Table of Content

14 September 2015, Volume 4 Issue 3

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Original Articles

The feature analysis of multi-slice spiral computer tomography and X-ray for 37 hematogeneous disseminated tuberculosis

WANG Yun-ling, DENG Jia-min, ZHAO Li-Ping, LIU Ying, JIA Wen-Xiao, WU Jian-lin

Journal of Tuberculosis and Lung Health. 2015, 4(3):  153-156.  doi:10.3969/j.issn.2095-3755.2015.03.002

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Objective To explore the clinical diagnosis value of multi-slice spiral computer tomography (MSCT) on the hematogeneous disseminated tuberculosis.Methods All 37 patients including 18 males and 19 females confirmed by smear, biopsy and diagnostic treatment were collected from department of Radiology in the Second Affiliated Hospital of Xinjiang Medical University from 2013—2015. All cases were checked by chest plain film and CT scanning with MSCT.Results Among 37 patients, 13 cases showed typical signs of the acute military pulmonary tuberculosis in plain film, a lot of fine, pin-point mottling opacities, and with same size, the same dentisy and homogeneous distribution. 6 cases showed enlargement of hilar lymph nodes or mediastinal lymph nodes. 12 cases showed clumped nodular and linear areas of increased opacity nonuniform distribution.8 cases showed calcifications in the lesions.4 cases only showed lungs transparency degree reducing. Twenty-nine cases among 37 patients showed typical signs of the acute military pulmonary tuberculosis in MSCT, pin-point mottling opacities, and with same size, the same density and homogeneous distribution. 6 cases with nodular edge blur. 21 cases nodules uniform distribution, is located in the center of lobular, bronchial blood vessel bundle, interlobular septa, and subpleural.5 cases showed both lungs were studded with nodular shadows, the shadows are not uniform in size, in density and in distribution. 3 cases interlobular septal thickening and lobular reticular opacities, both lungs showed “tree-in-bud” in random distribution with edge blur. CT scanning diagnosis rate was 86.5% (32/37), X-ray diagnosis rate was 35.1% (13／37). The difference is statistically significant (χ²＝13.46,P=0.031).Conclusion MSCT has a high value for clinical diagnosis of the Hematogenous disseminated pulmonary tuberculosis than the chest X-ray.

Comparison study of CT features between cavitary tuberculosis and peripheral lung cancer with cavity formation

XIONG Jing-tong, WU Hao, SHEN Jing, WU Jian-lin, ZHANG Guan-nan, ZHANG Guo-qing, GE Ying

Journal of Tuberculosis and Lung Health. 2015, 4(3):  157-161.  doi:10.3969/j.issn.2095-3755.2015.03.003

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Objective Retrospective analysis the CT features of cavitary tuberculosis and peripheral lung cancer with cavity formation, to improve the understanding and CT diagnosis of these two diseases.Methods Twenty-two cases of pathology-proved cavitary tuberculosis and 24 cases of pathology-proved peripheral lung cancer with cavity formation were collected from August 2011 to October 2014 by some hospitals in Dalian, all the clinical information and chest CT examination were collected. To analysis the CT features differences between the two groups, independent sample t test and Pearson χ² test were used, P<0.05 was considered statistically significant.Results The mean age of cavitary tuberculosis (43.59±13.16 years) was lower than lung cancer group (62.92±10.21 years) (t=5.591, P<0.001); The right lung was more vulnerable to occur these two diseases than the left lung (number of cases in right lungs/number in left lungs was “14/8” and “15/9” respectively), but not statistically significant (χ²=0.006, P=0.936). The emergence ratios of irregular cavity [41.7% (10/24)], unsmoothed inner wall [62.5%(15/24)], inner wall nodules [45.8% (11/24)], vascular within the lesion [41.7% (10/24)] and lobula-ted sign [20.8% (5/24)] in the lung cancer group were greater than cavitary tuberculosis group [13.6%(3/22), 27.3% (6/22), 18.2% (4/22), 0.0% (0/22) and 0.0% (0/22) respectively] (χ² values were 4.448, 5.741, 6.379, 1.713, 5.124, P<0.05); but the “satellite lesions” sign proportion of cavitary tuberculosis group is greater than the lung cancer group [they were 68.2% (15/22) and 0% (2/24) respectively](χ²=24.282, P<0.001).Conclusion CT features were different between cavitary tuberculosis and peripheral lung cancer with cavity formation, the cavity appearances and “satellite lesions” sign contribute to the differential diagnosis of the two diseases.

