Table of Content

30 December 2018, Volume 7 Issue 4

Previous Issue    Next Issue

Original Articles

Study of invasive adenocarcinoma as pulmonary pure ground glass nodules with CT value less than -560HU using thin-slice CT

Shuai HU,Meng-ying LI,Si-yu CHE,Guang-qing HAN,Xin-yan LIU,Ai-lian LIU,Zhi-yong LI

Journal of Tuberculosis and Lung Health. 2018, 7(4):  236-240.  doi:10.3969/j.issn.2095-3755.2018.04.003

Abstract ( 1513 )   HTML ( 14 )   PDF (3294KB) ( 571 )   Save

Figures and Tables | References | Related Articles | Metrics

Objective To explore imaging characteristics of invasive adenocarcinoma (IA) as pulmonary pure ground glass nodule (pGGN) with CT value less than -560HU using thin-slice CT.Methods One hundred and forty-four patients with pGGN of CT value less than -560HU confirmed by surgical pathology in the First Affiliated Hospital of Dalian Medical University were enrolled in this study. They were divided into two groups: 8 patients in IA and 136 in non-IA (including atypical adenomatous hyperplasia, adenocarcinoma in situ, microinvasive adenocarcinoma). All patients performed thin-slice CT scan. We measured the maximum diameters of pGGN.Results The maximum diameter of pGGN with CT value less than -560HU in IA group (2.00±0.71cm) was significantly larger than non-IA group (0.92±0.43cm)(t=-4.495,P=0.003),AUC=0.94, best cut-off value was 1.10cm, sensitivity was 100.00%.Conclusion The maximum diameter of pGGN with CT value less than -560HU is an optimum parameter to predict IA when cut-off value of maximum diameter is set up 1.10cm.

Differential diagnosis of lung cancers associated with cystic airspaces and cavitary pulmonary tuberculosis by CT

Yang TAN,Tai-chun QIU,Jian-lin WU,Guan-nan ZHANG,Guo-qing ZHANG

Journal of Tuberculosis and Lung Health. 2018, 7(4):  241-244.  doi:10.3969/j.issn.2095-3755.2018.04.004

Abstract ( 691 )   HTML ( 7 )   PDF (1332KB) ( 879 )   Save

Figures and Tables | References | Related Articles | Metrics

Objective To retrospectively analyze the CT features of lung cancers associated with cystic airspaces and cavitary pulmonary tuberculosis, and to improve the diagnosis and differential diagnosis.Methods Twenty-three cases with lung cancer associated with cystic airspaces who were admitted to Affiliated Zhongshan Hospital of Dalian University and confirmed by surgery and/or biopsy between March 2015 and May 2018 were collected as lung cancer group. In the same period, 31 cases of cavitary tuberculosis confirmed by laboratory bacteriological examination and clinical follow-up or treatment from Tuberculosis Hospital of Dalian were selected as tuberculosis group. The CT data of the patients were collected and the CT feature were compared between two groups.Results Most of the lesions were located in the right lung (lung cancer group: 60.9% (14/23); tuberculosis group: 61.3% (19/31)). The lesion size of lung cancer group was smaller than that of the tuberculosis group ((17.19±11.02) mm vs (27.13±10.42) mm), and the difference was statistically significant (t=-2.55, P=0.014). The average thickness of cavity wall of the lung cancer group ((1.91±0.73) mm) was smaller than that of the tuberculosis group ((2.69±0.47) mm), and the difference was statistically significant (t=3.05, P<0.05). The rate of patients with wall nodules in the cystic cavity in the lung cancer group (47.8%, 11/23) was higher than that in the tuberculosis group (19.4%, 6/31), and the difference was statistically significant (χ ²=7.69, P<0.05). In the lung cancer group, shadow of the vascular branch in the cystic cavity was shown in 43.5% (10/23) of the patients, but no vascular branch shadow appeared in the cavity of the tuberculosis group. The difference was statistically significant (χ ²=11.71, P<0.01). In the lung cancer group, 5 patients (21.7%) had lobular stenosis at the edge of the cyst, and 13 patients (56.5%) had burr marks. In the tuberculosis group, the lobes were visible at the margin of the cavity in 6 patients (19.4%), and 16 patients (51.6%) had burr sign. The difference was not statistically significant (χ ²=0.61, P>0.05). Among the patients in the lung cancer group, 12 patients (52.2%) had pleural indentation, and 23 patients (74.2%) in the tuberculosis group had different degrees of adjacent pleural thickening. The difference was statistically significant (χ ²=11.04, P<0.05). Conclusion CT findings of lung cancers associated with cystic airspaces are characteristic. Typical CT features can help us make a suggestive diagnosis of this type of lung cancer, and help to differential diagnosis from cavitary tuberculosis.

