Table of Content

20 April 2014, Volume 3 Issue 2

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Research progress of improving treatment of MDR-TB by identifying pyrazinamide susceptibility

LIU Wei,SUN Feng,ZHANG Wen-hong,ZHANG Ying.

Journal of Tuberculosis and Lung Health. 2014, 3(2):  77-81.  doi:10.3969/j.issn.2095-3755.2014.02.001

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Pyrazinamide (PZA) is an important component of the short course chemotherapy scheme for tuberculosis, also essential in the treatment of multidrug-resistant tuberculosis (MDR-TB). PZA affects transmembrane proton concentration gradient of Mycobacterium tuberculosis (Mtb) cell membrane and energy metabolism to kill Mtb in acid environment by its active form, pyrazinoic acid (POA). The mutations of pncA and rpsA genes are the main mechanism of PZA resistance to M.tb. MDR-TB patients have a high prevalence of PZA resistance (10%-85%), resistance to PZA in MDR-TB is associated with poor outcome, while PZA-sensitive patients using fluoroquinolone (FQ) and second-line injectable drugs (SLIDs) will significantly improve the success rate of treatment in MDR-TB. The following measures may potentially improve the curative effect, save the cost, and reduce the side effects of MDR-TB treatment: use molecular tests to rapidly identify PZA-sensitive MDR-TB (Z^S-MDR-TB), PZA-resistant MDR-TB (Z^R-MDR-TB) and susceptibility profile for FQ and SLIDs; avoid the use of PZA in the patient with Z^R-MDR-TB; and explore a combined chemotherapy regimen comprising PZA to shorten the treatment duration of Z^S-MDR-TB.

Discussion on establishing new mode of financing for TB diagnosis and treatment services

LIU Xiao-jun, XU Yong, ZHANG Pei, ZHOU Ping, FANG Zheng-chao.

Journal of Tuberculosis and Lung Health. 2014, 3(2):  82-85.  doi:10.3969/j.issn.2095-3755.2014.02.002

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We collected the medical expenses of 1592 cases of TB inpatients covered by new rural cooperative medical care system (referred to as “NCMS”) and of 722 cases covered by medical insurance, found the highest of reimbursement rate for inpatient covered by NCMS was up to 70.00% and the lowest was 35.52%,the outpatient cost for TB patients themselves were full at their own expenses;the reimbursement rate by workers medical insu-rance was up to 71.69% for TB patients, 53.6% for patients covered by resident care insurance, and the outpatient reimbursement rate was only 20.45%. Therefore the TB patients still bear large proportion of cost for TB diagnosis and treatment, the medical burden for them is still heavy. The TB institutions should do the calculation and coordination, perform the government duties, and establish the fund raising mechanism, take the advantage for multi-ways of fund raising system to compensate for TB prevention and treatment, protect the TB patients, promote TB prevention and treatment and further serve for public health equalization.

Value of “lesion stability of chest radiograph as treatment completion criteria” in TB treatment

LI Hong-xing, KAN Hong-yan, WANG Zhi-gang, YANG Ji-qing, CHEN Guang-qing, HE Rui, LI Wen-qiang, YANG Chun-xia, LI Li.

Journal of Tuberculosis and Lung Health. 2014, 3(2):  86-90.  doi:10.3969/j.issn.2095-3755.2014.02.003

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Objective To understand the value of lesion stability of chest radiograph as treatment completion criteria in smear positive TB treatment.Methods The chest X-ray films of smear positive TB patients cured in Yuanjiang county CDC from 2005 to 2012 were collected, and the changes of lesion were observed in 3, 6, 9,12,15,18 months after treatment, and the rate of drug withdrawal was analyzed, and median, M=P₅₀ on time of drug withdrawal was calculated.Results There were 85.0%(611/719) people whose focus had been reduced evidently in 719 new smear positive patients during the third month, and 194 patients stopped taking medicine after 6 months of treatment, and the rate of drug withdrawal was 27.0%(194/719),and 525 patients lengthened the treatment. The median of time on stabile foci is 11.09 months; There were 77.9%(67/86) people whose focus had been reduced evidently in 86 retreatment smear positive patients during the ninth month, and 18 patients stopped taking medicine after 9 months of treatment, and the rate of drug withdrawal was 20.9%(18/86), and 68 patients prolonged the treatment. The median time on stabile foci is 14.21 months.Conclusion That stabile foci as a standard to stop taking medicine is beneficial to TB thorough treatment.

