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    20 April 2023, Volume 4 Issue 2
    Special Topic
    Structure, substrate and function of mycobacterium type Ⅶ secretory system
    Jiang Zhiyong, Xie Jianping
    Journal of Tuberculosis and Lung Disease. 2023, 4(2):  98-109.  doi:10.19983/j.issn.2096-8493.20230025
    Abstract ( 175 )   HTML ( 24 )   PDF (1197KB) ( 61 )   Save
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    Bacterial secretion system is very important for bacterial development, intraspecific and interspecific competition, nutrition acquisition, virulence, physiology, genetics and ecology. Bacteria use the secretion system to secrete proteins outside the cell, which is also necessary for bacteria to adapt to the environment. Mycobacterium type Ⅶ secretory system and its substrate are closely related to the pathogenesis of Mycobacterium tuberculosis. This article introduces the composition, structure, substrate and function of type Ⅶ secretion system, especially its function in interaction with host, hoping to provide a basis for the research and development of new control measures for tuberculosis.

    Attach importance to the differential diagnosis of abnormal liver function in tuberculosis patients
    Ge Qiping, Gao Mengqiu
    Journal of Tuberculosis and Lung Disease. 2023, 4(2):  110-114.  doi:10.19983/j.issn.2096-8493.20220163
    Abstract ( 163 )   HTML ( 14 )   PDF (1075KB) ( 74 )   Save
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    Liver function injury is a common adverse drug reaction in the course of treatment of tuberculosis patients. Abnormal liver function can be caused by various types of hepatitis virus, drug or poison poisoning, autoimmune liver diseases, alcoholic liver disease, non-alcoholic fatty liver disease, cholestasis, et al.Sometimes it is difficult to diagnose the cause of liver injury. In clinical practice, it need to combine the history, biochemistry, etiology imaging and even liver biopsy to make a definite diagnosis. Clinically, in case of tuberculosis patients with abnormal liver function,it is necessary to identify the causes quickly and scientifically and intervene early meanwhile.It can contribute to the smooth progress of anti-tuberculosis treatment and improve the prognosis.

    Original Articles
    Analysis of latent tuberculosis infection among middle school and university freshmen in Guangzhou from 2018 to 2021
    Zhong Miner, Du Yuhua, Zhang Danni, Lin Ying, Wu Guifeng, Wang Ting, Liu Jianxiong
    Journal of Tuberculosis and Lung Disease. 2023, 4(2):  115-119.  doi:10.19983/j.issn.2096-8493.20230030
    Abstract ( 235 )   HTML ( 18 )   PDF (782KB) ( 67 )   Save
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    Objective: To investigate the situation of latent tuberculosis infection (LTBI) among middle school and university freshmen in Guangzhou, and to provides a reference for the prevention and control of tuberculosis and the formulation of strategies in schools and universities in Guangzhou. Methods: A total of 17632 incoming freshmen (including first-year students of junior high schools, senior high schools, junior colleges and universities) from 17 middle schools and universities in Guangzhou were selected from 2018 to 2021. All of them were treated with tuberculin skin test (TST) according to the principle of informed consent, and chest X-ray examination was added to students over 15 years at the same time. Students with TST results of moderately positive and above (average diameter of induration ≥10 mm) were further added with interferon-γ release assay (IGRA); when both TST and IGRA results were positive or chest X-ray showed abnormal shadows of the lungs, others auxiliary diagnostic tests such as sputum smear or sputum culture would be used. Screening results were analyzed using descriptive epidemiological methods. Results: A total of 17204 students were actually screened, with a screening rate of 97.57% (17204/17632). There were 4449 TST positive students, with a positive rate of 25.87% (4449/17199), a general positive rate of 15.98% (2748/17199), a moderate positive rate of 7.65% (1315/17199), and a strong positive rate of 2.24% (386/17199). The TST positive rate was the highest in the senior high school group (33.81%, 1408/4165), followed by that in junior high school group (30.58%, 329/1076), the TST positive rate was the lowest in the university group (22.68%, 2712/11958), and the difference between the groups was statistically significant (χ2=353.897, P<0.001). The positive rate of TST in boys was 26.68% (2789/10452), which was significantly higher than that of girls (24.60%, 1660/6747)(χ2=35.855, P<0.001). The 1701 students with moderately positive and above in TST (i.e., the average diameter of induration ≥10 mm) were tested for IGRA, 244 were positive for IGRA, and the positive rate of IGRA with TST moderate positive and above was 1.42% (244/17199). Of the 7 students found abnormal chest radiographs by screening, 1 was negative (IGRA not done) in TST and 6 were positive (5 IGRA positive and 1 IGRA negative) in TST. In the end, 5 cases of pulmonary tuberculosis were confirmed, and the detection rate of pulmonary tuberculosis was 29.06/100000 (5/17204). Conclusion: The tuberculosis infection situation of students in Guangzhou cannot be ignored, the physical examination of tuberculosis for junior high school and high school should be strengthened, and tuberculosis patients and LTBI students should be detected in time. The combined screening of TST and IGRA helps to improve the accuracy and efficiency of screening and is cost-effective.