Clinical study on multi-dimensional CT signs of ground glass lung adenocarcinoma to predict its invasion degree

Feng LI,Tai-chun QIU,Jia-wei LI,Jian-lin WU

Journal of Tuberculosis and Lung Health. 2018, 7(4):  245-250.  doi:10.3969/j.issn.2095-3755.2018.04.005

Abstract ( 465 )   HTML ( 5 )   PDF (989KB) ( 542 )   Save

Figures and Tables | References | Related Articles | Metrics

Objective Identify the value of multi-dimensional CT sings in predicting the tumor invasion degree and pathological subtype of lung adenocarcinoma characterized with ground-glass nodule(GGN).Methods Retrospective analysis of CT imaging data of 230 patients with pulmonary ground-glass nodules confirmed by pathology from January 2013 to December 2017 in Zhongshan Hospital affiliated to Dalian University, 12 patients had 2 lung ground-glass nodules. According to the latest classification criteria for lung adenocarcinoma in 2011, there were 110 preinvasive lesions, 32 microinvasive and 100 invasive adenocarcinomas. Analysis of CT signs, including general dimensions, marginal dimensions, internal dimensions, and lumen dimensions (including vascular and bronchial CT signs)Results (1) In general dimension signs, the proportion of round/quasi-round lesions in the preinvasive lesion group, microinvasive adenocarcinoma group and invasive adenocarcinoma group were 59.1% (65/110), 68.8% (22/32), 55.0% (55/100) respectively, the difference was not statistically significant (χ ²=1.904,P>0.05).However, the diameters of GGN lesions in three groups were (10.0±4.7)mm, (11.0±5.1)mm and (17.4±7.0)mm respectively,the difference was significant (U=68.312,P<0.05). ROC curve analysis showed that the preinvasive lesions and invasive adenocarcinoma lesions (including microinvasive and invasive lesions) had a critical value of 1.29 cm, and the diagnostic sensitivity is 70.0%, the specificity is 80.7%, and the AUC (area under ROC curve) is 0.802.(2)In marginal dimension signs, the proportion of lobulated signs were 21.8% (24/110), 56.3% (18/32) and 82.0% (82/100) in preinvasive lesion group, microinvasive adenocarcinoma group and invasive adenocarcinoma group respectively. The difference was statistically significant (χ ²=76.304,P<0.05).(3) In internal dimension signs, the proportion of vacuole signs in three groups were 10.9% (12/110), 18.8% (6/32), 55.0% (55/100) respectively. The difference was statistically significant(χ ²=50.620,P<0.05). (4) In lumen dimension signs, Vascular signs were obvious in type Ⅲ (57.0%, 57/100) and Ⅳ (40.0%, 40/100) invasive adenocarcinoma, type Ⅲ (62.5%, 20/32) microinvasive adenocarcinoma and in type Ⅱ (65.5%, 72/110) preinvasive lesions group. Bronchial signs were obvious in invasive adenocarcinoma type Ⅱ (34.0%, 34/100) and Ⅲ (37.0%, 37/100), microinvasive adenocarcinoma type Ⅲ (40.6%, 13/32) and preinvasive lesions type Ⅳ (50.9%, 56/110). There were significant differences among the three groups(χ ² values are 141.749、134.268,P<0.05).The accuracy of predicting probability of preinvasive lesions and invasive adenocarcinoma through vascular signs and bronchial signs alone or in combination were 86.4%(209/242)、82.2%(199/242)、89.3%(216/242)respectively. Conclusion Comprehensive analysis of multi-dimensional CT signs is helpful for preoperative prediction of GGN-like lung adenocarcinoma infiltration and pathological subtypes, especially the simultaneous identification of vascular signs and bronchial signs and combined diagnosis were more effective than the diagnosis of each sign. Multi-dimensional CT signs provides new information and direction for the preoperative prediction of GGN-like lung adenocarcinoma infiltration.

Clinical characteristics of renal tuberculosis in fourteen children

Yan GUO,Yu ZHU,Lin SUN,Xue QI,Xue-meng WAN,Xiao-rong LIU

Journal of Tuberculosis and Lung Health. 2018, 7(4):  251-254.  doi:10.3969/j.issn.2095-3755.2018.04.006

Abstract ( 520 )   HTML ( 9 )   PDF (810KB) ( 482 )   Save

References | Related Articles | Metrics

Objective We analyzed the clinical characteristics of children with renal tuberculosis to provide clues for the early diagnosis of renal tuberculosis in children.Methods We retrospectively analyzed the clinical data on 14 cases who hospitalized and diagnosed with renal tuberculosis in Beijing Children’s Hospital, Capital Medical University and West China Second Hospital, Sichuan University between January 2009 and December 2014, including the general information, medical history, clinical manifestations, and imaging features.Results The median age of the 14 children was 9.5 (9.3, 12.7) years old. Three of them only had renal tuberculosis, ten were complicated with pulmonary tuberculosis and extrapulmonary tuberculosis, and the remaining one was complicated with pulmonary tuberculosis. The interval between onset of the diseases and hospitalization was 2.0 (1.0, 7.0) months. Before hospitalized in our hospitals, all 14 children were diagnosed and treated in local hospitals, five of who were diagnosed with pulmonary tuberculosis, two were diagnosed with extrapulmonary tuberculosis, two were diagnosed with renal tuberculosis, and the remaining five were diagnosed with other disease but not tuberculosis. The most common symptom was fever (11 cases), followed by signs of urethral irritation such as urinary frequency, urgency and pain (three cases), hematuria (three cases), percussed pain in kidney (two cases), and low back pain (one case). Acid fast stain positive results were observed in urine sample in one child, gastric samples in two children and sputum sample in one child. Urine routine examination showed that 5 cases had positive urine occult blood and 5 patients had positive urine protein. Among the 14 children, 11 performed renal B-ultrasound or pelvic angiography examination, and the imaging results showed renal parenchyma damage, hydronephrosis and ureteral expansion.Conclusion Renal tuberculosis in children lacks systemic symptoms, and was usually complicated with tuberculosis infection in other sites. The urinary symptoms are not common. Renal tuberculosis has a long latency period, leading to a delay in diagnosis. Imaging and laboratory examination are critical for early diagnosis of renal tuberculosis.

