Dificultades y limitaciones para el diagnóstico y tratamiento de la tuberculosis

Abstract

Mycobacteria have been around for millions of years. Mycobacterium tuberculosis (M.tb) complex dates back 15.000 years, affecting humans as Tuberculosis (TB) since Neolitic period. M.tb was iden­tified in 1882 and the first drug therapies appeared in 1946.The World Health Organization (WHO) proposes the eradication of TB. However it remains a global endemic of 10 million cases per year. To achieve its eradication, it is important to detect, treat and cure people who transmit TB early. At this time, there is a diagnosis gap of 3 million cases per year and only 70% of diagnosed cases are treated. A cure of 88% is achieved in Rifampicin-sensitive TB (RSTB) and 63% in Rifampicin-resistant cases (RRTB). To improve diagnostic sensitivity, WHO proposes algorithms including a constellation of respi­ratory and systemic symptoms, computer-assisted chest radiography and rapid molecular testing (RMT) instead of smear. Some algorithms should be applied in populations with the following conditions: a) less access to health system (poor communities, migrants, refugees), b) TB prevalence greater than 100 cases per 100.000 inhabitants and c) belonging to groups at high risk of TB (HIV, intra-household contacts, deprived of liberty, exposed to silica or with residual lung lesions) having prolonged cough or alterations in chest radiology. If they are subjected to RMT can reach a diagnostic sensitivity of 84%, whereas screening of respiratory symptoms in general population,gets to only a 42 % of diagnostic sensitivity. Regarding the treatment time, there are successful clinical trials that shorten therapy to 4 months in RSTB (use of fluoroquinolones and Rifapentin) and to 6 months in RRTB (Bedaquiline + Pretomanid + Linezolid and Bedaquiline + Pretomanid + Linezolid + Moxifloxacin schemes). Our country’s health care system has incorporated some of these improvement strategies.