Zusammenfassung
Die Tuberkulose ist weltweit unverändert eine der bedeutendsten Infektionskrankheiten.
Aufgrund der vor allem in der Europaregion scheinbar unaufhaltsam fortschreitenden
Verbreitung medikamentenresistenter Tuberkulosebakterienstämme stellt die Krankheit
für Industriestaaten wie Deutschland auch heute noch eine Bedrohung dar. Daher dürfen
die Bemühungen um eine effektive Tuberkulosekontrolle trotz hierzulande rückläufiger
Fallzahlen nicht nachlassen, ganz im Gegenteil. Basierend auf einer möglichst genauen
Kenntnis der epidemiologischen Situation und der Resistenzraten bedarf es daran ausgerichteter
effektiver Kontrollstrategien und eines Auf- bzw. Ausbaus nationaler Tuberkulose-
sowie HIV-Kontrollprogramme. Aber auch forcierte und langfristig ausgerichtete Forschungsanstrengungen
sind erforderlich zur Entwicklung neuer antituberkulotischer Substanzen, einfacher
und zuverlässiger Diagnostika sowie eines wirksamen Impfstoffes.
Abstract
Tuberculosis (TB) remains one of the most important infectious diseases worldwide.
The seemingly unstoppable spread of drug-resistant TB strains, particularly in the
European region, make it a continuing threat even to industrialized nations such as
Germany. Therefore, effective TB control measures must not be neglected despite declining
case numbers in this country – on the contrary. Detailed knowledge of the epidemiological
situation and of resistance rates must be the basis for effective control strategies
and for the introduction or improvement of national TB and HIV control programmes.
There is likewise a need for intensified long-term research into new antituberculous
substances, simple and reliable diagnostic methods, and a highly protective vaccine.
Literatur
- 1
Migliori G B, Loddenkemper R, Blasi F. et al .
125 years after Robert Koch’s discovery of the tubercle bacillus: Is “science” enough to tackle the epidemic?.
Eur Respir J.
2007;
29
423-427
- 2
Cox H, Hargreaves S, Ismailov G.
Effect of multidrug resistance on global tuberculosis control.
Lancet.
2003;
362
858-1859
- 3
Davies P DO.
The world wide increase in tuberculosis: how demographic change, HIV infection and
increasing numbers in poverty are increasing tuberculosis.
Ann Med.
2003;
35
235-243
- 4 World Health Organization .Anti-tuberculosis drug resistance in the world. Report
No. 4, 2008. WHO/HTM/TB/2008.394
- 5 World Health Organization .Global tuberculosis control: surveillance, planning,
financing: WHO report 2008. WHO, Geneva, Switzerland, WHO/HTM/TB/2008.393
- 6
Cohen T, Colijn C, Wright A. et al .
Challenges in estimating the total burden of drug-resistant tuberculosis.
Am J Respir Crit Care Med.
2008;
177
302-1306
- 7 The WORLD BANK Human Development Network Health, Nutrition & Population Team .Economic
benefit of Tuberculosis Control. Policy Research Working Paper (WPS) 4295. 2007
- 8 Broekmans J, Caines K, Paluzzi J E. et al .Investing in strategies to reverse the
global incidence of TB. Earthscan London 2005
- 9 World Health Organization .Addressing poverty in TB control. Options for national
TB control programmes. WHO, Genf 2005. WHO/HTM/TB/2005.352
- 10 World Health Organization .Tuberculosis control in prisons. A manual for programme
managers. WHO Genf 2000. WHO/CDS/TB/2000.281
- 11
Dye C, Maher D, Weil D. et al .
Targets for global tuberculosis control.
Int J Tuberc Lung Dis.
2006;
10
460-462
- 12
Raviglione M C, Uplekar M W.
WHO's new Stop TB Strategy.
Lancet.
