Table of Content

30 September 2020, Volume 1 Issue 2

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Special Articles

Study on the prevention strategy of general hospital with fever clinic as the focus during the outbreak of COVID-19

LIN Ming-gui, LIN Jin-lan, WEI Lai, ZHANG Ping, ZHOU Bi-qin, ZHANG Wen-yan, HUA Hao, ZHAO Wen-jing, NIE Guang-meng, SHU Li-nan, WANG Xiao-hui, CHEN Kai-li

Journal of Tuberculosis and Lung Disease. 2020, 1(2):  109-111.  doi:10.3969/j.issn.2096-8493.2020.02.003

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Since the outbreak of COVID-19 in Wuhan, Hubei Province in December 2019, all hospitals across the country have been in an emergency prevention and control state due to the virus’ strong infectivity, fast spreading speed and high infection rate among medical personnel at early stage. Tsinghua Changgung Hospital, as a non-appointed COVID-19 treatment hospital with fever clinic in Beijing, is responsible for disease screening, diagnosis and transportation of COVID-19 patients since the outset of the epidemic. By carefully studying a series of law, diagnosis guidelines of the National Health Commission and the latest literature at home and abroad, also considering the characteristics of our own hospital, we focused on fever clinic, formulated a series of COVID-19 infection screening protocals and management strategies, and made corresponding adjustments and modifications according to changes of the epidemic. At the same time, by applying products of a number of scientific research with Tsinghua University, the fever clinic and isolation ward were reformed, and dedicated CT and laboratory were added. All staff in our hospital have no infections, make no missed diagnosis in screening patients and no error in transferring patients. At present, the prevention work of our hospital has entered into normalization, gained sustainability and regularity.

Original Articles

Clinical value of Genechip in detecting multidrug-resistant Mycobacterium tuberculosis bacteria in sputum samples

MA Yan, YANG Xiao-jun, REN Zhen-juan, SU Yun-kai

Journal of Tuberculosis and Lung Disease. 2020, 1(2):  112-116.  doi:10.3969/j.issn.2096-8493.2020.02.004

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Objective To evaluate the efficacy of Genechip technology in detection of multidrug-resistant tuberculosis (MDR-TB) bacilli, and to explore its clinical value in diagnosis of MDR-TB. Methods From June 1st 2019 to December 31st 2019, smear positive sputum samples of 295 patients in the Fourth Hospital of Inner Mongolia Autonomous Region were continuously enrolled and tested by Genechip. 60 cases for which traditional culture results were failure/contamination/non-tuberculous Mycobacteria, or gene chip couldn’t detect Mycobacterium tuberculosis bacteria or only detected non-tuberculous Mycobacteria were excluded. The susceptibility, specificity, positive predictive value (PPV) and negative predictive value (NPV) of detecting Rifampicin-resistant, Isoniazid-resistant and MDR TB were analyzed by using L-J solid proportion method as standard reference. Results The result indicated that susceptibility, specificity, PPV and NPV of detecting Rifampicin-resistance in 235 patients were 95.7% (22/23), 98.6% (209/212), 88.0% (22/25), 99.5% (209/210), respectively. The susceptibility, specificity, PPV and NPV for detecting Isoniazid-resistance were 80.0% (16/20),98.6% (212/215),84.2% (16/19) and 98.1% (212/216),respectively. The susceptibility, specificity, PPV and NPV for Multi-drug resistance were 76.2% (16/21), 97.2% (208/214), 72.7% (16/22), 97.7% (208/213) and 95.3% (224/235), respectively. Conclusion Using Genechip to detect drug resistantt TB in sputum samplesis of high value,high authenticity and high reliability in the diagnosis of Rifampicin, Isoniazid and Multidrug-resistant tuberculosis.

