Notice bibliographique
Résumé
To the Editor: An emergency has been declared in KwaZulu Natal, South Africa, where an outbreak of 53 cases of a highly lethal form of tuberculosis (TB) has occurred (1,2). This outbreak was caused by an extensively drug-resistant TB (XDR TB) strain. XDR TB is defined as TB caused by Mycobacterium tuberculosis isolates resistant to isoniazid and rifampicin plus any fluoroquinolone and ≥1 of the 3 injectable second-line drugs (3). XDR TB may be considered an emerging disease but not a new disease. Nosocomial outbreaks of multidrug-resistant TB (MDR TB) occurred in Spain at the height of the HIV epidemic, when 49 TB cases were reported in an HIV ward in Madrid from 1991 through 1995 (4,5). Molecular epidemiology found that a particular strain caused 16 cases in another hospital in Madrid in 1993–1995 (6) and 31 cases in a hospital in Malaga in 1995–1998 (7,8). In total, 22 hospitals from 6 different regions of Spain were affected by this outbreak, which included at least 114 cases, caused by an M. bovis XDR strain (B strain) belonging to the M. tuberculosis complex. The patients included 1 from the Netherlands (8) and another from Canada (9). The strain responsible for the 1991–1995 outbreak in Spain fits the XDR TB case definition; it was resistant to the 5 first-line drugs, as well as to ofloxacin, aminosalicylic acid, cycloserine, ethionamide, capreomycin, amikacin, and clarithromycin. Isolates were tested for drug susceptibility by the Canetti method on Lowenstein-Jensen medium supplemented with isoniazid, rifampicin, ethambutol, streptomycin, amikacin, and pyrazinamide (6). The isolates were also tested on 7H10 Middlebrook agar for susceptibility to aminosalicylic acid, ethionamide, capreomycin, clarithromycin, and ofloxacin (6). No effective medical treatment was available for these patients. In 2 of the hospitals affected, all patients died, with a short survival time (median of 44 and 49.5 days for the 2 hospitals) between diagnosis and death (6,7). A high rate of reinfection (45%) also was noted among HIV-positive patients treated with anti-TB drugs (7). As a result of this outbreak, Spanish hospitals now implement exhaustive control measures, such as maintaining respiratory isolation units under negative pressure; in addition, a national surveillance network for MDR TB was set up in Spain in 1998. From 1998 through 2003, we detected 22 new cases of infection with this strain (10), but no new cases have since been reported to the national MDR TB database. Our experience indicates that the implementation of more stringent control measures and the use of new, more effective treatments for HIV infection can help to bring XDR TB outbreaks under control in developed countries. However, the outlook is bleak for developing countries like South Africa, in which coinfection with HIV and a highly transmissible and untreatable XDR TB strain could amplify the TB problem to levels unprecedented since the advent of antimicrobial drugs. These countries urgently require assistance with the establishment of control measures and the development of new drugs and effective vaccines against TB.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,002 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,001 |
| Méta-épidémiologie (sens large) | 0,002 | 0,001 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,001 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».