Table of Content

30 June 2020, Volume 1 Issue 1

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Expert Forum

Progresses on the SARS-CoV-2 RNA-dependent RNA polymerase and potential anti-SARS-CoV-2 inhibitors

LI Gang, XIE Jian-ping

Journal of Tuberculosis and Lung Disease. 2020, 1(1):  6-10.  doi:10.3969/j.issn.2096-8493.2020.01.003

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The coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerges as global pandemic and public crisis. Due to the lack of specific antiviral therapy and vaccines, it is urgent for novel drugs and vaccines based on the molecular biology of the virus. As a positive single-stranded RNA virus, SARS-CoV-2 replication in host cells depends on its own RNA-dependent RNA polymerase (RdRp). Based on the high conservative of RdRp, this paper summarizes the progress of anti-coronavirus RdRp inhibitors as well as the structure and function of SARS-CoV-2 RdRp, with an aim to find drugs capable of inhibiting the RdRp function of SARS-CoV-2 and treatment of COVID-19.

Problems and suggestions in the treatment of TB/HIV coinfection

WU Gui-hui, HUANG Tao

Journal of Tuberculosis and Lung Disease. 2020, 1(1):  11-16.  doi:10.3969/j.issn.2096-8493.2020.01.004

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AIDS complicated with tuberculosis (TB) has become a serious public health problem in China. The mortality rate of TB/HIV co-infection is higher than that of HIV-negative TB patients. The treatment process involves anti-TB and anti-HIV treatment. Anti-TB and anti-HIV treatment are faced with serious challenges due to the initiation time of antiviral therapy, drug interactions, drug tolerance, the prevention and treatment of TB-associated immune reconstitution syndrome. The author discusses the latest research on the treatment and management of patients with TB/HIV co-infection, combined with literature and clinical experience.

Original Articles

Correlation between nutritional status and chest CT findings in patients with newly diagnosed smear positive pulmonary tuberculosis

LI Rong, MA Jin-bao, REN Fei, ZHANG Fan, TAN Gan-wen, ZHOU Jie, WU Yan-qin

Journal of Tuberculosis and Lung Disease. 2020, 1(1):  17-23.  doi:10.3969/j.issn.2096-8493.2020.01.005

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Objective To understand the nutritional status of patients with newly diagnosed smear positive pulmonary tuberculosis and to explore correlation between nutritional status and chest CT findings in those patients. Methods Basic information of 296 newly diagnosed pulmonary tuberculosis patients with positive sputum smear acid-fast bacilli testing results from April 2019 to September 2019 were collected. Among them, 204 were male and 92 were female, age range 18-72 years, median age 38 years. According to body mass index (BMI) <18.5 or albumin (ALB) <30 g/L, those patients were divided into malnutrition group (122 cases) and non-malnutrition group (174 cases). The incidence of malnutrition was 41.2% (122/296). Morphological and lesion characteristics of chest imaging of those two groups were compared. Results Proportion of morphological features of chest CT(cavity, pulmonary consolidation shadow, pleural effusion, mediastinal hilar lymph node enlargement, tree bud sign, interstitial changes, patch shadow, cord shadow, calcification, small nodules) in the malnutrition group was 82.0% (100/122), 89.3% (109/122), 24.6% (30/122), 41.8% (51/122), 32.0% (39/122), 9.8% (12/122), 68.9% (84/122), 18.9% (23/122), 16.4% (20/122), 39.3% (48/122) respectively, which was similar to the non-malnutrition group (77.6% (135/174), 89.7% (156/174), 19.5% (34/174), 38.5% (67/174), 29.3% (51/174), 11.5% (20/174), 67.8% (118/174), 20.1% (35/174), 6.9% (12/174), 47.7% (83/174)),without statistically significant differences (χ²=0.841, 0.007, 1.079, 0.325, 0.625, 0.205, 0.036, 0.073, 6.708, 2.030, all P>0.05). The proportion of lung lesions ≥4 lung fields and the number of cavities ≥2 in malnutrition group was 66.4% (81/122) and 69.7% (85/122), higher than that in the non-malnutrition group (42.0% (73/174) and 37.4% (65/174)),with statistically significant differences (χ ²=17.162, 29.963,all P<0.001). The proportion of lesions being at the posterior segment of the upper lobe tip and the dorsal segment of the lower lobe in malnutrition group was 89.3% (109/122), similar to the non-malnutrition group (86.2% (150/174)), without statistically significant difference (χ ²=0.645, P>0.05). Conclusion Patients with newly diagnosed smear-positive pulmonary tuberculosis with malnutrition got more lung fields affected than patients without malnutrition, and were more likely to have multiple cavities.

