Table of Content

30 September 2018, Volume 7 Issue 3

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Expert Note

Current situation and prospect of prevention and treatment among elderly tuberculosis

Yan MA,Wei-wei GAO

Journal of Tuberculosis and Lung Health. 2018, 7(3):  161-166.  doi:10.3969/j.issn.2095-3755.2018.03.003

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With the aging population globally, elderly tuberculosis (TB) has brought severe challenges to the global TB control targets. Finding and curing TB patients is the most effective way to control the TB epidemic. On the premise of ensuring a higher cure rate for patients, case finding need to be increased. It is of great significance to understand the TB burden and the current situation of treatment in order to make the prevention and cure strategies and to control the epidemic situation of TB in the elderly.

Expert Forum

Strengthening active screening for elderly tuberculosis by integrating it into National Basic Public Health Service Project

Jie XU,Zhi-hua CHEN,Can-you ZHANG,Jun CHENG

Journal of Tuberculosis and Lung Health. 2018, 7(3):  167-170.  doi:10.3969/j.issn.2095-3755.2018.03.004

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Elderly people are at high risk of tuberculosis (TB) infection, but they are at low rate of finding. The authors aimed to discuss the necessity of active TB case finding among elderly people targetting to improve the low discovery rate, by reviewing the past and current methods for active screening at home and abroad, and seeking a cost-effective way of active TB case finding. Based on the review, the authors believed that integrating health examination for the aged into the basic public health service project, is an cost-effective method for carrying out active TB screening.Authors also summarize the necessary conditions and possible challenge to provide references for future related work.

Original Articles

Epidemiology of tuberculosis in the elderly in Shapingba District in Chongqing, 2008—2017

Wen-jie ZHOU,Li ZHONG,Xing-neng LUO

Journal of Tuberculosis and Lung Health. 2018, 7(3):  171-175.  doi:10.3969/j.issn.2095-3755.2018.03.005

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Objective To analyze the epidemiological characteristics of tuberculosis (TB) in the elderly in Shapingba District of Chongqing and provide evidence for the prevention and control of elderly TB. Methods Descriptive epidemiological analysis was used to analyze the epidemic data of TB in the elderly (age ≥65 years) of Shapingba District from 2008 to 2017, including the incidence, gender and age characteristics. Results A total of 5368 TB cases were reported in Shapingba District during 2008-2017, and the registration rate was 59.55/100000 (5638/9468382). At the same time, 562 cases were elderly TB, and the registration rate of elderly TB was 65.20/100000 (562/861986); the difference was statistically significant (χ²=4.21,P<0.05). The incidence of registered active TB in the elderly declined from 93.08/100000 (66/70903) in 2008 to 80.31/100000 (78/97127) in 2017, but the downward trend was not statistically significant ($\chi ^{2}_{trend}$=3.30, P>0.05). The registration rate of smear positive TB in the elderly ranged from 33.85/100000 (24/70903) in 2008 to 53.54/100000 (52/97127) in 2017, and there was no downward trend ($\chi ^{2}_{trend}$=1.36, P>0.05). 96.26% (541/562) of elderly TB patients came from passive discovery such as symptomatic treatment, symptom recommendation, referral, and follow-up. The success rate of treatment of elderly TB was only 86.16% (417/484), and the mortality was 9.09% (44/484). Conclusion The epidemic situation of the prevention and control of TB in the elderly in Shapingba District is still grim. Strengthening the health education, using molecular diagnostic technology, conducting active screening, and improving the quality of health management should be taken in order to control TB epidemic of elderly population.