2006;
367
952-955
- 13 World Health Organization .Guidelines for the programmatic management of drug-resistant
tuberculosis. World Health Organization, Genf 2006
- 14 World Health Organization .Plan to stop TB in 18 high-priority countries in the
WHO European Region 2007–2015. WHO, Genf 2007 . http://www.euro.who.int/document/E91049.pdf
- 15 World Health Organization .The Stop TB Strategy. Building on and enhancing DOTS
to meet the TB-related Millenium Development Goals. World Health Organization, Genf
2006. WHO/HTM/STB/2008
- 16 World Health Organization .Guidelines for Establishing DOTS-Plus pilot projects
for the management of multidrug-resistant tuberculosis. WHO, Genf, 2000. WHO/DCS/TB/2000.279
- 17 World Health Organization .Strategic framework to decrease the burden of HIV. WHO,
Genf 2002. WHO/CDS/TB2002.296 WHO/HIV_AIDS/2002.2
- 18
Friedland G, Churchyard G J, Nardell E.
Tuberculosis and HIV coinfection: current state of knowledge and research priorities.
J Infect Dis.
2007;
196
S1-S3
- 19 Centers for Disease Control and Prevention .Managing drug interactions in the treatment
of HIV-related tuberculosis [online] . http://www.cdc.gov/tb/TB_HIV_Drugs/default.htm
- 20
Scholten J N, de Vlas S J, Zaleskis R.
Under-reporting of HIV infection among cohorts of TB patients in the WHO European
Region, 2003–2004.
Int J Tuberc Lung Dis.
2008;
12
85-91
- 21 Konietzko N, Loddenkemper R. (Hrsg) .Tuberkulose. Georg Thieme Verlag Stuttgart
New York 1999
- 22
Cox H, Kebede Y, Allamuratova S. et al .
Tuberculosis recurrence and mortality after successful treatment: Impact of drug resistance.
PLoS Med.
2006;
3
e384
- 23
Zignol M, Hosseini M S, Wright A. et al .
Global incidence of multidrug-resistant tuberculosis.
J Infect Dis.
2006;
194
479-485
- 24
Centers for Disease Control and Prevention .
Notice to readers: Revised definition of extensively drug-resistant tuberculosis.
MMWR.
2006;
55
1176
- 25
Migliori G B, Besozzi G, Girardi E. et al .
Clinical and operational value of the extensively drug-resistant tuberculosis definition.
Eur Respir J.
2007;
30
623-626
- 26
Vier H, Schaberg T, Gillissen A.
XDR (extensive resistance)-Tuberkulose.
Pneumologie.
2007;
61
606-609
- 27
Migliori G B, de Iaco G, Besozzi G. et al .
First tuberculosis cases in Italy resistant to all tested drugs.
Euro Surveill.
2007;
12(5)
-E070517.1
- 28
Basu S, Andrew J R, Poolman E M. et al .
Prevention of nosocomial transmission of extensively drug-resistant tuberculosis in
rural South African district hospitals: an epidemiological modelling study.
Lancet.
2007;
370
1500-1507
- 29
Lange C, Grobusch M P, Wagner D.
Extensiv-resistente Tuberkulose (XDR-TB).
Dtsch Med Wschr.
2008;
133
374-376
- 30
Gandhi N R, Moll A, Sturm A W, Pawinski R. et al .
Extensively drug-resistant tuberculosis as a cause of death in patients co-infected
with tuberculosis and HIV in a rural area of South Africa.
Lancet.
2006;
368
1575-1580
- 31 Euro TB and the national coordinators for tuberculosis surveillance in the WHO
European Region .Surveillance of tuberculosis in Europe. Report on tuberculosis cases
notified in 2006. Institut de veille sanitaire, Saint-Maurice, France. März 2008
- 32
Aerts A, Hauer B, Wanlin M. et al .
Tuberculosis and tuberculosis control in European prisons.
Int J Tuberc Lung Dis.
2006;
11
1213-1223
- 33 Deutsches Zentralkomitee zur Bekämpfung der Tuberkulose: 31 .Informationsbericht,. Berlin
2008
- 34 Deutsches Zentralkomitee zur Bekämpfung der Tuberkulose: 31 .Informationsbericht,. Berlin
2008 . http://www.euro.who.int/tuberculosis/tbforum/20070621_1
- 35 European Centre for Disease Prevention and Control .Framework action plan to fight
tuberculosis in the European Union. Stockholm Februar 2008 . http://www.euro.who.int/Document/E90833.pdf
- 36
Broekmans J F, Migliori G B, Rieder H L. et al .
