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Tuberculosis research and innovation: Interpretation of the WHO Global Tuberculosis Report 2021 SHU Wei, SUN Yu-xian, ZHANG Li-jie, XIE Shi-heng, GAO Jing-tao, LIU Yu-hong Chinese Journal of Antituberculosis    2022, 44 (1): 45-48.   DOI: 10.19982/j.issn.1000-6621.20210685 Abstract （2625）   HTML （130）    PDF（pc） （1294KB）（1423）       Knowledge map    Save Tuberculosis research and innovation is one of the three pillars to achieve the targets of End TB Strategy set by World Health Organization (WHO). On October 14, 2021, WHO released the Global tuberculosis report 2021, updating the newest progress of global tuberculosis research and innovation. This paper reviews the key achievements in the areas of research and innovation for new diagnostic, new drugs and new vaccines introduced in the global report, and discuss with consideration of China’s situation in related areas. The aim of this paper is to facilitate the better understanding to global research feature and development trend, and to provide reference for further China original scientific research and innovation. Reference | Related Articles | Metrics

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Chinese expert consensus on the all-oral treatment of drug-resistant pulmonary tuberculosis (2021 Edition) Beijing Chest Hospital, Capital Medical University/Beijing Tuberculosis and Thoracic Tumor Research Institute, Chinese Antituberculosis Association, Editorial Board of Chinese Journal of Antituberculosis Chinese Journal of Antituberculosis    2021, 43 (9): 859-866.   DOI: 10.3969/j.issn.1000-6621.2021.09.002 Abstract （2103）   HTML （111）    PDF（pc） （1114KB）（1497）       Knowledge map    Save In 2020, the World Health Organization (WHO) proposed the all-oral treatment for drug-resistant pulmonary tuberculosis. Analysis showed that the success rate of all-oral treatment is higher than that of the treatment regimen containing injection. Although WHO guidelines recommend all-oral treatment regimen for different drug-resistant pulmonary tuberculosis patients, some drugs or dosages are not suitable for Chinese patients. There is no consensus on all-oral treatment for drug-resistant pulmonary tuberculosis patients in China. In order to formulate all-oral treatment for drug-resistant pulmonary tuberculosis in China, the Chinese Antituberculosis Association, Beijing Chest Hospital Affiliated to Capital Medical University and the Editorial Board of Chinese Journal of Antituberculosis jointly organized experts to write the “Chinese expert consensus on the all-oral treatment of drug-resistant pulmonary tuberculosis (2021 Edition)” (referred to as “Consensus”). Based on the research progress of all-oral treatment for drug-resistant pulmonary tuberculosis at home and abroad in recent years, this consensus recommends suitable all-oral treatment for patients with drug-resistant pulmonary tuberculosis in China, including the types and dosages of drugs used, and the types of patients and their applications and exclusion criteria. In addition, the relevant questions that may be encountered in the treatment are answered, and the precautions for the use of the plan are also emphasized, in order to improve the diagnosis and treatment of drug-resistant pulmonary tuberculosis in China. Table and Figures | Reference | Related Articles | Metrics

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Assessing next-generation sequencing for Mycobacterium tuberculosis diagnosis in clinical sputum samples DAI Xiao-wei, WANG Nen-han, CHEN Shuang-shuang, YANG Xin-yu, TIAN Li-li, CHEN Hong, ZHANG Hong-tai, LI Chuan-you Chinese Journal of Antituberculosis    2022, 44 (7): 669-679.   DOI: 10.19982/j.issn.1000-6621.20220097 Abstract （2011）   HTML （42）    PDF（pc） （907KB）（447）       Knowledge map    Save Objective: To evaluate detection efficacy of next-generation sequencing (NGS) to Mycobacterium tuberculosis from clinical sputum samples. Methods: Sputum samples of 49 suspected pulmonary tuberculosis patients diagnosed in Tuberculosis Outpatient Department of Beijing Center for Disease Prevention and Control (Beijing Center for Tuberculosis Research and Control) were collected from August to November, 2021. Suspected pulmonary tuberculosis were detected from sputum samples with acid-fast staining (smear),L-J culture and MGIT 960 liquid culture (culture), GeneXpert MTB/RIF (Xpert) and NGS methods. The positive detection rates of 4 kinds of methods were compared in the selected patients. We also evaluated the detection efficacy of different methods based on the results of clinical diagnosis. Results: There were 40 pulmonary tuberculosis patients (25 confirmed pathogen-positive pulmonary tuberculosis patients and 15 clinical diagnosed cases) and 9 non-pulmonary tuberculosis patients (6 cases of pneumonia, 1 case of nontuberculous mycobacteria infection, 1 case of COPD and 1 case of asthma). The positive detection rates are statistically difference (χ2=17.614,17.018,20.753;Ps=0.000) among smear 44.9% (22/49), culture 51.0% (25/49), Xpert 49.0% (24/49) and NGS 69.4% (34/49). For etiology-negative pulmonary tuberculosis patients, the positive detection rate by the NGS was 46.7% (7/15). Sensitivity were 55.0% (22/40), 60.0% (24/40), 60.0% (24/40), 80.0% (32/40), and specificity were 9/9, 8/9, 9/9, 7/9, and concordance rate were 63.3% (31/49), 65.3% (32/49), 67.3% (33/49), 79.6% (39/49), Kappa values were 0.310,0.297,0.355,0.459 based on smear, culture, Xpert and NGS respectively. Conclusion: NGS has the highest sensitivity and consistency based on the national clinical diagnosis standard of pulmonary tuberculosis, which can diagnose suspected pulmonary tuberculosis earlier and detect Mycobacterium tuberculosis from sputum samples rapidly and effectively. Table and Figures | Reference | Related Articles | Metrics

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Recommendations on pretomanid (PA-824) in the treatment of multidrug-resistant tuberculosis Chinese Antituberculosis Association , National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention Chinese Journal of Antituberculosis    2022, 44 (1): 38-44.   DOI: 10.19982/j.issn.1000-6621.20210655 Abstract （1806）   HTML （47）    PDF（pc） （1406KB）（541）       Knowledge map    Save The duration of treatment of multidrug-resistant tuberculosis (MDR-TB) is 18-24 months, and severe adverse effect, poor treatment compliance, and no second-line anti-tuberculosis drugs to form an effective treatment regimen for some patients due to the wide drug resistance spectrum and led to high mortality always happened in the treatment. Therefore, the research of new drugs for MDR-TB treatment is an important issue for global tuberculosis control, as well as the key to improve the status of MDR-TB control and prevention in China. Pretomanid (PA-824), which was developed by the TB Alliance, combined with bedaquiline and linezolid to form the BPaL regimen. The new regimen had advantages of short course, oral drugs in the whole treatment, improved treatment compliance, high cure rate, brings new hope for severe MDR-TB patients, and was recommended by World Health Organization in 2020. Currently, bedaquiline and linezolid are available in China and used as second-line anti-tuberculosis drugs for the MDR-TB treatment. Therefore, it is urgent for PA-824 to be approved in China to save more MDR-TB patients. The Chinese Antituberculosis Association and the Chinese Center for Disease Control and Prevention co-organized domestic experts on TB control, clinical and basic research to write Recommendations on pretomanid (PA-824) in the treatment of multidrug-resistant tuberculosis after discussions, to provide reference for accelerating the registration and application of PA-824 and BPaL regimen in China. Reference | Related Articles | Metrics

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Expert consensus on detection and preventive treatment of latent tuberculosis infection in high-risk population Chinese Antituberculosis Association Chinese Journal of Antituberculosis    2021, 43 (9): 874-878.   DOI: 10.3969/j.issn.1000-6621.2021.09.004 Abstract （1615）   HTML （123）    PDF（pc） （1134KB）（1252）       Knowledge map    Save Active discovery and preventive treatment is the core measure of tuberculosis control of the global strategy for ending tuberculosis epidemic. China is one of the countries with high burden of tuberculosis in the world. For the goal of ending tuberculosis in the world, strengthening the active discovery of latent tuberculosis infection (LTBI), screening the close contacts of tuberculosis patients, and preventive treatment for the newly infected and immunocompromised LTBI populations are important measures to reduce the incidence of LTBI. However, there are still many doubts and disputes about the applicable objects, regimes and effect of preventive treatment now. New diagnostic techniques and preventive treatment methods are constantly studied and applied. In view of this, experts from Chinese Antituberculosis Association have compiled the Expert consensus on detection and preventive treatment of latent tuberculosis infection in high-risk population, and reviewed the principle and detection of LTBI, and objects of prevention treatment, diagnostic methods, chemical prevention and immunization prevention, to provide reference for Chinese tuberculosis control workers. Table and Figures | Reference | Related Articles | Metrics

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Efficacy and safety of recombinant Mycobacterium tuberculosis fusion proteins (EC) for the diagnosis of Mycobacterium tuberculosis infection: A system review Cheng Xiao, Chen Zhe, Jiao Xuefeng, Yang Nan, Diao Sha, Ni Xiaofeng, Liu Zheng, He Siyi, Zeng Linan, Wan Chaomin, Kang Deying, Wu Bin, Ying Binwu, Zhang Hui, Zhao Rongsheng, Zhang Lingli Chinese Journal of Antituberculosis    2022, 44 (9): 917-926.   DOI: 10.19982/j.issn.1000-6621.20220253 Abstract （1449）   HTML （42）    PDF（pc） （1379KB）（382）       Knowledge map    Save Objective: Compared with purified protein derivative of tuberculin (TB-PPD), to systematically evaluate the efficacy and safety of recombinant Mycobacterium tuberculosis fusion protein (EC) in the diagnosis of Mycobacterium tuberculosis (MTB) infection. Methods: Data were searched from the clinical guideline database, biomedical literature database, official websites of health administrative departments and industry associations, and official websites of adverse reaction monitoring. The retrieval time is from the time of building the database to February 2022. English search terms were recombinant Mycobacterium tuberculosis fusion protein and CFP10/ESAT6; Chinese search terms were recombinant Mycobacterium tuberculosis fusion protein, Yika, and CFP10/ESAT6. Guidelines, consensuses, group standards, systematic reviews, and original studies on the efficacy and safety of recombinant Mycobacterium tuberculosis fusion protein (EC) and TB-PPD in diagnosing MTB infection were collected. Two investigators independently screened literature, extracted data, and assessed the risk of bias of included studies. Meta-analysis or descriptive analysis were used according to the size of heterogeneity. Results: Two guidelines, three expert consensus papers, and two group standards were included, and all presented that both recombinant Mycobacterium tuberculosis fusion protein (EC) and TB-PPD could be used for the detection of MTB infection and tuberculosis. One systematic review was included, and the results showed that the recombinant Mycobacterium tuberculosis fusion protein (EC) skin test recruited a total of 887 participants, with the sensitivity of 86.06% (95%CI: 82.39%-89.07%). The four original studies included were randomized controlled trials. The effectiveness meta-analysis showed that, regardless of the population, the sensitivity (89.3% vs. 90.4%) and negative likelihood ratio (0.177 vs. 0.220) of recombinant Mycobacterium tuberculosis fusion protein (EC) and TB-PPD were not significantly different. The specificity (85.5% vs. 47.3%), diagnostic odds ratio (42.238 vs. 8.040), positive likelihood ratio (6.048 vs. 1.710), positive predictive value (66.0% vs. 35.1%) and negative predictive value (96.2% vs. 94.0%) of recombinant Mycobacterium tuberculosis fusion protein (EC) were significantly better than those of TB-PPD. The safety results showed that the adverse events of recombinant Mycobacterium tuberculosis fusion protein (EC) and TB-PPD were just local itching and pain, and no serious adverse events occurred. Conclusion: Recombinant Mycobacterium tuberculosis fusion protein (EC) can be used for the diagnosis of MTB infection and auxiliary diagnosis of tuberculosis, and has better efficacy when compared with TB-PPD. Table and Figures | Reference | Related Articles | Metrics

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Expert consensus on the rational use of glucocorticoids in tuberculosis treatment Tuberculosis Prevention and Control Key Laboratory/Beijing Key Laboratory of New Techniques of Tuberculosis Diagnosis and Treatment /Institute for Tuberculosis Research/Department of Tuberculosis of the 8th Medical Center of Chinese PLA General Hospital, Editorial Board of Chinese Journal of Antituberculosis Chinese Journal of Antituberculosis    2022, 44 (1): 28-37.   DOI: 10.19982/j.issn.1000-6621.20210683 Abstract （1373）   HTML （60）    PDF（pc） （1399KB）（850）       Knowledge map    Save Glucocorticoids have pharmacological effects of anti-inflammatory, anti-allergic, anti-bacterial endotoxin and immunosuppression, and can reduce immune damage caused by an allergic reaction to Mycobacterium tuberculosis.Glucocorticoids can quickly control the disease, but also can lead to adverse reactions such as dysbacteriosis, peptic ulcer, osteoporosis, and so on. There is still unreasonable use of glucocorticoids in the adjuvant treatment of tuberculosis in the clinic. Therefore, it is urgent to standardize the application of glucocorticoids in the treatment of tuberculosis.This consensus briefly introduces the advantages and basic principles of glucocorticoid therapy for tuberculosis, provides a recommendation of glucocorticoids used in the adjuvant treatment of tuberculous meningitis, tuberculous pericarditis, tuberculous pleuritis, tuberculous peritonitis, acute disseminated pulmonary tuberculosis, and caseous pneumonia under the strong and effective anti-tuberculosis treatment when necessary, and forwards the precautions, adverse reactions, and solution for the application of glucocorticoids. It is emphasized that more strict indications, the balance of advantages and disadvantages, rational use of glucocorticoids in the adjuvant treatment of tuberculosis. Table and Figures | Reference | Related Articles | Metrics