    Baseline screening and follow-up cohort study of close contacts of school tuberculosis epidemic
    Zhou Jianwei, Zhang Songtao, Li Zhanhui, Xu Xingjun, Zhang Wei, Zhao Hongxia
    Journal of Tuberculosis and Lung Disease. 2023, 4(2):  120-127.  doi:10.19983/j.issn.2096-8493.20220164
    Abstract ( 144 )   HTML ( 19 )   PDF (1198KB) ( 64 )   Save
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    Objective: By investigating the incidence and characteristics of tuberculin skin test (tuberculin skin test,TST) and active tuberculosis in close contacts of pulmonary tuberculosis patients in schools, to provide basic data for the prevention and control of tuberculosis in schools. Methods: In this paper, a cohort study was used to research 307 close contacts of students (excluding 19 transfer scholars) from a school in Yiyang County, Luoyang City, He’nan Province during the epidemic treatment from March 2019 to May 2021 as the subjects of baseline screening, and 300 close contacts of students (excluding 7 active tuberculosis patients found in the baseline screening) as the subjects of two-year follow-up cohort study, including suspicious symptom screening, TST test, and chest X-ray examination. The incidence rate of tuberculosis, the strong positive prevalence of TST and the strong positive conversion rate of TST were observed at different follow-up stages. Results: A total of 119 TST strongly positive patients were found during the 2-year follow-up cohort survey. The strong positive prevalence of TST were 26.06% (80/307), 33.45% (99/296), 39.64% (111/280), 40.71% (114/280), 42.09% (117/278) and 43.12% (119/276) with the baseline screening and five follow-up screening. The difference between the strong positive prevalence of TST for baseline screening and the previous two follow-up screenings (two months before ultraviolet disinfection in September 2019) was statistically significant (χ2=6.261, P=0.044). A total of 75 students with strong positive conversion rate of TST were found in the five follow-up screenings, and the positive conversion rate was 18.92% (42/222), 9.47% (16/169), 4.05% (6/148), 4.20% (6/143) and 3.73% (5/134), respectively, among which the difference in the positive conversion rate of the first and second follow-up screening was statistically significant (χ2=5.097, P=0.024). A total of 28 patients with active pulmonary tuberculosis were found in the five follow-up screenings, and the incidence rate was 5.00/100 person years (28/560.22 person years). The incidence of 77 TST strongly positive patients diagnosed with tuberculosis during follow-up (9.47/100 person-years, 13/137.23 person years) at baseline was significantly higher than the incidence of 214 TST negative patients at baseline (3.70/100 person-years, 15/404.99 person years), with a statistically significant difference (χ2=6.143, P=0.013). The 85 students with strong positive TST and completed the whole course of preventive treatment had no disease, and there was a statistically significant difference in the incidence rate (21.14/100 person years,17/80.41 person years) of 51 students strongly positive for TST without preventive treatment (26 students) and completed the full course of preventive treatment (25 students)(χ2=31.820, P=0.000). Conclusion: Close contacts of school tuberculosis patients have a high risk of cluster infection, and it is necessary to screen close contacts of pulmonary tuberculosis during the infection period and window period for suspected symptoms, TST and chest X-ray examination for multiple times, and those TST strong positive students should receive active preventative anti-tuberculosis treatment.