Correlation between amikacin resistance and rrs gene mutation in multidrug-resistant Mycobacterium tuberculosis

REN Zhen-juan, ZHANG Hai-jie, SU Yun-kai, MA Yan, LIU Yao

Journal of Tuberculosis and Lung Disease. 2020, 1(2):  117-120.  doi:10.3969/j.issn.2096-8493.2020.02.005

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Objective To analyze the correlation between Amikacin (Am) resistance and rrs gene mutation in multidrug-resistant Mycobacterium tuberculosis (MDR-MTB). Methods A total of 159 MDR-MTB clinical isolates were selected from the reference laboratory of the Fourth Hospital of Inner Mongolia Autonomous Region in year 2005 and 2015. The absolute concentration method was used to detect the drug resistance rate to Am. At the same time, the rrs gene of Am resistant strains was sequenced, and the minimum inhibitory concentration (MIC) in vitro was determined by microplate Alamar Blue assay (MABA). Based on results of test using the absolute concentration method, receiver operating characteristic curve (ROC curve) of MIC value for diagnosis of the drug resistance of Am was made. Results Among the MDR-MTB strains isolated in 2005,18(24.0%,18/75) were resistant to Am, as to those in 2015, the proportion was 27 (32.1%, 27/84). Of the Am resistant MDR-MTB strains, 44(97.8%) had A1401G mutation and 10 (22.2%) had T1384A mutation. Analysis of ROC curve showed that the cut-off value of Am was 1.5 μg/ml, the corresponding sensitivity was 91.1%, and the corresponding specificity was 98.2%. Conclusion A1401G and T1384A mutations in rrs gene of MDR-MTB strains were associated with Am resistance. The MIC value of 1.5 μg/ml could be used to distinguish the sensitivity and resistance of MDR-MTB strains to Am.

The value of GeneXpert MTB/RIF technology in tuberculosis detection and resistance to rifampin

TANG Gui-hua, SUN Qian, WANG Xiao-fan, XIAN Hai-bin, ZHANG Qian, YANG Xiao-wei, WANG Li

Journal of Tuberculosis and Lung Disease. 2020, 1(2):  121-125.  doi:10.3969/j.issn.2096-8493.2020.02.006

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Objective To analyze the feasibility of GeneXpert MTB/RIF technology to detect tuberculosis (TB) and resistance to rifampin in basic TB control institutions. Methods Retrospective analysis was performed on all patients with suspected symptoms of TB who visited Changping Institute for Tuberculosis Control and Prevention from January 1st to December 31st, 2019, which was a total of 1719 cases. Sputum smears, Roche solid culture, and GeneXpert tests were performed on the 1719 patients. Among them, 587 patients with other diseases were confirmed by clinical and laboratory test results, 550 patients with inactive TB were diagnosed and 582 active cases were diagnosed. Among the 582 active TB cases, 237 patients had laboratory etiological evidence (the same sputum sample of the same patient was also cultured by Roche and the M. tuberculosis MPB64 antigen was used for strain identification, and the GeneXpert detection system was used as well), was diagnosed as etiological positive patient, and the remaining 345 patients were clinically diagnosed patients. The positive detection rates of sputum specimen of the 237 TB cases by smear, culture and GeneXpert were compared, and rifampin resistance related indexes were compared as well. Chi-square test was used to compare the count data. When the theoretical frequency was lower than 5, the Fisher exact probability method was used for comparison. The difference was statistically significant with P<0.05. Results Of 237 etiologically positive patients, the detection rates were 25.3% (60/237), 79.7% (189/237) and 96.2% (228/237) by smear, culture and GeneXpert, respectively. The detection rate of GeneXpert was significantly higher than that of culture and smear (χ²=249.742, P<0.001; χ²=30.332, P<0.001). Took Roche solid ratio method rifampicin resistance test result as the reference standard, the sensitivity, specificity, positive predictive value, negative predictive value and consistency were 99.6% (232/233), 100.0% (4/4), 100.0% (232/232), 80.0% (4/5) and 99.6% (236/237) respectively. Conclusion GeneXpert has a high detection rate for etiologically positive patients and rifampin resistance. It is of great value to carry out TB detection and rifampin resistant TB detection at the basic level.

Analysis of the dynamic evolution of Chest CT lesions quality and peripheral blood lymphocyte count in patients with coronavirus disease 2019

SHEN Cong, JIAO Lei, BAI Lu, ZHANG Yi-li, GUO You-min

Journal of Tuberculosis and Lung Disease. 2020, 1(2):  126-130.  doi:10.3969/j.issn.2096-8493.2020.02.007

