Table of Content

20 May 2011, Volume 33 Issue 5

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Analyze the epidemical multidrug-resistant Mycobacterium tuberculosis from Shenzhen by DNA sequencing

Cui Yunyong, Wang Feng, Liu Xiaoli, Yang Hui, Gui Jing, Hu Siyu

Chinese Journal of Antituberculosis. 2011, 33(5):  257-262. 

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Objective To investigate the epidemiologic characteristic of multidrug-resistant (MDR) Mycobacterium tuberculosis(MTB) in Shenzhen.Methods According to the standard of WHO, International Union Against Tuberculosis and Lung Disease (IUATLD), drug-susceptive and MDR MTB strains were collected by drug susceptibility test (DST) of 1% proportion method.kat G,inh A, intergenic region ofoxy R- ahp C and 81bp core region ofrpo B genes in 153 drug-susceptive strains and 132 MDR strains were analyzed by DNA sequencing.  Results 27.5%（42/153）of drug-susceptive strains and 98.5%（130/132）of MDR strains showed gene mutations. Of 132 MDR strains, 73.5%（97/132）had kat G mutations, and 68.9%（91/132）of kat G mutations were at codon 315; 18.2%（24/132）had inh A mutations, and none specific mutations were found at codon 94 of inh A; 11.4%（15/132）had mutations at inh A-promoter region; 16.7%（22/132）had ahp C mutations, 10.6%（14/132）had mutations at intergenic region of oxy R- ahp C; 93.2%（123/132）had mutations at the 81bp core region of rpo B.  Conclusion The codon 315 of kat G, promoter region of inh A,ahp C and the 81bp core region of rpo B play predominant roles in MDR-TB in Shenzhen.

 Clinical value of real-time FQ-PCR assay for detection of Mycobacterium tuberculosis/non-tuberculous mycobacteria

Kang Lijun,Hong Feng,Feng Jianbing,Liu Wei,Wu Hua,Yi Junli,Yi Junli,Wang Sumin

Chinese Journal of Antituberculosis. 2011, 33(5):  263-266. 

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Objective To evaluate the clinical diagnostic value of real-time FQ-PCR assay for the detection of Mycobacterium tuberculosis(MTB)/non-tuberculous mycobacteria (NTM). Methods 420 specimens were detected by real-time FQ-PCR, and the results were compared with those of AFB smear and culture.  Results The sensitivity of FQ-PCR was 48.5%, in which the sensitivity in bacterium-positive and bacterium-negative specimens were 95.8% and 14.5%, respectively. The specificity, positive predictive value and negative predictive value of FQ-PCR were 99.3%, 99.1% and 55.5%, respectively. 1 of 388 sputum specimens was NTM-positive by FQ-PCR, which was confirmed by DNA sequencing. 32 NTM isolates were confirmed by FQ-PCR and DNA sequencing. Their accuracy was 100%.  Conclusions The real-time FQ-PCR was a simple, rapid and specific assay for the detection ofMycobacterium tuberculosis /non-tuberculous mycobacteria in a sealed tube.

A comparative study on two interferon-gamma quantitative detection kits for the diagnosis of tuberculosis

Li Xiaofei,Zhao Qin,Wang Yaling,Yu Wenlin

Chinese Journal of Antituberculosis. 2011, 33(5):  267-270. 

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Objective To evaluate the sensitivity and specificity of interferon-gamma (IFN-γ) quantitative detection kit (TB-IGRA, Beijing Wantai Biological Pharmacy Corporation Ltd.) for the diagnosis of tuberculosis (TB).  Methods We detected the serum specimens from 319 patients with pulmonary TB, 23 patients with extrapulmonary TB, 39 patients with non-TB lung disease and 104 healthy people with TB-IGRA and QuantiFERON-TB GOLD in tube (QFT-GIT, Cellestis, Australia) simultaneously, and compared their Results .  Results The sensitivities of TB-IGRA for TB and extrapulmonary TB were 90.9% and 78.3%, respectively, and it’s specificity was 76.9%. The sensitivities of QFT-GIT for TB and extrapulmonary TB were 88.4% and 78.3%, respectively, and it’s specificity was 80.4%. There was no significant difference between these two kits. Conclusion TB-IGRA is a highly sensitive and specific kit in the diagnosis of TB, and it can be used in the accessory diagnosis of tuberculosis, especially extrapulmonary tuberculosis.

The diagnostic value for renal tuberculosis by detection of Mycobacterium tuberculosis from Urine with phage amplified biologically assay

He Jian，Chen Dongyun，Wei Jiao

Chinese Journal of Antituberculosis. 2011, 33(5):  271-274. 