    Analysis of the epidemiological characteristics and treatment outcomes of pulmonary tuberculosis with positive etiology in Tongzhou, Beijing from 2012 to 2021
    Yang Chao, Wang Jing, Xie Ke, Tang Guilin, Gao Hanqing, Wang Bin
    Journal of Tuberculosis and Lung Disease. 2023, 4(2):  128-134.  doi:10.19983/j.issn.2096-8493.20230031
    Abstract ( 192 )   HTML ( 16 )   PDF (796KB) ( 76 )   Save
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    Objective: To analyze the epidemiological characteristics and treatment outcomes of pulmonary tuberculosis (PTB) with positive etiology in Tongzhou, Beijing, and to provide scientific evidence for the formulation of PTB prevention and control measures. Methods: The clinical data of PTB patients registered in Tongzhou, Beijing from 2012 to 2021 were collected from Tuberculosis Management Information System of China Information System for Disease Control and Prevention. A total of 4996 cases of PTB patients were registered, among which 1926 cases were positive in etiological examination. The information of PTB patients with positive etiology were collected, including household registration, gender, age, ethnicity, occupation, cases source, treatment classification, complication and treatment outcomes, etc. The epidemiological characteristics of the population were analyzed, and the seasonal effect of time series was analyzed using seasonal index. Results: From 2012 to 2021, a total of 1926 PTB patients with positive etiology were registered in Tongzhou, Beijing, accounting for 38.55% (1926/4996). The registration rate of PTB patients with positive etiology showed an upward trend, increasing from 7.35/100000 (95/1.292 million) in 2012 to 15.41/100000 (284/1.843 million) in 2021, the difference was significant ($\chi_{\text {trend}}^2$=52.668, P=0.000). The positive rate of etiology in PTB patients also showed an upward trend, increasing from 28.19% (95/337) in 2012 to 50.18% (284/566) in 2021, and the difference was also significant ($\chi_{\text {trend}}^2$=36.652, P=0.000). The male-female ratio of patients was 2.10:1 (1304/622). The main age group was 15-44 years (55.61%, 1071/1926), the main occupation was housekeepers/unemployed people (38.84%, 748/1926), the main source of patients was due to referral from general hospitals (69.52%, 1339/1926), the visit delay were common (44.29%, 853/1926), and 59.40% (1144/1926) of patients with non-local residence registration. The prevalence of PTB with positive etiology was from June to September per year, and the seasonal indexes were 123.99,110.28,120.25 and 132.09, respectively. The overall treatment success rate was 91.07% (1754/1926). Of the patients, 47 (2.44%) were defaulted, 55 (2.86%) died, and 43 (2.23%) transferred to multidrug-resistant PTB. Conclusion: The registration rate and positive rate in etiology of PTB patients with positive etiology in Tongzhou, Beijing increased and showed seasonal variation from 2012 to 2021. The patients are mainly male, young adults, non-local, housekeepers/unemployed, with delayed visit and regional distribution, corresponding prevention and control strategies should be formulated according to the epidemiological characteristics.