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Objective To comprehensively analyze the consistency and inconsistency of CT manifestations of lung lesions and the dynamic evolution of lymphocyte count in patients with new coronavirus pneumonia (coronavirus disease 2019, COVID-19). Methods A retrospective collection of 17 patients who were diagnosed with novel coronavirus pneumonia by nucleic acid testing in our hospital from January 28, 2019 to April 11, 2020, all of them were of ordinary type. Collect the first and follow-up CT examinations (110 times in total) and the lymphocyte count (LC) of peripheral blood (145 times in total). Use a computer to automatically segment the lesion and calculate the lesion quality (LQ). The LC and LQ of each patient were divided by the maximum value in the entire course of the patient, and standardized to the interval (0,1). Taking the patient’s first symptom as the first day, the dynamic changes of LC and LQ of each patient were drawn, and the moving weighted average method was used to fit the change trend, and the consistency and inconsistency of imaging and lymphocyte changes were described. Results The changes in LC and LQ of each patient were plotted. Using the moving weighted average method to fit, the lowest value of LC was calculated at (5.294±3.820) days (days 1-12), and the peak of LQ was at (9.589±3.203) days (days 5-16). There was a significant difference between the two (t=7.170, P<0.05); the median number of days for LC to returning to normal level was 19 days (15 to 42 days). On the 1st to 5th days of the disease course, the lesion progresses rapidly, LC decreases, and LQ rises rapidly; on the 6th to 10th days, the lesion progresses slowly, and LC begins to recover, and LQ slows down; on the 11th to 22nd days, LC continues to rise to the normal level, LQ declined rapidly, and there was a significant negative correlation between the two (r=-0.764, P=0.002); after 22 days, LC was close to or maintained at a normal level, and LQ remains at a low level. Conclusion The lymphocyte count of patients with novel coronary pneumonia decreased earlier than the maximum lesion area.

Clinical characteristics and effect analysis of 39 cases of 2019 novel Coronavirus-related pneumonia

JIN Min-lu, CHANG Yun-qing, QI Feng-ming, GUAN Xiao-gang, ZHENG Guan-hua, ZHAO Yong-hua, LI Zhen-qiang, LI Xiao-sheng, WANG Li-fen, WANG Fang, BAI Yin-jie

Journal of Tuberculosis and Lung Disease. 2020, 1(2):  131-135.  doi:10.3969/j.issn.2096-8493.2020.02.008

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Objective To investigate the clinical characteristics and therapeutic effects of the coronavirus disease 2019 (COVID-19), and provide evidence for clinical diagnosis and treatment. Methods 39 patients diagnosed with COVID-19 who were admitted to Taiyuan Fourth People’s Hospital from January 21 to March 05,2020 were collected, the epidemiology,demographic characteristics clinical manifestations, laboratory examination,chest CT features, treatment plan and effect evaluation were analyzed. Results Median age (quartile) (M(Q₁,Q₃)) was 58(37,68), 25 males (64.1%),and 14 females (35.9%). 33 cases (84.6%) had a clear exposure history of contact with COVID-19 patients, 23 cases (59.0%) were clustered patients. The most common clinical symptoms were fever (30 cases (76.9%)), followed by cough (24 cases (61.5%)), expectoration (17 cases (43.6%)), chest distress or dyspnea (11 cases (28.2%)), fatigue (10 cases (25.6%)), inappetence (4 cases (10.3%)), runny nose in (3 cases (7.7%)), nasal obstruction and pharyngeal dryness and pharyngalgia (2 cases (5.1%)), and muscle soreness (1 case (2.6%)). CT features showed that bilateral multiple lesions (34 cases, 87.2%) and unilateral lesions (5 cases,12.8%),and the shadows were mostly outside the lung. The median days (quartile) (M(Q₁,Q₃)), from the onset to the negative of the nucleic acid test of the pharyngeal swab negative, were 15(11,19)days. Chest CT features of the lesions from onset to dissipation were 17 (14,19)days. All 39 patients were cured and discharged from hospital, and no recurrence was found in the follow-up after 2 to 4 weeks. Conclusion Most of the COVID-19 patients are cluster cases, and the main symptoms are fever, cough, expectoration, chest distress, dyspnea and fatigue. Chest CT features have important diagnostic value. On the basis of antiviral therapy, oxygen therapy and appropriate glucocorticoid therapy can help reduce symptoms and improve the prognosis.

