Table of Content

20 October 2022, Volume 3 Issue 5

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Original Articles

Preliminary study on the colloidal gold method to evaluate the lserum pertussis toxin antibody IgG

Hu Yahong, Liu Dandan, Gao Wei, Meng Qinghong, Yao Kaihu

Journal of Tuberculosis and Lung Disease. 2022, 3(5):  360-363.  doi:10.19983/j.issn.2096-8493.20220084

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Objective: To evaluate the accuracy of colloidal gold method in the determination of serum anti-pertussis toxin IgG (PT-IgG). Methods: Samples with PT-IgG concentration <20 IU/ml (n=100) and ≥20 IU/ml (n=100) within 6 months were selected continuously from the serum samples frozen at -30 ℃ from Beijing Children’s Hospital affiliated to Capital Medical University in the reverse order, and one sample with insufficient quantity was excluded. Finally, 199 samples were included. ELISA kit and colloidal gold method (the positive detection limit was 20 IU/ml and 80 IU/ml) were used to detect the concentration of PT-IgG in the two groups, respectively, and the consistency between the concentration range of the colloidal gold method and the results of ELISA was evaluated. Results: Taking the results of ELISA as the standard, the sensitivity and specificity of colloidal gold strip with the detection limit of 20 IU/ml were 76.2% (80/105) and 95.7% (90/94), respectively; the positive predictive value and the negative predictive value were 95.2% (80/84) and 78.3% (90/115), and Youden index was 0.7. The sensitivity and specificity of colloidal gold strip with the detection limit of 80 IU/ml were 100.0% (23/23) and 69.9% (123/176); the positive predicted value and the negative predictive value were 30.3% (23/76) and 100.0% (123/123), and Youden index was 0.7. Conclusion: Taking the results of ELISA as the standard, the colloidal gold method with 20 IU/ml as the detection limit has high specificity and positive predictive value, and the positive results are reliable, which indicates that the body has a certain level of pertussis immunity. However, the colloidal gold method with the detection limit of 80 IU/ml has high sensitivity and negative predictive value, which can be used to exclude acute or recent pertussis infection in combination with clinical practice.

Clinical analysis of five children with joint tuberculosis misdiagnosed juvenile idiopathic arthritis

Li Yan, Han Tongxin, Piao Yurong, Mao Huawei

Journal of Tuberculosis and Lung Disease. 2022, 3(5):  364-370.  doi:10.19983/j.issn.2096-8493.20220099

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Objective: To analyze the clinical characteristics of children with joint tuberculosis misdiagnosed juvenile idiopathic arthritis (JIA), and to explore the methods of reducing the rate of misdiagnosis. Methods: We retrospectively analyzed the characteristics, diagnosis and treatment process of 5 children with joint tuberculosis who were misdiagnosed as JIA in Department of Immunology, Beijing Children’s Hospital, Capital Medical University from April 1, 2021 to April 1, 2022. Results: Of the five patients, two patients were misdiagnosed as enthesitis related arthritis, and three patients were misdiagnosed as oligoarticular JIA. All the five patients above had asymmetric arthritis in the large joints of the lower limbs, and presented with joint pain and limited movement. More than one joint with damage in four patients, and the knee was the most commonly affected (4/5). CRP and ESR increased in four patients, and PPD and T-SPOT.TB positive in four patients who were misdiagnosed. Three patients were given immunosuppressants and biological agents, with joint symptoms aggravating and imaging progressing before the diagnosis of joint tuberculosis. High resolution CT scanning was performed in five patients with joint tuberculosis. Tuberculosis was found in three patients, and multiple bone destruction was seen in joint imaging. Two patients underwent joint cavity puncture due to joint swelling, and acid fast bacillus staining was positive. Finally, all five patients were treated with anti tuberculosis drugs, and the symptoms, inflammatory indexes and imaging were improved. However, three patients had sequelae of joint contracture and muscle atrophy. Conclusion: The clinical symptoms, laboratory examination and imaging changes of children’s joint tuberculosis and juvenile idiopathic arthritis were similar. The main cause of misdiagnosis was lack of etiological examination at the lesion. Improving the detection of Mycobacterium tuberculosis in the affected joints can effectively reduce the misdiagnosis rate.

