Journal of Tuberculosis and Lung Disease

Discussion on the effect of Global Fund Tuberculosis Project on floating population in Hefei City

WANG Li-li, CHEN Wei,BAO Yuan-song,ZHANG Huan

Journal of Tuberculosis and Lung Health. 2015, 4(2): 85-88. doi:10.3969/j.issn.2095-3755.2015.02.002

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Objective To understand the effect for The Global Fund TB Project (GFTP) in patients detection and treatment management of the floating population in Heifei city, Anhui province, China.Methods Use the quarterly statement of the GFTP and Tuberculosis Information Systems (TBIS),to analyze the patients detection, treatment outcome and cross-regional management between 275 floating population tuberculosis patients (originated from quarterly statement) and 5 019 461 registered population (the 2010 census data) among July 2010 to June 2012, then using χ² test to compare the differences about household registered patients, and to explore the reasons for P<0.05 was considered statistically significant.Results Two hundred and severty five floating population tuberculosis patients were found during the program in two years, the registered rate is 40.26/100 000 (275/683 005). Among it, the registered rate of new sputum smear positive is 17.42/100 000 (119/683 005), the registered rate of new sputum smear negative is 21.52/100 000 (147/683 005), the registered rate of resident tuberculosis patients is 151.77/100 000 (7618/5 019 461), the difference was statistically significant (χ²=540.8, P<0.01). Patient population flows mainly from suburban 38.46% (106/275) and the province 34.07% (94/275) in Hefei. Patient management across the region shows that the floating population of patients transferred out rate 23.64% (65/275), turn rate 8.73% (24/275), turn the place into the patient rates were 89.23% (58/65) and 95.83% (23/24),the diffe-rence was not statistically significant (χ²=0.3013, P>0.05).Treatment and outcome of floating population patients with pulmonary tuberculosis, for locally and overseas to achieve successful treatment rates were 91.71% (199/217) and 58.62% (34/58), the difference was statistically significant (χ²=38.713,P<0.01).Conclusion GFTP has achieved good results in Hefei, the feature of patients among floating population was grasped preliminary,the finding level and successful treatment rate was improved, and insist to the floating population in the discovery is necessary to complete the treatment.

Investigation and analysis of nutritional status of patients with multi-drug resistant pulmonary tuberculosis

HOU Chao, WANG Xian-hua, ZHAO Shan-liang,LIU Pei-ying,MA Ai-guo, LIN Rui-han,HAN Xiu-xia

Journal of Tuberculosis and Lung Health. 2015, 4(2): 89-92. doi:10.3969/j.issn.2095-3755.2015.02.003

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Objective To study the nutritional status of the patients with multi-drug resistant pulmonary tuberculosis and provide scientific basis for promoting the treatment and rehabilitation.Methods Collected 109 cases of patients with multi-drug resistant pulmonary tuberculosis who were hospitalized in people’s hospital of Linyi during the period of 2012 to 2014, including the initial treatment group (untreated patients with multi-drug resistant pulmonary tuberculosis) 58 cases, the retreatment group (the retreated patients with multi-drug resistant pulmonary tuberculosis) 51 cases. The two groups were collected at admission physical examination and blood test results, including body mass index (BMI): ＜18.5 as malnutrition (thin), 18.5-23.9 as normal, ≥24 as overweight or obese); hemoglobin (Hb (g/L): ＜110 as malnutrition (anemia), 110-150 as normal); external peripheral blood lymphocyte count (TLC (×10⁹/L): ＜2.0 ×10⁹/L as malnutrition (TLC reduction), 2-3.2 as normal); serum albumin count (Alb (g/L): ＜35 as malnutrition (hypoproteinemia), 35-55 as normal), according to above indicators results to analyze and compare the nutritional status of patients.Results Among 109 patients with multi-drug resistant pulmonary tuberculosis, low weight accounted for 42.2% (46/109), anemia accounted for 29.4% (32/109), TLC reduction accounted for 69.7% (76/109), low protein accounted for 55.0% (60/109). In initial treatment group patients, the low weight accounted for 37.9% (22/58), anemia accounted for 27.6% (16/58), TLC reduction accounted for 69.0% (40/58), low protein accounted for 41.4% (24/58); In the retreatment group, low weight accounted for 47.1% (24/51), anemia accounted for 31.4% (16/51), TLC reduction accounted for 70.6% (36/51), low protein accounted for 70.6% (36/51), the initial treatment and retreatment group only to Albumin (Alb) evaluation of malnutrition had significant difference (χ²=9.356,P＜0.05). Two groups of the nutrition indicators test results: the initial treatment group BMI, Hb, TLC, Alb levels were 20.58,124.41 g/L,1.63×10⁹/L,35.26 g/L;the retreatment group patients were 18.06, 116.86 g/L, 1.42×10⁹/L, 31.53 g/L, the initial treatment group were significantly higher than the retreatment group (χ² values were 4.438,2.215,2.122,3.638, P＜0.05).Conclusion The patients with multi-drug resistant pulmonary tuberculosis has a higher malnutrition incidence, and the retreatment group is even worse than untreated group. Therefore, we should focus on the nutritional status of the patients and the early targeted nutrition support treatment are essential for patients.