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Expert consensus on the diagnosis and treatment of retreatment pulmonary tuberculosis Shanghai Clinical Research Center for Infectious Disease (Tuberculosis)/Shanghai Pulmonary Hospital, Tongji University School of Medicine, Beijing Chest Hospital , Capital Medical University/Beijing Tuberculosis and Thoracic Tumor Research Institute, Chinese Antituberculosis Association, Editorial Board of Chinese Journal of Antituberculosis Chinese Journal of Antituberculosis    2021, 43 (12): 1226-1238.   DOI: 10.3969/j.issn.1000-6621.2021.12.002 Abstract （1260）   HTML （93）    PDF（pc） （1232KB）（1044）       Knowledge map    Save Retreatment pulmonary tuberculosis is an important part of the national tuberculosis control plan, and it is also a difficult point of tuberculosis control in China. The situation of patients with retreatment pulmonary tuberculosis is complex, and the previous treatment regimen is now outdated, and the classification and diagnosis of retreatment pulmonary tuberculosis should be reassessed. Therefore, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Beijing Chest Hospital, Capital Medical University, Chinese Antituberculosis Association, and Editorial Board of Chinese Journal of Antituberculosis organized domestic experts to repeatedly discuss the classification, diagnosis and treatment of retreatment pulmonary tuberculosis and then formed the “Expert consensus on the diagnosis and treatment of retreatment pulmonary tuberculosis” to standardize the diagnosis and treatment of retreatment pulmonary tuberculosis in China and improve the treatment effect. Reference | Related Articles | Metrics

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Analysis of inconsistency between genotypic and phenotypic results of Mycobacterium tuberculosis rifampicin susceptibility test WANG Shao-hua, ZHAO Guo-lian, WANG Pei, TAN Xiao-wen, CUI Xiao-li, KANG Lei, DANG Li-yun Chinese Journal of Antituberculosis    2022, 44 (2): 169-173.   DOI: 10.19982/j.issn.1000-6621.20210445 Abstract （1236）   HTML （38）    PDF（pc） （750KB）（306）       Knowledge map    Save Objective: To investigate the inconsistency between the fluorescent PCR probe melting curve method (“melting curve method”) and the microplate method in detecting the susceptibility of rifampicin, and to provide an explanation for the inconsistency between clinical genotypic and phenotypic drug susceptability test (pDST) results. Methods: We collected the data of 2562 culture positive tuberculosis patients in Xi’an Chest Hospital from August 2019 to September 2020 and screened out 1294 strains with different results using melting curve method and microplate pDST. The correlation between the inconsistent results and the mutation of rpoB gene were analyzed by sequencing the rpoB gene. Results: Among the 54 patients (4.17%, 54/1294) whose melting curve testing results were inconsistent with the pDST test results, 45 were melting curve method positive for mutants but pDST negative, and 8 were melting curve method negative for mutants but pDST positive. One case was detected as having heterogeneous drug resistance by melting curve method, thus was excluded from the analysis. When the rpoB gene was mutated at codons of 507-512, the inconsistency rate with the pDST results was the highest (70.59%, 24/34), and the minimum inhibitory concentrations of the inconsistent strains tested with the microplate method were mostly ≤1 ug/ml. Leu511pro was the most frequently observed mutation, accounting for 45.28% (24/53), followed by Leu533pro, accounting for 15.09% (8/53) of all of the inconsistent strains. Both Asp516Tyr and His526Asn mutations accounted for 5.66% (3/53). All 8 strains that were melting curve method negative for mutants but pDST positive were sequenced as no mutation in the rpoB gene region. Conclusion: The mutations of Leu511Pro, Leu533Pro, Asp516Tyr and His526Asn in the rpoB region were the main reasons for the inconsistency between the genotypic and phenotypic results for Mycobacterium tuberculosis susceptibility to rifampicin, but whether it was related to the low-level drug resistance mechanism still need further research. Table and Figures | Reference | Related Articles | Metrics

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Analysis of phenotypic drug sensitivity test of rifampicin-resistant Mycobacterium tuberculosis by GeneXpert MTB/RIF FANG Mu-tong, SU You-feng, MAO Zhi, ZHANG Hong-yi, ZENG Jian-feng, ZENG Jian, CAO Wei-peng, WANG Zhong-yuan Chinese Journal of Antituberculosis    2021, 43 (11): 1159-1163.   DOI: 10.3969/j.issn.1000-6621.2021.11.010 Abstract （1198）   HTML （19）    PDF（pc） （801KB）（240）       Knowledge map    Save Objective To analyze the drug resistance and types of phenotypic drug sensitivity test (phenotypic drug sensitivity test) of rifampicin-resistant Mycobacterium tuberculosis (MTB) isolates diagnosed by GeneXpert MTB/RIF (Xpert). Methods A retrospective study was conducted in which 346 rifampicin-resistant pulmonary tuberculosis (RR-PTB) patients (142 new cases and 204 re-treated cases) from the Third People’s Hospital of Shenzhen between January 2015 and December 2020. The drug resistance and types of phenotypic drug sensitivity test of clinical isolates of MTB strains to 10 anti-tuberculosis drugs (rifampicin, isoniazid, streptomycin, rifabutin, ethambutol, levofloxacin, p-aminosalicylic acid, amikacin, protionamide, capreomycin) were analyzed. Results The resistance rates of the 346 strains to 10 anti-tuberculosis drugs from high to low were rifampicin (95.95%, 332/346), isoniazid (84.68%, 293/346), streptomycin (58.38%, 202/346), rifabutin (57.23%, 198/346), ethambutol (50.29%, 174/346), levofloxacin (34.39%, 119/346), p-aminosalicylic acid (11.85%, 41/346), amikacin (10.69%, 37/346), protionamide (5.78%, 41/346) and capreomycin (5.20%,18/346). In the re-treated cases, the resistant rates to isoniazid, levofloxacin, ethambutol and amikacin were significantly higher than those in the new cases (88.24% (180/204) vs. 79.58% (113/142), χ 2=4.838, P=0.028; 40.69% (83/204) vs. 25.35% (36/142),χ 2=8.725, P<0.01; 55.39% (113/204) vs. 42.96% (61/142), χ 2=6.372, P=0.012; 13.73% (28/204) vs. 6.34% (9/142), χ 2=4.784, P=0.029, respectively). Analysis of drug resistance types showed that the multi-drug resistant (MDR) rate was 84.68% (293/346), the pre-extensive drug resistance rates (pre-XDR) of levofloxacin resistance and second-line injection resistance were 26.30% (91/346) and 5.20% (18/346), and the extensive drug resistance (XDR) rate was 6.65% (23/346). The MDR and pre-XDR rate in re-treated cases were significantly higher than those in the new cases (88.24% (180/204) vs. 79.58% (113/142), χ 2=4.147, P=0.042; 37.75% (77/204) vs.22.54% (32/142), χ 2=8.976, P<0.01), while the single resistance rate of rifampicin in the re-treated was significantly lower than that in the new cases (11.76% (24/204) vs. 20.42% (29/142),χ 2=4.838,P=0.028). Conclusion The rifampicin-resistant tuberculosis strains showed a higher rate of resistance to isoniazid and levofloxacin, especially in re-treated cases. It was necessary to detect resistance to isoniazid and fluoroquinolones as early as possible in rifampicin-resistant pulmonary tuberculosis patients, to optimize the treatment regimen. Table and Figures | Reference | Related Articles | Metrics

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Analysis of adverse reactions of bedaquiline containing regimen in the treatment of drug-resistant pulmonary tuberculosis ZHANG Yu-xia, XIONG Yu, CHANG Ting-ting, LIU Feng-xia Chinese Journal of Antituberculosis    2022, 44 (3): 239-245.   DOI: 10.19982/j.issn.1000-6621.20210702 Abstract （1196）   HTML （32）    PDF（pc） （780KB）（207）       Knowledge map    Save Objective: To analyze the adverse reactions of bedaquiline combined with conventional anti-tuberculosis drugs in the treatment of drug-resistant pulmonary tuberculosis, so as to provide basis for the safe use and monitoring of bedaquiline. Methods: A retrospective study was conducted in 127 patients with multidrug-resistant tuberculosis, pre-extensive drug-resistant pulmonary tuberculosis, extensively drug-resistant pulmonary tuberculosis and rifampicin-resistant pulmonary tuberculosis from the Drug-Resistant Tuberculosis Ward of Shandong Public Health Clinical Center. All of them completed 24-week treatment and follow-up from November 2018 to December 2020. And 66 patients treated with bedaquiline containing regimen were considered as the observation group, the other 61 patients treated without bedaquiline containing regimen were considered as the control group. Clinical data including age, gender, drug resistance type, whether or not complicated with diabetes mellitus, whether or not take other drugs that led to prolonged QTc interval, etc., were collected. The occurrence of adverse drug reactions in the treatment of the two groups was monitored, and the influencing factors of QTc interval prolongation (>450 ms) in the observation group were analyzed. Results: The incidence of QTc interval prolongation in the observation group was 48.5% (32/66), which was significantly higher than that in the control group (26.2% (16/61)) (χ2=6.678, P=0.001). There were 3 cases (4.5%) and 1 case (1.6%) with QTc interval >500 ms in the observation group and the control group, respectively. The difference was not statistically significant (Fisher exact probability method, P=0.143). There was no difference in the occurrence of other adverse drug reactions between the two groups. The QTc interval in the observation group gradually increased with the use time of the treatment regimen containing bedaquiline. At the end of the 4th week, the QTc interval was (435.1±28.8) ms, which was significantly higher than that in the baseline period ((419.0±23.2) ms) (t=3.477, P=0.001), and the peak appeared at the end of the 12th week ((439.5±30.7) ms). Multivariate analysis showed that, if treated with bedaquiline containing regimen, the risk of QTc interval prolongation in patients aged ≥45 years was 9.027 times (95%CI: 1.033-78.859) of that in patients aged 18-45 years; combined use of other drugs that can lead to QTc interval prolongation was also an independent risk factor for QTc interval prolongation (OR (95%CI)=9.033 (1.042-78.326)). Conclusion: The incidence of QTc interval prolongation increased in patients with drug-resistant pulmonary tuberculosis after treatment with bedaquiline containing regimen, but there was no serious adverse cardiac events. The incidence of adverse events in other systems did not increase. Elderly patients were at high risk of QTc interval prolongation. Table and Figures | Reference | Related Articles | Metrics

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Interpretation of the new definition of extensive drug-resistant tuberculosis defined by World Health Organization LI Ren-zhong, RUAN Yun-zhou, LI Yu-hong Chinese Journal of Antituberculosis    2021, 43 (6): 539-541.   DOI: 10.3969/j.issn.1000-6621.2021.06.003 Abstract （1147）   HTML （93）    PDF（pc） （1030KB）（835）       Knowledge map    Save The definition of extensive drug-resistant tuberculosis (XDR-TB) first proposed by World Health Organization (WHO) in 2006 has played an important role in guiding the prevention and control of drug-resistant tuberculosis. With the development of new diagnostic technologies and new drugs, WHO updated the original definition of XDR-TB in January 2021. In this paper, the background, history, reasons and general principles of the new definition of XDR-TB were interpreted, and the impact and significance of the new definition for the tuberculosis control in the future were summarized, in order to provide reference for tuberculosis control workers in China. Reference | Related Articles | Metrics

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Meta analysis of the differences between BCG-PPD and TB-PPD in tuberculosis screening Ding Xiaojuan, Wang Dan, Zhang Yaozhi, He Jianqing Chinese Journal of Antituberculosis    2022, 44 (10): 1096-1099.   DOI: 10.19982/j.issn.1000-6621.20220156 Abstract （1130）   HTML （21）    PDF（pc） （1417KB）（250）       Knowledge map    Save To investigate the differences between pure protein derivative of BCG (BCG-PPD) and pure protein derivative of tuberculin (TB-PPD) in tuberculosis screening. Relevant literatures published from the establishment of the databases to February 2022 were searched from PubMed, Embase, Medline, Cochrane Library, CNKI and Wanfang. Open Meta Analyst software was used for meta-analysis of the included literatures. Cochrane Risk of Bias Assessment tool with Rev Man 5.3 software was used to evaluate the quality of the literature. Finally, 7 articles were included, with a total of 36131 participants, including 18314 participants in BCG-PPD group and 17817 participants in TB-PPD group. Dichotomous random effect model was used to analyzed. The combined OR (95%CI) value was 2.072 (1.683-2.550), I2=78.73%, P<0.001, indicating high heterogeneity, and the source of heterogeneity should be further analyzed. The results of subgroup analysis showed that the OR (95%CI) value of students and newborns was 2.393 (2.132-2.686), I2=50.15%, P=0.091, and I2 value decreased significantly. The OR (95%CI) value of tuberculosis patients in the subgroup was 0.481 (0.236-0.978), I2=0, P=0.043, and the fixed-effect model was used. Differences in the positive detection rate of TB-PPD and BCG-PPD in different populations were found. The positive detection rate of BCG-PPD is higher than that of TB-PPD in students and neonates, and the positive detection rate of TB-PPD was higher than that of BCG-PPD in tuberculosis patients. Table and Figures | Reference | Related Articles | Metrics