Analysis of the characteristics of tuberculosis epidemic situation among students in Heilongjiang Province from 2011 to 2017

Bi-bo ZHANG,Xin WANG,Xue HAN,Hong-hai LI

Journal of Tuberculosis and Lung Health. 2018, 7(3):  176-179.  doi:10.3969/j.issn.2095-3755.2018.03.006

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Objective To analyze the characteristics of tuberculosis epidemic among students in Heilongjiang Province, 2011-2017. Methods The tuberculosis epidemic data of 6173 students reported from the Infectious Disease Information Management System in Heilongjiang Province from 2011 to 2017 were collected. The demographic data were from the 2012-2017 Heilongjiang Statistical Yearbook. The reported incidence of pulmonary tuberculosis and reported incidence of smear positive pulmonary tuberculosis among students in Heilongjiang Province from 2011 to 2017 were calculated, and the incidence trend and epidemic characteristics were described. Results The reported incidence of tuberculosis among students in Heilongjiang Province was 13.85/100000 (729/5263189) in 2017, decreasing by 14.40% in comparison with 16.18/100000 (1056/6526400) in 2011. The overall trend was downward (χ²=51.54,P<0.01). Students reported higher incidence of tuberculosis in the third quarter in 2014 (29.46%, 274/930), and higher in the fourth quarter in 2017 (27.98%, 204/729). From 2011 to 2013 and 2015 to 2016, the proportion of patients reporting in the second quarter was relatively high: 34.09% (360/1056), 30.26% (332/1097), 32.34% (293/906) and 33.29% (235/706), 28.30% (212/749), respectively. The top of three regions with high incidence in 2017 were Hegang city (24.16/100000, 30/124181), Qitaihe city (22.88/100000, 26/113621) and Jixi city (20.58/100000, 45/218703). The incidence rate in the 16-18 age group was the highest (40.88%, 298/729), followed by the age group over 19 (36.49%, 266/729). Conclusion The tuberculosis epidemic situation in schools in Heilongjiang Province showed an downward trend overall. Except for a few years, the incidence in the second quarter was the highest. Hegang, Qitaihe and Jixi cities had the highest incidence of the disease, with the highest number of people at the high school stage.

Rapid detection of Mycobacterium tuberculosis drug resistance by GenoType MTBDR plus assay

Chuang-yue HONG,Jin-li LI,Guang-lu ZHAO,Jing GUI,Yu-mei ZHU,Feng WANG

Journal of Tuberculosis and Lung Health. 2018, 7(3):  180-184.  doi:10.3969/j.issn.2095-3755.2018.03.007

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Objective To evaluate the ability of GenoType MTBDR plus assay (a linear probe hybridization technology, hereinafter referred to as “HAIN technology”) for detection of drug resistance in Mycobacterium tuberculosis in Shenzhen. Methods Using HAIN technology, the drug resistance of 1140 clinical isolates which were from Shenzhen Drug Resistance Monitoring Project in 2014-2016 (conducted in Shenzhen Center for Chronic Disease Control and Shenzhen District Chronic Disease Prevention and Treatment Institute) were tested. The traditional proportional drug susceptibility testing (DST) was used as standard to evaluate the capability of HAIN technology in detecting drug resistance. The McNemar test was used to compare the detection results. The sensitivity and specificity were used to evaluate the authenticity. The positive predictive value (PPV) and negative predictive value (NPV) were used to evaluate the application value of HAIN technology, and Kappa test was used to evaluate the consistency of the detection results of the two methods. Results The results of proportional DST showed that 123 and 75 cases were resistant to isoniazid and rifampicin, respectively, and 52 cases were resistant to multidrug. The HAIN technique detected 120 cases of isoniazid resistance, 79 cases of rifampicin resistance, and 52 cases of multidrug resistance (MDR). No significant difference was detected between the two methods (McNemar test, P values were 0.250, 0.219 and 1.000, respectively). Taking proportional DST as standard, the sensitivity and specificity of HAIN technique for the detection of isoniazid resistance were 97.6% (120/123) and 100.0% (1017/1017), the PPV and NPV were 100.0% (120/120) and 99.7% (1017/1020), and the Kappa value was 0.986. The sensitivity and specificity of HAIN technique for the detection of rifampin resistance were 98.7% (74/75) and 99.5% (1060/1065), the PPV and NPV were 93.7% (74/79) and 99.9% (1060/1061), and the Kappa value was 0.958. The sensitivity and specificity of HAIN technique for the detection of MDR were 96.2% (50/52) and 99.8% (1086/1088), the PPV and NPV were 96.2% (50/52) and 99.8% (1086/1088), and the Kappa value was 0.960. The results of HAIN technique demonstrated that the most frequent mutation in the rifampicin-resistant gene, rpoB was wild-type band 8 deletion and S531L site mutation (58.7%, 44/75), followed by wild-type band 7 deletion and H526Y site mutation (10.7%, 8/75) and wild-type band 2 deletion (10.7%, 8/75); the most frequent mutation in the isoniazid-resistant genes was wild-type band 1 deletion and S315T1 site mutation in katG (70.8%, 85/120), followed by wild-type band 1 deletion and C15T site mutation in inhA (18.3%, 22/120). Conclusion With its high sensitivity and specificity, GenoType MTBDR plus assay (HAIN technology) is a promising rapid method to detect isoniazid and rifampicin resistance in Mycobacterium tuberculosis strains.