CT manifestations analysis of primary pulmonary cryptococcosis in immunocompetent or immunosuppressive patients

WU Chong-chong, ZHAO Shao-hong, NIE Yong-kang, CAI Zu-long, YANG Li, JIN Xin

Journal of Tuberculosis and Lung Health. 2015, 4(3):  162-168.  doi:10.3969/j.issn.2095-3755.2015.03.004

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Objective To analyse CT image features of primary pulmonary cryptococcosis (PPC) in immu-nocompetent or immunosuppressive patients in order to improve its cognitive and diagnostic level.Methods We analyzed retrospectively 43 cases with primary pulmonary cryptococcosis (PPC) from our hospital during February 2008 to February 2015. All the cases were confirmed diagnosis by pathology through surgery or CT-guided percutaneous lung biopsy. CT manifestations of the two groups (immunocompetence and immunosuppression) were analyzed.Results Imaging characteristics on CT were divided into 5 types: (1) solitary nodule／mass in 13 cases, 10 in immunocompetent patients and 3 in immunosuppressive patients respectively;(2)multiple nodules／masses in 15 cases, 10 in immunocompetent patients and 5 in immunosuppressive patients; (3) patchy or solid appearance in 6 cases, 4 in immunocompetent patients and 2 in immunosuppressive patients; (4) mixed type in 7cases,all in immunosuppressive patients; (5) mixed type accompanying with abnormal lymphadenectasis in mediastinum in 2 cases, both in immunocompetent children patients and the lymph nodes showed fusion, and necrosis. 85.3% (29/34) of nodule, mass and patchy solid types appeared unilaterally, 38.2% (13/34) in the upper lobe and 44.1% (15/34) in the lower lobe. Mixed type always be found bilaterally and both in upper and lower lobe the proportion was 77.8% (7/9). There was no significant difference in the lobe distribution of the 5 types. In immunocompetent group, it was mainly periphery distributed of 77.8% (21/27), however, in the immunosuppressive group, it always showed periphery and random distribution of 37.5% (6/16) and 50% (8/16) respectively. Ground glass opacity,hato sign,and air bronchogram were common to see, and the rates were 39.5% (17/43), 41.8% (18/43), 67.4% (29/43) respectively, and the cavity sign was rare (13.9%,6/43). These signs rates found in immunocompetent patients were 38.4% (10/27), 38.4% (10/27), 55.5% (15/27) and were 43.7% (7/16), 50% (8/16), 87.5% (14/16) in immunosuppressive group. Ground glass opacity and hato sign showed no significant difference in the two groups, while bronchogram sign likely occurred in the mmunosuppressive group.Conclusion The CT imaging is diverse in PPC. Lesions in immunocompetent patients show mainly nodule／lump types and peripheral areatus distribution, and show mixed type, prehperal and random distribution in immunosuppressive patients. Mixed type accompanying with abnormal enlargement, fusion, and necrosis of mediastinal lymph nodes in children should be highly concerned about PPC. Ground glass opacity,hato sign,and air bronchogram indicate this disease.

Correlation study of traditional Chinese medicine syndrome differentiation typing and lung computed tomography signs in 58 smear positive retreated tuberculosis patients in the first diagnosis

JI Bin-ying, GUO Chun-hui, XIE Xiao-xia, WANG Xiao-rui, WU Jing, CHE Dao-lin, LIN Hong

Journal of Tuberculosis and Lung Health. 2015, 4(3):  169-173.  doi:10.3969/j.issn.2095-3755.2015.03.005

