Vzestup lékově rezistentní tuberkulózy

BALTIMORE – Tuberkulóza, jedno z nejzhoubnějších infekčních onemocnění, opět řádí, zejména v Africe. Extenzivně lékově rezistentní tuberkulóza (XDR-TB) je nesnadno léčitelný kmen TBC, který útočí tam, kde jsou historicky slabé zdravotnické soustavy, zejména v oblastech vysokého výskytu HIV. Neschopnost potlačovat lokální vzplanutí, vyvinout nástroje a strategie k rozpoznání a léčbě XDR-TB a investovat do dlouhodobějšího zkvalitnění kontroly nad TBC by naši čaromocnou farmakologickou munici mohla proměnit ve slepé náboje.

Vývoj chemoterapie proti TBC ve 40. až 70. letech 20. století proměnil kdysi vražedný „bílý mor“ ve vyléčitelnou nemoc. Nad léčbou TBC ale už od úsvitu éry antibiotik visí mrak rezistence vůči působení léků. Před patnácti lety epidemie mnohočetně lékově rezistentní tuberkulózy (MDR-TB) v New Yorku vyvolala bezmála paniku, než rozsáhlý příliv financí do zdravotnické infrastruktury tento vývoj ve Spojených státech zvrátil a zájem veřejnosti opadl. Problém lékové rezistence ovšem přetrval a úsilí o jeho celosvětové zadržení není dostatečné.

Na scénu přišla XDR-TB. Světová zdravotnická organizace odhaduje, že v roce 2004 se objevilo 425 tisíc nových případů MDR-TB, přičemž Čína, Indie a Rusko tvořily něco málo přes 60%. Problematika extenzivně lékově rezistentních organismů se ale do centra celosvětové pozornosti dostala až po propuknutí XDR-TB u lidí nakažených HIV v jihoafrické oblasti KwaZulu-Natal.

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