The application value of GeneXpert MTB/RIF in detecting sputum specimens of pulmonary tuberculosis patients

Bai-feng LIN,Xin WANG,Lu TANG,Xue-zhi ZHANG,Li CHEN

Journal of Tuberculosis and Lung Health. 2018, 7(3):  185-187.  doi:10.3969/j.issn.2095-3755.2018.03.008

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Objective To analyze the application value of GeneXpert MTB/RIF in detecting sputum specimens of patients with pulmonary tuberculosis (PTB). Methods 1355 untreated patients were continuously selected from the outpatient clinic of Heilongjiang Tuberculosis Control and Prevention Center from August 2015 to January 2017, including 636 active PTB patients and 719 non-active PTB patients. The sputum samples of the patients were collected for sputum smear test, sputum culture test, proportional drug susceptibility test (DST), and GeneXpert MTB/RIF test. The detection performance of GeneXpert was analyzed. Results Sputum smear test was positive in 173 cases and negative in 1182 cases. Sputum culture was positive in 317 cases and negative in 1038 cases. GeneXpert detection was positive in 386 cases and negative in 969 cases. Taking the smear test as standard, the sensitivity and specificity of GeneXpert were 98.3% (170/173) and 81.7% (966/1182), respectively. Taking the culture test as standard, the sensitivity and specificity of GeneXpert were 93.4% (296/317) and 91.3% (948/1038), respectively. Taking the clinical diagnosis as standard, the sensitivity and specificity of GeneXpert were 58.0% (369/636) and 97.6% (702/719), respectively. Taking the DST as standard, the sensitivity and specificity of GeneXpert were 85.5% (47/55) and 98.3% (237/241), respectively, regarding the detection of rifampicin resistance. Conclusion With high sensitivity, high specificity, short detection time, and low requirements on laboratory biosafety and technical level of personnel, GeneXpert is suitable for the application in the grassroots laboratory.

Application of bacterial ultrasonic dispersion counter in pretreatment of microbiology experiment

Tong-ming FENG,Mei-fang XIAO,Wei WANG,Xiao-ying CUI,Zhi-long WU,Jie ZHOU

Journal of Tuberculosis and Lung Health. 2018, 7(3):  188-193.  doi:10.3969/j.issn.2095-3755.2018.03.009