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Objective To explore the correlation between traditional Chinese medicine (TCM) syndrome differentiation typing and lung computed tomography (CT) signs in smear positive retreated tuberculosis (TB) patients in the first diagnosis.Methods According to TCM syndrome differentiation typing,58 TB patients were divided into Lung Yin deficiency type,type of Yin deficiency and fire hyperactivity and Qi Yin deficiency type.The correlation between TCM syndrome differentiation typing and lung CT signs was analyzed.Results In the 58 cases, 23 were Lung Yin deficiency type, accounted for 39.66%, and the lung CT signs mainly presented exudative process or acini nodular lesions. 19 were the type of Yin deficiency and fire hyperactivity, accounted for 32.76%. The lung diseases shew extensive distribution, and CT signs mainly presented cheese or invasive focus, accompanied cavity focus. Sixteen were Qi Yin deficiency type, accounted for 27.59%, The lung lesions increased gradually, showing repeated damage and repair changes. The lung CT signs presented multiplication and fibrous focus based on cheese, invasive and cavity focus, even appeared collapse and damage of lung.Conclusion There are some correlation and regularity in TCM syndrome differentiation typing and lung CT signs in retreated smear positive pulmonary tuberculosis cases, which has important practical value for objective diagnosis and treatment of TCM syndrome differentiation typing in pulmonary tuberculosis.

Epidemic characteristic and spread trend analysis of human pulmonary tuberculosis in seven counties of Southern Ningxia

ZHU Gui-na, YANG Shu-kun, YIN Yuan-jie, CHEN Dan-dan, WANG Xiao-lin, WANG Li, HOU Huai-zhe, JING Yong-feng,WANG Ping, Magda Ellis,Donald,P. McManus, YANG Yu-rong

Journal of Tuberculosis and Lung Health. 2015, 4(3):  174-178.  doi:10.3969/j.issn.2095-3755.2015.03.006

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Objective The aim of this study was to understand the TB epidemic features and transmission situation through investigations of clinical records and case follow-up, in order to provide reliable references for the sustainable control policy development.Methods We retrospectively investigated the clinical records of 2931 TB cases in 2008 and 2009 registered in seven high-epidemic counties of Ningxia, and their demographic and clinical information were collected. We also followed-up the 965 cases of TB patients still under active TB treatment in 2010, collected their demographic and clinical information, as well as clinical and laboratory results. All the collected data were input into SPSS for the further analysis. The transmission risks were estimated according to delay days of TB confirmative diagnosis after symptom onset. The Chi-square test was used to compare the different rates between groups. 95% confidential limits at P<0.05 were set as the significant cutoff.Results Data analysis showed that in 2008 the male patients accounted for 58.01% (851/1467), and female accounted for 41.99% (616/1467); and in 2009 the male patients accounted for 59.02% (864/1464), and female accounted for 40.98% (600/1464); in 2010 followed up patients, male accounted for 54.61% (527/965) and female for 45.39% (438/965). The proportion of Muslim patients had a large change, in 2008, the Muslim patients accounted 1/5 of Han patients (Muslim 205 cases, Han 1262), and none in Haiyuan, Pengyang, Xiji county; in 2009 the number of Muslim patient to Han patients was close to 1∶1 (Muslim 744 cases, Han 720 cases); in 2010 followed-up patients, the number of Muslim patients was significantly higher than Han patients (Muslim 618 cases, Han 347 cases). Among the cases, average age was (46±21) years in 2008, (45±21) years in 2009; (46±17) years in 2010;The highest incidence was found in farmers [84.73 (1243/1467) in 2008; 62.50 (915/1464) in 2009; 93.06 (898/965) in 2010] and followed by students [7.43 (109/1467) in 2008; 5.40 (79/1464) in 2009; 3.21 (31/965) in 2010]; The delay of TB diagnosis was common among cases. 43.22% (319/738) cases were confirmed as TB in one month later since symptom onset, about 85% (633/738) cases were delayed up to three months. Theoretically, the diagnosis delay of 738 cases of pulmo-nary tuberculosis patients within 1 year could increase the number of patients to 2.9 times.Conclusion We should strengthen the TB knowledge health promotion in Southern Ningxia.

