Table of Content

20 February 2011, Volume 33 Issue 2

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dy on adverse drug response of anti-TB treatment in patients living with TB/HIV co-

Zhou Lin,Chen Lei,Lai Yuji,Wang Ni,Liu Eryong,He Jinge,Liu Feiying,Wang Qiaozhi

Chinese Journal of Antituberculosis. 2011, 33(2):  77-81. 

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Objective To understand the frequency and related impact factors of adverse drug response during TB treatment course in people living with TB/HIV co-infection. Methods Adverse drug response of newly discovered TB/HIV patients in 6 counties of 3 provinces was observed.  Results  A total of 332 TB/HIV patients were observed. The overall incidence of adverse response was 81.6%. Of which, 44.2% in gastrointestinal tract, 13.3% in liver, 11.4% of skin allergies, 24.4% of the blood system, 18.7% of nervous system, 3.6% of bones and joints, 4.2%of kidneys, vision, ears and other reaction, 68.1% of adverse response happened within 30 days of anti-TB treatment, 66.8% lasted for more than 15 days, 87.9% of patients died of illness happened in intensive periods of anti-TB treatment. Smear-positive tuberculosis, low-weight, intravenous drug abuse, late initiation of antiviral treatment are impact factors of severe adverse drug response.  Conclusion Patients living with TB/HIV co-infection has higher incidence and longer duration of adverse drug response than pure TB patients. Therefore, adverse response should be monitored, especially in intensive TB treatment period. Patients with smear positive pulmonary tuberculosis, low weight, intravenous drug abuse, late initiation of anti-viral treatment are the focus population; Anti-viral treatment should be initiated early for patients living with TB/HIV co-infection.

A cross-sectional study on Multidrug-resistant tuberculosis diagnosis and treatment in prefecture level designated TB hospitals

Li Renzhong,Geng Cheng,Zhang Hui,Wang Lixia

Chinese Journal of Antituberculosis. 2011, 33(2):  82-86. 

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Objective The purpose of the study was to understand the status of multidrug-resistant tuberculosis(MDR-TB) diagnosis and treatment in prefecture level designated TB hospitals, to analyze problems existed in the process of MDR-TB diagnosis and treatment. Methods A cross-sectional study was conducted to understand the status of TB service delivery through key informant interview and tuberculosis hospitals investigation, to obtain medical diagnosis and therapy situation through inpatients’ medical records investigation.  Results The proportion of financial input by government in total hospital revenue ranged from 5.0% to 30.2% in five hospitals, among them only one out of five hospitals could carry out drug susceptibility test (DST). During hospitalization periods, the standard chemotherapy rate was only 13.3% for multi-drug resistant tuberculosis patients, the median hospital stay was 26 days, the median hospitalization cost was 10893 Yuan, average daily hospital expenses was 362.2 Yuan. The proportion of out of pockets fee by patient accounted for 59%. Only 6.6% of patients were transferred to TB institutions after hospital discharge.  Conclusions At present, the hospitals received low government financial input, and their diagnosis capacity for MDR-TB is weak. The standard chemotherapy rate of MDR-TB patient is low during patients’ hospitalization. In addition, the high hospitalization expenses are in compared with low reimbursement proportion. Most patients discharging from hospitals do not receive timely referral to local TB institutions.

Evaluation on tuberculosis case detection work of Bao’an district of Shenzhen

ZHAO Mei-Gui, ZHANG Neng-Hua, ZHAO An-Gui, GUO Ling, SUN Bi-Hui, ZHENG Juan-Juan

Chinese Journal of Antituberculosis. 2011, 33(2):  87-90. 

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Objective To evaluate the tuberculosis (TB) case detection work of Bao’an district of Shenzhen and explore the weakness in order to further improve the case detection mechanism. Method Data from internet based TB reporting system, TB registers was collected from 2007 to 2009. General hospitals were sampled to check the X-ray diagnosis, TB reporting, referral and tracking information, the usage of anti-TB drugs by inpatients. The situation of anti-TB drugs in drug retailers was also investigated and analyzed.  Result From 2007 to 2009, new smear positive case detection rates of Bao’an district were 80.7%, 100.9% and 97.8% respectively. 88.3% of patients were referred by the general hospitals. Among the TB suspects not in place after referral, in these 3 years, 59.3%, 36.7% and 12.1% were due to unknown address respectively. The sample showed that, the TB suspects’ referral rate reached 100% in every public hospital.No inpatient took drugs from hospitals after discharging. In the five sampled retail drug stores, three of them sold anti-TB drugs.  Conclusion The working quality of reporting and referral of TB suspects in general hospitals of Bao’an District has improved. The case detection rate is in a relatively high level. However, the loss of patients of floating population and lack of monitoring of anti-TB drug retailers is the weakness part in the process of TB case detection.

