latest global tb estimates - 2007
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siaxleebi tuberkulozis sferoSi _ 2009
Carlz l.deli
mikobaqteriuli da respiratoruli infeqciebis ganyofileba
kolorados universitetidenveri, kolorado
“American Journal of Respiratory and critical care madicine” Vol 181.2010
marina janjRava, “samSabaToba”, 11.05.10
Latest global TB estimates - 2007
Estimated number of
cases
Estimated number of
deaths
1.7 million1.7 million9.3 million9.3 million
~150,000 ~500,000
All forms of TB
Multidrug-resistant TB (MDR-TB)
Extensively drug-resistant TB (XDR-TB)
~50,000 ~30,000
mniSvnelovani mimarTulebebi
tuberkulozis paTogenezis ukeT Seswavla
maRali xarisxis swrafi diagnostikuri testebis Seqmna
axali ufro efeqturi medikamentebis Seqmna
axali vaqcinebis SemuSaveba
19 kvleva tuberkulozis epidemiologia da kontroli
tuberkulozis diagnostika
axali medikamentebi Seqmna da mkurnalobis xangrZlivobis Semcireba
tuberkulozis latenturi infeqciis diagnostika da mkurnaloba
imunologia da vaqcinebis Seqmna
tuberkulozis epidemiologia da kontroli
CDC-is monacemebiT aSS-Si 2008w. daregistrirda 12.898 axali SemTxveva 59% ucxoeTSi dabadebuli pirebi
filtvis aqtiuri tuberkulozis maCvenebeli aSS imigrantebsa da ltolvilebSi – 7%
tuberkulozis kontrolis gaumjobesebis mizniT ucxoeTSi dabadebulTa Soris gaZlierdes tuberkulozis kontrolisa da prevenciis zomebi
skriningis algoriTmi:
anamnezis Segroveba
naxvelis nacxis samjeradi mikroskopia
gulmkerdis rentgenografia
tuberkulozis SemTxvevaTa gamovlenis gaumjobesebisaTvis daemata kulturaluri gamokvlevebi, riTac gaumjobesdeba skriningis procedura da tuberkulozis kontroli aSS-Si
aSS-Si 1992w. tuberkulozis SemTxvevebi da maCveneblebi yovelwliurad mcirdeba
2008w daregistrirda 12.898 axali SemTxveva 4.2 % 100000 mosaxleze
kvleviT dadasturda tuberkulozis SemTxvevaTa dagvianebuli diagnostika• mgb(+) SemTxvevebis arseboba• rentgenologiurad kavernebis arseboba 1993 _ 18.5 % 2006 _ 26.1 %
jandacvis muSakTa profesiuli unar-Cvevebis Semcireba
tuberkulozis Sorswasuli SemTxvevebis mateba TeTrkanian mosaxleobaSi – 56.4% dasaqmebul mosaxleobaSi _ 62.3% aSS-Si dabadebul pirebSi _ 59.2%
Sorswasuli SemTxvevebi gamovlinda dabali riskis mqone pirebSi dabali gavrcelebis mqone regionebSi
gamosavali: jandacvis departamentma moiZios diagnostikaSi gamocdili
eqimebi Cautardes treningi pjd eqimebs gaZlierdes kerZo seqtoris warmomadgenlebis CarTva
tuberkulozis SemTxvevaTa marTvis gundSi
tuberkulozis kontrolis damatebiTi RonisZiebebis SemuSavebisa da ganxorcielebisaTvis, maRali riskis mqone mosaxleobis miznobrivi skriningis gaumjobesebisaTvis - Seswavlil iqna risk-faqtorebi, rac xels uwyobs latentur tuberkulozis daavadebaSi gadasvlas.
_ Tambaqos moweva warmoadgens tuberkulozis ganviTarebis risk-faqtors
sigaretis mowevasa da tuberkulozs Soris kavSiris
Seswavlis mizniT kvleva Catarda taivanSi
mosaxleobaSi maRalia Tambaqos moxmareba tuberkulozis registrirebuli SemTxvevebi
monawileoba miiRo _ 17.699 pirovnebam (asaki 12welze >)dakvirveba mimdinareobda 2001 – 2004 ww.
insidentobis maCvenebeli _ saxelmwifo samedicino dazRvevis monacemTa bazidan
mwevelTa statusi kavSirSia tuberkulozis riskis zrdasTan
daavadebis ganviTarebis maCvenebeli–1.94 (asaki 65welze< )
mniSvnelovani kavSiri 1dRisa da wlis ganmavlobaSi
moxmarebuli sigaretis raodenobas Soris
miuxedavad imisa, rom kvleva ver akontrolebda gansxvavebebs im zemoqmedebebs Soris, romelsac sigareti
axdens organizmze, miRebuli monacemebi sandoa.
msoflioSi 1.3 miliardi mwevelia, maTi umetesoba cxovrobs saSualo da dabali Semosavlebis qveynebSi, sadac tuberkulozi prevalentur daavadebad iTvleba.
