Table of Content

30 June 2019, Volume 8 Issue 2

Previous Issue    Next Issue

Expert Forum

Responsibility of doctors from tuberculous hospitals in the diagnosis and treatment of tuberculosis outbreak in school

Wei SHA

Journal of Tuberculosis and Lung Health. 2019, 8(2):  83-85.  doi:10.3969/j.issn.2095-3755.2019.02.002

Abstract ( 439 )   HTML ( 10 )   PDF (900KB) ( 485 )   PDF（mobile） (900KB) ( 3 )   Save

References | Related Articles | Metrics

Standardized diagnose and treatment of student tuberculosis(TB) is one of the most important issues to prevent the spread of tuberculosis epidemic in school. Specialized tuberculous hospital doctors play an important role in it. State laws and regulations must be followed as well as tuberculosis related guidelines during case finding, early diagnosis, regimen formulation, epidemic notification and recovery certification, to ensure that the school TB patients recovered and back to campus early.

Original Articles

Analysis of the incidence of pulmonary tuberculosis among students in Shandong Province from 2011 to 2016

Qian WANG,Bin LUO,Xiu-lei ZHANG,Xiao-yan GUO

Journal of Tuberculosis and Lung Health. 2019, 8(2):  86-89.  doi:10.3969/j.issn.2095-3755.2019.02.003

Abstract ( 467 )   HTML ( 4 )   PDF (731KB) ( 539 )   Save

Figures and Tables | References | Related Articles | Metrics

Objective To analyze the incidence characteristics of pulmonary tuberculosis (PTB) among students in Shandong Province from 2011 to 2016.Methods The number of reported PTB, the number of reported cases with smear-positive PTB, the number of students in all age groups, and the number of reported cases with different occupations among students in Shandong Province from 2011 to 2016 were obtained based on “China Disease Prevention and Control Information System and Tuberculosis Information Management System”, meanwhile, the PTB data of students in 15 cities of Shandong Province were collected from the “Shandong Provincial Tuberculosis Surveillance Report”. Then descriptive analysis of the epidemiological characteristics of PTB was performed among students in Shandong Province from 2011 to 2016.Results The reported incidence of PTB among students declined from 2011 to 2016 with a statistically significant difference (χ ²=42.94, P＜0.05). The reported incidence of PTB among students was 9.68/100000 (1423 cases) and 7.87/100000 (1178 cases) in 2011 and 2016, respectively; and the reported incidence of smear-positive PTB was 2.41/100000 (355 cases) and 1.29/100000 (193 cases) in 2011 and 2016, respectively. The reported incidence of PTB and smear-positive PTB decreased by 18.70% and 46.47%, respectively. When stratified by age, the highest incidence was found in the 15-24 age group, with an average incidence of 89.84% (7103/7906). The reported incidence of PTB in male students was 60.83% (4809/7905), which was higher than that in females (39.17% (3096/7905)). The top four cities with the highest annual average incidence of PTB among the 15 cities were Ji’nan (184 cases), Weifang (166 cases), Yantai (98 cases), and Linyi (81 cases), with annual average proportion of 9.03%, 6.60%, 4.82%, and 1.72%, respectively.Conclusion From 2011 to 2016, the PTB epidemic among students in Shandong Province shows a declining trend year by year. The prevention and control campaigns of PTB in schools exert positive effects. The collaboration between schools and the public health department should be strengthened to further improve the prevention and control of PTB

Analysis of characteristics of delayed visiting in the students’ patients with tuberculosis in Mianyang City from 2014 to 2018

Hong-ying SUN,Jin-chao DUAN,Chang-wu YAN,Xiao-rong YANG,Lei LUO,Guo TANG

Journal of Tuberculosis and Lung Health. 2019, 8(2):  90-93.  doi:10.3969/j.issn.2095-3755.2019.02.004