Comparison of the CT scanning features of lymphadenectasis of pediatric tuberculosis and other pulmonary infectious diseases

REN Hui-li, LIU Wen, FANG Wei-jun

Journal of Tuberculosis and Lung Health. 2015, 4(2): 93-96. doi:10.3969/j.issn.2095-3755.2015.02.004

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Objective To provide the scientific basis for the CT scan in the diagnosis and differential diagnosis of pediatric tuberculosis (TB).Methods Retrospective analysis was applied by collecting CT scan data of 60 1 month-12 years old patients diagnosed as pulmonary TB (TB group) and of 72 1-12 years old patients diagnosed as pulmonary infectious diseases (including: 42 cases of the bacterial pneumonia, 20 cases of mycoplasma pneumonia, 10 cases of fungal pneumonia) (pneumonia group) from October 2009 to October 2014 in Guangzhou Chest Hospital. The incidence、anatomical sites (mediastinal, pulmonary hilar, axillary) distribution, density of CT scan and CT enhancement characteristic of lymphadenectasis were described by percentage composition. The significance of difference was analyzed and compared by Chi-square test. P<0.05 was considered statistically significant.Results 98.33% (59/60) patients of the TB group showed lymphadenectasis in CT scan, which was significantly higher than that of the pneumonia group (41.67%, 30/72) (χ²=47.85, P<0.05). In terms of anatomical site, 90.00% (54/60), 61.67% (37/60) and 48.33%(29/60) TB patients had lymphadenectasis shown in mediastinal, pulmonary hilar and axillary respectively, which were significantly higher than those of the pneumonia group [(22.22%, 16/72,χ²=60.36, P<0.05) (12.50%, 9/72,χ²=34.85, P<0.05) and (15.28%, 16/72,χ²=16.93, P<0.05)]. In terms of CT scan density, 52.54% (31/59), 42.37% (25/59) and 5.08% (3/59) of TB patients showed uniform density, calcification and necrosis, and 80.00% (24/30), 16.67% (5/30) and 3.33% (1/30) for the pneumonia group. The percentage of uniform density in pneumonia group was significantly higher than TB group χ²=6.35, P<0.05). The image of calcification was on the contrary (χ²=10.47, P<0.05). In the CT enhancement scan of 8 cases of TB group, the rates of uniform and uneven enhancement were 12.50% (1/8) and 87.50% (7/8). While 83.33%(10/12) and 16.67 (2/12) were shown in 12 cases of the pneumonia group.Conclusion The application of anatomical sites, density of CT scan, CT enhancement characteristic of lymphade-nectasis can help the diagnosis and differential diagnosis of pediatric tuberculosis.

