Table of Content

12 July 2011, Volume 33 Issue 7

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Baseline investigation of tuberculosis drug-resistant of Guangdong province

Zhong Qiu,Yin Jianjun,Qian Ming,Zhou Lin,Chen Tao,Li Jianwei,Huang Guiqing,Jiang Li

Chinese Journal of Antituberculosis. 2011, 33(7):  393-399. 

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Objective To understand the prevalence and characteristic of drug-resistant tuberculosis(DR-TB) in Guangdong province in order to provide evidence base for strategy development.
Methods Smear positive PTB patients were sampled by two-stage random sampling methods.The clinical information of patients were collected through questionnaires and proportion methods were employed in drug susceptibility test(DST) for rifampicin,isoniazid,streptomycin,ethambutol,ofloxacin and kanamycin. Results 1)This study found a total of 45 cases of non-tuberculous mycobacteria infection,accounting for 2.2% of all culture positive cases,among which 28 were new smear positive cases and 17 were retreatment cases. 2)The total drug-resistant rate(DRR) were 16.4%,acquired DRR(22.5%) were higher than primary DRR(14.1%)(χ²=17.9, P<0.01).Multidrug-resistant rate(MDRR) were 4.9%,with higher acquired MDRR(8.2%) than primary MDRR(3.6%)(χ²=13.6, P<0.01).28.9% of MDR-TB cases were proved to be extensively drug-resistant tuberculosis(XDR-TB) which were 1.4% of total. 3) Compared with that of 1998,the DRR and MDRR were decreased by 16.2% and 23.3% respectively so far. 4) Through the DST of six drugs,35 types of drug-resistant spectrum were found including 5 types of single DR,19 types of poly-resistant and 12 types of MDR(including 2 types of XDR-TB).Conclusions 1) Although the DR-TB epidemic showed a overall downward trend,Guangdong province still have a high burden of DR-TB and face the challenge from MDR-TB and XDR-TB. 2) The polymorphism and complexity of the drug resistance spectrum calls for a more urgent and more comprehensive interventions against the prevalence of DR-TB in Guangdong province.

Tracking of peptide-specific CD4⁺ T cells in peripheral bloods from untreated and treated patients with pulmonary tuberculosis by using E7/HLA-DR8 tetramers

Li Yifen,Huang Lirong,Liu Guobiao,Fang Yimin,Li Yan,Peng Yi,Lai Xiaomin

Chinese Journal of Antituberculosis. 2011, 33(7):  400-406. 

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Objective To track peptide E7-specific CD4⁺ T cells in peripheral bloods(PBL) from pulmonary tuberculosis(PTB) patients during the untreated and 6-months treatment.Methods Two types of E7/HLA-DR8(E7/HLA-DRB1*08032 and E7/HLA-DRB1*0818) tetramers were prepared by using biotinylated monomers expressed and purified from constructed stable Drosophila Schneider 2 cell(S2 cell) lines,and then respectively used to detect tetramer-positive(peptide E7-specific) CD4⁺ T cells and total CD4⁺ T cells in the PBL of PTB patients about at days 0,15,30,45,60,90,120,150 and 180 during their regular anti-tuberculosis(TB) therapy by anti-human CD4-FITC staining and flow cytometric analysis.The PBL of non-TB patients with pulmonary infection and healthy adults,and umbilicalcord blood were used as controls.Results The percentage of total CD4⁺ T cells in the PBL of most untreated PTB patients was slightly lower than normal level;along with treatment,it got to increase rapidly and reach almost normal level in a short period;but statistical difference was only found between the PBL of untreated PTB patients and umbilicalcord blood(P<0.05),and statistical differences were not seen between other groups(P>0.05).High levels of tetramer-positive CD4⁺ T cells in the PBL of PTB patients could be detected about at days 0,15,30,45 and 60 during their regular anti-TB therapy,respectively,and statistical differences were found between the PBL of these time-points and both of subsequent time-points and 3 control groups(P<0.01 or P<0.05).In contrast,there was no statistical difference between 2 tetramer staining(P>0.05).The results suggested that relatively high and the highest levels of tetramer-positive CD4⁺ T cells appeared in the PBL of untreated PTB patients and treated cases at days 15-60,respectively.Subsequently,although some small rise and fall in some patients,the percentages of tetramer-positive CD4⁺ T cells began to decrease,and gradually reached and kept at a relatively low even normal level.Conclusion Peptide/HLA-DR tetramers could be used to track peptide-specific CD4⁺ T cells in the PBL of TB patients during the untreatment and treatment,which combined with the detection of total CD4⁺ T cells is significant for monitoring TB development and recovery.