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Expert consensus on the estimation of the national burden on latent tuberculosis infection Institute of Pathogen Biology, Chinese Academy of Medical Sciences and Peking Union Medical College , Chinese Center for Disease Control and Prevention , Union Medical Institute of Geographic Sciences and Natural Resources Research, Chinese Academy of Sciences Chinese Journal of Antituberculosis    2022, 44 (1): 4-8.   DOI: 10.19982/j.issn.1000-6621.20210662 Abstract （1128）   HTML （92）    PDF（pc） （1373KB）（822）       Knowledge map    Save Preventive treatment for high-risk population with latent tuberculosis infection (LTBI) is an effective tool to reduce the incidence rate of tuberculosis (TB), and also an important strategy for achieving the global goals of the End TB Strategy. As a high burden country of TB, how to achieve the goal of rapid decline in TB incidence by carrying out LTBI treatment is worth exploring in China. First of all, accurately mastering the burden and epidemic characteristics of LTBI in China is the premise to discuss the feasibility and scientific of the strategy. In the absence of nationwide epidemiological investigation of LTBI, the LTBI burden in China was estimated by small sample spatial statistical model based on the epidemiological LTBI survey data of interferon-gamma release assay and the nationwide incidence of reported TB. The results showed, in 2013, the prevalence of LTBI in people aged 5 years old and above was 18.1% (95%CI: 13.7%-22.4%) and in people aged 15 years old and above was 20.3% (95%CI: 15.6%-25.1%), respectively. The LTBI prevalence showed a trend of increasing with age and it was significantly higher in men than that in women at the same age group. Experts in the field have extensively demonstrated the results and formed the Expert consensus on the estimation of the national burden on latent tuberculosis infection as reference for improving Chinese TB control. Reference | Related Articles | Metrics

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Analysis on the epidemic situation of pulmonary tuberculosis in schools in China from 2004 to 2021 Chen Hui, Zhang Canyou, Zhang Hui, Cheng Jun, Li Tao Chinese Journal of Antituberculosis    2022, 44 (8): 768-776.   DOI: 10.19982/j.issn.1000-6621.20220200 Abstract （1115）   HTML （94）    PDF（pc） （2813KB）（515）       Knowledge map    Save Objective: To investigate the epidemic trend of pulmonary tuberculosis (PTB) of students and staff in China from 2004 to 2021. Methods: The reported data of PTB in students and staff (excluding Taiwan, Hongkong and Macao) from 2004 to 2021 were collected from Infectious diseases surveillance system and China statistical yearbook, and the trend of epidemic situation in schools was analyzed. Results: From 2004 to 2021, a total of 908171 student patients with PTB were reported, with the reported incidence of 19.26/100000, while 112336 staff patients with PTB were reported with the reported incidence of 34.12/100000. From 2008 to 2019, the reported incidence rates of PTB among students and staff both showed the downward trend (average annual percent change=―3.41% and ―8.22%, Z=―2.005 and ―6.626, P=0.045 and <0.001). Eighteen provinces showed significantly decreasing trends in incidence among students, and eleven provinces showed stable trends. However, two provinces (Tibet and Qinghai) showed significantly increasing trends. Conclusion: The PTB reported incidence in schools in China was decreasing, but incidences of Tibet and Qinghai were on the rise. PTB prevention and control in schools has achieved positive effects. It is still necessary to continue to strengthen the prevention and control of PTB in schools, and more attention should be paid to key areas and schools. Table and Figures | Reference | Related Articles | Metrics

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Expert consensus on immune function assessment and immunotherapy in patients with active tuberculosis (2021 Edition) Tuberculosis Prevention and Control Key Laboratory/Beijing Key Laboratory of New Techniques of Tuberculosis Diagnosis and Treatment/Institute for Tuberculosis Research of the 8th Medical Center of Chinese PLA General Hospital, Editorial Board of Chinese Journal of Antituberculosis , Basic and Clinical Speciality Committees of Tuberculosis Control Branch of China International Exchange and Promotive Association for Medical and Health Care Chinese Journal of Antituberculosis    2022, 44 (1): 9-27.   DOI: 10.19982/j.issn.1000-6621.20210680 Abstract （1098）   HTML （84）    PDF（pc） （2035KB）（824）       Knowledge map    Save Tuberculosis is not only a bacterial infectious disease but also an immune disease. The occurrence, development, and prognosis of tuberculosis are closely related to the anti-tuberculosis immunity of the patients. Patients with active tuberculosis usually have abnormalities in the function of innate immune and adaptive immune. Detecting the number of immune cells and immune function can evaluate the immune status of active tuberculosis patients, to provide evidence for clinical immune intervention. The immune intervention using immune agents can enhance immunity function, improve the cure rate and shorten the course of treatment, eliminate the persistent Mycobacterium tuberculosis and reduce the recurrence rate. Although the immunodiagnosis of tuberculosis is widely used in the clinic, the mechanisms of anti-tuberculosis immunity and immune abnormality and their role in tuberculosis are not well understood and lack in-depth research. There is no consensus on the indication of immune function evaluation, the application of the evaluation index, and their clinical significance in active tuberculosis patients. In addition, the application of immune agents is limited by the policy, and there is also no consensus on immune intervention or not, the indication of immunotherapy and selection of immune agents for active tuberculosis patients. Therefore, the experts were organized to draw up “Expert consensus on immune function assessment and immunotherapy in patients with active tuberculosis (2021 Edition)” by the Eighth Medical Center of Chinese PLA General Hospital, Editorial Board of Chinese Journal of Antituberculosis, Basic and Clinical Speciality Committees of Tuberculosis Control Branch of China International Exchange and Promotive Association for Medical and Health Care. This expert consensus outlines the mechanism of anti-tuberculosis immunity and immune abnormality in tuberculosis patients; introduces the immunological detection methods commonly used in tuberculosis clinic practice; puts forward the indications, methods, and strategies for evaluating the immune status of active tuberculosis patients; systematically introduces the clinical immunotherapy preparations available in clinic practice, and puts forward the indications and contraindications of immunotherapy for active tuberculosis patients, to help clinicians timely and reasonably carry out the immunotherapy in the patients with active tuberculosis. Table and Figures | Reference | Related Articles | Metrics

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Spatial and temporal distribution characteristics and correlation analysis of HIV/AIDS and tuberculosis in Liangshan Yi Autonomous Prefecture, Sichuan from 2013 to 2019 LI Jing, YUAN Feng-shun, LI Ting, LI Yun-kui, GAO Wen-feng, YANG Cheng-bin, HE Jin-ge, YANG Wen Chinese Journal of Antituberculosis    2021, 43 (7): 708-715.   DOI: 10.3969/j.issn.1000-6621.2021.07.012 Abstract （1073）   HTML （22）    PDF（pc） （10045KB）（236）       Knowledge map    Save Objective To compare the temporal and spatial distribution of reported cases of HIV infection and AIDS (HIV/AIDS) and tuberculosis in Liangshan Yi Autonomous Prefecture (Liangshan Prefecture) in Sichuan from 2013 to 2019, and analyze the temporal and spatial correlation of the two diseases and the hot areas of the disease, so as to provide reference for formulating prevention and control strategies. Methods Numbers of reported HIV/AIDS and tuberculosis cases between 2013 and 2019 were collected from internet-based reporting system of Chinese Center for Disease Control and Prevention. The temporal and spatial correlation of the two diseases was analyzed by simple correlation, linear regression and spatial autocorrelation. SPSS 23.0 software was used to analyze the simple correlation and linear regression, ArcGIS 10.0 software was used to analyze the global spatial autocorrelation and local spatial autocorrelation, and the dual variable spatial autocorrelation analysis was carried out using GeoDa 1.1.4 software. Results HIV/AIDS and tuberculosis patients were reported from all the 17 counties (districts) in Liangshan Prefecture. The numbers in each year were 4139, 4406, 4005, 4802, 5570, 10105 and 4694, respectively, and the increasing rates were 6.5%, -9.1%, 19.9%, 16.0%, 81.4% and -53.5%, respectively. Numbers of reported tuberculosis cases in each year were 4590, 4323, 4453, 5931, 6748, 6432 and 6893, respectively, and the increasing rates were -5.8%, 3.0%, 33.1%, 13.8%, -4.7% and 7.2%, respectively. The results of linear regression analysis showed that the correlation coefficient (rs) between numbers of reported cases of HIV/AIDS and tuberculosis in Liangshan Prefecture according to a linear distribution with the year (x). The linear regression equation was: rs=-106.602+0.53x (regression coefficient test: t=3.109, P=0.027), the goodness of fit was average (determination coefficient R 2=0.659, correction coefficient R 2=0.591). Global spatial autocorrelation analysis showed that there was a positive spatial correlation between the reported incidence of HIV/AIDS from 2013 to 2018 (Moran’sI values were 0.213, 0.194, 0.342, 0.368, 0.271 and 0.180, respectively; P values were 0.028, 0.033, 0.003, 0.002, 0.008 and 0.027, respectively); the reported incidence of tuberculosis from 2013 to 2019 had a positive spatial correlation of medium degree and above (Moran’sI values were 0.374, 0.500, 0.451, 0.347, 0.487, 0.472 and 0.532, respectively; all P<0.05). Local spatial autocorrelation analysis showed that, from 2013 to 2018, Zhaojue County, Butuo County, and Jinyang County in Liangshan Prefecture were hot spots for reported cases of HIV/AIDS. From 2013 to 2015, the hot spots for tuberculosis were mainly concentrated on Leibo County, Meigu County, and Jinyang County; Ganluo County was a hot spot from 2015 to 2017; Zhaojue County became the hot spot in 2014 and had continued to be a hot spot since 2016, and it had spread to Yuexi County. The bivariate global spatial autocorrelation analysis showed that the reported incidence of HIV/AIDS and tuberculosis were positively correlated from 2013 to 2019 (Moran’sI values were 0.312, 0.345, 0.385, 0.419, 0.388, 0.345 and 0.293, respectively; all P<0.05). Conclusion There was a strong positive correlation between HIV/AIDS and tuberculosis reported cases in the temporal and spatial distribution, which suggested that Liangshan Prefecture should pay equal attention to the two diseases in the prevention and control of these two infectious diseases, close combination were needed, the diagnosis and treatment of HIV/AIDS and tuberculosis patients should be improved, the prevention and control measures for key areas and groups should be strengthened, and the diagnosis, treatment and health care should be improved. Table and Figures | Reference | Related Articles | Metrics

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Expert consensus on the therapeutic drug monitoring of anti-tuberculosis drugs Beijing Chest Hospital, Capital Medical University, Editorial Board of Chinese Journal of Antituberculosis Chinese Journal of Antituberculosis    2021, 43 (9): 867-873.   DOI: 10.3969/j.issn.1000-6621.2021.09.003 Abstract （1068）   HTML （73）    PDF（pc） （1165KB）（697）       Knowledge map    Save Therapeutic drug monitoring (TDM) is an individualized administration guided by determining the drug exposure, pharmacological markers or efficacy indicators in patients, by using quantitative pharmacological model and taking the drug treatment window as the benchmark. In the process of anti-tuberculosis treatment, there are many problems such as individual differences in drug concentration and various adverse effects, which may lead to treatment failure, drug resistance and recurrence. The use of anti-tuberculosis drugs TDM can optimize drug treatment, improve drug efficacy and reduce toxic and side effects. In order to promote the standardization of tuberculosis TDM in China, ensure the scientificity, ethics and legality of TDM, and maximize the benefits of patients, the Expert Consensus on the Therapeutic Drug Monitoring of Anti-Tuberculosis Drugs was composed. This consensus has been repeatedly discussed by experts in the fields of tuberculosis, including clinicians and pharmacologists. Based on the significance, indications, detection methods, implementation process and quality control of TDM, the experts generated the consensus. Table and Figures | Reference | Related Articles | Metrics

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CT imaging of 56 cases of epididymal tuberculosis Li Xiang, Ma Zhongxu, Fu Xuwen, Qi Min, Xu Yanling, Shen Lingjun Chinese Journal of Antituberculosis    2022, 44 (10): 1100-1103.   DOI: 10.19982/j.issn.1000-6621.20220208 Abstract （1057）   HTML （10）    PDF（pc） （1064KB）（157）       Knowledge map    Save To understand the CT imaging features of epididymal tuberculosis, the author analyzed 56 patients with epididymal tuberculosis admitted to Kunming Third People’s Hospital from September 1, 2020 to October 31, 2021, who were diagnosed with pathology, bacteriology or effective with anti-tuberculosis treatment.The results revealed the median age of 56 patients with epididymal tuberculosis was found to be 42 years old, and 37 cases (66.1%) had symptoms of scrotal swelling and pain. Among them, 9 cases (16.1%) were combined with scrotal skin sinus tract formation. The number of cases with combined pulmonary tuberculosis, renal tuberculosis, syringomyelia and testicular involvement were 29 (51.8%), 26 (46.4%), 24 (42.9%) and 15 (26.8%).CT showed the epididymis was thickened in 56 cases (100.0%), multiple lesions in 34 cases (60.7%).The epididymis was involved unilaterally in 32 cases (57.1%), and the epididymis was calcified in 8 cases (14.3%). The number of cases with only nodular enhancement, only rim enhancement and both were 23 (41.1%), 19 (33.9%) and 14 (25.0%), respectively, on CT-enhanced scans of epididymal lesions in the portal vein phase. It is believed that patients with epididymal tuberculosis mostly have scrotal swelling and pain, and can be combined with pulmonary and renal tuberculosis. CT scans mostly show unilateral epididymal involvement with multiple lesions and nodular or rim enhancement on enhancement CT scans, which have certain CT imaging characteristics. Table and Figures | Reference | Related Articles | Metrics