Analysis of the correlation between nutritional risk status and clinical characteristics of pulmonary tuberculosis patients

MAO Yi, CHEN Yi, WU Gui-hui, CHEN Jing

Journal of Tuberculosis and Lung Disease. 2020, 1(1):  24-28.  doi:10.3969/j.issn.2096-8493.2020.01.006

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Objective To study the correlation between nutritional risk status and clinical characteristics of pulmonary tuberculosis patients. Methods To collected the nutritional risk profile and clinical features of information (including sex, age, time, type, extrapulmonary tuberculosis, complications, patients with respiratory tract specimens, respiratory specimens of acid-fast stain BACTEC MGIT 960 liquid culture) of 313 cases tuberculosis patients admitted to TB Division of Chengdu Public Health Clinical Center from Jan to May, 2019. Nutritional risk was assessed by Nutritional Risk Screening 2002, including nutritional status score, disease severity score and age score, the total score is 0-7. Single linear regression analysis was carried out for each clinical feature, and the correlation between nutritional risk and clinical characteristics of pulmonary tuberculosis patients was analyzed by multiple linear regression. Results The nutritional risk assessment score of 313 patients based on Nutritional Risk Screening 2002 was 0-7, with an average score of 4.06±1.27; 279 patients with scores ≥3 points, accounting for 89.1%, 34 patients with scores <3 points, accounting for 10.9%. Among them, the average score of nutritional status was 2.49±1.03, the average score of disease severity was 1.02±0.07, and the average score of age was 0.07±0.01. Single linear regression analysis showed that age 60 years or more (t=7.653, P=0.002), disease onset period (t=10.558, P=0.001), the types of patients (t=2.305, P=0.002), concurrent extrapulmonary tuberculosis (t=4.755, P=0.016), complications (t=45.343, P=0.017) had a statistically significant difference in nutritional risk score. The results of multiple linear regression analysis showed that age elder than 60 years old (t=1.345, P=0.016), time of onset (t=3.986, P=0.001) and complications (t=8.569, P<0.001) were the factors that affected the nutritional risk. Conclusion Elderly pulmonary tuberculosis patients, time of onset and complications are the risk factors affecting the nutritional risk status of pulmonary tuberculosis patients.

Insights into a possible connections underlying outcome of nutritional risk screen and impact factors out of 203 cases with intestinal tuberculosis

LIU Xin, LI Jian, SHEN Sheng-rong

Journal of Tuberculosis and Lung Disease. 2020, 1(1):  29-33.  doi:10.3969/j.issn.2096-8493.2020.01.007