Research on the method of need for Fixed-dose combination drugs

Xu Hancheng,Chen Cheng,Liu Jianjun,He Guangxue

Chinese Journal of Antituberculosis. 2011, 33(2):  91-94. 

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Objective Research on the calculation formula of need for Fixed-dose combination drugs (FDCS) in NTP and estimative parameter, which will be shared by drug management systems of other diseases.  Methods Based on the calculation method of FDCS’s need, recommended by WHO, and the local FDCS’s characteristic, and the experience on drug supplying in china, obtain the calculation formula of need for Fixed-dose combination drugs (FDCS); the parameter for need calculation was obtained from 484 new smear positive cased by measure their weight and non-negative conversion rate at the end of second month and drug refuse rate.  Results Calculation formula: HRZ: X×（A_30-39×180+A_30-39×R×90+A _40-49×240+A_40-49×R×120+A₅₀×300+A₅₀×R×150）×1.25.streptomycin: X×（22.5+11.25×R）×1.25.HR X×（A_30-39×180+A _40-49×180+A₅₀×240）×1.25. the loose drug:X×B×1.25.; parameter: south provinces:the proportion of 30～39 kg is 5.88%（2.89%，8.87%）, the proportion of 40～49 kg is 40.34%(34.10%，46.57%), the proportion of more than 50 kg patient  kg is 53.78%(47.45%，60.12%).North provinces the proportion of 30～39 kg is 3.67%（1.32%，6.03%）, the proportion of 40～49 kg is 21.63%（16.48%，26.79%）, the proportion of more than 50 kg patient is 74.69%（69.25%，80.14%）. non-negative conversion rate at the end of second month is 5.47％（3.46％，7.47％）. drug refuse rate is 2.69％（1.25％，4.13％）. Conclusion The calculative principle and formula has special reference to estimating the drug need in NTP, and be shared with other drug’s supply system.

Clinical significance of CD4CD^high₂₅ T cells in patients with pulmonary tuberculosis

Zhang Qing,Xiao Heping,Su Bo

Chinese Journal of Antituberculosis. 2011, 33(2):  95-98. 

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Objective To observe theclinical significance of CD4CD^high₂₅ T cells from peripheral blood in pulmonary tuberculosis (PTB) patients.  Methods From January 2008 to February 2010, 40 hospitalized PTB patients and 38 healthy controls from outpatient department for physical examination were enrolled. CD4, CD8 and CD4CD^high₂₅ T cells which were presented by their percentages in peripheral blood lymphocytes of the above subjects were assessed by flow cytometry.  Results The frequencies of CD4CD^high₂₅ T cells in PTB patients （1.9%±1.3%）were significantly higher than that in healthy controls （0.7%±1.0%）(t=5.237, P<0.01). The frequencies of CD4T cells in PTB patients （47.9%±11.2%）were significantly lower than that in healthy controls （56.0%±14.6%）(t=2.830, P<0.01). The frequencies of CD8T cells in PTB patients（26.2%±6.1%） were somewhat lower than that in healthy controls （33.0%±11.1%）, but there was not statistical difference（t=0.353, P>0.05）. After 2 months of anti-TB treatment, the frequencies of CD4CD^high₂₅ T cells in PTB patients （1.8%±0.8%）were decreased as compared with pre-treatment but without statistic significance (t=0.811, P>0.05), while the frequencies of CD4T cells and CD8T cells in PTB patients （51.6%±14.4%，33.7%±11.5%）were all increased as compared with pre-treatment but without statistic significance (t=1.496, 0.570, respectively, all P>0.05).  Conclusions CD4CD^high₂₅T cells are involved in cellular immune of PTB patients, inhibiting the activation and proliferation of CD4 and CD8T cells, affecting the clinical manifestations and prognosis of PTB.

uential therapy of endobronchial tuberculosis by argon plasma coagulation and cr

Chen Zhi,Zhang Guangyu,Liang Jianqin,Wang Jinhe,Tang Jing,Wang Lingling

Chinese Journal of Antituberculosis. 2011, 33(2):  99-103. 