Analysis of the effect of stage I operation for different types of abdominal tuberculosis

Liu Xin, Guo Le, Li Junxiao, Chen Qiliang, Wu Qianhong

Journal of Tuberculosis and Lung Disease. 2022, 3(5):  371-376.  doi:10.19983/j.issn.2096-8493.20220112

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Objective: To investigate the effect of stage I operation on different types of abdominal tuberculosis. Methods: Clinical data of 75 abdominal tuberculosis patients treated with surgery in patients with tuberculosis from Shaanxi Tuberculosis Prevention and Control Hospital between January 1, 2016 and June 30, 2020 were collected. The diagnosis was confirmed by bacteriology or pathology. According to whether abdominal tuberculosis involves ≥2 abdominal organs, the patients were divided into pure group (n=37) and the composite group (n=38), the surgery conditions, postoperative complications, and the efficacy of surgery of the two groups were compared. Results: All the patients in the two groups were treated with stage I operation, 11 intestinal tuberculosis patients from the simple group underwent excision of ileocecal part the end of the cecum and ascending colon end to end anastomosis, 23 tuberculous peritonitis patients underwent removal of abdominal tuberculous abscess lesions, 3 patients with abdominal lymph node tuberculosis underwent mesenteric lymph node tuberculosis and removal of retroperitoneal lymph node tuberculosis kitchen. In the composite group, 4 patients were treated with intestinal perforation underwent perforation repair+abdominal abscess removal+intestinal adhesion release, and 15 intestinal tuberculosis patients complicated with tuberculous peritonitis underwent ileocecal intestinal resection and anastomosis+abdominal abscess removal+intestinal adhesion release, 19 intestinal tuberculosis patients complicated with tuberculous peritonitis and abdominal lymph node tuberculosis were treated with intestinal resection and anastomosis+abdominal abscess removal+mesenteric and retroperitoneal lymph node removal+intestinal adhesion release. Intraoperative blood loss, and operation time and postoperative drainage volume in the composite group were significantly higher than those in the simple group ((1271.84±66.28) ml vs. (594.32±35.92) ml, t=―8.986, P<0.001; 210.0 (145.0, 307.5) min vs. 80.0 (60.0, 90.0) min, Z=―6.839, P<0.001; and (1200.79±55.68) ml vs. (711.35±29.08) ml, t=―7.791, P<0.001, respectively). The incidence of incomplete obstruction in simple group was 16.2% (6/37), which was lower than that in composite group (63.2%, 24/38), and the difference was statistically significant (χ²=17.212, P<0.001). There was no intestinal perforation or intestinal fistula in the simple group. In the composite group, the incidence of intestinal perforation and fistula was 10.5% (4/38). Among them, 3 cases of fistula healed after anti-tuberculosis, nutritional support and dressing change drainage treatment, and the other one underwent cecal perforation enterectomy and anastomosis again. The patients in the two groups were followed up for 18-24 months, 1 case died (composite group) with the mortality rate of 1.3% (1/75), 6 cases were lost to follow-up, and 68 cases improved after treatment with the cure rate of 98.6% (68/69). Conclusion: Most of the patients with abdominal tuberculosis can achieve good surgical results. The intraoperative blood loss, operation time and postoperative drainage volume are higher in patients with abdominal tuberculosis involving a larger range of abdominal organs. Reasonable preoperative anti-tuberculosis, anti-infection and nutritional support therapy can reduce the incidence of postoperative complications.

Application value of uterine laparoscopy in suspected genital tuberculosis in infertile women

Sun Xiuli, Li Yabo, Gou Liangzhi, Ren Beiying, Wu Qianhong

Journal of Tuberculosis and Lung Disease. 2022, 3(5):  377-381.  doi:10.19983/j.issn.2096-8493.20220134

