Table of Content

30 March 2020, Volume 9 Issue 1

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Expert Forum

Analysis on diagnosis and treatment of coronavirus disease 2019(COVID-19)

DENG Guo-fang, LEI Jian-ping

Journal of Tuberculosis and Lung Health. 2020, 9(1):  7-10.  doi:10.3969/j.issn.2095-3755.2020.01.003

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The novel coronavirus pneumonia (also named as coronavirus disease 2019 (COVID-19) By WHO) has been causing a severe public health problem in China. Now the epidemic has been posing great emergency not only in China, but also to the public health system worldwide. More than 80000 confirmed cases in China and more than 100000 confirmed cases worldwide have been reported at the day of this manuscript. For enhancing the clinicians’ understanding of COVID-19, we briefly summarized some main points of diagnosis and treatment from our experiences of COVID-19 patients care, literature review and recent diagnosis and treatment regimen. We hope to provide some references to clinicians when taking care of COVID-19 patients.

Clinical features and CT imaging diagnosis of novel coronavirus pneumonia

PENG Peng, YU Hui-shan, ZHOU Xin-hua

Journal of Tuberculosis and Lung Health. 2020, 9(1):  11-15.  doi:10.3969/j.issn.2095-3755.2020.01.004

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Novel coronavirus pneumoia, also named by corona virus disease 2019 (COVID-19) according to WHO, is a highly infectious pulmonary inflammatory disease. The author adopted the cluster sampling method to collect 185 positive cases of nucleic acid from the patients diagnosed with COVID-19 in Wuhan Pulmonary Hospital for statistical analysis. The discovery and naming of COVID-19, nucleic acid detection, clinical manifestations, CT characteristics and diagnostic value were to be comprehensively analyzed. The data in this group showed that 157 (84.9%) of the 185 patients with fever were mainly low-grade fever, and only 8 (4.3%) of those with high fever above 39.0 ℃. Weakness, joint acidity, swelling, and pain in both lower limbs were presented in 58 patients (31.4%); There were 142 cases (76.8%) with discontinuous cough with less phlegm and chest distress. The main CT imaging features were multiple patchy, patchy and large patches ground-glass shadows and interstitial changes. Most of the lesions were distributed in the lower lobe and in the outer zone of both lungs. The thickened pulmonary vascular marking was obvious in lesions and the lesion was progressing rapidly. According to the characteristics of CT imaging,the accuracy of imaging diagnosis of COVID-19 was as high as 87.0% when as a first diagnostic tool. Therefore, CT examination has a very important value in the diagnosis of COVID-19. Meanwhile, it plays an irreplaceable role in evaluating the severity of pulmonary lesions, dynamic changes during treatment, and follow-up observation of patients in recovery phase.

Expert Note

Virus genome, the direct way to know the SARS-CoV-2 virus

LIU Di

Journal of Tuberculosis and Lung Health. 2020, 9(1):  16-18.  doi:10.3969/j.issn.2095-3755.2020.01.005

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WHO announced the COVID-19 epidemic as a global pandemic on 11 March 2020. Understanding the genome of the pathogen SARS-CoV-2 virus, and unravelling the science behind the virus will pave the way for controlling the disease. This manuscript summarized the aspects that virus genome could contribute to, including virus identification, essential gene analysis, virus origination, transmission dynamics, and epidemic prediction. Meanwhile, key directions of SARS-CoV-2 virus genomics in the current stage, and the importance of communication and collaboration are stated.

Original Articles

The analysis of imaging characteristics of high-resolution CT in 250 cases with coronavirus disease 2019

YU Hui-shan, QIN Li-xin, DING Chen-yu, LIU Jing, LI Bao-xue, LI Zheng-min

Journal of Tuberculosis and Lung Health. 2020, 9(1):  19-24.  doi:10.3969/j.issn.2095-3755.2020.01.006