Analysis on the results of bacteria identification and drug sensitivity test among patients with culture-positive pulmonary tuberculosis in Suzhou

JIANG Jun,ZHANG Xiao-long.

Journal of Tuberculosis and Lung Health. 2014, 3(2):  91-95.  doi:10.3969/j.issn.2095-3755.2014.02.004

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Objective In order to provide more reference to the diagnosis and treatment of pulmonary tuberculosis (TB), to analyze the distributions of non-tuberculous mycobacterium (NTM) and drug-resistant (DR) TB among the patients with culture-positive pulmonary TB in Suzhou.Methods Identification of bacteria and drug sensitivity test (DST) were performed for 371 patients with culture-positive pulmonary TB who were detected from January 2012 to May 2013 in Suzhou city and the results of the tests were analyzed; at the same time, the basic information of those patients were collected. With the SPSS 19.0 software, the unconditional logistic regression model was used to identify the associated factors influencing the distribution of Mycobacterium tuberculosis (Mtb) and NTM.Results Among 371 culture-positive pulmonary TB patients, 316 patients (85.2%) were Mtb while 55 patients (14.8%) were NTM; 79 patients had multidrug-resistance (MDR), so the overall MDR rate was 21.3%. Out of the 79 patients with MDR, 32 patients (10.1%, 32/316) were Mtb while 47 patients (85.5%, 47/55) were NTM. The MDR rate in NTM patients was significantly higher than that in Mtb patients (χ²=158.608, P<0.001). Multivariate logistic regression analysis showed that the following two factors were the independent factors influencing the distribution of Mtb and NTM: age ≥65 year (OR=0.108, 95%CI=0.016-0.711, P=0.021) and the history of anti-TB treatment (OR=0.277, 95%CI=0.145-0.532, P<0.001).Conclusion The situation of drug resistance and the infection of NTM in patients with culture-positive pulmonary TB are serious in Suzhou city, so the diagnosis and treatment patterns should be improved.

Cost-benefit analysis of the National Tuberculosis Control Programme (2002—2012) in Guoyang county

LIU Ting-jie.

Journal of Tuberculosis and Lung Health. 2014, 3(2):  96-99.  doi:10.3969/j.issn.2095-3755.2014.02.005

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Objective To analyze the cost effectiveness of the National Tuberculosis Control Programme (NTP) in Guoyang county, and to evaluate the implementation effect of the NTP.Methods An evaluation on the basis of the standards and requirements of final-term evaluation of NTP (2002—2012) was conducted.Results From 2002 to 2012, 5.4714 million Yuan had been invested in total in the county, and 9611 active tuberculosis cases had been treated successfully. It resulted in 3258 fewer deaths, 41695 fewer infections and 4170 fewer attacks of tuberculosis. Medical cost (direct social benefit) of 4.8675 million Yuan was saved, and social economic value (indirect social benefit) of 232million Yuan was retrieved.Conclusion The implementation of the NTP in Guoyang county has achieved notable social and economic benefits,which is cost-benefit in the disease control and prevention.

Analysis of latent tuberculosis infection among village and township hospital doctors in Hanggin Rear Banner of Inner Mongolia

YAN Dai-qin, SONG Yu-dan, WANG Ya-li, GAO Fei, REN Li-ping, CHEN Liang, HE Guang-xue.

Journal of Tuberculosis and Lung Health. 2014, 3(2):  100-103.  doi:10.3969/j.issn.2095-3755.2014.02.006