Abstract ( 453 )   HTML ( 3 )   PDF (681KB) ( 574 )   Save

Figures and Tables | References | Related Articles | Metrics

Objective To understand characteristics of the delayed visting in the students’ patients with tuberculosis, and to provide reference for further promoting the prevention and control of tuberculosis in schools.Methods The registration data of 586 students with pulmonary tuberculosis reported in our city from 2014 to 2018 were analyzed by descriptive epidemiological survey, and the influencing factors of delayed treatment were described in this study.Results Among 586 students with pulmonary tuberculosis in Mianyang City from 2014 to 2018, the delayed visting rate was 36.86% (216/586). The median days of delayed visiting (quartile) was 34 (8, 42)d. The delayed visiting rates of male and female were 34.36% (123/358) and 40.79% (93 /228), respectively. There was no significant difference statistically (χ ²=2.476,P=0.069). The delayed visiting rates of students with different academic qualifications were 39.13% (9/23) in primary school, 42.70% (38/89) in junior middle school, 35.08% (114/325) in general high school, 40.48% (17/42) in vocational high school, and 35.51% (38/107) in the university, respectively. There was no significant difference statistically (χ ²=2.117,P=0.714). The delayed visiting rate of local household registration students (38.45%, 193/502) was more higher than that of foreign household registration students (27.38%, 23/84) with significant difference (χ ²=3.266,P=0.043). The delayed visiting rate of students (36.86%) was lower than that of the whole population(58.80%, 10002/17009) with significant difference (χ ²=110.339,P=0.000). The delayed visiting rates of students were 45.98% (40/87), 40.48% (34/84), 40.13% (61/152), 30.06% (49/163) and 32.00% (32/100) during 2014 to 2018, respectively. The overall trend showed a downward trend ( {\chi }_{\mathrm{trend}}^2 =0.851,P=0.026). Among the methods of case finding, the delayed visiting rates of referrals, symptomatic visiting and follow-up were 38.78% (114/294), 41.72% (63/151) and 49.28% (34/69), respectively. There was no significant difference among the three methods (χ ²=2.586,P=0.274). However, the delayed visiting rate of patients found by physical examination (6.94%, 5/72) was lower than that of patients with referrals (χ ²=29.187,P=0.000).Conclusion Although the delayed visiting rate of students’ patients with tuberculosis in Mianyang City is lower than that of the whole population, the overall trend shows a downward trend. It needs to strengthen health education, especially to strengthen supervision and management for students of local household registration and students’ patients found by non-health physical examination.

Analysis on tuberculosis epidemical situation and screening results of close contacts in schools of Songjiang District of Shanghai in 2018

Jin LI,Li-ping LU,Xiao-qin GUO,Yong LI,Jin-yan ZOU

Journal of Tuberculosis and Lung Health. 2019, 8(2):  94-99.  doi:10.3969/j.issn.2095-3755.2019.02.005

Abstract ( 434 )   HTML ( 10 )   PDF (857KB) ( 608 )   Save

Figures and Tables | References | Related Articles | Metrics

Objective To get comprehensive understanding of the tuberculosis epidemic and screen the close contacts in schools in Songjiang, and to provide scientific evidence for the tuberculosis prevention and control in schools.Methods The pulmonary TB (PTB) epidemic information in local schools was collected from the Tuberculosis Information Management System (TBIMS) and cases reported by Center for Disease Control and Prevention (CDC) of other provinces and schools. The monitoring objects include 9 universities, 2 vocational schools, 28 middle schools, 56 elementary schools and 157 kindergartens. The number of students and teachers were 79011 for universities and 261196 for other schools, respectively. The research screened close contacts by suspicious symptoms, chest X-ray and tuberculin (PPD) skin test.Results In 2018, a total of 69 tuberculosis cases were reported in 16 schools of Songjiang with the ratio of male versus female was 1.09∶1 (36/33). The reported incidence was 69.61/100000 (55/79011) in university and 5.36/100000 (14/261196) in other schools, and the difference was significant (χ ²=123.49, P<0.001). The constituent ratios of reported PTB students in four quarters were 17.39% (12/69), 30.43% (21/69), 27.54% (19/69) and 24.64% (17/69) respectively without statistical difference between each quarter (χ ²=2.59, P>0.05). 38 (55.07%) cases registered in TBIMS, 20 cases (28.99%) were identified by information communication with other provinces and 11 cases (15.94%) were reported by school medical clinics. A total of 2617 close contacts were screened, 2235 of whom were screened by chest X-ray and 2 students had abnormalities. Tuberculin skin test was carried out among 2392 students, among whom 735 (30.73%) were positive, 48 (2.01%) were strong positive. 2 new cases were detected by further examination. The positive rates of PPD for close contacts of smear-positive and smear-negative (including tuberculous pleurisy cases) cases were 29.03% (234/806) and 32.85% (521/1586), and the strong positive rates of PPD were 2.48% (20/806) and 1.77% (28/1586), respectively. Both had no statistical difference (χ ²=3.61, P>0.05; χ ²=1.39, P>0.05).Conclusion In 2018, the incidence of tuberculosis in schools in Songjiang district is mainly among college students, with the highest incidence ratio in the second quarter. Timely and effective screening of close contacts can prevent outbreaks of tuberculosis in schools.