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Short-term effectiveness and safety of a regimen containing bedaquiline in the treatment of multidrug-resistant/extensively drug-resistant tuberculosis WU Guo-lan, GAO Jing-tao, CHEN Xiao-hong, CHEN Li-zhou, WENG Li-zhen, GUO Zhi-ping, CHEN Xiu-ping, LIN Jian-dong, CHEN Su-xia, GAO Meng-qiu, LIU Yu-hong Chinese Journal of Antituberculosis    2021, 43 (9): 899-904.   DOI: 10.3969/j.issn.1000-6621.2021.09.008 Abstract （1042）   HTML （31）    PDF（pc） （786KB）（316）       Knowledge map    Save Objective To analyze the short-term effectiveness and safety of bedaquiline-containing regimen in 16 patients with multidrug-resistant tuberculosis (MDR-TB) or extensively drug-resistant tuberculosis(XDR-TB). Methods From September 2018 to January 2020, 16 patients treated with bedaquiline regimen and met the inclusion criteria in Fuzhou Pulmonary Hospital were selected, including 4 MDR-TB patients, 6 XDR-TB patients, and 6 pre-XDR-TB patients. The conversion of sputum culture for Mycobacterium tuberculosis at 24 weeks was analyzed. Changes of electro-cardiogram QTcF at 1, 2, 4, 8, 12, 16, 20, 24 weeks before enrollment and changes of chest lesions at 12 and 24 weeks after treatment were monitored, and adverse drug reactions and treatment for them were recorded. Results All of the 16 patients completed 24 weeks of intensive therapy, and the median time of sputum culture conversion was 8 (IQR:4,12) weeks. The time of conversion was 4 weeks in 2 patients, 8 weeks in 10 patients, and 12 weeks in 3 patients,1 patient was continuously positive in culture. Chest CT scan of lung lesions showed significant absorption in 7 cases, partial absorption in 7 cases, and no change in 2 cases. Adverse reactions mainly were prolonged QTcF (25.8%, 42/163), tolerable gastrointestinal reactions (22.1%, 36/163), abnormal liver function (3.7%, 6/163), hyperuricemia (36.8%, 60/163), and leukopenia (4.3%, 7/163), fatigue, joint muscle soreness (3.1%. 5/163), respiratory failure (0.6%, 1/163), and skin redness (3.7%, 6/163). The median ECG QTcF value at baseline time for those 16 patients was 412.50 (IQR: 398.25, 420.75) ms,while it changed to 414.00 (405.00, 426.75) ms at 2 weeks, 419.50 (402.00, 434.50) ms at 4 weeks, 410.50 (398.25, 421.25) ms at 8 weeks, 421.50 (409.50, 434.75) ms at 12 weeks, and 424.50 (413.75,432.25) ms at 16 weeks, 421.50 (409.50, 434.75) ms at 20 weeks and 424.00 (414.00, 435.25) ms at 24 weeks. There were statistically significant differences at 12, 16, 20 and 24 weeks comparing with the baseline (Z=-2.198,P=0.028;Z=-2.096,P=0.036;Z=-1.965,P=0.049;Z=-2.406,P=0.016). None of the 16 patients had QTcF>500ms. Conclusion The treatment regimen containing bedaquiline showed good clinical effectiveness and high safety in the treatment of MDR-TB patients, which can enrich the clinical drug selection for treating MDR-TB. Table and Figures | Reference | Related Articles | Metrics

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Resistance to fluoroquinolones and the influencing factors in patients with drug-resistant pulmonary tuberculosis SHI Wen-hui, CHU Nai-hui Chinese Journal of Antituberculosis    2021, 43 (9): 905-909.   DOI: 10.3969/j.issn.1000-6621.2021.09.009 Abstract （1023）   HTML （32）    PDF（pc） （766KB）（400）       Knowledge map    Save Objective To analyze the resistance to fluoroquinolones and the influencing factors in patients with drug-resistant pulmonary tuberculosis. Methods Retrospective analysis was conducted on 988 drug-resistant tuberculosis patients diagnosed and hospitalized in Beijing Chest Hospital, Capital Medical University from January 2015 to December 2020. All the subjects were positive in sputum mycobacterium culture and the strains were identified as Mycobacterium tuberculosis. All the patients were tested for drug sensitivity, and resistant to one or more of the following drugs: isoniazid, rifampicin, rifapentine, rifabutin, ethambutol, clofazimine, amikacin, prothiazide, clarithromycin, kanamycin, capreomycin, and streptomycin, etc. Proportional drug sensitivity test was used to detect the resistance of ofloxacin, levofloxacin, and moxifloxacin, etc. The drug resistance of subjects with different characteristics to fluoroquinolones was analyzed, and the influencing factors of fluoroquinolones resistance in patients with drug-resistant pulmonary tuberculosis were analyzed by multivariate logistic regression model. Results Among the 988 subjects, 431 were resistant to fluoroquinolones, and the resistance rate was 43.62%. Of the patients with fluoroquinolones resistant, 0.93% (4/431) were aged <18 years, 17.86% (77/431) were newly treated patients, and 14.62% (63/431) lived in Beijing, all the proportions were significantly higher than those of the patients sensitive to fluoroquinolones (3.05% (17/557), 36.98% (206/557) and 31.42% (175/557), respectively; χ 2 were 6.154, 43.453 and 37.508, respectively, all P<0.05); the patients with rifampicin resistance accounted for 94.66% (408/431), significantly higher than that in the patients sensitive to fluoroquinolones (84.38%, 470/557; χ 2=25.968, P<0.01); 3.81% (15/431) had a history of fluoroquinolones, and there was no significant difference compared to those who were sensitive to fluoroquinolones (2.98%, 15/557; χ 2=0.465, P=0.495). Multivariate logistic regression analysis showed that rifampicin resistance (OR(95%CI)=2.704 (1.585-4.615)) and history of fluoroquinolones (OR(95%CI)=2.661 (1.210-5.854)) were the risk factors of fluoroquinolones resistance in patients with drug-resistant pulmonary tuberculosis; while initial treatment (OR (95%CI)=0.402 (0.283-0.571)) and living in Beijing (OR (95%CI)=0.411 (0.289-0.585)) were the protective factors. Conclusion Drug-resistant pulmonary tuberculosis patients had a higher rate of resistance to fluoroquinolone drugs. The risk of fluoroquinolone drug resistance increased in patients with retreatment, rifampicin resistance, fluoroquinolone history, and non-Beijing residents. Table and Figures | Reference | Related Articles | Metrics

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CT imaging of inactive tuberculous pleurisy and active tuberculous pleurisy HE Wei, LYU Ping-xin, LYU Yan, WANG Dong-po, LI Cheng-hai, ZHOU Zhen, NING Feng-gang, LI Fang, WANG Yue, SUN Meng-yan, WANG Yi-chuan Chinese Journal of Antituberculosis    2022, 44 (4): 315-321.   DOI: 10.19982/j.issn.1000-6621.20210728 Abstract （1014）   HTML （21）    PDF（pc） （1529KB）（195）       Knowledge map    Save Objective: To investigate computed tomography (CT) features of inactive and active tuberculous pleurisy. Methods: A total of 68 patients with pure inactive tuberculous pleurisy admitted to Beijing Chest Hospital affiliated to Capital Medical University from June 1, 2012 to March 30, 2021 were analyzed retrospectively, and compared with the CT findings of 44 patients with active tuberculous pleurisy during the same period. Results: (1)The CT findings of inactive tuberculous pleurisy (68 cases):pleural adhesion 62 cases (91.2%), pleural calcification was 28 cases (41.2%), interlobular fissure involvment in 22 cases (32.4%), pleural effusion 12 cases (17.6%), and encapsulated effusion 8 cases (11.8%). (2)The CT findings of active tuberculous 44 cases: pleural adhesion 30 cases (68.2%), no pleural calcification was observed, pleurisy interlobular fissure involvement 32 cases (72.7%), pleural effusion 43 cases (97.7%),and encapsulated effusion 26 cases (59.1%). (3) Comparison of CT scan images of inactive and active tuberculous pleurisy: the incidence of pleural adhesion and pleural calcification were higher, with statistical significance (χ2=9.630,P=0.002;χ2=23.737,P=0.000, respectively); the incidence of interlobar fissure involvement, pleural effusion and encapsulated pleural effusion was lower, and the differences were statistically significant (χ2=12.692,P=0.000;χ2=68.548,P=0.000;χ2=28.301,P=0.000,respectively). Conclusion: In comparison of CT scan images of inactive and active tuberculous pleurisy,the incidence of pleural adhesion and pleural calcification of inactive tuberculous pleurisy was higher but the incidence of pleural effusion, encapsulated effusion, and interlobar fissure involvement was lower. The identification of CT scan features of inactive and active tuberculous pleurisy is helpful to guide clinical treatment of patients. Table and Figures | Reference | Related Articles | Metrics

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Clinical study on one-stage focal debridement and total hip replacement for treating active hip tuberculosis YAO Li-ming, DONG Zhao-liang, YAO Xiao-wei, WANG Lian-bo, JIA Chen-guang, LI Zhuo, LIU Feng-sheng Chinese Journal of Antituberculosis    2022, 44 (2): 147-152.   DOI: 10.19982/j.issn.1000-6621.20210580 Abstract （991）   HTML （22）    PDF（pc） （1557KB）（143）       Knowledge map    Save Objective: To evaluate the therapeutic plan and clinical effectiveness of one-stage focal debridement and total hip replacement (THR) in treatment of active hip tuberculosis. Methods: A retrospective analysis was done for 25 cases of active hip tuberculosis who were treated with one-stage focal debridement and THR in Hebei Chest Hospital from June 2015 to June 2018. All patients were treated with anti-tuberculosis chemotherapy regularly for 4-8 weeks (average (6.20±1.22) weeks). The abscess, acetabular sequestra and synovium around the joint were cleared in all operations. The removed normal femoral neck issue were used as implants in area of bone defects and cementless THR as artificial arthroplasty. All cases were confirmed as hip tuberculosis by pathological examination. Anti-tuberculosis treatment were applied for at least 18 months after operations. Operative conditions, healing of lesions, the erythroeyte sedimentation rate (ESR), the C-reactive protein (CRP), position of the prostheses, recovery of hip functions and complications were observed. Results: The follow-up period ranged from 24 to 60 months (average (35.62±8.64) months). The average ESR on 1 d preoperative, 1 month postoperative and at the last time of follow-up were (41.64±12.10) mm/1 h, (23.36±5.87) mm/1 h and (9.88±2.01) mm/1 h, respectively; the average CRP were (43.60±10.35) mg/L, (14.00±3.16) mg/L and (3.80±1.19) mg/L, respectively; the average Harris hip pain scores were 18.40±4.73, 41.68±3.15 and 43.52±1.33, respectively; the average Harris hip total scores were (33.00±6.01), (92.52±3.64), and (97.36±1.80), respectively; The average ESR and CRP on 1 month postoperative and at the last time of follow-up were significantly lower than those on 1 d preoperative (F=103.008, P<0.001; F=270.299, P<0.001). The average Harris hip pain scores and total scores on 1 month postoperative and at the last time of follow-up were significantly improved from 1 d preoperative (F=432.654, P<0.001; F=1832.393, P<0.001). All patients had first intention healing. No deep venous thrombosis, pulmonary embolism, periprostheyic fracture or joint dislocation happened. There were 1 case having incision ruptured into chronic sinus at 6 weeks after surgery, and got lesions healed after dressing and applying ointment for 2 months. Other cases all got recovered with no complications. The joint prosthesis were all well positioned during the follow-up period and no recurrence were observed. Conclusion: Peroperative effective anti-tuberculosis chemotherapy combined with one-stage debridement and THR in treatment of hip joint tuberculosis can significantly decrease hip pain and improve the hip function. Table and Figures | Reference | Related Articles | Metrics

