Table of Content

20 May 2010, Volume 32 Issue 5

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Causes analysis of tuberculosis patients back to native town during treatment among floating population and their tracking results in Changping

Gao Tiejie,Liu Lina,Han Yuefei

Chinese Journal of Antituberculosis. 2010, 32(5):  8-10. 

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Objective Analysis the reasons of tuberculosis patients back to native town during treatment among floating population in Changping District in order to reduce related treatment interruption.  Methods Back home reasons of registered tuberculosis patients of floating population and their tracking Results in 2007 were analyzed.  Results 737 cases of tuberculosis patients were registered in 2007, of which 461 cases of floating population, accounting for 62.6%. 230 cases received standard treatment in TB institution, 231 cases went back to their native town, accounting for 50.1% of these patients. Main reasons are unemployment and economic difficulty. Among them, 165 cases went to local TB institution after follow-up, accounting for 71.4%.  Conclusion s Financial support should be provided to tuberculosis patients of floating population with economic difficulties. For patients go back to their native town, trans-regional management should be implemented in order to reduce treatment interruption.

Analysis of prevalence and discovery situation of smear negative pulmonary tuberculosis in Tongliao city

Zhao Dexin,Zhang Huijie，Peng Guolin

Chinese Journal of Antituberculosis. 2010, 32(5):  12-14. 

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Objective To understand prevalence of smear negative pulmonary tuberculosis and its discovery situation before and after implementing the tuberculosis control program, to analyze the causes of existing problem and importance ofimproving smear negative case finding. Methods Data was obtained fromlocal registration information of pulmonary tuberculosis cases and tuberculosis epidemiology survey as well as from internet based Chinese infectious reporting system in Tongliao City from 2005 to 2008.Results According to four times of tuberculosis epidemiology survey, the prevalence rate of smear negative pulmonary tuberculosis is higher than that of smear positive, and accounted for two third of number of active pulmonary tuberculosis. From 1991 to 2003, the ratio of smear negative to smear positive stabilized between 1.1 to 2.4. However, from 2004to 2008, the registration number of the new smear negative and positive pulmonary tuberculosis cases both increased year by year, the ratio of smear negative to smear positive decreased to 0.60～0.85. This result is significantly different in comparison with the Results of epidemiology survey. Conclusion Since 2004,there was an obvious imbalance in terms of number of smear negative to smear positive detected; Registration rate of smear negative cases was relatively low. Therefore control work of smearnegative tuberculosis should not be overlooked while we emphasis smear positive case finding.

Effect analysis of Global Fund Round 5 tuberculosis project on floating population in Minhang district,Shanghai

Tang Lihong,Yan Huiqin,Cheng Yuping,Zhang Jinlan

Chinese Journal of Antituberculosis. 2010, 32(5):  15-19. 

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Objective To understand the effects of case registration and treatment outcome of pulmonary tuberculosis in Minhang district in the past 2 years after implementing China global fund round 5 TB projecton floating population, in order to provide evidence based formulation of TB control strategies. Methods Data from, internet bases infectious disease reporting system and TB register were analyzed from Oct.2005 to Sep.2008.  Results In these two year,268 smear positive cases were registered in tuberculosis special hospitals.The overall in place rate of patients reported by non-TB institutions increased from 65.0% to 81.5%.The registration rate of new sputum smear-positive TB patients rose from 13.87/100 000 to 22.65/100 000. 2 month’s sputum conversion rate for new smear-positive cases increased from 58.5% to 76.5%. The cure rate was 83.5% for the new smear positive patients detected in the first project year, and treatment success rate was 85.2% which reached 85% ofWHO target. Conclusion The global fund round 5 project on floating population make the government officials pay greater attention to TB control. and a complete TB prevention and control management mode was formed.Case detection and management has both improved than before.

Feasibility study of domestic four-drug fixed-dose combination under DOTS as initial treatment in ptients with smear positive pulmonary tuberculosis

Ma Liping,Wu Xiaoguang,Chu Naihui,Zhu Lizhen,Shan Bin,Wang Min,Wang Yan,Zhang Wenshu,Li Huijun,Hou Dong

Chinese Journal of Antituberculosis. 2010, 32(5):  21-25. 

