Table of Content

20 December 2025, Volume 6 Issue 6

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Interpretation of Standards

Interpretation of the World Health Organization’s Global Tuberculosis Report 2025

Qu Yan, Li Tao, Ma Wenbin, Xu Caihong, Yan Tianxin, Huang Fei, Zhao Yanlin, Zhang Hui

Journal of Tuberculosis and Lung Disease. 2025, 6(6):  613-623.  doi:10.19983/j.issn.2096-8493.20250178

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On November 12, 2025, the World Health Organization published the Global Tuberculosis Report 2025, which presents a comprehensive and up-to-date assessment of the global tuberculosis epidemic and the progress of response efforts at global, regional, and national levels in alignment with established international commitments, strategies, and targets. By analyzing the report, this paper aims to assist tuberculosis control practitioners in gaining a thorough understanding of the global burden of tuberculosis, advancements in patient-centered diagnosis, treatment, and care, as well as key strategic directions for accelerating progress toward ending the tuberculosis epidemic.

Interpretation of the fouth edition of WHO consolidated guidelines on tuberculosis, Module 3:diagnosis

Ding Feng, Lu Shuihua

Journal of Tuberculosis and Lung Disease. 2025, 6(6):  624-633.  doi:10.19983/j.issn.2096-8493.20250072

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On April 16, 2025, the World Health Organization (WHO) officially released the fourth edition of the WHO Consolidated Guidelines on Tuberculosis, Module 3: Diagnosis. This edition, for the first time, consolidates policy guidance on testing for tuberculosis (TB) diagnosis, drug resistance and infection. It established two new classes of TB diagnostic tests for the initial detection of TB and resistance to rifampicin, and introduces new recommendations on concurrent testing of respiratory and non-respiratory samples for the initial detection of TB and resistance to rifampicin for adults and adolescents living with HIV, children living with HIV, and children without HIV or with unknown HIV status. The author interprets the key updates in the guideline to support clinicians in understanding and implementing the revised recommendations in practice.

Guideline·Standard·Consensus

Expert consensus on the rational use of rifamycins in the treatment of tuberculosis with comorbidities

National Clinical Research Center for Infectious Disease/Shenzhen Third People’s Hospital, Tuberculosis and Diabetes Branch of Chinese Antituberculosis Association, Multidisciplinary Diagnosis and Treatment Branch of Chinese Antituberculosis Association

Journal of Tuberculosis and Lung Disease. 2025, 6(6):  634-658.  doi:10.19983/j.issn.2096-8493.20252005

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Tuberculosis frequently coexists with multiple chronic diseases, necessitating combination pharmacotherapy. Rifamycin-class anti-tuberculosis agents exhibit clinically significant interactions with many drugs used to treat comorbidities, potentially reducing their efficacy, causing treatment failure, or increasing toxicity. However, evidence-based clinical guidance on these interactions is currently lacking. To improve clinicians’ understanding of the interactions between rifamycins and medications for comorbid conditions and to support their rational use, this consensus statement was developed. It was based on a systematic review of domestic and international literature, drug-label information, and appraisal of the best available evidence, and was finalized after three rounds of focused discussion and revision. The document covers an overview of rifamycins agents, their mechanisms of drug-drug interaction, guiding principles for clinical application, and a comprehensive summary of evidence on interactions with commonly prescribed comorbidity medications, together with practical dose-adjustment recommendations. The aim is to provide safe and effective rifamycin-based therapeutic regimens for tuberculosis patients with comorbidities and to offer an actionable reference for clinical practice.

Original Articles

Effect of diagnosis delay on pulmonary function and related indicators in children with bronchial asthma

Wei Xiaoling, Xue Min, Liu Yanqin, Liu Miao, Zhang Yun, Cheng Lu, Ma Xiang

Journal of Tuberculosis and Lung Disease. 2025, 6(6):  659-665.  doi:10.19983/j.issn.2096-8493.20250116

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Objective: To investigate the effect of diagnosis delay (from first onset to diagnosis) on respiratory function, fractional exhaled nitric oxide (FeNO), eosinophils (EOS), immunoglobulin E (IgE) in children with bronchial asthma. Methods: We analyzed data of asthma children treated in Children’s Hospital Affiliated to Shandong University from January 1, 2012, to December 31, 2022. All of the children were divided into 5 groups according to their diagnosis delay: immediate diagnosis, delayed for (0-1] year, (1-2] years, (2-4] years, and >4 years. The differences of lung function, FeNO, EOS, IgE at patients’ first diagnosis of asthma in different groups were compared. Multiple linear regression analysis was done to investigate the effects of various factors on lung function, FeNO, EOS, and IgE. Results: The median (quartile) diagnosis delay was 22.98(4.28,42.88) months in asthmatic children without rhinitis and 12.25 (4.03,34.49) months in children with asthma and rhinitis (Z=-0.18,P=0.860). The diagnosis delay was shorter among female than male (Z=-2.61,P=0.009). The children whose first asthma onset age was ≤3 years had a longer diagnosis delay than those whose first onset age was >3 years (Z=-17.07,P=0.000). Conclusion: The longer the diagnosis delay, the more severe the damage to lung function and FeNO, EOS, IgE. Therefore, diagnosing asthma according to its diagnostic criteria and providing standardized treatment in time, will contribute greatly to advancing physical and mental health of children with asthma and reducing damage and disability brought by asthma.