Efficacy analysis of linezolid in the treatment of XDR-PTB

WANG Ying, CAI Chun-kui, XU Yan, SUN Shi-xue, LI Gang, GU Xiao-feng, YU Yang

Journal of Tuberculosis and Lung Disease. 2020, 1(2):  136-139.  doi:10.3969/j.issn.2096-8493.2020.02.009

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Objective To explore the clinical efficacy and adverse reactions of linezolid in the treatment of extensively drug-resistant pulmonary tuberculosis (XDR-PTB) patients. Methods Sixty-five XDR-PTB patients enrolled in Dalian Drug-resistant Tuberculosis Project from July 2012 to December 2019 were divided into control group (routine chemotherapy without linezolid, 31 cases) and observation group (linezolid combined with routine chemotherapy, 34 cases) according to their drug history and whether the individualized treatment regimen included linezolid. The therapeutic effect and the occurrence of adverse reactions between the two groups were compared. Results The conversion rate of sputum culture at 6 months, 12 months and the end of treatment in observation group were 47.1% (16/34), 67.6% (23/34) and 61.8% (21/34) respectively, which were significantly higher than those of the control group (16.1% (5/31), 35.5% (11/31) and 32.3% (10/31)). The differences were statistical significance (χ² were 7.093, 6.724 and 5.659, P values were 0.008, 0.010 and 0.017). At the end of treatment, chest radiograph of 73.5% (25/34) patients in the observation group showed improvement of the lesion, which was significantly higher than that of the control group (41.9%, 13/31). The difference was statistically significant (χ²=6.665, P=0.010). The clinical symptoms of 27 patients in the observation group (79.4%, 27/34) were significantly improved, which was significantly higher than that in the control group (51.6%, 16/31) (χ²=5.597, P=0.018). However, in terms of adverse reactions, the incidence of lower limb numbness in the observation group was 29.4% (10/34), and the incidence of anemia was 11.8% (4/34), the control group did not have the above adverse reactions. Conclusion Linezolid has a definite therapeutic effect on XDR-PTB, but there are many adverse reactions exist, so that patients should be closely observed and treated.

Diagnostic value of fluorescent staining combined with 1,3-β-D glucan test in chronic obstructive pulmonary disease complicated with fungal infection

WU Jing, XU Yan, FANG Yong-mei, ZHANG Jing-jing, ZHANG Yan, ZHONG Feng

Journal of Tuberculosis and Lung Disease. 2020, 1(2):  140-143.  doi:10.3969/j.issn.2096-8493.2020.02.010

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Objective To investigate the diagnostic value of fluorescent staining combined with 1,3-β-D glucan (G) test in chronic obstructive pulmonary disease (COPD) complicated with invasive pulmonary fungal infection (IPFI). Methods A total of 174 patients diagnosed with COPD in the Second Affiliated Hospital of Wannan Medical College from January to December 2019 who failed to relieve clinical symptoms and the body temperature did not drop at 38℃ or rose again after 5 days of standard treatment with broad-spectrum antibiotics were collected as subjects for the study. Eighty-one cases with confirmed IPFI and with proposed IPFI were taken as the observation group, and 93 cases without IPFI were taken as the control group. The results of sputum or alveolar lavage were analyzed by fluorescent staining, and the peripheral blood were detected by G test and procalcitonin (PCT). The detection efficiency of various detection techniques was compared. Results Based on the clinical diagnosis results as the reference standard, the receiver operating characteristic (ROC) curve analysis showed that the sensitivity and specificity of fluorescent staining were 81.6% and 87.3%, respectively, which were higher than those of G test (81.5% and 78.3%) and PCT test (74.9% and 73.1%). The sensitivity and specificity of fluorescent staining combined with G test were 96.2% and 76.3%, respectively, the positive predictive value and negative predictive value were 83.1% and 88.7%, respectively, and the area under the curve (AUC) was 0.894, which was significantly superior to all the individual detection efficiency. Conclusion Fluorescence staining method has good detection efficiency in detecting COPD accompanying with IPFI, and its combined with G test can effectively improve the diagnostic rate.