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Objective To evaluate the efficacy, indications and the possible side effects of sequential therapy of endobronchial tuberculosis by argon plasma coagulation and cryotherapy.  Methods Thirty-six patients with endobronchial tuberculosis that were diagnosed by acid-fast stain and culture of sputum(bronchoalveolar lavage fluid), radiology, bronchoscopy and pathology were studied. Sequential therapy by argon plasma coagulation and cryotherapy were performed on the basis of antituberculosis chemotherapy. Efficacy and complication were assessed and followed up after the sequential therapy.  Results Efficacy was assessed by symptoms, physical signs, radiology and bronchoscopy. Thirty-six patients with endobronchial tuberculosis were treated 4±2 times by the sequential therapy. The significant improvement rate was 66.7%(24/36 patients), the clinical effective rate was 27.8%(10/36 patients), the light effective rate was 5.6%(2/36 patients). Severe adverse effects have not found in all the patients.  Conclusions The sequential therapy by argon plasma coagulation and cryotherapy could rapidly relieve clinical symptoms and inhibit efficiently granulation. The sequential therapy by argon plasma coagulation and cryotherapy is an effective and safe method of treatment in patients with endobronchial tuberculosis.

lysis of pathogens isolated from lower respiratory tract in patients with multidrug-resistant pulmonary tub

Hao Xiaohui，Tang Shenjie，Chen Xianping，Liu Yidian，Yue Jun

Chinese Journal of Antituberculosis. 2011, 33(2):  103-108. 

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Objective To investigate the distribution and drug resistance of pathogens in multidrug-resistant pulmonary tuberculosis patients with lower respiratory tract infection.  Methods From January 2007 to December 2009, 127 multidrug-resistant pulmonary tuberculosis patients with sputum culture-positive lower respiratory tract infection and 432 first medicina treatment of pulmonary tuberculosis patients with sputum culture-positive lower respiratory tract infection were examined for bacterial identification and susceptibility test, then analysis.  Results A total of 157 pathogenic bacteria strains were isolated from 127 cases of multidrug-resistant pulmonary tuberculosis with lower respiratory tract infection.Among them, Gram-negative bacillus was in the first place, accounting for 67.5%, followde by Fungi accounted for 30.5%, Gram-positive bacteria 2%. Compared with the first medicina treatment of pulmonary tuberculosis patients,ratioof opportunistic Gram-negative bacillus in patients with multidrug-resistant pulmonary tuberculosis, Klebsiella pneumoniae, Escherichia coli, Enterobacter cloacae, Acinetobacter,was significantly higher.However, ratioof less resistant pathogens, Haemophilus parainfluenzae,in MDR patients was significantly lower than that of patients with the first medicina treatment of pulmonary tuberculosis,it was statistically significant difference between the two groups (P<0.05).Ratio of Fungal infection(30.5%) in patients with multidrug-resistant pulmonary tuberculosis is significantly higher than that of first medical treatment of pulmonary tuberculosis patients (20.6%)（P<0.05）.Gram-positive cocci infection rate of MDR patients is lower than that of first medical treatment of pulmonary tuberculosis patients,it was statistically significant difference between the two groups (P<0.05). Mixed infection rate increased in MDR patients (P<0.05).Gram-negative bacteria susceptibility showed theThe third generation of the above cephalosporins, carbapenems, quinolones had more sensitive, the bacterial resistance level was incresed between the two groups (P<0.05). Gram-positive cocci to penicillin, clindamycin resistance rates was higher, more sensitive to vancomycin.  Conclusion The primary pathogenic bacteria was Gram-negative opportunistic pathogen in lowerrespiratory tract of the patients with lower infection MDR pulmonary tuberculosis,and drug resistance is serious, fungal infection and mixed infection rate increased. Clinical attention should be paid bacterial culture and sensitivity test, to reduce irrational drug use, aggressive treatment of complications, reduce the mixed infection.

Risk factors on the development of multi-drug resistance tuberculosis

Wang Haidong，Xie Yanguang，Yan Xinglu，Li Fabin，Fan Jihuan，Hu Dongmei，He Guangxue

Chinese Journal of Antituberculosis. 2011, 33(2):  109-112. 

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Objective To analyze the factors affecting multi-drug resistance tuberculosis (MDR-TB) development among recruit patients of drug resistant (DR) surveillance programme in Heilongjiang.  Methods Questionnaire survey was conducted on all MDR-TB cases of DR surveillance programme, and their information recorded was collected and analyzed.  Results The proportion of MDR-TB patients among retreatment cases was higher, the main factors affecting MDR-TB development were residence place, number of days of prior treatment and times of prior treatment. Conclusion The longer prior irregular treatment and the more prior irregular treatment received, the more likely MDR-TB occur. Implementation of high quality DOTS can reduce MDR-TB ultimately.