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Objective To evaluate the diagnostic value for renal tuberculosis by detection of Mycobacterium tuberculosis from Urine with phage amplified biologically(phaB) assay. Methods 63 patients with renal tuberculosis and 21 healthy subjects were recruited as research group and control, respectively. We detected Mycobacterium tuberculosis in the urine from research group patient using smear, culture and phaB. Meanwhile TB-DNA were detected from the urine by polymerase chain reaction(PCR). The urine from the control were detected using phaB and PCR.  Results The positive rate of detection for Mycobacterium tuberculosis from urine by phaB in research group was significant higher than that by smear and culture (P<0.01). But the positive rate was no significant difference between using phaB and using PCR (P>0.05), Specificity and sensitivity of phaB for detecting Mycobacterium tuberculosis from urine was 95.2% and 69.8%, respectively.  Conclusion PhaB is useful tool to detectMycobacterium tuberculosisfrom urine for diagnosis of renal tuberculosis.

Treatment outcomes of linezolid for multidrug-resistant tuberculosis:a systematic review and meta-analysis

Huang Hairong,Yu Xia,Jiang Guanglu,Dai Guangming,Ma Yu

Chinese Journal of Antituberculosis. 2011, 33(5):  275-279. 

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Objective To evaluate the efficacy and safety of linezolid for treating multidrug resistant tuberculosis（MDR-TB）. Methods Cochrane Controlled Trials database, Pubmed, Embase, CBM, CNKI, Wanfang Date and other electronic databases were searched. Clinical studies matched the inclusion criteria would be analysed statistically. Results A total of five clinical studies met the inclusion criteria in seven countries. The Results showed that the mean proportion of patients achieving treatment success was 82% (95% CI 73％—89%); the mean proportion of patients whose outcome were treatment failure,default and death were 2%, 5% and 11%,respectively. The incidence rate of adverse events in hematopoietic system and neurotoxicity and gastrointestinal system were 32%, 25%, 6%, respectively.  Conclusion Linezolid against MDR-TB has a good efficacy, but the incidence of adverse events is higher.

Clinical analysis on 13 cases with multiple intracranial tuberculomas

Li Shuyan,Liu Guoli,Wu Hailiang,Zhan Yunfei,Yang Xiaoguang

Chinese Journal of Antituberculosis. 2011, 33(5):  280-283. 

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Objective To investigate the clinical features and the Methods of diagnosis and treatment for multiple intracranial tuberculomas.  Methods 13 patients with multiple intracranial tuberculomas were retrospectively analyzed from January 2004 to December 2007 in Shandong Chest Hospital.  Results The clinical presentations mostly consisted of headache(11/13), fever (10/11), vomiting(7/11) and increased intracranial pressure (8/13). Cell count from cerebral spinal fluid(CSF) was high in 11 cases. Extracranial tuberculosis were combined in 10 cases. Magnetic resonance imaging(MRI) showed iso-intense signal on T1-weighted imaging and hypo-intense signal on T2-weighted imaging. Histopathologic examination revealed tuberculosis granulomatous inflammation in 3 cases. Using comprehensive therapy including intensive anti-tuberculosis regimen, hormone and intrathecal injection with drugs, efficacy was satisfactory.  Conclusion Multiple intracranial tuberculomas is a special type of intracranial tuberculosis. Combination withits clinical,manifestation radiological features and CSF result, clinical diagnosis is helpful to be established. Comprehensive therapy including the intensive anti-tuberculosis regimen, hormone and intrathecal injection with drugs is recommended.

Clinical analysis on diagnosis of sarcoidosis in 45 patients

Zhang Tongmei,Qin Na,Lu Baohua,Wang Jingping,Li Baolan

Chinese Journal of Antituberculosis. 2011, 33(5):  285-289. 

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Objective To deepen the understanding on the diagnosis of sarcoidosis and to reduce the misdiagnosis.  Methods We analyzed retrospectively data of clinical features,diagnosis approaches and misdiagnosis from 45 patient with sarcoidosis hospitalized in our hospital from 1990 to 2000.  Result Of 45 cases, intrathoracic, systemic and extrathoracic sarcoidosis were 30, 14 and 1, respectively. There were 19 cases in stage 1, 24 cases in stage 2 and 1 case in stage 3. In additional, one case belonged to extrathoracic sarcoidosis. Cough and chest tightness were the most common presentation. The best method for confirmed diagnosis was biopsy by mediastinoscopy，thoracoscopy and operation. The alternative method for confirmed diagnosis was also biopsy with superficial lymph nodes and cutaneous focus. In 35 cases, 18 cases were misdiagnosed as pulmonary tuberculosis, 7 cases as pneumonia, 5 cases as lung cancer,3 cases as lymphoma, one case as eye disease and one case as autoimmune disease. Conclusion The clinical manifestation on sarcoidosis is varied and it is easy to be misdiagnosed. If patient has extrathoracic focus, biopsy of superficial lymph nodes and cutaneous focus are recommended as preferred method. It is difficult to differentiate with tuberculosis, lymphoma and lung cancer. Therapy should be considered carefully before confirmed diagnosis.