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Objective: To explore the application value of hysteroscopy in infertile women with suspected genital tuberculosis, and provide reference for clinical diagnosis and treatment. Methods: From January 2018 to December 2021, 62 infertile patients of high suspicion of genital tuberculosis with strong positive tuberculin skin test (PPD test) and positive tuberculosis infection T-cell spot test (T-SPOT.TB test) were selected from the Tuberculosis Prevention and Treatment Hospital of Shaanxi Province. They all underwent chest+pelvic CT examination and laparoscopy or combined exploration of hysteroscopy and laparoscopy. The clinical manifestations, chest and pelvic CT results, hysteroscopy and laparoscopy of the patients were analyzed, as well as the diagnostic value of suspected genital tuberculosis. Results: Of the 62 patients, 51 (82.3%) were primary infertility. The chest CT showed that, 10 cases (16.1%) had active pulmonary tuberculosis, 41 cases (66.1%) had inactive pulmonary tuberculosis, and 11 cases (17.7%) had no lesions in the chest. Among the 62 patients, 48 had pelvic lymph node calcification, bilateral adnexal spot calcification, low density mass with uneven density, intrauterine spot calcification and incomplete intestinal obstruction; 25 patients underwent hysteroscopy combined with laparoscopy, and 3 patients were diagnosed as endometrial tuberculosis by hysteroscopy; all the 62 patients were diagnosed as suspected genital tuberculosis through laparoscopy, and 40 were diagnosed as FGT. Conclusion: The location, size, shape, peripheral conditions and pelvic status of the lesions in infertile patients with suspected genital tuberculosis could be clearly detected by laparoscopy or hysteroscopy combined with laparoscopy. This is of great significance for the diagnosis of female suspected genital tuberculosis and can provide reference for clinical diagnosis and treatment.

The diagnostic value of stool samples detected by GeneXpert MTB/RIF for intestinal tuberculosis

Li Jing, Liang Yaping, Zou Yuanwu, Zhang Siqi, Zheng Jianbao, Wu Qianhong

Journal of Tuberculosis and Lung Disease. 2022, 3(5):  382-387.  doi:10.19983/j.issn.2096-8493.20220119

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Objective: To evaluate the diagnostic value of GeneXpert MTB/RIF (Xpert) detection of stool samples in patients with intestinal tuberculosis. Methods: The laboratory data of stool specimens from 98 patients with suspected intestinal tuberculosis admitted to Shaanxi Provincial Hospital of Tuberculosis Prevention and Treatment from August 2019 to May 2022 were retrospectively analyzed, which included test data detected by concentrated collection of bacteria floating method (referred to as “collection method”), BACTEC MGIT 960 liquid culture (referred to as “MGIT 960 culture”) and Xpert method simultaneously. Taking the final clinical diagnosis as the reference standard, the diagnostic efficacy of the three methods for detecting fecal specimens for intestinal tuberculosis was evaluated. Results: Of the 98 patients with suspected intestinal tuberculosis, 54 (55.1%) patients were confirmed intestinal tuberculosis, and 44 (44.9%) were non-intestinal tuberculosis. The positive detection rates of bacterial Xpert method (38.8% (38/98)) was apparently higher than collection method (15.3% (15/98)) and MGIT 960 culture (16.3% (16/98)), respectively. The differences were all statistically significant (χ²=25.496, P=0.000; χ²=20.224, P=0.000). The positive detection rate of stool samples positive for smear and/or culture was 95.5% (21/22), and the positive detection rate of stool samples negative for both smear and culture was 53.1% (17/32). Taking clinical diagnosis as reference, the sensitivity of collection method, MGIT 960 culture and Xpert method were 27.8% (15/54), 29.6% (16/54) and 70.4% (38/54), respectively, and the specificity was 97.7% (43/44), 100.0% (44/44) and 90.9% (40/44), the coincidence rates were 59.2% (58/98), 61.2% (60/98) and 79.6% (78/98), respectively, the Kappa values were 0.24, 0.27, and 0.60, respectively. Conclusion: The sensitivity and Kappa values of Xpert method for detecting feces are higher than that of collection method and MGIT 960 culture, which is consistent with clinical diagnosis. Xpert method can provide a diagnostic basis for early diagnosis of intestinal tuberculosis.