Renal tuberculosis as manifestation of autonephrectomy in two cases and literature review

Jie ZHANG,Yu-qin LIU,Yu-ze LI,Li-qing HAN,Shu-qin LIU,Hong-ming LI,Yang SUN,Yu-ling QI

Journal of Tuberculosis and Lung Health. 2018, 7(4):  255-260.  doi:10.3969/j.issn.2095-3755.2018.04.007

Abstract ( 504 )   HTML ( 7 )   PDF (2455KB) ( 628 )   Save

Figures and Tables | References | Related Articles | Metrics

Objective To summarize the clinical, imaging and pathological features of renal tuberculosis as manifestation of autonephrectomy in order to improve the clinical diagnosis level of autonephrectomy.Methods We analyzed the clinical features, pathological manifestations, laboratory results, imaging characteristics, treatment and prognosis in two cases of renal tuberculosis with autonephrectomy admitted in Infectious Disease Hospital of Heilongjiang Province on Nov. 11, 2017 and Dec. 4, 2017, respectively. Taking 2000-2018 as the retrieval time and “renal tuberculosis, autonephrectomy” as the key word, 10 articles including 12 cases were retrieved from PubMed, Wanfang database and China National Knowledge Infrastructure (CNKI). The general information, duration of disease, location of lesion, clinical manifestations, laboratory and imaging results, complications, diagnostic methods, treatment and prognosis were collected and made meta-analysis.Results There were frequent micturition, urgent micturition, odynuria and lumbago in two cases. The results of molecular biology of Mycobacterium tuberculosis including the gene chip assay for Mycobacterium tuberculosis resistance in urine and T-SPOT.TB test in blood were all positive. Renal CT showed volumetric reduction and complete calcification in the left renal. Intravenous pyelography showed no development of left renal pelvis, renal calyx and ureter. Clinical diagnosis was autonephrectomy. Two patients underwent left nephrectomy. The gross pathological features were grayish yellow cysts on the cut surface of renal tissue, gray-yellow gray-white necrotic foci in the capsule, and yellowish soybean dregs like greasy substance in the renal tissue. Chemotherapy containing pasiniazide or isoniazid, rifampicin, ethambutol, pyrazinamide was performed after operation for one year. After 6 and 9 months of discharge, the symptoms of frequent micturition, urgent micturition, odynuria disappeared. There were 14 cases data including 12 cases with autonephrectomy from literature screening and 2 cases from the report of this study. Of 14 cases, 9 cases were male and 5 cases were female, aged from 34 to 77 years old. There were bilateral renal tuberculosis in 3 cases and unilateral renal tuberculosis in 11 cases including 6 cases in left renal and 5 cases in right renal. The volume of diseased renal reduced and complicated with calcification in 12 cases, and the volume of diseased renal enlarged with circular cysts and thick-walled circular calcification in 2 cases. There were complicated with hypertension in 2 cases, seminal vesicle tuberculosis and bladder tuberculosis in 1 case, epididymis tuberculosis in 2 cases, retroperitoneal lymph node tuberculosis in 1 case, right spontaneous renal fistula in 1 case, and contralateral ureteral calculi complicated with acute renal failure in 3 cases. Nephrectomy of diseased renal underwent in 6 cases, and chemotherapy was performed in 5 cases, and treatment was done with unknown regimen in 3 cases. The symptoms of frequent micturition, urgent micturition, odynuria disappeared in all cases after treatment.Conclusion The clinical symptoms are more serious with more complications in renal tuberculosis with nephrectomy. Imaging examination is an important means of diagnosis. Nephrectomy of diseased renal is one of the important methods of treatment.

Epidemiological investigation on an aggregation outbreak of tuberculosis in floating population in a company in Tianjin

Xiao-rong LI,Yan-yong FU,Ming-jie YANG

Journal of Tuberculosis and Lung Health. 2018, 7(4):  261-267.  doi:10.3969/j.issn.2095-3755.2018.04.008

