Extensiv-resistente Tuberkulose (XDR-TB)

Zusammenfassung

In den vergangenen Jahren werden weltweit zunehmende Antibiotika-Resistenzen von Mycobacterium tuberculosis (MTB) Stämmen beschrieben. Der Begriff XDR (extensively drug-resistant)-Tuberkulose wurde von der Weltgesundheitsorganisation (WHO) eingeführt, um multiresistente MTB-Stämme mit weiteren Antibiotika-Resistenzen gegenüber Fluorochinolonen und einem der injizierbaren Substanzen Amikacin, Capreomycin oder Kanamycin neben Isoniazid- und Rifampicin-Resistenzen zu charakterisieren. XDR-MTB-Stämme breiten sich aktuell im südlichen Afrika durch Kontakte vor allem unter HIV-seropositiven Personen stark aus. Hier stellt die XDR-TB-Epidemie für das Gesundheitswesen eine schwer lösbare Aufgabe dar. In Deutschland werden vereinzelt XDR-TB-Fälle, vor allem unter vortherapierten Migranten aus osteuropäischen Staaten, beobachtet. Die Entwicklung schneller diagnostischer Methoden zur Resistenztestung und neuer Präparate zur Therapie der Tuberkulose wurde in den vergangenen Jahrzehnten unzureichend unterstützt. Durch die plötzliche Zunahme von XDR-MTB-Stämmen besteht nun hohe Dringlichkeit zur Entwicklung solcher Testverfahren und neuer Substanzklassen, um allen Patienten eine Chance für eine effektive Behandlung der Tuberkulose zu ermöglichen.

Abstract: Extensively drug-resistant tuberculosis

Recently an increasing number of antibiotic-resistant Mycobacterium tuberculosis (MTB) strains have been described worldwide. The term XDR- (extensively drug-resistant) tuberculosis (TB) has been introduced by the World Health Organisation (WHO) to characterize multi-drug-resistant MTB strains that are in vitro resistant against fluorochinolones and one of the injectible substances amikacin, capreomycin or kanamycin in addition to isoniazid and rifampin. Strains of XDR-MTB are currently increasingly seen in HIV-seropositive individuals with tuberculosis in southern Africa, where these strains are passed by person-to person contact. XDR-TB has become a serious problem for the health administrations in this region. In contrast, cases of XDR-TB are only rarely seen in Germany so far, mainly among the population of pre-treated migrants from eastern Europe. The development of rapid diagnostic tests for resistance testing and new drugs for the treatment of tuberculosis has lacked support for several decades. The sudden emergence of XDR-MTB strains now warrants immediate action for the development of such tests and new classes of antibiotics to give all patients with TB a chance for a successful treatment.

Tuberkulose - XDR-Tuberkulose - Resistenz

tuberculosis - XDR tuberculosis - extensively drug-resistant tuberculosis

Literatur

• 1 Affolabi D, Odoun M, Martin A, Palomino J C, Anagonou S, Portaels F. Evaluation of direct detection of Mycobacterium tuberculosis rifampin resistance by a nitrate reductase assay applied to sputum samples in Cotonou, Benin.  J Clin Microbiol. 2007;  45 (7) 2123-2125
• 2 Arias M, Mello F C, Pavon A. et al . Clinical evaluation of the microscopic-observation drug-susceptibility assay for detection of tuberculosis.  Clin Infect Dis. 2007;  44 (5) 674-680
• 3 Basu S, Andrews 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 (9597) 1500-1507
• 4 Check E. After decades of drought, new drug possibilities flood TB pipeline.  Nat Med. 2007;  13 (3) 266
• 5 Friedland G, Churchyard G J, Nardell E. Tuberculosis and HIV coinfection: current state of knowledge and research priorities.  J Infect Dis. 2007;  196 Suppl 1 S1-S3
• 6 Gandhi N R, Moll A, Sturm A W. 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 (9547) 1575-1580
• 7 Hillemann D, Rusch-Gerdes S, Richter E. Evaluation of the GenoType MTBDRplus assay for rifampin and isoniazid susceptibility testing of Mycobacterium tuberculosis strains and clinical specimens.  J Clin Microbiol. 2007;  45 (8) 2635-2640
• 8 John M A, Menzes C A, Chita G, Sanne I, Grobusch M P. High tuberculosis and HIV coinfection rate, Johannesburg.  Emerg Infect Dis. 2007;  13 795-796
• 9 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 (4) 623-626
• 10 Migliori G B, IG, Besozzi G, Centis R, Cirillo D M. First tuberculosis cases in Italy resistant to all tested drugs.  Euro Surveill. 2007;  12 (5) E070517
• 11 Migliori G B, Ortmann J, Girardi E. et al . Extensively drug-resistant tuberculosis, Italy and Germany.  Emerging Infectious Diseases. 2007;  13 (5) 780-782
• 12 Mole R, Trollip A, Abrahams C, Bosman M, Albert H. Improved contamination control for a rapid phage-based rifampicin resistance test for Mycobacterium tuberculosis.  J Med Microbiol. 2007;  56 (Pt 10) 1334-1339
• 13 Parrish N, Osterhout G, Dionne K. et al . A Rapid, Standardized, Susceptibility Method for Mycobacterium tuberculosis using Mycolic Acid Analysis.  J Clin Microbiol. 2007;  , doi: 10.1128/JCM.02528 - 06
• 14 Protopopova M, Bogatcheva E, Nikonenko B, Hundert S, Einck L, Nacy C A. In search of new cures for tuberculosis.  Med Chem. 2007;  3 (3) 301-316
• 15 Shah N S, Wright A, Bai G H. et al . Worldwide emergence of extensively drug-resistant tuberculosis.  Emerg Infect Dis. 2007;  13 (3) 380-387
• 16 Singh J A, Upshur R, Padayatchi N. XDR-TB in South Africa: no time for denial or complacency.  PLoS Med. 2007;  4 (1) e50
• 17 Spigelman M K. New tuberculosis therapeutics: a growing pipeline.  J Infect Dis. 2007;  196 Suppl 1 S28-S34
• 18 WHO .Anti-tuberculosis drug resistance in the world report no. 3. 2004 WHO/HTM/TB/2004.343
• 19 WHO . Extensively drug-resistant tuberculosis (XDR-TB): recommendations for prevention and control.  Wkly Epidemiol Rec. 2006;  81 (45) 430-432
• 20 WHO .The Global MDR-TB and XDR-TB Response Plan 2007 - 2008. http://www.who.int/tb/challenges/xdr/global_response_plan/en/index.html; WHO/HTM/TB/2007.387
• 21 WHO .XDR-TB: extensively drug-resistant tuberculosis: October 2007. http://www.who.int/entity/tb//challenges/xdr/news_oct07.pdf
• 22 Zignol M, Hosseini M S, Wright A. et al . Global incidence of multidrug-resistant tuberculosis.  J Infect Dis. 2006;  194 (4) 479-485