Epidemiological characteristics of tuberculosis patients in Haizhu District of Guangzhou from 2014 to 2018

Xiao-ting CAI,Yu-hua DU,Jing ZHONG,Gang HE,Kun-hong JIANG

Journal of Tuberculosis and Lung Health. 2019, 8(2):  100-105.  doi:10.3969/j.issn.2095-3755.2019.02.006

Abstract ( 395 )   HTML ( 4 )   PDF (918KB) ( 837 )   Save

Figures and Tables | References | Related Articles | Metrics

Objective To understand the epidemic characteristics of tuberculosis (TB) patients in Haizhu District of Guangzhou from 2014 to 2018, so as to provide basis for the formulation of TB control measures.Methods Data of 6555 TB patients registered in Haizhu District of Guangzhou from 2014 to 2018 were collected from sub-system of China Disease Prevention and Control Information system - Tuberculosis Management Information System (Referred to as “Special Report System”). Descriptive epidemiological method was used to analyze the average annual registration rate, distribution of TB patient in different time and regions.Results A total of 6555 TB patients were registered from 2014 to 2018, the average annual registration rate was 79.86/100000 (6555/8208100), and that for household registered population and non-household registered population were 68.77/100000 (3529/5131400) and 98.35/100000 (3026/3076700) with 3529 and 3026 TB patients registered respectively. The registration rates from 2014-2018 were 93.70/100000 (1499/1599800), 85.08/100000 (1373/1613700), 82.85/100000 (1357/1637900), 73.12/100000 (1216/1663100) and 65.54/100000 (1110/1693600), which presented a tendency of decrease (χ ²=96.33, P=0.000). Patients were registered in each month, among which the numbers of patients registered in April and September were more, which was 631 (9.63%, 631/6555) and 605 (9.23%, 605/6555), respectively. All the streets in the district had registered patients, and the highest was Nanzhou Street with the average annual registration rate of 136.99/100000 (754/550411), and the lowest was Nanshitou Street with the average annual registration rate of 57.26/100000 (336/586848). There were 4545 male patients and 2010 female patients in the district, with a male-female ratio of 2.3∶1. The majority of TB patients were aged 25-34 years, accounting for 21.88% (1434/6555). However, the registration rate of 55-64 years age group was the highest for household registered population, accounting for 21.82% (770/3529). The highest occupational distribution was among the housework and unemployed patients, accounting for 45.98% (3014/6555).Conclusion From 2014 to 2018, the epidemic of TB in Haizhu District of Guangzhou shows a declining trend year by year, and the epidemic control has achieved certain results. Male, 25-34 years old age group, Nanzhou Street, household and unemployed people are the key groups of TB prevention and control in the future.

Analysis of patient delay and influencing factors among pulmonary tuberculosis patients in Ji’nan City

Rui JING,Mei-hua WANG,Xiao-ting WANG,Yan-min CAO

Journal of Tuberculosis and Lung Health. 2019, 8(2):  106-110.  doi:10.3969/j.issn.2095-3755.2019.02.007

Abstract ( 370 )   HTML ( 3 )   PDF (749KB) ( 854 )   Save

Figures and Tables | References | Related Articles | Metrics

Objective To investigate the patient delay among tuberculosis patients in Ji,nan and analyze the influencing factors in order to provide data support for health decision-making.Methods In November 2018, Ji’nan Municipal Center for Disease Control and Prevention selected 3 counties from all 10 counties by stratified sampling, the eastern counties with high economic level county (Zhanqiu District), the western counties with moderate economic level (Pingyin County) and the southern counties with low economic level (Changqing District). A face-to-face questionnaire survey was conducted on 234 patients with tuberculosis who were diagnosed and managed in the county-level tuberculosis control institutions from January to June 2018, and the demographic data (gender, age, occupation, education level, marital status), incidence and patient delay and access to health services (from village clinic/community health service station, township health center/community health service center, county tuberculosis designated hospital and general hospital) information such as distance and time required, 234 questionnaires were collected, and 234 information was completed, with an effective rate of 100.0%. Chi-square test and multivariate logistic regression were used to analyze the factors affecting the delay time of the visit.Results The patient delay rate of pulmonary tuberculosis patients in Ji’nan was 33.8% (79/234). Patients were divided into a delayed group (79 patients, 33.8%) and a non-delayed group (155 patients, 66.2%) according to the delay criteria for patient delay (≥14days). Multivariate logistic regression analysis showed that high school (Wald χ ²=4.19, P=0.041, OR (95%CI)=0.16 (0.03-0.93)), college and above (Wald χ ²=6.67, P=0.010, OR (95%CI)=0.13 (0.03-0.61)), and distance from the clinic >0.5 km (Wald χ ²=15.63, P=0.000, OR (95%CI)=5.48 (2.37-12.69)) were the factors affecting the patient delay.Conclusion The educational level of high school and college and above are the influencing factors to reduce the rate of patient delay. The distance from the clinic >0.5 km is the factor that increases rate of patient delay.