A study on the relationship between depression, fatigue, and quality of life in lung cancer patients and their spouses based on the actor-partner interdependence model

Huang Biqiong

Journal of Tuberculosis and Lung Disease. 2025, 6(6):  666-672.  doi:10.19983/j.issn.2096-8493.20250145

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Objective: To explore the actor-partner interdependence between depression, fatigue, and quality of life in lung cancer patients and their spouses. Methods: A total of 240 lung cancer patients and their spouses who received treatment in Affiliated Hospital of Putian University from January 6, 2023 to January 6, 2025 were selected as the research subjects. The Self-rating depression scale (SDS), Fatigue scale-14 (FS-14), and Short-form 36 health survey scale (SF-36) were used to investigate the patients and their spouses. Based on the Actor-partner interdependence model (APIM), the predictive effects of depression and fatigue on the quality of life of both the patients and their spouses were tested. Results: The average SDS score of the 240 lung cancer patients was (49.1±5.3), FS-14 score was (7.2±2.4), SF-36 score was (410.6±76.5). The spouse’s average SDS score was (43.6±5.3), FS-14 score was (5.0±2.2), SF-36 score was (507.7±86.5). The patients’ SDS and FS-14 scores were significantly higher than those of their spouses, while their SF-36 score was significantly lower (t=11.579,10.114,13.029,all Ps<0.001). At the actor-effect level, depression in both patients and their spouses negatively predicted their own quality of life (β=-0.209, P=0.013; β=-0.245, P=0.003), and fatigue in both patients and their spouses negatively predicted their own quality of life (β=-0.177, P=0.018; β=-0.195, P=0.040). In terms of partner effects, depression in patients and their spouses negatively predicted each other’s quality of life (β=-0.214, P=0.007; β=-0.246, P=0.003), and fatigue in patients and their spouses negatively predicted each other’s quality of life (β=-0.262, P=0.001; β=-0.259, P=0.001). Conclusion: Lung cancer patients have higher levels of depression and fatigue than their spouses, and their quality of life is influenced by both themselves and their spouses. It is important to pay attention to the interaction between depression and fatigue in patients and their spouses in order to improve their quality of life.

The effect of child interest induction combined with detailed nursing on the emotional state and therapeutic outcomes of children with community-acquired pneumonia

Lin Nan

Journal of Tuberculosis and Lung Disease. 2025, 6(6):  673-677.  doi:10.19983/j.issn.2096-8493.20250111

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Objective: To observe the effects of child interest induction combined with detailed nursing on the emotional state and therapeutic outcomes of children with community-acquired pneumonia. Methods: A prospective study was conducted, enrolling 82 children with community-acquired pneumonia admitted to the Putian University Affiliated Hospital from February 2023 to April 2024 as the study subjects. The subjects were randomly divided into an observation group and a control group, with 41 cases in each group. The control group received routine nursing care, while the observation group received playful induction combined with detailed nursing care in addition to routine measures. The emotional state, treatment compliance, symptom improvement time, and hospitalization duration were observed and compared between the two groups. Results: After intervention, the child medical fear scale (CMFS) score and the screen for child anxiety related emotional disorders (SCARED) score in the observation group were (18.29±1.83) points and (26.85±2.67) points, respectively, which were significantly lower than those in the control group (22.68±2.70) points and (34.25±3.47) points, and the differences were statistically significant (t-values were 8.618 and 10.822, respectively, with P values<0.001). The total compliance rate of the observation group was 95.12% (39/41), significantly higher than the control group’s 80.49% (33/41), and the difference was statistically significant (Z=2.312, P=0.021). The observation group had significantly shorter durations of fever reduction ((2.76±0.45) days), wheezing ((3.75±0.54) days), disappearance of lung rales ((6.52±0.68) days), and hospitalization time ((7.41±0.32) days), respectively, compared to the control group ((3.86±0.52) days, (4.46±0.62) days, (7.68±0.84) days, and (8.35±0.46) days, respectively), with statistically significant differences (t-values of 10.242, 5.529, 6.873, 10.741, P values<0.001). Conclusion: The combination of child interest induction and detailed nursing can improve the emotional state of children with community-acquired pneumonia, enhance treatment compliance, promote disease recovery process, shorten symptom improvement and hospitalization time.