European framework for tuberculosis control and elimination in countries with a low
incidence. Recommendations of the World Health Organization (WHO), International Union
Against Tuberculosis and Lung Disease (IUATLD) and Royal Netherlands Tuberculosis
Association (KNCV) Working Group.
Eur Respir J.
2002;
19
765-775
- 37 Robert Koch-Institut .Bericht zur Epidemiologie der Tuberkulose in Deutschland
für 2006. Robert Koch-Institut, Berlin 2008 http://. www.rki.de
- 38 Robert Koch-Institut .Infektionsepidemiologisches Jahrbuch meldepflichtiger Krankheiten
für 2007. Robert Koch-Institut, Berlin 2008
- 39 Robert Koch-Institut .Falldefinitionen des Robert Koch-Instituts zur Übermittlung
von Erkrankungs- oder Todesfällen und Nachweisen von Krankheitserregern. Ausgabe 2007
- 40
Centers for Disease Control .
Trends in tuberculosis – United States, 2007.
MMWR weekly report.
2008;
57
281-285
- 41
Borgdorff M W, Nagaldkerke N J, Dye C. et al .
Gender and tuberculosis: a comparison of prevalence surveys with notification data
to explore gender differences in case detection.
Int J Tuberc Lung Dis.
2000;
4
123-132
- 42
Forssbohm M, Zwahlen M, Loddenkemper R. et al .
Demographic characteristics of patients with extrapulmonary tuberculosis in Germany.
Eur Respir J.
2008;
31
99-105
- 43 Weiss M G, Auer C, Somma D B. et al .Gender and tuberculosis: cross-site analysis
and implications of a multi-country study in Bangladesh, India, Malawi, and Colombia. TDR/SDR/SEB/RP/06.1,
WHO 2006
- 44
Kunitz F, Brodhun B, Hauer B. et al .
Die aktuelle Tuberkulosesituation in Deutschland und die Auswirkungen der globalen
Situation.
Pneumologie.
2007;
61
467-477
- 45 Statistisches Bundesamt Deutschland .Statistisches Jahrbuch für die Bundesrepublik
Deutschland. 2007
- 46
Blaas S H, Mutterlein R, Weig J. et al .
Extensively drug resistant tuberculosis in a high income country: A report of four
unrelated cases.
BMC Infect Dis.
2008;
8
60
Bisher erschienene Beiträge dieser Serie
- 47
Murray J.
Die historische Entwicklung der Tuberkulose seit Robert Kochs Entdeckung des Tuberkelbazillus
1882.
Pneumologie.
2007;
61
64-771
- 48
Ulrichs T.
Immunologie der Tuberkulose und Entwicklungsstand neuer Impfstoffe.
Pneumologie.
2008;
62
143-148
- 49
Kalsdorf B, Strassburg A, Greinert U. et al .
Klinik und Diagnose der Tuberkulose.
Pneumologie.
2008;
62
284-294
- 50
Rüsch-Gerdes S, Hillemann D.
Moderne mykobakteriologische Labordiagnostik.
Pneumologie.
2008;
62
533-540
1 multidrug-resistant tuberculosis, MDR, d.h. mindestens Resistenz gegenüber Isoniazid
und Rifampicin
2 extensively drug-resistant tuberculosis, XDR= MDR + Resistenz gegenüber einem Fluorchinolon
und wenigstens gegen eines der injizierbaren Medikamente Capreomycin, Kanamycin und
Amikacin
3 extremely drug-resistant tuberculosis, XXDR, resistent gegenüber allen antituberkulotischen
Erst- und Zweitrangmedikamenten
Dr. Barbara Hauer, MPH
Deutsches Zentralkomitee zur Bekämpfung der Tuberkulose, Lungenklinik Heckeshorn,
HELIOS Klinikum Emil von Behring
Walterhöferstr. 11
14165 Berlin
eMail: bhauer@dzk-tuberkulose.de