    Environmental monitoring and analysis of Mycobacterium tuberculosis and discussion on the effect of disinfection equipment in a tuberculosis hospital
    Luo Yi, Tao Fengxi, Li Guofei, Zhang Huihui, Peng Peng, Ren Yi, Liu Suyang
    Journal of Tuberculosis and Lung Disease. 2023, 4(2):  135-140.  doi:10.19983/j.issn.2096-8493.20230017
    Abstract ( 197 )   HTML ( 7 )   PDF (784KB) ( 34 )   Save
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    Objective: To understand the pollution of Mycobacterium tuberculosis (MTB) in the Wuhan Pulmonary Hospital (Wuhan Institute for Tuberculosis Control), and evaluate the effects of different types of environmental disinfection equipment, so as to provide reference for optimizing the prevention and control measures of tuberculosis in the hospital area. Methods: According to the risk level of the hospital, air and surface samples were taken twice in 44 places in high-risk areas, such as respiratory and critical care medicine wards and tuberculosis wards, dirt rooms, sputum retention rooms, bronchoscopy clinics in endoscopy centers, and cleaning and disinfection rooms. Real-time polymerase chain reaction (qPCR) was used to detect the genome-specific fragment IS6110 of MTB and the culture of mycobacterium, and the types of disinfection equipment in the positive detection areas were analyzed to evaluate the disinfection effect. Results: After 7 days and 10 days of continuous sampling, 55 air samples and 139 surface samples were collected. After qPCR detection, MTB was detected in two air samples and two surface samples respectively, and the positive detection rates were 3.64% (2/55) and 1.44% (2/139), respectively. But the culture of mycobacterium was negative. The disinfection equipments in the qPCR positive detection area were all upper ultraviolet air disinfection lamps without aerodynamic force and ordinary hanging ultraviolet lamps, and the positive rate was 3.25% (4/123) which was not statistically different from that in the area with aerodynamic environmental disinfection equipment (0.00% (0/71))(χ2=1.022, P>0.05). Conclusion: The positive detection rate of MTB in environmental samples was low in the tuberculosis hospital, and there was no influence of aerodynamic force on the disinfection effect of MTB in the environment. But it is still necessary to strengthen disinfection treatment in high-risk areas and to strictly implement hospital control measures.

    Analysis of smoking cessation effect and influencing factors among outpatients in Guangzhou Chest Hospital
    Chen Wenhan, Tan Shouyong, Zhou Qiang, Lai Keng, Zheng Minli, Long Huiyan, Huang Elin, Xie Wei, Liu Yumei, Li Litao
    Journal of Tuberculosis and Lung Disease. 2023, 4(2):  141-146.  doi:10.19983/j.issn.2096-8493.20230006
    Abstract ( 179 )   HTML ( 8 )   PDF (782KB) ( 49 )   Save
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    Objective: To explore the effect and influencing factors of smoking cessation among smokers after intervention in the smoking cessation clinic, and propose measures for improving smoking cessation intervention. Methods: Using a prospective intervention study design, intensive smoking cessation intervention was conducted among smokers who were consulted at the Quitting Clinic of Guangzhou Chest Hospital from January 2021 to January 2022, with clear recommendations for quitting smoking. Then, standardized follow-up visits were conducted for 1 week, 1 month, 3 months, and 6 months in sequence. Those who did not quit smoking and those who quit smoking for less than 7 days were recorded as quitting failure groups, while those who quit smoking for more than 7 days (including relapse after quitting for 7 days) were recorded as quitting success groups for 7 days. After completing a 6-month follow-up, the smoking cessation behavior, smoking cessation outcomes, and relapse status of smokers were analyzed, and the influencing factors of success or failure in quitting smoking were explored. Results: A total of 79 smokers completed a 6-month follow-up. Twenty-three successfully quit smoking, 15 did not quit smoking, and 41 relapsed smokers. Relapse occurred in all follow-up periods, but most relapse occurred within the first week after quitting smoking, accounting for 48.8% (20/41). The success rate of quitting smoking was 55.7% (44/79). Comparing the baseline status of the two groups, the average daily smoking volume in the successful quitting group (17.43±4.95) was significantly lower than that in the unsuccessful quitting group (21.43±7.43), with a statistically significant difference (t=-2.859, P=0.005); The score of tobacco dependence (5.43±1.11) was significantly lower than that of smoking cessation failure group (6.14±0.97), with a statistically significant difference (t=-2.987, P=0.004). Multivariate logistic regression analysis showed that daily average smoking volume (≥20) was an independent influencing factor for smoking cessation failure (OR (95%CI): 4.441 (1.652 to 11.940), P=0.003). Conclusion: After intensive intervention in the smoking cessation clinic, smokers can achieve better results in quitting smoking. The daily average smoking amount is the main factors affecting smoking cessation.

