[Emergence extensive drug resistance tuberculosis (XDR)]. / XDR (extensive resistance)-Tuberkulose.

Multi-drug resistant tuberculosis (MDR-Tb), caused by Mycobacterium tuberculosis, is long known, and it is defined to be resistant to both isonizid and rifampicin with or without resistance to other drugs. In addition to MDR-Tb, XDR-Tb (extensively drug-resistant tuberculosis) is resistant to any fluoroquinolone, and at least one of three injectable drugs, in addition to MDR-Tb. For some years these highly resistant Tb have been isolated world wide, which was named XDR 2006. Once no reliable therapy is available, the best way to prevent XDR-Tb is to ensure the efficacy of national TB control programs. The treatment must be in accordance with the results of drug susceptibility testing. Further, there is an urgent need to develop new Tb drugs. However, treatment is made difficult due to specific characteristics of Tb, e. g. the presences of metabolically silent, persistent or dormant bacteria within host lesions, which are not susceptible to antimycobacterial drugs, and its capability to rapidly develop drug resistance. This article informs about the current threat of the emerging XDR-Tb and summarizes possible options to curb with this phenomenon.

[Asthma, alveolitis, aspergillosis, berylliosis. What to do when there is allergic reaction of the lung?]. / Asthma, Alveolitis, Aspergillose, Berylliose. Was tun, wenn die Lunge allergisch reagiert?

Among the major allergic pulmonary disorders are bronchial asthma, extrinsic allergic alveolitis, allergic aspergillosis and berylliosis. Asthma is diagnosed on the basis of clinical symptoms (wheezing, respiratory distress, tight chest, coughing) and lung function tests possibly supplemented by allergic and provocative testing. Asthma treatment is differentiated into long-term medication and as-required medication. Specific immunotherapy is considered the sole causal therapy. Extrinsic allergic alveolitis is work- or hobby-related (farmer's/cheese worker's/bird-fancier's lung) and manifests as diffuse pneumonitis with dyspnea, coughing and fever. For the diagnosis, the antigen provocative test in particular plays a major role. In the main, treatment comprises strict avoidance of allergens. The diagnosis of allergic pulmonary aspergillosis is based on the history, clinical findings, skin tests, serology and radiography. Treatment is stage-related by means of immunosuppressive agents. In terms of radiographic and pulmonary function findings, berylliosis is similar to sarcoidosis. Here, too, immunosuppressive agents are to the fore.