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Objective To investigate whether incidence of nutritional risk is associated with the clinical characteristics of patients with intestinal tuberculosis and to provide the guideline with the patients for the needs of the reasonable nutrition treatment. Methods Two hundred and three patients admitted to the Chest Hospital of Xinjiang Uyghur Autonomous Region identified as having laboratory- and clinical-confirmed intestinal tuberculosis. Data were collected from January 2016 to January 2019. Of the 203 patients studied and by age, 97 patients admitted to the youth group (group A1, less than 44 years), 64 patients to the middle age group (group A2, 45 to 60 years) and 42 patients to the old age group (group A3, more than 60 years). Or by lesion site, 38 patients admitted to the simple ileum terminal group (group L1), 23 patients to the colonic group (group L2), 68 patients to the ileum and colon group (group L3), and 20 patients to the upper gastrointestinal tract group (group L4), 54 patients to the upper digestive tract and ileum terminal or colon or ileocolon group (group L4+L1/L2/L3). Or by the pathological classification, 95 patients admitted to ulcer type (type B1), 47 patients to proliferative type (type B2) and 61 patients to mixed type (type B3). Or by the disease activity stage, 159 patients admitted to active stage and 44 patients to stable period. The nutritional risk score and clinical data, collected using the European nutritional risk screening tool (NRS 2002) and standardized case reported form. Results All studied cases were evaluated by NRS 2002. The incidence of nutritional risk in patients at onset of intestinal tuberculosis was 81.28% (165/203), of which was occupied by 80.61% (79/98) in men and by 81.90% (86/105) in women (χ²=0.056,P>0.05). Also, in different age groups we observed that the incidence of nutritional risk was 74.23% (72/97) in group A1, 84.38% (54/64) in group A2 and 92.86% (39/42) in group A3, respectively (χ²=7.274,P=0.026). Additionally, in different lesion site group the incidence of nutritional risk was evaluated as the follows: 81.58% (31/38) in group L1, 56.52% (13/23) in group L2, 79.41% (54/68) in group L3, 90.00% (18/20) in group L4, and 90.74% (49/54) in group L4+L1/L2/L3, respectively (χ²=12.066,P=0.014). Moreover, in different pathological types the incidence of nutritional risk was involved in type B1, B2 and B3 with 89.47% (85/95), 72.34% (34/47) and 75.41% (46/61), respectively (χ²=8.042,P=0.018). Interestingly, in the active or stable period the incidence of nutritional risk was 89.31% (142/159) and 52.27% (23/44), respectively (χ²=31.068,P<0.001). Conclusion The occurrence of incidence of nutritional risk of hospitalized patients with intestinal tuberculosis was quite frequent, and routine nutritional risk screen was strongly recommended. Here, we also implicated that the nutritional risk screen in elderly patients, active patients, patients with upper digestive involvement, and patients with ulcerative and mixed intestinal tuberculosis should be tightly conducted.

Influence of respiratory training intervention on respiratory function and quality of life in patients with chronic obstructive pulmonary disease

LIU Si-mei, XI Xiu-feng, LI Bing

Journal of Tuberculosis and Lung Disease. 2020, 1(1):  34-38.  doi:10.3969/j.issn.2096-8493.2020.01.008

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Objective To evaluate the effect of respiratory training intervention on pulmonary function, anxiety, depression and other negative emotions, and symptom of dyspnea on hospitalized patients with acute exacerbation of chronic obstructive pulmonary disease (COPD). Methods A total of 82 COPD patients who were hospitalized due to acute exacerbation of the disease from June 2019 to December 2019 were collected and grouped according to the single and double numbers of the enrollment time series. Concretely, 41 patients received respiratory training intervention based on usual care at stable stage as the observation group, and 41 patients were adopted the routine nursing methods as the control group. Five patients with aggravation were removed. Finally, 77 cases were actually completed, including 40 in the observation group and 37 in the control group. The lung function of patients in the two groups was measured using lung function instrument. The self-assessment scale for anxiety (SAS) and the self-assessment scale for depression (SDS) were used to evaluate the negative emotions of patients. The self-assessment test questionnaire (CAT) was used to evaluate the symptoms of patients. The dyspnea scale (mMRC) was used to evaluate the symptoms of dyspnea. The respiratory function and quality of life of patients in the two groups were measured and evaluated by means of randomized experiment. Results The lung function of patients in the observation group after intervention was as follows: the forced expiratory volume in 1 second (FEV₁) was (1.91±0.42) L, the FEV₁ accounted for the percentage of predicted value (FEV₁(%)) was (68.16±5.79)%, and the ratio of FEV₁ to forced vital capacity (FEV₁/FVC) was 66.20±2.00; the corresponding values in the control group were (1.59±0.31) L, (63.95±6.95)%, and 61.35±3.71, respectively, with the statistically significant differences between the two groups (t=3.86, 2.91, 7.06, respectively; all P=0.000). The SAS score of patients in the observation group after intervention was 38.55±8.72, which was lower than that in the control group (44.68±8.62), with the statistically significant difference (t=-3.10, P=0.000). The SDS score of patients in the observation group after intervention was 38.85±6.26, which was significantly lower than that of the control group (46.54±7.31), with the statistically significant difference (t=-4.94, P=0.000). The CAT score of patients in the observation group after intervention was 23.88±4.30, which was significantly lower than that of the control group (32.41±3.87), with the statistically significant difference (t=-9.16, P=0.000). The mMRC score of patients in the observation group after intervention was 1.73±0.85, which was significantly lower than that of the control group (2.49±0.93), with the statistically significant difference (t=-3.74, P=0.000). Conclusion The implementation of respiratory training intervention for patients with acute exacerbation of COPD can improve the lung function, reduce anxiety and depression, and improve the symptoms of dyspnea.