Clinical characteristics and influencing factors of culture-positive pulmonary tuberculosis patients coinfected with non-tuberculous mycobacteria

YU Yan-yan, CHEN Zhen-hua, WANG Jue, LYU Yan, CHEN Zhong-nan, LIU Bin-bin, YI Song-lin, HU Pei-lei, TAN Yun-hong

Journal of Tuberculosis and Lung Disease. 2020, 1(2):  144-148.  doi:10.3969/j.issn.2096-8493.2020.02.011

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Objective To analyze the clinical characteristics and influencing factors of culture-positive pulmonary tuberculosis patients coinfected with nontuberculous mycobacteria (NTM).Methods The observation group included 177 culture-positive pulmonary tuberculosis patients coinfected with NTM diagnosed in Hunan Chest Hospital from January to December in 2019; 124 patients only with culture-positive pulmonary tuberculosis from Hunan Chest Hospital during the same period were selected as the control group. Age, gender, concurrent underlying diseases, chief complaint symptoms, duration of anti-tuberculosis treatment, and results of tuberculosis-related laboratory tests (serum total protein (TP), serum albumin (ALB), serum IgA, and serum IgG) were collected. The clinical characteristics and influencing factors of culture-positive pulmonary tuberculosis coinfected with NTM were analyzed. Results In the observation group, 62.1% (110/177) were male and 33.9% (60/177) aged ≥61 years old, which were significantly higher than those in the control group (75.8% (94/124), χ²=6.230, P=0.013; 18.6% (23/124), χ²=35.681, P=0.000). Patients with bronchiectasis and diabetes in the observation group accounted for 26.0% (46/177) and 6.8% (12/177), respectively, which were significantly higher than those in the control group (10.5% (13/124), χ²=11.120, P=0.001; 21.8% (27/124), χ²=14.541, P=0.000). The level of serum IgA and IgG in the observation group were lower than those in the control group ((2.3 (1.7, 3.3) g/L vs. 2.7 (2.1, 3.6) g/L, Z=212.380, P=0.010; 13.6 (11.1, 15.4) g/L vs. 15.9 (12.5, 17.8) g/L, Z=181.190, P=0.003), respectively. The duration of anti-tuberculosis treatment in the observation group was 9.0 (5.0, 17.0) months, which was significantly longer than that in the control group (5.5 (2.0, 12.0) months) (Z=116.341, P=0.000). Multivariate logistic regression analysis showed that male (OR(95%CI): 1.941(1.061-3.572)), age ≥61 years (OR(95%CI): 1.196(1.050-2.501)), duration of anti-tuberculosis treatment ≥9 months (OR (95%CI): 1.865(1.090-3.191)), concurrent diabetes (OR(95%CI): 3.420(1.462-8.041)) or bronchiectasis (OR(95%CI): 2.390(1.121-5.130)) were risk factors for NTM pulmonary disease in culture-positive pulmonary tuberculosis patients. Conclusion Elderly, male, longer duration of anti-tuberculosis treatment, complicated with underlying diseases such as diabetes and bronchiectasis, were risk factors for NTM lung disease in culture-positive pulmonary tuberculosis patients.

The effect of endobronchial ultrasound-guided isoniazid administration combined with cryotherapy in treatment of tracheobronchial tuberculosis fistula

XIAO Yang-bao, LUO Lin-zi, LU Zhi-bin, FENG Dan, BAI Li-qiong, LUO Li

Journal of Tuberculosis and Lung Disease. 2020, 1(2):  149-153.  doi:10.3969/j.issn.2096-8493.2020.02.012

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Objective To evaluate the therapeutic effect and safety of Endobronchial Ultrasound (EBUS)-guided isoniazid administration combined with cryotherapy in patients with subtype Ⅵ tracheobronchial tuberculosis (TBTB). Methods A total of 41 eligible patients who received treatment in Hunan Chest Hospital from January 2014 to December 2018 were included. 20 patients who received EBUS-guided isoniazid administration (0.2 g,once a week,a total of 53 times) plus cryotherapy were treatment group, 21 patients who received cryotherapy plus ebdobronchial isoniazid administration (0.2 g,once a week,a total of 198 times) were control group. Times of interventional therapy patients need to take, curative effects and complications of those two groups were analyzed. Results The treatment group received bronchoscopic cryotherapy for 134 times, and the median (quartile) (M(Q₁,Q₃)) was 6.0 (5.0,8.0) times/case,the control group received bronchoscopic cryotherapy for 198 times, and the median (quartile) (M(Q₁,Q₃)) was 9.0(6.0,13.0) times/case,the difference was statistically significant (Z=-2.336,P=0.019). Comparing the median (quartile)(M(Q₁,Q₃)) time of necrosis disappearance at the airway fistula after treatment in the treatment group (24.0(15.3,33.0) weeks) with the control group (43.0(21.5,57.5) weeks), the median time for treatment group was shorter, and the difference was statistically significant (Z=-2.572,P=0.010). The median (quartile)(M(Q₁,Q₃)) time of fistula healing in the treatment group (31.0(20.8,46.0) weeks) was shorter than the control group (56.0(31.0,77.5) weeks) too, the difference was statistically significant (Z=-2.688,P=0.007). Airway recanalization was completely effective in 19 cases in the treatment group, and in 1 case it was partially effective, while in the control group in 17 cases completely effective, and in 4 cases partially effective. The total effective rate was 100.0%. There were no serious complications such as drug-induced hepatic and renal dysfunction, mediastinal abscess, bronchial-mediastinum fistula, or hemorrhage in both groups. Conclusion EBUS-guided isoniazid administration combined with cryotherapy for subtype Ⅵ TBTB can help to clear necrosis, reduce the times of interventional therapy needed, shorten the interventional therapy time, and be safe and effective.

