El regreso de la tuberculosis

Generaciones de médicos, políticos y funcionarios de salud pública lucharon para derrotar a la tuberculosis. Sin embargo, después de años de éxito, la tuberculosis está en franco retorno. El aumento de los casos de tuberculosis en el mundo desarrollado desde 1992 inicialmente se atribuyó al VIH. Pero, con el tiempo, surgieron otros factores detrás de la creciente cantidad de casos, como la inmigración y un tipo particular de tuberculosis resistente a los medicamentos.

La Organización Mundial de la Salud desarrolló una estrategia para combatir el retorno de la tuberculosis, que incluye una terapia estandarizada que especifica qué drogas, dosis y momento de aplicación de la terapia son apropiados. Desafortunadamente, la tuberculosis resistente a múltiples drogas (MDR-TB), que es cualquier tuberculosis resistente a los tratamientos tradicionales de isoniazida y rifampicina, representa un desafío importante: dado que el tratamiento estándar es menos efectivo para curarla, su transmisión continúa.

Es más, cualquier tuberculosis tratada de manera inadecuada se vuelve resistente a múltiples drogas, de modo que un tratamiento fallido puede ser la causa o la consecuencia de la MDR-TB. Esto subraya la necesidad de un régimen determinado para tratar hoy la tuberculosis, así como una estrategia más compleja para controlar la enfermedad -una estrategia que cure la mayor cantidad de casos posible, impida una resistencia adquirida a las drogas y reduzca la transmisión de la infección-. La OMS recomienda lo que da en llamar una “Estrategia de Terapia Directamente Observada” (DOTS) y ha establecido umbrales de diagnóstico de por lo menos el 70% de los casos infecciosos, y umbrales curativos del 85%.

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