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Objective To explore the application value of bacterial ultrasonic dispersion counter in pretreatment of microbiology experiment. Methods The bacterial suspensions of nine different types of bacteria species were prepared by using the traditional manual dispersion method and the new instrument ultrasonic dispersion method, and then the dispersion effects of those bacterial suspensions which prepared by two methods were compared through the macroscopic observation, gram’s stain microscopy and turbidity measure of bacterial suspension. The impacts of these two methods on the activity of bacteria were also compared in this study. Results Seven types of bacteria could be dispersed sufficiently in low level power, while the other two types of bacteria were dispersed in medium level power. Different types of bacteria had different ultrasonic processing time, with the longest 120 s and the shortest 10 s. The degree of uniformity of the bacterial suspensions prepared by the instrument ultrasonic dispersion method was better and there was no obvious bacterial aggregation. The dispersion effects of the bacterial suspensions of Acinetobacter baumannii, Klebsiella pneumoniae and Stenotrophomonas maltophilia, etc. prepared by the two methods had no statistically significant difference. The ideal dispersion effect of the bacterial suspensions could be obtained at 30 s of ultrasonic dispersing; the extension of ultrasonic dispersing time, the turbidity of most of bacterial suspensions didn’t change significantly. However, as for Acinetobacter baumannii, Enterobacter cloacae and Escherichia coli, the turbidity of bacterial suspensions significantly decreased with the extension of ultrasonic dispersing time, while for Klebsiella Pneumoniae, the turbidity of bacterial suspension got top at 60s and then gradually declined with the extension of ultrasonic dispersing time. Under the 1∶10 ⁵ dilution degree, the mean number of plate bac-terial colonies of Escherichia coli dispersed by the instrument ((59±6)×10 ⁵ CFU/ml)) was significantly lower than that of the manual dispersions ((76±8)×10 ⁵ CFU/ml)), F=10.321, P=0.033; the mean number of plate bacterial colonies of Noka bacteria dispersed by the instrument ((9±6)×10 ⁵ CFU/ml)) was significantly higher than that of the manual dispersions ((2±0)×10 ⁵ CFU/ml)), F=8.693, P=0.015; there was no significant difference on growth activity in bacterial suspensions of other 7 types of bacteria species prepared by using the instrument ultrasonic dispersion method and the traditional manual method. Conclusion Compared with traditional manual dispersion method, the dispersion effect of bacterial ultrasonic dispersion counter for the tested bacteria species is more ideal, and instrument ultrasonic dispersion need shorter time and have no influence to bacteria growth activity at the same time. The bacterial ultrasonic dispersion counter is able to provide a set of safe, efficient, and standardized solution for bacterial suspension preparation, which has high application value in pretreatment of microbiology experiment.

Clinical analysis of the adverse reactions in 138 cases of multidrug-resistant tuberculosis following cycloserine treatment

Xin-min WEN,Kun-yun YANG,Heng-zhong YI,Dan-lin LUO,Yong ZHANG,Zhi-gang TANG,Juan LI,Tian YUAN

Journal of Tuberculosis and Lung Health. 2018, 7(3):  194-197.  doi:10.3969/j.issn.2095-3755.2018.03.010

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Objective To analyze the psychiatric and neurologic adverse reactions of cycloserine in 138 patients with multidrug-resistant tuberculosis. Methods Retrospective analysis was conducted based on the clinical data of 138 cases of multidrug-resistant tuberculosis who were admitted to the Department of Multidrug Resistant Tuberculosis, Hu’nan Chest Hospital from July 1, 2012 to June 30, 2014. The occurrence and treatment strategies of adverse reactions of cycloserine were summarized and analyzed. Results Of the 138 cases of multidrug-resistant tuberculosis using cycloserine, 18 (13.04%) occurred the psychiatric and neurologic adverse reactions. Seven (5.07%) cases discontinued cycloserine. They received 6Cm(Am)-Lfx(Mfx)-Pto-PAS-Z/18Lfx(Mfx)-Pto-PAS-Z regimen, and all psychiatric and neurologic adverse reactions disappeared. The remaining 11 (7.97%) cases increased the dosage of VitB6, and maintained the original regimen for anti-tuberculosis treatment. After treatment, they all did not occur the psychiatric and neurologic adverse reactions. Conclusion It is relatively safe to use cycloserine-containing regimen to treat multidrug-resistant tuberculosis, if we master the indications and closely monitor the adverse events.

Visual citation analysis on co-morbid tuberculosis and diabetes mellitus publications based on the Web of Science

Jian-jun MA,Yan-li YUAN,Tie-juan ZHANG

Journal of Tuberculosis and Lung Health. 2018, 7(3):  198-204.  doi:10.3969/j.issn.2095-3755.2018.03.011