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Analysis of the therapeutic effect of probiotics combined with enteral nutrition on patients with comorbidity of tuberculosis and type 2 diabetes with malnutrition TANG Han-mei, ZHANG Sheng-kang, YAN Mi, YUAN Dan, CAO Han-juan, ZHANG Xiao-bing, BAI Li-qiong, YI Heng-zhong, TANG Xi-liang Chinese Journal of Antituberculosis    2021, 43 (10): 1027-1031.   DOI: 10.3969/j.issn.1000-6621.2021.10.010 Abstract （970）   HTML （10）    PDF（pc） （716KB）（170）       Knowledge map    Save Objective To assess the effects of probiotics combined with enteral nutrition on patients with comorbidity of pulmonary tuberculosis-type 2 diabetes mellitus (PTB-T2DM) with malnutrition. Methods Since January 5, 2018, patients with PTB-T2DM and malnutrition admitted in Hunan Chest Hospital were randomly allocated in observation group and control group using random number table. By December 15, 2020, 150 patients were enrolled in the study, 75 in the observation group (age: (60.8±8.6) years) and 72 in the control group (age: (57.9±10.6) years).The control group was treated with conventional anti-tuberculosis treatment, hypoglycemic diet and low GI enteral nutrition solution; the observation group was prescribed with probiotics additionally. Hemoglobin (Hb), albumin (Alb) and body mass index (BMI) were assessed before and after 14 days’ nutritional treatment. The occurrences of gastrointestinal adverse reactions such as nausea and vomiting during the nutritional treatment of those two groups were observed. Results After 14 days’ nutritional treatment, a significantly higher proportion of patients in the observation group had meaningful clinical response than in the control group based on the Hb, Alb and BMI ((104.69±16.37) g/L, (32.80±6.76) g/L and 19.23±3.04 vs (100.80±15.59) g/L, (32.44±4.77) g/L and 20.38±3.11, t values were 2.667, 2.023, 2.288, and P values were 0.008, 0.046, 0.023, respectively). The incidence of abdominal distension, diarrhea and constipation were lower in the observation group compared with the control group (5.33% (4/75), 2.67% (2/75) vs 18.06% (13/72), 12.50% (9/72), respectively, χ2 of abdominal distension and constipation were 5.841 and 5.131, P values were 0.016, 0.024, respectively). The incidence of diarrhea was using performed by Fisher’s exact test, it shown that the observation group had lower incidence than control group (1.33% (1/75) vs 9.72% (7/72)). Conclusion Probiotics combined with enteral nutrition can significantly improve the nutritional status and prognosis of PTB-T2DM patients with malnutrition. Table and Figures | Reference | Related Articles | Metrics

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CT features in patients with inactive and active pulmonary tuberculosis LI Chun-hua, LIU Xue-yan, TANG Guang-xiao, SHU Wei-qiang, WANG Yao, WANG Jia-nan, ZHENG Jiao-feng, LI Yong-mei, LYU Sheng-xiu Chinese Journal of Antituberculosis    2022, 44 (4): 329-335.   DOI: 10.19982/j.issn.1000-6621.20210713 Abstract （959）   HTML （30）    PDF（pc） （1761KB）（274）       Knowledge map    Save Objective: To investigate the CT features in patients with inactive pulmonary tuberculosis and active pulmonary tuberculosis. Methods: All of 181 patients with inactive pulmonary tuberculosis (inactive group) and 166 patients with active pulmonary tuberculosis (active group) diagnosed and treated in Chongqing Public Health Medical Center from August 2020 to July 2021 were retrospectively collected, and CT manifestations in the two groups were analyzed. Results: The percentages of lesions involving one lobe (19.9% (36/181)) and two lobes (25.4% (46/181)) in the inactive group were significantly higher than that in the active group (10.8% (18/166) and 13.3% (22/166), respectively)(χ2=5.392 and 8.128 respectively, and P=0.020 and 0.004, respectively). The percentage of lesions involving 5 lobes (21.5% (39/181)) was significantly lower than that in the active group (48.2% (80/166))(χ 2=27.283, P=0.000). The percentages of lesions in the right middle lobe and lower lobe as well as the left lower lobe (38.7% (70/181), 45.3% (82/181) and 46.4% (84/181), respectively) were also significantly lower than those in the active group (69.9% (116/166), 77.1% (128/166) and 68.7% (114/166))(χ 2=33.903, 36.657, 17.520; Ps=0.000). CT findings: the incidences of patchy consolidation (22.1%, 40/181), caseous lesions (0.6%, 1/181), cavity (16.6%, 30/181), pleural effusion (0.6%, 1/181), lymphadenopathy (18.8%, 34/181) and tree-in-bud signs (18.2%, 33/181) in the inactive group were significantly lower than those in the active group (80.1% (133/166), 7.2% (12/166), 27.1% (45/166), 31.9% (53/166), 53.6% (89/166), 66.9% (111/166))(χ 2=116.598, 10.703, 5.671, 64.868, 45.906 and 84.365, respectively, and P=0.000, 0.001, 0.017, 0.000, 0.000, 0.000, respectively). The incidences of bronchiectasis (61.3%, 111/181), parenchyma cavity (12.2%, 22/181), pleural calcification (10.5%, 19/181), calcified nodules (34.8%, 63/181), sclerosis (37.0%, 67/181) and fibrosclerosis (91.7%, 166/181) in the inactive group were significantly higher than those in the active group (44.0% (73/166), 4.2% (7/166), 3.6% (6/166), 16.9% (28/166), 0.6% (1/166), 27.7% (46/166))(χ 2=10.464, 7.124, 6.135, 14.403, 70.576 and 149.222 respectively, and P=0.001, 0.008, 0.013, 0.000, 0.000 and 0.000, respectively). Conclusion: The lesions of inactive pulmonary tuberculosis in the lower lobe are less distributed, and fibrosclerosis, bronchiectasis, sclerosis, calcified nodules and pleural calcification are more common signs on CT. CT scanning plays an important role in assessing the activity of pulmonary tuberculosis. Table and Figures | Reference | Related Articles | Metrics

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Progress in diagnosis and treatment of Mycobacterium avium-intracellular complex vertebral osteomyelitis Zhou Weidong, Zhang Zhengdong, Lin Mei, Li Tongxia Chinese Journal of Antituberculosis    2023, 45 (4): 420-425.   DOI: 10.19982/j.issn.1000-6621.20230020 Abstract （956）   HTML （154）    PDF（pc） （779KB）（260）       Knowledge map    Save In recent years, more and more reports have been reported about the spinal infection of Mycobacterium avium-intracellular complex (MAC) group, and more cases of clinical misdiagnosis and mistreatment have been reported. The treatment effect of this disease is poor. This paper reviews the epidemiology and susceptibility factors of MAC vertebral osteomyelitis, the clinical manifestations, imaging examination and laboratory examination, and analyzes the causes of misdiagnosis and unsatisfactory therapeutic effect, so as to help clinicians understand more about MAC spinal infection, and promote the standardized diagnosis and treatment of MAC vertebral osteomyelitis. Reference | Related Articles | Metrics

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Guideline for clinical management of adverse reactions of bacillus Calmette-Guérin Chinese Journal of Antituberculosis    2021, 43 (6): 532-538.   DOI: 10.3969/j.issn.1000-6621.2021.06.002 Abstract （949）   HTML （55）    PDF（pc） （1107KB）（722）       Knowledge map    Save Bacillus Calmette-Guérin (BCG) is a live attenuated vaccine against tuberculosis, and is one of the most widely used and safest vaccines in the world. The prevalence and mortality of miliary tuberculosis and tuberculous meningitis in children have significantly decreased since being vaccinated with BCG from 1978 in China. BCG is applicated in the prevention of tuberculosis, in addition, it is also commonly used in perfusion therapy for bladder carcinoma in situ. BCG instillation helps to reduce and delay the recurrence and progression of non-muscle invasive bladder carcinoma, it is considered as the best intravesical instillation drug at present. However, due to the production process, the virulence of the vaccine, the methods of usage of the vaccine, individual differences and other factors, the adverse reactions after BCG vaccination and perfusion often occur. The clinical treatment of BCG adverse reactions has not been standardized by now. Therefore, the Tuberculosis Branch of Chinese Medical Association, the School and Children Tuberculosis Branch of Chinese Antituberculosis Association organized some experts to formulated the “Guideline for Clinical Treatment of BCG Adverse Reactions” after discussions. The guideline includes the types of BCG, the methods of usage, and clinical characteristics, diagnostic criteria, treatment and prevention of the adverse reactions of BCG vaccine, in order to standardize with the treatment for the adverse reactions of BCG. Reference | Related Articles | Metrics

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Analysis of gene polymorphism of Mycobacterium tuberculosis with negative MPT64 antigen in culture filtrate ZHAO Guo-lian, TAN Xiao-wen, CUI Xiao-li, DANG Li-yun Chinese Journal of Antituberculosis    2021, 43 (7): 659-663.   DOI: 10.3969/j.issn.1000-6621.2021.07.004 Abstract （945）   HTML （16）    PDF（pc） （884KB）（331）       Knowledge map    Save Objective To analyze the gene polymorphism of Mycobacterium tuberculosis (MTB) with negative MPT64 antigen in culture filtrate. Methods A total of 1962 mycobacteria clinical isolates were collected from Xi’an Chest Hospital between January 2018 and June 2020 were retrospectively analyzed. The samples were from sputum, bronchoalveolar lavage fluid and pleural effusion, positive in BACTEC MGIT 960 and confirmed by Ziehl-Neelsen anti-acid dyeing method. They were also tested by MPT64 antigen detection (colloidal gold immune-chromatography), p-nitrobenzoic acid/thiophene-2-carboxylic acid hydrazide (PNB/TCH) growth test and mycobacterial species identification (DNA microarray chip method). When results of MPT64 antigen test and the mycobacterial species identification was not inconsistent, GeneXpert MTB/RIF and PNB culture test were performed. MPT64 gene sequencing was performed on 14 strains identified as MTB but negative in MPT64 antigen test. Results Among the 1962 clinical isolates of mycobacteria, 88 (4.5%) were NTM and 1874 (95.5%) were MTB. By MPT64 antigen detection, 87 non-tuberculous mycobacteria (98.9%) and 14 MTB (0.7%) were negative. The results of MPT64 gene sequencing showed that 92.9% (13/14) of the 14 MTB clinical isolates negative in MPT64 antigen detection had mutations in nucleotides 197-259 and amino acid deletions at positions 66-86 of the MPT64 protein gene, and the other one had an IS6110 gene fragment of 1361 bp inserted at position 587. Conclusion The main reason for the false negative detection of the MTB strain in MPT64 antigen test might be the deletion mutation of nucleotides 197-259 of the MPT64 protein gene, and the insertion of IS6110 fragment might also cause the false negative detection. Table and Figures | Reference | Related Articles | Metrics

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Analysis of efficacy in the treatment of 44 pulmonary tuberculosis patients with mycobacterium culture-positive multidrug-resistant/extensively drug-resistant with bedaquiline-containing regimen for 24 weeks PEI Yi, GAO Jing-tao, HUANG Yun-hui, HE Fang, FENG Wen-jun, YANG Xiao-yun, HU Yu-meng, LEI Li-ping, SHI Li Chinese Journal of Antituberculosis    2021, 43 (11): 1139-1145.   DOI: 10.3969/j.issn.1000-6621.2021.11.007 Abstract （921）   HTML （14）    PDF（pc） （1033KB）（265）       Knowledge map    Save Objective To evaluate the efficacy and safety of 24-week bedaquiline (Bdq)-containing regimen on multidrug-resistant pulmonary tuberculosis and extensively drug-resistant pulmonary tuberculosis (MDR/XDR-PTB) patients and provide clinical evidence for further safe and effective use in more Chinese MDR/XDR-PTB patients. Methods Forty-four patients with mycobacterium culture-positive MDR-TB and XDR-TB were enrolled in Changsha Central Hospital Affiliated to University of South China from March 2018 to March 2020 and then treated with Bdq-containing regimen. Out of them, 31 were males and 13 were females with a median age of 38.2 (26, 49) years in the whole, while 25 with pulmonary cavities. The efficacy of the regimen was evaluated by culture conversion rates and pulmonary cavity closure rate at the end of 24 weeks, and the safety was evaluated by the incidence of adverse events, especially the occurrence of QT prolongation. Results Out of 44 patients, 38 achieved successful culture conversion, 2 failed sputum conversion, 2 died, 1 dropped out, and 1 lost to follow-up, with favorable outcome at 86.4% (38/44). Forty patients completed 24 weeks of Bdq treatment, and the culture conversion rates were 45.5% (20/44), 72.5% (29/40), 95.0% (38/40), 100.0% (40/40) and 95.0% (38/40) at the end of 2, 4, 8, 12 and 24 weeks, respectively, with the median conversion time at 22 days (interquartile range IQR18-59). Among the 25 patients with pulmonary cavities, 23 completed 24 weeks of treatment, and the rate of pulmonary cavity closure was 39.1% (9/23) and 82.6% (19/23) at the end of 12 and 24 weeks, respectively. Twenty-nine patients (65.9%, 29/44) reported a total of 81 adverse events (AEs), 72.8% (59/81) of which were grade 1 or 2.QT prolongation was the most common one probably associated with Bdq (40.9%,18/44). Conclusion Inclusion of Bdq in the regimen can achieve higher rates of culture conversion and cavity closure at the end of 24 weeks with acceptable safety profiles in MDR/XDR-TB patients. Table and Figures | Reference | Related Articles | Metrics

