Tuberculosis (TB) is an infectious and contagious disease, caused mainly by Mycobacterium tuberculosis complex, which involves in most cases the lungs, but which can localize in many other organs, including the kidney, the skeletal system, the meninges and the reproductive system. The most significant process in the knowledge of the nature of the disease was made by Robert Koch, who first clearly identified the infectious etiology in 1882. This discovery was followed by others who have progressively reduced the mortality from tuberculosis infection, up to the revolutionary discovery of anti-mycobacterial occurred between 1944 and 1946. Despite this, and although in most cases the disease is treatable with a pharmacological approach, TB remains a major cause of death worldwide, especially in developing countries; HIV after being the second leading cause of death due to a single infectious agent. Within this framework, it assumes enormous importance today the emergence of drug resistant strains: Multidrug-resistant Tuberculosis (MDR-TB) and Extensively drug-resistant Tubercolsis (XDR-TB). The resistance to common first-line anti-tuberculosis drugs is the result of spontaneous mutations in the genome of organisms belonging to the Mycobacterium tuberculosis complex, as well as incorrect use of these drugs (monotherapy, insufficient duration, poor patient compliance ...). Globally, according to data of the WHO, in 2014 were 480 000 cases of MDR-TB, of which about half have died. Within this framework, and in a world with an increasingly important presence of migration, mostly coming from endemic areas, we can 'talk of a "new explosion" European of tuberculosis, a disease that was considered perhaps too prematurely already defeated. Surgery tuberculosis, in the past fundamental approach in the treatment of the disease, appears to be of enormous relevance, not only in the most common complications of the disease, but often as the only therapeutic solution in most situations not solved with the only drug therapy.
La tubercolosi (TBC) è una malattia infettiva e contagiosa, causata principalmente da Mycobacterium tuberculosis complex, che interessa nella maggior parte dei casi i polmoni, ma che può localizzarsi in numerosi altri organi, tra i quali il rene, l’apparato scheletrico, le meningi e l’apparato genitale. Il processo più significativo nella conoscenza della natura della malattia si deve a Robert Koch, che per primo ne identificò chiaramente l’eziologia infettiva nel 1882. A questa scoperta ne sono seguite altre che hanno progressivamente ridotto la mortalità da infezione tubercolare, fino ad arrivare alla rivoluzionaria scoperta della terapia anti-micobatterica avvenuta tra il 1944 ed il 1946. Nonostante ciò, e sebbene nella gran parte dei casi la malattia sia curabile con un approccio di tipo farmacologico, la tubercolosi resta una delle maggiori cause di morte nel mondo, specialmente nei paesi in via di sviluppo; essendo dopo l’HIV la seconda causa di decessi dovuta ad un singolo agente infettivo. All’interno di tale quadro, assume oggigiorno enorme importanza la comparsa di ceppi farmaco resistenti: Multidrug-resistant Tubercolosis (MDR-TB) ed Extensively drug-resistant Tubercolsis (XDR-TB). La resistenza ai comuni farmaci antitubercolari di prima linea è il risultato di mutazioni spontanee all’interno del genoma di organismi appartenenti al Mycobacterium tuberculosis complex, così come all’incorretto utilizzo di tali farmaci (monoterapia,durata insufficiente,scarsa compliance del paziente…). Globalmente, secondo i dati del WHO, nel 2014 sono stati 480 000 i casi di MDR-TB, di cui circa la metà sono deceduti. All’interno di tale quadro, ed in un mondo caratterizzato da una sempre più importante presenza di flussi migratori, provenienti per lo più da aree endemiche, si puo’ parlare di una “nuova esplosione” europea della Tbc, patologia che forse si riteneva troppo prematuramente già sconfitta. La chirurgia della tubercolosi, già in passato approccio fondamentale nel trattamento della malattia, risulta essere di enorme attualità, non solo nelle più comuni complicanze della malattia, ma spesso quale unica soluzione terapeutica in situazioni non più risolvibili con la unica terapia farmacologica.
ATTUALITA’ DELLA TERAPIA CHIRURGICA NELL’APPROCCIO ALLE FORME DI MULTIDRUG-RESISTANT TUBERCOLOSIS (MDR-TB) ED EXTENSIVELY DRUG-RESISTANT TUBERCOLSIS (XDR-TB)
DONATI, MARCO
2014/2015
Abstract
Tuberculosis (TB) is an infectious and contagious disease, caused mainly by Mycobacterium tuberculosis complex, which involves in most cases the lungs, but which can localize in many other organs, including the kidney, the skeletal system, the meninges and the reproductive system. The most significant process in the knowledge of the nature of the disease was made by Robert Koch, who first clearly identified the infectious etiology in 1882. This discovery was followed by others who have progressively reduced the mortality from tuberculosis infection, up to the revolutionary discovery of anti-mycobacterial occurred between 1944 and 1946. Despite this, and although in most cases the disease is treatable with a pharmacological approach, TB remains a major cause of death worldwide, especially in developing countries; HIV after being the second leading cause of death due to a single infectious agent. Within this framework, it assumes enormous importance today the emergence of drug resistant strains: Multidrug-resistant Tuberculosis (MDR-TB) and Extensively drug-resistant Tubercolsis (XDR-TB). The resistance to common first-line anti-tuberculosis drugs is the result of spontaneous mutations in the genome of organisms belonging to the Mycobacterium tuberculosis complex, as well as incorrect use of these drugs (monotherapy, insufficient duration, poor patient compliance ...). Globally, according to data of the WHO, in 2014 were 480 000 cases of MDR-TB, of which about half have died. Within this framework, and in a world with an increasingly important presence of migration, mostly coming from endemic areas, we can 'talk of a "new explosion" European of tuberculosis, a disease that was considered perhaps too prematurely already defeated. Surgery tuberculosis, in the past fundamental approach in the treatment of the disease, appears to be of enormous relevance, not only in the most common complications of the disease, but often as the only therapeutic solution in most situations not solved with the only drug therapy.È consentito all'utente scaricare e condividere i documenti disponibili a testo pieno in UNITESI UNIPV nel rispetto della licenza Creative Commons del tipo CC BY NC ND.
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https://hdl.handle.net/20.500.14239/18034