MDR –is mkurnalobis erT-erTi yvelaze efeqturi medikamentebia axali Taobis ftorqinolonebi:
levofloqsacini moqsifloqsacini gatifloqsacini
risk-faqtoriam jgufis medikamentebis farTod gamoyenebam SeiZleba ganapirobos rezistentobis SeZena, rac usargeblos gaxdis maT MDR –is mkurnalobisTvis.
tenesis StatSi samedicino sadazRvevo sqemiT mocul mosaxleobaSi gamoiyo kulturiT dadasturebuli tuberkuloziT daavadebuli pirebi
pacientebi, romelTac tuberkulozis dadgenamde 12 TviT adre Catarebuli aqvT mkurnaloba ftorqinolonebiT
kvlevaSi gamoyenebul iqna tenesis Statis samedicino sadazRvevo sqemis saafTiaqo monacemebi
kvlevaSi monawileobda 640 pacienti 116 (18%) – tuberkulozis dadgenamde 12 TviT adre
mkurnalobda ftorqinolonebiT
16 (2.5%) _ ftorqinolonebisadmi rezistentuli Stami
54 pac. _ ftorqinolonebiT mkurnalobda 10 dReze meti xnis ganmavlobaSi
7 (13%) _ ftorqinolonebisadmi rezistentuli Stami
ftorqinolonebisadmi rezistentobis saerTo maCvenebeli tenesis StatSi SedarebiT maRalia
ftorqinolonebis 10 dReze ufro xangrZlivad miReba, gansakuTrebiT ki 60 dRiT adre tuberkulozis dadgenamde asocirebulia rezistentobis ganviTarebis maRal riskTan.
rezistentuli tuberkulozis mkurnalobis efeqturobis asamaRleblad mniSvnelovania, rom eqimebma gaiTvaliswinon tuberkulozis diagnozis SesaZlo arseboba da Tavi aaridon tuberkulozis maRali riskis mqone pacientebSi ftorqinolonebis xangrZlivad gamoyenebas.
tuberkulozis diagnostika
farTod gamoiyeneba naxvelis nacxis mikroskopia, romelic gamoirCeva dabali sensitiurobiT
tuberkulozis diagnostika rCeba globalur problemad
janmos axali gaidlainebis moTxovniT • tuberkulozze saeWvo nacx-uaryofiT pacientebSi• tuberkulozze saeWvo aiv-inficirebul pirebSidiagnostikisaTvis gamoyenebul iqnas naxvelis kulturaluri gamokvleva
• tuberkulozis diagnostikisTvis gamoyenebuli 3-jeradi baqterioskopia Seicvalos 2-jeradi gamokvleviT
am rekomendaciebis efeqturobis Sefasebis mizniT Catarda kvleva
monawileobda _ 1.060 pacienti (tailandi, vietnami)
TiToeuli pirovnebidan iRebdnen naxvelis nacxis 3 sinjs da damatebiT masalas eqstrapulmonaruli lokalizaciidan
gamokvleva xdeboda:
naxvelis nacxis mikroskopiiT kulturaluri gamokvleviT myar niadagze kulturaluri gamokvleviT Txevad niadagze
147 (14%) _ tuberkulozis SemTxveva dadasturda kulturaluri gamokvlevebis safuZvelze
126 SemTxvevidan baqterioskopiis mesame analiziT sasurveli Sedegi miRebul iqna mxolod 25 SemTxvevaSi
mikroskopia arasensitiuria aiv-inficirebul pacientebSi
naxvelis nacxis mikroskopiiT ver gamovlinda tuberkulozis SemTxvevebis 2/3, rac adasturebs janmos rekomendacias, rom SemTxvevaTa gamovlenis gaumjobesebisTvis aucilebelia kulturaluri gamokvlevebis ganxorcieleba (Txevadi niadagis gamoyeneba)
dakvirveba axal medikamentebze da mkurnalobis xangrZlivobis Semcireba
R – 207910 (TMC 207) – diarilkvinolaini, gamoirCeva mniSvnelovani baqteriociduli moqmedebiT tuberkulozis mikobaqteriis mimarT
am preparatis masterilizebeli aqtivoba dadasturda Tagvebze dakvirvebiT
medikamentebi mkurn. xangrZ. recidivi
TMC 207+ R + Z 4 Tve 13%
stand.mkurn.I rigis medik. 6 Tve 17%
Tu adamianebze Catarebul klinikur kvlevebSi dadasturda igive Sedegebi, SesaZlebelia mkurnalobis Semcireba 4 Tvemde
linezolidi _ oqsazolidinonis jgufis antibiotiki. gaaCnia baqteriostatuli moqmedeba tuberkulozis mikobaqteriaze, aseve rezistentuli Stamebis mimarT
PNU – 100480 _ oqsazolidinoni, axasiaTebs linezolidze ufro Zlieri baqteriociduli moqmedeba.