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Objective To investigate the current situation of latent tuberculosis infection (LTBI) among village and township hospital doctors in Hanggin Rear Banner of Inner Mongolia.Methods A cross-sectional study was conducted in November 2011. All village and township hospital doctors who had been registered at the local health authorities were recruited in the study and received the questionnaire investigation and tuberculin skin test (TST). The questionnaire which was used in an investigation of LTBI and TB incidence among the Chinese village and township hospital doctors in the China-U.S. Collaborative Program on Emerging and Reemerging Infectious Diseases (EID) was also used for this study. A total of 443 questionnaires were distributed and all questionnaires were returned and valid, so the overall response rate was 100.0%. The statistical indexes, such as constituent ra-tio, were used to analyze the basic information of the doctors. The rate of LTBI was calculated based on the different cutoff value of TST (average induration diameter of 5mm and 10mm were taken as the cutoff value of TST respectively).Results A total of 443 village and township hospital doctors in Hanggin Rear Banner received questionnaire investigation. Among them, the proportion of male doctors was 50.6% (224/443), the median age was 39 years old and the proportion of doctors who had high school diploma or equal education level was 62.8% (278/443). Four hundred and thirty-nine doctors received TST. Among them, the rates of LTBI were 39.9% (175/439) and 17.5% (77/439) respectively by taking 5mm and 10mm as the cutoff values of TST.Conclusion The rate of LTBI among village and township hospital doctors in Hanggin Rear Banner is higher. The effective TB infection control measures should be adopted in the basic health facilities in rural areas.

Analysis of knowledge, attitude and behavior on tuberculosis control and prevention among 454 primary and secondary school students in Panyu district of Guangzhou

GUO Wan-ru,TAN Shou-yong, LAO Luo-bin, HE Chao-wen,LIN Hui, LAI Jing-wen.

Journal of Tuberculosis and Lung Health. 2014, 3(2):  104-109.  doi:10.3969/j.issn.2095-3755.2014.02.007

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Objective To understand the situation of knowledge, attitude and behavior on tuberculosis (TB) control and prevention among students from a primary school and a middle school in Shiqi Town of Panyu District, Guangzhou City, and to provide direction and focus for health education of TB.Methods An investigation was conducted in a primary school and a middle school of Panyu District on 10-15 May 2013. Four hundred and sixty-four students were recruited through cluster sampling. Face-to-face interview with a standard questionnaire was carried out in participants and the following information were collected: the basic information of the students, the awareness of 5 TB core information, attitude and behavior on TB, the method to obtain TB knowledge, as well as what knowledge related to TB are needed. In the end, the number of valid questionnaires was 454, so the rate of effective response was 97.84% (454/464), including 230 junior middle school students in grade 2 and 224 primary school students in grade 5. The FoxPro software was used for the establishment of the database and the statistics analysis; the χ² test was used to analyze the difference between the groups.Results The overall awareness rate of 5 TB core information was 70.44% (1599/2270), and it was 79.22% (911/1150) and 61.43% (688/1120) respectively among the junior middle school and primary school students; it was 68.08% (674/990) and 72.27% (925/1280) respectively among the male and female. The rates of students who had active attitude towards knowing more about TB, who showed concern about whether the classmate gets TB or not, who were willing to take actions on TB prevention were 33.04% (74/224), 23.21% (52/224) and 60.71% (136/224) respectively among the primary school students; the rates were 46.09% (106/230), 50.43% (116/230) and 98.26% (226/230) respectively among the junior middle school students. The rates of correct answers to questions about no spitting, ventilation by opening windows, strengthening physical exercise, health-seeking behavior were respectively 77.68% (174/224), 69.64% (156/224), 67.86% (152/224) and 54.46% (122/224) in the primary school students; those rates were 96.52% (222/230), 94.78% (218/230), 89.57% (206/230) and 86.96% (200/230) respectively in the junior middle school students. The top 3 methods for the primary school students to acquire information/knowledge were from newspapers and magazines 60.71% (136/224), school courses 58.93% (132/224) and TV 58.04% (130/224); for the junior middle school students, the top 3 methods were from TV 87.83% (202/230), newspapers and magazines 77.39% (178/230), internet and broadcast 73.91% (170/230). The rates of students who would like to obtain the knowledge about TB prevention, treatment, rehabilitation and others were 83.04% (186/224), 58.93% (132/224), 58.93% (132/224) and 3.57% (8/224) in the primary school students; the rates were 97.39% (224/230), 90.43% (208/230), 88.70% (204/230) and 11.30% (26/230) in the junior middle school students.Conclusion The students in junior middle school and primary school of Panyu District had lower awareness of the core information and correct behaviors on TB prevention and control; the knowledge acquisition approach of the students was inadequate; the students were lack of motivation and positive attitude towards obtaining TB knowledge. According to the different needs of the students at different school levels, the TB institutions should carry out school health promotion activities in more effective ways to improve the TB knowledge level of students.