Abstract ( 422 )   HTML ( 4 )   PDF (975KB) ( 648 )   Save

Figures and Tables | References | Related Articles | Metrics

Objective To analyze an aggregation outbreak of tuberculosis mainly in floating population in an electronics Co., Ltd. in Tianjin city, and to explore the prevention and control strategy of tuberculosis in floating population in enterprises and institutions.Methods The case investigation of 19 tuberculosis patients diagnosed in an electronics Co., Ltd in Tianjin from January 2017 to April 2018, screening report of close contacts and field epidemiological investigation report of the electronics co., LTD. were collected. The epidemic characteristics of this outbreak were summarized and analyzed.Results The age of the 19 clinically diagnosed tuberculosis cases were from 21 to 42 years old, with an average of 29.68±7.29 years. Fifteen patients were migrant workers from other provinces and 4 patients were Tianjin registration personnel. Eight cases were in complete machine assembly (LX) department and 7 cases were in electron segment assembly (LVI) department. After the outbreak, the company organized three close contacts screening with the Tanggu Tuberculosis Control Institute. A total of 1796 staff in LX and LVI departments and the dormitory were screened. Seventeen suspected patients were found and 10 cases (58.82%) were confirmed. According to the distribution of time, region and population, this outbreak of tuberculosis was considered to be caused by a typical mixed transmission, that was, the first aggregation was not treated in time, resulting in continued transmission and triggering secondary patients.Conclusion The outbreak of tuberculosis was mainly in floating population, showing a certain aggregation characteristic. Strengthening the responsibility consciousness of medical institutions at various levels, strengthening tuberculosis core knowledge education in the floating population, and improving the communication system of infectious diseases situation between Tuberculosis Prevention and Control Institutions and large-scale labor enterprises are the key to controlling the tuberculosis epidemic among floating population in enterprises and institutions.

Clinical application of multicolor melting curve analysis in detection of drug resistance of Mycobacterium tuberculosis in sputum samples

Ming YU,Xin-xin XU,Peng YAN,Bao-qing ZHANG,Chun-tao LIU,Jing-qiu WU,Yu-qin LIU,Kai-li WANG,Yan-jie HOU

Journal of Tuberculosis and Lung Health. 2018, 7(4):  268-274.  doi:10.3969/j.issn.2095-3755.2018.04.009

Abstract ( 498 )   HTML ( 5 )   PDF (846KB) ( 561 )   Save

Figures and Tables | References | Related Articles | Metrics

Objective Evaluation of multicolor melting curve analysis (MMCA) in the detection of mycobacterium tuberculosis resistance in sputum Samples.Methods 235 morning sputum specimen, which were concentrated acid-fast bacterium-positive and/or M.tuberculosis molecular test positive, were collected. Then, the MMCA drug-resistant detection, mycobacterium fluid culture and proportion drug-susceptibility testing (DST) were conducted simultaneously. The results of the MMCA and DST were compared using Kappa test. Sanger sequencing was conducted for those samples that had discordant results between MMCA and DST.Results Concordance rates between MMCA and DST for rifampicin (RFP), isoniazid (INH), ethambutol (EMB), levofloxacin (Lfx), moxifloxacin (Mfx), and multidrug-resistant tuberculosis (MDR-TB) were 94.04%(221/235), 90.63% (213/235), 80.00% (188/235), 94.89% (223/235), 77.87% (183/235), and 89.36% (210/235), respectively. The Kappa value between these two methods for RFP, INH, Lfx and MDR-TB were 0.88, 0.81, 0.88, and 0.77, respectively, indicating an excellent consistency. The discordant samples were verified by Sanger sequencing. The total coincidence rates of sequencing results and MMCA for sputum and culture isolates were 89.80%(132/147) and 98.64%(145/147), respectively.Conclusion Direct and rapid detection of drug resistance of mycobacterium tuberculosis in sputum samples by MMCA has good concordance rates with DST or Sanger Gene sequencing. MMCA is easy to operate, rapid and accurate, and it will play an important role in the diagnosis of tuberculosis and rapid screening for drug-resistant tuberculosis.

Analysis of tuberculosis case-finding and incidence in prisoners in Tianjin Prison System during 2011 to 2017

Zhi ZHANG,Wei WANG,Guo-qin ZHANG,Wen-liang WEI

Journal of Tuberculosis and Lung Health. 2018, 7(4):  275-278.  doi:10.3969/j.issn.2095-3755.2018.04.010

Abstract ( 463 )   HTML ( 5 )   PDF (797KB) ( 597 )   Save

Figures and Tables | References | Related Articles | Metrics

Objective To analyze tuberculosis (TB) case-finding as well as the trend among prisoners in Tianjin Prison System.Methods The registration data of 1280 prisoners with pulmonary TB in the Tianjin Tuberculosis Registration and Management System from 2011 to 2017 were collected, and changes in the case-finding methods and incidence were analyzed.Results Among the 1280 pulmonary TB patients, patients found by entry screening, annual massive screening and case-finding based on suspect TB symptoms accounted for 28.6% (366 cases), 42.2% (540 cases) and 29.2% (374 cases), respectively. Regarding the case-finding methods, percent by entry screening increased from 15.2% (30/197) in 2011 to 62.5% (135/216) in 2017, and the difference was statistically significant (χ ²=157.22, P<0.01); percent by massive screening decreased from 35.5% (70/197) in 2011 to 26.4% (57/216) in 2017, and the difference was statistically significant (χ ²=16.33, P<0.01); percent by case-finding based on suspect TB symptoms decreased from 49.3% (97/197) in 2011 to 11.1% (24/216) in 2017, and the difference was statistically significant (χ ²=65.12, P<0.01). The incidence of smear positive pulmonary TB patients among prisoners in Tianjin Prison System declined from 44.0/100000 (9/20450) in 2011 to 9.8/100000 in 2017 (2/20452), and the difference was statistically significant (χ ²=6.60, P=0.010). Conclusion Relying on active (entry screening and massive screening) and passive (based on suspect TB symptoms) case finding, TB prevalence among prisoners in Tianjin was effectively controlled. Compared to conventional passive case finding, active case finding played a more important role in TB control among prisoners.