Investigation of a tuberculosis outbreak in an university in Yangjiang prefecture, Guangdong Province

ZENG Yu-huan, CHEN Jian-ren, YAO Zheng-gang, ZHANG Chen-chen, WEN Wen-pei

Journal of Tuberculosis and Lung Disease. 2020, 1(2):  154-158.  doi:10.3969/j.issn.2096-8493.2020.02.013

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Objective To explore the occurrence, development and response of a tuberculosis epidemic in an university in Yangjiang prefecture, and to provide practical experience for the prevention and control of tuberculosis in schools. Methods From September to December 2019, 9 tuberculosis cases were found in an university in Yangjiang prefecture, Guangdong Province. Chest X-ray and tuberculin pure protein derivative (PPD) skin test were performed on 676 students in close contact with the patients. In the first round of investigation, 65 classmates from the “17 animation class”, roommates and teachers of TB patients were screened; In the second round of screening, 389 students from other classes that shared classrooms with the “17 animation class”, students on the same floor with TB patient’s dormitory and relevant teachers were screened. Classes that found patients in those 2 rounds were defined as the high exposure group (total 454 students in 5 classes). In the third round, 222 students from other classes in the same floor (other than the same classroom) with the “17 animation class” were screened, which was considered as the low-exposure group(222 students in 4 classes). We analyzed the epidemic characteristics, causes and treatment measures of this outbreak to discuss the causes of spread of this epidemic. Results Among those 9 patients, 4 had cough symptoms, among whom 1 had being coughing for more than half a year (suspected to be the first source of infection). In the first round of close contact screening, 65 students underwent PPD skin test, of which 11 were strongly positive (strong positive rate:16.92%), and 13 showed abnormality in chest radiograph. A total of 389 students were screened in the second round, 8 of them were strongly positive for PPD skin test (strong positive rate: 2.06%) and 5 showed abnormality in chest radiograph. In those first two rounds, totally 19 students were strongly positive, with a positive rate of 4.19%. Among the 222 students screened in the third round, 2 were strongly positive in PPD skin test, with a positive rate of 0.90% and 2 with abnormal chest radiograph; the PPD positive rate of high exposure group (4.19%, 19/454) was significantly higher than that of low exposure group (0.90%, 2/222),difference was statistically significant (χ²=4.16,P=0.040). Conclusion Close contact screening were carried out in a timely manner,the result showed that latent TB infection in high exposure group was significantly higher than that of the low exposure group.

Analysis of the reported incidence of pulmonary tuberculosis among students in Fujian Province from 2011 to 2019

DAI Zhi-song, LIN Shu-fang, WEI Shu-zhen, CHEN Dai-quan.

Journal of Tuberculosis and Lung Disease. 2020, 1(2):  159-164.  doi:10.3969/j.issn.2096-8493.2020.02.014