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Objective To provide a reference for the researchers in conducting studies in related fields by visual citation analysis on publications of tuberculosis complicated by diabetes mellitus. Methods With Web of Science as the database source, HistCite software was used to assess the journals published, literature institutions, authors and important literatures in the field of tuberculosis and diabetes mellitus and to analyze the historical development status and research focus. Results The researches on tuberculosis and diabetes mellitus were rapidly increased in 2011-2017. The average number of annual published literatures was 152.1 (1065/7), and the highest number of literatures was observed in 2016 (207). The most important journal was International Journal of Tuberculosis and Lung Disease, which ranked first in citation (770 times) and second in literature published number (63) in the world in the field of tuberculosis complicated with diabetes. Harries, Kapur and Lonnroth were important authors in this field with 36, 31, and 27 publications, respectively. The most frequently cited literatures were published by the World Health Organization (456 times), followed by London Health and Tropical School of Medicine (440 times). The core literature was “Tuberculosis and diabetes mellitus: convergence of two epidemics”, with a total citation frequency of 171 times.

Conclusion

The research on tuberculosis and diabetes mellitus started late, and the number and quality of literatures published by professional research institutes of tuberculosis were the highest.

Effects of clustering nursing intervention on compliance and quality of life of drug-resistant tuberculosis patients after discharge

Bo CHEN

Journal of Tuberculosis and Lung Health. 2018, 7(3):  205-207.  doi:10.3969/j.issn.2095-3755.2018.03.012

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Objective To analyze the effects of clustering nursing intervention on compliance and quality of life of drug-resistant tuberculosis patients after discharge.Methods Sixty drug-resistant pulmonary tuberculosis patients admitted from July 2016 to February 2017 were selected as control group and another 60 cases treated from March to October 2017 as observation group. The control group was given routine nursing, and the observation group was given clustering nursing intervention on the basis of routine nursing. The compliance and quality of life before and after nursing were compared between the two groups.Results The therapeutic compliance rate in the observation group was 95.0% (57/60), which was higher than that in the control group (83.3%, 50/60); the difference was statistically significant (χ²=4.23, P<0.05). The scores of body function, psychological function and social function after nursing were (53.18±10.93), (48.67±8.22) and (49.17±9.15) in the observation group and (47.12±11.09), (44.16±6.34) and (43.18±8.29) in the control group, respectively. The scores in the observation group were higher when compared with the control group, with statistical significances (t=3.01, 3.36, and 3.76, all Ps<0.05).Conclusion Clustering nursing intervention can effectively improve the com-pliance and quality of life of drug-resistant tuberculosis patients after discharge.

Review Articles

Research progress on risk factors and active screening strategies in senile tuberculosis

Nan QIN,Jun CHENG,Wei-bing WANG

Journal of Tuberculosis and Lung Health. 2018, 7(3):  208-212.  doi:10.3969/j.issn.2095-3755.2018.03.013

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With increasing Chinese aging population, the incidence of tuberculosis in the elderly is on the rise. The elderly population is a key group among tuberculosis patients, but they often have limited knowledge of tuberculosis. In addition, the symptoms of tuberculosis in this population are relatively hidden, often causing missed diagnosis or misdiagnosis of tuberculosis and delaying the optimal treatment time. Therefore, actively promoting active screening methods in the elderly population can make up for the shortcomings of traditional passive discovery methods and improve the detection rate of tuberculosis. This paper summarizes the risk factors of tuberculosis in the elderly, and helps to explore prevention and control strategies and measures. It aims to provide reference and basis for the development of tuberculosis research and policy measures for the elderly nationwide.

Clinical characteristics and the treatment of traditional Chinese medicine in senile pulmonary tuberculosis patients

Xiao-ming YANG,Zhong-da LIU,Zun-jing ZHANG,Jing GUO

Journal of Tuberculosis and Lung Health. 2018, 7(3):  213-216.  doi:10.3969/j.issn.2095-3755.2018.03.014

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Senile pulmonary tuberculosis patients have unique clinical features: untypical clinical symptoms and imaging, higher male prevalence, more comorbidities and complications, high bacterial positive rate and retreatment rate and high drug adverse reactions. Early detection and early diagnosis of senile pulmonary tuberculosis should be achieved by the pathogen and histological evidence combined with the patient’s clinical symptoms, imaging and epidemiology. At the same time, strengthen the publicity and education of knowledge in elderly tuberculosis patients, improve the quality of diagnosis and treatment services, supervise the whole process, standardize diagnosis and treatment had important role. Traditional Chinese medicine as a adjuvant treatment in senile TB patients had obvious advantages in improving the clinical symptoms of patients, increasing the negative rate of sputum bacteria, reducing the toxic and side effects of anti-tuberculosis drugs, improving the body immunity and the cure rate. This is worthy of further verification and promotion.