Ofloxacin-resistant characteristics of Mycobacterium tuberculosis isolated from Changping District in Beijing during 2016-2018

Yan-fei WANG,Jin-feng WU,Qian SUN,Lu HAN,Shu-bo MA,Zhi-guo ZHANG

Journal of Tuberculosis and Lung Health. 2019, 8(2):  111-114.  doi:10.3969/j.issn.2095-3755.2019.02.008

Abstract ( 396 )   HTML ( 1 )   PDF (688KB) ( 560 )   Save

Figures and Tables | References | Related Articles | Metrics

Objective To investigate the prevalence and molecular characteristics of Ofloxacin (Ofx)-resis-tant Mycobacterium tuberculosis (MTB) isolates from Changping District of Beijing, so as to provide reference for clinical prevention and treatment of drug-resistant tuberculosis.Methods Seven hundred and one strains of MTB clinical isolates in Changping Tuberculosis Dispensary were collected from 2016 to 2018. Conventional proportional method (referred to as “drug sensitivity test”, DST) was used to detect in vitro drug susceptibility of MTB isolates. Among those clinical isolates, 51 strains were detected as multi-drug resistant(MDR)MTB, 650 strains were not MDR. GyrA gene mutations of Ofx-resistant isolates were test by gene sequencing. The resistance rates of Ofx in each year were compared using Cochran-Armitage trend test. The difference was significant if P<0.05.Results Of 701 MTB isolates, 41 (5.8%) were resistant to Ofx. Statistical analysis revealed that the resistance rate of Ofx was significantly increased from 2.9% (7/243) in 2016 to 8.0% (18/226) in 2018 ( {\chi }_{\mathrm{trend}}^2 =5.567, P=0.018). In addition, the Ofx resistant rates were 37.2% (19/51) and 3.4% (22/650) in MDR and non-MDR clinical MTB isolates, respectively, with significant difference (χ ²=92.462, P<0.01). GyrA gene mutation was detected in 31 strains (75.6%) of 41 Ofx resistant MTB strains. The most common mutations were 94 codons (36.6%) and 90 loci (34.1%).Conclusion The Ofx resistant rate of the clinical isolates of MTB in Changping District shows an increasing trend from 2016 to 2018. The mutation of GyrA gene is the most predominant mechanism associated with Ofx resistance in this region.

Delay in detection of tuberculosis in children under 15 years of age in Zhejiang Province from 2009 to 2018

Kui LIU,Ting WU,Wei WANG,Ying PENG,Fei WANG,Tie-niu HE,Cheng-liang CHAI,Xiao-meng WANG,Bin CHEN

Journal of Tuberculosis and Lung Health. 2019, 8(2):  115-120.  doi:10.3969/j.issn.2095-3755.2019.02.009

Abstract ( 402 )   HTML ( 3 )   PDF (752KB) ( 832 )   Save

Figures and Tables | References | Related Articles | Metrics

Objective To investigate the case-finding delay of tuberculosis in children aged <15 years in Zhejiang Province, and to provide reference for scientific policy-making of childhood tuberculosis control and prevention.Methods The specific TB case information of the children aged <15 years old was collected from “China Information System for Disease Control and Prevention Tuberculous Management Information System” during the period of 2009-2018. There were a total of 1730 childhood cases included in this study. Descriptive analysis was performed to present the epidemic characteristics of case-finding delay by Excel 2019 software, and SPSS software 18.0. One-way analysis of variance (χ ²) and logistic regression analysis were used to identify the potential influential factors causing the case-finding delay. Results Among the 1730 children cases under 15 years old reported in the 11 cities of Zhejiang Province, the median delay interval of case finding was 24(12,50)d with delay proportion of 44.10%(763/1730). The median interval of patient delay time was 18(7,40)d with delay proportion of 55.78%(965/1730).Multivariate logistic regression analysis showed that the region of first diagnosis, occupation, age group, diagnosis results and diagnosis type play a vital role in the occurrence of finding delay (Wald χ ² value was 28.586,7.718, 6.996, 24.064 and 17.143, P value was 0.001, 0.052, 0.072, <0.001 and 0.002).Conclusion The finding delay of tuberculosis among children aged <15 years was more serious than that of other groups in Zhejiang Province. Region of first diagnosis, occupation, age group, diagnosis results and diagnosis type were associated with finding delay. More attention should be play by all levels of TB control facilities.

