Table of Content

30 December 2019, Volume 8 Issue 4

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Expert Forum

Current status and challenges of tuberculosis patient management supported by mobile health platform

Yan MA,Shi-ming CHENG

Journal of Tuberculosis and Lung Health. 2019, 8(4):  238-243.  doi:10.3969/j.issn.2095-3755.2019.04.002

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In 1994, the World Health Organization proposed the directly observed treatment (DOT) strategy, which pointed out that medical staff should mainly carry out DOT for TB patients. The implementation of DOT has made great achievement in improving patient adherence and strengthening patient management, and played a favorable role in controlling the tuberculosis epidemic, but the implementation of DOT in countries and regions with limited resources and high burdens still faces many difficulties and challenges. The arrival of mobile health has brought new opportunities and vitality for the management of tuberculosis patients. This article aims to explore the current state of mobile health, introduce the development of mobile health, and the application of mobile health such as short messaging service (SMS) and video observed therapy (VDOT) in the management of tuberculosis patients, and provide reference for enriching the management model of tuberculosis patients and improving treatment compliance.

Implementation electronic medication monitor in tuberculosis medication management

Ni WANG,Fei HUANG,Hui ZHANG

Journal of Tuberculosis and Lung Health. 2019, 8(4):  244-248.  doi:10.3969/j.issn.2095-3755.2019.04.003

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Implement effective treatment management is one of the key factors for the End TB Strategy. With the emergence of new technologies, it has become a new choice to use digital technology to support patient treatment management. Electronic medication monitor is the most widely used new tool for TB patient management in the world because of its relatively simple technology, low cost and simple operation. The purpose of this article is understanding the implementation situation, as well as prospect of using electronic pillbox at home and abroad, to solve the problem that DOT is not suitable for every district and patient. In this paper, the author discussed the emergence and implementation of electronic medication monitor, the implementation of electronic pillbox in China, and the challenges for the further promotion. This will provide reference for policy makers, staff in TB control facilities and manufacturers at all levels.

Current status and future prospects on the treatment of multi/extensively drug-resistant tuberculosis with bedaquiline

Song YANG,Xiao-feng YAN

Journal of Tuberculosis and Lung Health. 2019, 8(4):  249-252.  doi:10.3969/j.issn.2095-3755.2019.04.004

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Difficult-to-treat multi/extensively drug-resistant tuberculosis (MDR-TB/XDR-TB) is an extremely lethal infectious disease which still pose a threat as a global public health issue. With the development of new drugs such as bedaquiline (Bdq), delamanid or pretomanid, the regimens of Bdq plus background regimen (BBR) have achieved amazing treatment success rate. Bdq can be safe and effective when continued for up to 18 months, and it can also benefit children, adolescents, pregnant women, positive HIV patients and other special groups. However, the inevitable issues, including primary and acquired drug resistance, cross-resistance, recurrence, prolonged Q-T interval, and increased mortality and side-effects caused by the combined treatment with delamanid, pretomanid, or clofazimine, can not be ignored. In order to make the new drug Bdq exert a long-term clinical treatment effect, the understanding of the side-effects of Bdq should be enhanced, and the corresponding treatment and protection measures should be taken. Meanwhile, the premature occurrence and spread of Bdq resistance should be avoided.

Original Articles

Effect of video observed therapy for tuberculosis patients’ management by internet and mobile phones

Yu-bao QIN,Hong-xia FANG,Ming-chuan ZHANG,Yan WANG,Yi-ting WEI,Nian-sha ZHANG,Qiu-zi CHEN,Xiao-ping TAN,Kai-qiao ZHENG,Chang-wei LIU,Xin-feng YAN,Zhi-cong CHEN

Journal of Tuberculosis and Lung Health. 2019, 8(4):  253-258.  doi:10.3969/j.issn.2095-3755.2019.04.005