Effect analysis of awareness rate of tuberculosis prevention and control among the elderly aged ≥65 years in rural areas of Jiangyou City

Jie CAO,Gang CHEN,Ping LIU,Jun LI,Yong GAO,Hong-lin LEI,Rui JING,Fu-you WANG

Journal of Tuberculosis and Lung Health. 2018, 7(4):  279-283.  doi:10.3969/j.issn.2095-3755.2018.04.011

Abstract ( 394 )   HTML ( 4 )   PDF (868KB) ( 539 )   Save

Figures and Tables | References | Related Articles | Metrics

Objective To evaluate the effect of multi-form active health education on the awareness of the core knowledge of tuberculosis (TB) control among the elderly in rural areas.Methods This study was carried out during 2013-2014 with two baseline surveys combined with the annual physical examination project of basic public health services in Jiangyou City, Sichuan Province. Three rural towns in Jiangyou City (Chonghua Town, Houba Town, Erlangmiao Town) were selected by cluster random sampling method as investigation points, and various forms of public health education on TB was carried out from July 2013 to July 2014. Cross-sectional survey was used. Before the face-to-face household baseline survey and 1 year after the implementation of the intervention, the face-to-face inquiry survey was conducted among the permanent residents aged 65 or above by the unified designed questionnaire on the awareness rate of core knowledge of TB prevention and control used in the annual TB baseline survey to understand the awareness of core knowledge before and after the intervention.Results The total awareness rate of core knowledge on TB was increased by 44.35% after the implementation of the intervention ((54.66% (15727/28775) and 10.31% (3053/29640)) (χ ²=13168.16, P<0.001). After the intervention, the percentage of interviewee who provided correct answers for all core knowledge on TB (14.56%, 838/5755) increased by 13.01% (P<0.001) compared with that before intervention (1.55%, 92/5928)(χ ²=674.53, P<0.001). The total awareness rates of male before (12.14%, 1766/(2909×5)) and after intervention (56.95%, 7987/(2805×5)) were higher than those of female (8.53% (1287/(3019×5)) and 52.47% (7740/(2950×5))) (χ ²=104.81, P<0.05). Before and after the intervention, the awareness rate increased by 44.81%in males (χ ²=6375.64, P<0.001) and 43.94% in females (χ ²=6829.73, P<0.001). Conclusion The active health education can increase the awareness rate of TB core knowledge among the elderly aged ≥65 years old in rural areas, and promote and improve active TB detection in the elderly in rural areas. It is an indispensable and important means for the aged TB patients in rural areas to improve their awareness of TB prevention and control.

Evaluation of cross primer amplification technique application in diagnosis of tuberculosis

Bai-feng LIN,Xin SU,Xue-zhi ZHANG

Journal of Tuberculosis and Lung Health. 2018, 7(4):  284-287.  doi:10.3969/j.issn.2095-3755.2018.04.012

Abstract ( 422 )   HTML ( 3 )   PDF (799KB) ( 512 )   Save

Figures and Tables | References | Related Articles | Metrics

Objective To explore amplification of cross primer amplification (CPA) technique in tuberculosis (TB) prevention and control.Methods Sputum specimens were collected from the TB suspects who visited TB clinic of Wuchang TB Dispensary for seeking health care during May 2017 to March 2018. Diagnosis to those TB suspects were performed following the WS 288-2008 Diagnostic Criteria for Tuberculosis. Finally 331 cases were confirmed as TB including 267 cases were pulmonary TB while 64 cases were extra-pulmonary TB. Sputum smear, sputum culture and CPA were performed for TB diagnosis and the effectiveness of CPA was evaluated.Results Among 331 confirmed TB cases, 66 cases were sputum smear positive while 265 cases were smear negative; 136 cases were sputum culture positive while 195 cases were culture negative; 137 cases were CPA positive while 194 cases were CPA negative. When culture was as the standard, the sensitivity and specificity of CPA were 98.94% (186/188) and 92.31% (132/143) respectively; when clinical diagnosis was as the standard, the sensitivity and specificity of sputum smear were 23.97% (64/267) and 96.88% (62/64), the sensitivity and specificity of sputum culture were 48.69% (130/267) and 90.63% (58/64), the sensitivity and specificity of CPA were 51.31% (137/267) and 96.88%(62/64).Conclusion CPA is a new thermostatically diagnostic technology for tuberculosis, which is simple, fast and stable. It has higher sensitivity and specificity on Mycobacterium tuberculosis detection, can significantly improve the positive detection rate of TB. It is suitable for application in tuberculosis laboratories at county/district level.

Diagnostic value of ELISA in HIV-infected patients with tuberculosis

Yan-yan YU,Yun-hong TAN,Zhen-hua CHEN,Zhong-nan CHEN,Bin-bin LIU,Jue WANG

Journal of Tuberculosis and Lung Health. 2018, 7(4):  288-292.  doi:10.3969/j.issn.2095-3755.2018.04.013

