Table of Content

10 August 2011, Volume 33 Issue 8

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Characteristics of new smear positive pulmonary tuberculosis in floating population in 2010

Du Xin, Liu Eryong, Cheng Shiming

Chinese Journal of Antituberculosis. 2011, 33(8):  461-465. 

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Objective  To analyze and compare the characteristics of new smear positive pulmonary tuberculosis (PTB) registered among floating and resident population, and provide evidence base for floating population TB control strategies development.  Methods  The age, sex, occupational, geographical and time distribution of new smear positive PTB among floating and resident population were analyzed based on the national TB-specific internet-based reporting system in 2010. Results  In 2010, a total of 429 812 cases of new smear positive PTB were registered nationally, among  which 29 924 cases were from floating population, accounting for 7.0% (29 924/429 812) of total cases. For different age categories, 88.9%（26 617/29 924）of cases were from 15—55 years age group in floating population, higher than 60.7%（242 771/399 888） of this age group in resident population. For sex distribution, male accounfed for 67.1% (20 076/29 924), female accounted for 32.9% （9848/29 924）in floating population higher than that of 28.3% （113 103/399 888）in resident population. For occupational distribution, the highest were workers accounting for 47.8% （14 312/29 924）followed by 15.8% （4729/29 924）of farmers and herdsmen in floating population, in contrast, in resident population, farmers and herdsmen accounted for 73.3%（293 229/399 888）, followed by 7.4%（29 449/399 888） for workers; the proportion of migrant new smear positive PTB cases was 68.0% （20 341/29 924）in total cases in eastern region and 39.1% （1851/4728）in Beijing, Tianjin and Shanghai region. The registration of migrant new smear positive PTB cases peaked from April to June, monthly registration exceeded 10% of the whole year. Conclusion  In comparison with resident population, floating new smear positive PTB cases showed different characteristics in terms of age, sex, occupational, geographical and time distribution. Therefore, to fully understand and analyze the characteristics is important in TB control strategies development among floating population.

Baseline survey of multidrugresistant tuberculosis (MDR-TB) in MDR-TB diagnosis and management pilot areas

Mi Fengling, Du Jian, Xu Caihong, Jiang Xiaoying, Ma Yan, Gao Jingtao

Chinese Journal of Antituberculosis. 2011, 33(8):  466-470. 

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Abstract：Objective  To examine the rationality of MDR-TB standardized treatment regimen according to the MDR-TB baseline survey results in China Global Fund MDR-TB pilot areas-Wuhan and Shenzhen. Methods  One hundred and five MDRTB bacterial strains acquired from drug resistant surveillance in Shenzhen and Wuhan during January 1 to December 31 of 2008 were given drug susceptibility test (DST) for stréptomycin(S), ethambutol(E),  kanamycin (Km), and ofloxacin(Ofx). Among them, 58 bacterial strains came from new patients and 47 came from retreatment cases. The rationality of treatment regimen was analyzed based on the drug resistant spectrum. Test results were entered into database designed by Epidata and SAS was used for data analysis. Constituent ratios of drug resistance status were described. χ² test and Fisher's exact test were used to examine the difference between groups for enumeration data. P  value<0.05 was considered statistically significant.  Results  Among the 105 MDR-TB strains, 74.3%, 41.0%, 11.4% and 22.9% of strains were resistant to S, E, Km and Ofx respectively. The resistant proportions to these four drugs were 75.9%, 41.4%, 10.3%, 19.0% respectively for new cases and 72.3%, 40.4%, 12.8%, 27.7% for retreatment cases. There has no statistically significant difference between new cases and retreatment cases in terms of the resistance proportion to the four drugs (χ² are 0.001, 0.013, 0.231 and 1.423 respectively, all  P＞0.05). In Shenzhen, the resistant proportions to these four drugs were 76.0%, 40.0%, 16.0% and 4.0% for new cases and 68.8%, 43.8%, 6.3% and 18.8% for retreatment cases. In Wuhan, these proportions were 75.8%, 42.4%, 6.1% and 30.3% for new cases, and 74.2%, 38.7%, 16.1% and 32.3% for retreatment cases. Comparison between Shenzhen and Wuhan showed that for new patients, Ofx resistant in Wuhan is significantly higher than that in Shenzhen (χ²=6.4033, P＜0.05). Between the two cities, there has no significant difference in other three drugs for new cases and in all drugs for retreatment cases. Conclusion  The current standardized regimen is applicable to new and retreatment MDR-TB cases in Shenzhen, however, whether Ofx could be taken as one of main drugs in Wuhan needs to be further studied.

Previous treatment and management history of patients with multidrugresistant tuberculosis (MDR-TB)

Zhang Jiasheng, Sun Qiang, Li Wenjing, Bian Xuefeng, Yan Yun, Wang Lixia, Li Renzhong

Chinese Journal of Antituberculosis. 2011, 33(8):  471-474. 