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Objective To evaluate the effect of video observed therapy (VOT) for tuberculosis patients’ management by internet and mobile phones.Methods By a prospective cohort study, 1174 pulmonary tuberculosis patients were registered and recruited for VOT management in Shenzhen Longhua Center for Chronic Disease Control (CCDC), from January 1st, 2017 to June 30th, 2018. The medicine records in system of VOT was selected and analyzed.Results During research period, 1301 patients were registered in Longhua CCDC, 90.2% (1174/1301) of the patients joined VOT management. Total medication times of patients in the study were 265.6 thousand, and the medication times uploaded in the system were 196.4 thousand (73.9%, 196400/265600). The number of patients whose uploaded medication rates in VOT system were divided into under 50%, 50%-, 90%-, 100% were 283 (24.1%, 283/1174), 256 (21.8%, 256/1174), 538 (45.8%, 538/1174), 97 (8.3%, 97/1174), respectively. The upload medication rates were significance different in the different groups of age and gender. The risk without upload medication regularly in male was higher 1.456 (1.130-1.876) than in female; the risk in over 40 age was higher 1.430 (1.130-1.811) than in under 40 age group.Conclusion Most pulmonary tuberculosis patients can accept and comply with VOT supervision as required. Additional training and guidance should be given to the age over 40 age or male patients undergoing VOT surveillance.

Investigation on public awareness in key information of tuberculosis prevention and control in Shenzhen

Chun-rong LU,Xiao-ling CHE,Ming-zhen LI,Qing-fang WU,Zhi-peng ZUO,Bing-ling YANG,Wei-guo TAN

Journal of Tuberculosis and Lung Health. 2019, 8(4):  259-264.  doi:10.3969/j.issn.2095-3755.2019.04.006

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Objective To investigate the current status of public awareness in key information of tuberculosis (TB) control and prevention in Shenzhen, so as to provide scientific basis for TB health promotion in the future.Methods The cross-sectional survey was applied to 3022 samples selected from 7457 residents from 10 districts of Shenzhen during the 2019 “World TB Day” publicity campaign between March 18, 2019 and March 25, 2019. All of the subjects were conducted by face-to-face questionnaires. A total of 3022 questionnaires were issued and 2960 valid questionnaires were received, the effective rate was 97.95%.Results The overall awareness rate of the key information of TB control and prevention among surveyed people was 87.30% (15505/17760). And the awareness rate of men (88.05%, 7576/8604) was significantly higher than that of women (86.60%, 7929/9156) (χ ²=8.45, P=0.004). The awareness rate of all the key information of TB control and prevention among surveyed people was 60.03% (1777/2960); and that in men (62.97%, 903/1434) was significantly higher than in women (57.27%, 874/1526) (χ ²=10.00, P=0.002). The awareness rate of the transmission of TB was the lowest single key information(77.60% (2297/2960)). The awareness rate of which symptoms should be suspected of tuberculosis was the highest (93.75%, 2775/2960).Conclusion The awareness rate of TB key information of the residents in Shenzhen reached standard of the National TB Control Program, but the awareness rates of TB transmission and of over 60 years old age group are lower the standard. It is suggested to strengthen the propaganda education of TB transmission and the aged to enhance the effectiveness of health promotion.

Analysis of drug resistance of tuberculosis patients in Dalian from 2012 to 2018

Chun-kui CAI,Xin-tong LYU,Gang LI,Shi-xue SUN,Xiao-feng GU,Yan XU,Ying WANG,Yang YU,Xi-wei LU

Journal of Tuberculosis and Lung Health. 2019, 8(4):  265-271.  doi:10.3969/j.issn.2095-3755.2019.04.007