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Objective To assess antituberculosis efficacy and adverse events of domestic four-drug fixed-dose combination in smear positive pulmonary tuberculosis under the management of directly observed treatment short-course (DOTS).  Method Two hundreds and twenty-five new patients with smear positive pulmonary tuberculosis were randomly divided into a treatment group (2yinuonikang/4yifu capsule) and a control group (2HRZE/4HR) to observe rates of sputum negative conversion in short time, chest X-ray improvement and advert events.  Result The sputum negative conversion rates in the treatment group and the control were 94.6% and 93.8% at the 2nd month, and 99.1% and 96.5% at the end of treatment. Chest radiography showed remarkable improvement of lesions. The foci absorption rate in the treatment group and the controls were 98.2% and 97.4%, respectively, and the cavity closure rates were 72.2% in the treatment group and 56.4% in the controls. Hepatic dysfunction was seen among 4 cases in the treatment group and 3 cases in the controls.  Conclusion Domestic four-drug fixed-dose combination shows an excellent therapeutic efficacy, safety and good compliance in antituberculous chemotherapy which could be recommended widely in tuberculosis control in China.

The value of CT scan in the diagnosis of pleural tuberculoma

Zhang Lei，Zhou Yanhui,He Yan,Zhao Guangcheng,Li Jingqing,Wang Junying,Liu Jia,Wang Lefeng,Jia Suhua

Chinese Journal of Antituberculosis. 2010, 32(5):  28-30. 

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Objective To investigate the CT scan in the diagnosis of pleural tuberculoma.  Methods CT images of 35 patients with pleural tuberculoma were analyzed retrospectively, including contrast-enhanced CT scan in 16 cases in our hosptial from Nov. 2002 to Oct. 2009The final diagnosis for all patients were confirmed by pathology, cytologic examination and long term follow-up. There were 53 lesions found in 35 cases with single pleural tuberculoma in 26 cases and multiple pleural tuberculomas in 9 case.  Results The CT characteristics of pleural tuberculoma were mass or nodular image findings bulging toward the lung. The CT scan showed papillary nodules in 13 cases, semicircular in 15 cases, round-like in 21 cases, oval in 2 cases, flat focus in 1 case and irregular in 1 case. There were 39 foci with homogeneous intensity, 13 foci with heterogeneous intensity and 1 focus with stripes calcifications. Of 26 foci wih contrast-ehanced scan, 8 foci were not obvious enhanced, 15 foci were marginal enhanced and 3 were obvious homogeneous enhanced.  Conclusion CT scan is a clinical valuable tool in the diagnosis and differential diagnosis of pleural tuberculoma.

Clinical Analysis on 16 Cases with Splenic Tuberculosis

Chen Songsong,Guo Qing

Chinese Journal of Antituberculosis. 2010, 32(5):  31-33. 

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Objective To study clinical diagnosis and treatment of splenic tuberculosis. Methods The clinical data of 18 cases with splenic tuberculosis were retrospectively analyzed.  Results Among 18 patients, fever was found in 14,abdominal pain in 9.The course of fever varied 1 week to 12 months and the mean course is about 2 months. Other common symptoms and signs had abdominal distension in 4, night sweat in 4, anergy in 5,anorexia in 7, splenomegaly in 9. Twelve cases of splenic tuberculosis were confirmed by surgery and pathologic diagnosis,1 case by founding of acid-fast bacillus in gastric juice,5 cases by diagnostic therapy. Of 18 patients, 10 cases had extra-splenic tuberculosis. 9 cases were misdiagnosed before confirmed diagnosis. Among the 18 cases, except 2 dead cases, the others received anti-tuberculosis chemotherapy for more than 1 year, and recovered well.  Conclusion Splenic tuberculosis mainly presents with a long course of fever and abdominal pain, having high rate of misdiagnosis. The diagnosis of splenic tuberculosis mainly relies on pathology and diagnostic therapy, systemic antituberculous therapy and selectivity surgical treatment are the major therapenutic method.

Clinical significance of T cells,NKT and NK cells in diagnosis and treatment of tuberculosis

Zhang Qing,Xiao Heping

Chinese Journal of Antituberculosis. 2010, 32(5):  34-38. 

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Objective To explore the clinical expression and significance of CD3+ T cells, CD3+CD16+CD56+ N KT cells and CD3-CD16+CD56+ N K cells in pulmonary TB patients. Methods Percentages of T cells, N KT and NK cells in peripheral whole blood samples from 123 pulmonary TB patients (73 first-treated pulmonary TB and 50 retreated pulmonary TB) and 83 healthy controls (43 positive PPD test and 40 negative PPD test) were analyzed by flowcytometry.  Results Percentage of NKT cells in first-treated and retreated pulmonary TB patients significantly increased than that in healthy controls (P<0.01), but percentages of T and NK cells had no significant difference between first-treated pulmonary TB patients and healthy controls(P>0.05). There was also a significant difference in the percentage of T cells according to severity of disease（P<0.01）,while no significant difference in the percentages of NKT and NK cells could be found among these groups (P>0.05). Percentage of T cells in retreated pulmonary TB patients was significantly higher as compared with first-treated pulmonary TB patients (P<0.01), but those of NKT and NK cells had no significant difference (P>0.05).  Conclusion s T and NKT cells play an important role in cellular immunity against TB. To monitor the percentage of T cells in peripheral blood for pulmonary TB patients is helpful in finding recurrent tuberculosis and predicting prognosis. NKT cells in peripheral blood increase only in active TB patients. It can be used as one of the assistant non-invasive indicators for active pulmonary TB.