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Objective To analyze and summarize the imaging characteristics of high-resolution CT (HRCT) in 250 cases with coronavirus disease 2019 (COVID-19), so as to improve the accuracy of HRCT diagnosis of COVID-19. Methods Four hundred and ninety-two suspected COVID-19 cases were selected from Wuhan Pulmonary Hospital (2020.01.01-2020.02.20) by cluster sampling, 250 of them were definitely diagnosed with positive nucleic acid test, and their HRCT imaging characteristics were analyzed retrospectively. Among the 250 cases, 169 (67.6%) were males and 81 (32.4%) were females. The age ranged from 21 to 83 years old with the median age of 51 years old. Among the clinical symptoms, 229 cases had fever, among which 210 (84.0%) had moderate or low fever. There were 195 cases (78.0%) with respiratory symptoms. There were 38 cases (15.2%) without any clinical symptoms but had close contact with the confirmed patients, and their abnormal lung conditions were found through physical examination. SPSS 23.0 software was used for statistical analysis. Descriptive statistical method was used for this group of data, and the enumeration data was expressed as “rate or composition ratio (%)”. Results (1) Gender and age characteristics: there were 169 male patients (67.6%) and 81 female patients (32.4%),and the percentage difference was 35.2%. In different age groups from 21 to 83 years old, there were 6 cases (2.4%) in the age group from 21 to 30 years old, which was the lowest percentage, 89 cases (35.6%) in the age group from 50 to 60 years old, was the highest percentage.(2) Clinical features: there were 210 (84.0%) cases with low fever, 195 (78.0%) cases with respiratory symptoms, and 38 (15.2%) cases in close contact with the confirmed patients, asymptomatic but with pulmonary abnormalities. Of the 250 cases who tested positive for nucleic acid and were finally confirmed, 221 (84.4%) were diagnosed with COVID-19 at the first HRCT diagnosis.(3) HRCT imaging characteristics are: Multiple pulmonary ground - glass opacity (GGO) in 195 cases (78.0%), multiple patchy shadows in 36 cases (14.4%),27 cases (10.8%) with diffuse interstitial infiltrating shadows, multiple large patchy consolidation in 20 cases (8.0%),increased vascular bundle in 207 cases (82.8%).The lesions were found in 207 cases (82.8%) in the external areas of subpleural areas. In the dynamic observation, 221 cases (88.4%) with interval 3 days short-term reexamination showed an increase in an explosive mode. Conclusion After mastering the typical HRCT imaging characteristics of COVID-19 mentioned above, the CT diagnostic accuracy of COVID-19 will be greatly improved, and the clinical comprehensive diagnosis level of COVID-19 will be greatly improved.

Ultrasonographic features of peripheral lung lesions at different stages in patients with novel coronavirus pneumonia

HUANG Yi, WANG Si-han, ZHENG Chu-yun, LIU Yue, ZHANG Yao-hui

Journal of Tuberculosis and Lung Health. 2020, 9(1):  25-31.  doi:10.3969/j.issn.2095-3755.2020.01.007

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Objective To investigate the ultrasonographic features of peripulmonary lesion of novel coronavirus pneumonia (COVID-19) patients in different period of onset, and to provide reference for clinical diagnosis and efficacy evaluation. Methods Retrospective analysis was conducted in the 15 patients with COVID-19 diagnosed clinically in our hospital from January to February 2020. Among them, 3 patients were in early stage, 10 patients were in advanced stage and 2 patients were in severe stage. All patients were examined by two-dimensional ultrasound and color doppler ultrasound to observe the image characteristics of lesions under ultrasound imaging. Results (1) The main manifestations of ultrasound were that the pleura line was not smooth or interrupted, resulting in solid shadows and visible “B” line. The incidence of the above three ultrasonic imaging changes was 100.00% (15/15), bronchiectasis in solid lesions was 66.67% (10/15) and pleural thickening was 53.33% (8/15). (2) There were different characteristics in different stages of the disease. It was occasionally seen that the peripulmonary pleura line was rough in the early stage of the disease. In the advanced stage, the pleura line of the patients was rough and partial interruption, at the same time several B lines could be seen and the position of B line was fixed, in some patients subpleural patchy pulmonary consolidation could be seen. In the severe stage, beside the characteristics of common patients, interruption and disappearance of pleura line, large irregular consolidation shadow under pleura and a large number of fusion B line were observed, as well as bronchiectasis in the consolidation area. At the same time, the adjacent pleura had local thickening. Color doppler flow imaging (CDFI) in the focal consolidation area showed lack of blood flow signals. Conclusion The ultrasound images of patients with COVID-19 have certain characteristics imaging manifestations at different stages of disease progression, which can provide basis for clinical diagnosis and efficacy evaluation.