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Objective To analyze the drug resistance of tuberculosis (TB) in Dalian from 2012 to 2018.Methods Based on China Information System of Disease Prevention and Control, a total of 5512 TB patients newly registered with smear-positive and sputum culture (modified Roche culture method) were collected from TB Information Management System in Dalian from 2012 to 2018. Among these patients, 5241 (95.1%) patients with positive culture were subjected to strain identification and anti-TB drugs sensitivity test (referred to as “drug susceptibility test”). Finally, 5050 strains of Mycobacterium tuberculosis (MTB) (96.4%, 5050/5241) and 191 strains of non-tuberculosis mycobacteria (NTM) (3.6%, 191/5241) were obtained. The drug resistance of the strain identified as MTB was analyzed based on drug susceptibility test results. SPSS 12.0 software was used to conduct Chi-square test or Chi-square trend test on the counting data or the annual drug resistance rate, and the linear regression equation was used to verify the drug resistance rate, multidrug resistance rate, year and the situation of the initial treatment or the retreatment. P<0.05 was considered as a statistically significant difference.Results The total drug resistant rate, total multidrug resistant rate, drug resistant rate of the initial treatment, multidrug resistant rate of the initial treatment, resistant rate of the retreatment, and multidrug resistant rate of the retreatment in Dalian were, respectively, 64.5% (223/346), 34.7% (120/346), 46.6% (34/73), 23.3% (17/73), 69.2% (189/273), and 37.7% (103/273) in 2012, while which were dropped to 24.0% (176/733), 6.7% (49/733), 19.0% (99/522), 4.8% (25/522), 36.5% (77/211), and 11.4% (24/211) in 2018, showing a significant downward trend ( {\chi }_{\mathrm{trend}}^2 =213.930, 223.357, 40.371, 49.536, 86.323, 66.990, all P values =0.000). The results of the linear regression equation showed that the total drug resistant rate, year and the condition of initial treatment and retreatment showed a decreasing trend (P_resistance=0.000, P_{multidrug resistance}=0.000). The total resistant rate of the 5050 strains to INH, RFP, Sm, Ofx, Km, EMB were, respectively, 19.2% (970/5050), 17.8% (900/5050), 8.9% (447/5050), 10.3% (521/5050), 4.8% (243/5050), and 2.5% (124/5050). There were 46 combinations of drug resistance in 1623 strains, including 6 kinds of single drug resistance, accounting for 45.3% (735/1623) of the total drug resistance spectrum, with the highest INH resistance (13.3%, 216/1623); 16 kinds of multidrug resistance (including extensive drug resistance), accounting for 36.8% (598/1623) of the total drug resistance spectrum, with the highest resistance to INH + RFP (13.3%, 216/1623); 24 kinds of multidrug resistance, accounting for 17.9% (290/1623) of the total drug resistance spectrum, with the highest resistance to INH + Sm (4.0%, 65/1623).Conclusion From 2012 to 2018, the total drug resistance rate and the total multidrug resistance rate of TB showed a significant downward trend in Dalian. The treatment and management of MDR-TB system exerts the remarkable prevention and control effects.

Characteristics of preoperative multi-slice spiral computed tomography images in adult patients with active spinal tuberculosis with different outcomes

Min SONG,Zhi-en XIE,Hong-zhi YANG,Hua-qiang WU,Zu-yuan XU,Wei-jun FANG

Journal of Tuberculosis and Lung Health. 2019, 8(4):  272-279.  doi:10.3969/j.issn.2095-3755.2019.04.008