 The diagnostic value of real-time fluorescent quantitative PCR assay for detection of Mycobacterium tuberculosis in paraffin-imbedded tissues

Li Xiuwu,Li Xingbin,Du Xiuran,Jia Chenguang,Chen Rongjuan

Chinese Journal of Antituberculosis. 2010, 32(5):  39-41. 

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Objective To evaluate the diagnostic value of real-time fluorescent quantitative PCR (FQ-PCR) assay for detection ofMycobacterium tuberculosisDNA in paraffin-imbeded tissues.  Methods 275 tissue specimens were examined by routine histopathology and acid-fast bacillus (AFB) staining, and the FQ-PCR was applied for the detection ofMycobacterium tuberculosisDNA in paraffin-imbedded tissues.  Results Of 275 cases, 211(76.7%) were positive by FQ-PCR, 183 (66.5%) were positive by histopathology, and 23 (8.4%) were positive by AFB staining. Of 183 histopathology-positive cases, 171(93.4%) were FQ-PCR positive. Of 23 AFB-positive cases, 22 (95.7%) were FQ-PCR positive.  Conclusion The FQ-PCR assay is simple, rapid, highly sensitivie and specific. FQ-PCR combined with histopathology may improve the diagnostic accuracy for tuberculosis.

Evaluation of fluorescence microscopy with light emitting diode in detecting Mycobacterium tuberculosis

Shang Mei,Liu Guan,Zhao Liping,Xia Hui,Jiang Guanlu,Huang Hairong,Zhao Yanlin

Chinese Journal of Antituberculosis. 2010, 32(5):  42-46. 

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Objective To assess the performance of fluorescence microscopy with light emitting diodes (LEDFM) in detectingMycobacterium tuberculosis . Methods Using solid L-J culture (L-J) as gold standard, 409 sputum samples were detected by Ziehl-Neelsen (ZN), conventional fluorescence microscopy (FM) and LEDFM. Their sensitivities, specificities, detection times, and feeling of the user were compared. Results Of 175 L-J-positive samples,112 samples were ZN positive,121 samples were FM positive,130 samples were LEDFM positive. Their sensitivities were 64.0%, 69.1%, 74.3%, respectively. Of 234 L-J-negative samples, 233 samples were ZN negative, 227 samples were FM negative, 227 samples were LEDFM negative. Their specificities were 99.6%，97.0%，97.0%, respectively. There were significant difference among the Results of LEDFM and the other two Methods （P<0.001). Detection times of ZN-, FM-, LEDFM-positive slides were 186.7 sec, 75.1 sec, 72.2 sec, respectively, in which there was significant difference between ZN and LEDFM（P<0.05），but not between FM and LEDFM. LEDFM was highly appreciated by technicians involved in this study.  Conclusions LEDFM had better efficacy and use value in detectingM tuberculosisthan ZN and FM.

Application of liquid-based Peng's interlayer vessel technique on detecting acid-fast bacilli

Yang Hualin,Tan Yunhong,Bai Liqong,Hu Peilei

Chinese Journal of Antituberculosis. 2010, 32(5):  46-49. 

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Objective To evaluate the clinical valu of liquid-based Peng’s interlayer vessel technique on detecting acid-fast bacilli (AFB). Methods 642 morning sputum specimens and 1140 timely sputum specimens were collected from 1190 patients with suspected pulmonary tuberculosis, each sputum specimen was detected simultaneously by three Methods as follow: liquid-based Peng’s interlayer vessel technique, sputum smear and acid-fast staining microscopy (direct AFB) and Lwenstein-Jensen (L-J) culture. Result Of 642 morning sputum specimens, the positive rates of Peng’s interlayer vessel technique, direct AFB and L-J culture were 23.5%, 12.7%, 26.6%, respectively. Of 1140 timely sputum specimens, their positive rates were 18.1%, 9.6% and 23.3%, respectively. The positive rate of morning sputa was significantly higher than that of timely sputa (P<0.05). Using L-J culture as golden standard, the sensitivity and specificity of Peng’s interlayer vessel technique were 68.9% and 95.8%, respectively, which were significantly higher than those of direct AFB (P<0.05).  Conclusion The liquid-based Peng’s interlayer vessel technique could increase the sensitity of sputum detecting and had higher specificity. It was simple, convenient, easy to be standardized, andworthy to popularize as a diagnostic method of pulmonary TB.

