Çoklu İlaca ve Yaygın İlaca Dirençli Tüberküloz İçin Hızlı Tanı Yöntemleri

Çok ilaca dirençli tüberküloz (ÇİD-TB) M.tuberculosis complex (MTBC) izolatlarının birinci seçenek ilaçlardanhem izoniyazid INH) hem de rifampisine (RIF) dirençli olmasıdır. Yaygın ilaca dirençli tüberküloz (YİD-TB) iseÇİD-TBye ek olarak izolatların herhangi bir kinolon grubu antibiyotiğe ve en az bir parenteral kullanılan ikinci se- çenek ilaca (kapreomisin, kanamisin, amikasin) karşı dirençli olduğu zaman gelişir. ÇİD- ve YİD-TB tüm dünyada önemli bir sağlık sorunudur. MTBC izolatlarının anti-TB ilaç duyarlılıklarının saptan- ması için pek çok yöntem geliştirilmiştir. Middlebrook 7H10 ve 7H11 besiyerleri kullanılarak yapılan agar propor- siyon yöntemi, CLSI tarafından önerilen referans bir yöntemdir. Ancak bu yöntem hızlı tanı yöntemi değildir. ÇİDve YİD olgularının erken tanısı ve sağlıklı bireylere bulaşın engelenmesi için hızlı, güvenilir ve pratik standardizeanti-TB ilaç duyarlılık test yöntemlerine ihtiyaç vardır. Bu derlemede, ÇİD- ve YİD-TB tanısında kullanılabilen fenotipik testler içerisinde yer alan sıvı kültür yöntemlerin- den BACTEC 460 TB, BACTEC MGIT 960 Sistemi, MB/BacT ALERT 3D Sistemi (MB/BacT) (Organon Teknika,Boxtel, Netherlands), Versa TREK (E SP II), katı kültür yöntemlerinden E-test yöntemi ve moleküler direnç yöntem- leri (Real time PCR (Gen expert ), revers hibridizasyon testi (line probe yöntemi, DNA dizi analizi ) gibi hızlı ticariyöntemler tartışılmıştır.

Rapid Diagnostic Methods For Multidrug- And Extensively Drug-Resistant Tuberculosis

Multi drug- resistant tuberculosis (MDR-TB) means that M.tuberculosis complex (MTBC) isolates are resistant toboth of the first-line drugs rifampin (RIF) and isoniazid (INH). Extensively drug- resistant TB (XDR-TB) developwhen isolates are resistant to an antibiotic of quinolone group and at least one parenterally used second-line drug(capreomycin, kanamycin, amikacin) in addition to MDR-TB.MDR- and XDR-TB are a major health problem worldwide. It has been developed many methods for detecting anti- TB drug susceptibilities of MTBC isolates. The agar proportion method using Middlebrook 7H10 and 7H11 media isthe reference method recommended by CLSI. But, it is not a rapid diagnostic method. The rapid, reliable and practicalstandardised methods for anti-TB drug susceptibility tests are needed for early diagnosis of MDR and XDR cases andto prevent transmission to healthy individuals. In this review, it was discussed rapid commercial techniques used in diagnosis of MDR- and XDR-TB that are liquidculture systems such as BACTEC 460TB, BACTEC-MGIT 960 system, MB/BacT ALERT 3D system (MB/BacT)(Organon Teknika, Boxtel, Netherlands), Versa TREK (formerly ESP culture system II), solid culture method such asE-test among phenotypic tests, and molecular tests such as real-time PCR (GeneXpert), reverse-hybridization-basedassays (line probe assay, DNA sequence analysis).

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