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Expert consensus on diagnosis and treatment of latent tuberculosis infection in patients with rheumatic diseases National Clinical Research Centre for Infectious Disease/The Third People’s Hospital of Shenzhen, Peking University Shenzhen Hospital, Peking Union Medical College Hospital of Chinese Academy of Medical Sciences, Chinese Antituberculosis Association, Editorial Board of Chinese Journal of Antituberculosis, Shenzhen Key Laboratory of Inflammatory and Immune Diseases Chinese Journal of Antituberculosis    2022, 44 (9): 869-879.   DOI: 10.19982/j.issn.1000-6621.20220225 Abstract （912）   HTML （61）    PDF（pc） （1599KB）（793）       Knowledge map    Save Rheumatic diseases are autoimmune diseases that occur when an individual’s immune system mistakenly attacks healthy tissues, and are often treated with glucocorticoids, immunosuppressants, biological agents, and small-molecule targeted drugs, etc., which can lead to an increased risk of other autoimmune dysfunctions in patients and the activation of latent tuberculosis infection (LTBI). Therefore, LTBI screening in clinical is essential for patients with rheumatic diseases who meet the screening criteria. This requires greater collaboration and awareness between rheumatologists and tuberculosis physicians, to conduct scientific assessment for patients with rheumatic diseases who need LTBI screening, and to develop preventive treatment guidelines to prevent patients with rheumatic diseases from developing active tuberculosis after LTBI. Therefore, the National Clinical Research Centre for Infectious Disease/The Third People’s Hospital of Shenzhen, Peking University Shenzhen Hospital, Peking Union Medical College Hospital of Chinese Academy of Medical Sciences, Chinese Antituberculosis Association, Editorial Board of Chinese Journal of Antituberculosis and Shenzhen Key Laboratory of Inflammatory and Immune Diseases joint effort in the publication of an expert consensus on the diagnosis and treatment of LTBI in patients with rheumatic diseases. This consensus is based on the epidemiology, evidence-based medicine, and clinical research of rheumatic diseases complicated with LTBI, and has been discussed for many times and reached consensus. It can serve as a reference. Table and Figures | Reference | Related Articles | Metrics

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Interpretation of WHO consolidated guidelines on tuberculosis, Module 4: treatment-drug-resistant tuberculosis treatment, 2022 update Fu Liang, Ren Tantan, Zhang Peize, Lu Shuihua Chinese Journal of Antituberculosis    2023, 45 (4): 336-348.   DOI: 10.19982/j.issn.1000-6621.20220523 Abstract （909）   HTML （80）    PDF（pc） （1104KB）（704）       Knowledge map    Save World Health Organization (WHO) published the WHO consolidated guidelines on tuberculosis, Module 4: treatment-drug-resistant tuberculosis treatment, 2022 update on February 15, 2022. The author introduced the main points of the updated guidelines, including the recommendations on the treatment of drug-resistant tuberculosis (focusing on a new short-term plan), management, patient care, and treatment monitoring, and discussed the feasibility of the guidelines in clinical practice and future research directions in China. Reference | Related Articles | Metrics

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Research progress of molecular biology detection technology for tuberculosis FAN Ru, LI Xiao-fei Chinese Journal of Antituberculosis    2022, 44 (3): 294-298.   DOI: 10.19982/j.issn.1000-6621.20210646 Abstract （901）   HTML （47）    PDF（pc） （774KB）（461）       Knowledge map    Save With the continuous development of medical science and technology, especially the advent of the era of precise diagnosis and treatment, molecular biology detection technology has been widely valued and applied in the early diagnosis of tuberculosis. Molecular biological detection technology has the advantages of accuracy, high efficiency and high throughput, which brings a new dawn for the diagnosis and treatment of tuberculosis and the prevention and control of the epidemic. Researches at home and abroad were summarized to expound the application status and the latest research progress based on nucleic acid amplification test technology, gene sequencing tuberculosis detection and drug sensitivity analysis technology and other new tuberculosis detection technology, in order to provide reference for the auxiliary diagnosis of tuberculosis. Reference | Related Articles | Metrics

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Interpretation of Rifampicin-resistant pulmonary tuberculosis diagnostic process LI Ren-zhong, RUAN Yun-zhou, SU Wei, HE Yu-ying, LIU Kuang-yi Chinese Journal of Antituberculosis    2021, 43 (11): 1113-1115.   DOI: 10.3969/j.issn.1000-6621.2021.11.002 Abstract （901）   HTML （32）    PDF（pc） （1068KB）（435）       Knowledge map    Save The Rifampicin-resistant Pulmonary Tuberculosis Diagnostic Process is a group standard issued by Chinese Antituberculosis Association on May 12, 2021 and implemented since then. The standard specifies the diagnostic algorithms of rifampicin resistant pulmonary tuberculosis patients under different technical conditions: the drug resistance diagnosis process of traditional drug sensitivity detection technology, the drug resistance diagnostic progress of combination of molecular biology drug resistance detection technology and traditional drug sensitivity detection technology, multi-color nested real-time fluorescence quantitative PCR, molecular biology drug resistance detection technology and drug resistance diagnosis process of combination of traditional drug sensitivity detection technology. The main contents and applicable conditions of this standard are hereby interpreted. Reference | Related Articles | Metrics

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Expert advice on anti-novel coronavirus vaccination for tuberculosis patients Tuberculosis Branch of Chinese Medical Association Chinese Journal of Antituberculosis    2021, 43 (12): 1239-1242.   DOI: 10.3969/j.issn.1000-6621.2021.12.003 Abstract （900）   HTML （34）    PDF（pc） （1096KB）（398）       Knowledge map    Save The epidemic of Corona Virus Disease 2019 (COVID-19) is still widespread in the world. As an important measure to control the epidemic, the COVID-19 vaccine is being promoted worldwide. Tuberculosis (TB) patients are high risk group to be infected by COVID-19 and suffer severe, therefore, priority vaccinate should be given to them. However, at present, there is not enough evidence of high quality evidence-based medicine for whether TB patients could be vaccinated and how to vaccinated COVID-19 vaccine. Based on WHO recommendations and related technical guidelines in China, as well as combined with the actual situation of TB patients, the Tuberculosis Branch of Chinese Medical Association, put forward the expert advice on vaccination for this special group. It is recommended that all TB patients should be vaccinated except for active TB patients in the course of anti-tuberculosis reinforcement or combined with other unstable chronic diseases. Reference | Related Articles | Metrics

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Analysis of therapeutic effects and factors affecting treatment outcomes of Mycobacterium abscessus subspecies abscessus pulmonary disease for 6 months Bao Shengjuan, Shao Lingling, Wang Jing, Han Xiqin, Huang Hairong, Duan Hongfei Chinese Journal of Antituberculosis    2023, 45 (4): 349-354.   DOI: 10.19982/j.issn.1000-6621.20220522 Abstract （894）   HTML （32）    PDF（pc） （774KB）（230）       Knowledge map    Save Objective: To assess the efficacy of different antibiotics combined on Mycobacterium abscessus subspecies abscessus pulmonary disease (M.abscessus-PD) and analyze the influencing factors of treatment outcomes for 6 months. Methods: Sixty-six patients in Beijing Chest Hospital, Capital Medical University diagnosed with M.abscessus-PD were enro1led prospectively from January 1st, 2016 to October 1st, 2022. Clinical information of the patients were collected, including gender, age, body mass index, clinical manifestations, history of past illness and anti-tuberculosis treatment, imaging examinations, laboratory examinations and medications. The factors influencing treatment outcomes of M.abscessus-PD for 6 months among different therapicregimens was compared. Results: After 6 months of treatment, 32 (48.5%) achieved sputum culture conversion and 34 (51.5%) didn’t among the 66 patients. The result shows that the 6-month sputum culture conversion rate of azithromycin users (57.4%, 27/47) was higher than clarithromycin users (26.3%, 5/19), with statistically significant (χ2=5.250,P=0.022). In 24 cases (36.4%, 24/66) treated with imipenem, 17 (70.8%, 17/24) achieved 6 months sputum culture conversion, which was higher than that of non-imipenem (35.7%, 15/42), with statistically significant difference (χ2=7.542, P=0.006). The efficacy of multidrug therapy regimen showed that macrolide combined with amikacin, imipenem, linezolid and clofazimine achieved 68.4% (13/19) culture conversion rate after 6 months. Multivariate analysis shows that patients treated with macrolide combined with imipenem were more likely to achieve sputum culture conversion within 6 months (OR (95%CI)=0.229 (0.077-0.676)). Conclusion: In the initial stage of treatment, at least 4 weeks of injection use (amikacin and imipenem), and the combination of macrolides with amikacin, clofazimine, and linezolid in the continued treatment, may have good curative effect on M.abscessus-PD. Table and Figures | Reference | Related Articles | Metrics

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Research status of drug resistance of antituberculosis drugs bedaquiline and clofazimine Shang Yuanyuan, Nie Wenjuan, Huang Hairong, Chu Naihui Chinese Journal of Antituberculosis    2023, 45 (1): 116-122.   DOI: 10.19982/j.issn.1000-6621.20220292 Abstract （874）   HTML （24）    PDF（pc） （815KB）（267）       Knowledge map    Save The emergence of multidrug-/rifampicin-resistant tuberculosis (MDR/RR-TB) and extensively drug-resistant tuberculosis (XDR-TB) poses a huge threat to tuberculosis (TB) control worldwide. Due to the lack of effective drugs, the success rate for MDR-TB patients was only 59%, and less than 50% for XDR-TB patients. In recent years, the application of the new anti-TB drug bedaquiline (Bdq) and the old drug clofazimine (Cfz) in patients with MDR/RR-TB and XDR-TB can significantly improve the treatment outcomes of patients. Both drugs work by impairing energy metabolism of mycobacterium and are still used in combination by clinicians in clinical care despite cross-resistance. Therefore, in the process of clinical application, attention should be paid not only to the adverse drug reactions, but also to the drug resistance of Bdq and Cfz. The author aims to summarize the mechanisms associated with drug resistance of Bdq and Cfz, the emergence of drug resistance of Bdq and Cfz in clinical treatment, and to discuss how to delay the accumulation and spread of acquired drug resistance of Bdq and Cfz. Table and Figures | Reference | Related Articles | Metrics

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Evidence-based guidelines for active screening of pulmonary tuberculosis in Chinese communities Tuberculosis Control Branch of Chinese Antituberculosis Association, Elderly Tuberculosis Control Branch of Chinese Antituberculosis Association, Editorial Board of Chinese Journal of Antituberculosis Chinese Journal of Antituberculosis    2022, 44 (10): 987-997.   DOI: 10.19982/j.issn.1000-6621.20220321 Abstract （869）   HTML （73）    PDF（pc） （1257KB）（642）       Knowledge map    Save To achieve the goals of the End Tuberculosis Strategy, stronger measures are urgently needed to improve the detection and treatment of tuberculosis, and active screening is an important part of achieving the goals to ensure early diagnosis of tuberculosis. Tuberculosis Control Branch and Elderly Tuberculosis Control Branch of Chinese Antituberculosis Association, and Editorial Board of Chinese Journal of Antituberculosis organized experts to develop the Chinese guidelines for active screening of pulmonary tuberculosis in communities based on the evidence and recommendations of the latest World Health Organization guidelines in 2021. The guidelines also supplemented follow-up newly published literature and relevant literature and research evidence in China. The guidelines systematically summarized the characteristics of active screening techniques such as symptom screening, chest imaging and C-reactive protein, and proposed to conduct pulmonary tuberculosis active screening among close contacts of pulmonary tuberculosis patients, former tuberculosis patients, HIV/AIDS patients, the elderly, diabetic patients, and the general population in epidemic areas. It would provide a basis for the country and localities to improve and optimize the active tuberculosis screening strategy of key populations. Table and Figures | Reference | Related Articles | Metrics

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Estimation of the national burden on latent tuberculosis infection based a multi-center epidemiological survey and the space statistics model GAO Lei, ZHANG Hui, HU Mao-gui, XU Cheng-dong, XIA Yin-yin, LI Tao, CHEN Wei, HE Yi-jun, CAO Xue-fang, XIN He-nan, ZHANG Hao-ran, ZHAO Yan-lin, WANG Jin-feng, CHENG Shi-ming, JIN Qi, LIU Jian-jun Chinese Journal of Antituberculosis    2022, 44 (1): 54-59.   DOI: 10.19982/j.issn.1000-6621.20210661 Abstract （868）   HTML （63）    PDF（pc） （3480KB）（531）       Knowledge map    Save Objective: To estimate the prevalence of latent tuberculosis infection (LTBI) in China, which would provide essential evidence for improving the comprehensive strategy of tuberculosis (TB) control. Methods: The data of multi-center LTBI epidemiological survey in 2013 and the nationwide incidence of reported TB by counties between 2013-2019 were collected, and the prevalence of LTBI was estimated by using the Biased Sample Hospital-based Area Disease Estimation (B-SHADE). The accuracy was verified by using cross validation method with the survey data of two additional study sites. Results: In 2013, the prevalence of LTBI in people 5 years old and above was 18.08% (95%CI: 13.73%-22.42%) and in people 15 years old and above was 20.34% (95%CI: 15.63%-25.06%), respectively. The LTBI prevalence showed a trend of increasing with age and it was significantly higher in men (24.02% (95%CI: 18.27%-29.77%)) than that in women (16.91% (95%CI: 12.13%-21.70%)) at 15 years old and above group. The average absolute error of the estimations of two additional verification sites by B-SHADE model was found to be 0.95%. Conclusion: The prevalence of LTBI estimated by using the results of multi-center epidemiological survey and B-SHADE method makes up the lack of relevant data in recent years, which will provide evidence for China to timely strengthen LTBI management in target populations and to improve the prevention based TB control strategy. Table and Figures | Reference | Related Articles | Metrics