Comparison between different imaging presentations and pulmonary function in children aged 5-13 with Mycoplasma pneumoniae pneumonia during the acute phase

Li Zhongqiang, Wu Xuejun, Li Rui, Lyu Gaomei, Ren Zhijuan, Yang Huimin, Ge Yunpeng, Xu Leilei, Hou Lingyun, Xing Yuge

Journal of Tuberculosis and Lung Disease. 2025, 6(6):  678-683.  doi:10.19983/j.issn.2096-8493.20250148

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Objective: To explore the characteristics of pulmonary function corresponding to different imaging manifestations in children aged 5-13 with Mycoplasma pneumoniae pneumonia (MPP) during the acute phase. Methods: A total of 133 children hospitalized with MPP in the Department of Pediatric Respiratory Medicine at Linyi People’s Hospital between September 2024 and February 2025 were enrolled. Based on chest imaging features, they were divided into a lobar pneumonia group (65 cases) and a non-lobar pneumonia group (68 cases). Pulmonary function parameters were compared between the two groups. Results: In both groups, the maximal vital capacity (VCmax), forced vital capacity (FVC), forced expiratory volume in the first second (FEV₁), and peak expiratory flow (PEF)(measured/predicted values) were below 80%; the FEV₁ to vital capacity ratio (FEV₁/FVC)(measured/predicted value) was below 94%; and the forced expiratory flow at 25%, 50%, and 75% of FVC (MEF25, MEF50, MEF75) as well as maximal midexpiratory flow (MMEF75/25)(measured/predicted values) were below 65%. In the lobar pneumonia group, the VCmax, FVC, and FEV₁ (measured/predicted values) were (67.45±14.10) %, (70.09±14.95) %, (69.60±15.34) %, significantly lower than those in the non-lobar pneumonia group ((73.09±14.45) %, (76.12±15.55) %, (75.68±16.85) %). The differences were statistically significant (t-values were -2.280, -2.278, -2.172, respectively, all P-values <0.05). In children with single-lobe involvement group, the VCmax, FVC, FEV₁, and MEF75 (measured/predicted values) were (72.79±11.60) %, (75.29±12.67) %, (74.31±13.88) %, (58.94±23.70) %, significantly higher than those in the multiple-lobe involvement group ((61.21±14.36) %, (64.01±15.30) %, (64.11±15.35) %, (45.69±18.58) %). The differences were statistically significant (t-values were 3.596, 3.251, 2.811, 2.477, respectively, all P-values <0.05). Conclusion: During the acute phase of MPP, children aged 5-13 years with different chest imaging exhibit mixed ventilatory dysfunction, including both restrictive and obstructive ventilatory dysfunction, accompanied by small airway impairment. Patients with lobar pneumonia demonstrate more severe pulmonary function impairment, and multi-lobe involvement is associated with greater dysfunction compared to single-lobe disease.

Qualitative study on kinesiophobia experience and coping needs in patients with chronic obstructive pulmonary disease

Wang Yuwei, Wang Xiaodong, Jiang Qiuling, Lu Yu, Xu Yulin

Journal of Tuberculosis and Lung Disease. 2025, 6(6):  684-689.  doi:10.19983/j.issn.2096-8493.20250130

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Objective: To explore the experience and coping needs of patients with chronic obstructive pulmonary disease (COPD) with kinesiophobia, and to provide a basis for formulating a comprehensive and targeted intervention program for kinesiophobia. Methods: Using purposive sampling, 15 COPD patients with kinesiophobia who met the inclusion criteria were recruited from the Department of Respiratory Medicine at the First Affiliated Hospital of Zhengzhou University between May and June 2024. Semi-structured interviews were conducted, and traditional content analysis method was employed to extract themes related to the inner experiences of kinesiophobia and perceptions towards physical activity. Results: Through 15 interviews, 3 themes and 11 sub-themes were extracted: the multidimensional causes of kinesiophobia (excessive psychological anxiety, cognitive biases affecting decision-making, lack of regulatory skills, and absence of intrinsic motivation), positive factors mitigating fear (perceived benefits of exercise, appropriate form of exercise, positive emotional state, family and peer support), and urgent needs to be addressed (disease-related knowledge needs, social and information support needs, and guidance needs for exercise rehabilitation). Conclusion: Healthcare providers should provide targeted interventions based on the multidimensional causes of kinesiophobia and the positive factors that mitigate it in COPD patients. Providing exercise rehabilitation guidance and various forms of external support can help alleviate kinesiophobia and promote patient engagement in exercise rehabilitation.

Study on the intervention effect of hierarchical chain nursing combined with fun games in children with acute bronchitis

Li Bihua, Wang Rongjin, Huang Yanping

Journal of Tuberculosis and Lung Disease. 2025, 6(6):  690-695.  doi:10.19983/j.issn.2096-8493.20250097