Monitoring of pulmonary function in patients with active tuberculosis during anti-tuberculosis treatment

WANG Chun-ting, LI Ya-qi, MI Yan, MO Nian-chun, LIU Hong-yan, LE Xing, ZHOU Li, WU Bi-feng, HAN Shi-yun, BAI Li-qiong, ZHANG Chuan-fang

Journal of Tuberculosis and Lung Disease. 2020, 1(1):  39-44.  doi:10.3969/j.issn.2096-8493.2020.01.009

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Objective To observe changes of pulmonary function of patients with active tuberculosis as the treatment progresses. Methods Data were collected on 628 patients with active tuberculosis admitted to Hunan Chest Hospital from January 2018 to August 2019. 249 patients were included in the analysis according to inclusion and exclusion criteria. Pulmonary functions of patients were measured before treatment,at the end of the first month, at the end of intensive period and at the end of treatment. Overall lung function, pulmonary ventilation function, diffusing capacity, lung volume, and airway resistance at those four time points were compared. Results The abnormal rate of overall lung function assessment,pulmonary ventilation function, diffusion function, lung volume, respiratory impedance results before treatment were 91.97% (229/249), 67.07% (167/249), 48.19% (120/249), 71.89% (179/249) and 34.14% (85/249) respectively. As the treatment went on, the abnormal rate dropped to 77.11% (192/249), 51.81% (129/249), 30.12%(75/249), 44.18% (110/249), 23.69% (59/249) at the end of the treatment. Differences were statistically significant (χ²=25.434, 25.255, 37.227, 60.238, 27.153, all P=0.000). Patients with restrictive and mixed ventilation dysfunction decreased from 27.31% (68/249) and 12.85% (32/249) before treatment to 11.65% (29/249) and 6.83% (17/249) at the end of treatment, differences were statistically significant ( {\chi }_{\mathrm{trend}}^2 =39.222, 16.068; P=0.000, 0.001). Patients with obstructive ventilation dysfunction before treatment were 26.91% (67/249), at the end of treatment it increased to 33.33% (83/249), the difference was not statistically significant ( {\chi }_{\mathrm{trend}}^2 =1.233, P=0.745). Conclusion Pulmonary tuberculosis patients often suffers with lung function damage. With the progress of treatment, lung function damage has been repaired to varying degrees, but the abnormal rate of lung function is still high at the end of the treatment course. The restrictive and mixed pulmonary ventilation dysfunction were improved significantly at the end of treatment, while obstructive ventilation dysfunction persisted.

Application of lung protective ventilation strategy in mechanical ventilation of patients with pulmonary tuberculosis complicated with HIV infection

MAO Yi, WU Gui-hui, CHEN Juan, CHEN Hong-de

Journal of Tuberculosis and Lung Disease. 2020, 1(1):  45-48.  doi:10.3969/j.issn.2096-8493.2020.01.010

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Objective To explore the application value of lung protective ventilation strategy in mechanical ventilation treatment of patients with pulmonary tuberculosis (PTB) complicated with human immunodeficiency virus (HIV) infection and its effect on the prognosis of patients. Methods A retrospective study of 42 patients with PTB complicated with HIV infection who were hospitalized in the tuberculosis intensive care ward of the Chengdu Public Health Clinical Medical Center from January 2013 to December 2018 was conducted, including 21 patients treated with lung protective ventilation strategy as the observation group, and the 21 patients treated with conventional mechanical ventilation as the control group. The patients of the observation group were treated with mechanical ventilation under the lung protective ventilation strategy (tidal volume of 6-8 ml/kg, positive end-expiratory pressure (PEEP) of 5-10 cm H₂O (1 cm H₂O=0.098 kPa)), while the patients of the control group were treated with conventional mechanical ventilation (tidal volume of 10-12 ml/kg, PEEP of 0-4 cm H₂O). The changes of blood gas analysis indexes before and after mechanical ventilation treatment, as well as the differences in mean mechanical ventilation time, incidence of lung injury (VILI) caused by ventilator, incidence and mortality of ventilators associated pneumonia (VAP) were compared between the two groups. Results After 2 h of mechanical ventilation treatment, the oxygenation index of the observation group was (250.62±21.45) mm Hg (1 mm Hg=0.133 kPa), which was better than that of the control group ((218.23±18.63) mm Hg), and the difference was statistically significant (t=21.56, P=0.028). The average ventilation time in the observation group was (4.92±1.13) d, which was significantly shorter than that in the control group ((8.74±2.35) d), and the difference was statistically significant (t=2.73, P=0.033). The incidence of VILI in the observation group was 4.8% (1/21), which was significantly lower than that in the control group (19.0% (4/21)), and the difference was statistically significant (Fisher exact probability, P=0.027). The incidence of VAP in the observation group was 9.5% (2/21), which was significantly lower than that in the control group (28.6% (6/21)), with the statistically significant difference (Fisher exact probability, P=0.031). Conclusion The lung protective ventilation strategy is superior to the conventional ventilation strategy in improving the therapeutic effect of mechanical ventilation, reducing the incidence of VILI and VAP, and shortening the treatment time of mechanical ventilation in patients with PTB complicated with HIV infection.