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Objective To analyze the characteristics of incidence of pulmonary tuberculosis(PTB) among students in Fujian Province from 2011 to 2019. Methods The PTB reporting data of students in Fujian Province from 2011 to 2019 were collected and analyzed based on“China Disease Prevention and Control Information System”. Student data were collected from Fujian Provincial Bureau of Statistics. The epidemiological characteristics of PTB in students were analyzed. Results From 2011 to 2019, the reported incidence of active PTB in students showed a tendency that decreased first and then increased. The incidence rate of students from 2011 to 2015 were 12.57/100000 (722/5741800), 10.26/100000 (593/5779600), 9.65/100000 (549/5687300), 9.36/100000 (537/5740100) and 6.68/100000 (391/5852500),respectively, with a statistically significant difference ({\chi }_{\mathit{趋势}}^2=96.43, P<0.05), and those from 2016 to 2019 were 8.00/100000 (478/5972200), 9.82/100000 (598/6090200), 12.52/100000 (792/6324000) and 10.92/100000 (721/6602600), respectively, with a statistically significant difference ({\chi }_{\mathit{趋势}}^2=38.02, P<0.05). The peak of reported cases concentrated in March from 2011 to 2013, and the proportions of cases reported in students throughout the year were 17.31% (125/722), 23.78% (141/593) and 23.68% (130/549) respectively. And the peaks of reported cases concentrated in December from 2015 to 2019, and the proportions were 19.44% (76/391), 19.67% (94/478), 12.88% (77/598), 14.52% (115/792) and 15.40% (111/721) respectively. There were two peaks displayed in March and December in 2014, and the proportions of which were 19.74% (106/537) and 19.37% (104/537). The highest proportion of reported cases was found in the 15-<20 age group with an average of 59.91% (3224/5381). The proportion of male was higher than that of female and the sex ratio was about 1.37∶1 (3113∶2268). Conclusion The reported incidence of active PTB among students showed a decreased first and then increased trend from 2011 to 2019. The proportion of incidence in 15-<20 age group was the highest. And the reported cases in male students were higher than the female cases. We should attach great importance to the prevention and control of tuberculosis in schools, and implement the measures required by the school tuberculosis prevention and control regulations.

Analysis of the epidemiologic feature of pulmonary tuberculosis in Xishuangbanna,2005—2018

XIONG Li-fen, LAI Ming-yue, YANG Qian-ru, FAN Jian-hua, YAN Wan-ming, GUO Li-zhu.

Journal of Tuberculosis and Lung Disease. 2020, 1(2):  165-169.  doi:10.3969/j.issn.2096-8493.2020.02.015

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Objective To analyze the incidence trends and epidemic characteristics of pulmonary tuberculosis in Xishuangbanna from 2005 to 2018, so as to provide scientific basis for developing TB control strategies and measures. Methods Using infectious disease reporting information management system, a subsystem of China’s disease prevention and control information system to collect monitoring data, 12949 cases of pulmonary tuberculosis patients with cumulative reports from 2005 to 2018 were selected as the research objects. Descriptive statistical analysis method was used to analyze the distribution of onset time, region and population characteristics. Results A total of 12949 TB cases were reported from 2005 to 2018 in Xishuangbanna with an average annual newly reported incidence rate of 83.18/100000 (12949/15566693), the incidence declined from 89.44/100000 (926/1035276) in 2005 to 64.18/100000 (737/1148310) in 2014 and climbed to 117.12/100000 (1382/1180000) in 2018, which showed significant statistical difference ({\chi }_{\mathrm{trend}}^2=178.320,P<0.001). The peak incidence was reported in January (1315 cases) and the lowest in December (858 cases). The male average annual reported incidence rate of 109.46/100000 (8783/8024177), Whereas the female average annual reported incidence rate of 55.23/100000 (4166/7542516), which showed significant statistical difference (χ²=1375.344,P<0.001); Farmers accounted for the highest proportion of occupation (61.25%, 7931/12949), and the cumulative number of reported patients mainly concentrated in the age of 20-59, accounting for 72.06% (9331/12949). Conclusion The incidence of tuberculosis shows a rising trend in Xishuangbanna from 2005 to 2018, epidemic situation was serious, it is necessary to strengthen the TB prevention and control among the young adults, men and farmers.

Review Articles

Current status and intervention progress of latent tuberculosis infection in student population

LIN Pei-xin, ZHANG Chen-chen

Journal of Tuberculosis and Lung Disease. 2020, 1(2):  170-173.  doi:10.3969/j.issn.2096-8493.2020.02.016

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Students are the key population of latent tuberculosis infection research. The current status of latent tuberculosis infection in the student population, the selection of screening methods, the determination and management of chemopreventive treatment objects, the selection of treatment regimens, treatment effect and influencing factors are all issues worthy of attention. By reviewing and discussing to the relevant national and international literatures published in recent years, the author aims to provide a valuable reference for screening and reasonable treatment of latent tuberculosis infection in the student population.