(Tagvebze Catarebuli kvlevebiT)
medikamentebi mkurn. xangrZ. recidivi
I rigis medik. 4 Tve 90 %
I rigis medik. 2 Tve 35 %PNU – 100480
I rigis medik. 4 Tve 5 %PNU – 100480
PNU – 100480 gaaCnia masterilizebeli aqtivoba, iZleva mkurnalobis xangrZlivobis Semcirebis SesaZleblobas
moqsifloqsacini _ mRrRnelebze Catarebuli kvleviT gamovlinda Zlieri masterilizebeli moqmedeba kulturalur statusze dakvirvebiT. kvleva Catarda braziliaSi.
medikamentebi mkurn. xangrZ. kult.negat.
I rigis medik. 8 kvira 63 %
I rigis medik. 8 kvira 80 %moqsifloqsacini etambutolis naclad
moqsifloqsacins gaaCnia maRali antituberkulozuri da masterilizebeli moqmedeba
tuberkulozis kvlevis konsorciumma ganaxorciela da waradgina angariSi randomizirebuli, placebo-kontrolirebadi, ormagad brma meore fazis klinikuri kvlevis Sedegebis Sesaxeb.
kvlevis mizani – moqsifloqsacinis antibaqteriuli zemoqmedebisa da usafrTxoebis Sefaseba
medikamentebi mkurn. xangrZ. kult.negat.
I rigis medik. 2 Tve 54.9 %
I rigis medik. 2 Tve 60.4 %moqsifloqsaciniizoniazidis nacvlad
moqsifloqsacins gaaCnia saukeTeso tubsawinaaRmdego moqmedeba. jer kidev Sesaswavlia, gaaCnia Tu ara mas iseTi masterilizebeli moqmedeba, rom xeli Seuwyos mkurnalobis xangrZlivobis Semcirebas
rifapentini _ rifampicinis jgufis preparati xasiaTdeba ufro xangrZlivi naxevardaSlis periodiT
TMC 207 _ gaaCnia xangrZlivi naxevardaSlis periodi kvlevis mizani _ perioduli mkurnalobis SemuSaveba medikamentis miReba kviraSi erTjer
kvleva Catarda _ mRrRnelebis modelze adamianebze
medikamentis miReba kviraSi erTxel
medikamentebi mkurn. xangrZ. baqt. datv.
rifapentini 8 kvira Semcirda 4-jer
TMC 207 8 kvira Semcirda 6-jer
rifapentini 8 kvira maRali aqtivoba TMC 207 pirazinamidi
TMC 207 - aqtiuri medikamentia perioduli mkurnalobisTvis, ufro Zliermoqmedia, vidre standartuli samkurnalo reJimi.
TMC 207 - danergvis molodinSi mniSvnelovania, iseTi midgomebis gamovlena, romlebic mogvcemen mkurnalobis kursis xangrZlivobis Semcirebis SesaZleblobas
mkurnalobis Sedegebis gaumjobesebisa da mkurnalobis xangrZlivobis SemcirebisaTvis arsebobs kidev erTi midgoma
maspinZeli organizmis imunuri reaqciis gaZliereba.
vitamini D - deficiti asocirdeba tuberkulozis ganviTarebis riskis zrdasTan.
kvlevis mizani – kavSiri vitamini D samkurnalo sqemaSi damatebiT gamoyenebas, klinikuri Sedegebis gaumjobesebasa da sikvdilobis Semcirebas Soris.
gvinea besauSi Catarda randomizirebuli, ormagad brma, placebo-kontrolirebadi kvleva.
365 klinikurad dadasturebuli filtvis mgb(+) tuberkuloziT daavadebuli pacienti.
I jgufi – qolekalciferoli 100.000 IU II jgufi – placebo
kvlevis Sedegad ar dadasturda raime gansxvaveba daavadebis klinikuri simwvavis Semcirebis naxvelis konversiis sikvdilobis Semcirebis TvalsazrisiT
kvlevam ver gansazRvra vitamini D miRebiT raime zemoqmedeba tuberkulozis mkurnalobaze (tropikul regionSi)tuberkulozis prevenciis mizniT saWiroa dainergos damatebiTi kvlevebi
gmadlobT yuradRebisTvis