Influencing factors of tuberculosis infection of newly admitted patients in a drug rehab center from 2017 to 2019

WANG Yan, ZHENG Kai-qiao, WEI Yi-ting, FANG Hong-xia

Journal of Tuberculosis and Lung Health. 2020, 9(1):  32-36.  doi:10.3969/j.issn.2095-3755.2020.01.008

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Objective To analysis the current states and influencing factors of tuberculosis infection of drug addicts before compulsory isolation and rehabilitation. Methods Tuberculin skin test (TST) was used to screen the tuberculin infection of the newly admitted detoxists from April 2017 to June 2019. According to the WS 288-2017 tuberculosis diagnosis. Logistic regression was used to analyze the possible influencing factors of tuberculosis infection, with age, education level, marital status, body mass index (BMI) value, BCG scar, suspicious symptoms of tuberculosis, underlying disease, years of drug abuse, times of drug withdrawal and other factors as independent variables and infection as dependent variables. Results A total of 754 drug addicts were screened, 429 (56.9%) were positive for TST and 148 (19.6%) were strongly positive. There were 428 cases (56.8%) have a BCG scar. According to the standard, there were 379 people infected with tuberculosis, and the tuberculosis infection rate of drug addicts was 50.3%. Multivariate logistic regression analysis showed that, age (OR=1.04,P=0.001) and BMI (OR=1.08,P=0.003) were influencing factors of tuberculosis infection. Conclusion Drug addicts have a relatively high level of tuberculosis infection before compulsory isolation for drug rehab.In order to avoid the outbreak of tuberculosis epidemic, the drug treatment centers should strengthen the prevention and control of tuberculosis for drug addicts, especially those who are older and higher BMI.

Inhibitory effect of cisplatin combined with rapamycin or 3-methyladenine in lung adenocarcinoma A549 cells

BU Jing, DU Yun, JI Xiao-kun, WU Jia-ning

Journal of Tuberculosis and Lung Health. 2020, 9(1):  37-43.  doi:10.3969/j.issn.2095-3755.2020.01.009

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Objective To observe the inhibition effect of cisplatin (CP) combined with rapamycin (RAPA) or 3-methyladenine (3-MA) on lung adenocarcinoma A549 cells, so as to provide evidence for improving the chemotherapeutic effectiveness of CP. Methods From March 2013 to June 2014, we accessed human lung adenocarcinoma A549 cells from the scientific research center of the Fourth Hospital of Hebei Medical University. Cells’ proliferation inhibition rate and the 50% inhibitory concentration (IC50) of CP, RAPA and 3-MA were obtained by conducting tetramethylazozolium 3-(4,5-dimethylthiazol-2-yl) -2,5-diphenyltetrazolium (MTT) experiment and those IC50s were used in the inhibitory experiment. Four groups were studied: control group (without drug intervention), CP group (15 μmol/L of CP), CP+RAPA group (10nmol/L of RAPA followed by 15 μmol/L of CP), CP+3-MA group (add 3 μmol/L of 3-MA for 1 hour and then add 15 μmol/L of CP). The A549 cells in logarithmic growth phase were seeded into 6-well plates with a concentration of 1.0×10⁶/ml. When the cells grew to cover about 70%-80% of the bottom area of the well, diluted drugs were added and cells then were cultured for 24 h, 48 h, 72 h. The growth and migration of A549 cells were detected by cell scratch test, and the expression of mTOR, LC3-Ⅱ and Bax mRNA and proteins were detected by RT-PCR and Western blot test. Data were processed and analyzed using SPSS17.0 statistical software. Results The IC50 results of MTT experiment were 15 μmol/L for CP, 10 nmol/L for RAPA, and 3 μmol/L for 3-MA. Scratch experiments showed that the weakest migration ability was in CP+RAPA group at 24 h and CP+3-MA group at 48 h and 72 h. RT-PCR showed that the expressions of LC3-Ⅱ mRNA in CP+RAPA group (2^-△△Ct: 24 h 1.866±0.069, 48 h 1.803±0.083, 72 h 1.836±0.056) were significantly increased (24 h F=149.780, 48 h F=111.599, 72 h F=167.855, P<0.01) compared with CP group (2^-△△Ct: 24 h 1.489±0.031, 48 h 1.325±0.007,72 h 1.428±0.080), while the expressions of Bax mRNA in CP+3-MA group (2^-△△Ct: 48 h 1.864±0.104, 72 h 1.935±0.068) were increased significantly (48 h F=52.853, 72 h F=202.118, P<0.01) compared with CP group (2^-△△Ct: 48 h 1.346±0.080, 72 h 1.462±0.029). Western blot test showed that the expressions of LC3-Ⅱ protein in CP+RAPA group (2^-△△Ct: 48 h 0.556±0.010, 72 h 0.571±0.009) were significantly higher than that of CP group (2^-△△Ct: 48 h 0.426±0.0107, 72 h 0.492±0.009) (48 h F=372.056, 72 h F=930.500, P<0.01), and the expressions of Bax protein in CP+3-MA group (2^-△△Ct: 48 h 0.897±0.022, 72 h 0.916±0.005) were significantly higher than that of CP group (2^-△△Ct: 48 h 0.463±0.011, 72 h 0.581±0.007), (48 h F=1100.412, 72 h F=5715.778, P<0.01). Conclusion CP combined with RAPA or 3-MA can inhibit the growth of A549 cells better than CP alone. CP combined with 3-MA has the strongest effect when used for a long time.