Treatment and management need analysis of new smear positive pulmonary tuberculosis patients in floating population

Guan Hongyun,Yang Yingzhou,Tan Weiguo,Lv Jianwen,Wu Qingfang

Chinese Journal of Antituberculosis. 2011, 33(7):  407-411. 

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Objective To analyze the treatment,management and social support needs of new smear positive pulmonary tuberculosis(PTB) patients in floating population,in order to provide more targeted service for floating population.Methods Four hundred and fifty five cases of new smear positive PTB patients in floating population were investigated by self-designed questionnaire.Results The social-economic survey shows that,82.6% of the patients the monthly income were below 2000 yuan;in addition to the cost covered by free policy,75.8% of the patients paid the additional medical expenses by themselves.44.2% chose holiday to visit the doctor,and 91.9% felt that 4 h was most appropriate for one time visit.51.9% thought 200 yuan is the affordable upper limit for each visit.For treatment,only 28.8% was willing to go to DOT spots,27.3% would like to take medicine at home supervised by family member or by doctors through the phone call,44.0% wished to take the medicine by themselves without any supervision.The social support survey shows that 89.5% and 92.7% hoped to reduce the cost for auxiliary drugs and examinations respectively,85.9% would not like to disclose the disease to their working unit,and 69.9% thought they will be dismissed if their employers knew their disease,63.3% continued to work after TB diagnosis,80.9% needed psychological counseling.Conclusions The new smear positive tuberculosis patients in floating population were in poor socio-economic conditions.TB institutions and other related departments should give attention to the treatment and management needs of the patients and give necessary psychological support.The fact that more than 40% of the patients wished to take the medicine by themselves posts a new challenge for TB patients management.

Comparison of two methods in treatment of aspergilloma inside cavities of pulmonary tuberculosis

Zheng Minli,Tang Chunmei,Xiao Haihao,Liu Weiguang,Fang Qiong,Xie Yikai,Zhang Yanbin

Chinese Journal of Antituberculosis. 2011, 33(7):  412-415. 

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Objective To compare clinical value of bronchofibroscope excision and surgical resection in treatment of aspergilloma inside cavities of pulmonary tuberculosis.Methods One hundred and eighty three hospitalized cases with aspergilloma inside cavities of pulmonary tuberculosis were analyzed retrospectively on time of therapy,treatment costs,complication of therapy and efficacy.Results Of 183 cases,126 cases received excision of aspergilloma by bronchoscope and 57 cases received surgical resection.Average time of therapy were 49 days and 46 days using bronchofibroscope excision and surgical resection,respectively.Average treatment costs were 26 535 yuan and 50 296 yuan,respectively.Incidence rate of complications using surgical resection was higher than that of bronchofibroscope excision.But surgical resection was complete and low rate of relapse.Conclusion Bronchofibroscope excision can get relatively thorough,efficacy,less complication and low costs in patients with aspergilloma inside cavities of pulmonary tuberculosis.It is a better method in patients who are poor pulmonary function reserve,high surgical risk and reluctant to accept surgery.

Analysis of cooperation model and effect of TB/HIV co-infection

Cheng Shiming, Zhou Lin, Liu Eryong, Wang Xuejing, Lai Yuji, Wang Dongmei, Li Dongmin, Wang Ning

Chinese Journal of Antituberculosis. 2011, 33(7):  416-421. 

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Objective To explore the cooperation models in different regions and their effects on TB/HIV case finding. Methods Six counties of 4 provinces including Henan,Yunnan,Sichuan and Guangxi were selected to investigate the distribution and function of TB and HIV related institutions.2135 of 2396 new registered TB patients in 6 counties from Sep.2006 to Feb.2007 were tested for HIV infection,68 cases were detected HIV positive,and 3879 cases of HIV/AIDS were administered face-to-face TB questionnaires,1751 cases were detected as positive questionnaire and among them,250 cases were TB patients.Through the two-way screening,318 cases were detected as TB/HIV cases. Results There were two patterns of cooperation model in these 6 counties.One is inter-division cooperation within the same institution;the other is inter-institution cooperation between disease control institutions and medical agencies.In 3 counties with inter-division cooperation model,referral in place rate of HIV/AIDS patients all reached 100.0%（54/54,159/159,335/335）;In other 3 counties with inter-institution cooperation,this rate was 100.0%（39/39）,91.0%（343/377）and 99.9%（786/787）respectively.In these 6 counties,the HIV testing rate of TB patients was 89.1%（2135/2396）（33.0%100.0%）,the detection rate of TB cases was 14.3%（250/1751）（1.6%—22.9%） in people living with HIV/AIDS,and the HIV/AIDS detection rate in TB patients was an average of 3.2%（68/2135）（1.0%6.5%）.TB/HIV case detection through TB screening among HIV/AIDS contributed 78.6%（250/318）（54.9%98.6%） of the total 318 cases detected. Conclusion To establish the cooperation model is the prerequisite for TB/HIV case detection.