Analysis of detection of rifampicin-resistant tuberculosis and rpoB gene mutation by using different methods

Yong-ming LIN,Xiao-wei HUANG,Shu-fang LIN,Shu-zhen WEI,Jian LIN,Yong ZHAO

Journal of Tuberculosis and Lung Health. 2019, 8(2):  121-126.  doi:10.3969/j.issn.2095-3755.2019.02.010

Abstract ( 551 )   HTML ( 5 )   PDF (714KB) ( 547 )   Save

Figures and Tables | References | Related Articles | Metrics

Objective To explore the efficacy of different methods on detection of rifampicin-resistant tuberculosis (TB) and to analyze the situation of ropB gene mutation of rifampicin-resistant strains.Methods A total of 511 patients who had been notified as pulmonary TB in 10 county or district TB designated hospitals of Quanzhou City, Fujian Province in 2017, and received 3 kinds of tests as follows: drug susceptibility test with proportional method on solid media (proportional method), reverse linear probe hybridization (GenoType MTBDRplus method) and GeneXpert MTB/RIF (Xpert), were enrolled in this study and their situation of rifampicin resistance was collected. Among 511 TB patients, the ropB gene sequencing of 66 MTB strains with rifampicin resistance, which were detected by one of the 3 test methods at least, were conducted and the situation of the ropB gene mutations in 55 strains, which the sequence of rpoB gene were obtained, was analyzed.Results Among 511 strains tested, the rifampicin resistance rates detected by proportional method, MTBDRplus and Xpert were 38.16% (195/511), 40.51% (207/511) and 45.99% (235/511), respectively. There was no significant difference in rifampicin resistance rate between MTBDRplus technique and proportional method (χ ²=0.590, P=0.442), while it was significantly higher by Xpert technique than that of proportional method (χ ²=6.424, P=0.011). When the test result of proportional method was regarded at the standard, the sensitivity, specificity and consistency rates of Xpert and MTBDRplus to rifampicin resistance were 93.85% (183/195) and 95.39% (186/195), 83.54% (264/316) and 93.35% (295/316), 87.48% (447/511) and 94.13% (481/511), respectively. Among the 55 strains that their rpoB gene sequences were obtained, 36 types of mutation at 17 locations between 371 and 566 loci happened in the ropB gene of 47 strains (85.46%): 13 strains (23.64%) had base deletion or insertion, 7 strains (12.73%) had point mutation and 27 strains (49.09%) had joint mutation. Forty-five strains (81.82%, 45/55) were sensitive to rifampicin by proportional method but rifampicin resistance was detected by molecular susceptibility test (including 14 strains (34.15%, 14/55) of rifampicin resistance were detected by both MTBDRplus and Xpert, 30 strains (54.55%, 30/55) of rifampicin resistance were detected only by Xpert while MTBDRplus results were sensitive to rifampicin, 1 strain (1.82%, 1/55) of rifampicin resistance was detected by MTBDRplus only while Xpert result was sensitive to rifampicin, 8 strains (14.55%, 8/55) were resistant to rifampicin by proportional method but rifampicin sensitive by MTBDRplus and Xpert. The results of MTBDRplus and Xpert test were same in 22 strains, including 14 rifampicin resistant strains and 8 rifampicin sensitive strains; the ropB gene mutations were found in all 14 rifampicin resistant strains, but it happened in 6 strains out of 8 rifampicin sensitive strains. The difference examination results between MTBDRplus and Xpert, were found in 33 strains, of which 31 strains were rifampicin sensitive by MTBDRplus but rifampicin resistant by Xpert.Conclusion Molecular drug susceptibility test method is more sensitive than proportional method in detecting rifampicin resistance. The mutation rate of ropB gene in rifampicin-resistant strains is relatively high. Regardless of which techniques, if the results show rifampicin-resistance, rifampicin-resistant MTB should be considered and other examination methods should be used to confirm it as soon as possible.

