结核-与结核抗争.ppt

* * TB epidemic has been well controlled by great efforts of TB DOTS Program. But HIV is now fuelling TB epidemic. * Shanghai Public Health Clinical Center Shanghai Public Health Clinical Center Shanghai Public Health Clinical Center 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 TB incidence, 2009 (WHO) (WHO, 2008) WHO, 2008 WHO, 2008 Estimated TB cases not detected in 2009 (McNerney and Daley, Nat Med, 2011) Spread of Beijing clade of M. 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？ …… 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) tuberculosis is defined as disease caused by strains of Mycobacterium tuberculosis that are at least resistant to treatment with isoniazid and rifampicin. Extensively drug-resistant (XDR) tuberculosis refers to disease caused by multidrug-resistant strains that are also resistant to treatment with any fluoroquinolone and any of the injectable drugs used in treatment with second-line anti-tuberculosis drugs (amikacin, capreomycin, and kanamycin) 截至2009，报道过泛耐药结核的国家 The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. ? WHO 2009. All rights reserved 耐药结核的治疗 TB Epidemic DOTS HIV Epidemic HIV 合并结核感染 估计的HIV/TB患者地理分布图 Kenneth Mayer. CID. 2010 Poorly Formed to No Significant Granuloma Formation in Severely Immunosuppressed HIV (+) Compared to well Formed Granulomas in HIV (-) TB in HIV 结核菌素试验 Tuberculin Test 5 mm is classified as positive in HIV-positive persons False negative in late HIV stage and overwhelming TB disease Fal