The nasopharyngeal carriage rate, serotype distribution and antimicrobial resistance of Haemophilus influenzae among children with upper respiratory infection in Beijing

GAO Wei, SHI Wei, YU Sang-jie, YUAN Lin, YAO Kai-hu, YANG Yong-hong

Journal of Tuberculosis and Lung Health. 2015, 4(3):  179-183.  doi:10.3969/j.issn.2095-3755.2015.03.007

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Objective To investigate the nasopharyngeal carriage rate, serotype distribution and antimicrobial resistance of Haemophilus influenzae among children visiting an outpatient department in Beijing Children’s Hospital with upper respiratory infection from March 2013 to February 2014.Methods We selected 100 Hi isolates randomly. The serotypes were determined by the latex-agglutination and the antibiotic susceptibility was tested by E-test method. The serotyping and antimicrobial resistance data were analyzed with the WHONET 5.3 software. The χ² test, performed with the SPSS software v. 16.0 (SPSS Inc. USA), was used for statistical comparisons. A two-tailed cut-off of P<0.05 was deemed to indicate statistical significance.Results The nasopharyngeal carriage rate for Haemophilus influenzae was 9.2% (271/2930), major in April to June (19.5%, 20.6% and 24.5%). The number of boys was larger than that of girls’ (χ²=7.219, P<0.05), and mostly aged 4~6 years old (＞10%). All of the isolates were non-typable. The susceptibility to tetracycline, chloramphenicol, amoxycillin/clavulanate, and cefuroxime were 97.0%, 96.0%, 91.0% and 82.0%, respectively. The non-susceptibility to penicillin was 35.0%. The carriage rate of beta-lactamase was 23.0%.Conclusion About 9.2% of children with upper respiratory infection were nasopharyngeal colonized by Haemophilus influenzae. The infection is closely related with age, gender and season in Beijing. The non-susceptibility to penicillin was high, and the beta-lactamase positive rate of Haemophilus influenzae was high and increased rapidly.

Analysis on pulmonary tuberculosis in students from the Xinjiang Uygur Autonomous Region during 2010 to 2014

YANG Jin-ming, LI Yue-hua, TAI Xin-rong, LI Tao

Journal of Tuberculosis and Lung Health. 2015, 4(3):  184-188.  doi:10.3969/j.issn.2095-3755.2015.03.008

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Objective To understand the surveillance results of pulmonary tuberculosis among students in the Xinjiang Uygur Autonomous Region (Xinjiang), and to provide evidence for developing effective TB control mea-sures in schools.Methods Using infectious disease report management information system of China disease prevention and control information system, collected from Xinjiang 2010—2014 report of the incidence of tuberculosis patients (total 5347 cases), respectively, the time distribution (divided into 1-12 months), sex distribution and age distribution (divided into 5 age groups: 5- years old, 15- years old, 20- years old and 25- years old). Using China TB management information system, collected registration 4689 student cases with active pulmonary tuberculosis with national distribution (divided into five categories, the Uygur, Han, Kazak, Hui and other ethnic minorities) and treatment delay data. Data analysis with software Excel 2010 and SPSS 21.0, distribution of different time, different gender, different age group the incidence rate were compared with chi square test, P<0.05 for statistical significance.Results During 2010 to 2014, 5347 cases with pulmonary tuberculosis were reported in Xinjiang, the incidence rate was 20.99/100 000, 18.14/100 000, 16.73/100 000, 16.25/100 000, 17.87/100 000, the incidence of the students was reported as decline trend in five years. Comparison of incidence rates of each year showed that the difference was statistically significant (χ²=45.26,P<0.001). Students’ cases with pulmonary tuberculosis accounted for 2.48%－3.54% of the whole population tuberculosis cases, The annual incidence of TB patients in Jan-May every year was significantly higher than that of other months, the constituent ratio of incidence of students’ cases in different months had statistical significance (χ²=85.08,P<0.001).Males’ cases were less than females’. Students’ gender ratios in different years was no significant difference (χ²=3.80,P=0.434). Students’ cases with pulmonary tuberculosis in 15－ years old group accounted for 55.00% (2941/5347). The constituent ratio of students’ cases with pulmonary tuberculosis in each age group of different years was significant difference (χ²=47.21,P<0.001). During 2010 to 2014, 4689 cases with pulmonary tuberculosis were registered by tuberculosis management information system in Xinjiang Uygur Autonomous Region, the Uygur accounted for 46.51%, and the average delay time was from 36 to 44 days.Conclusion From 2010 to 2014, the report system of students’ incidence case of Xinjiang is continuously improved, and the report incidence rate is declining annually. The peak of incidence rate is from Jan. to May. The proportion of students’ cases with pulmonary tuberculosis in 15－ age group is the highest. According to the features of the students’ epidemic situation in Xinjiang, tuberculosis dispensary at all levels should perform their duties, and effectively strengthen the students’ tuberculosis control and prevention work.