Value of GeneXpert MTB/RIF in detection of tuberculosis suspects among children by using gastric juice

Lian-zhi WANG,Chun-lei ZHANG,Jing ZHANG,Ying-ying LI,Hui JIANG,Lin-chuan LANG,Jun SUN,Lan-wei CUI,Bin-ying JI

Journal of Tuberculosis and Lung Health. 2019, 8(2):  127-132.  doi:10.3969/j.issn.2095-3755.2019.02.011

Abstract ( 550 )   HTML ( 2 )   PDF (718KB) ( 698 )   Save

Figures and Tables | References | Related Articles | Metrics

Objective To evaluate the value of GeneXpert MTB/RIF (GeneXpert) in tuberculosis (TB) diagnosis by testing gastric juice obtained from children who are suspected to be pulmonary TB.Methods A total of 155 TB suspects aged from 2 months to 14 years, who were admitted to the Department of Pediatric TB of Harbin Chest Hospital, the Department of Respiration of Harbin Children’s Hospital and the Department of Pediatrics of the First Affiliated Hospital of Harbin Medical University from September 2017 to December 2018, were enrolled into this study. Among them, 115 children were clinically diagnosed as pulmonary TB while 40 children were diagnosed as non-TB. All enrolled patients were taken fasting gastric juice in the morning and the samples were performed the following examinations: fluoresce smear microscopy (smear examination), BACTEC MGIT 960 liquid culture (MGIT 960 method) and GeneXpert. The clinical diagnosis results were regarded as the standard, the diagnostic efficacy of smear, MGIT 960 and GeneXpert in gastric juice was evaluated; and then the MGIT 960 susceptibility test results were regarded as the standard, the efficacy of GeneXpert in detecting rifampicin resistant MTB was evaluated.Results When the clinical diagnosis results were regarded as the standard, the sensitivity of smear examination, MGIT 960 method and GeneXpert in detection of pediatric pulmonary TB was 30.4% (35/115), 54.8% (63/115), 69.6% (80/115) and the specificity was 95.0% (38/40), 100.0% (40/40), 97.5% (39/40), respectively. In 115 cases who were clinically diagnosed as pulmonary TB, the positive rates of GeneXpert test were 96.7% (29/30), 81.8% (27/33) and 40.4% (19/47) respectively among the TB children with smear positive and culture positive, smear negative and culture positive, smear negative and culture negative; the number of patients with positive GeneXpert test result was 5 (5/5) in children with smear positive and culture negative; the positive rate of GeneXpert test was 97.1% (34/47), 57.5% (46/80) and 46.2% (24/52) in the children with smear positive, smear negative and culture negative. When the MGIT 960 culture results were regarded as the standard, the sensitive of GeneXpert was 88.9% (56/63). Among 115 children who were clinically diagnosed as pulmonary TB, 56 cases were positive for both MGIT 960 culture and GeneXpert test; 11 cases were rifampicin resistance with MGIT 960 test while 45 cases were rifampicin sensitive; 13 cases were rifampicin resistance with GeneXpert test while 43 cases were rifampicin sensitive. When the MGIT 960 drug susceptibility test was regarded as the standard, the sensitivity of GeneXpert test was 100.0% (11/11) in diagnosis of rifampicin resistant MTB and its specificity was 95.6% (43/45), which was in good consistency with MGIT 960 susceptibility test (Kappa value=0.894). Conclusion >GeneXpert test has high sensitivity and specificity in MTB detection in gastric juice of children with TB, and has a high detection rate too in pediatric TB patients with culture negative. The detection of rifampicin resistant MTB by using GeneXpert test was also in high consistency with using MGIT 960 drug sensitivity test, which has a good application value in the diagnosis of pediatric TB and proving guidance of treatment.

The value of GeneXpert MTB/RIF in diagnosis of pulmonary tuberculosis with smear-negative and rifampicin resistance

Yin-fa ZHOU,Yan-pin LI,Shu-zhen WEI,Shu-fang LIN,Yong ZHAO,Jian-li ZHEN,Jian LIN,Shan-ying ZHANG

Journal of Tuberculosis and Lung Health. 2019, 8(2):  133-137.  doi:10.3969/j.issn.2095-3755.2019.02.012