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Abstract：Objective   To investigate the previous treatment and management history of patients with MDR-TB.  Methods  Questionnaires were used to investigate 43 hospitalized multidrug-resistant tuberculosis patients in TB hospitals in Tianjin, Daqing and Puyang in order to get the quantitative data and SPSS 16.0 was used for data analysis.  Results  53.5%（23/43） of patients received the first treatment in TB dispensaries, 37.2% （16/43）of patients did not complete the first anti-TB treatment. The treatment days between diagnosis of TB and MDR-TB are 767 days on average. The average cost is 24 536 yuan, 72.1%（31/43） of patients had been treated in more than two medical institutions, 23.3%(10/43) of patients had ever interrupted the treatment, 46.5% (20/43)of patients was managed under the doctors’ supervision. Conclusion   The treatment process was complex and treatment behavior was not standardized. The management of TB dispensary is inadequate. Therefore, we should strengthen the guidance

The implementation of "Handbook of Chinese control and prevention  of TB infection"in four health-care facilities

Zhang Weimin, Hong Feng, Wang Haidong, He Guangxue, Guo Hui, Zhang Xiumei

Chinese Journal of Antituberculosis. 2011, 33(8):  475-479. 

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Abstract：Objective   To understand the implementation status of “Handbook of Chinese control and prevention of TB infection” in four health-care facilities. Methods   Data was collected through “ Monitoring and evaluation form of TB infection control in health care facilities” which is a supplement of the handbook and analysis was made on the data.  Results  Six doctors and nurses fell ill with TB in three health-care facilities with sick records from 2005 to 2009. In four health-care facilities, only one and two facilities conducted regular monitoring and maintenance of ventilation equipment respectively; none carried out the fitness tests of medical protective masks and relevant training; only two facilities carried out TB infection control health education publicity activities to TB patients and general public. Conclusion  The overall implementation situation of “Handbook of Chinese control and prevention of tuberculosis infection” is good in general, however,we need to take further effective measures to strengthen TB infection control monitoring and evaluation, ventilation, masks wearing fitness test and publicity activities.

Analysis of TB case-finding in prisoners in Tianjin prison system from 2000 to 2009

Fu Yanyong, Li Shanglun, Wei Wenliang, Zhang Guoqin, Zou Yiwei, Sun Jianping, Gao Xueran, Zhang Changyou, Yang Decai

Chinese Journal of Antituberculosis. 2011, 33(8):  480-485. 

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Abstract：Objective  To know the TB case-finding in prisoners and its trend in Tianjin prison system.  Methods  Tianjin center for TB control and prevention initiated TB case-finding in prison system since 2000 through physical examination of new prisoner, general screening, and passive case finding. During 2000 to 2009, 1811 active TB cases were diagnosed. Data in last decade was collected and the methods of TB case-finding, characteristic and trend of TB in prisons were analyzed.  Results  In the 1811 TB cases, smearpositive pulmonary TB accounted for 9.7%(176/1811) and smear negative accounted for 82.9%(1502/1811), and 7.3%(133/1811) were TB pleurisy; the majority of TB were male and young adults, male accounted 98.3%(1780/1811); 25—54 age category accounted 84.0%(1522/1811). The proportion of retreatment cases decreased from 39.0%(144/369) in 2000 to 3.3%(7/211) in 2009; In terms of case detection methods, patients detected through massive screening decreased from 70.2%(207/295) in 2001 to 19.4%(41/211) in 2009, while the other two methods-new prisoners physical examination and passive case-finding contributed 7.5%(22/295) and 22.4%(66/295) in 2001 respectively, and increased to 38.4%(81/211) and 42.2%(89/211) in 2009; Patients with suspicious TB symptoms, namely cough and expectoration for more than 2 weeks, or having bloody sputum or hemoptysis, decreased from 56.9% in 2000 to 28.4% in 2009; for the cases detected by passive case-finding, the patients’ delay in health seeking reduced from 38.38 days in 2000 to 8.41 days in 2009. Conclusion   Physical examination of new prisoner, general screening, and passive case finding were three main methods for tuberculosis case-finding in prisoners. However, the proportion of patients detected by general screening decreased, while increased for other two methods; the proportion of retreatment and with TB suspicious symptoms decreased; the patients’ delay in health seeking reduced. These findings indicate that tuberculosis cases in prisons became more timely, and cas-finding methods achieved good effect. In the future, we will continue to combine these three methods in case finding in prisoners. 

Serodiagnostic value of twelve antigens from  M. tuberculosis for tuberculosis

Yang Yourong, Wang Quanli, Wu Xueqiong, Liang Yan, Zhang Junxian

Chinese Journal of Antituberculosis. 2011, 33(8):  486-491. 