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Objective: To analyze the intervention effects of hierarchical chain nursing combined with fun games on children with acute bronchitis (AB). Methods: A prospective study was conducted, involving 96 children with AB admitted to Putian Children’s Hospital from January 2023 to December 2024. These children were divided into a control group (48 cases) and an observation group (48 cases) with the random number table method. The control group received routine nursing intervention, while the observation group received hierarchical chain nursing combined with fun games besides the routhine intervention. The relief time of main symptoms (fever, cough, and wheezing) were compared between the two groups. Psychological states (with scores on the Screen for Child Anxiety-Related Emotional Disorders (SCARED) and the Children’s Medical Fear Scale (CMFS)) and treatment compliance were also compared before and after the intervention. Results: The relief time of fever, cough, wheezing and hospitalization in the observation group were (3.05±0.51) d, (4.12±1.02) d, (3.35±0.69) d and (7.05±1.11) d respectively, shorter than that of the control group ((3.85±0.64) d, (5.85±1.11) d, (4.85±0.74) d, (9.13±1.21) d, respectively), and the differences were statistically significant (t-values were 6.773, 7.951, 10.271, 8.776, respectively; P<0.001). After the intervention, the SCARED and CMFS scores in the observation group were 30.25±3.61 and 25.05±3.05, respectively, lower than those in the control group (38.74±4.17 and 30.08±2.94, respectively), with statistically significant differences (t-values: 10.665, 8.226; P<0.001). The excellent treatment compliance rate in the observation group (97.92%, 47/48) was higher than that in the control group (83.33%, 40/48), with a statistically significant difference (χ²=4.414, P=0.036). Conclusion: The application of hierarchical chain nursing combined with fun games in children with AB can alleviate anxiety and fear, improve treatment compliance, and promote symptom relief.

Analysis of spatiotemporal distribution dynamics of pulmonary tuberculosis and correlation with precipitation in Xiamen, China (2014—2023)

Ke Ran, Zheng Rongrong, Zheng Chunmei, Xue Jianhang, Liu Xunrui, Lin Weiqi, Li Lu, Cao Hong

Journal of Tuberculosis and Lung Disease. 2025, 6(6):  696-702.  doi:10.19983/j.issn.2096-8493.20250078

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Objective: With investigating the spatial-temporal dynamic distribution of pulmonary tuberculosis (PTB) incidence in Xiamen City, Fujian Province from 2014 to 2023, and analyzing the precipitation associated with spatiotemporal clustering, to provide a scientific basis for optimizing the strategies for tuberculosis prevention and control. Methods: This retrospective study employed spatial epidemiological methods to analyze the spatiotemporal clustering patterns of PTB in Xiamen from January 1, 2014 to December 31, 2023. A total of 20207 reported PTB (including tuberculous pleurisy) cases were collected through the China Information System for Disease Control and Prevention. The monthly and yearly precipitation data were collected from Loess Plateau Branch of National Earth System Science Data Center, National Science and Technology Infrastructure. The Chi-square trend test and Mann-Kendall trend test were respectively applied to analyze the trend of annual incidence and precipitation. With the retrospective discrete Poisson spatiotemporal scanning statistics, the spatiotemporal dynamics of PTB incidence was analyzed.With the Chi-square test and binary logistic regression analysis, the monthly precipitation in the scanned cluster/non-cluster areas was analyzed to identify the influencing factors.Statistical significance was set as α=0.05. Results: The average annual PTB incidence rate was 40.78 cases per 100000 population (20207/4955600) in Xiamen from 2014 to 2023, showing a generally fluctuating downward trend ($\chi_{\text {trend }}^2$=253.000,P<0.001); From 2014 to 2023, the spatiotemporal scanning statistics scanned 6 significant clusters, covering 3 districts.Both the Level 1 and Level 2 clusters were in Jimei District.The clustering occurred from June 2017 to September 2019 (RR=1.52, P<0.001), with an average annual incidence of 60.68/100000 population (1375/2265917) and from March 2014 to September 2016 (RR=1.33, P<0.001), with an average annual incidence of 53.44/100000 population (1156/2163167), respectively. A positive correlation was observed between monthly precipitation and the clustering of reported PTB incidence (χ²=5.829,P=0.016). For every 10 mm increase in precipitation, the risk of clustering of reported PTB incidence increased by 2.9% (OR=1.029,95%CI:1.003-1.055). Conclusion: The spatiotemporal clustering of PTB in Xiamen has decreased,and precipitation was identified as a factor influencing the clustering of reported PTB incidence in Xiamen.

Analysis of treatment outcomes and influencing factors for bacteriologically positive pulmonary tuberculosis in Ningxia Hui Autonomous Region from 2019 to 2023

Tian Xiaomei, He Xiaoxue, Lei Juan, Wang Xiaowei, Gu Jianjun

Journal of Tuberculosis and Lung Disease. 2025, 6(6):  703-709.  doi:10.19983/j.issn.2096-8493.20250084