Abstract ( 487 )   HTML ( 0 )   PDF (698KB) ( 792 )   Save

References | Related Articles | Metrics

Objective To evaluate the clinical value of GeneXpert MTB/RIF system in diagnosis of pulmonary tuberculosis(PTB) smear-negative and rifampicin resistance.Methods Lab testing results of PTB patients in Longyan city during 2018, including sputum smear microscopy, sputum culture, GeneXpert system test, traditional drug susceptibility test (DST) and bacterial identification, were collected from the laboratory registration and corrected with the information of patients registered in the Tuberculosis Management Information System. Six hundred and fifty nine results of suspected tuberculosis patients with smear-negative were collected,307 of them were detected by GeneXpert, 519 by solid sputum culture and bacterial identification, 228 by both GeneXpert and solid sputum culture. Finally 622 PTB patients with smear-negative were clinical diagnosis. Regarding clinical diagnosis and sputum culture as standard to evaluate the sensitivity, specificity and consistency of GeneXpert in detecting MTB. Another 97 PTB patients detected by both GeneXpert and proportional DST were included to evaluate the efficacy of GeneXpert in detecting rifampicin resistance. SPSS 24.0 software were used to data management to analysis.Chi-square tests were performed to compare the detection rates of Mycobacterium tuberculosis(MTB) by different tests. P<0.05 was considered statistically significant. Results Among the 622 PTB patients with smear negative.The MTB detection sensitivity of GeneXpert system in smear negative TB patients (29.97%, 92/307) was significantly higher than that of sputum culture (7.13%, 37/519) (χ²=76.30, P<0.05). Regarding the result of clinical diagnosis as standard, the specificity of GeneXpert system was consistent with the solid sputum culture(100.00%),and the sensitivity was higher than that of solid sputum culture (31.40%(92/293) vs 7.46% (37/496)),the Kappa values were very poor(Kappa=0.037,0.007). Regarding the result of solid sputum culture and bacterial identification as standard, the sensitivity, specificity, positive predictive value and Kappa value of GeneXpert system in detecting MTB were 90.32%(28/31)、77.00%(154/200)、37.84%(28/74)、98.09%(154/157) and 0.420, respectively. There was no significant difference between Genexpert (9.28%,7/97) and proportionate drug sensitivity (6.18%, 6/97) in detecting rifampicin resistance of 97 PTB patients(χ²=0.00, P>0.05). Conclusion GeneXpert system has a good performance in detecting MTB with smear-negative patients, as well as the rifampicin resistance MTB. Therefor it could be recommended as a rapid clinical diagnostic method for smear-negative tuberculosis and rifampicin-resistant tuberculosis in primary designated tuberculosis hospitals.

Clinicopathologic features and pathogenic detection of 164 cases with tracheobronchial tuberculosis

Li YANG,Zong-cheng YANG,Qian-hong WU,Jing-min WANG,Wen DUAN,Li LIU

Journal of Tuberculosis and Lung Health. 2019, 8(2):  138-141.  doi:10.3969/j.issn.2095-3755.2019.02.013

Abstract ( 463 )   HTML ( 3 )   PDF (687KB) ( 621 )   Save

Figures and Tables | References | Related Articles | Metrics

Objective This study aimed to investigate the clinicopathologic features and pathogenic detection value of tracheobronchial tuberculosis (TBTB).Methods Totally, 164 patients with TBTB were enrolled in Shaanxi Provincial Tuberculosis Control Hospital from January to December 2017. The general information, CT scan image, tissue biopsy, sputum test, MTB culture and GeneXpert MTB/RIF (GeneXpert) detection results were collected. Then the clinical and CT imaging features, the type of lesions under bronchoscopy, histopathological features, and pathogenic detection results of TBTB patients were analyzed.Results Among 164 subjects, 153 (93.29%) had cough and 108 (65.85%) had fever; and the lesions of 109 cases (66.46%) were predominantly on the right side. CT scan mainly showed irregular lumen stenosis in 92 cases (56.10%), irregular wall thickening in 45 cases (27.44%), and hilar or near-lung soft tissue shadow in 27 cases (16.46%). Bronchoscopy mainly exhibited inflammatory infiltration (69 cases (42.07%)), ulcer necrosis (46 cases (28.05%)), and granulation proliferation (29 cases (17.68%)). Histopathological changes showed 46 cases of exudative lesions (28.05%), 32 cases of proliferative lesions (19.51%), 36 cases of necrotic lesions (21.95%), and 50 cases of complex lesions (30.49%). Eighty-five subjects all underwent acid-fast staining in tissue and sputum, MTB culture and GeneXpert test. The positive rate of acid-fast staining+GeneXpert+MTB culture was 57.65% (49/85), which was significantly higher than that of acid-fast staining (37.65% (32/85)), with a significant statistical difference (χ ²=6.82, P=0.009).Conclusion TBTB patients exhibit diverse bronchoscopy and pathological features, and the positive rates of different pathogenic detection methods are quite different. These results indicated that TBTB should be diagnosed based on the comprehensive analysis, including clinicopathologic features, CT imaging and various pathogenic detection results.

