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결핵 진료지침 초 안 - lungkorea.org

Clinical Practice Guideline for Tuberculosis . ( ).. 2011. 2.. (WHO) . 1/3 2008 937 . 2009. 36,000 OECD .. 2005 4 .. , .. 1.. 2010 2.. , , , , , , . , .. 2.. , , , , .. 3.. 28 .. Appraisal of Guidelines, Research and Evaluation (AGREE) . 7 . 1. ( , 2005). 2. ( , 2010). 3. Treatment of tuberculosis (ATS, 2003). 4. Canadian tuberculosis standard (2007). 5. NICE guideline (Clinical diagnosis and management of tuberculosis, 2006 ).. 6. Treatment of tuberculosis (WHO, 2009). 7. International standard for tuberculosis care (TBCTA, 2006).. (adaptation) . 4.. (quality of evidence) . (strength of the recommendation) .. (ATS) . ( 3) (Infectious Diseases Society of America: IDSA) .. (Quality of evidence supporting the recommendation).

결핵 진료지침 초 안 월 결핵및호흡기학회, 감염학회, 소아감염병학회, 진단검사의학회, 흉부영상의학회, 질병관리본부, 결핵

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Transcription of 결핵 진료지침 초 안 - lungkorea.org

1 Clinical Practice Guideline for Tuberculosis . ( ).. 2011. 2.. (WHO) . 1/3 2008 937 . 2009. 36,000 OECD .. 2005 4 .. , .. 1.. 2010 2.. , , , , , , . , .. 2.. , , , , .. 3.. 28 .. Appraisal of Guidelines, Research and Evaluation (AGREE) . 7 . 1. ( , 2005). 2. ( , 2010). 3. Treatment of tuberculosis (ATS, 2003). 4. Canadian tuberculosis standard (2007). 5. NICE guideline (Clinical diagnosis and management of tuberculosis, 2006 ).. 6. Treatment of tuberculosis (WHO, 2009). 7. International standard for tuberculosis care (TBCTA, 2006).. (adaptation) . 4.. (quality of evidence) . (strength of the recommendation) .. (ATS) . ( 3) (Infectious Diseases Society of America: IDSA) .. (Quality of evidence supporting the recommendation).

2 I.. (At least one properly randomized trial with clinical end point). II.. (Clinical trials that either are not randomized or were conducted in other populations). III. (Expert opinion). (Strength of recommendation). A. (Preferred: should generally be offered). B. (Alternative: acceptable to offer). C.. (Offer when preferred or alternative regimens cannot be given). D. (Should generally not be offered). E. (Should never be offered). 5.. 6.. 7 ( , , , . , , , ), .. 7.. , , .. , .. , , .. , , .. 5 ( , 2009) .. 8.. ( , , , . ), ( , , , ) . , .. 9.. , ( ( )) .. 10.. (Directly observed therapy: DOT), . (intermittent therapy), (fixed dose drug combination) .. 2014 . 2014 . 11.. 2010 .. , , .. 2011 2 .. : ( ).. ( ) ( ).

3 ( ) ( ). ( ) ( ). ( ) ( ). ( ) ( ). ( ). ( ). ( ). ( ). ( ). ( ). ( ). ( ). ( ) ( ).. ( ) ( ). ( ) ( ).. ( ) ( ). ( ) ( ). ( ) ( ). ( ) ( ). ( ) ( ). ( ).. ( ) .. ( ) .. ( ) ( ).. ( ). ( ). ( ).. ( ). ( ).. ( ) ( ).. ( ). ( ).. (list of abbreviation).. (Isoniazid: INH, H). (Rifampin: RIF, R). (Ethambutol: EMB, E). (Pyrazinamide: PZA, Z). (Streptomycin :S). (Kanamycin: Km). (Amikacin: Amk). (Cycloserine: Cs). (Prothionamide: Pto). (p-aminosalicylic acid: PAS). (Levofloxacin: Lfx). (Moxifloxacin: Mfx). (Ofloxacin: Ofx).. (Rifabutin: Rfb). (Capeomycin: CPM). (Linezolid: Lzd).. (Immune Reconstitution Inflammatory syndrome: IRIS). (Nontuberculous mycobacterium: NTM). (Human immunodeficicency virus: HIV). (Inteferon-gamma releasing assay: IGRA).

