Table of Content

20 March 2011, Volume 33 Issue 3

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

Yan Bei,Cai Fengzhu,Bai Yun,Sun Qiao

Chinese Journal of Antituberculosis. 2011, 33(3):  137-140. 

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Objective To evaluate the effects of Global Fund Round 5 project on case detection, referral and treatment of pulmonary tuberculosis (PTB) among floating population in Pudong district.  Methods The data was obtained from “Infectious disease surveillance system” and TB registers.  Results After theproject implementation, the registration rate of PTB patients among the floating population rose significantly from 39.26/100 000 to 51.26/100 000 and 53.52/100 000 for the second and the third implementation year，for new smear positive PTB patients, the registration rate rose from 9.37/100 000 to 16.09/100 000 and 18.59/100 000. The referring in place rate of TB patients by non-TB institutions increased from 81.2% to 90.6% before and after the project implementation. The proportion of patients receiving treatment in Shanghai for more than 1 month and 6 months also increased significantly from 82.9％ and 70.5% to 88.2% and 80.9% for the second implementation year and 88.5% and 80.4% for the third year.  Conclusions The global fund project enhanced the working level of floating population TB case detection, referral and treatment in Shanghai.

Analysis of case detection of pulmonary tuberculosis patients through large-scale household survey and concentrated recommendation of tuberculosis suspects in Chengdu

Tian Ming,Lei Rong,Gao Chengfu,Pan Rong,Chen Yi,Deng Xiaoying

Chinese Journal of Antituberculosis. 2011, 33(3):  141-144. 

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Objective This study aims to understand the role and effect of household survey and concentrated recommendation on pulmonary tuberculosis (PTB) case detection.  Methods TB suspects were detected through face to face inquiry and observation, and they were referred to designated hospitals through concentrated recommendation for screening. TB patients were confirmed by TB institutions.  Results In 2009, nine districts (counties) fully carried out this household survey. A total of 3 910 504 people were registered and 3 817 928 people were investigated, the investigation rate was 97.6%. 411 cases of active PTB were detected, among which 172 were new smear positive, accounting for 41.8%. This survey contributed 23.8% and 21.9% respectively in terms of new active case and smear positive case detection in local CDC during the same periods. 78.6% of PTB patients detected showed symptoms of cough, expectoration ≥2 weeks or hemoptysis, bloody sputum.   Conclusions Household survey and concentrated recommendation of TB suspects is an effective way in improving case detection. Household survey is conducive to the implementation of DOTS strategy and the increase of TB knowledge among general public, benefits understanding of TB prevention among township and village doctors. In addition, this survey could promote the active diagnosis and regular treatment, which ultimately improve PTB case detection.

The differential diagnosis of cryptococcal meningitis and tuberculous meningitis

Kong Zhongshun,Chen Xichen,Ma Liping,Gao Mengqiu

Chinese Journal of Antituberculosis. 2011, 33(3):  145-148. 

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Objective To investigate the differential diagnosis of cryptococcal meningitis(CM) and tuberculous meningitis(TBM).  Methods  We analyzed retrospectively the clinical data of clinical manifestation, cerebrospinal fluid(CSF) and head CT or MRI in 19 cases with cryptococcal meningitis and in 50 cases with tuberculous meningitis.  Results There were significant differences in delayed diagnostic time, complications, cranial nerve damage, intracranial pressure and glucose value of CSF, positive rate of polymerase chain reaction for TB(PCR-TB）, positive rate of lipoarabinomannan antibody(LAM-Ab) in serum and CSF, erythrocyte sedimentation rate(ESR), the detect rate of abnormal imaging in head CT or MRI between TBM and CM. However, there were not significant differences in clinical manifestation, white cell count in CSF, protein value, chloride value, adenosine deaminase(ADA) value, head CT or MRI imaging between TBM and CM.  Conclusions The clinical characteristics of CM are atypical. It is difficult to be differentiated with TBM and be misdiagnosed easily. Multiple markers combination is useful to diagnose CM earlier.

Extraction of lipoarabinomanan and its diagnosis value for pulmonary tuberculosis

Peng Rong,Yue Jun,Jin Ruiliang,Jing Lingjie,Han Min

Chinese Journal of Antituberculosis. 2011, 33(3):  149-152. 

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Objective To develop a method for extracting lipoarabinomanan（LAM）fromMycobacterium tuberculosis , and to evaluate serodiagnosis value of LAM for pulmonary tuberculosis.   Methods Mycobacterium tuberculosiswas sonicated in ice and then refluxed with ethanol; treated with DNase I and RNase; removed proteins with phenol; removed phenol and lipide with chloroform/methanol. The crude lipopolysaccharide (LPS) was prepared. LPS was purified with Sephacryl-100 gel filtration, and LAM were obtained. LAM was used as antigen to detect anti-LAM IgG in serum by dot immunogold filtration assay.  Results The relative molecular weight of LAM was approximately 37 kDa, consistent with the reference. The sensitivity, specificity, positive predictive value, negative predictive value and coincidence with smear were 91.7%, 87.8%, 92.7%, 86.2% and 90.2%, respectively.  Conclusions LAM was obtained successfully. LAM used as antigen to detect anti-TB antibody in serum showed good specificity and sensitivity, and might be one of canditate antigens for the serodiagnosis of TB serology.