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Objective: By analyzing the epidemiology and influencing factors of treatment outcomes among bacteriologically positive pulmonary tuberculosis patients in Ningxia Hui Autonomous Region from 2019 to 2023, to provide epidemiological evidence for enhancing tuberculosis prevention and control efforts. Methods: The anti-tuberculosis treatment data and treatment outcomes of bacteriologically confirmed pulmonary tuberculosis patients registered in Ningxia from 2019 to 2023 were exported from the “Infectious Disease Surveillance Management System”, a subsystem of the “China Information System for Disease Control and Prevention”. Univariate and multivariate binary logistic regression analyses were used to identify influencing factors of treatment outcomes. Results: From 2019 to 2023, the treatment success rate for bacteriologically confirmed pulmonary tuberculosis (PTB) patients was 93.16% (5175/5555). Notably, the year 2023 achieved the highest success rate at 95.63% (1203/1258). Among unfavorable outcomes, mortality accounted for the highest proportion at 4.15% (231/5555). The treatment success rate demonstrated a statistically significant upward trend across years ($\chi_{\text {trend }}^2$=1864.000, P<0.01). Univariate analysis showed that the treatment success rate of male PTB patients (91.54%,2544/2779) was lower than that of female patients (94.78%,2631/2776), and male patients experienced higher unfavorable outcomes (8.46%,235/2779) than females (5.22%,145/2776). Patients aged above 75 years achieved the lowest treatment success rate (87.69%,1183/1349) and highest unfavorable outcome rate (12.31%,166/1349). Occupational variations were observed, with retirees (12.97%,52/401), housework and unemployed individuals (7.84%,91/1161), and farmers (6.86%,218/3177) showing higher unfavorable outcomes than other occupation groups.The unfavorable outcomes of retreated cases (10.20%,36/353)were higher than that of initial treated patients (6.61%,344/5202). Gender, age, occupation and treatment type all had an impact on both the treatment success and unfavorable outcomes, and the differences were statistically significant (P<0.01). The results of the multivariate logistic regression analysis showed that male patients had a 1.559 times higher risk of poor treatment outcomes compared to female patients (OR=1.559, 95%CI: 1.311-1.853). Patients in the 0-14 age group had a lower risk of poor treatment outcomes than those among ≥75 age group (OR=0.318, 95%CI: 0.039-2.570). Initial treated patients had a lower risk of poor treatment outcomes than retreated patients (OR=0.351, 95%CI: 0.276-0.446). Conclusion: Tuberculosis (TB) prevention and control in Ningxia has achieved significant results. However, certain populations including males, the elderly, retreatment cases, as well as some occupation groups such as retirees, housework and unemployed individuals, and farmers, still face a higher risk of poor treatment outcomes.

Analysis of treatment outcome and its influencing factors of multidrug/rifampicin-resistant pulmonary tuberculosis patients in Ningxia Hui Autonomous Region from 2018 to 2022

Sha Xiaolan, Tian Xiaofu, Tian Xiaomei, Liu Tao, Lei Juan

Journal of Tuberculosis and Lung Disease. 2025, 6(6):  710-716.  doi:10.19983/j.issn.2096-8493.20250103

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Objective: To analyze the treatment outcome and its influencing factors of patients with multidrug-resistant/rifampicin-resistant pulmonary tuberculosis (MDR/RR-PTB) in Ningxia Hui Autonomous Region from 2018 to 2022, so as to provide a theoretical basis for further strengthening prevention and control of drug-resistant pulmonary tuberculosis in this region. Methods: A retrospective research method was adopted to collect medical record information of MDR/RR-PTB patients in Ningxia region from 2018 to 2022 from the Tuberculosis Information Management System (including patients’ gender, age, occupation, educational level, date of first medical visit, reason for discontinuation of treatment, medical record status, results of drug susceptible tests, previous history of anti-tuberculosis treatment, treatment classification, and whether anti-tuberculosis treatment was received, etc.), which was then matched with relevant information of drug-resistant pulmonary tuberculosis patients treated in the Fourth People’s Hospital of Ningxia Hui Autonomous Region from 2018 to 2022 collected in its Hospital Information System (HIS). Univariable and multivariable logistic regression were used to analyze the treatment outcome and its influencing factors of matched MDR/RR-PTB patients. Results: A total of 362 patients with MDR/RR-PTB were identified in Ningxia region from 2018 to 2022, and 318 cases were included in treatment, the treatment inclusion rate was 87.85%. Treatment inclusion rates of students (100.00%, 30/30) and patients with high school education or above (96.97%, 64/66) were significantly higher than farmers (84.39%, 173/205) and patients with junior high school education or below (85.81%, 254/296), respectively, with statistically significant differences (χ²=10.904, P=0.012; χ²=6.294, P=0.043). Among the 318 treated patients, their treatment success rate was 61.95% (197/318), and rose from 62.37% (58/93) in 2018 to 64.91% (37/57) in 2020, and then dropped to 58.54% (24/41) in 2022, showing an overall downward trend ($\chi_{\text {trend }}^2$=59.285, P<0.001). Multivariable logistic regression showed that treatment success rate was higher in the age groups of 20-39 and 40-59 years old, students, other occupation groups, farmers, and newly diagnosed patients compared with those aged 60-94 years old, homemaker/unemployed people, and patients undergoing re-treatment (OR=4.468, 95%CI: 2.146-9.302; OR=2.205, 95%CI: 1.146-4.241; OR=27.819, 95%CI: 3.155-245.292; OR=5.887, 95%CI: 2.263-15.314; OR=4.019, 95%CI: 1.801-8.966; OR=1.808, 95%CI: 1.041-3.141). Conclusion: The MDR/RR-PTB patient treatment inclusion rate in Ningxia region from 2018 to 2022 had met the requirement of a treatment inclusion rate of ≥80% as in the provincial tuberculosis control plan. But attention should be paid to the downward trend from 2021 to 2022. The financial support policy for MDR/RR-PTB patients should be strengthened to reduce their economic burden as much as possible and improve their treatment compliance. High attention should be paid to health education and treatment management towards patients aged 60 and above, farmers, homemaker/unemployed people, and re-treatment patients.