    Primary ciliary dyskinesia for DNAAF3 gene mutations: a case report and literature review
    Yang Cui, Li Yuan, He Zhentao, Xu Jiaxing, Yu Xiaoying, Lu Chengyu, Chen Dehui, Zhai Yingying
    Journal of Tuberculosis and Lung Disease. 2023, 4(2):  147-152.  doi:10.19983/j.issn.2096-8493.20230015
    Abstract ( 178 )   HTML ( 7 )   PDF (1150KB) ( 38 )   Save
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    Objective: To review the clinical characteristics, diagnosis, treatment and prognosis of a child with primary ciliary dyskinesia (PCD) caused by DNAAF3 mutations. Methods: Clinical data and treatment process of a 4 months and 10 days old boy with PCD in the Department of Pediatrics, the First Affiliated Hospital of Guangzhou Medical University, were retrospectively reviewed. Wanfang, China National Knowledge Infrastructure, China Biology Medicine Disc and PubMed were searched up to August 2022 using “primary ciliary dyskinesia DNAAF3” as the search terms. Results: After birth (March 1, 2022), the child received phlegm reduction, asthma relief, anti-infection and non-invasive ventilator-assisted ventilation due to neonatal pneumonia/severe pneumonia, visceral inversion, pathologic jaundice, neonatal anemia and neonatal sepsis, but the treatment was not effective. In July 2022, he was admitted to our hospital due to “recurrent cough for more than 4 months, aggravated with wheezing for 2 days”. After completion of blood routine examination, inflammatory marker testing, respiratory etiology testing, chest CT scan, color Doppler ultrasound of the heart, liver, bile, pancreas and spleen, he was diagnosed as pulmonary infections (caused by Streptococcus pneumoniae, respiratory syncytial virus, parainfluenza type 2 virus) and multi-site visceral translocation. The fiberoptic bronchoscopy showed that the left and right bronchial images were inverted, and the electromicroscopy of ciliary biopsy showed obvious absence of external ciliary motor arm. In addition, the whole exome sequencing found the presence of DNAAF3 gene mutation (c.748_752dupGACGC and c.326G>C), and the diagnosis was PCD. After 10 days of treatment with phlegm reduction, anti-infection and fiberoptic bronchoscopy, the child was recovered and discharged. We combined our findings with the previous reported characteristics of 4 children with PCD caused by DNAAF3 gene mutation, and found that 4 patients were less than 1 year old and the other was only 10 years old. All the 5 children had full-term natural delivery. Except for the child in our study, all of them had neonatal respiratory distress and sinusitis. Chest CT scan showed that all 5 cases had visceral inversion. Electron microscopy of respiratory cilia showed that 1 case was deficient in motor arm, 3 cases were deficient in inner dynein arm and outer dynein arm, and 1 case was deficient in outer dynein arm. However, these 5 cases had different chromosome locations of gene mutations, which can be seen in chromosome 2, 3, 4, 5, 6, 12, 19. The prognosis was good after anti-infection or symptomatic treatment. Conclusion: DNAAF3 mutation can lead to PCD in children, and the clinical phenotype is related to genotype. Clinicians should pay more attention to children with visceral transposition accompanied by recurrent cough, sputum and sinusitis. Nasal and expiratory nitric oxide detection, electron microscopic examination of respiratory cilia and gene detection can improve the diagnosis rate of PCD.

    Review Articles
    Research progress of targeting bronchial epithelium in asthma
    Huang Junwen, Chen Ying, Cai Shaoxi, Zhao Haijin
    Journal of Tuberculosis and Lung Disease. 2023, 4(2):  153-157.  doi:10.19983/j.issn.2096-8493.20230021
    Abstract ( 167 )   HTML ( 13 )   PDF (779KB) ( 73 )   Save
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    Asthma is a heterogeneous disease affected by both heredity and environment. Airway epithelial injury is a common pathological change in asthma. The physical barrier function and immunomodulatory function of airway epithelium cooperatively respond to the stimulation and post-injury repair of viruses, allergens and air pollutants, and play an important role in airway inflammation, airway hyper-responsiveness and airway remodeling. In recent years, targeted therapy for bronchial epithelium had shown clinical value and became a potential new intervention target for asthma, especially for severe asthma. This article will focus on the role of airway epithelium in the pathogenesis of asthma and the treatment strategy targeting the airway epithelium of asthma.

