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Webinar Presentation of DR Jose "Pepe" Caminero On Scientific Highlights of 47th Union World Conf On Lung Health in Liverpool UK
Webinar Presentation of DR Jose "Pepe" Caminero On Scientific Highlights of 47th Union World Conf On Lung Health in Liverpool UK
Extensively-drug-resistance TB (XDR-TB)
MDR-TB plus resistance to any Fluoroquinolone and, at least, one
second line drug injectable (kanamycin, amikacin and capreomycin),
the two best second line drugs available
- 50.000 new cases yearly and 30.000 deaths
DR-TB control
Coming soon
Xpert for HIV-1 Viral Load
(< 2houres, until 400 resulta/day)
GeneXpert Omni (point of care, smalles,
mobile, low consume, aso for HPV, HCV,
ebola. )
Xpert MTB/Rif Ultra (more sensitive,
to liquid culture)
Xpert XDR (in a bear future)
similar
GeneXpert Omni
Available in 2016
Price $2,895
Cepheid C360
(Remote Expert)
RemoteXpert
for Robust Data Management
Real-time communications
Automated remote data
collection
Accelerates clinical
decision-making and patient
management
System-wide data surveillance
11
Cepheid. Confidential
Target
85 minutes following 15 minute
incubation
<2 mins
Sputum, induced sputum, sediment
MTBC (IS6110, IS1081), RIF (rpoB)
MTB Complex
98% (Smear+, Culture+)
90% (Smear-, Culture+)
95%
98%
98%
Not needed, users can use existing
instrumentation
TUBERCULOSI S DI AGNOSTI CS
WHO
RECOMMENDATIONS
ON THE USE OF THE SL-LPA
WHO
rifampicin-resistant
or MDR-TB patients, including
W
HO
RECOMMENDATIONS
RECOMMENDAT
IONSof the smear
adults and children
(irrespective
ON THE USE OF THE SL-LPA
ON THE USE OF THE SL-LPA
status).
S
For second-line injectable results, resistance
conferring mutations detected by SL-LPA are highly
A AT COUNTRYLEVEL
correlated
with
culture-based
phenotypic
resistance.
For fluoroquinolones, resistance confirming
mutations detected by SL-LPA are better correlated
with culture-based phenotypic resistance to
ofloxacin/levofloxacin
in
comparison
to
moxifloxacin; inclusion of moxifloxacin in a
rifampicin-resistant or MDR-TB regimen is
therefore best guided by phenotypic testing.
http:/ /www.who.int/tb/areas-of-work/ laboratory/ policy_statements
POLICYRECOMMENDATION
CONDITIONS
appropriate
laboratory
uipment must be available,
y biosafety precautions and
ontamination:
specimen
re and manipulation of
ntainment laboratories with
safety cabinets. Laboratory
re at least three separate
for DNA extraction, preres, and amplification and
cedures. Restricted access
results
pattern
http:/ / www.who.int/tb/areas-of-work/laboratory/policy_statements
POLICYRECOMMENDATION
CONDITIONS
Assay
results
pattern
WHO
POLICYRECOMMENDATION
CONDITIONS
results
pattern
http:/ / www.who.int/tb/areas-of-work/laboratory/policy_statements
POLICYRECOMMENDATION
CONDITIONS
Assay
results
pattern
TB in
on on
under
enefit
dwide;
sening
riately
mized
n the
ective
/tb
THE SHORTER
MDR-TB REGIMEN
REGIMENCOMPOSITION
4-6 Km-Mfx-Pto-Cfz-Z-H
-E / 5 Mfx-Cfz-Z-E
Km=Kanamycin; Mfx=Moxifloxacin;
Km=Kanamycin; Mfx=M
Pto=Prothionamide; Cfz
Pto=Prothionamide; Cfz=Clofazimine;
Z=Pyrazinamide; Hhigh-do
Z=Pyrazinamide; H
=high-dose Isoniazid;
E=Ethambutol
Conventional MDR-TB
regimen
% (95% CI)
% (95% CI)
1008/1116
90.3% (87.8%
92.4%)
4033/5850
78.3% (71.2%
84%)
19/28
67.9% (47.6%
84.1%)
81/137
59.1% (50.6%
67.1%)
90/100
88.8% (47.3%
98.6%)
840/1075
81.4% (71.6%
88.4%)
12/15
80.0% (50.0%
94.1%)
72/120
64.4% (49.6%
76.9%)
121/125
96.8% (77.3%
890/1119
83.5% (75.7%
LINEZOLID
BEDAQUILINE
DELAMANID
2.
GeneXpert
1.
2.
LPA for SLD Important support to identify XDR-TB and adequate treatment
2. Treatment
1.
2.