MDR/XDR-TB management of patients and contacts: Challenges facing the new decade. The 2020 clinical update by the Global Tuberculosis Network

•Updated clinical guidance on MDR-TB is needed.•Several new MDR-TB diagnostics have been recently approved by WHO to complement existing tools.•To design a regimen, 4–5 active drugs are needed with a treatment duration up to 24 months.•Post-treatment sequelae might require pulmonary rehabilitation.•...

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Published in:International journal of infectious diseases Vol. 92; pp. S15 - S25
Main Authors: Migliori, Giovanni Battista, Tiberi, Simon, Zumla, Alimuddin, Petersen, Eskild, Chakaya, Jeremiah Muhwa, Wejse, Christian, Muñoz Torrico, Marcela, Duarte, Raquel, Alffenaar, Jan Willem, Schaaf, H. Simon, Marais, Ben J., Cirillo, Daniela Maria, Alagna, Riccardo, Rendon, Adrian, Pontali, Emanuele, Piubello, Alberto, Figueroa, José, Ferlazzo, Gabriella, García-Basteiro, Alberto, Centis, Rosella, Visca, Dina, D’Ambrosio, Lia, Sotgiu, Giovanni, Arkub, T. Abu, Akkerman, O.W., Aleksa, A., Belilovski, E., Bernal, E., Blanc, F-X., Boeree, M., Borisov, S., Bruchfeld, J., Cadiñanos Loidi, J., Caminero, J.A., Carvalho, A.C., Cebrian Gallardo, J.J., Charalampos, Danila, E., Davies Forsman, L., Denholm, J., Dheda, K., Diel, R., Diktanas, S., Dobler, C., Enwerem, M., Esposito, S., Escobar Salinas, N., Filippov, A., Formenti, B., García García, J.M., Goletti, D., Gomez Rosso, R., Gualano, G., Isaakidis, P., Kaluzhenina, A., Koirala, S., Kuksa, L., Kunst, H., Li, Y., Magis-Escurra, C., Manfrin, V., Manga, S., Manika, K., Marchese, V., Martínez Robles, E., Maryandyshev, A., Matteelli, A., Mariani, A., Mazza-Stalder, J., Mello, F., Mendoza, L., Mesi, A., Miliauskas, S., Mustafa Hamdan, H., Ndjeka, N., Nieto Marcos, M., Ottenhoff, T.H.M., Palmero, D.J., Palmieri, F., Papavasileiou, A., Payen, M.C., Pontarelli, A., Pretti Dalcolmo, M., Quirós Fernandez, S., Romero, R., Rossato Silva, D., Santos, A.P., Seaworth, B., Sinitsyn, M., Skrahina, A., Solovic, I., Spanevello, A., Tadolini, M., Torres, C., Udwadia, Z., van den Boom, M., Volchenkov, G.V., Yedilbayev, A., Zaleskis, R., Zellweger, J.P.
Format: Journal Article
Language:English
Published: Canada Elsevier Ltd 01.03.2020
Elsevier
Subjects:
Diagnosis
MDR-TB
Prevention
Rehabilitation of sequelae
Treatment
XDR-TB
Prevention
MDR-TB
Treatment
XDR-TB
Diagnosis
Rehabilitation of sequelae
ISSN:1201-9712, 1878-3511, 1878-3511
Online Access:Get full text
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Summary:•Updated clinical guidance on MDR-TB is needed.•Several new MDR-TB diagnostics have been recently approved by WHO to complement existing tools.•To design a regimen, 4–5 active drugs are needed with a treatment duration up to 24 months.•Post-treatment sequelae might require pulmonary rehabilitation.•LTBI management and infection control are core elements of the MDR-TB public health approach. The continuous flow of new research articles on MDR-TB diagnosis, treatment, prevention and rehabilitation requires frequent update of existing guidelines. This review is aimed at providing clinicians and public health staff with an updated and easy-to-consult document arising from consensus of Global Tuberculosis Network (GTN) experts. The core published documents and guidelines have been reviewed, including the recently published MDR-TB WHO rapid advice and ATS/CDC/ERS/IDSA guidelines. After a rapid review of epidemiology and risk factors, the clinical priorities on MDR-TB diagnosis (including whole genome sequencing and drug-susceptibility testing interpretations) and treatment (treatment design and management, TB in children) are discussed. Furthermore, the review comprehensively describes the latest information on contact tracing and LTBI management in MDR-TB contacts, while providing guidance on post-treatment functional evaluation and rehabilitation of TB sequelae, infection control and other public health priorities.
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ISSN:1201-9712
1878-3511
1878-3511
DOI:10.1016/j.ijid.2020.01.042