 Analysis of human resource situation of laboratories of tuberculosis control program

Jiang Guanglu,Xia Hui,Song Yuanyuan,Zhao Yanlin

Chinese Journal of Antituberculosis. 2011, 33(5):  290-294. 

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Objective This study aims to investigate current national situation of human resources in tuberculosis prevention and control system in order to improve the quality of laboratory work and strengthen the tuberculosis laboratory services. Methods Personnel data of TB laboratories staff was from the 2009 laboratory survey. The composition of professional title, age, major, and time spent on the tuberculosis laboratory work were analyzed respectively.  Results The situation of human resource was extremely uneven. Although the number of laboratory personnel could meet the basic need of current smear microscopy, there is only 1 technician in 60.8% of county level and 41.8% of prefecture level laboratories, and the proportion of full time staff is low. The quality of laboratory staff needs to be strengthened in order to meet more needs in diagnosis services in the future.  Conclusions To meet the higher requirements for future work, the human resource needs to be improved through increasing the quantity of staff and training.

Analysis of public awareness rate of tuberculosis in Shenzhen

Lv Jianwen, Yang Yingzhou, Lv Deliang, Wu Qingfang, Zhang Yuhua, Guan Hongyun, Li Mingzhen

Chinese Journal of Antituberculosis. 2011, 33(5):  295-298. 

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Objective To understand awareness rate of tuberculosis control and prevention in the resident of Shenzhen city, in order to carry out more effective health education.  Method 5 249 people were selected through a multi-stage cluster random sampling method, they were administered to face to face questionnaire survey.  Results 5 046 questionnaires were eligible collected. The public awareness rate to all core information is 12.5%, the total public awareness rate to core information is 52.9%.The total awareness rate to core information of the local residents is 55.7%, which is significantly higher than 49.4% of the floating population in Shenzhen.The awareness rate is closely related to age and sex, and age and the awareness rate is inversely related.  Conclusions The public awareness rate of TB knowledge inShenzhen is stilllow.We should strengthen health education on TB knowledge focusing on the floating population, elderly and female population.

The investigation and analysis of medical insurance status of patients with pulmonary tuberculosis in Kaifeng City

Zhang Junqin,Li Weibin,Hou Jianzhong,Liu Hong

Chinese Journal of Antituberculosis. 2011, 33(5):  299-302. 

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Objective To understand the medical insurance status and economic burden of patients with pulmonary tuberculosis in Kaifeng City and provide evidence base for formulation of relevant policies.Methods This study used a unified questionnaire. Non-MDR-TB patients who registered in 2009 and have completed treatment were eligible for enrollment. Twenty-five eligible patients in each insurance category including the new cooperative medical system, medical insurance for urban workers, and residents insurance were randomly selected respectively. Investigations were made through face-to-face and telephone interview. Results The reimbursement policies on the proportion of TB patients varied between three types of health insurance. The medical expenses of out-patient pulmonary tuberculosis patients were not included in the scope of reimbursement. The reimbursement for patients living in hospital was between 60％～80%. The survey also found that the actual reimbursement proportion of hospitalization expenses for the new cooperative medical system, medical insurance for urban workers, and residents insurance were 27.2%, 53.7% and 50.8% respectively, lower than the reimbursement policies and regulations; Medical expenses excluding the reimbursement accounted for 53.7%, 30.6% and 32.7% respectively in non-food expenditure. Conclusions Including pulmonary tuberculosis in the health insurance could reduce the economic burden to a certain extent. However, the reimbursement policies varied between different types of insurance. The actual reimbursement were significantly lower than the reimbursement policies and regulations, The economic burden of new rural cooperative system TB patients is still relatively heavy.

Analysis of the referral and tracking situation of pulmonary tuberculosis (TB) patients reported through internet-based infectious disease reporting system by non-TB Institutions in Chaohu city

Cao Hong

Chinese Journal of Antituberculosis. 2011, 33(5):  303-306. 

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Objective To analyze the referral and tracing status of PTB patients reported through internet-based infectious disease reporting system by non-TB institutions in Chaohu city, to evaluate the status of cooperation and coordination between TB and non-TB institutions, and provide evidence for increasing TB case finding.Methods TB control monthly reports of 5 counties of Chaohu city from 2007 to 2009 were collected to analyze the status of referral and tracking in place of TB patients reported by non-TB institutions.  Results The number of TB patients and suspicious TB referral by non-TB institutions were 1 697, 1 793 and 1 738 cases respectively from 2007 to 2009. The number of referral in place patients was 688, 677 and 543 cases respectively. The corresponding referral in place rate was 40.5%, 37.8% and 31.2%. A total of 785, 957 and 961 patients visited TB control institution after tracking, the tracking in place rate was 80.4%,87.2% and 82.2%, which was significantly statistical higher than the referral in place rate (P<0.05). Conclusions There are still some problems in referral in patients reported by non-TB institutions through internet-based infectious disease reporting system, therefore, it is necessary to strengthen the cooperation between TB institutes and medical agencies in order to improve the overall in place rate of TB patients.