Research progress of isobaric tags for relative and absolute quantitation and two-dimensional liquid chromatography-tandem mass spectrometry in the diagnosis of tuberculosis

Xin HU,Wushouer Qimanguli·

Journal of Tuberculosis and Lung Health. 2018, 7(3):  217-220.  doi:10.3969/j.issn.2095-3755.2018.03.015

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In recent years, with the development of biotechnology, the study focus on tuberculosis diagnosis has shifted to serum proteomics research that can reflect the state of organism in time and identify differential proteins in the serum of tuberculosis patients, providing an important theoretical basis for early diagnosis and differential diagnosis of disease. Isobaric tags for relative and absolute quantitation and two-dimensional liquid chromatography-tandem mass spectrometry (iTRAQ-2DLC-MS/MS) technology is concerned and widely used by researchers because of its strong separation ability, wide analysis range, high sensitivity, high specificity, and low detection limit. This article reviews the researches on serum proteomics of tuberculosis patients based on iTRAQ-2DLC-MS/MS technology.

Continuous lumbar drainage in the treatment of tuberculous meningitis

Yu CHEN,Li-chao FAN,Yu CHEN,Ya-juan ZHU

Journal of Tuberculosis and Lung Health. 2018, 7(3):  221-224.  doi:10.3969/j.issn.2095-3755.2018.03.016

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Tuberculous meningitis is one of the most severe forms of extrapulmonary tuberculosis. In addition to routine anti-tuberculosis, intracranial pressure reduction, glucocorticoid and intrathecal administration, there are no more advanced clinical treatments. The incidence of complications of tuberculous meningitis is high, with often severe sequelae and even high mortality. In recent years, continuous lumbar drainage has been applied in patients with tuberculous meningitis and achieved satisfactory results. This paper reviews the application of continuous lumbar drainage in the treatment of tuberculous meningitis in order to provide an effective method for the treatment of tuberculous meningitis.

Short Articles

CT features of patients with tuberculous peritonitis combined with intestinal perforation (with seven cases)

Ji-li WU,Qing-an WANG

Journal of Tuberculosis and Lung Health. 2018, 7(3):  225-228.  doi:10.3969/j.issn.2095-3755.2018.03.017

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The abdominal CT scans of seven patients with tuberculous peritonitis combined with intestinal perforation were retrospectively reviewed. We analyzed the CT features of the patients, including peritoneum, omentum, mesentery, retroperitoneal space, and abdominal parenchymal viscera. The main features in the abdominal CT scans of tuberculous peritonitis combined with intestinal perforation appeared as follows. (1) Large encapsulated effusion and gas abscess were found in five cases. (2) One case of free gas under the diaphragm was identified. (3) Multiple small bubbles surrounding the bowels and abdominal cavity were present in seven cases. (4) Intestinal obstruction was found in four cases. (5) Small amount of free ascites with high density were identified in seven cases. (6) Peritoneum and retinal thickening were found in seven cases. (7) The mesentery of seven cases showed a “smudge” change. (8) Secondary pulmonary tuberculosis were identified in six cases, combined hematogenous disseminated pulmonary tuberculosis happened in one patient and combined tuberculous pleurisy were found in two cases. (9) Six cases were found with combined secondary hydronephrosis. Therefore, the CT scan features of tuberculous peritonitis combined with intestinal perforation may appear as a small amount of free ascites, peritoneal thickening, omental and mesenteric involvement. Acute perforation is indicated when free gas under the diaphragm occurs. In addition, chronic perforation is indicated when large encapsulated effusion and gas abscesses appear in the abdominal cavity and surrounding the bowels, multiple small bubbles appear in the omentum and mesentery. CT scan can provide important information for the diagnosis of tuberculous peritonitis combined with intestinal perforation.