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The IUATLD and tobacco prevention
Abstracts
below 100. Clinical research is evaluating various treatment protocols including rifabutin, clarithromycin, and azithromycin for prophylaxis and therapy of these infections. Other pathogens have emerged associated with HIV, including M. genavense, M. haemophilum, and M. kansasii. Diagnosis in therapy of these infections has remained a clinical challenge. In non-HIV infected patients, extrapulmonary disease is a definite but less important problem. Rapidly growing mycobacteria (M. fortuitum, M. chelonae, and 3/. abscessus) as well as M. marinum are responsible for a significant number of skin and soft tissue infections, usually following local trauma. These mycobacteria may also be associated with disseminated infection, usually in the setting of immunosuppression, catheter-related infections, and post-surgical infections. Nosocomial infections have occurred usually related to the use of contaminated water, and have resulted in surgical wound infections primarily following augmentation mammaplasty and cardiac surgery. Drug therapy has focused on the newer quinolones and macrolides, important agents which have greatly enhanced clinical therapy. Thus despite the dramatic increase in disease due to tuberculosis, the NTM remain a diagnostic and therapeutic challenge that will continue to be a problem as the HIV epidemic continues its spread around the world.
5
It is against this rather uncertain background but encouraging future prospects for those affected, both the immunocompetent and the immunodeficient, that we have to examine a plethora of mycobacteriosis and its possible management in absence of 'standard' treatments. There are many 'recommendations' on either side of the Atlantic as also elsewhere on the management of mycobacteriosis. These can best be reviewed and examined through grouping of these infections according to their observed unique responses to treatment: 1. Those infections (like M. kansasii and M. xenopi) which even if not as responsive as M. tb disease to similar treatment do so with some consistency. 2. The rapid growers, mainly the M. fortuitum-Complex, which, with a different therapeutic approach giving variable but a reasonably favourable response. 3. Frustrating treatment of M. avium Complex infections in the immunocompetent lately somewhat improving because of lessons learnt from its management in immunodeficient patients. 4. Management of mycobacteriosis (in particular disseminated MAC) affecting the AIDS patients. 5. New, emerging or unusual mycobacterial infections and their unique individually differing treatments.
The IUATLD and tobacco prevention Management of mycobacteriosis
Billo, N.E. IUATLD, Paris, France
Patel, A.M. Specialised Health Services 63 George Street, Brisbane, Queensland, Australia
The next century will experience an epidemic of disease and death caused by tobacco, especially in developing countries, if we are not able to implement comprehensive tobacco prevention programmes in these countries. Tobacco prevention activities in industrialized countries show that it is possible to reduce the burden of tobacco related morbidity and mortality. The strategy of IUATLD to combat the tobacco epidemic will consist of 1) close collaboration with other organizations devoted to tobacco prevention activities within the International Non-Governmental Coalition Against Tobacco, 2) raising awareness among medical students, physicians and the general population through publications, 3) production and distribution of educational material for developing countries, 4) elaboration of a model tobacco prevention programme for low income countries, 5) assisting constituent members of IUATLD to develop advocacy activities to reduce the influence of the tobacco industry, 6) stimulating collaboration between members of IUATLD in all matters related to tobacco prevention.
Decades of progressive understanding and successful management of tuberculosis are not matched by our knowledge of the pathogenic role of the environmental mycobacteria and their management, both being limited. Depending on, and drawing analogy from our knowledge of M. tb infections, we have attempted models of diagnosis and treatment of these infections without notable success. Recently however, largely through the much stimulated work in the area of AIDS and mycobacteriosis, in particular Mycobacterium avium Complex (MAC), our understanding of the interaction between the host and these mycobacteria has given us reasons for early optimism. Better insight into the natural history of mycobacteriosis has further clarified its pathogenicity and enabled us to set clearer goals of treatment. New detection systems have increased speed and accuracy of diagnosis and non-traditional approach to the in vitro susceptibility testing has at least stimulated many hypotheses even if some of these are controversial. All this has not necessarily resulted in identifiable treatment modalities approaching the well established and efficient 'standard regimens' for the treatment of M. tb disease. However, the recent surge of research and activities and in particular the recent spurt of new pharmacological agents claiming effectiveness against MAC, has given us weapons of potential usefulness in spite of the lack of adequate and controlled trials.