Screening and follow-up of tuberculosis among undergraduate freshmen in Haidian District, Beijing, 2011—2015

LIU Xi, LI Jie

Journal of Tuberculosis and Lung Disease. 2020, 1(1):  49-54.  doi:10.3969/j.issn.2096-8493.2020.01.011

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Objective To analyze the tuberculosis (TB) screening situation of undergraduate freshmen and follow-up during undergraduate study in Haidian District of Beijing from 2011 to 2015. Methods A total of 266770 undergraduate freshmen from 30 universities in Haidian District of Beijing from 2011 to 2015 were selected as the survey objects. All the TB screening work was carried out in Haidian District, Beijing. The basic information and TB screening information were collected and analyzed, including tuberculin pure protein derivative (PPD) test results, chest X-ray examination results and follow-up information. Results Of the 266770 respondents, 263021 completed TB screening. Among 262742 who completed PPD screening, the strong positive rate of PPD was 5.46% (14357/262742). A total of 189 cases with TB were detected in the freshmen who received TB screening, and the detection rate was 71.86/100000 (189/263021). During the 4 years of undergraduate education, 423 cases were diagnosed with TB cumulatively, with a cumulative incidence rate of 158.68/100000 (423/266581). Freshmen with a strong positive PPD test for admission screening had the highest cumulative incidence (576.00/100000 (82/14236)) during the undergraduate period. During the undergraduate period, there were 28 cases of tuberculosis clustering epidemic, 4751 close contacts were screened, 69 patients were detected, and the recurrence rate was 1.45% (69/4751). Conclusion Universities should strengthen the mobilization of TB screening for freshmen, improve the completion rate of TB screening for freshmen, strengthen the symptom monitoring of strong PPD positive students in school, strengthen the management of rest and resumption of school for patients with confirmed tuberculosis, and timely screen close contacts.

Analysis the distribution of MTB resistance and resistance gene mutation in 263 adult tuberculosis patients with human immunodeficiency virus co-infection

FU Xiao-yan, HUANG Tao, CHEN Qing, HE Wei, HUANG Xiao-qiu, WU Gui-hui

Journal of Tuberculosis and Lung Disease. 2020, 1(1):  55-59.  doi:10.3969/j.issn.2096-8493.2020.01.012

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Objective To investigate the MTB resistance rate, resistance spectrum and distribution of resistance genes in tuberculosis and HIV co-infection patients to provide guidance for clinical treatment. Methods A total of 263 patients with tuberculosis and HIV co-infection who met the inclusion and exclusion criteria in Chengdu Public Health Clinical Center from July 1, 2017 to June 30, 2019 were collected as the research objects. BACTEC MGIT 960 identification system was used for bacterial type identification, microplate proportion method was used for drug sensitivity test, and DNA microarray chip was used to detect drug resistance genes. The drug resistance rate,spectrum and gene distribution were analyzed among these patients. Results Among the 263 tuberculosis patients complicated with HIV infection, a total of 78 cases developed MTB resistance, with an overall drug resistance rate of 29.7%. The distributions of anti-tuberculosis drug resistance were as follows:INH (14.8%, 39/263),RFP (11.0%, 29/263),Sm (8.4%, 22/263),Mfx (6.5%, 17/263),Rfb (6.1%, 16/263),Lfx (4.6%, 12/263),EMB (4.2%, 11/263),Pto (3.4%, 9/263),PAS (3.0%, 8/263). The incidence of drug resistance in retreatment tuberculosis complicated with HIV infection was 57.4% (35/61), which was significantly higher than that in initial treatment tuberculosis complicated with HIV infection (21.3%, 43/202), and the difference was statistically significant (χ²=29.25,P=0.000). The drug resistance gene mutation of INH in katG were 24 strains (68.6%, 24/35) and 11 strains in inhA (31.4%, 11/35); the drug resistance gene mutation of RFP in rpoB 531 were 16 strains (61.5%, 16/26), 7 strains (26.9%, 7/26) in rpoB 526, and 3 strains (11.5%, 3/26) in rpoB 516. Conclusion The drug resistance rate of tuberculosis and HIV co-infection patients was higher, and distribution of the anti-tuberculosis drugs were mainly the first-line drugs. The rpoB531 mutations are the most common in RFP resistance, and katG mutations are common in INH resistance.