Abstract ( 495 )   HTML ( 4 )   PDF (820KB) ( 612 )   Save

Figures and Tables | References | Related Articles | Metrics

Objective To investigate the clinical diagnostic value of enzyme-linked immunosorbent assay (ELISA) in HIV-infected patients with tuberculosis.Methods 95 HIV-infected patients with tuberculosis and 19 HIV-infected patients with non-tuberculosis lung disease were selected as subjects who were diagnosed in Hunan Chest Hospital from January 2015 to September 2018. The positive detection rates of tuberculosis were analyzed with GeneXpert MTB/RIF detection technology (“GeneXpert”), BACTEC MGIT 960 detection technology (“MGIT 960”) and ELISA in whole blood sample. Analyzing the sensitivity, specificity, positive and negative predictive value of the three detection techniques for diagnosing HIV-infected patients with tuberculosis based on clinical diagnosis.Results In 95 HIV-infected patients with tuberculosis, the positive rates of GeneXpert, MGIT 960 and ELISA were 42.11% (40/95), 47.37% (45/95), and 67.37% (64/95) respectively, the positive rate of ELISA was significantly higher than that of GeneXpert and MGIT 960, and the difference was statistically significant (χ ²=50.031,P=0.000). In 19 HIV-infected patients with no-tuberculosis lung disease, the number of positive detection patients were 0, 0 and 3 in three groups. Based on clinical diagnosis, the sensitivity of GeneXpert was 42.11% (40/95), the specificity was 100.00% (19/19), the positive predictive value was 100.00% (40/40), and the negative predictive value was 25.68% (19/74); the MGIT 960 assay was 47.37% (45/95), 100.00% (19/19), 100.00% (45/45), 27.54% (19/69); and the ELISA was 73.56% (64/87), 84.21% (16/19), 95.52% (64/67), and 41.03% (16/39) respectively.Conclusion The detection of ELISA method is rapid and convenient with a high sensitivity, and it is suitable for clinical diagnosis of HIV-infected patients with tuberculosis.

Analysis of epidemic situation of senile pulmonary tuberculosis in Heilongjiang Province from 2011 to 2017

Bi-bo ZHANG,Hong-hai LI

Journal of Tuberculosis and Lung Health. 2018, 7(4):  293-297.  doi:10.3969/j.issn.2095-3755.2018.04.014

Abstract ( 421 )   HTML ( 3 )   PDF (810KB) ( 455 )   Save

Figures and Tables | References | Related Articles | Metrics

Objective To analyze the epidemic characteristics of pulmonary tuberculosis (PTB) in the elderly people in Heilongjiang Province.Methods A total of 227 812 PTB cases whose current address was Heilongjiang Province in “National Notifiable Disease Report System” from 2011 to 2017 were collected, including 38177 cases aged ≥65 years. The demographic data was derived from Heilongjiang Statistical Yearbook. Descriptive statistical methods were used to analyze the epidemic characteristics of senile PTB.Results The reported incidence of senile PTB decreased from 152.7/100000 in 2011 to 122.4/100000 in 2017, indicating an annual decline rate of 3.6%; the difference was statistically significant (χ ²=362.77, P<0.01). The reported incidence of smear-positive senile PTB decreased from 57.4/100000 in 2011 to 26.1/100000 in 2017, indicating an annual decline rate of 12.3%; the difference was statistically significant (χ ²=672.80, P<0.01). The reported incidence of PTB in the elderly was 142.4/100000, which was 1.6 times that of the whole population (87.0/100000). The highest number of elderly PTB cases was reported in the first quarter, which accounting for 30.7% (11717/38177) of the year. The top three cities for the incidence of senile PTB were Mudanjiang City (182.7/100000), Jixi City (180.0/100000) and Shuangyashan City (170.2/100000), respectively. The incidence of senile PTB was highest in the 80-84 age group, which was 175.8/100000. The reported incidence of PTB was 91.1/100000 in elderly males, which was 1.8 times that of the elderly females (51.2/100000). Conclusion From 2011 to 2017, the epidemic situation of PTB in the elderly in Heilongjiang Province showed a downward trend year by year, but it was still serious. The elderly is the focus of TB control in our province.

The values of different detection indicators in early screening for pleural adhesion in patients with tuberculous pleurisy

Yi-min TANG,Juan-juan ZHANG,Tao-sheng YE,Guo-liang ZHANG,Ying-xia LIU

Journal of Tuberculosis and Lung Health. 2018, 7(4):  298-304.  doi:10.3969/j.issn.2095-3755.2018.04.015