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Analysis of diagnosis and treatment for a pulmonary lymphangitic carcinomatosis misdiagnosed as pulmonary tuberculosis caused by false positive molecular biological test YANG Cheng-qing, MEI Chun-lin, DU Rong-hui, LEI Mei, QIN Li-xin Chinese Journal of Antituberculosis    2022, 44 (3): 289-293.   DOI: 10.19982/j.issn.1000-6621.20210561 Abstract （856）   HTML （12）    PDF（pc） （1778KB）（300）       Knowledge map    Save On April 17, 2019, a 69-year-old male patient with pulmonary lymphangitic carcinomatosis was admitted to the Respiratory Department of Wuhan Pulmonary Hospital,and diagnosed as pulmonary tuberculosis due to the positive tuberculosis molecular biological result in other hospital. The patient was hospitalized because of “pulmonary shadow for 3 months and intermittent cough for 2 months”. He had previously been diagnosed with colon cancer. Chest CT scan revealed diffusing nodules along bronchovascular bundles with ground glass shadows, interlobular septal thickening, bilateral hilar and mediastinal lymph node enlargement and bilateral pleural effusion. In bronchoalveolar lavage fluid (BALF), MTB (extremely low) was detected by GeneXpert MTB/RIF (referred to as “GeneXpert”) and MTB was detected by TB-PCR in previous hospital. Therefore, he was diagnosed as tuberculosis, then transferred to Wuhan Pulmonary Hospital. After admission, relevant examinations were completed. PPD skin test and interferon gamma release test was negative, and chest CT imaging features were not consistent with pulmonary tuberculosis. We suspected it was a false positive molecular biological result. Therefore, GeneXpert and tracheal endoscopic ultrasound-guided needle aspiration biopsy (EBUS-TBNA) were recommended. However, the patient refused. The doctor performed a pleural puncture for diagnosis, and 20 ml pleural effusion was extracted. The examination showed that the carcinoembryonic antigen (118.4 μg/L) was significantly elevated, indicating malignant pleural effusion. Finally, medical thoracoscopic pleural biopsy revealed metastatic poorly differentiated adenocarcinoma. Combined with chest CT findings, the patient was diagnosed as pulmonary lymphangitic carcinomatosis who later died due to deterioration of his condition. Therefore, the authors suggest that radiographic findings of nodules along the bronchovascular bundle with thickening of interlobular septa and mediastinal lymph node enlargement should be considered as pulmonary lymphangitic carcinomatosis for differential diagnosis. When imaging findings are not consistent with tuberculosis and molecular biological test is positive, we should be cautious about diagnosing tuberculosis to avoid misdiagnosis and mistreatment. Table and Figures | Reference | Related Articles | Metrics

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Changes of plasma concentration of bedaquiline during the treatment of drug-resistant pulmonary tuberculosis and its assocation with QTc interval prolongation XIE Li, ZHU Hui, GAO Jing-tao, LIU Zhong-quan, MA Li-ping, ZHANG Li-qun, GE Qi-ping, NIE Li-hui, KONG Zhong-shun, WU Xiao-guang, LIU Rong-mei, CHEN Hong-mei, SONG Yan-hua, LI Qiang, LYU Zi-zheng, LIU Yu-hong, LU Yu, PANG Yu, GAO Meng-qiu Chinese Journal of Antituberculosis    2022, 44 (3): 219-226.   DOI: 10.19982/j.issn.1000-6621.20210696 Abstract （855）   HTML （31）    PDF（pc） （1056KB）（201）       Knowledge map    Save Objective: To explore the changes of plasma concentration of bedaquiline during the treatment in patients with drug-resistant pulmonary tuberculosis and its association with QTc interval prolongation. Methods: All 119 patients with multidrug-resistant/rifampicin resistant pulmonary tuberculosis (MDR/RR-PTB) were enrolled prospectively according to the inclusion criteria in Beijing Chest Hospital from Feb. 2018 to Feb. 2020, provided with individualized bedaquiline-containing regimen by the expert group. Baseline information were collected before the first dose of bedaquiline and electrolyte (potassium, calcium and magnesium), blood routine, urine routine, hepatic and renal function, QTcF value and plasm drug concentration of bedaquiline were serially recorded at different time points post treatment initiation. Univariate and multivariate logistic regression analysis were performed to analyze the risk factors associated with QTc interval prolongation. Results: All 119 patients had completed full course of 72 week-treatment and were in period of post treatment follow-up. Out of them, 5 (4.2%) had QTcF >500ms within 24 weeks and bedaquiline was discontinued as per protocol; 114 patients completed full doses of bedaquiline, among which 53 took for 24 weeks and 61 took for 36 weeks. For the 114 patients who completed full administration of bedaquiline, their trough concentration was highest at the end of week 2 (1.753(1.365,2.412) μg/ml), significantly higher(Z=-9.222,P<0.001;Z=-7.798,P<0.001)than that at the end of week 4 (0.830(0.586,1.035) μg/ml) and week 24 (1.098(0.909,1.440) μg/ml) while it was higher at the end of week 24 than that at week 4 with significance(Z=-7.826,P<0.001). No matter patients with 24-week or 36-week bedaquiline exposure, the plasma concentration of it returned to the level at the end of week 4 (0.769(0.500,0.947) μg/ml and 0.824(0.642,1.023) μg/ml) respectively after bedaquiline was discontinued for 12 weeks. Furthermore, the plasma concentration of it was still close to the effective value (0.6 μg/ml) after bedaquiline was discontinued for 24 weeks. The trend for the QTcF value was basically consistent with that of bedaquiline plasma concentration which presented gradual increase with bedaquiline accumulated administration and hit the peak before and after its discontinuation, then decreased gradually. Eight cases (6.7%) had QTcF>500ms, 36 cases (30.3%) had QTcF>450ms and no serious ventricular arrhythmia was found in all patients during the above observation period. Multivariate analysis indicated that elder age (≥55 years), low body mass index (<18.5) and hypocalcemia (<2.3 mmol/L) were the risk factors for occurrence of QTc interval prolongation (OR (95%CI)=7.056 (1.841-27.043),3.850 (1.236-11.989), 2.786 (1.029-7.541)). Conclusion: Given the long half-life of bedaquiline, its effective plasma concentration could maintain until 24 weeks post its discontinuation. Moreover, extending bedaquiline exposure to 36 weeks presented safe and effective.During bedaquiline administration, the occurrence of QTc interval prolongation was relatively high but severity grade was mainly mild to moderate. ECG monitoring should be intensified for patients with elder age, low body mass index and hypocalcemia. Table and Figures | Reference | Related Articles | Metrics

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Analysis of direct medical costs and influencing factors of pulmonary tuberculosis patients in Chongqing ZHANG Ting, SU Qian, WU Cheng-guo, WANG Qing-ya, LEI Rong-rong, CHEN Jian Chinese Journal of Antituberculosis    2021, 43 (9): 910-915.   DOI: 10.3969/j.issn.1000-6621.2021.09.010 Abstract （853）   HTML （25）    PDF（pc） （774KB）（213）       Knowledge map    Save Objective To investigate the direct medical expenses of active pulmonary tuberculosis (PTB) patients in Chongqing and analyze the influencing factors. Methods Clinical data of PTB patients (excluded patients with simple extra-pulmonary tuberculosis and rifampicin-resistant tuberculosis) registered in 41 district/county level TB hospitals in Chongqing from January to December in 2019 were collected from the subsystem (Tuberculosis Information Management System) of the China Information System for Disease Control and Prevention, and match with the diagnosis, treatment and cost information (such as outpatient and inpatient records, charging and reimbursements, etc.) of TB medical institutions at the municipal and district/county level in Chongqing from January 1, 2019 to May 31, 2020. Finally, 11745 patients who had been cured or had completed the treatment were included. Single-factor analysis and multi-factor generalized linear model analysis were used to investigate the direct medical expenses and influencing factors. Results The total direct medical expenses of 11745 cases were 83856000 yuan, of which 34009000 yuan (40.56%) for drugs, 32053000 yuan (38.22%) for examinations, and 17794000 yuan (21.22%) for others. The median (quartiles) of direct medical cost per case was 4517.0 (2144.0, 8903.0) yuan. Multifactorial generalized linear model analysis showed that secondary hospitals, tertiary hospitals, workers with urban health insurance, complications and hospitalization were the influential factors that increased the direct medical costs of general PTB patients. The medians (quartiles) of the direct medical costs of these five factors are: 4701.0 (2262.0, 9165.0), 5258.0 (2198.0, 11197.5), 6158.0 (2960.0, 11619.0), 6289.0 (2658.0, 11417.0) and 10858.0 (7544.0, 16390.0)yuan, respectively; OR (95%CI) values are: 1.299 (1.062-1.437), 1.123 (1.020-1.366), 1.240 (1.114-1.379), 1.149 (1.096-1.205) and 3.115 (3.012-3.226), respectively. Conclusion The direct medical expenses of PTB patients in Chongqing were high. High-level medical institutions, workers with health insurance, complications and hospitalization were the influential factors that increased the direct medical costs. We should proactively develop and implement the medical insurance policy of single-disease payment should be promoted, second- and third-level TB hospitals and the treatment of employees with medical insurance should be regulated. Table and Figures | Reference | Related Articles | Metrics

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Expert consensus on the diagnosis and treatment of Brucella spondylitis The Joint Tuberculosis Professional Branch of Chinese Antituberculosis Association, The Western China Bone Tuberculosis Union, The North China Union of Bone Tuberculosis Chinese Journal of Antituberculosis    2022, 44 (6): 531-538.   DOI: 10.19982/j.issn.1000-6621.20220138 Abstract （840）   HTML （42）    PDF（pc） （1185KB）（695）       Knowledge map    Save Brucellosis spondylitis has been increasing in recent years, because of the low early diagnosis rate, there is often the possibility of misdiagnosis and mistreatment, resulting in the difficulty of later treatment and disability of patients. In order to standardize the diagnosis and treatment process of patients with Brucella spondylitis, help more specialist to get the treatment details of such disease, and have evidence in the treatment, the Expert consensus on the diagnosis and treatment of Brucella spondylitis was jointly formulated by the Joint Tuberculosis Professional Branch of Chinese Antituberculosis Association, the Western China Bone Tuberculosis Union, the North China Union of Bone Tuberculosis. This consensus starts from the epidemiological characteristics of Brucella spondylitis, deeply expounds and discusses its common clinical manifestations, laboratory examination and diagnostic criteria, therapeutic drugs, surgical treatment methods, prognosis and so on. Reference | Related Articles | Metrics

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Interpretation of the Procedure of tuberculin skin test-interferon-gamma release assay two-step testing HE Yi-jun, CAO Xue-fang, GAO Lei Chinese Journal of Antituberculosis    2022, 44 (5): 438-441.   DOI: 10.19982/j.issn.1000-6621.20210731 Abstract （836）   HTML （51）    PDF（pc） （1129KB）（373）       Knowledge map    Save Procedure of tuberculin skin test-interferon-gamma release assay two-step testing (T/CHATA 016-2021) is a social organization standard issued by Chinese Antituberculosis Association on July 9th, 2021. This document clarifies the related term and definitions, target populations, operation process, interpretation and disposal suggestions of detection of Mycobacterium tuberculosis (MTB) infection by tuberculin skin test-interferon-gamma release assay (TST-IGRA) two-step testing. It is applicable to disease prevention and control institutions at all levels, designated medical institutions for tuberculosis, primary medical institutions, comprehensive medical institutions and other relevant institutions in China. As a supplement to the technical specification of MTB infection detection, this article provided a detailed interpretation of the main content and precautions in the implementation, so that the TST-IGRA two-step method could be better applied to the practice of MTB infection detection by medical staff. Reference | Related Articles | Metrics

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Study on the prevalence and incidence of pulmonary tuberculosis in high-risk populations in China ZHANG Can-you, CHEN Bin, YE Jian-jun, HOU Jing-long, LI Hong-hai, YAO Yu-xia, ZHOU Fang-jing, ZHAO Jin-ming, LI Ting, YAN Hui-qin, LENG Dan-jing, ZHAO Fei, XIA Yin-yin, CHEN Hui, CHENG Jun, ZHANG Hui, WANG Li-xia Chinese Journal of Antituberculosis    2021, 43 (12): 1260-1268.   DOI: 10.3969/j.issn.1000-6621.2021.12.006 Abstract （832）   HTML （83）    PDF（pc） （879KB）（498）       Knowledge map    Save Objective To obtain the prevalence,incidence of tuberculosis (TB) and influencing factors among elderly people aged 65 years and older, diabetic patients, people with TB history, close contacts of active TB patients, and HIV/AIDS patients(referred as “five key populations” hereafter) in China through continuous screening, and to provide basic evidence for developing screening strategies in key populations. Methods In 27 townships/communities of 10 counties selected from 10 provinces located in eastern, middle and western regions of China, face-to-face questionnaire surveys and chest X-ray examination were performed on all participants every year for 3 consecutive years. TB prevalence and incidence density of the five key populations were calculated, and univariate and multivariate analysis of different demographic characteristics were also conducted. Results From 2013 to 2015, 38193, 35305 and 30295 participants were screened respectively. After 3 years of continuous screening, the prevalence of bacteriologically confirmed TB in all key populations dropped by 28.9% ((246.1-174.9)/246.1×100%), and the annual decline rate was 15.7% ($\big(\sqrt \frac{246.1}{174.9}-1 \big)$×100%); the prevalence of active TB dropped by 32.3% ((746.2-505.0)/746.2×100%), and the annual decline rate was 17.7% ($\big(\sqrt \frac{746.2}{505.0}-1 \big)$×100%). Taking survey of 2013 as the baseline, the incidence density of bacteriologically confirmed TB and active TB with 1-year follow-up (2014) in all key populations were 132.3 per 100000 person years (36/27202.4) and 143.7 per 100000 person years (71/49393.8), while with 2-years follow-up (2015), they were 488.9 per 100000 person years (133/27202.4) and 475.8 per 100000 person years (235/49393.8). Multivariate analysis found: male, advanced age (group ‘aged 75-84’ and group ‘aged 85 and older’), living in rural areas, ethnic minorities, unmarried/divorced/widowed, low family income per capita (2300-9999 yuan) and malnutrition (body mass index BMI<18.5) were risk factors for TB (OR (95%CI) were 3.4 (2.6-4.5), 1.6 (1.2-2.2) and 2.2 (1.3-3.5), 2.0 (1.5-2.8), 2.2 (1.6-3.0), 1.4 (1.1-1.9), 1.8 (1.3-2.4) and 1.9 (1.4-2.6) respectively), and overweight (body mass index ≥24) was a protective factor for TB (OR (95%CI)=0.3 (0.2-0.5)). Male, ethnic minorities and family with low annual income per capita (2300-9999 yuan) were risk factors for the onset of TB (aHR (95%CI) were 2.5 (1.9-3.5), 6.8 (4.8-9.6), 1.4 (1.0-1.9)), and overweight (BMI≥24) was a protective factor for the onset of TB (aHR (95%CI) was 0.5(0.4-0.7)). Conclusion The five key populations are high-risk populations of TB in China. Continuous active screening should be carried out in those key populations to quickly reduce the tuberculosis epidemic. Through identify people with different combinations of risk factors, we can set high-risk populations to target at them, thereby to increase the screening benefits. Table and Figures | Reference | Related Articles | Metrics