Analysis of drug resistance characteristics of newly diagnosed pulmonary tuberculosis patients in Liuzhou City, Guangxi Zhuang Autonomous Region

Meng Xuejia, Tang Liusheng, Dong Jie, Zeng Qingxue

Journal of Tuberculosis and Lung Disease. 2025, 6(6):  717-724.  doi:10.19983/j.issn.2096-8493.20250085

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Objective: To analyze the drug resistance characteristics of Mycobacterium tuberculosis (MTB) isolates in Liuzhou, Guangxi Zhuang Autonomous Region, and to provide evidence for local tuberculosis prevention and rational clinical drug use. Methods: A cross-sectional survey was conducted, 418 MTB isolates of 418 cases of primary treatment pulmonary tuberculosis meeting the inclusion criteria were collected from Liujiang District, Liucheng County, Luzhai County, Sanjiang County, Rong’an County, and Rongshui County under Liuzhou City from January to December 2024. The resistance rates and resistance profile to 14 anti-tuberculosis drugs were analyzed across patients of different genders, ages, and regions. Results: Among the 418 MTB isolates, the overall resistance rate to 14 anti-tuberculosis drugs was 12.20% (51/418), and the multi-drug resistance rate was 0.72% (3/418). The top three drugs with the highest resistance rates were isoniazid (5.74% (24/418)), streptomycin (4.55% (19/418)), and moxifloxacin (2.63% (11/418)). Among the 51 resistant strains, mono-resistant strains accounted for 56.86% (29/51), poly-resistant strains accounted for 37.26% (19/51), and multi-drug resistant strains accounted for 5.88% (3/51). Among mono-resistant strains, isoniazid resistance (23.53% (12/51)) was most common, while among poly-resistant strains, combined resistance to streptomycin and isoniazid (11.76% (6/51)) were predominant. The resistance rate in the 40-60 age group (17.36% (25/144)) was significantly higher than that in the <40 age group (5.00% (3/60)), with a statistically significant difference (χ²=8.208, P=0.004). The mult-idrug resistance rate in female patients (2.17% (2/92)) was significantly higher than that in male patients (0.31% (1/326)), with a statistically significant difference (χ²=4.209, P=0.040). Luzhai County had the highest resistance rate (16.44% (12/73)), while Rong’an County had the lowest (4.55% (2/44)), however, the regional differences were not statistically significant (χ²=5.832, P=0.271). Conclusion: The overall drug resistance rate of newly diagnosed tuberculosis patients in Liuzhou region is basically consistent with the 2018—2020 national tuberculosis drug resistance surveillance data (10.8%). However, isoniazid resistance remains a prominent issue. Elderly populations, females, and patients from Luzhai County are key targets and areas for drug resistance prevention and control. Strengthening resistance surveillance, optimizing treatment regimens, and reducing the transmission of drug-resistant tuberculosis are recommended.

Analysis of treatment outcomes and influencing factors among student pulmonary tuberculosis patients in Chongqing from 2020 to 2023

Liao Wenping, Zhang Liyi, Zhang Wen, Su Qian

Journal of Tuberculosis and Lung Disease. 2025, 6(6):  725-730.  doi:10.19983/j.issn.2096-8493.20250138

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Objective: To analyze the treatment outcomes and influencing factors among student pulmonary tuberculosis (PTB) patients in Chongqing from 2020 to 2023, and to provide a reference for further improving TB prevention and control in schools. Methods: Data of student PTB patients in Chongqing from 2020 to 2023 were collected through the Tuberculosis Management Information System of the China Disease Control and Prevention Information System. Descriptive methods were used to analyze the registration and treatment outcomes of student PTB patients, and binary logistic regression was employed to identify factors influencing their treatment outcomes. Results: A total of 4021 student PTB patients were registered in Chongqing from 2020 to 2023, with an average annual registration rate of 17.04/100000 (4021/23599456). The registration rate decreased from 23.43/100000 (1367/5834206) in 2020 to 13.74/100000 (810/5897039) in 2023, showing a significant downward trend ($\chi_{\text {trend }}^2$=200.302, P<0.001). Among these cases, 3968 were successfully treated, with a success rate of 98.68% (3968/4021). 53 cases had unsuccessful outcomes, with an incidence of 1.32% (53/4021). Multivariate logistic regression analysis revealed that ethnic minorities (OR=3.55, 95%CI: 1.99-6.33), retreatment (OR=5.24, 95%CI: 1.54-17.82), and not being included in community-based health-care management (OR=4.31, 95%CI: 1.98-9.40) were risk factors for unsuccessful outcomes in student PTB patients. Conclusion: The registration rate of student PTB patients in Chongqing shows a declining trend, and overall treatment outcomes were favorable. It is recommended to focus on student patients who are ethnic minorities, retreatment, or not enrolled in community-based management. Strengthening tuberculosis health education, improving patient adherence, ensuring all identified student pulmonary tuberculosis patients are incorporated into community-based management, and enhanced supervision, are essential to further increase the treatment success rate.