Analysis on referral and tracing of tuberculosis cases reported by non-TB control institutions in 2010—2013 in Jingkou District, Zhenjinang City

LI Ai-hua, GU Xiao-yong, ZHANG Jian-min, SONG Wei

Journal of Tuberculosis and Lung Health. 2015, 4(2): 97-100. doi:10.3969/j.issn.2095-3755.2015.02.005

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Objective To analyze the status of referral and tracing of tuberculosis (TB) cases reported by non-TB control institutions in 2010—2013 in Jingkou District, Zhenjiang City, and to explore the measures for improving TB cases finding.Methods The numbers of TB cases reported by non-TB control institutions from 2010 to 2013 in Jingkou District were 321, 315, 290 and 266. The referral, tracking and monthly, quarterly reports from 2010 to 2013 were collected and analyzed. The status of referral and arrival, tracing and arrival, and diagnosis of the cases that arrived in TB control institutes were analyzed. The numbers of referral and arrival were 1179 and 747 respectively, and those of tracing and arrival were 440 and 435. The numbers of referral and arrival of bacteriologically confirmed TB were 110 and 127, those of negative bacteria were 187 and 278, and those of no sputum were 448 and 784. There were 1182 cases arrived in TB control institutions, among whom 411 TB cases were diagnosed.Results The referral arrival rate, tracking arrival rate and overall arrival rate of TB cases or TB suspects reported by non-TB control institutions in 2010—2013 in Jingkou District were 62.67% (747/1192), 98.86% (435/440) and 99.33% (1184/1192) respectively. The referral arrival rates of bacteriologically positive, bacteriologically negative and no sputum TB cases were 86.61% (110/127), 67.27% (187/278) and 57.14% (448/784) respectively. The TB confirmation rates of bacteriologically positive, bacteriologically negative and no sputum TB suspects who arrived were 99.21% (125/126), 32.36% (89/275) and 25.22% (197/781) respectively.Conclusion Non-TB control institutions play an important role in TB case detection, and will help to further improve the TB case detection and treatment in Jingkou District.

Analysis on tuberculosis epidemic characteristics and implementation effect of DOTS strategy in Juxian of Shandong Province during 2003 to 2013

ZHONG Jing-ming, LU Ji-xu, SONG Guo-qiang, HE Nai-ling

Journal of Tuberculosis and Lung Health. 2015, 4(2): 101-105. doi:10.3969/j.issn.2095-3755.2015.02.006

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Objective To understand the implementation effect of Tuberculosis Control Program (2001—2010) of Juxian and find out the characteristic of TB incidence, provide scientific basis for TB control strategies in Juxian.Methods The total population is 12 166 055 during 2003—2013 in Juxian. Through TB information mana-gement system and relevant statistic reports, we analyzed TB registration rate, epidemiological character and trea-tment effect of 4481 TB patients registered during 2003 to 2013 of Juxian, and evaluated the effect and social benefit of DOTS strategy.Results During 2003—2013 registration rates of active and new SS+ pulmonary TB cases were 36.83/10⁵ (4481/12 166 055) and 21.59/10⁵ (2627/12 166 055) respectively. The male to female ratio is 2.74∶1. In terms of the age distribution, the first three age group is 15- age group which accounted 21.36% (957/4481), 55－ age group which accounted 17.96% (805/4481) and 65－74 age group which accounted 15.53% (696/4481). In terms of the occupational distribution, the first place is farmer, accounted 87.61% (3926/4481). Sputum conversion rates of new and retreatment SS+TB cases were 98.82% (2596/2627) and 95.91% (211/220). The average cure rate of SS+ TB cases was 95.36% (2715/2847). It avoided 22 460 people from being infected with Mycobacterium tuberculosis, and avoided 2246 people from active TB, saved medical costs of 1 533 765 Yuan and restore economic losses worth a total of 266 685 094 Yuan for society.Conclusion Modern TB control strategy was promoted actively in Juxian. TB registration rate showed a downward trend during 2003—2013. TB cure rate reached and exceeded the requirement of national TB program. DOTS strategies received significant effect.