Evaluation of effectiveness of chemotherapy regimens with linezolid in treatment of severe tuberculous meningitis

JIANG Ling, LUO Ting-ru, ZHOU Xiao-qi, TANG Na, MENG Chang-ping, QIAN Chun-fang

Journal of Tuberculosis and Lung Health. 2020, 9(1):  44-48.  doi:10.3969/j.issn.2095-3755.2020.01.010

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Objective To explore the efficacy and safety of the chemotherapy regimens with linezolid in the treatment of severe tuberculous meningitis. Methods A total of 167 patients with tuberculous meningitis were treated at the Chongqing Public Health Medical Center from January to December 2018. Among them, 33 patients were determined as severe tuberculous meningitis by using the criteria of the Medical Research Council (MRC) of UK. Those severe patients were divided into two groups according to whether they received linezolid for anti-tuberculosis (anti-TB) treatment or not: 16 patients received the chemotherapy regimens with linezolid and was called as the observation group; 17 patients received the conventional chemotherapy regimens without linezolid and was called as the control group. After 4 weeks treatment, the changes of the patients’body temperature, Glasgow (GCS) score and the indicators of cerebrospinal fluid in the two groups were compared and analyzed; at the same time, the side-effect of linezolid was also recorded. SPSS 17.0 software was used to carry out data statistical analysis; when the measurable data were in normal distribution, “$\bar{x}$±s” was used to illustrate it and t test was used for comparison; when the measurable data were in skew distribution, “median (quartile) (M(Q₁,Q₃))” was used to illustrate it and Wilcoxon rank sum test was used for comparison; the difference was statistically significant with P<0.05. Results On the 7th day of treatment, the average body temperature of the patients in the observation group decreased to (37.83±0.74) ℃, which was significantly lower than that of in the control group (38.49±0.87) ℃, the difference was statistically significant (t=-2.15, P=0.041). On the 10th day of treatment, the body temperature of the patients in the observation group returned to normal ((36.99±0.51) ℃) while the body temperature of the patients in the control group returned to normal ((36.93±0.76) ℃) on the 21st day of treatment. Before treatment, the GCS scores of the patients in the two groups were lower; after 2 weeks treatment, the GCS score of the patients in the observation group was (13.06±1.34) which was significantly higher than that in the control group (11.35±1.93), the difference was statistically significant (t=-2.99,P=0.006); after 4 weeks treatment, the GCS score of the patients in the observation group was (14.69±0.60) which was closed to 15 scores (GCS score <15 was regarded as consciousness disorder) and significantly higher than that in the control group (13.88±1.49), the difference was statistically significant (t=-2.01, P=0.050). In terms of the changes of CSF indicators, before treatment, the ratio of CSF glucose to synchronized blood glucose was 0.18 (0.05, 0.52) and the CSF protein quantification was 1.34 (0.60, 7.81) g/L in the observation group while those values were 0.28 (0.03, 0.52) and 1.81 (0.60, 2.53) g/L in the control group respectively, there were no significant differences between the two groups (Z=-0.90, P=0.368; Z=-0.18, P=0.857); after 4 weeks treatment, the ratio of CSF glucose to synchronized blood glucose was 0.61 (0.17, 6.00), which was significantly higher than that in the control group (0.33 (0.06, 0.79)); the CSF protein quantification in the observation group was 0.87 (0.35, 5.40) g/L which was significantly lower than that in the control group (0.97 (0.38, 3.71) g/L); the differences were statistically significant (Z=-3.35, P=0.001; Z=-3.17, P=0.002). Conclusion The chemotherapy with linezolid has advantages for the patients with severe tuberculous meningitis on controlling their body temperature, improving GCS score and improving some of cerebrospinal fluid indicators.