Observation on the efficacy of all-oral standardized short-course treatment for 80 cases of multidrug/rifampicin-resistant pulmonary tuberculosis

Su Wei, Liu Yinshan, Luo Xushan, Gulizibaier·Saimaier , Turhong·Wushouer , Paerhati·Shalayiding , Qi Haibo, Yasen·Tuerxun , Gulmira·Imin , Maiwelanjiang·Abulimiti , Zhou Linjun, Huang Fei

Journal of Tuberculosis and Lung Disease. 2025, 6(6):  731-737.  doi:10.19983/j.issn.2096-8493.20250141

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Objective: To verify the feasibility, safety and efficacy of a 9-11-month all-oral, short-course standardized treatment regimen (abbreviated “short-term plan”) for multidrug/rifampicin-resistant tuberculosis (MDR/RR-TB) patients under the framework of tuberculosis control programs. Methods: A prospective study was conducted from March 2022 to March 2024, patients with MDR/RR-PTB who were diagnosed with rifampicin resistance and fluoroquinolone susceptibility at Kashgar Prefectural Pulmonary Hospital, Xinjiang Uygur Autonomous Region. Patients were enrolled in the short-course treatment group (short-course group) based on the inclusion criteria. The remaining MDR/RR-PTB patients were assigned to the 18-20-month long-course treatment group (long-course group). The treatment outcomes and costs of the two groups of completed patients were observed and evaluated, and to analyze the characteristics of adverse reactions and treatment outcomes in the short-term group. Results: A total of 242 MDR/RR-PTB patients who met the inclusion criteria and completed treatment were enrolled. The overall treatment success rate was 54.13% (131/242). Among them, the treatment success rates were 76.25% (61/80) for the 80 patients treated with the short-course regimen and 43.21% (70/162) for the 162 patients treated with the long-course regimen, respectively. In the short-course group, the treatment success rate of retreated patients (44.26% (27/61)) was significantly lower than that of new patients (55.74% (34/61)), with a statistically significant difference (χ²=6.989, P=0.008); the incidences of liver function abnormalities, gastrointestinal reactions and high uric acid were 21.25% (17/80), 16.25% (13/80) and 3.75% (3/80), respectively. Only one patient discontinued the drug for 2 weeks due to severe liver dysfunction, none of the remaining patients discontinued treatment due to adverse drug reactions. The average treatment cost per patient in the short-course group was 61000 yuan less than that in the long-course group, with drug costs being the main component (59000 yuan). Conclusion: The 9-11-month all-oral standardized short-course treatment achieves a relatively high treatment success rate and exhibits favorable safety profiles in eligible MDR/RR-TB patients, which is generally consistent with existing literatures. It can also reduce medical costs and is suitable for application in regions equipped with rapid diagnostic capabilities for rifampicin and fluoroquinolone resistance.

The diagnostic value of thoracoscopic cryobiopsy in internal medicine for suspected tuberculous pleurisy

Guan Tingting, Wang Ying, Wang Lianzhi

Journal of Tuberculosis and Lung Disease. 2025, 6(6):  738-746.  doi:10.19983/j.issn.2096-8493.20250105

