肺結核菌及其抗藥性診斷之現況、困境與發展

Current Development and Dilemma in Diagnosis of Mycobacterium Tuberculosis Infection and the Coping Strategy

陳昌傑(Chang-Chieh Chen) ； 賴信志(Hsin-Chih Lai)

《科儀新知》 179期 (2010/12) Pp. 49-64

https://doi.org/10.29662/IT.201012.0006

摘要

目前結核病的診斷除了需要完整的病史評估、理學檢查和影像醫學檢查外，最重要的是要在患者的檢體中，以抗酸性染色及細菌培養鑑定出結核分枝桿菌的存在才能確診，一個診斷流程可能耗時長達八週。因此傳統的鏡檢及細菌培養等檢測方法已不敷臨床的需求，唯有快速診斷可確保結核病患者的有效治療並減少結核病的發生與散播。而多重及廣泛抗藥性結核的出現則是另一個棘手的問題，這類具抗藥性結核的患者，可能因不適當的治療而長期具傳染性，如果不能迅速有效的診斷出來，將造成更多的傳染。再者，如何增進潛隱性結核感染的偵測效率也是結核病防治的一項重要課題。本篇文章將介紹肺結核菌診斷的現況、困境與發展，包括：活動性結核、抗藥性結核、肺外結核及潛隱性感染等。

並列摘要

The diagnosis of Mycobacterium tuberculosis (Mtb) essentially depends on isolating the bacteria from tissue. In addition to sputum smears for acid fast bacilli staining (AFB), definitive diagnosis requires growing the bacteria and confirming that the culture is Mtb with biochemical tests or DNA probe. This can take up to eight weeks. Thus, traditional X-ray radiography, acid fast bacilli staining and culture methods will gradually not cope with the clinical requirements. Rapid detection of Mtb will ensure quick treatment for patients and could dramatically reduce the incidence and consequences of tuberculosis. Another problem encountered is the drug-resistance problems of MDR (multi-drug resistant)/XDR (extended drug-resistant) Mtb. Patients with multidrug-resistant Mtb who are on inadequate therapy or who have persistently positive sputum AFB smear or culture results might remain infectious for a prolonged period of time. Those patients, if not isolated effectively, should be reassessed for transmission as long as they remain infectious. More rapid and accurate drug resistance detection methods should be developed, besides the traditional antibiotics dilution methods. Furthermore, how to improve the efficacy of detection of latent infections from the community population is another important issue. In this article, we will introduce current developments and dilemma in diagnosis of Mtb infection, including active tuberculosis, drug-resistant tuberculosis, extrapulmonary tuberculosis and latent tuberculosis.