台灣結核防治：回顧過去，立足現在與展望未來

A Survey on Tuberculosis: Recall the Past, Gauge the Present, and Look into the Future

結核病是個歷史悠久的疾病，即便在發現病原菌，發明抗結核藥物，發展新的診斷工具後，結核在今日仍是影響著全世界眾多人口的傳染病，而愛滋病人口增加以及多重抗藥性的問題讓今日的人類在面對這個古老的敵人，並不比先人輕鬆。結核分枝桿菌經由空氣傳播，在陰暗的環境可以存活許久，等待下一次傳染的機會，維持結核不易生存的環境可以降低感染的機會。卡介苗主要是降低感染後疾病惡化的可能性，目前尚沒有能提供完全保護的疫苗。找出具有傳染性的病人給予有效的治療，是降低盛行率的最有效方法，適當的痰液檢體塗片與培養，搭配影像工具是診斷活動性結核的主要方法，然而非結核分枝桿菌的盛行率增加的確增加臨床上正確診斷的困難度，然後相對多的藥物，相對高的副作用機率與相對長的治療時間，讓診斷後的完治變成一件困難的挑戰，都治計畫是幫助醫師治療病人的利器，可以提升病人的服藥順從性與降低抗藥性的產生，正確的防護與適度的隔離也是避免醫護人員在照護病人時被傳染或是病人再傳染給別人很重要的關鍵。當上述措施都已臻完美，找出潛伏性結核的病人並治療，是邁向根除結核病的方法下一步。

Historically, tuberculosis is an important disease that continues to affect large populations in spite of having identified the causative pathogen, discovering anti-tuberculosis drugs, and developing new diagnostic tools. Increasing acquired immune deficiency syndrome (AIDS) -associated tuberculosis and resistance to multiple anti-tuberculosis drugs have aggravated the scenario. As is known, Mycobacterium tuberculosis causes air-borne infections. BCG decreases the rate of progression to lethal tuberculosis but prevents all infections. The most effective strategy to decrease the prevalence of tuberculosis and cure the infected patients is to quarantine the latter. Accurate diagnosis of active tuberculosis depends on correct sputum collection, acid-fast stain, and culture accompanied by imaging. Unfortunately, increasing prevalence of non-tuberculosis mycobacteria confounds clinical judgment. Moreover, curing patients with tuberculosis is challenging owing to the number of medications that need to be taken for a long duration, and the frequent adverse effects caused by these medications. Directly Observed Treatment Short (DOTS) is effective in improving drug compliance of the patient and decreasing the development of drug resistance. However, it is important to bear in mind that preventive measures are also necessary. Seeking, elucidating, and curing the latent form of tuberculosis will be the next step to eradicating the disease.