Analysis of AIDS/TB dual infection situation in Wenshan Zhuang and Miao Autonomous Prefecture

ZHANG Guo-hua,ZHANG Xin-yue,GAO Da-rui,ZOU Ping

Journal of Tuberculosis and Lung Health. 2015, 4(2): 106-108. doi:10.3969/j.issn.2095-3755.2015.02.007

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Objective To investigate epidemiological association of HIV (human immunodeficiency virus) and tuberculosis (TB) dual infection patients in Wenshan Zhuang and Miao Autonomous Prefecture (Wenshan Prefecture) and provide scientific basis for the development of HIV/TB dual infection prevention and control countermeasures.Methods We collected the TB patients information screened from 6230 cases of HIV/AIDS patients,and HIV/AIDS patients patients screened from 6430 cases of TB patients between 2007 and 2012 in Wenshan Prefecture. Then make a descriptive analysis.Results After screening, we detected a total of 382 cases of TB/HIV dual infection patients,and active tuberculosis detection rate in HIV/AIDS patients is 5.01% (312/6230) and HIV infection rate in TB patients is 1.09% (70/6430).Conclusion The co-infection epidemic is serious in Wenshan Prefecture. Therefore, AIDS prevention should be an important work of TB control in the future, Examination and treatment of tuberculosis should become an important area in fighting against AIDS.

Application of transbronchial needle aspiration under CT-guided in diagnosing mediastinal mass and pulmonary hilar mass

YANG Xian-ming, CHEN Wei-sheng, WENG Jia-hao, ZHENG Shao-ting, CHEN Ming-hua

Journal of Tuberculosis and Lung Health. 2015, 4(2): 109-112. doi:10.3969/j.issn.2095-3755.2015.02.008

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Objective To investigate the diagnosis effect of transbronchial needle aspiration under CT-guided for mediastinal mass and pulmonary hilar mass.Methods One hundred and forty patients underwent mediastinal mass and pulmonary hilar mass were randomly divided into either observation group (n=70) or control group (n=70) by random number table method after signing informed consent. In the observation group, transbronchial needle aspiration was carried out under real-time CT guidance. In the control group, transbronchial needle aspiration was carried out without CT guidance. The number of positive patients, false positive patients, negative patients and false negative patients were recorded in both groups. The sensitivity, specificity, positive predictive value and negative predictive value were calculated in both groups. The incidence of complication was also recorded in both groups. For enumeration data, χ² test was applied to test significance. A P-value less than 0.05 was deemed significant.Results Forty patients with malignant tumor, 1 benign tumor, 13 tuberculosis, 2 sarcoidosis and 14 normal tissues were identified in the observation group. Thirty-eight patients with malignant tumor, 2 benign tumor, 11 tuberculosis, 3 sarcoidosis and 16 normal patients were found in the control group. There was no difference between two groups (The χ² values were respectively 0.029, 0.000, 0.050, 0.000 and 0.042. The P-values were respectively 0.734, 1.000, 0.823 1.000 and 0.837). The false negative patients (1 case) in the observation group were less than those (7 case) in the control group (χ²=4.275, P=0.039). The number of the positive patients (65 case) in the observation group were similar to those in (59 case) the control group (χ²=1.764, P=0.184). The number of the false positive patients (1 case) in the observation group were similar to those in (2 case) the control group (χ²=0.000, P=1.000). The number of the negative patients (3 case) in the observation group were similar to those in (2 case) the control group (χ²=0.000, P=1.000). The sensitivity, specificity, positive predictive value and negative predictive value in the observation group were 98.48%, 75.00%, 98.48%, and 75.00%, respectively. The sensitivity, specificity, positive predictive value and negative predictive value in the control group were 89.39%, 50.00%, 96.72%, and 22.22%, respectively. There was not mediastinal emphysema or pneumothorax patient in the observation group, but six mediastinal emphysema or pneumothorax patients in the control group. There was significant difference between two groups (χ²=4.353, P=0.037). There was one hemorrhage patient in the observation group, but eight hemorrhage patients in the control group. There was significant difference between two groups (χ²=4.275, P=0.039).Conclusion Transbronchial needle aspiration under CT is more effective for diagnosing mediastinal mass and pulmonary hilar mass and its complication is less.