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Objective To investigate the characteristics of preoperative multislice spiral computed tomography images (MSCT) in adult patients with active spinal tuberculosis with different outcomes.Methods A total of 242 adults patients with active spinal tuberculosis who underwent surgery in Guangzhou Chest Hospital from January 2015 to July 2018 were included in this retrospective study. They were divided into three groups according to the indexes of muscle strength, clinical symptoms and CT findings one year after operation: abnormal muscle strength group (Abnormal group; 33 cases), normal muscle strength with abnormal clinical symptoms group (Clinical abnormal group; 22 cases), postoperative normal group (Normal group; 187 cases). The MSCT features of the three groups before operation, including central vertebral body distribution, vertebral destruction degree, osseous spinal canal interruption, compression of the spinal canal and bilateral intervertebral foramen caused by lesions, and Cobb angle of lesion vertebral kyphosis, were analyzed.Results Preoperative MSCT showed that in the abnormal group, clinical abnormal group and normal group, the ratio of central vertebral bodies with obvious destruction in thoracic and thoracolumbar segment were 90.9% (30/33), 54.5% (12/22), and 56.7% (106/187); the ratio of central vertebral bodies with obvious destruction in lumbar and lumbosacral segment were 0.0% (0/33), 36.4% (8/22), and 36.4% (68/187); the ratio of central vertebral bodies with obvious destruction in anterior middle posterior columns were 19.4% (19/98), 21.6% (16/74) and 9.7% (57/587); the ratio of osseous spinal canal interruption were 24.2% (8/33), 27.3% (6/22), and 9.1% (17/187); and the ratio of obvious compression of vertebral canal caused by lesions were 100.0% (33/33), 77.3% (17/22), and 55.1% (103/187), and the ratio of obviously compressing bilateral intervertebral foramen were 87.9% (29/33), 72.7% (16/22) and 54.0% (101/187); and the ratio of calcium-like high-density compressive substances were 48.5% (16/33), 40.9% (9/22) and 18.7% (35/187), and it had significant difference in these aspects among the three groups (χ ² values: 14.28, 17.49, 14.33, 10.30, 26.40, 15.00, and 16.70, respectively; P values: 0.001, <0.001, 0.001, 0.006, <0.001, 0.001, and <0.001, respectively). The median (quartile) of kyphosis Cobb angle in the abnormal group, clinical abnormal group and normal group were 20.77 (18.40, 25.40)°, 21.01 (17.10, 22.77)°, and 15.63 (11.71, 19.61)°, respectively, and there were significant difference among groups (H=27.65, P<0.001).Conclusion Adult patients with active spinal tuberculosis might have poor prognosis and outcome if they have preoperative MSCT signs such as lesions located in thoracic and thoraco lumbar segment, three column destruction, interruption of osseous spinal canal, calcium-like high-density compressive substances with obvious compression of vertebral canal and bilateral foramen, and large kyphosis Cobb angle.

Clinical analysis of 15 cases of tuberculous meningitis after in vitro fertilization and embryo transplantation

Yu CHEN,Qiao-si LI,Li-chao FAN,Ya-juan ZHU,Long ZHANG,Ming-fang ZHOU,Yue-qiu LYU,Zhong-yuan YU

Journal of Tuberculosis and Lung Health. 2019, 8(4):  280-284.  doi:10.3969/j.issn.2095-3755.2019.04.009110000

