Tuberkuloza pluća - bolest u porastu

master's thesis

• Title (english): Pulmonary tuberculosis - on the rise again
• Author: Nives Živković
• Mentor: Marija Gomerčić Palčić (mentor)
• Committee member: Sanja Popović-Grle (predsjednik povjerenstva)
• Committee member: Marko Jakopović (član povjerenstva)
• Committee member: Marija Gomerčić Palčić (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Internal Medicine); Zagreb
• Defense date and country: 2020-07-17, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Internal Medicine

Abstract

Tuberkuloza pluća, bolest uzrokovana infekcijom Mycobacterium tuberculosis vodeći je infektivni uzročnik smrti diljem svijeta. Iako se razvijene zemlje uspješno bore s infekcijom, u nerazvijenim dijelovima svijeta dolazi do nekontroliranog širenja infekcije čime uzročnik razvija snažnije mehanizme otpornosti i virulencije. Potrebno je napomenuti da se uvođenjem novih imunomodulatornih lijekova povećava broj pacijenata kod kojih je potrebno provesti kemoprofilaksu zbog dokazane latentne tuberkuloze. Također porastom incidencije bolesti koje karakterizira imunokompromitiranost povećava se i mogućnost infekcije tuberkulozom. Klinička slika plućne tuberkuloze mijenjala se kroz 20. stoljeće zbog ranijeg prepoznavanja i efikasnijeg liječenja, no iako se činilo da je infekcija kontrolirana i broj novozaraženih u padu pojavili su se novi izazovi. Pojava HIV infekcije, produživanje života u pacijenata s kroničnim bolestima i agresivnije terapijske mogućnosti pogodovale su nastanku novih rizičnih skupina. Rizik infekcijom tuberkuloze nekoliko puta je veći u HIV pozitivnih pacijenata nego u zdrave populacije. Koinfekcija M. tuberculosis s HIV-om ubrzava replikaciju virusa i dovodi do brže progresije bolesti zbog oslabljenje stanične imunosti tijekom HIV infekcije. Istraživanjima i kliničkim iskustvom potvrđena je povezanost tuberkulozne infekcije i primjene biološke terapije, posebice inhibitora TNF-α infliksimaba, adalimumaba i etanercepta. Osim toga, vodeći izazov u liječenju tuberkuloze je pojava farmakorezistentnih sojeva koji ne reagiraju na standardne terapijske protokole antituberkuloticima, a režim liječenja takvih sojeva zahtjeva dugotrajnu terapiju novim skupinama lijekova. Razvojem molekularne biologije i genetičkim istraživanjima čovjek pokušava biti korak ispred mikobakterije, razviti dijagnostičke postupke visoke osjetljivosti i specifičnosti, pravovremeno otkriti infekciju i učinkovito ju liječiti. S ciljem prevencije tuberkuloze u Hrvatskoj se kontinuirano provodi BCG cijepljenje kojim je infekcija tuberkuloze uspješno kontrolirana i gotovo eradicirana. O javnozdravstvenoj važnosti tuberkuloze govori i to da je na globalnoj razini pod vodstvom Svjetske zdravstvene organizacije pokrenuta strategija zaustavljanja tuberkuloze i smanjenja broja novozaraženih do 2035. godine kojoj je cilj do 2035. smanjiti incidenciju za 90% u odnosu na 2015.

Abstract (english)

Pulmonary tuberculosis, a disease caused by infection M. tuberculosis, is a main infectious disease of death in the world. Even though the developed countries are combating the infection successfully, in undeveloped parts of the world infection is spreading uncontrollably. M.tuberculosis is evolving strong mechanisms of resistance and virulence. In the 20th century pulmonary tuberculosis has changed its clinical presentation because of the earlier recognition of the disease and more effective treatment. It seemed that the infective agent is under control and the number of contaminated is falling, but new challenges emerged. The emergence of HIV-infection, prolonged life expectancy of patients with chronic diseases and more aggressive therapeutic options have favoured the emergence of new groups of patients at increased risk of contracting TB. The risk of pulmonary infection is higher with the patients who have HIV infection than the ones who do not have. The coinfection of M. tuberculosis with HIV accelerates the replication of the virus and the progression of the disease because of the lower immunity of the body cells which is caused by HIV infection. The research and the clinical experience have confirmed the connection between the pulmonary tuberculosis infection and the use of biological therapy, especially TNF-α blockers infliximab, adalimumab and etanercept. Also, one of the main challenges of tuberculosis treatment is the appearance of pharmacoresistant types which do not respond to standard therapeutic antituberculotic protocols. Treatment regime of those types demands long term therapy with new drug types. Development of molecular biology and genetic research is a man's attempt to be one step in front of Mycobacterium, to evolve diagnostical procedures of high sensitivity and specificity, to recognise the infection on time and efficiently treat it. BCG vaccination is a procedure done in Croatia continually with the goal of tuberculosis infection prevention, and the result is that the infection is now successfully under control and almost eradicated. The fact that magnifies the importance of tuberculosis infection in the eyes of public health is that under the lead of World Health Organization a new strategy of tuberculosis infection prevention was launched and its' goal is to lower the number of new patients by 90% until 2035. as opposed to 2015.

• Keywords: M. tuberculosis; BCG; HIV; anti-TNF α; farmakorezistencija
• Keywords (english): M. tuberculosis; BCG; HIV; anti-TNF α; drug resistance
• Language: croatian
• URN:NBN: urn:nbn:hr:105:231416
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2021-08-25 11:05:00