    Research progress of airway remodeling mechanism in asthma
    Wang Zhongzhao, Tang Hao
    Journal of Tuberculosis and Lung Disease. 2023, 4(2):  158-163.  doi:10.19983/j.issn.2096-8493.20230036
    Abstract ( 172 )   HTML ( 10 )   PDF (846KB) ( 52 )   Save
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    Asthma is a global respiratory disease characterized by chronic inflammation in the airway and reversible airway restriction. Typical clinical symptoms of asthma are dyspnea, cough, chest tightness, and wheezing, etc. The airway remodeling and persistent airflow restriction in asthmatic patients may occur in the early stage of the disease, and is closely related to exacerbation of symptoms and medication. Therefore, early identification intervention may become an important way to treat asthma patients. High-resolution computed tomography (HRCT), as a non-invasive technique, is increasingly used to examine different aspects of airway remodeling in asthma. In this paper, the diagnosis airway remodeling in asthmatics by HRCT and the mechanism of airway remodeling in recent years were reviewed.

    The role of ceramide and ceramide synthetase in asthma
    Hu Tingting, Chang Chun
    Journal of Tuberculosis and Lung Disease. 2023, 4(2):  164-168.  doi:10.19983/j.issn.2096-8493.20230016
    Abstract ( 156 )   HTML ( 5 )   PDF (782KB) ( 34 )   Save
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    Ceramide is the center of sphingolipids metabolism and is an important signal molecule participates in many biological functions such as cell differentiation, proliferation, apoptosis and migration. Synthesis is mediated by ceramide synthetase. Asthma is a chronic airway disease characterized by airflow obstruction, airway hyper-responsiveness and lung inflammation, which greatly affects the quality of life and is an important public health problem. Studies have shown that ceramides play an important role in the pathophysiological development of asthma. This article focuses on the effects of ceramides on various cells involved in the pathogenesis of asthma and the differences in the effects of different ceramides, to provide a theoretical basis for better understanding of asthma and finding potential therapeutic targets for asthma.

    Research advance of biological target therapy and its cause of anaphylaxis for common allergic diseases
    Ru Yi, Li Lisha, Guan Kai
    Journal of Tuberculosis and Lung Disease. 2023, 4(2):  169-177.  doi:10.19983/j.issn.2096-8493.20230018
    Abstract ( 264 )   HTML ( 7 )   PDF (842KB) ( 49 )   Save
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    With the understanding of pathogenesis, biologics are gradually being applied as a mean of precision medicine for a variety of common allergic diseases, and good therapeutic results have been achieved. However, compared to foreign countries, China has fewer approved drugs and patients’ treatment options are more limited, so expanding the range of drugs and indications is the way forward. As with any emerging drug, safety remains a key issue for biologics, where anaphylaxis, a rapid-onset, life-threatening and serious adverse reaction, have been found to occur in the treatment of a variety of biologics, but it is not well understood or taken seriously enough. The authors therefore review eight biologics used internationally to treat common allergic reactions: omalizumab (anti-IgE), mepolizumab (anti-IL-5), reslizumab (anti-IL-5), benralizumab (anti-IL-5), dupilumab (anti-IL-4, IL-13), tralokinumab (anti-IL-13), nemolizumab (anti-IL-31R) and tesepelumab (anti-TSLP), and summarises the incidence of anaphylaxis to these biologics in order to promote awareness among healthcare professionals, to provide reasonable and necessary supervision after drug administration, and to be able to identify and manage anaphylaxis when they occur.

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ISSN 2096-8493
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