Review Articles

The global and national tuberculosis epidemic situation of children and schools

Jing YAO,Xin SHEN,Kai-kan GU,Zhi-hong LI,Zhi-ying HAN,Huai-qing ZHANG,Bing SHEN

Journal of Tuberculosis and Lung Health. 2019, 8(2):  142-145.  doi:10.3969/j.issn.2095-3755.2019.02.014

Abstract ( 387 )   HTML ( 7 )   PDF (743KB) ( 560 )   Save

References | Related Articles | Metrics

With the global attention on tuberculosis, the prevention and control of tuberculosis in children has also made great progress, but we still need to scale up the detection, diagnosis and treatment, so as to achieve the goal of “towards zero death for childhood tuberculosis” at an early date. This review discussed the global and domestic children’s tuberculosis epidemic situation and the incidence of tuberculosis among students, and analyzed the influencing factors of tuberculosis incidence in children and students, as well as the challenges we faced by the current prevention and control work.

Advances in identification techniques for nontuberculous mycobacteria strains

Xuan ZENG,Jian LU,Yu-xiang XU,Tao-sheng YE

Journal of Tuberculosis and Lung Health. 2019, 8(2):  146-148.  doi:10.3969/j.issn.2095-3755.2019.02.015

Abstract ( 540 )   HTML ( 6 )   PDF (685KB) ( 610 )   Save

References | Related Articles | Metrics

Nontuberculous mycobacteria (NTM) widely exist in nature and can cause disease in humans, and the incidence is increasing year by years. Accurate identification of bacterial species is the prerequisite for precision medicine. In this paper, the experimental principles, advantages, disadvantages and accuracy of the traditional identification methods, bacterial components and molecular biological identification methods were reviewed, in order to provide reference for medical workers.

Short Articles

Analysis of effect of FDC chemethorapy combined with levofloxacin in patients with smear positive pulmonary tuberculosis

Shuang LIANG,Dong-wei HAN,Wei ZHONG,Ning MAO,Yi LIU,Yi-wen JIANG

Journal of Tuberculosis and Lung Health. 2019, 8(2):  149-152.  doi:10.3969/j.issn.2095-3755.2019.02.016

Abstract ( 462 )   HTML ( 4 )   PDF (685KB) ( 681 )   Save

Figures and Tables | References | Related Articles | Metrics

A retrospective analysis was conducted in 167 patients with re-treatment smear-positive pulmonary tuberculosis (PTB), who received anti-TB treatment at the Center for Tuberculosis Control and Prevention of Yingkou City Center for Disease Control and Prevention from March 2014 to December 2015. Out of those 167 patients, 116 patients received treatment of fixed-dose combination (FDC) anti-TB drugs; among 116 patients, 51 patients were treated by using levofloxacin combined with FDC (namely “combination treatment group”) while 65 patients were treated by using FDC. Out of 51 patients, 2 patients were confirmed to be drug-resistant PTB and their treatment regiments were changed and then excluded from this study, so finally 49 patients with smear-positive PTB were remaining in the combination treatment group. Another forty-nine patients with smear-positive PTB were randomly selected from 65 patients, who received FDC treatment, by using random number table method and as the “FDC treatment group”. The patients in the FDC treatment group received FDC treatment (3 isoniazid+rifampicin+pyrazinamide+ethambutol/6 isoniazid+rifampicin+ethambutol), while the patients in the combination treatment group received treatment of FDC combined with levofloxacin. In the combination treatment group, the sputum negative conversion rate, lesion absorption rate and cavity reduction rate of the patients at 2 months, 5 months and 8 months of treatment were 75.5% (37/49), 81.6% (40/49), 83.7% (41/49), 77.6% (38/49), 73.5% (36/49) respectively, the rates were much higher than those in the FDC treatment group (51.0% (25/49), 63.3% (31/49), 65.3% (32/49), 57.1% (28/49), 53.1% (26/49)). The difference of those rates between the two groups was statistically significant (χ² values were 6.32, 4.14, 4.35, 4.64, 4.39; P values were 0.012, 0.042, 0.037, 0.030, 0.036). The incidence of adverse reactions in the combination treatment group was 18.4% (9/49), and it was no significant difference compared with that in the FDC treatment group (26.5% (13/49)) (χ²=1.10, P=0.896). So this study showed that the treatment outcomes obviously improved by using FDC combined with levofloxacin in smear-positive pulmonary tuberculosis patients and it might be valuable to expand this chemotherapy method at the grassroots level.