11 S e p t e m b e r
1995
Interaction HIV/TB De Cock, K.M. LSHTM, London, UK
WHO estimates that there are 5.6 million people world-
below 100. Clinical research is evaluating various treatment protocols including rifabutin, clarithromycin, and azithromycin for prophylaxis and therapy of these infections. Other pathogens have emerged associated with HIV, including M. genavense, M. haemophilum, and M. kansasii. Diagnosis in therapy of these infections has remained a clinical challenge. In non-HIV infected patients, extrapulmonary disease is a definite but less important problem. Rapidly growing mycobacteria (M. fortuitum, M. chelonae, and 3/. abscessus) as well as M. marinum are responsible for a significant number of skin and soft tissue infections, usually following local trauma. These mycobacteria may also be associated with disseminated infection, usually in the setting of immunosuppression, catheter-related infections, and post-surgical infections. Nosocomial infections have occurred usually related to the use of contaminated water, and have resulted in surgical wound infections primarily following augmentation mammaplasty and cardiac surgery. Drug therapy has focused on the newer quinolones and macrolides, important agents which have greatly enhanced clinical therapy. Thus despite the dramatic increase in disease due to tuberculosis, the NTM remain a diagnostic and therapeutic challenge that will continue to be a problem as the HIV epidemic continues its spread around the world.
5
It is against this rather uncertain background but encouraging future prospects for those affected, both the immunocompetent and the immunodeficient, that we have to examine a plethora of mycobacteriosis and its possible management in absence of 'standard' treatments. There are many 'recommendations' on either side of the Atlantic as also elsewhere on the management of mycobacteriosis. These can best be reviewed and examined through grouping of these infections according to their observed unique responses to treatment: 1. Those infections (like M. kansasii and M. xenopi) which even if not as responsive as M. tb disease to similar treatment do so with some consistency. 2. The rapid growers, mainly the M. fortuitum-Complex, which, with a different therapeutic approach giving variable but a reasonably favourable response. 3. Frustrating treatment of M. avium Complex infections in the immunocompetent lately somewhat improving because of lessons learnt from its management in immunodeficient patients. 4. Management of mycobacteriosis (in particular disseminated MAC) affecting the AIDS patients. 5. New, emerging or unusual mycobacterial infections and their unique individually differing treatments.
The IUATLD and tobacco prevention Management of mycobacteriosis
Billo, N.E. IUATLD, Paris, France
Patel, A.M. Specialised Health Services 63 George Street, Brisbane, Queensland, Australia
The next century will experience an epidemic of disease and death caused by tobacco, especially in developing countries, if we are not able to implement comprehensive tobacco prevention programmes in these countries. Tobacco prevention activities in industrialized countries show that it is possible to reduce the burden of tobacco related morbidity and mortality. The strategy of IUATLD to combat the tobacco epidemic will consist of 1) close collaboration with other organizations devoted to tobacco prevention activities within the International Non-Governmental Coalition Against Tobacco, 2) raising awareness among medical students, physicians and the general population through publications, 3) production and distribution of educational material for developing countries, 4) elaboration of a model tobacco prevention programme for low income countries, 5) assisting constituent members of IUATLD to develop advocacy activities to reduce the influence of the tobacco industry, 6) stimulating collaboration between members of IUATLD in all matters related to tobacco prevention.
Decades of progressive understanding and successful management of tuberculosis are not matched by our knowledge of the pathogenic role of the environmental mycobacteria and their management, both being limited. Depending on, and drawing analogy from our knowledge of M. tb infections, we have attempted models of diagnosis and treatment of these infections without notable success. Recently however, largely through the much stimulated work in the area of AIDS and mycobacteriosis, in particular Mycobacterium avium Complex (MAC), our understanding of the interaction between the host and these mycobacteria has given us reasons for early optimism. Better insight into the natural history of mycobacteriosis has further clarified its pathogenicity and enabled us to set clearer goals of treatment. New detection systems have increased speed and accuracy of diagnosis and non-traditional approach to the in vitro susceptibility testing has at least stimulated many hypotheses even if some of these are controversial. All this has not necessarily resulted in identifiable treatment modalities approaching the well established and efficient 'standard regimens' for the treatment of M. tb disease. However, the recent surge of research and activities and in particular the recent spurt of new pharmacological agents claiming effectiveness against MAC, has given us weapons of potential usefulness in spite of the lack of adequate and controlled trials.
11 S e p t e m b e r
1995
Interaction HIV/TB De Cock, K.M. LSHTM, London, UK
WHO estimates that there are 5.6 million people world-