320 Ch 319. Tuberculosis (Pulmonary)

TB 全球 #1 infectious cause of death from single pathogen (~ 1.5 million deaths/yr)；台灣 TB incidence ~ 35-40 / 100,000（中等流行）；Mycobacterium tuberculosis 經 aerosol 傳播；phases：(1) primary infection；(2) latent TB infection (LTBI) — 25% global infected；(3) active TB — 5-10% LTBI 進展至 active；HIV ↑ progression 100×；diagnosis：IGRA (QFT, T-SPOT) > TST in vaccinated；active TB = AFB smear + culture + NAAT (Xpert MTB/RIF + RIF resistance)；4-drug regimen：RIPE (Rifampin + Isoniazid + Pyrazinamide + Ethambutol) × 2 months → RI × 4 months（共 6 月）；MDR-TB / XDR-TB (resistant to INH + RIF 至少)：bedaquiline + pretomanid + linezolid (BPaL, Nix-TB + ZeNix 2022) = 6 months 治療突破，取代過去 18-24 month 4-7 drug regimens；latent TB：3HP (rifapentine + isoniazid weekly × 12 weeks) 是 preferred；台灣 TB Control Program + DOTS (directly observed therapy) + 全民健保支援；HIV co-infection 需 ART + TB 同治療；TB + DM, CKD, biologics (TNF-α inhibitor) 為 risk factors。