Relationship between genetic polymorphisms rs3804100, rs3804099 and rs2295080 and type 2 diabetes mellitus complicated with pulmonary tuberculosis in Heilongjiang Province

CHEN Hai-jun, BO Lu, GUO Xin, ZHANG Kun, HAO Li-jie, LI Qiang, LI Yu-ze

Journal of Tuberculosis and Lung Health. 2020, 9(1):  49-54.  doi:10.3969/j.issn.2095-3755.2020.01.011

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Objective To investigate the relationship between genetic polymorphisms rs3804100, rs3804099 in Toll-like receptor 2 (TLR2), rs2295080 in mammalian target of rapamycin (mTOR) and type 2 diabetes mellitus complicated with pulmonary tuberculosis (PTB). Methods From January 2017 to September 2017, 300 patients with PTB complicated by type 2 diabetes in Infectious Diseases Hospital of Heilongjiang Province were selected as observation group, and 300 patients with type 2 diabetes who admitted to the endocrinology department of Fourth Affiliated Hospital of Harbin Medical University were included as control group at the same time. DNA was extracted from the blood of all patients, and genetic polymorphisms (rs3804100, rs3804099 in TLR2, rs2295080 in mTOR) was detected by PCR technology. The relationship between the polymorphisms in these three gene loci and type 2 diabetes complicated with PTB was performed by univariate and multivariate logistic analysis. Results Univariate analysis showed that TT, TC and CC (T, thymine; C, cytosine) genotypes distribution composition ratios in TLR2 rs3804100 were 51.3% (154/300), 25.7% (77/300), and 23.0% (69/300) in the observation group; and 47.0% (141/300), 31.3% (94/300), and 21.7% (65/300) in the control group, respectively, without the statistically significant difference between these two groups (χ²=2.382, P=0.304). The TT, TC and CC genotypes distribution composition ratios in TLR2 rs3804099 were 53.0% (159/300), 29.7% (89/300), and 17.3% (52/300) in the observation group; and 54.3% (163/300), 33.0% (99/300), and 12.7% (38/300) in the control group, respectively, without the statistically significant difference (χ²=2.759, P=0.252). The TT, TG and GG (G, guanine) genotypes distribution composition ratios in mTOR rs2295080 were 26.7% (80/300), 67.3% (202/300), and 6.0% (18/300) in the observation group; and 24.3% (73/300), 66.0% (198/300), and 9.7% (29/300) in the control group, respectively, without the statistically significant difference (χ²=2.935, P=0.231). The results of logistic multivariate analysis revealed that the OR (95%CI) values of TC, CC genotypes in TLR2 rs3804100 were 1.261 (0.591-2.689) and 1.284 (0.542-3.042), respectively; P values were 0.549 and 0.569, respectively. The OR (95%CI) values of TC, CC genotypes in TLR2 rs3804099 were 0.752 (0.461-1.227) and 0.729 (0.430-1.235), respectively; P values were 0.254 and 0.240, respectively. The OR (95%CI) values of TG, GG genotypes in mTOR rs2295080 were 1.789 (0.890-3.596) and 1.603 (0.839-3.063), respectively; P values were 0.103 and 0.15, respectively. Conclusion The genetic polymorphisms rs3804100, rs3804099 in TLR2 and polymorphisms rs2295080 in mTOR are not associated with type 2 diabetes mellitus complicated with PTB in Heilongjiang Province.