Effect of “knowledge, belief and behavior” model intervention on mastering tuberculosis knowledge in elderly patients with pulmonary tuberculosis

ZHANG Shi-xia, LI li

Journal of Tuberculosis and Lung Disease. 2020, 1(1):  60-64.  doi:10.3969/j.issn.2096-8493.2020.01.013

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Objective To explore the effect of “knowledge, belief and behavior” model intervention on mastering tuberculosis knowledge in elderly patients with tuberculosis (TB). Methods From January 2018 to June 2019, 80 elderly patients with pulmonary tuberculosis who were hospitalized in Zaozhuang Chest Hospital for more than 10 days and met the research criteria were selected as the study objects. Using the questionnaire, the first household survey of knowledge, belief and behavior intervention for patients was carried out within 3 days after discharge from hospital. According to the results of the investigation, using the mode of “knowledge, belief and behavior intervention”, distributing an easy-to-understand brochure on TB prevention and control, the elderly TB patients were intervened by means of face-to-face communication and behavior demonstration. After 15 days of intervention, a second questionnaire survey was conducted to track the effect of “knowledge, belief and behavior intervention”. 160 questionnaires were distributed and 160 were effectively recovered. The effective recovery rate of questionnaire was 100.00%. Results As for the knowledge of prevention and treatment of tuberculosis (routes of transmission, treatment methods, etc.), the awareness rate before intervention was 76.63% (613/800), and the awareness rate after intervention was 95.63% (765/800). The difference was statistically significant (χ²=120.84, P=0.000). The awareness rate of belief to prevention and treatment before intervention was 79.00% (316/400), and the awareness rate after intervention was 93.00% (372/400). The difference was statistically significant (χ²=32.56, P=0.000). The awareness rate of behavior to prevention and treatment before intervention was 82.25% (329/400), and the awareness rate after intervention was 97.75% (391/400). The difference was statistically significant (χ²=53.39, P=0.000). Conclusion The application of knowledge, belief and behavior intervention model for health education can improve the elderly TB patients’ knowledge of TB, improve their health belief and behavior, so as to promote rehabilitation and reduce the spread of disease.

Analysis of risk factors of drug-induced liver injury in hospitalized tuberculosis patients complicated with HIV/AIDS co-infection

WANG Yan, HE Wei, HUANG Tao, WU Gui-hui

Journal of Tuberculosis and Lung Disease. 2020, 1(1):  65-70.  doi:10.3969/j.issn.2096-8493.2020.01.014

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Objective To investigate the clinical characteristics and risk factors of drug-induced liver injury in with hospitalized tuberculosis (TB) patients complicated with HIV/AIDS. Methods Clinical data of 164 TB patients complicated with HIV/AIDS co-infection from the Public Health Clinical Center of Chengdu in 2017 were retrospecively analyzed. The data included gender, age, type of TB, HIV-infected route, whether or not complicated with viral hepatitis B (HBV) and/or viral hepatitis C (HCV), count of CD4⁺T cell, history of highly active anti-retroviral therapy (HAART), sulfonamides and antifungal treatment, etc. The patients were divided into liver injury group (n=87) and non-liver injury group (n=77) according to the occurrence of drug-induced liver injury within 2 weeks after anti-TB drug treatment, and the risk factors of drug-induced liver injury was analyzed. Results Multivariate logistic regression analysis showed that CD4⁺T cell count between 200-<414 cells/μl and the use of antifungal drugs were independent risk factors for drug-induced liver injury in TB patients complicated with HIV/AIDS during anti-TB drug treatment (Wald χ²=6.769, P=0.009, OR (95%CI)=13.357 (1.895-94.136); Wald χ²=7.122, P=0.008, OR (95%CI)=2.834 (1.319-6.089)). Conclusion When treated with anti-TB drug, TB patients complicated with HIV/AIDS should be alert to the drug-induced liver injury if CD4⁺T cell counts between 200 and 414 cells/μl and anti-fungal treatment. Frequent monitoring, early detection and early intervention should be conducted, and so as the preventive liver protection treatment if necessary .