Analysis on the result of clinical isolates and sputum samples using Gene Xpert Mtb/RIF

SONG Shi-sen.

Journal of Tuberculosis and Lung Health. 2014, 3(2):  110-114.  doi:10.3969/j.issn.2095-3755.2014.02.008

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Objective To analyze the result of clinical isolates (strains of acid-fast bacilli) and sputum samples using Gene Xpert Mtb/RIF (Xpert) and to evaluate the value of Xpert.Methods One hundred and forty-eight clinical isolates and 40 sputum samples were detected using Xpert. Forty sputum samples were cultured with acid Lwenstein Jensen (L-J) me-dium. All clinical isolates were identified with medium (PNB) and performed drug susceptibility testing(DST).Results (1) 144 Mycobacterium tuberculosis(Mtb) and 4 nontuberculosis mycobacteria(NTM) were identified by Xpert in 148 clinical isolates, and 37 Mtb and 3 NTM were identified by Xpert in 40 sputum samples. The result was consistent of identification for 4 NTM strains by PNB and Xpert.(2) Culture was positive in 40 smear-positive sputum samples. 181 Mtb were identified in total 188 clinical isolates. Of 181 Mtb, rifampin resistance was 8 strains including 1 mono-resistant to rifampin,6 multidrug-resistant tuberculosis and 1 extensively drug resistant tuberculosis. The DST result was consistent of Xpert’s in strains resistant to rifampin.Conclusion Xpert can assist judgment Mtb and NTM. It has great value to find patient with tuberculosis and drug resistant tuberculosis.

The analysis of bacillus Calmette-Guérin purified protein derivative and tuberculin purified protein derivative in tuberculosis screening among tuberculosis close contacts in school

YUAN Lei-ling, TAN Shao-qing, LI Jia-zheng, WU Zhi-long.

Journal of Tuberculosis and Lung Health. 2014, 3(2):  115-119.  doi:10.3969/j.issn.2095-3755.2014.02.009

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Objective Analyzed the different varieties of purified protein derivative(PPD) used in screening of tuberculosis for tuberculosis close contacts in school, providing reference for school TB screening.Methods According to the sequences of tuberculosis cases found in school, purified protein derivative bacillus Calmette-Guérin(BCG-PPD) and purified protein derivative of tuberculin(TB-PPD) tests for tuberculosis close contacts were carried out respectively in 11 and 5 schools(1098 cases).The results were observed after 72 hours. Skin induration ≥5 mm is positive, ≥15 mm or partially blisters, necrosis, lymphangitis were strongly positive, <5 mm were negative. The difference between the resistant rates was compared with χ² test, and the significance level was set at P<0.05.Results 846 contacts had received BCG-PPD test, 574 were positive with positive rate of 67.85%; 178 were strong positive with the strong positive rate of 21.04%, 94 were negative with the negative rate of 11.11%.; 2 cases of active pulmonary tuberculosis were detected in Strong positive students, with the detection rate of 1.12%. 252 contacts had accepted TB-PPD test, 68 were positive with the positive rate of 26.98%; 13 were strong positive with the strong positive rate of 5.16%, 171 were negative with the negative rate of 67.86%.; 1 cases of active pulmonary tuberculosis were detected in strong positive students with the detection rate of 7.69%. Result rates of the two groups had significant statistical differences (The positive rate, positive rate and the negative rate of χ²=133.53, 34.08, 341.47, P<0.05). The detection rate of active pulmonary tuberculosis among strong positive population were not statistically significant different(χ²=0.47,P>0.05).Conclusion Different reagents for PPD test results varied, In school TB close contacts screening, PPD selection should from the perspective of preventing the undetected TB patients.

Epidemiological analysis on registered tuberculosis patients in Rizhao city during 2005—2012

CHEN Li, DING Xiu-qin, LU Ji-xu.