Application value of gene chip technology in the rapid diagnosis of tuberculosis and the identification of mycobacterium

TANG Zai-qing, TANG Ming-hao, ZHU Xiao-lin, LIU Yu-qin

Journal of Tuberculosis and Lung Health. 2020, 9(1):  55-57.  doi:10.3969/j.issn.2095-3755.2020.01.012

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Objective To explore the application value of gene chip technology in the diagnosis of pulmonary tuberculosis (PTB) and the identification of mycobacterium. Methods A total of 1248 patients with suspected PTB whose sputum smears were tested positive for three consecutive times were collected in Infections Disease Hospital of Heilongjiang Province from January 2017 to December 2017. The 3-5 ml of early morning sputum specimens were collected from each patient, and the samples were tested by culturing with BACTEC MGIT 960 (MGIT 960) and gene chip technology, respectively. MGIT 960 culturing was used as reference method to analyze the detection efficiency of gene chip technology. Results Among 1248 sputum specimens, 98.08% (1224/1248) sputum specimens were positive by culture method with MGIT 960, and 97.11% (1212/1248) were positive by gene chip technology. The sensitivity, specificity, coincidence rate and Kappa value of the gene chip method were 98.94% (1211/1224), 95.83% (23/24), 98.88% (1234/1248), and 0.76, respectively, compared with the MGIT 960 culture method which was regarded as a standard. Among the 1212 positive patients by gene chip method, 60 cases (4.95%) were infected with non-tuberculosis mycobacterium (NTM), and 1152 cases (95.05%) were infected with MTB. Among the 60 patients infected with NTM, the most common strain was Mycobacterium intracellularis (43.33%, 26/60). Conclusion The results of gene chip technology have good consistency with the results of MGIT 960 culture method, which can quickly and accurately distinguish between Mycobacterium tuberculosis complex and NTM, and can be used for future identification of mycobacterium.

Analysis of CT features of drug-resistant tuberculosis in children

SONG Min, FANG Wei-jun, HAN Yuan-yuan, FENG Hui-yong

Journal of Tuberculosis and Lung Health. 2020, 9(1):  58-63.  doi:10.3969/j.issn.2095-3755.2020.01.013

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Objective To investigate the CT imaging features of drug-resistant tuberculosis (DR-TB) in children. Methods A total of 29 children with DR-TB in Guangzhou Chest Hospital diagnosed by clinical and laboratory from January 2012 to December 2018 were retrospectively collected as DR-TB group (Group DR). Meanwhile, based on 1:3 case-control study, 87 children in the same period with drug-sensitive tuberculosis (DS-TB) who met the inclusion criteria were selected as drug-sensitive group (Group DS). The principle of comparative matching was the same sex and age ±2 years old. In these two groups, the children aged 0- years old were classified into Drug-resistant Group 1 (Group DR1, 12 cases), and Drug-sensitive Group 1 (Group DS1, 36 cases); the children aged 5-14 years old were classified into Drug-resistant Group 2 (Group DR2, 17 cases), and Drug-sensitive Group 2 (Group DS2, 51 cases). The CT features of drug-resistant children and drug-sensitive children in different age groups were compared and analyzed, and the CT features of DR-TB children were summarized. Results The incidence of lesions involving lobes of both lungs in Group DR1 and Group DS1, Group DR2 and Group DS2 was 66.67% (8/12) and 30.56% (11/36), 52.94% (9/17) and 23.53% (12/51), respectively. There were significantly differences between the two groups (χ² values: 4.907, and 5.167, respectively; P values: 0.027 and 0.023, respectively). The incidence of multiple nodular lesions in Group DR1 and Group DS1 was 83.33% (10/12) and 44.44% (16/36), respectively, and that of consolidation was 50.00% (6/12) and 86.11% (31/36), that of pleural effusion was 8.33% (1/12) and 38.89% (14/36), that of bronchostenosis was 16.67% (2/12) and 52.78% (19/36), respectively. There were significantly differences in these aspects between the two groups (χ² values: 5.483, 6.644, 3.911, and 4.769, respectively; P values: 0.019, 0.010, 0.048, and 0.029, respectively). The incidence of pleural effusion in Group DR2 and Group DS2 was 11.76% (2/17) and 43.14% (22/51), respectively, and that of bronchostenosis was 47.06% (8/17) and 21.57% (11/51), respectively. There were significantly differences between the two groups (χ² values: 5.495, and 4.115, respectively; P values: 0.019 and 0.043, respectively). Conclusion The CT features of children with DR-TB are as follows: compared with children with DS-TB in the same age group, lung lesions are more widely distributed in children with DR-TB; multiple nodular lesions are common in DR-TB children aged 0- years old, and there is high incidence of bronchostenosis in DR-TB children aged 5-14 years old.