Abstract ( 452 )   HTML ( 3 )   PDF (2189KB) ( 502 )   Save

Figures and Tables | References | Related Articles | Metrics

Objective To investigate the values of different detection indicators in early screening for pleural adhesion in patients with tuberculous pleurisy.Methods From March 2015 to March 2017 in the Third People’s Hospital of Shenzhen, 134 patients with tuberculous pleurisy who had been diagnosed for more than one month but were not treated with standardized anti-tuberculosis drugs were included in this study. Patients were divided in the adhesion group (n=102) and non-adhesion group (n=32) according to the occurrence of pleural adhesions or not. Routine biochemical tests (including detection of adenosine deaminase (ADA), lactate dehydrogenase (LDH), and percentage of monocytes (MONO%)), C-reactive protein (CPR) determination, erythrocyte sedimentation rate (ESR) determination, and enzyme-linked immunospot assay (ELISPOT) were conducted for the pleural effusions and peripheral blood. Pleural effusion thickness and pleural thickness were measured by CT scan and were scored. The correlations between various indicators and pleural adhesion in patients with tuberculous pleurisy were analyzed by using SPSS 17.0, and the receiver operating characteristic (ROC) curve analyses for the significant indicators were analyzed by Graphpad software.Results There were no statistical significances in the levels of MONO%, CRP, ESR, pleural adhesion score by CT, pleural effusion thickness, pleural thickness, PBMC-ELISPOT-E6, PBMC-ELISPOT-peptide, PFMC-ELISPOT-E6, and PFMC-ELISPOT-peptide between the patients in the adhesion group ((68.36±30.72)%, (51.21±34.95) mg/L, (52.37±28.44) mm/1h, (6.76±6.03) points, (33.50±16.65) mm, (4.70±3.70) mm, (59.87±48.94) SFCs/well), (72.37±72.40) SFCs/well, (244.20±28.70) SFCs/well, and (242.00±134.20) SFCs/well) and non-adhesion group ((83.37±12.63)%, (58.36±47.66) mg/L, (54.36±29.92) mm/1h, (5.07±5.47) points, (28.85±21.30) mm, (3.60±3.00) mm, (60.71±64.52) SFCs/well, (44.80±52.39) SFCs/well, (203.10±174.70) SFCs/well, and (203.10±174.70) SFCs/well) (t=1.882, P=0.067; t=0.520, P=0.604; t=0.511, P=0.826; t=0.943, P=0.352; t=2.352, P=0.022; t=0.584, P=0.571; t=0.400, P=0.691; t=1.310, P=0.197; t=0.914, P=0.373; and t=0.720, P=0.372, respectively). The ADA ((78.49±24.42) U/L) and LDH ((613.40±172.20) U/L) levels in the adhesion group were higher than those in the non-adhesion group (49.64±18.98) U/L and (348.80±131.40) U/L) (t=24.981 and 22.590, P values <0.001). ROC curve analysis was performed on the ADA and LDH values. The area under the curve (95%CI), sensitivity, and specificity of ADA and LDH levels in diagnosing pleural adhesion in patients with tuberculous pleurisy were 0.84 (0.76-0.93) and 0.89 (0.82-0.96), 81.30% and 81.82%, and 84.35% and 73.68%.Conclusion The levels of ADA and LDH in pleural effusion of patients with tuberculous pleurisy are significantly different in the non-adhesion group and the adhesion group, and can be used as important indicators to predict the occurrence of pleural adhesion in the late stage of tuberculous pleurisy.

Discussion on surgical treatments for chronic massive tuberculous empyema

Yong FENG,Hong-bin LIANG,Wei-zhong DING

Journal of Tuberculosis and Lung Health. 2018, 7(4):  305-310.  doi:10.3969/j.issn.2095-3755.2018.04.016

Abstract ( 395 )   HTML ( 7 )   PDF (939KB) ( 500 )   Save

Figures and Tables | References | Related Articles | Metrics

Objective To discuss surgical treatments for chronic massive tuberculous empyema.Methods From 2015 to 2017 in Shenyang Chest Hospital, 36 patients who underwent surgical resection, were pathologically confirmed as tuberculous empyema after surgery, and had empyema occupying more than 50% of the thoracic cavity of the affected side (indicated by preoperative chest X-ray) were included in this study, including 20 patients with large encapsulated empyema and 16 patients with total empyema. The therapeutic effects of pleural fiberboard decortication, pleural pneumonectomy and thoracoplasty for different patients were analyzed.Results All 36 patients underwent complete resection of the lesions. Twenty-six patients underwent pleural fiberboard decortication, including 20 cases of large encapsulated empyema and six cases of total empyema. In 10 patients with large encapsulated empyema, the fiberboard on parietal pleura were not removed, as the lung was poorly re-expanded and there was a small residual cavity after decortication of the fiberboard on visceral pleura. After closed drainage for 2 to 8 weeks combined with negative pressure suction, the lung of these patients were well re-expanded and the residual cavity disappeared. Thus they were cured and discharged. Seven patients with total empyema complicated with lung destruction underwent pleural pneumonectomy. Among them, two patients received pleural fiberboard decortication and total pneumonectomy, as the lung could not expand at all; and five patients received pleural fiberboard decortication and pulmonary lobectomy, as severe intralobar tuberculosis was found in single pulmonary lobe but another pulmonary lobe showed mild pleural rupture and was well expanded. These patients were clinically cured after receiving mechanical ventilation for one to three days and standardized anti-tuberculosis drugs for six to nine months. Three patients with total empyema underwent thoracoplasty. Among them, one patient complicated with bronchial pleural fistula directly received thoracoplasty; and the other two patients received pleural fiberboard decortication and localized thoracoplasty, as intrapulmonary tuberculosis lesions were stable in these cases and the lung was poorly re-expanded and a large residual cavity was left even after removing the fiberboard on visceral pleura and retaining the fiberboard on parietal pleura. They underwent compression dressing and was cured and discharged three weeks later. Of the 26 patients who underwent pleural fiberboard decortication, internal bleeding occurred in one patients. Of the seven patients who underwent pleural pneumonectomy, one experienced acute respiratory failure. Of the three patients who underwent thoracoplasty, one had poor wound healing.Conclusion Pleural fiberboard decortication is the first choice for tuberculous empyema. On the basis of strict adherence of surgical indications, the three surgical procedures are safe and effective.