Evaluation of tuberculosis management status in general hospital in Dapeng district of Shenzhen

WU Dao-shen,LI Yan-liang,TAN Wei-guo

Journal of Tuberculosis and Lung Health. 2015, 4(3):  189-192.  doi:10.3969/j.issn.2095-3755.2015.03.009

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Objective To evaluate tuberculosis (TB) management status and effect in general hospital, and to summarize experience and provide reference for improving the TB management work.Methods The referral information of 4225 suspected pulmonary TB patients in general hospitals, district health care facilities and TB control institutions in 2009—2013 were checked. The TB management system and procedure in general hospitals were gotten by field interviewing and spot-check of X-ray chest films was carried out to evaluate the diagnosis level. Rate and proportion were used to describe the categorical data. Chi-square test was applied for rate comparison. P<0.05 was set as the criteria for statistical difference.Results The referral arrival rates were 85.08% (154/181), 85.56% (160/187), 87.50% (168/192), 90.34% (187/207) and 94.29%(198/210) from 2009 to 2013. The referral arrival rate increased significantly year by year (χ²_trend=10.74, P=0.001), which indicated the general hospitals attached great importance to patient referral work. Among them, 46.78% (457/977) of the referral suspected patients from general hospitals were diagnosed as active pulmonary TB, which accounted for 33.55% (457/1362) of the total referral TB cases in the district. Among the suspected pulmonary TB patients, 65.97% (572/867) arrived on the same day, among which 80.97% (702/867) were arrived actively, 20.88% (181/867) were transferred from the TB control institution to the general hospital because of illness requirement.Conclusion The general hospital plays an important role in TB case finding. The standardization work flow is the key to guarantee the referral efficiency of suspected TB patients in general hospitals. The effect of TB management in district general hospital is good.

Analysis on patients’ reporting and referral by non-TB control agencies in Tianshui city in 2009—2013

LI Jiang-hong, LEI Cai-ying, YAN Shu-ping, TAN Xiao-yan, LIU Xiao-lan, FAN Yu-qing, WANG Run-xiang, JIA Ling-ling

Journal of Tuberculosis and Lung Health. 2015, 4(3):  193-195.  doi:10.3969/j.issn.2095-3755.2015.03.010

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Objective To analyze the pulmonary tuberculosis (PTB) patients’ reporting and referral by non-TB control agencies in Tianshui in 2009—2013.Methods By Chinese Center for Disease Control and Prevention of TB Management Information System and manual reporting, the referral and tracing data of 7781 PTB cases reported by non-TB control agencies between 2009 to 2013 were collected and analyzed.Results in the period from 2009 to 2013, the overall arrival rate of non-TB institutions in Tianshui increased from 37.53% (641/1708) in 2009 to 86.68% (1002/1156) in 2013 (χ²=1423.11, P<0.05), and referral arrival rate increased from 19.96% (341/1708) in 2009 to 65.14% (753/1156) in 2013 (χ²=840.16, P<0.05), tracing arrival rate raised from 47.45% (251/529) in 2009 to 94.17% (291/309) in 2013 (χ²=165.33, P<0.05).Conclusion In 2009—2013, the non-TB institutions in Tianshui city continued to regulate the management of TB patients, and the referral and tracing arrival rate increased year by year.

Clinical Case Discussion

A case of granulomatous polyangiitis with latent tuberculosis infection

SONG Xiao-dong,HUANG Xiao-lei,XU Qi-feng,LU Xi-wei

Journal of Tuberculosis and Lung Health. 2015, 4(3):  196-199.  doi:10.3969/j.issn.2095-3755.2015.03.011

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Granulomatous polyangiitis is a kind of autoimmune diseases with varied clinical manifestations, which is easily confused with tuberculosis in imaging findings. In this paper, we collected the data of a case of gra-nulomatous polyangiitis with latent tuberculosis infection (LTBI). Through the discussion of the differential diagnosis, the value of T-SPOT.TB in diagnosing pulmonary tuberculosis was evaluated, and the ability of clinician’s diagnosis and differential diagnosis in granulomatous polyangiitis was improved.