberculosis beschleunigt, präzisiert und ersetzt zunehmend bisherige molekulare und phänotypische Verfahren der Resistenztestung.

  • Die Therapie der medikamentensensiblen Tuberkulose kann bei Erwachsenen im Falle der Verfügbarkeit des aktuell in der EU nicht erhältlichen Rifapentin, zusammen mit Moxifloxacin, Isoniazid und Pyrazinamid, von 6 auf 4 Monate verkürzt werden.

  • Kinder bis 16 Jahre dürfen ebenfalls im Falle einer wenig schweren Erkrankung nach 2 Monaten 4-fach Standardtherapie und 2 Monaten 2-fach-Therapie mit Rifampicin und Isonizid die Behandlung beenden.

Schlüsselwörter

pulmonale Tuberkulose - molekulare Diagnostik - Genomesequenzierung - Therapieverkürzung

Keywords

pulmonary tuberculosis - molecular diagnosis - genome sequencing - treatment shortening


Publikationsverlauf

Artikel online veröffentlicht:
04. Oktober 2023

© 2023. Thieme. All rights reserved.

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