4 (Latent tuberculosis infection: LTBI). (Tuberculin skin test: TST). (antiretroviral therapy: ART). Adenosine deaminase (ADA). Private-public mix (PPM).. I.. 1.. 2. X- . 3.. 1. 4. 5. 7. 7. 9. 10.. 12. 12. ( ) 13. 4. 14. 5. 15. 15. 16. 17. 17.. 6. 18. 19. 19. II. 21. 1. 24. 2. 32. 3. 33. 4. 35. 35. 36.. 5.. 38. 38. 39. III. 43. 1. 46. 46.. 47. 2. 49. 3. 50. 4. 53. IV. 57. 1. 60. 2. 61. 3. 63.. V. (HIV) 65. 1. HIV 69. 69. 69. 70. 71. 2. HIV 73. 74. 74. VI. 77. 1.. 2.. 3.. 4.. 80. 82. 85. 87. 5. 89. 6. 91. 7. 93.. 8. 93. 9. 95. 10. 96. VII. 99. 1. 102. 2. 104. 3. 108. 4. 114. 5. 122.. VIII. 129. 1. 132. 2. 133. 3. 138. 4. 142. 5. TNF 147. IX. 153. 1. 156. 2. 156. 3. : - (PPM) 162. 4.. 1.. 164. 169. 172. 2. 181. 3.

5 186. 4. 190.. I.. Clinical Practice Guideline for Tuberculosis . I.. 1. 4. 2. X- 5. 3. 7. 7. 9.. ( ). 10. 12. 12. 13. 4. 14. 5. 15. 15. 16.. 17. 17. 6. 18. 19. 19.. 3.. I.. , .. X- , , , . , .. 1.. 2-3 .. (IIIA). , . (IIIA).. , , . , , .1 , ..2 , 2-3 ..3 , .. 4.. References 1. Achkar JM, Sherpa T, Cohen HW, Holzman RS. Differences in clinical presentation among persons with pulmonary tuberculosis: a comparison of documented and undocumented foreign-born versus US-born persons. Clin Infect Dis 2008;47:1277-83. 2. Brandli O. The clinical presentation of tuberculosis. Respiration 1998;65:97-105. 3. Lawson L, Yassin MA, Thacher TD, Olatunji OO, Lawson JO, Akingbogun TI, et al. Clinical presentation of adults with pulmonary tuberculosis with and without HIV infection in Nigeria.

6 Scand J Infect Dis 2008;40:30-5. 2. X- .. X- X- . (IA). X- X- . (IIA). X- . (IIIA).. X- . X- . , .. (inter-observer inconsistency) 25% . 3 (intra-observer inconsistency) 20% .. X- . X- (primary tuberculosis) (post-primary tuberculosis) ..1 , .. (reactivation tuberculosis) .. 5.. , ..2 .. X- . , . , , X- ..3,4 1/3 . , X- . X- .. X- . X- .. X- X- .. X- ( . ) X- .. (IIIA). 6 X- . References . 1. Jeong YJ, Lee KS. Pulmonary tuberculosis: up-to-date imaging and management. AJR Am J. Roentgenol 2008;191:834-44. 2. Lee KS, Hwang JW, Chung MP, Kim H, Kwon OJ. Utility of CT in the evaluation of pulmonary tuberculosis in patients without AIDS. Chest 1996;110:977-84. 3. Korean Center for Disease Control and Prevention.