The significance of tumor necrosis factor-α in pleural effusion between tuberculous pleurisy and lung cancer

Xie Yuqin, Zhang Jinhong, Xie Lilan

Chinese Journal of Antituberculosis. 2011, 33(7):  422-424. 

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Objective To explore the diagnostic significance of the level of tumor necrosis factor-alpha(TNF-α) in pleural effusion between tuberculosis and lung cancer.Methods Fifty three cases with tuberculosis pleural effusion(32 males and 21 females) and 61 cases with lung cancer with pleural effusion(45 males and 16 females) were enrolled;the control group included 55 cases(31 males and 24 females);all of specimens were measured by enzyme linked immunosorbent assay(ELISA) and the data were analyzed by SPSS statistical software.Results The pleural effusion levels of TNF-α were(36.38±4.73)ng/L and(11.42±2.57)ng/L in tuberculosis group and lung cancer group,repectively.TNF-α content in the lung cancer group pleural effusion was less than that of tuberculous pleural fluid(t=35.63,P<0.001).Compared with the disease groups and the control group,blood levels of TNF-α was(11.75±1.94) ng/L,(28.43±4.11) ng/L and(13.88±2.33)ng/L in the control group,the lung cancer group and pulmonary tuberculosis group,respectively.which showed statistically significant(t=27.46,P<0.01).Conclusion This study shows that there was of significance of TNF-α level in pleural effusion and peripheral blood for diagnosis and differential diagnosis of lung cancer and pulmonary tuberculosis.

Impact of perioperative psychological supportive therapy on postoperative cognitive dysfunction in elderly patients with tuberculosis

Tao Shu,Zeng Huazhi,Wei Yanfang,Fan Yuyun,Ye Mintao,Liu Hongtao

Chinese Journal of Antituberculosis. 2011, 33(7):  425-429. 

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Objective To explore the impact of perioperative psychological support therapy on postoperative cognitive dysfunction in elderly patients with tuberculosis.Methods A case-control study was conducted.The elderly patients with tuberculosis who had undergone surgery during the period of July 2008 to May 2009(93 patients,control group) and of June 2009 to July 2010(91 patients,study group) were assessed by using the Mini-Mental State Examination(MMSE),Trail Making Test(TMT) Parts A & B,Digit Symbol Substitution Test(DSST),and Digit Span Test(DST) in Wechsler Adult Intelligence Scale-Revised by China(WAIS-RC),and Self-Rating Anxiety Scale(SAS).Results Seven days after surgery,the scores on TMT A were 49.96±10.43 in the control group and 44.02±17.29 in the study group(t=2.942,P<0.05),and those on TMT B were 67.99±17.72 and 60.37±18.88,respectively(t=2.971,P<0.05);the scores on DSST was 24.44±8.31 in the control group and 28.76±8.76 in the study group(t=3.578,P<0.01);the scores on MMSE was 26.47±2.07 in the control group and 27.62±2.73 in the study group(t=3.359,P<0.05);the scores on SAS was 35.33±7.12 in the control group and 30.51±5.10 in the study group(t=5.502,P<0.01).One month after surgery,the scores on TMT A were 44.49±10.89 in the control group and 37.61±13.49 in the study group(t=3.968,P<0.01),and those on TMT B were 61.64±15.35 and 54.00±16.49,respectively(t=3.392,P<0.05);the scores on DSST were 27.38±7.81 in the control group and 32.58±8.17 in the study group(t=4.602,P<0.01);the scores on DST were 7.71±1.33 in the control group and 8.81±1.36 in the study group(t=5.785,P<0.01);the scores on MMSE were 27.63±1.69 in the control group and 28.67±2.17 in the study group(t=3.785,P<0.01);the scores on SAS were 31.13±7.09 in the control group and 27.30±3.53 in the study group(t=4.836,P<0.01).Conclusion Perioperative psychological support therapy can effectively reduce the adverse effects of surgery on patients psychology and lower the degree of anxiety

Analysis of the situation of HIV infection among TB patients in Guangdong province

Zhong Qiu, Li Jianwei, Zhou Lin, Jiang Li, Lian Yonge

Chinese Journal of Antituberculosis. 2011, 33(7):  430-433. 