Study on the diagnostic value of four detection methods of Mycobacterium tuberculosis in cerebrospinal fluid for tuberculous meningitis

Han Lijun,Yan Shiming,Qin Guixiang,Sun Li,Feng Lina

Chinese Journal of Antituberculosis. 2010, 32(5):  50-52. 

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Objective To evaluate the diagnostic value of smear, 3D, PhaB and PCR to detectMycobacterium tuberculosisin cerebrospinal fluid for tuberculous meningitis.  Methods The positive rates of smear, 3D, PhaB and PCRto detectMycobacterium tuberculosisin cerebrospinal fluid were analyzed in 60 patients with tuberculous meningitis and 30 patients with non-tuberculous meningitis. The sensitivity and specificity of four detection Methods for tuberculous meningitis were also evaluated by statistical analysis. Results The positive rate in tuberculous meningitis group and the other group were 0 both in smear,23.3% and 0 in 3D,23.3% and 26.7% in PhaB and6% and 0 in PCR. The differences of four Methods in different groups were not statistically significant. Thesensitivity and specificity were 23.3% and 100% in 3D, 23.3% and 73.3% in PhaB, 10% and 100% in PCR.  Conclusions The sensitivity of Smear, 3D, PhaB and PCR to detectMycobacterium tuberculosisin celebrospinal fluid was low. It is urgent for laboratorys to develop new Methods to detectMycobacterium tuberculosisin cerebrospinal fluid and to improve the positive rate of new Methods .

Observation of pulmonary function after bronchoplasty by fiberoptic bronchoscopic balloon dilatation in the management of tubercular tracheobronchial stenosis

Jiang Ruihua,Sha Wei

Chinese Journal of Antituberculosis. 2010, 32(5):  52-56. 

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Objective To assess improvement of pulmonary function in patients with tubercular tracheobronchial stenosis treated by balloon dilatation through fiberopile bronchoscopy.  Methods Twenty-four patients with proximal tracheobronchial stenosis induced by tracheobronchial tuberculosis were treated by high pressure balloon dilataion through flexible fiberoptic bronchoscopy. Before the procedure and immediately after the last operation, dyspnea index, pulmonary function parameters including VC(%)、FVC(L)、FEV1(%)、FEV1/FVC(%) were tested in all patients, and complications were also evaluated. These Results were compared with 18 cases before and after treatment as a control group. All patients were followed up for twelve to twenty-four months. Results 24 patients received 2 to 6 times of high pressure balloon dilataion respectively, the mean time was 3.64±1.29. After dilatation, dyspnea index decreased from 1.45±1.01 to 0.45±0.59(P<0.01), FEV1(%) increased from 81.47±10.07 to 96.03±10.79(P<0.01), FEV1/FVC(%) increased from 79.56±10.77 to 87.16±7.55（P<0.05）, FVC(L) increased from 4.03±0.41 to 4.62±0.86(P<0.05）, and VC (%) increased from 77.01±19.35 to 79.24±15.15(P>0.05).There were no significant changes in all above-mentioned parameters in the control group before and after balloon dilatation. The long-term effects were 91.67％(22／24) after follow-up for 12 to 24 months.No severe complications were found in all patients,except for 3 patients suffering from mild laceration at distal bronchial mucosa.  Conclusions Bronchoplasty by high-pressure balloon dilation through flexible fiberoptic bronchoscopy is a simple but effective and safe method to treat proximal tubercular tracheobronchial stenosis and to improve pulmonary function.

Evaluation of an Immunochromatographic Assay Kit for Rapid detection of Mycobacterium tuberculosis in Clinical Isolates

Han Min,Yue Jun

Chinese Journal of Antituberculosis. 2010, 32(5):  57-59. 

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Objective To evaluate a new immunochromatographic assay (ICA) for rapid discrimination betweenMycobacterium tuberculosisand non-tuberculosis mycobacteria (NTM) in clinical isolates.  Method 290 clinical isolates including 175Mycobacterium tuberculosis , 65 NTM, 38 bacteria, 12 fungal isolates were detected using an ICA kit.  Results The sensitivity and specificity of the kit were 98.9% (173/175) and 100% (115/115).  Conclusions The ICA can detect rapidly and effectivelyMycobacterium tuberculosisin clinical isolates.