Clinical analysis of 28 cases of artificial stone associated silicosis complicated with pulmonary tuberculosis and non-tuberculous mycobacteria disease

Chen Zidan, Mao Ling

Journal of Tuberculosis and Lung Disease. 2022, 3(5):  388-393.  doi:10.19983/j.issn.2096-8493.20220117

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Objective: To investigate the clinical characteristics of artificial stone associated silicosis (AS-silicosis) complicated with pulmonary tuberculosis and non-tuberculous mycobacteria disease, and to provide reference for clinical diagnosis. Methods: A retrospective study was conducted, 28 patients with AS-silicosis complicated with pulmonary tuberculosis and non-tuberculous mycobacteria disease admitted to the Department of Pneumoconiosis of Shanghai Pulmonary Hospital from January 2017 to December 2020 were selected as study objects. The clinical symptoms, bacteriological test results, Mycobacterium tuberculosis (MTB) nucleic acid test results, chest CT imaging features and treatment outcomes of all subjects were collected and analyzed. Results: Among all 28 patients, AS-silicosis combined with non-tuberculous mycobacterium (NTM) lung disease and with pulmonary tuberculosis were both 14, accounting for 50.0% for each. The main clinical manifestations of all subjects were cough (92.9%, 26/28), expectoration (89.3%, 25/28), and puff (64.3%, 18/28). Smear positive rate among patients with NTM (64.3%, 9/14) was higher than those with pulmonary tuberculosis (28.6%, 4/14), while immunological test positive rate among NTM patients (25.0%, 3/12) was lower than those with pulmonary tuberculosis (40.0%, 4/10). Ground glass opacity (53.6%, 15/28), small nodule (92.9%, 26/28), patchy (25.0%, 7/28), progressive mass fibrosis (PMF)(71.4%, 20/28) and cavity (85.7%, 24/28) were the main manifestations of CT images in all subjects, and there was no significant difference between patients with NTM and patients with pulmonary tuberculosis. Cavities of patients with NTM mainly showed having thin wall (55.0%, 11/20) with smooth inner wall (70.0%, 14/20), while 0.0% (0/14) of cavities in patients with pulmonary tuberculosis got this feature. If imaging improvement such as CT lesion shrinking, cavity narrowing or close were considered as the necessary conditions for effective treatment, the effective treatment rate in patients with NTM and with pulmonary tuberculosis were 2/8 and 50.0% (6/12), respectively. Conclusion: AS-silicosis combined with pulmonary tuberculosis and non-tuberculous mycobacteria disease have low effective treatment rate. The difference of CT images could provide a basis for clinical diagnosis as thin-walled cavity with smooth inner wall may be associated with NTM lung disease.

Investigation on Knowledge-Attitude-Practice (KAP) of tuberculosis infection control among staff of a county-level designated tuberculosis hospital in Yunnan Province

Chen Tao, Yang Xing, Chen Lianyong, Chen Jin’ou, Ru Haohao, Tang Shunding, Xu Lin

Journal of Tuberculosis and Lung Disease. 2022, 3(5):  394-401.  doi:10.19983/j.issn.2096-8493.20220113

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Objective: To understand the status of KAP of tuberculosis (TB) infection control among staff of a county-level TB designated hospital, and provide reference for improving TB infection control in such hospitals. Methods: A county-level TB designated hospital in Yunnan Province was selected to carry out a questionnaire survey on the KAP of TB infection control among its staff. Statistical analysis was conducted. Results: A total of 398 pieces of questionnaire were obtained in this survey, all of which were included in the analysis. The awareness rate of infection control knowledge among employees in this TB designated hospital was 66.56% (2914/4378). The average scores of attitude and practice were 76.16±24.98 and 75.63±26.66, respectively. There were positive correlations between knowledge and attitude, knowledge and practice, attitude and practice (r=0.168, P=0.001; r=0.246, P<0.001; r=0.225, P<0.001). Multivariable logistic regression analysis showed that, for practice score, compared with clinicians, nurses, administrative/other staff were more likely to gain a higher score than the average (OR (95%CI): 0.46 (0.22-0.99) and OR (95%CI): 0.17 (0.07-0.46)); compared with staff having a knowledge score higher than the average, staff with a knowledge score lower than or equal to the average had a higher risk of getting a practice score less than or equal to the average (OR (95%CI): 2.35 (1.31-4.22)). Conclusion: The infection control practice of staff in the TB designated needs to be improved. Targeted routine training should be carried out to strengthen staff’s knowledge of TB infection control, improve their consciousness of infection control, and standardize their infection control behavior to reduce the risk of infection.