Journal of Tuberculosis and Lung Health. 2014, 3(2):  120-123.  doi:10.3969/j.issn.2095-3755.2014.02.010

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Objective To understand the features of tuberculosis epidemic in Rizhao city, so as to provide scientific basis for setting prevention plans.Methods Ten thousand one hundred and eighty-three tuberculosis patients registered were analyzed, patients’ information were collected by monthly, quarterly and annual reports in Rizhao city during 2005—2012.Results The TB registration rate fell from 46.22/100000(1302/2817066) of 2005 to 35.09/100000(1011/2880986) of 2012 in Rizhao city. In terms of the occupational distribution, farmers accounted for 76.22％(7761/10183), followed by workers 6.41%(653/10183) and the student 5.29%(539/10183); male to female is 2.56∶1(7321/2862); In terms of the age distribution, 15- year-old group were in first place, accounting for 18.53%(1887/10183); Sex and age distribution, male the highest is 55- year-old group, accounting for 20.04%(1467/7321), and the female highest is 15- year-old group, accounting for 27.64%(791/2862).Conclusion The epidemic situation of tuberculosis declined in Rizhao city during 2005—2012 but still in high level. Modern tuberculosis control strategies should be further promoted.

Impact of nursing intervention on sputum specimen quality of tuberculosis patients

GAO Yan-bo, GAO Cui-nan, XU Zhuo-wei, SHU Yang, ZHOU Lin.

Journal of Tuberculosis and Lung Health. 2014, 3(2):  124-127.  doi:10.3969/j.issn.2095-3755.2014.02.011

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Objective sTo evaluate the impact of nursing intervention on sputum specimen quality of tuberculosis (TB) patients, and to explore new nursing intervention methods to improve the sputum specimen quality.Methods A total of 1105 TB suspects or patients were registered in the Guangzhou Chest-Disease Hospital or Guangdong TB Control Center from Dec.2011 to Jan. 2013. According to the visit number, the subjects were divided into study and control groups randomly. 496 patients in control group collected the sputum specimen by themselves and 609 patients in study group were trained how to collect the sputum specimen by the nurses. The quality of sputum specimens and the detection rate of Mycobacterium tuberculosis were compared.Results There were 412 qualified sputum specimens in control group and the qualification rate was 83.1% (412/496), 130 positive sputum specimens were detected and the positive detection rate was 26.2%. In study group there were 579 qualified sputum specimens and the qualification rate was 95.1% (579/609), 207 positive sputum specimens were detected and the positive detection rate was 34.0%. There were significant difference between the two groups in sputum specimen qualification rate and the positive detection rate (χ²=42.6 and 7.81, P<0.01). The AFB (+) proportion was 19.2% (25/130) and 29.0% (29/207) respectively between control group and study group, and that of the control group was lower than the study group (χ²=4.03, P<0.05).Conclusion The nursing intervention can improve the quality of sputum specimen of TB patients and the positive detection rate can be improved as well. The nursing intervention can especially improve the positive detection rate of those with light lesion and little discharge of bacteria, and can reduce the misdiagnosis of smear positive TB cases.

Investigation and analysis of antibiotics application among patients with pulmonary tuberculosis

SHANG Ming-qun, XU Ye.

Journal of Tuberculosis and Lung Health. 2014, 3(2):  128-130.  doi:10.3969/j.issn.2095-3755.2014.02.012

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Objective To investigate the situation of the use of antibiotics among the in-patients with pulmonary tuberculosis (TB) in the Department of Lung Disease of our hospital, and to explore the importance of the rational use of the antibiotics.Methods A retrospective analysis was conducted in 300 patients who were confirmed to have pulmonary TB and once stayed at the Department of Lung Disease of our hospital within 3 years (2009, 2010 or 2011). The situation of the use of the common antibiotics (excluding anti-TB drugs) among those recruited pulmonary TB patients was analyzed, and the rational use of the antibiotics was evaluated.Results Among 300 study subjects, only 30 patients (10.0%) did not receive the treatment of common antibiotics and the rate of the use of common antibiotics was 90.0%. Common antibiotics were rationally used in 210 cases, accounting for 70.0%; they were irrationally used in 60 cases, accounting for 20.0%. The most frequently used drug was levofloxacin (85.3%, 256/300), and followed by cefoperazone-sulbactam (45.3%,136/300), mezlocillin (17.7%, 53/300) and cefonicid (15.0%, 45/300).Conclusion The irrational use of the antibiotics still exists in the pulmonary diseases ward of our hospital. In order to achieve the better treatment outcomes, it is important to explore the rational use of anti-biotics during the treatment of pulmonary TB; and it is also essential to strengthen the management of the use of antibiotics.