Discussion of the clinical features of 110 cases with drug-resistant tuberculosis

DENG Zhang-li, WU Dao-shen, LI Yan-liang, TAN Wei-guo

Journal of Tuberculosis and Lung Health. 2015, 4(2): 113-115. doi:10.3969/j.issn.2095-3755.2015.02.009

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Objective To analyze the clinical features of drug-resistant tuberculosis, and to understand mycobacteria, patient’s conditions and outcomes of treatment in drug-resistant TB patients.Methods The clinical data of 110 drug-resistant TB cases, at Shenzhen Chronic Disease Control and Prevention Centre from January 2009 to December 2012, were collected. Patients were assayed with smear, culture, X-Ray, bacterial identification and drug sensitivity test, etc. Effects and side effects were observed during treatment. A comprehensive assessment was conducted by experts through discussion.Results The prominent symptoms of 110 cases of drug-resistant TB were cough and expectoration. Amongst all patients, 21.8% (24/110) demonstrated Multi-drug resistant tuberculosis, and 19.1% (21/110) contracted tuberculosis resistant to 3 and more drugs. 57.3% (63/110) of patients had bila-teral lung field affected. The rate of +++ and above among the patients with sputum smear + was 30.9% (34/110). The rate of lesions absorption was 80.9% (89/110).The rate of successful treatment was 76.4% (84/110), while that of failure amounted to 13.6% (15/110).Conclusion The drug-resistant tuberculosis possesses apparent respiratory manifestation,It was shown there had been a high percentage of multi-drug resistant TB and poly-resistant TB, damaging the lung severely. We should enhance drug-resistant tuberculosis control and reduce the propagation of drug-resistant TB.

The influence of PRECEDE-PROCEED model on the therapeutic compliance of MDR-TB patients

LI Bing, BAO Feng-yu

Journal of Tuberculosis and Lung Health. 2015, 4(2): 116-120. doi:10.3969/j.issn.2095-3755.2015.02.010

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Objective To explore the influence of PRECEDE-PROCEED model on the therapeutic compliance of MDR-TB patients.Methods From the patient who were hospitalized and diagnosed as MDR-TB and admitted by China Global Fund TB Program, 90 patients who were hospitalized from July 2011 to December 2012 (intervention group) and 92 patients who were hospitalized from January 2010 to June 2011 (control group) were enrolled. There were 79 cases in contrast group and 82 cases in intervention group after elimination of the loss of follow-up and death cases. The patients in two groups were both treated with individualized regimen for 24 months (including 6 months intensive phase and 18 months consolidation phase). Conventional health education was applied in the patients in two groups. In addition, we provided the guidance of PRECEDE-PROCEED model to intervention group to form predisposing, enabling and reinforcing factors. During the course of treatment, the following tests were taken once a month within the first 6 months and once two months within the final 18 months: sputum smear, sputum culture, liver function, routine test of blood and urine and so on. Rate was used to describe categorical data, the database was established by Excel, and SPSS 13.0 software was applied for data analysis. Chi-square test was used to compare the awareness rate, compliance of treatment and care rate between two groups.Results The awareness rate of the patient in intervention group was 89.0%, which was significantly higher than control group (58.2%). The difference was statistically significant (χ²=19.8, P<0.01). The treatment adherence rate in intervention was 91.5%, and was significantly higher than control group (67.1%) (χ²=14.67, P<0.01). The sputum conversion rate of the intervention group was 65.9%, which was significantly higher than control group (43.0%)(χ²=7.91, P<0.05).Conclusion PRECEDE-PROCEED model intervention can effectively improve the treatment com-pliance of MDR-TB patients.

