Table of Content

20 June 2014, Volume 3 Issue 3

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Review and prospect of the comprehensive treatment of drug-resistant tuberculosis

TANG Shen-jie.

Journal of Tuberculosis and Lung Health. 2014, 3(3):  141-147.  doi:10.3969/j.issn.2095-3755.2014.03.001

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The increasing incidence of drug-resistant tuberculosis especially multidrug-resistant tuberculosis (MDR-TB) and extensively drug-resistant tuberculosis (XDR-TB) is a major concern for TB control programme. The treatment of drug-resistant tuberculosis is more expensive, with high side effect, and less effective. Chemothe-rapy, combined with immunotherapy, collapse therapy, interventional therapy, surgical operation, Chinese traditional medicine and nutrition treatment can improve the therapeutic efficacy of drug-resistant tuberculosis.

The analysis of using two methods to detect latent tuberculosis infection among 227 village doctors

HU Dong-mei, HOU Yue-yun, SONG Yu-dan, XIONG Yong-chao,GENG Meng-jie, HE Guang-xue.

Journal of Tuberculosis and Lung Health. 2014, 3(3):  148-151.  doi:10.3969/j.issn.2095-3755.2014.03.002

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Objective To acquire the status of latent tuberculosis infection (LTBI) among village doctors and compare the concordance between QuantiFERON-TB Gold In-Tube(QFT-GIT)and tuberculin skin test (TST, using purified protein derivative of tuberculin,PPD).Methods A cross-sectional study was adopted in Linhe district of Bayan Nur City of Inner Mongolia in November, 2011. The questionnaire was used to collect information. Both of QFT-GIT and TST were used to detect the LTBI among 227 village doctors. Two hundred and twenty-seven questionnaires were issued, and the overall response rate was 100.0%. Statistical indexes, such as proportion, rate were used to describe village doctors’ basic information and the rate of LTBI. The concordance of QFT-GIT and TST was evaluated with Kappa value.Results 227 village doctors completed QFT-GIT and excluded 2 indeterminate results, 99 of 225 village doctors’ QFT-GIT results were positive, the rate of LTBI was 44.0% (99/225). Two hundred and twenty-six village doctors completed TST, the rates of LTBI were 59.3% (134/226) with cutoff of 5 mm, 41.2% (93/226) with cutoff of 10 mm and 22.6% (51/226) with cutoff of 15 mm respectively. The Kappa values were 0.415 with cutoff of 5 mm, 0.444 with cutoff of 10 mm and 0.358 with cutoff of 15 mm respectively.Conclusion The rate of LTBI among 227 village doctors in Linhe district was higher,the agreement of these two methods was general. We should conduct tuberculosis infection control measures at village clinic, so that reduce the LTBI of village doctors.

The treatment experience of spontaneous pneumothorax complicated with pulmonary tuberculosis in 49 patients

XIA Zhao-hua, NING Xin-zhong, WANG Hai-jiang, DENG Qun-yi, LI Guo-bao, WANG Hui,DENG Guo-fang

Journal of Tuberculosis and Lung Health. 2014, 3(3):  152-156.  doi:10.3969/j.issn.2095-3755.2014.03.003

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Objective We summarized the treatment experience of spontaneous pneumothorax (SP) in patients diagnosed with TB.Methods We retrospectively collected and analyzed the medical records of 49 patients with TB and secondary SP treated in our hospital between July, 2008 and July, 2013.Results During the study period, a total of 850 patients with SP were treated in our hospital, 49 of whom had SP secondary to TB. Also during this period, 2179 cases of active TB were treated. Of the 49 cases with secondary SP, 21 presented with active TB at the moment of producing SSP and 28 had inactive TB. With regard to pleural drainage (PD) as a treatment for SSP, forty one (83.7%) patients needed one PD, four (8.1%) needed two, and two (4.1%) needed three. A decision to wait was made in two patients (4.1%), and the evolution of their SSP was favourable during their stay. The mean stay for PD was (12.5±11.1) days. The treatment for these recurrences was to perform another PD in 6 (18.3%) cases, 1 (4.1%)of them occurred contra laterally, and 5 (8.1%)patients needed surgery. VATS was performed in 14 (28.6%) patients for persistent air leakage after PD and relapses, There were 3 (21.4%) posto-perative complications: persistent air leaks for >5 days in 1 case, pneumonia in 1 case and surgical wound infection in 1. The hospital length of stay was (15.02±13.07) days.Conclusion The treatment of SP secondary to TB with PD is usually a sound response, with a good general prognosis and a low percentage of cases that require another PD and surgical treatment.