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Objective: To evaluate the diagnostic value of cryobiopsy in patients with suspected tuberculous pleurisy by comparing cryobiopsy and biopsy forceps biopsy. Methods: A prospective study was conducted. A total of 73 patients with suspected tuberculous pleurisy were consecutively included in Harbin Chest Hospital from May 2022 to August 2024 in accordance with the enrollment criteria. All enrolled patients underwent internal medicine thoracoscopic biopsy forceps biopsy and cryobiopsy simultaneously. Both the biopsy tissue and pleural effusion were tested by GeneXpert MTB/RIF, Mycobacterium tuberculosis resistance gene-on-chip method (referred to as “drug resistance gene-on-chip method”), and Mycobacterium tuberculosis BACTEC MGIT 960 (referred to as “MGIT 960”) culture and pathological examination. Based on the final clinical diagnosis results, the differences in tissue specimen diameter, pathological positive rate, etiological positive rate, complications and other indicators of biopsy forceps biopsy and cryobiopsy were compared, and the diagnostic value of internal thoracoscopic cryobiopsy for patients with suspected tuberculous pleurisy was evaluated. Results: All 73 patients obtained a definitive diagnosis. Among them, 64 patients (87.7%, 64/73) achieved a definitive diagnosis by biopsy forceps biopsy, while 71 patients (97.3%, 71/73) did so by cryobiopsy. A total of 60 cases (82.2%, 60/73) were diagnosed with tuberculous pleurisy, including 43 cases (58.9%, 43/73) of drug sensitive tuberculous pleurisy and 17 cases (23.3%, 17/73) of drug-resistant tuberculous pleurisy (including 3 cases of monodrug-resistant, 8 cases of multidrug-resistant, 1 case of polydrug-resistant, 2 cases of pre-extensively drug-resistant, and 3 cases of extensively drug-resistant). The remaining 13 cases (17.8%, 13/73) were diagnosed with pleural effusion due to other causes, including 6 cases (8.2%, 6/73) of malignant pleural mesothelioma, 2 cases (2.7%, 2/73) of adenocarcinoma, 1 case (1.4%, 1/73) of squamous cell carcinoma, 1 case (1.4%, 1/73) of small cell neuroendocrine carcinoma, 2 cases (2.7%, 2/73) of inflammation, and 1 case (1.4%, 1/73) of amyloidosis. The diameter of the tissue specimen of cryobiopsy ((7.47±0.71) mm) was significantly larger than that of biopsy forceps biopsy ((2.34±0.22) mm), and the histopathological positivity rate of cryobiopsy (97.3%, 71/73) was significantly higher than that of biopsy forceps biopsy (87.7%, 64/73); the differences were statistically significant (t=58.820, P<0.001; χ²=4.818, P=0.028). The histopathogenic positivity rate of cryobiopsy (GeneXpert MTB/RIF: 91.7%, 55/60; resistance gene chip examination: 61.7%, 37/60; MGIT 960 culture: 73.3%, 44/60) was significantly higher than those of biopsy clamp biopsy (GeneXpert MTB/RIF was 70.0% (42/60), drug resistance gene microarray was 28.3% (17/60), MGIT 960 culture was 40.0% (24/60)), and the differences were statistically significant (χ²=8.015, P=0.005; χ²=13.470, P<0.001; χ²=13.570, P<0.001). The diagnostic sensitivity of cryobiopsy for tuberculosis pleurisy (98.5%, 66/67) was significantly higher than that of biopsy forceps biopsy (88.9%, 56/63), and the difference was statistically significant (χ²=5.202, P=0.023). No serious adverse reactions occurred postoperatively in either biopsy methods. A total of 16 cases (21.9%, 16/73) developed mild chest pain, among which the incidence of chest pain in cryobiopsy (5.5% (4/73)) was lower than that in biopsy (16.4%, 12/73), and the difference was statistically significant (χ²=4.492, P=0.034). Conclusion: Internal thoracoscopic cryobiopsy has high diagnostic sensitivity and the advantage of high safety for patients with suspected tuberculous pleurisy, and can further improve the precise treatment level of tuberculous pleurisy through drug susceptibility testing.

Deletion of the pks5 gene (Rv1527c) impairs intracellular survival in macrophages and modulates inflammatory cytokine expression in Mycobacterium tuberculosis

Liu Quanxian, Zhao Zhaoliang, Zong Zhaojing, Chen Ling, Lan Yuanbo

Journal of Tuberculosis and Lung Disease. 2025, 6(6):  747-752.  doi:10.19983/j.issn.2096-8493.20250101

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Objective: To investigate the role of the pks5 (Rv1527c) gene in the pathogenic mechanism of Mycobacterium tuberculosis. Methods: The H37RvΔRv1527c knockout strain was constructed using phage-mediated homologous recombination. Bacterial morphology and growth characteristics were analyzed via acid-fast staining and solid-medium growth curves. A RAW264.7 macrophage infection model was established to assess bacterial intracellular survival rates. qPCR was employed to detect mRNA expression levels of inflammatory cytokines (IL-1β, TNF-α, IL-6) in infected macrophages. Results: The ΔRv1527c knockout strain showed no significant morphological differences compared to wild-type H37Rv. At 72 hours post-infection, the intracellular survival rate of the ΔRv1527c knockout strain in RAW264.7 macrophages (13.13%±1.05%) was significantly reduced by 68% compared to that of the wild-type strain (41.04%±2.11%)(t=15.732, P<0.001). Furthermore, relative to infection with the wild-type H37Rv strain, macrophages infected with the ΔRv1527c knockout strain exhibited a significant upregulation of IL-1β mRNA expression as early as 2 h (H37Rv-WT:1.05±0.08; H37RvΔRv1527c: 1.52±0.11; t=3.245, P=0.023), which remained at significantly higher levels at 4 h, 8 h, and 12 h. Similarly, TNF-α mRNA expression was significantly elevated at 4 h (H37Rv-WT: 1.12±0.10; H37RvΔRv1527c: 1.98±0.15; t=4.562, P=0.010) and 12 h (H37Rv-WT: 2.05±0.16; H37RvΔRv1527c: 3.12±0.21; t=5.328, P=0.006) post-infection. In contrast, for IL-6, its expression level in the ΔRv1527c knockout strain-infected group (1.42±0.10) was significantly suppressed at 24 h post-infection compared to the wild-type H37Rv-infected group (3.15±0.22)(t=11.732, P<0.001). Conclusion: The pks5 gene is a potential key virulence factor in Mycobacterium tuberculosis. It contributes to pathogenesis by impairing bacterial survival within macrophages and modulating host inflammatory responses (promoting IL-1β/TNF-α expression and suppressing IL-6 expression).