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Latest global TB estimates - 2007

hammett-maxwell
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Latest global TB estimates - 2007

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  1. siaxleebi tuberkulozis sferoSi _ 2009Carlz l.delimikobaqteriuli da respiratoruli infeqciebis ganyofilebakolorados universitetidenveri, kolorado“American Journal of Respiratory and critical care madicine” Vol 181.2010 marina janjRava, “samSabaToba”, 11.05.10

  2. Latest global TB estimates - 2007 Estimated number of cases Estimated number of deaths All forms of TB 9.3 million 1.7 million Multidrug-resistant TB (MDR-TB) ~500,000 ~150,000 Extensively drug-resistant TB (XDR-TB) ~30,000 ~50,000

  3. mniSvnelovani mimarTulebebi • tuberkulozis paTogenezis ukeT Seswavla • maRali xarisxis swrafi diagnostikuri testebis Seqmna • axali ufro efeqturi medikamentebis Seqmna • axali vaqcinebis SemuSaveba

  4. 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

  5. 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

  6. 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

  7. 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

  8. 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

  9. 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

  10. 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

  11. 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.

  12. MDR –is mkurnalobis erT-erTi yvelaze efeqturi medikamentebia axali Taobis ftorqinolonebi: • levofloqsacini • moqsifloqsacini • gatifloqsacini risk-faqtori am jgufis medikamentebis farTod gamoyenebam SeiZleba ganapirobos rezistentobis SeZena, rac usargeblos gaxdis maT MDR –is mkurnalobisTvis.

  13. 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

  14. 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

  15. 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.

  16. 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 pirebSi diagnostikisaTvis gamoyenebul iqnas naxvelis kulturaluri gamokvleva • tuberkulozis diagnostikisTvis gamoyenebuli 3-jeradi baqterioskopia Seicvalos 2-jeradi gamokvleviT

  17. 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

  18. 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)

  19. 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

  20. 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

  21. 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

  22. 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 % moqsifloqsacini izoniazidis nacvlad moqsifloqsacins gaaCnia saukeTeso tubsawinaaRmdego moqmedeba. jer kidev Sesaswavlia, gaaCnia Tu ara mas iseTi masterilizebeli moqmedeba, rom xeli Seuwyos mkurnalobis xangrZlivobis Semcirebas

  23. 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

  24. medikamentismiRebakviraSierTxel medikamentebimkurn. xangrZ. baqt. datv. rifapentini 8 kviraSemcirda 4-jer TMC 207 8 kviraSemcirda 6-jer rifapentini 8 kviramaRaliaqtivoba TMC 207 pirazinamidi TMC 207 - aqtiurimedikamentiaperiodulimkurnalobisTvis, ufroZliermoqmedia, vidrestandartulisamkurnaloreJimi. TMC 207 - danergvismolodinSimniSvnelovania, iseTimidgomebisgamovlena, romlebicmogvcemenmkurnalobiskursisxangrZlivobisSemcirebisSesaZleblobas

  25. 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.

  26. 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

  27. gmadlobT yuradRebisTvis

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