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ID:19653820
大小:3.68 MB
页数:27页
时间:2018-10-04
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1、上海市(复旦大学附属)公共卫生临床中心复旦大学附属华山医院卢洪洲与结核抗争结核杆菌的发现TBincidence,2009(WHO)(WHO,2008)WHO,2008WHO,2008EstimatedTBcasesnotdetectedin2009(McNerneyandDaley,NatMed,2011)SpreadofBeijingcladeofM.tuberculosis影响中国结核发病率的关键因素人口流动问题?耐药结核?艾滋病合并结核?诊断问题?潜伏感染活动?……高度人口流动每年流动人口人次达两亿两千万:主要从农村到城市,以青、壮年为主每年出国旅游达几百万;国内旅游有六亿六千万每
2、年从海外入境人数两千万经常有短期内大量人口聚集活动,例如2010上海Expo,来上海参加人数达七千三百万之多耐药结核Multidrug-resistant(MDR)tuberculosisisdefinedasdiseasecausedbystrainsofMycobacteriumtuberculosisthatareatleastresistanttotreatmentwithisoniazidandrifampicin.Extensivelydrug-resistant(XDR)tuberculosisreferstodiseasecausedbymultidrug-resista
3、ntstrainsthatarealsoresistanttotreatmentwithanyfluoroquinoloneandanyoftheinjectabledrugsusedintreatmentwithsecond-lineanti-tuberculosisdrugs(amikacin,capreomycin,andkanamycin)截至2009,报道过泛耐药结核的国家Theboundariesandnamesshownandthedesignationsusedonthismapdonotimplytheexpressionofanyopinionwhatsoeveron
4、thepartoftheWorldHealthOrganizationconcerningthelegalstatusofanycountry,territory,cityorareaorofitsauthorities,orconcerningthedelimitationofitsfrontiersorboundaries.Dottedlinesonmapsrepresentapproximateborderlinesforwhichtheremaynotyetbefullagreement.WHO2009.Allrightsreserved耐药结核的治疗TBEpidemicDOT
5、SHIVEpidemicHIV合并结核感染估计的HIV/TB患者地理分布图KennethMayer.CID.2010PoorlyFormedtoNoSignificantGranulomaFormationinSeverelyImmunosuppressedHIV(+)ComparedtowellFormedGranulomasinHIV(-)TBinHIV结核菌素试验TuberculinTest>5mmisclassifiedaspositiveinHIV-positivepersonsFalsenegativeinlateHIVstageandoverwhelmingTBdiseas
6、eFalsepositive:InfectedwithMycobacteriaotherthanTB,e.g,MACBCGvaccination对HIV/TB感染诊断的意义有限免疫学诊断方法:ELISPOTAfairlysensitivemethodtodiagnoseHIV/TBCanbeusedtodetectlatentTBinHIV-infectedpatientsCanbeinfluencedbyCD4counts?CandistinguishMTBfromothermycobacterialinfectionorpreviousBCGvaccinationT-SPOT(ELI
7、SPOT)testESAT-6andCFP-10:twocommonusedmycobacterialtuberculosisantigens分子生物学诊断方法:Nucleicacidamplification(NAA)testMTB/RIF的快速分子诊断WHO建议的HIV/TB合作内容预防HIV/TB异烟肼预防治疗(IPT)诊断(ICF)感染控制(IC)抗反转录病毒治疗(ART)3I’SLTBINewinpatientsandou
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