Biological mass spectrometry analysis of Mycobacterium chelonae culture filtrate Proteome

QIAN Ming, CHEN Tao, ZHUO Wen-ji, LIU Zhi-hui, GUO Hui-xin, ZHONG Qiu, ZHOU Lin.

Journal of Tuberculosis and Lung Health. 2014, 3(3):  157-160.  doi:10.3969/j.issn.2095-3755.2014.03.004

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Objective To describe the protein secretion activity of M.chelonae, and to provide the research basis for its pathogenicity and detection methods.Methods With weak cation exchange protein chip (WCX2), Middlebrood 7H9 culture filtrate proteins for 7 days’ culture and Middlebrook 7H9 culture proteins of 11 M.chelonae clinical isolates and ATCC19977 reference strain, were detected by surface enhanced laser desorption/ionization time-of-flight mass spectrometry (SELDI-TOF-MS), the M.chelonae, culture filtrate proteins were analyzed descriptively.Results 49－101 kinds of differential proteins were detected in 11 M.chelonae Middlebrook 7H9 culture filtrate for 7 days’ culture, the relative molecular mass ranged from 1101－3953, and the abundance level in relative strength were 84－7238. Thirty-two kinds of differential proteins were detected in 11 M.chelonae, the molecular mass ranged from 1108-3953, and the abundance level in relative strength were 98－7231.Conclusion A variety of small proteins were secreted by M.chelonae in the process of growth in vitro, while there characteristics and effects needs further research.

The retrospective analysis of a tuberculosis outbreak in a middle school

QI Yi, LU Hua-yue, YANG Lian-jun, YANG Yun-yi, ZHOU Ying, LU Xi-wei.

Journal of Tuberculosis and Lung Health. 2014, 3(3):  161-165.  doi:10.3969/j.issn.2095-3755.2014.03.005

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Objective Retrospective analysis was conducted for a tuberculosis (TB) outbreak in a middle school to explore the best principles and methods of handling the TB outbreak.Methods A total of 229 students in grade 3 in the junior high school with TB outbreak were screened by chest X ray and PPD. The distribution of time, space and population was described, and the relation among the exposure level, TST result and the secondary cases was evaluated.Results According to the degree of contact with the index TB case, the 229 students were divided into four groups: Level 1 (L1) students studied with the index case in the same classroom. Level 2 (L2): students studied in the adjacent class but studied frequently in the same classroom. Level 3 (L3) students studied on the same floor but in different classroom with the index case. Level 4 (L4) students studied on the different floor and in different classrooms. Based on the above criteria, the strongly positive PPD rates were 74.0% (37/50), 58.5% (24/41), 31.8% (21/66) and 12.7% (9/71) respectively in the 4 group. The attack rates of TB were 16% (8/50) and 2.4% (1/41) in L1 and L2 respectively (χ²=4.65, P<0.05). According to the TST results of the first screening in close contacts (L1), the attack rates of TB of the group of TST≥15 mm and TST＜15 mm were 13.3% (2/15) and 17.1% (6/35) respectively (χ²=0.11, P>0.05). Based on the TST results of the second screening in close contacts (L1, 3 months later), the attack rates of TB with TST≥15 mm and TST＜15 mm were 16.2% (6/37) and 15.4% (2/13) respectively (χ²=0.00, P>0.05). In the TB outbreak, even if the preventive therapy was applied to all of the 15 students with TST≥15 mm after the first TST, only 22.2% (2/9) of the se-condary case could be selected to received the early intervention.Conclusion The level of exposure is a high risk factor for TB incidence during an TB outbreak. Whether the TST is strongly positive or not is unrelated to secondary cases. Establishing a mechanism for risk evaluation is an effective means of preventing TB outbreak in school.

Analysis of tuberculosis death surveillance in Xinmi city, He’nan, 1992—2012

XING Jin,JIN Xiao-wei,DUAN Hai-xia,WEI Xiao-hui,JIN Hong-jian,HE Shi-de,LIU Yuan-sen.