Review Articles

The main immune cells against Mycobacterium tuberculosis infection and their mechanisms

HU Xiao-guang, CHEN Can-can, ZHANG Ya-nan, MA Jun-yang, CHEN Wei

Journal of Tuberculosis and Lung Disease. 2020, 1(1):  71-77.  doi:10.3969/j.issn.2096-8493.2020.01.015

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Mycobacterium tuberculosis (MTB) is a kind of intracellular parasitic bacterium. Cellular immunity plays a key role in the body’s immune process against MTB infection. Macrophages and natural killer (NK) cells are the early defense cells against this pathogen, and the adaptive immune cells, CD4⁺ and CD8⁺ T-cells, play an important role in the process against bacteria. However, the “immune escape” mechanism of MTB allows it to persist in the host. In this paper, the main immune cells and their immunity mechanisms in the process of TB immunity were summarized, and the immune evasion of MTB were discussed, so as to offer references for developing new preventive and therapeutic measures.

Clinical characteristics and choices of treatment for lymphadenitis after BCG vaccination in infants

LIU Chen, XU Xiao-liang, FU Ting-liang

Journal of Tuberculosis and Lung Disease. 2020, 1(1):  78-81.  doi:10.3969/j.issn.2096-8493.2020.01.016

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BCG vaccination is an effective and safe measure to prevent tuberculosis. Although its adverse effect rate is very low, we still need to pay attention to prevention and management of BCG-related lymphadenitis in infants for which there are still some puzzles in diagnosis and treatment. In this paper, we reviewed latest updated literature and focused on clinical characteristics and treatment choices of BCG-related lymphadenitis in order to provide available reference for its prevention and proper treatment.

Research progress on latent tuberculosis infection

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

Journal of Tuberculosis and Lung Disease. 2020, 1(1):  82-88.  doi:10.3969/j.issn.2096-8493.2020.01.017

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Latent tuberculosis infection is a hotspot in the field of tuberculosis control. There is a large number of people with latent tuberculosis infection in the world and in China, so many issues are still worthy to be paid further attentions, such as the policies on screening of the key populations and management of the people with latent tuberculosis infection in different countries, interpretation of the screening results, identification of people who need prophylactic medication, evaluation of treatment effects and the progress of vaccine research and development, etc. The author conducted review and exploration in terms of the above issues so as to provide academic reference for the related follow-up researches.

Short Articles

Epidemiological investigation and management of a tuberculosis cluster epidemic in a school

LI Ya-ru, JIN Xiao-wei, WEI Xiao-hui, DUAN Hai-xia, JIN Hong-jian

Journal of Tuberculosis and Lung Disease. 2020, 1(1):  89-92.  doi:10.3969/j.issn.2096-8493.2020.01.018