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Objective To investigate the HIV infection situation among TB patients in Guangdong province and to analyze its epidemiological characteristics. Methods This is a cross-sectional design.New registered patients registered from September 2008 to January 2009 in 30 counties were investigated by questionnaire and tested for HIV infection.Results 5447 TB cases were investigated,of which 25 cases were found HIV-positive.The HIV infection rate was 0.46%（95%CI:0.28%—0.64%）.The HIV infection rate among TB patients in Western Guangdong was 1.28%（95%CI:0.67%—1.88%）which is higher than the average rate of the whole province,and also higher than Middle and Eastern Guangdong（P<0.01）.For age distribution,the HIV infection rate was highest of 0.85% in TB patients between 30 to 50 years old（χ²=8.883,P=0.012）.The HIV infection rate among TB patients in household population was higher than the floating population（χ²=4.624,P=0.032）.Conclusion The overall HIV infection among TB patients was at a low level in Guangdong,but high in part areas.It is necessary to implement TB/HIV prevention and control in the area with high HIV/AIDS epidemic and/or high TB/HIV co-infection rate.

Study on the early warning model of multidrug resistant tuberculosis in Guangdong province

Zhou Lin,Zhong Qiu,Liu Yongqi,Jiang Li,Wu Huizhong

Chinese Journal of Antituberculosis. 2011, 33(7):  434-437. 

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Objective To explore the early warning model of multidrug resistant tuberculosis suit for Guangdong features providing Guangdong province even nationwide with scientific and reliable theory foundation for the MDR-TB control and the implementation of national 10 years plan.Methods Establish the differential equation based on cybernetic theory and the assessment of MDR-TB mortality,detection rate and cure rate though weighted mean method.Results Build the MDR-TB transmission dynamical model with the threshold value of stimulated or derived R0 from real parameter.Conclusion The establishing of warning model of MDR-TB and the indicator adjusting need sophisticated drug resistant monitoring data.As a trying step to MDR-TB warning model,this research did find some clues for the improvement of national MDR-TB control.

Profile analysis of China TB mortality information from 1984 to 2008

Liu Jianjun,Wang Lixia,Yao Hongyan,Wang Ping,Zheng Wenjing

Chinese Journal of Antituberculosis. 2011, 33(7):  438-441. 

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Objective The aim is to understand the source,profile and trend of China tuberculosis(TB) mortality information.Method By consulting experts and reviewing published papers and surveillance or survey reports to know clues of the China TB mortality data resource,then to find out the data resources we needed and describe the data profile and the trend of China TB mortality.Results The sources of the information include Cause-of-death Surveys of China National Disease Surveillance Points System,National TB Epidemiological Survey,Annual Chinese National Health Statistics,WHO annual report: Global TB Control.For the overall TB mortality rate,in WHO annual report,this rate was 19.00/100 000 in 2000,and then decreased gradually to 15.00/100 000 in 2007;In the three National TB Epidemiological Surveys which was conducted in 1984—1985,1989 and 1999,this rate was 35.00/100 000,20.40/100 000 and 9.80/100 000 respectively;In Cause-of-death Surveys of China National Disease Surveillance Points System,this rate dropped from 6.18/100 000 in 2005 to 3.41/100 000 in 2008.For the respiratory TB mortality rate,the rate dropped by year from 5.89/100 000 in 2005 to 3.20/100 000 in 2008.For the pulmonary TB mortality rate,this rate was 31.00/100 000,19.10/100 000 and 8.80/100 000 respectively in the three National Tuberculosis Epidemiological Surveys.Conclusion Currently there is a multiple source of TB mortality data.In general the TB mortality showed a decreasing trend.

Analysis of trans-regional transfer out situation of pulmonary tuberculosis patients in floating population in Bao’an district of Shenzhen

Zhao Meigui,Guo Ling,Zhao Angui,Sun Bihui,Zheng Juanjuan

Chinese Journal of Antituberculosis. 2011, 33(7):  442-444. 

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Objective To understand the trans-regional transfer out situation of pulmonary tuberculosis(PTB) patients in floating population in Bao’an district,analyze factors affecting the arrival rate of patients transferred out and explore possible ways to improve this rate.Methods Through the TB-specific reporting system,the trans-regional transfer out situation of PTB in floating population registered from Jan.2009 to Aug.2010 were analyzed to explore the factors affecting the arrival rate.Results In recent 20 months,a total of 626 PTB patients in floating population were performed trans-regional referral among which 431 cases arrived in place accounting for 68.8%.Main reasons for non-arrival rate include: patients did not go to the transfer destination;patients lost,patients went out again,wrong address left by the patients and patients refusing for medication.Conclusion The arrival rate is low for transfer out PTB patients,the major factor affecting the low arrival rate lies in the patients themselves.