7 Guidelines for the control of tuberculosis 2005. Seoul 2005. 4. Long R, Ellis E. Introducing the sixth edition of the Canadian Tuberculosis Standards. Can J. Infect Dis Med Microbiol 2007;18:283-4. 6 .. 3.. 1.. 3 . (IA). , 24 (IIIA). (Mycobacterium tuberculosis) . (acid fast bacilli: AFB) . Carbolfuchsin .. Carbolfuchsin Ziehl-Neelsen (ZN) 1,000 .. auramine O rhodamine 250 450 .. ZN 10% .. 25-80% ..1-3. 83-87% 10-12% . 3-5% .4 3 ( . , 1 ) .. , .. , .. (induced sputum) , . ( ). 24 .. (WHO) (CDC) .. 7.. 10% ..5 .. 1. (WHO). (No. of bacilli observed). Carbolfuchsin Fluorochrome stain* . stains (1,000x) 250x 450x 630x 0 / 100F No AFB seen 0 0 0. (No AFB per 100 fields). 1-9 / 100F Report exact count (number per 100 fields).

8 10-99 / 100F. 1-9 / F. >9 / F. Divide observed count by 10.. Divide observed count by 4. Divide observed count by 2. 1+. 2+. 3+. 2. (US CDC/CLSI). (No. of bacilli observed). Carbolfuchsin Fluorochrome stain* . stains (1,000x) 250x 450x . 0 / 300F 0 0 No AFB seen 1-2/ 300F 1-2 / 30F 1-2 / 70F Doubtful Repeat test (Trace). 1-9 / 100F 1-9 / 10F 2-18 / 50F Rare (1+). 1-9 / 10F 1-9 / F 4-36 / 10F Few (2+). 1-9 / F 10-90 / F 4-36 / F Moderate (3+). >9 / F >90 / F >36 / F Numerous (4+). 8 .. 2.. (IA). (IIB).. (IIIA)..6 , . 1) , 2) , 3) .. , .. , .. , .. , , , , ..7 .. Ogawa Lowenstein-Jensen Middlebrook 7H10 .. , 3-8 .. BACTEC MGIT960 (BD) BacT/ALERT. (bioMerieux) . 2 . , .. 15% .. , .. 9.. 6 . References 1. Boyd JC, Marr JJ.

9 Decreasing reliability of acid-fast smear techniques for detection of tuberculosis. Ann Intern Med 1975;82:489-92. 2. Kim TC, Blackman RS, Heatwole KM, Kim T, Rochester DF. Acid-fast bacilli in sputum smears of patients with pulmonary tuberculosis. Prevalence and significance of negative smears pretreatment and positive smears post-treatment. Am Rev Respir Dis 1984;129:264-8. 3. Gordin F, Slutkin G. The validity of acid-fast smears in the diagnosis of pulmonary tuberculosis. Arch Pathol Lab Med 1990;114:1025-7. 4. 5.. Harries A. What is the additional yield from repeated sputum examinations by microscopy and culture? In: Frieden TR, editor. Toman's tuberculosis. Case detection, treatment and monitoring 2nd ed: World Health Organization; 2004.

10 Koh WJ, Yu CM, Suh GY, Chung MP, Kim H, Kwon OJ, et al. Pulmonary TB and NTM lung disease: comparison of characteristics in patients with AFB smear-positive sputum. Int J. Tuberc Lung Dis 2006;10:1001-7. 6. Long R, Ellis E. Introducing the sixth edition of the Canadian Tuberculosis Standards. Can J. Infect Dis Med Microbiol 2007;18:283-4.. 7. Public Health Agency of Canada, and the Canadian Lung Association/Canadian Thoracic Society. Canadian Tuberculosis Standards. 6th edition. 2007. 3.. 3 (IIIB).. (IIIA). (DNA) (polymerase chain 10 .. reaction: PCR) .. , , ..1 .. 3 .. , 90-100% , ..2 , . , ..1. , .. ( . ).. , , ..3. , (indeterminate) .. (kit) , FDA . , .. , ..1.. 11.. References 1. Public Health Agency of Canada, and the Canadian Lung Association/Canadian Thoracic Society.