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Interpretation of the Diagnosis process for etiology negative pulmonary tuberculosis (T/CHATA 008—2020) YANG Chun-long, ZHOU Lin, CHEN Ming-ting Chinese Journal of Antituberculosis    2021, 43 (11): 1116-1119.   DOI: 10.3969/j.issn.1000-6621.2021.11.003 Abstract （828）   HTML （34）    PDF（pc） （1078KB）（525）       Knowledge map    Save Based on the Diagnostic for pulmonary tuberculosis (WS 288—2017) and Classification of tuberculosis (WS 196—2017), the Diagnosis process for etiology negative pulmonary tuberculosis (T/CHATA 008—2020) is the diagnostic criteria specifically developed for etiology negative tuberculosis. The guideline is so instructional and practical that it can help medical care institutions and their staff across the country to standardize the diagnostic performance for etiology negative tuberculosis. In this article we describe the background, the main contents and the matters need attention of the guideline in detail, with the aim of facilitating medical staff to better apply the algorithms in their clinical practice. Reference | Related Articles | Metrics

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Epidemiological investigation on an outbreak of tuberculosis epidemic in school WANG Da-kuan, HE Yi-jun, LIU Zi-sen, WANG Kun, WANG Jing, ZHANG Li-chao, LI Jie, GAO Lei, PAN Shou-guo Chinese Journal of Antituberculosis    2021, 43 (11): 1194-1198.   DOI: 10.3969/j.issn.1000-6621.2021.11.015 Abstract （821）   HTML （28）    PDF（pc） （783KB）（378）       Knowledge map    Save Objective The epidemiological investigation on an outbreak of school tuberculosis epidemic was conducted to explore the challenges and deficiencies in the management of the tuberculosis epidemic in schools. Methods Descriptive epidemiological tools were used to investigate and analyze an outbreak of school tuberculosis epidemic occurred between October 2020 and June 2021. Active case finding and close contacts tracing were conducted using the tools including tuberculin skin test (TST) and chest X-ray. Results After 1 case with sputum smear positive tuberculosis was diagnosed, a total of another 4 active tuberculosis cases were identified during 4 times of close contacts surveys. The first-round survey was conducted among 54 close contacts (47 students, 7 faculty) of the index case. The prevalence of TST≥15 mm was 4.44% (2/45) for students and 1/7 for faculty, and chest radiographs were found to be normal for all of them. None of the students with TST≥15 mm and without active pulmonary tuberculosis received preventive treatment on the basis of informed consent. In the subsequent survey, the TST conversion rate was 6/8 among students living in the same dormitory with the index case, 4/5 among the students studied in the same group with the index case and 3/3 among those ate together regularly with the index case. In addition, the 4 new identified cases were all TST converters. Conclusion Our results indicated that the investigation and management of close contacts need to be further strengthened in the process of handling tuberculosis epidemic in schools. To identify recent infections among close contacts and to improve the coverage of preventive treatment are key work should be improved. Table and Figures | Reference | Related Articles | Metrics

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Stages in the natural history of tuberculosis and the current status and prospect of diagnosis LI Meng, GAO Qian Chinese Journal of Antituberculosis    2021, 43 (11): 1125-1131.   DOI: 10.3969/j.issn.1000-6621.2021.11.005 Abstract （820）   HTML （36）    PDF（pc） （1244KB）（632）       Knowledge map    Save From Mycobacterium tuberculosis infection to active disease, it is a complex continuous process that has been artificially separated into many stages. The focus of past studies, diagnostic tests, and pharmacological therapy are mainly on latent infection or active disease. The continuing high epidemic of tuberculosis has led to a gradual focus on other stages. Understanding the definition and characteristics of the different stages in the natural history of tuberculosis is essential for developing new diagnostic techniques and developing more rational interventions. This article provided a review of the definitions and characteristics of the various stages in the natural history of tuberculosis and the current status and prospect of its diagnosis, with the hope to aid in the development of early diagnostic tools and tuberculosis prevention strategies. Table and Figures | Reference | Related Articles | Metrics

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Diagnostic accuracy of Xpert MTB/RIF Ultra for tuberculous meningitis HUANG Mai-ling, SUN Qing, WANG Gui-rong, LI Wen-sheng, DU Ya-dong, CAI Bao-yun, HUANG Hai-rong, LI Qi, CHU Nai-hui Chinese Journal of Antituberculosis    2021, 43 (7): 670-676.   DOI: 10.3969/j.issn.1000-6621.2021.07.006 Abstract （817）   HTML （17）    PDF（pc） （929KB）（333）       Knowledge map    Save Objective To evaluate the performance of Xpert MTB/RIF Ultra (Xpert Ultra) for tuberculous meningitis (TBM) diagnosis. Methods All of 189 TBM suspected patients were consecutively enrolled from January 2017 to December 2018 at Beijing Chest Hospital. According to the clinical reference standard, the final sample size for analysis was 151 patients, which included 32 definite TBM, 55 probable TBM, 19 possible TBM, and 45 non-TBM patients. Uncentrifuged CSF specimens collected from each patient were subjected to smear, culture, Xpert and Xpert Ultra. The sensitivity and specificity of all the tests were assessed against uniform clinical case definitions of TBM. Results The direct head-to-head diagnostic performance comparison showed higher sensitivity of Xpert Ultra in contrast with Xpert (44.3% (47/106) vs. 24.5% (26/106); χ2=16.000, P<0.01) among 106 TBM patients. Xpert Ultra also produced a higher sensitivity than culture (44.7%, (34/76)vs. 18.4% (14/76); χ2=12.893,P<0.01) in 76 having culture results patients. When Xpert Ultra outcomes were integrated, the percentage of definite TBM cases increased from 30.2% (32/106) to 50.0% (53/106). Besides, among 62 patients with CSF culture-negative, the positive rate of Xpert Ultra was also higher than Xpert (38.7% (24/62)vs. 21.0% (13/62);χ2=7.692,P=0.003). Both Xpert Ultra (76.1% (35/46) vs. 20.0% (12/60); χ2=33.189, P<0.01) and Xpert (39.1% (18/46)vs. 13.3% (8/60); χ2=9.360, P=0.002) produced higher positive rate in patients without prior anti-TB treatment than those under anti-TB therapy. The positive rate of Xpert Ultra was higher than Xpert in patients without prior anti-TB treatment (χ2=15.059,P<0.01). Both Xpert Ultra and Xpert accurately identified the one rifampicin (RFP)-resistant and the 5 RFP-sensitive cases defined by phenotypic drug sensitivity test. Xpert Ultra outperformed both Xpert and culture for TBM diagnosis, especially for CSF culture negative TBM patients, making it a useful tool for rapid diagnosis of TBM. Table and Figures | Reference | Related Articles | Metrics

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Characterization of rifampin resistance determining region mutations in tuberculosis patients with GeneXpert MTB/RIF positive RNA polymerase β subunit gene mutation SUN Qing, LIAO Xin-lei, WANG Chen-qian, JIANG Guang-lu, DONG Ling-ling, WANG Fen, ZHAO Li-ping, HUANG Hai-rong, WANG Gui-rong Chinese Journal of Antituberculosis    2022, 44 (4): 349-353.   DOI: 10.19982/j.issn.1000-6621.20210635 Abstract （817）   HTML （28）    PDF（pc） （821KB）（198）       Knowledge map    Save Objective: To analyze the mutation distribution and frequency of RNA polymerase β subunit (rpoB) gene probe in tuberculosis (TB) patients with GeneXpert MTB/RIF (Xpert) positive rpoB gene mutation, and to elucidate the mutation characteristics of rifampicin resistance determining region. Methods: A total of 682 consecutive TB patients with positive Xpert test and rpoB gene mutation who visited Beijing Chest Hospital, Capital Medical University from June 2019 to June 2020 were involved, including 618 pulmonary TB (PTB) cases and 64 extrapulmonary TB (EPTB) cases. Clinical examination samples, including 465 sputum, 153 bronchoalveolar lavage fluid, 37 pus, 19 pleural effusion, 7 stool and 1 cerebrospinal fluid, were collected from patients. All Xpert positive specimens were analyzed for semi-quantitative results of Mycobacterium tuberculosis (MTB) and mutation distribution of the rpoB gene probe. Results: Of the 682 samples, 6.45% (44/682) were high, 25.07% (171/682) were medium, 25.51% (174/682) were low, and 42.96% (293/682) were very low in MTB semi-quantitative. The proportion of very low levels of MTB semi-quantitative was significantly higher in EPTB samples than in PTB samples (64.06% (41/64) vs. 40.78% (252/618), χ 2=12.83, P<0.001). Smear positive rates were 84.62% (33/39), 64.02% (105/164), 27.27% (42/154), and 7.84% (20/255) in semiquantitatively high, medium, low, and very low levels of MTB specimens, respectively. The mutation rate of the rpoB gene was 92.82% (633/682) for single probe, 6.89% (47/682) for double probe, and 0.29% (2/682) for triple probe. The mutation rate of probe E was the highest in specimens with single probe mutation (74.34%, 507/682), followed by probe D (8.80%, 60/682); the mutation rate of probe D+E was the highest in specimens with double probe mutation (4.25%, 29/682), followed by probe A+B (1.76%, 12/682); and all three probe mutations were probe A+D+E (2 cases). Conclusion: Single probe mutation is predominant in Xpert positive rpoB gene mutation MTB, and the most common mutation probes in PTB and EPTB are probe E and probe D. Table and Figures | Reference | Related Articles | Metrics

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Incidence and risk factors of catastrophic expenditure for multidrug-resistant tuberculosis in Guangdong Province Yu Meiling, Liang Hongdi, Zhou Fangjing, Chen Liang, Wu Ya, Gao Lijie, Wen Wenpei, Zhu Sui, Wu Huizhong Chinese Journal of Antituberculosis    2022, 44 (12): 1262-1272.   DOI: 10.19982/j.issn.1000-6621.20220235 Abstract （803）   HTML （16）    PDF（pc） （1153KB）（208）       Knowledge map    Save Objective: To investigate the incidence and risk factors of catastrophic expenditure among patients with multidrug-resistant tuberculosis (MDR-TB) in Guangdong Province. Methods: The MDR-TB patients diagnosed in 11 designated medical institutions in 9 prefecture-level cities in Guangdong Province from 2018 to 2019 were selected. Questionnaires for surveying basic characteristics, patients’ disease and medical visit history, financial burden, and health insurance policies of medical institutions, individuals and cities were collected. A two-level logistic regression model was used to explore the risk factors of catastrophic expenditure in MDR-TB patients. Results: A total of 398 patients were included in this study. The median direct medical expenses was 51100 (22600, 98200) yuan; the median direct non-medical expenses was 14600 (7100, 33300) yuan; the median indirect costs was 5100 (3100, 7300) yuan; the median total costs was 84300 (42900, 147600) yuan; and the median total out-of-pocket expenses was 58400 (29700, 111800) per case. A total of 259 MDR-TB patients suffered with catastrophic expenditure, with an incidence of 65.08%. The two-level logistic regression model showed that the risk of catastrophic expenditure for households with debt was 2.57 times of that for households without debt (95%CI: 1.43-4.62). The incidence of catastrophic expenditure increased gradually with the patients’ hospitalization length, and the incidence for patients hospitalized for 1 month and ≥2 months were 4.38 (95%CI:2.38-8.06) times and 31.37 (95%CI: 11.09-88.74) times of that for non-hospitalized patients. Conclusion: A high incidence of catastrophic expenditure for MDR-TB patients was found in Guangdong Province. Debt and length of hospitalization were the risk factors for incidence of catastrophic expenditure. Multiple measures should be taken to reduce the incidence of catastrophic expenditure in MDR-TB patients. Table and Figures | Reference | Related Articles | Metrics