Application progress of proteome in research of the Mycobacterium tuberculosis infection

FENG Feng, TANG Feng-zhen, YAO Ming-mei, CHENG Lu, DU Li-jun

Journal of Tuberculosis and Lung Disease. 2020, 1(2):  174-178.  doi:10.3969/j.issn.2096-8493.2020.02.017

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China is one of the countries with high burden of tuberculosis worldwide. The drug-resistant mycobacterium tuberculosis increases the difficulties of prevention and treatment of tuberculosis. Because of the new subjects such as genomes, transcriptomics and proteomes, researches of pathogens, diagnosis, treatment and drug resistance of tuberculosis get more comprehensive and complete. Proteome is a chromatography and mass spectrometry-based Biomics technology of the separation, identify and quantify of proteins. We reviewed the progress of proteomics on pathology, diagnosis and treatment of tuberculosis, in order to provide clues and ideas for its further application in treatment and prevention of tuberculosis.

Short Articles

Analysis on reporting and referral quality of pulmonary tuberculosis cases by general hospitals above level Ⅱ in Shuyang County,Jiangsu Province during 2018—2019

ZHONG Chong-xia, WANG Hua-shan

Journal of Tuberculosis and Lung Disease. 2020, 1(2):  179-182.  doi:10.3969/j.issn.2096-8493.2020.02.018

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Shuyang Center for Disease Control and Prevention inspected the registration data of tuberculosis-related departments (including outpatient department, radiology department, laboratory department and record room, etc.) in eight general hospitals at or above level Ⅱ in Shuyang County in 2018 and 2019. The results showed that report rate (92.38%, 788/853), referral rate (82.88%, 707/853) and referral arrival rate (86.42%, 611/707) in 2018 were significantly lower than those in 2019 (96.79%, 753/778; 90.23%,702/778; 95.58%, 671/702) (χ² values were 15.156, 18.681 and 36.255, P values were all less than 0.001). Consider that the report rate, referral rate and referral arrival rate in 8 general hospitals at or above level Ⅱ are satisfactory in 2018 and 2019, and all indicators in 2019 are higher than those in 2018, there is still room for further improvement.

Clinical analysis of 27 neurobrucellosis cases misdiagnosed as tuberculosis meningitis

WANG Li-hua, LIU Yan-yan

Journal of Tuberculosis and Lung Disease. 2020, 1(2):  183-185.  doi:10.3969/j.issn.2096-8493.2020.02.019

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To investigate the clinical features of neurobrucellosis patients and reduce misdiagnosis,a retrospective study was conducted on 27 cases with neurobrucellosis in Taiyuan Tuberculosis Hospital during Jan 2009 to Dec 2019. Epidemiological information, clinical manifestations, etiology/laboratory data and imaging characteristics,diagnosis and treatment outcomes were collected from medical record. All of 27 patients were misdiagnosed as suspected tuberculosis meningitis and transferred to our hospital,18 (66.7%) had a history of raising livestock,and 1 had brucellosis history; 27 cases (100.0%) had headache, other common symptoms were fever (88.9%, 24/27), dysuria or urinary incontinence and constipation (37.0%, 10/27),etc. Laboratory tests showed that 22 cases (81.5%) had meningeal irritation signs, 22 cases (81.5%) had increased cerebrospinal fluid pressure,27 cases (100.0%) had increased leukocyte counts and proteins, 25 (92.6%) had decreased glucose level, and 23(85.2%) had chloride decrease. Imaging findings all patients were characterized by demyelinating changes and encephalitis in white matter area of the brain.Twenty-five patients were diagnosed by RBPT and 2 by next-generation sequencing of cerebrospinal fluid. The time of disease onset to diagnosis ranged from 2 week to 8 months, with 20 cases (74.1%) more than 1 month. Based on treatment of doxycycline combined with rifampicin, adding ceftriaxone, levofloxacin, amikacin could improve patients’ symptoms after 2 weeks’ treatment,25 cases (92.6%) were cured after 6-12 month’ treatment and 2 cases were in medical terms.Consider that compared with other central nervous system diseases,the neurobrucellosis has diverse clinical manifestations, lack specificity, resulting in the high rate of misdiagnosis; RBPT should be performed to detect neurobrucellosis if there was a history of living or traveling in pastoral areas or unexplained neurological symptoms accompanied with fever,and the treatment outcomes is obvious and the prognosis is good.