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Objective To investigate the clinical characteristics of patients with tuberculous meningitis after pregnancy undergoing in vitro fertilization and embryo transplantation.Methods The clinical data of 15 patients with tuberculous meningitis (15 patients underwent routine pulmonary CT scan and tuberculin tests before the operation to exclude active tuberculosis) after pregnancy undergoing in vitro fertilization-embryo transfer treated in the Department of Tuberculosis of the Shenyang Tenth People’s Hospital from May 2014 to May 2019 were retrospectively analyzed. Including general conditions, clinical manifestations, signs, enhanced brain MR scan and tuberculin test, T-cell spot test for blood tuberculosis infection (T-SPOT.TB), tuberculosis antibodies, AFP, CD4 ⁺/CD8 ⁺, cerebrospinal fluid (CSF) tuberculosis culture, CSF rifampicin resistance real-time quantitative nucleic acid amplification detection technology (GeneXpert MTB/RIF), CSF loop-mediated isothermal amplification (LAMP) to summarize the clinical characteristics.Results Fourteen of 15 patients had fever, including 3 cases with high fever (39.1-41.0℃), 9 with moderate fever (38.1-39.0℃) and 2 with low fever (37.3-38.0℃). Among the 15 patients, 6 cases had hematogenous disseminated tuberculosis, 2 cases had concurrent hematogenous disseminated tuberculosis and tuberculous pleurisy, 1 case had concurrent hematogenous disseminated tuberculosis and secondary pulmonary tuberculosis, and 3 cases had secondary pulmonary tuberculosis, 1 case had tuberculous pleurisy, and 1 case had concurrent secondary pulmonary tuberculosis and tuberculous pleurisy. Among the 15 patients, 14 patients underwent enhanced cranial MR scans, and 12 patients were abnormal. The main manifestations were: The bilateral brain, cerebellum and brain stem had long T₁ and T₂ signals, and there were multiple intracranial enhancement nodules; 15 cases underwent skin tuberculin test, 6 cases were strongly positive; 15 cases T-SPOT.TB test, 14 cases were positive; 15 cases were tested for tuberculosis antibody, 9 cases were positive; 10 cases were underwent CSF GeneXpert MTB/RIF test, 2 cases were positive in which 1 case with a negative MGIT 960 culture; 15 patients underwent MGIT 960 culture and 4 were positive; 10 of 15 patients underwent abortion in the first and second trimester, 1 had a normal delivery and 4 had cesarean section in the late pregnancy. Of the 5 babies born, 1 died of congenital tuberculosis after birth in nearly one month, and the remaining 4 infants were healthy. Of the 15 patients, 5 had hypokalemia and 6 had anemia; 5 had abnormal liver function and 5 had hyperuricemia after anti-tuberculosis treatment. The average treatment time for the patient’s CSF pressure to return to the normal value below 180 mm H₂O (1 mm H₂O=0.0098 kPa) was (22.4±20.5) d. And the average treatment time for fluid indicators (CSF protein, glucose, chloride, and cell numbers) to return to normal was (70.8±74.0) d; After active anti-tuberculosis treatment, 14 patients were cured and 1 patient died.Conclusion Patients with tuberculous meningitis after pregnancy undergoing in vitro fertilization-embryo transfer usually have fever symptoms, concurrent with hematogenous disseminated tuberculosis, high positive rate of peripheral blood T-SPOT.TB test, low positive rate of CSF etiology and a long time for CSF pressure to return to normal.

Clinical characteristics of 344 cases of bronchial tuberculosis

Hua CHEN,Guang-hui XU,Yong-ping XIE

Journal of Tuberculosis and Lung Health. 2019, 8(4):  285-288.  doi:10.3969/j.issn.2095-3755.2019.04.010

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Objective To summarize the clinical features of bronchial tuberculosis and improve the understanding of bronchial tuberculosis.Methods Data of 344 patients with bronchial tuberculosis diagnosed after bronchoscopy at the Jiangmen City Tuberculosis Control and Prevention Center in Guangdong Province from Nov. 2011 to Dec. 2018 were collected. Demographic characteristics, symptoms, chest CT findings and characteristics of the first bronchoscopy result were summarized.Results Clinical features of 344 patients with bronchial tuberculosis were: (1) age distribution, the highest proportion of patients were in the 20-29 age group (25.58%, 88/344). (2) The clinical symptoms were mainly cough and expectoration (87.50%, 301/344). (3) Most patients suffered with symptom duration >3 months (40.99%, 141/344). (4) Lesions were mostly located in the right upper lobe (33.14%, 114/344) of lungs. (5) Most common findings of chest CT were lung cavities (36.63%, 126/344). (6) The most common type of bronchoscopy classification result was inflammatory infiltration (86.92%, 299/344).Conclusion The bronchial tuberculosis happened more in young people, symptoms last for a long time, and there was no specific clinical symptoms. The most common lesions were in the right upper lobe bronchus. Chest CT usually found cavities. The most common bronchoscopy result was inflammatory infiltration type of tuberculosis.