Analysis of screening results of close contacts of tuberculosis patients in schools in Ji’nan in 2018

JING Rui, WANG Mei-hua, CAI Jun-li, ZHANG Wen-qian, REN Wen

Journal of Tuberculosis and Lung Health. 2020, 9(1):  64-67.  doi:10.3969/j.issn.2095-3755.2020.01.014

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Objective To investigate the screening results of close contacts of tuberculosis patients in schools in Ji’nan in 2018, and to analyze the epidemic situation and treatment of tuberculosis in schools. Methods The database of tuberculosis incidence and treatment results in schools in Ji’nan City in 2018 was established, including patients who had been reported in the “Infectious Disease Report Information Management System” at the city and county levels in Ji’nan, patients notified by the school and school patients feedback from outside units. In 2018, a total of 197 students or teachers with tuberculosis were found in the city, and 10 patients with internship, graduation or recent screening were excluded. Then, a case-by-case epidemiological investigation was conducted on 187 patients with tuberculosis, and a total of 11617 close contacts were identified. Among them, 2138 were identified as close contacts of 24 patients with positive pathogenic pulmonary tuberculosis, and 2104 were actually screened; 9479 were identified as close contacts of 163 patients with tuberculosis negative and non-pathogenic results, and 9384 were actually screened. The close contacts were screened for tuberculin skin test (PPD test) using the BCG pure protein derivative reagents uniformly distributed throughout the city. Results In 2018, the tuberculosis patients in Ji’nan schools were mainly college students, accounting for 81.28% (152/187). Among 11488 close contacts of PPD test results, 8988 were negative (77.45%), 1434 (12.48%) were generally positive, 651 (5.67%) were moderately positive, and 505 (4.40%) were strongly positive. The strong positive rate of PPD test in close contacts of 24 pathogenic positive patients (7.41%, 156/2104) was significantly higher than that in 163 non-pathogenic positive patients (3.72%, 349/9384) (χ²=55.84, P<0.001). Thirty-one patients with tuberculosis were found by screening. Conclusion Some tuberculosis patients can be found through screening of close contacts of tuberculosis patients in schools; and implementation of tuberculosis screening for close contacts of tuberculosis patients can reduce the spread of tuberculosis in schools.

Study on the effect of peripherally inserted central venous catheter in patients with pulmonary tuberculosis using ultrasound-guided modified Seldinger technique

ZHAO Yan-hong, MA Yun-hong, WU Guo-jing

Journal of Tuberculosis and Lung Health. 2020, 9(1):  68-71.  doi:10.3969/j.issn.2095-3755.2020.01.015

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Objective To compare and analyze the application effect of ultrasound-guided modified Seldinger technique and blind puncture for the implementation of peripherally inserted central venous catheter (PICC) in patients with pulmonary tuberculosis (PTB). Methods A total of 150 patients with PTB underwent PICC in Kunming Third People’s Hospital from March 2016 to March 2018 were collected as research subjects, and then divided into two groups according to the mode of PICC catheterization. Concretely, 70 patients who received PICC catheterization by blind puncture were included in the control group, and 80 patients who underwent PICC catheterization with ultrasound-guided modified Seldinger technique were included in the observation group, and the effects of catheterization were compared between the two groups. Results The success rates of one-time puncture and catheterization in the observation group were 97.5% (78/80) and 100.0% (80/80), respectively, which were significantly higher than those in the control group (85.7% (60/70) and 92.9% (65/70), respectively), with the statistically significant differences (χ²=7.05 and 5.91, P=0.008 and 0.015, respectively). The incidence of complications after catheterization in the observation group was significantly lower than that in the control group (5.0% (4/80) vs. 21.4% (15/70)), with the statistically significant differences (χ²=9.11, P=0.003). Conclusion The effect of ultrasound-guided modified Seldinger technique on PICC catheterization in patients with PTB is better than that of blind puncture, and it has higher safety.