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The epidemiological investigation data of a tuberculosis cluster epidemic in a high school in Xinmi city, Henan province in January 2018 were collected, as well as the tuberculosis-related physical examination results of students in this grade at the time of enrollment and the original data of the tuberculosis patient registration at the municipal Tuberculosis Prevention and Control were collected. Finally, a total of 1306 students were included for a descriptive analysis of the data. The investigation showed that the patient, female, 17 years old, high school sophomore, had a history of contact with tuberculosis, and the tuberculin pure protein derivative (PPD) test was strongly positive during the physical examination in senior high school, and no preventive anti-tuberculosis drug treatment was carried out. In November 2017, she developed cough and other symptoms, and the symptomatic treatment was not standardized. On January 29, 2018, cough, low fever and other symptoms were aggravated, and the patient was diagnosed with secondary tuberculosis, cavitation and positive sputum bacteria (). In January, May, October, 2018 and January 2019, the patients in the patient’s class were registered for suspicious symptoms of tuberculosis, chest X-ray photography and PPD test. The strong positive rate of the PPD test was 16.9% (12/71) at the initial screening, and increased to 51.5% (35/68) after 3 months. Among the 56 students who were negative for PPD test at enrollment, 30 turned strongly positive for PPD test, with an infection rate of 53.6% (30/56). In May 2018, tuberculosis screening was performed on the students in the grade of the patient, and 51.0% (666/1306) of the students in that grade had negative PPD test; 13 patients (1.0%, 13/1306) had suspected symptoms of pulmonary tuberculosis; chest radiographs showed cough in 1 of 6 patients and no symptoms in the remaining 5. After 2 years of follow-up, as of January 2020, 16 cases of close contacts of the patients had become TB, including 10 cases of tuberculosis (62.5%) and 6 cases of tuberculous pleurisy (37.5%); 8 cases (50.0%) were found in non-tuberculosis designated medical institutions after showing symptoms of tuberculosis, and then transferred to tuberculosis prevention and treatment institutions. The survey suggests that tuberculosis prevention knowledge propaganda and education in schools, freshmen tuberculosis health screening, focusing on students with family history of tuberculosis, strengthening the morning check and absence of classes due to illness registration tracking system for early detection of tuberculosis suspicious symptoms, playing a role of school doctor, checking close contacts, preventive anti-tuberculosis drug therapy for students with strong positive of PPD test are the important measures to reduce the occurrence and spread of tuberculosis in schools.

Analysis of the results of two skin tests of tuberculin for different reasons

LI Hong-xing, LIU Dong-qin, YANG Chun-xia, CHEN Guang-qing, LI Zhang-yu, LI Jie

Journal of Tuberculosis and Lung Disease. 2020, 1(1):  93-95.  doi:10.3969/j.issn.2096-8493.2020.01.019

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This paper analyzes the results of two PPD tests for different reasons in a middle school of Yuanjiang County. In the first physical examination of 516 freshmen, one patient was detected, the positive rate of PPD was 5.62% (29/516), of which the strong positive rate was 1.16% (6/516); in the second physical examination of 522 close contacts, three patients were detected, the positive rate of PPD was 14.37% (75/522), of which the strong positive rate was 2.49% (13/522). Through the evaluation of the results of two PPD tests, it is considered that PPD test for close contacts has an important value in the screening of tuberculosis in schools.

A study of application of electronic pillbox and mobile WeChat APP on pulmonary tuberculosis patient supervision and management of taking medication

JING Rui, CAO Yan-min, YANG Yi-jun, WU Hong-yan, CAI Jun-li, REN Wen, ZHANG Wen-qian, WANG Mei-hua

Journal of Tuberculosis and Lung Disease. 2020, 1(1):  96-99.  doi:10.3969/j.issn.2096-8493.2020.01.020

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Changqing District and Jiyang District of Ji’nan are the pilot sites of the “Study on the Applicability of the Use of Intelligent Electronic Pillboxes and Mobile WeChat App Management System for Pulmonary Tuberculosis Patients” conducted by the Chinese Center for Disease Control and Prevention. According to inclusion criteria, 60 newly registered primary active pulmonary tuberculosis patients with informed consent between September 1, 2017 and March 15, 2018 from tuberculosis designated hospital were sequentially included (20 patients used intelligent electronic kits (pillbox group), 10 cases used mobile WeChat APP (WeChat group) in each district. A 6-month prospective supervision medication management study was conduct, the use of intelligent electronic pillboxes and mobile WeChat APP for medication management, return visit and the follow up by medical staff were recorded and analyzed. The results showed that the overall medication rate and the rate of return visit of the electronic pill box group were significantly lower than those of the WeChat group (92.62% (3841/4147) vs. 96.59% (3281/3397), χ²=205.37, P=0.000; 94.59% (175/185) vs. 99.09% (109/110), χ²=3.89, P=0.049) although all the rates were high. It indicated that majority of the patients in the two groups had good compliance with medication and return visit, and data of WeChat group were better than those of pillbox group. The overall rate of follow up by medical staff were low in both two groups, and the rate in pillbox group was significantly lower than that in WeChat group (41.99% (139/331) vs.53.14% (110/207), χ²=6.37, P=0.012). The overall rate of follow up was poor and needed to be improved.