The prognostic value of the combined detection of serum procalcitonin, hypersensitive c-reactive protein and d-dimer in patients with acute exacerbation of chronic obstructive pulmonary disease

Zheng-hua ZHOU,Bao-jiang WEN,Sheng-hong GONG,Zhi-yong LIANG

Journal of Tuberculosis and Lung Health. 2019, 8(4):  289-293.  doi:10.3969/j.issn.2095-3755.2019.04.011

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Objective To investigate the prognostic value of the combined detection of serum procalcitonin (PCT), hypersensitive c-reactive protein (hs-CRP) and d-dimer (D-D) in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD).Methods The medical records of 87 AECOPD patients who admitted to the Respiratory Department of Qingyuan Chronic Disease Prevention and Control Hospital, Guangdong Province from July 2017 to February 2019 were retrospectively analyzed. The patients were divided into the survival group (65 cases) and the death group (22 cases) according to the prognosis. The serum PCT expression was detected by immunolatex turbidimetry; the serum D-D expression was detected by immunoturbidimetry; and the serum hs-CRP expression was measured by dry immunofluorescence assay. Receiver operating characteristic (ROC) curve was used to analyze the value of single and combined detection for predicting the prognosis of AECOPD patients.Results The expression levels of PCT, hs-CRP and D-D in the death group were (11.63±2.51) μg/L, (31.84±6.42) mg/L, and (6.70±2.13) mg/L respectively, which were significantly higher than those in the survival group ((5.72±1.24) μg/L, (17.57±4.36) mg/L, and (3.35±1.08) mg/L, respectively). The differences were statistically significant (t values: 14.53, 11.69 and 9.61, respectively; all P values <0.01). The sensitivity, specificity, accuracy and AUC of the combined detection of serum PCT, hs-CRP and D-D to predict the prognosis of AECOPD patients were 90.77%, 90.90%, 90.80% and 0.917, respectively.Conclusion The combined detection of serum PCT, hs-CRP and D-D has a high clinical value in predicting the prognosis of AECOPD patients.

Technical Communication

Construction of a monitoring system for drug resistance screening of new pathogen positive pulmonary tuberculosis cases based on Power Pivot

Yin-suo YAN,Li-ying TAO,Hong-wei ZHANG,Yan-yuan LI,Zhi-dong GAO

Journal of Tuberculosis and Lung Health. 2019, 8(4):  294-298.  doi:10.3969/j.issn.2095-3755.2019.04.012

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In order to understand the quality of drug resistance screening for new pathogen positive tuberculosis (TB) cases and standardize the drug resistance screening, Power Pivot tool was used in this study to construct a drug resistance screening auxiliary monitoring system. After the construction of the system, it can generate the drug resistance screening reports of new pathogen positive TB patients in different interactive dimensions according to the time conditions such as year, quarter and regional conditions such as region, institution, and accurately generate the list of patients who not screened for drug resistance. As an assistant and supplement to the statistical module of Tuberculosis Information Management System, a subsystem of the China Information System for Disease Control and Prevention, the tool provides a solution to reflect the quality of drug resistance screening work flexibly, quickly and accurately.

Review Articles

Research progress on glucocorticoids application in treatment of patients with tracheobronchial tuberculosis

Fu-ping YANG,Kun LEI,Song YANG

Journal of Tuberculosis and Lung Health. 2019, 8(4):  299-302.  doi:10.3969/j.issn.2095-3755.2019.04.013

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There are still disputes and contradictions about the role of glucocorticoids (GCS) in the treatment of tracheobronchial tuberculosis (TB). Some studies found that the treatment for the patients with active tracheobronchial TB aimed to control infection and prevent tracheobronchial stenosis. At the early stage of inflammatory in the patients with active with tracheobronchial TB, inhaled corticosteroids (ICS) can be used to control inflammation, relieve symptoms and prevent bronchostenosis. However, the possibility of occurrence of ICS-TB-related pneumonia,nontuberculous mycobacterial pulmonary disease or lung cancer need to be vigilant and closely monitored.