Review Articles

Current status and progress of imaging diagnosis in patients with urinary tract tuberculosis

Yang ZHENG,Xiao-ming WANG

Journal of Tuberculosis and Lung Health. 2018, 7(4):  311-316.  doi:10.3969/j.issn.2095-3755.2018.04.017

Abstract ( 463 )   HTML ( 8 )   PDF (4081KB) ( 550 )   Save

Figures and Tables | References | Related Articles | Metrics

Urinary tract tuberculosis mainly includes renal tuberculosis, ureteral tuberculosis and bladder tuberculosis, and most of them are secondary to pulmonary tuberculosis, intestinal tuberculosis or bone and joint tuberculosis, the most common is secondary to pulmonary tuberculosis. The imaging examination methods in diagnosis of urinary system tuberculosis include kidney, ureter and bladder X-ray examination (KUB, abdominal X-ray), intra venous pyelogram (IVP), retrograde ureteropyelography, CT scan and MRI, etc., which can reflect the characteristics of urinary tract tuberculosis from the aspects of morphology, structure and function. Those imaging methods have their own advantages and also have certain limitations. Combined application of multiple examination methods can increase accurate diagnose rate of urinary tract tuberculosis.

Progress in the diagnosis of urinary tract tuberculosis

Liang FU,Guo-fang DENG

Journal of Tuberculosis and Lung Health. 2018, 7(4):  317-322.  doi:10.3969/j.issn.2095-3755.2018.04.018

Abstract ( 486 )   HTML ( 7 )   PDF (851KB) ( 750 )   Save

References | Related Articles | Metrics

Urinary tract tuberculosis (UTB) is the second most frequent form of extrapulmonary tuberculosis, after lymph node involvement. The diagnosis of UTB is very difficult due to the non-specificity of the clinical presentation and the low accuracy of routine examinations. Unfortunately, delayed diagnosis can seriously affect urinary system function of the patients. As a result, the authors would like to review the progress in the diagnosis of UTB in order to improve the clinicians’ understanding and ability to diagnose this disease.

Research progress of desensitization therapy and cutaneous adverse drug reactions induced by rifampicin and isoniazid

Chao-gang XIONG,Fei REN,Xiao-hui LYU,Lei-peng REN,Jun ZHOU,Ying LI

Journal of Tuberculosis and Lung Health. 2018, 7(4):  323-327.  doi:10.3969/j.issn.2095-3755.2018.04.019

Abstract ( 588 )   HTML ( 9 )   PDF (820KB) ( 437 )   Save

Figures and Tables | References | Related Articles | Metrics

Rifampicin and isoniazid, as the core drugs for the treatment of tuberculosis, can cause delayed allergic reactions, even severe adverse reactions such as Stevens-Johnson syndrome (SJS), drug-induced hypersensitivity syndrome (DIHS) and other severe allergic systemic symptoms, threatening the life safety of patients. Identification of allergenic drugs and implementation of desensitization therapy have become the key to safe and effective anti-tuberculosis therapy. In this article, we made a comprehensive literature review, and analyzed and summarized the sensitizing mechanisms of rifampicin and isoniazid in skin anaphylaxis, the common clinical manifestations, the detection of sensitizing drugs and the desensitization therapeutic scheme, so as to provide references for the desensitization treatment of these two drugs.

Short Articles

Analysis of misdiagnosis in 36 elderly patients with pulmonary tuberculosis

Long-ling YE,Shuang-chu LI,Zhi CHENG,Yu-xia GUO,Jun WANG,Hong-zhang CHEN

Journal of Tuberculosis and Lung Health. 2018, 7(4):  328-331.  doi:10.3969/j.issn.2095-3755.2018.04.020

Abstract ( 517 )   HTML ( 3 )   PDF (861KB) ( 528 )   Save

Figures and Tables | References | Related Articles | Metrics

In order to explore the reasons of misdiagnosis in elderly patients with pulmonary tuberculosis (PTB), this paper retrospectively analyzed the clinical data of 36 elderly PTB patients aged 60 years and above who were admitted to stay at Xiaogan Institute for TB Prevention and Control from October 2012 to September 2018 and received treatment. Of which 11 cases were misdiagnosed by the institute while the remaining 25 cases were misdiagnosed by the general hospitals before they came to the institute. Among those 36 elderly PTB cases, 4 cases with tuberculoma were misdiagnosed as peripheral lung cancer, 5 cases with bronchial tuberculosis were misdiagnosed as bronchial asthma, 4 cases with bronchial tuberculosis and atelectasis were misdiagnosed as central lung cancer, 1 case with bronchial tuberculosis and atelectasis was misdiagnosed as inflammatory atelectasis, 2 cases with hematogenous disseminated pulmonary tuberculosis were misdiagnosed as alveolar carcinoma, 5 cases with caseous pneumonia were misdiagnosed as lobar pneumonia, 3 cases with interstitial tuberculosis were misdiagnosed as interstitial pneumonia, 3 cases had pulmonary tuberculosis with fluid filling were misdiagnosed as pulmonary abscess, 4 cases had PTB with mass shadow and thick-walled irregular cavity were misdiagnosed as lung carcinoma, 5 cases with intractable tuberculous pleural effusion were misdiagnosed as malignant pleural effusion. Due to the atypical clinical features in elderly patients with pulmonary tuberculosis, it is very easy to be misdiagnosed, so clinicians should pay enough attentions to it.