Application of knowledge, attitudes and practices (KAP) in tuberculosis area in China

FANG Hong-xia, QIN Yu-bao, YAN Xin-feng, CHEN Zhi-cong, HONG Feng, YU Wen-long, WEI Ji-long, CHANG Chun, HE Xiao-xin

Journal of Tuberculosis and Lung Health. 2015, 4(2): 121-129. doi:10.3969/j.issn.2095-3755.2015.02.011

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Objective To investigate the application and the potential problems of the theory knowledge, attitudes and practices (KAP) in tuberculosis area in China.Methods We therefore performed a systematic review and retrieved Chinese articles, with the major topic about “KAP (or KABP)” and “tuberculosis (or TB)”, involving in Chinese populations, published before May 31st, 2015. One hundred and forty-four articles were involved in this study from 1789 articles published during study period.Results Only 13 articles (9.03%, 13/144) were published from 1999 to 2006. The number of articles rose quickly in 2007, and reached at the top of 23 articles (15.97%, 23/144) in 2009 then slowly went down, and rose again in 2013. The present situation of KAP was showed in 62 articles (43.06%,62/144). Three kinds of questions about KAP were set in 106 articles (73.61%, 106/144); one or two kinds of questions about KAP were set in 28 articles (19.44%, 28/144); and no questions or few questions were introduced in 10 articles (6.94%,10/144). Among three kinds of questions about KAP were correlation in 57 articles (53.77%, 57/106). The practice studies adopting the theory of KAP were reported in 22 articles (38.60%, 22/57; 15.28%, 22/144).Conclusion More and more articles about the application of KAP in tuberculosis area were published after 2007. But the most of these articles didn’t set three kinds of question of KAP or absent the correlation among three kinds of questions about KAP. Only few articles about the practice studies were adopting the theory of KAP.

Clinical analysis of pulmonary tuberculosis complicated with fungal infection

FAN Xiang-yang

Journal of Tuberculosis and Lung Health. 2015, 4(2): 130-132. doi:10.3969/j.issn.2095-3755.2015.02.012

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Objective To observe the therapeutic effects of the pulmonary tuberculosis patients combined with pulmonary fungal infections.Methods Thirty-five tuberculosis combined with pulmonary fungal infections patients admitted in our hospital from December 2012 to December 2014 were selected and the clinical data were retrospectively analyzed. The SPSS 16.0 software is used for statistical analysis, and the differences of before and after treatment were compared by t-test and χ²-test.Results The total effective rate was 94.29% (33/35).The mainly fungal infection was Candida albicans accounting for 28.57% (10/35). The sputum smear-negative culture-positive rate of patients before and after the treatment was 94.29% (33/35)、2.86 (1/35) respectively (χ²=164.94,P＜0.05). The white blood cell count was reduced from (5.8±1.6)×10⁹/L to (4.7±1.5)×10⁹/L (t=2.96,P＜0.05). Blood platelet count was reduced from (228.7±68.8)×10⁹/L to (178.3±58.2)×10⁹/L (t=3.30,P＜0.05). ALT and BUA values were also reduced from (22.4±5.3)U/L to (16.4±6.5)U/L (t=4.23,P＜0.05) and (585.3±185.6)μmol/L to (456.5±183.8)μmol/L (t=2.93,P＜0.05).Conclusion The patients with pulmonary tuberculosis are susceptible to invasive fungal infections, using a combination of treatment methods can achieve significant therapeutic effect.

Research progress on molecular mechanism of ethambutol resistance in Mycobacterium tuberculosis

XU Yu-hui, ZHANG Zong-de

Journal of Tuberculosis and Lung Health. 2015, 4(2): 133-136. doi:10.3969/j.issn.2095-3755.2015.02.013

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Tuberculosis is one of the oldest infectious diseases that put great threat to the human life. Ethambutol (EMB) is one of the most important anti-tuberculosis drugs for the drug sensitive and multidrug resistant tuberculosis. With the long time use of this drug EMB-resistant Mycobacterium tuberculosis is on the rise and being reported all over the world. This article reviewed the research progress in molecular mechanism of EMB resistance.

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