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

• Record Type: Journal Article
• 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.;
• Is Part Of: International journal of infectious diseases. Volume 92 Supplement(2020)
• Page Start: S15
• Page End: S25
• Publication Date: 2020-03
• Subjects: MDR-TB -- XDR-TB -- Diagnosis -- Treatment -- Prevention -- Rehabilitation of sequelae; Communicable diseases -- Periodicals; Communicable Diseases -- Periodicals; Communicable diseases; Periodicals; Electronic journals; 616.9
• DOI: 10.1016/j.ijid.2020.01.042
• Languages: English
• ISSNs: 1201-9712

Abstract

Highlights: 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. Abstract: 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.