The expression and its significance of MIF、TNF-α in pulmonary tuberculosis tissue

Qi Yun, Shi Zhihong, Gou Chaolun

Chinese Journal of Antituberculosis. 2011, 33(3):  153-157. 

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Objective To study the expression difference and clinical value of MIF, TNF-α in pulmonary tuberculosis (PTB) tissue and normal lung tissue.  Methods The lung specimens were divided into normal control group (17 cases) and PTB group (33 cases).All the specimens in PTB group were divided into 15 non-cavity groups (including 15 tubercle tissues and 15 peripheral tissues of tubercle) and 18 cavity groups (including 18 tubercle tissues and 18 peripheral tissues of tubercle).The expressions of MIF、TNF-α in lung tussues were examined with quantitative immunohistochemistry assay.  Results There are a lot of expressions of MIF、TNF-α,in which most of them were expressed by epithelioid cell and Langhans’ giant cells in tubercles of PTB. The expression levels of MIF、TNF-α in the tubercles of PTB is much higher than that in the peripheral tissues of the tubercles in PTB, which was much higher than that in the normal lungs. The expression levels of MIF、TNF-α of cavity groups is higher than that of non-cavity groups. The tubercles of PTB, MIF and TNF-α are positively correlated.  Conclusions MIF、TNF-α are closely correlated with the formation of tubercles in PTB. The overexpression of MIF and TNF-α in the tubercles of PTB might play a crucial role in the formation of cavity of PTB.

Evaluation of phage amplified biologically assay for amikacin susceptibility test of Mycobacterium tuberculosis

Li Tongxin, Cui Zhenling, Wang Xiaoli,Lu Junmei, Wang Jie, Hu Zhongyi

Chinese Journal of Antituberculosis. 2011, 33(3):  158-162. 

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Objective To set up a rapid detective technique for amikacin (Am) resistance inMycobacterium tuberculosis( M .TB) by phage amplified biologically (PhaB) assay, and to evaluate its value for application in clinical isolates.  Methods The different concentrations of M .TB and Am were screened to obtain the best conditions in PhaB assay. Am susceptibility of 108 M .TB clinical isolates were detected by PhaB assay and compared with the Results from Bactec MGIT 960. If the Results of two Methods were different, the MICs of strains were detected.  Results The best test conditions of PhaB assay were that 10^-3 mg/ml of M .TB and 2 μg/ml of amikacin were mixed and incubated at 37 ℃ for 48 hours．Of 108 M .TB clinical isolates, 82 were sensitive and 26 were resistant to Am by PhaB assay; while 80 were sensitive and 28 were resistant to Am by Bactec MGIT 960. When Bactec MGIT 960 was used as the control，the sensitivity，specificity, PPV, NPV and accuracy of PhaB assay were 89.3%, 98.8%, 96.2%, 96.3%, 96.3%, respectively.  Conclusions The PhaB assay only need 3 days. It is a highly sensitive, specific, accurate, simple and low-cost method for the rapid Am susceptibility test of M .TB isolates.

Comparative analysis on the anti-tuberculosis drug resistance of the rifampin-dependent and -resistant strains of Mycobacterium tuberculosis

Yang Caie,Wang Yan,Lei Hong,Sun Bin,Meng Xianghong,Dong Mei

Chinese Journal of Antituberculosis. 2011, 33(3):  163-165. 

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Objective To compare the drug resistance patterns of rifampin(R)-dependent Mycobacterium tuberculosis with R-resistant Mycobacterium tuberculosis. Methods The double-phase Kuang’s agar medium was used to culture and isolate M. tuberculosisfrom the patient’s sputum specimens. Patterns of drug resistance and rifampin-dependence were determined simultaneously.  Results The R-dependent M. tuberculosis strains exhibited higher rates of resistance to all the 8 anti-tuberculosis drugs than the R-resistant strains. The rates of resistance to streptomycin, ethambutol, paraminosalicylic acid and amikacin in these two groups of strains showed significant difference (P<0.05), and the resistance to levofloxacin had highly significant difference (P<0.01). 100% of R-dependent strains and 98.6% of R-resistant strains showed the resistance to multi-drugs. The ratio of extensively drug-resistant (XDR) isolates in the R-dependent strains and R-resistant strains were 14.6% and 5.8% (P=0.05), respectively.  Conclusion All the rifampin-dependent Mycobacterium tuberculosis strains were multi-drug resistant (MDR), which showed high drug resistance rate against first-line and second-line drugs and had more XDR strains.

Effects of BCG-PSN on U937 cells stimulated by PMA

Zhang Haiping,Chang Xiao,Lian Shi

Chinese Journal of Antituberculosis. 2011, 33(3):  166-168. 

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Objective To study the effect of BCG-PSN on the inflammatory cytokine TNF-α and IL-1β secreted from macrophage U937.  Methods Human mononuclear macrophage U937 were cultured and induced to be mature by PMAin vitro , and then divided into five groups: control group, LPS group, low dose BCG-PSN group, middle dose BCG-PSN group, high dose BCG-PSN group. TNF-α as well as IL-1β released from the U937 cells were detected by ELISA.  Results The level of TNF-α released from the stimulated U937 cells in BCG-PSN groups increased significantly than that in the control group (P<0.05); while the level of IL-1β in BCG-PSN groups had not significant difference with that in the control group.  Conclusions U937 cells could be activated to increase the secretion of TNF-α by BCG-PSN. BCG-PSN has not effect on the secretion of IL-1β.