Analysis of visit delay and its risk factors among 205 hospitalized tuberculosis patients in Shenyang

JIANG Jing, SUN De-bin, LIU Jia-qi, WANG Liang, GAO Jing-jing, HAN Song, ZHANG Ying

Journal of Tuberculosis and Lung Health. 2020, 9(1):  72-78.  doi:10.3969/j.issn.2095-3755.2020.01.016

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Objective To investigate the patient visit delay among tuberculosis patients in Shenyang, and analyze the influencing factors in order to provide basis for development of improving measures. Methods This study mainly adopted the method of prospective data collection. From 2017 to 2018, all 205 inpatients who were diagnosed with tuberculosis and ≥15 years old in the second department of tuberculosis in Tenth People’s Hospital of Shenyang City (Shenyang Chest Hospital), were investigated with questionnaires and their clinical data were recorded. Questionnaire survey and clinical data collection included general demographic characteristics (age, gender, body mass index, marital status, education level, floating population, drinking, smoking and insurance type), clinical characteristics (severity of the disease, primary treatment/retreatment, drug resistance, first diagnosing institution, whether paying clinical visit on symptoms, cavity exsistance, sputum smear test results) and knowledge of tuberculosis prevention and control (8 key knowledge about tuberculosis including main transmission route, suspicious symptoms, free policies and professional institutions for tuberculosis prevention and control). In this study, time interval from the date of tuberculosis symptoms onset to the date of first visit to clinical institution ≥14 d was set as the criteria for delay of visit. Chi-square test and multivariate logistic regression were used to analyze the influencing factors of the delay of visit. Results A total of 205 tuberculosis patients were investigated, among them 110 patients (53.7%) got visit delay. Multivariate logistic regression analysis showed that living far away from the hospital (OR(95%CI)=3.405(1.102-10.518)),mild illness (OR(95%CI)=12.384(3.558-43.109)),first time of treatment (OR(95%CI)=2.099(1.109-3.974)) and drinking (OR(95%CI)=2.283(1.212-4.299)) were factors affecting the visit delay. Conclusion The visit delay among Shenyang hospitalized TB patients is obvious, which is associated with living far away of the hospital, mild clinical symptoms, first time of treatment and drinking history. The education of tuberculosis relevant knowledge should be enhanced in general population.

Short Articles

Analysis of specimens examination results of patients with tuberculosis after surgery by using two laboratory techniques

GONG Ya-ya, LU Huai-wei, WANG Qi, CAO Le-jie

Journal of Tuberculosis and Lung Health. 2020, 9(1):  79-81.  doi:10.3969/j.issn.2095-3755.2020.01.017

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A total of 60 patients, who had been suspected diagnosed as tuberculosis (TB) and received surgery at department of thoracic surgery of Anhui Provincial Hospital from June 2017 to January 2019, were enrolled in this study. The lung tissue specimens were obtained from those enrolled patients. GeneXpert MTB/RIF and acid-fast staining tests were performed on all patients’ pathological specimens to evaluate the value of GeneXpert MTB/RIF and acid-fast staining on detection of pulmonary TB with their surgical tissue specimens. In 60 patients, the positive rate of GeneXpert MTB/RIF and acid-fast staining was 46.7% (28/60) and 48.3% (29/60) respectively. Five specimens with acid-fast staining positive but GeneXpert MTB/RIF negative were confirmed to be Mycobacterium tuberculosis (MTB) by mycobacteria identification. The positive rate of both GeneXpert MTB/RIF and acid-fast staining was 55.0% (33/60), which met the target of 50% pathogenic detection rate at least required in the 13th Five-year National TB Control Program. In conclusion, the TB detection rate is high by jointly using GeneXpert MTB/RIF and acid-fast staining and it’s valuable in clinical diagnosis of TB.