Review Articles

Research progress of diagnosis and treatment of drug resistant tuberculosis in children

Zheng Huiwen, Li Feina, Shen Chen

Journal of Tuberculosis and Lung Disease. 2022, 3(5):  402-404.  doi:10.19983/j.issn.2096-8493.20220106

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Drug resistant tuberculosis is one of the major health issues harming health of children. Significant difficulties existed in diagnosis and treatment of tuberculosis in child patients due to atypical clinical symptoms, low bacterial load, and difficulties in etiological diagnosis, which pose a serious threat to tuberculosis prevention and control. This paper reviews the latest progress in the diagnosis and treatment of drug resistant tuberculosis in children.

Research progress on the epidemic and economic burden of tuberculosis in children

Zhang Chunhua, Chen Wei

Journal of Tuberculosis and Lung Disease. 2022, 3(5):  405-409.  doi:10.19983/j.issn.2096-8493.20220131

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While the global tuberculosis epidemic has shown a downward trend in recent years, the burden of morbidity or mortality from tuberculosis in children has increased. There was research indicating that compared to adults, children were more likely to develop severe extrapulmonary tuberculosis, such as tuberculous meningitis, and the cost of treatment was high, having a serious impact on the economic burden of the patients and their families. The authors reviewed the current epidemic of tuberculosis in children and the research status of the economic burden of tuberculosis in children including factors affecting this burden in China and abroad. Our review will provide a reference for subsequent research on tuberculosis in children.

An update on researches of the receptors for respiratory syncytial virus infection

Feng Ziheng, Xu Lili

Journal of Tuberculosis and Lung Disease. 2022, 3(5):  410-414.  doi:10.19983/j.issn.2096-8493.20220105

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Respiratory syncytial virus (RSV) is a common cause of lower respiratory tract infections and responsible for a large proportion of mortality in children and the elderly. There are no licensed vaccines available to date. Prophylaxis and therapeutic RSV-specific antibodies are limited to populations at high risk owning to high cost and uncertain clinical value. Receptors and host factors are two determinants important for virus entry and establishment of infection in vivo. The identification and understanding of viral receptors and host factors can help us to gain insight into the pathogenesis of RSV infection. Herein, we reviewed receptors and host factors that have been reported thus far. We were characterized the functions and their roles in the life cycle of RSV, trying to provide an update on the information of RSV related receptors.

Research progress on the Mce4 protein family of Mycobacterium tuberculosis

Liu Yuanyuan, Li Lu, Wu Tuoya, Lu Jie

Journal of Tuberculosis and Lung Disease. 2022, 3(5):  415-419.  doi:10.19983/j.issn.2096-8493.20220089

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Tuberculosis (TB) caused by Mycobacterium tuberculosis has been the first cause of death for single infectious diseases since 2007. An indispensable cause of TB epidemic is that M.tuberculosis can dormant in host cells for a long time, and it has strong resistance to host defense and drug treatment. Mammalian cell entry (Mce) protein family plays a major role in M.tuberculosis invasion and intracellular survival.Among them, the mce operons (mce1-4) and the encoded Mce4 protein family are essential in the process of inducing pathogenic bacteria invasion, regulating host immunity, and ingesting and utilizing cholesterol. The authors reviews the research progress of mce4 operon and Mce4 protein family, to further comprehend the role of Mce4 proteins in the pathogenesis of M.tuberculosis and provide potential new targets for the treatment of tuberculosis.

Progress in the application of pulmonary rehabilitation training for patients with post tuberculosis lung disease

Liu Linlin, Wang Xiufen, Jiang Youli, Gui Min, Chen Jingfang

Journal of Tuberculosis and Lung Disease. 2022, 3(5):  420-424.  doi:10.19983/j.issn.2096-8493.20220086

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Pulmonary tuberculosis (PTB) is a severe infectious disease that poses a serious threat to public health and society development. For PTB patients, the ongoing destruction of lung tissue caused by infection is prone to develop into irreversible changes in lung structure as the disease progresses, causes lung injury and chronic inflammation which leads to functional changes such as respiratory distress, poor secretion drainage and immune function impairment. For post PTB lung disease, prompt pulmonary rehabilitation can help to improve lung function, retard the progression of lung disease, and improve quality of life. This review summarizes the current progress on the researches, implementation methods, and effectiveness evaluation of pulmonary rehabilitation training among post PTB lung disease patients, providing a reference for patients with post PTB chronic lung impairment who will need the rehabilitation training.