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siaxleebi tuberkulozis sferoSi _ 2009 Carlz l.deli mikobaqteriuli da respiratoruli infeqciebis ganyofileba kolorados universiteti denveri, kolorado “American Journal of Respiratory and critical care madicine” Vol 181.2010 marina janjRava, “samSabaToba”, 11.05.10
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Page 1: Latest global TB estimates - 2007

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

Page 2: Latest global TB estimates - 2007

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

Page 3: Latest global TB estimates - 2007

mniSvnelovani mimarTulebebi

tuberkulozis paTogenezis ukeT Seswavla

maRali xarisxis swrafi diagnostikuri testebis Seqmna

axali ufro efeqturi medikamentebis Seqmna

axali vaqcinebis SemuSaveba

Page 4: Latest global TB estimates - 2007

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

Page 5: Latest global TB estimates - 2007

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

Page 6: Latest global TB estimates - 2007

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

Page 7: Latest global TB estimates - 2007

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

Page 8: Latest global TB estimates - 2007

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

Page 9: Latest global TB estimates - 2007

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

Page 10: Latest global TB estimates - 2007

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

Page 11: Latest global TB estimates - 2007

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.

Page 12: Latest global TB estimates - 2007

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.

Page 13: Latest global TB estimates - 2007

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

Page 14: Latest global TB estimates - 2007

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

Page 15: Latest global TB estimates - 2007

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.

Page 16: Latest global TB estimates - 2007

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

Page 17: Latest global TB estimates - 2007

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

Page 18: Latest global TB estimates - 2007

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)

Page 19: Latest global TB estimates - 2007

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

Page 20: Latest global TB estimates - 2007

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

Page 21: Latest global TB estimates - 2007

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

Page 22: Latest global TB estimates - 2007

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

Page 23: Latest global TB estimates - 2007

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

Page 24: Latest global TB estimates - 2007

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

Page 25: Latest global TB estimates - 2007

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.

Page 26: Latest global TB estimates - 2007

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

Page 27: Latest global TB estimates - 2007

gmadlobT yuradRebisTvis