查看更多>>摘要：Background New Zealand has a low burden of tuberculosis; however, multidrug-resistant tuberculosis (MDR-TB) still represents a challenge for clinicians. This is the first description of clinical aspects of MDR-TB in New Zealand. Aims To evaluate the treatment and outcomes of patients with MDR-TB disease in Auckland. Secondary aims were to review the incidence and clinical characteristics of MDR-TB disease. Methods Clinical data were obtained for patients treated for MDR-TB at Auckland District Health Board (ADHB). Results There were 60 patients nationally with MDR-TB between 1989 and 2018; 41 (69%) of 60 patients received care at ADHB. Pulmonary infection was present in 36 (88%) of 41 patients, with 19 (46%) of 41 patients with smear-positive sputum (smear 1-2+ in 6/41, 15%; smear 3-4+ in 13/41, 32%). The median duration of treatment was 22 months (range 7.5-26) for 18 (44%) of 41 patients who completed MDR-TB treatment by August 2018. The median duration of amikacin treatment was 6 months (range 2-12) for the 23 (61%) of 38 patients in whom these data were available. All 38 patients who received treatment for MDR-TB experienced adverse effects, most commonly gastrointestinal (66%), neurological (50%), ototoxicity (47%) and psychiatric (37%). Complications of intravenous access were experienced by 10 (27%) of 37 patients. Of the 19 (46%) of 41 patients who completed treatment, 18 (95%) achieved cure. There was one case who had recurrence because of inadequate treatment, and one case who had spontaneous resolution without treatment. Seventeen (41%) patients left Auckland prior to completion of treatment, mostly to return to their country of origin (15/17, 88%). Conclusion MDR-TB is uncommon in New Zealand. Treatment is frequently associated with adverse events; however, rates of cure for people completing treatment in New Zealand are high.
查看更多>>摘要：Lethal infectious disease epidemics have historically occurred in military, refugee and mining camps where crowded conditions promote the spread of enteric, respiratory and insect-borne infections. The early history of gold mines around Palmer River, Queensland in the 1870s, Kalgoorlie, Western Australia in the 1890s and Papua on the island of New Guinea in the 1910s are recounted specifically as it relates to infectious disease deaths. Despite large diagnostic gaps, it is likely that malaria was the predominant problem in Palmer River, typhoid in Kalgoorlie and bacillary dysentery in Papua. Nearly two-thirds of all recorded deaths in the Palmer River district from 1873 to 1883 were due to infections, predominately 'fevers'. Typhoid fever likely killed >2000 Australians in the early phases of the Western Australian goldfields in the 1890s. Severe dysentery outbreaks killed up to a majority of the local workforce in the Lakekema goldfields of Papua resulting in the colonial authorities stopping mining activity in the second decade of the 20th century. In the absence of public health measures and specific chemotherapy, large mortality rates in miners reflected the over-riding economic drivers of gold miners and their lack of any understanding of microbial disease and its interruption by public health measures. Similar infectious disease epidemics are likely to reoccur when large numbers of impoverished miners use low-technology methods to work alluvial gold deposits in conflict areas as has been seen in modern Africa.
NSTL
Wiley