Journal of Tuberculosis and Lung Health. 2014, 3(3):  166-170.  doi:10.3969/j.issn.2095-3755.2014.03.006

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Objective To understand tuberculosis (TB) mortality and its trends in Xinmi city after the implementation of the National TB Control Programs (NTP),by analysis of TB mortality surveillance data.Methods We monitored all residents in Xinmi city for 21 years. Death registering and reporting system was established in TB control system in Xinmi and the death reporting cards were submited from 1992. The total population in Xinmi city in the first surveillace year was 684334, and it was 873664 in the 21^th year, with an annual population of 778994.Results (1)TB mortality declined from 3.95/10⁵ (27/684344) in 1992 to 0.92/10⁵ (8/873644) in 2012, with an annual decline rate of 7.0%. (2)The rank order of causes of death for TB had declined from 13^th in 1992 to 15^th in 2012. (3)The average life expectancy of TB patients had risen from 60.0 years old in 1992 to 70.0 years old in 2012. (4) Out of all deaths, the death ratio for TB fell from 0.6% in 1992 to 0.2% in 2012, with an annual reduction rate of 5.6%. (5)Out of those dead from TB, old people more than 65 years old accounted for 52.2% (187/358). The average annual mortality rate was as following: 0.07/10⁵ for 0- years old,0.22/10⁵ for 15- years old, 1.29/10⁵ for 25- years old, 1.02/10⁵ for 35- years old, 1.95/10⁵ for 45- years old, 3.90/10⁵ for 55- years old, 14.09/10⁵ for ≥65 years old.(6)Those dead from pulmonary TB accounted for 96.1% (344/358) of all TB deaths. (7)Out of those dead from all contagious diseases, 74.1% (344/464) were from TB.Conclusion TB mortality had decreased yearly with the full implementation of NTP. But it is still the leading cause of death from infectious diseases.

Analysis on the pulmonary tuberculosis prevalence survey in Xuhui district in Shanghai—2014

WANG Juan, CAI Xiao-feng, GUO Zu-ping, LI Shen-sheng, WANG Lan, YANG Mei-xia, XU Xiang, ZHANG Yi, JIANG Jing.

Journal of Tuberculosis and Lung Health. 2014, 3(3):  171-174.  doi:10.3969/j.issn.2095-3755.2014.03.007

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Objective To understand the tuberculosis (TB) prevalence status of Xuhui by cluster sampling survey.Methods Thirteen residents' committees were selected as survey points. The results and cost effectiveness of TB prevalence survey on 46136 people in Xuhui in 2014 were analyzed by descriptive epidemiology method. Chi-square test was used to compare the differences of TB prevalence between those with and without TB history, family history and symptoms, and P<0.05 was considered statistically significant.Results Symptoms investigation and chest X-ray screening were conducted in 39229 subjects, the examination rate was 85.03% (39229/46136). 11 pulmonary TB cases were detected, among whom 2 patients were new cases, the TB prevalence was 28.04/100000 (11/39229). 979 people had abnormal lung shadow, among whom 20 patients were diagnosed as lung cancer. The direct cost of the survey was 4463500 yuan, which can reduce social medical expenses of 330000－495000 yuan, and can save social value of 4725087 yuan, the benefit cost ratio was 1.15.Conclusion It is inappropriate to screening for TB by chest X-ray in the whole population in Xuhui. Chest X-ray can be used to screen other lung di-seases during the project implementation to improve the cost effectiveness.

Treatment analysis on uremic dialysis patients complicated with tuberculosis

DONG Qing-ze, JIN Tao, FU Chang, XIONG Yan.

Journal of Tuberculosis and Lung Health. 2014, 3(3):  175-177.  doi:10.3969/j.issn.2095-3755.2014.03.008

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Objective To improve experience and accuracy in diagnosis and treatment on dialysis patients complicated with tuberculosis by analyzing their clinical symptoms.Methods Retrospective analysis was carried out on the clinical data of 8 dialysis cases complicated with tuberculosis disease.Results All patients received anti-tuberculosis treatment. Seven patients were clinically cured. However, mild elevation in aminotransferase appeared in two cases, sudden cardiac death happened in 1 case.Conclusion Dialysis patients complicated with tuberculosis tend to be misdiagnosed, early diagnosis and rational treatment can prolong the patients’ life and decrease their death rate effectively. In addition, most side effect of anti-tuberculosis drug can be controlled with dialysis support at the same time.