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Abstract：Objective  To evaluate the value of twelve antigens from  M. tuberculosis on the serodiagnosis of tuberculosis (TB), and to develop more effective diagnostic reagents for tuberculosis. Method  470 human sera were detected the antibodies against twelve M. tuberculosis antigens by ELISA, which sensitivities and specificities were evaluated. Results  The sensitivities of antibody detected by single antigen were range from 13.3%（28/210） to 40.5%(85/210), and the specificities were range from 96.4%(185/192) to 99.5%(191/192). The sensitivity and specificity of antibodies detected by multiple antigens can reach 65.2%(137/210) and 92.2%(177/192), respectively. Conclusion  The multiple antigens can increase the sensitivity and specificity of anti-TB antibody detection, and it may be valuable in the diagnosis of TB.

Analysis on the result of smear and culture for Mycobacteria tuberculosis from 1284 sputum specimens

Li Guohong，Miao Runqing, Jia Yanhui, Wang Yuezhen

Chinese Journal of Antituberculosis. 2011, 33(8):  492-495. 

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Abstract：Objective   To understand the laboratory quality control of acid-fast bacilli (AFB) and culture for  Mycobacteria tuberculosis from sputum specimens in Pinggu district, and to explore the factors that affected the results of AFB and culture in order to enhance detective rate of smear- and culture-positive sputum specimens. Methods  1284 sputum specimens from patients with pulmonary tuberculosis were detected by Ziehl-Neelsen staining and culture for   Mycobacteria tuberculosis  followed the method recommended by the Chinese Antituberculosis Association. Results  The positive rates of smear and culture were 12.2%(157/1284) and 12.9%(166/1284), respectively. The rates of smear- and culture-positive, smear-negative and culturepositive, smear-positive and culture-negative were 11.1%(106/958), 4.0%（38/958） and 0.5%(5/958), respectively. The rate of smear-positive and culture-negative from sputum specimens was 8.6%（28/326）in the following-up patients with pulmonary tuberculosis. The rate of bacterial quantity in the smearpositive and culture-negative specimens less than 2+ were 87.9% (29/33). 71.4% (20/28) of the specimens with smear-positive and culture-negative were collected at the end of 2 or 3 month after treating. The rate of specimens with smear-positive and culture-negative in the follow-up patients was higher significantly than that of the specimens in the new patients（P<0.001）. No mistake result of smear and quantity error was found during this year by blind re-check . Conclusion   The accuracy of detecting result is verified by comparison smear with culture. The quality control of smear and culture in Pinggu district should be improved in the future.

Clinical analysis of ten cases with pulmonary cryptococcosis

Zhou Jie

Chinese Journal of Antituberculosis. 2011, 33(8):  496-499. 

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Abstract：Objective  To improve the level of diagnosis and treatment in pulmonary cryptococcosis according to summary the clinical characteristics of ten cases with pulmonary cryptococcosis. Methods  Ten patients with primary pulmonary cryptococcosis hospitalized in the Fourth People’ Hosptital of Foshan from 2006 to 2010 were analyzed for clinical data, imaging, laboratory results, pathological feature, diagnostic method and efficacy. Results  (1)Of ten cases, five cases suffered from basic diseases and eight cases presented  with clinical symptoms, such as cough,fever,hemoptysis, and atypical chest imaging. Seven cases were confirmed by percutaneous lung biopsy and three cases by surgical operation.(2)All patients were treated with fluconazole including three patients received surgical operation before taking fluconazole. There were seven patients cured and two patients improved.The course of treatments ranged from six to twelve months.  Conclusion   Primary pulmonary cryptococcosis present with various clinical features and chest imaging.Lung biopsy can contribute to diagnose. Primary pulmonary cryptococcosis can get satisfactory efficacy with fluconazole only.

Analysis on clinical efficacy of four cases with multidrug-resistant tuberculous meningitis and literatures review

Chen Zhicheng, Fang Yimin, Chen Yonghao, Dong Haiping

Chinese Journal of Antituberculosis. 2011, 33(8):  500-504. 

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Abstract：Objective  To investigate the antituberculosis therapeutic methods, regimen, course and efficacy judgment for multidrug-resistant tuberculous meningitis. Methods  Four tuberculous meningitis cases with multidrug-resistant tuberculosis isolated from cerebrospinal fluid were analyzed retrospectively in our hospital in recent years and relevant literatures were reviewed. Results  Four patients were treated with individual anti-TB therapeutic regimen and combined with intrathecal injection with isoniazid and dexamethasone. Two patients had been cured and drug withdrawal and the others were dead due to serious complications or adverse drug reaction. Conclusion  Tuberculous meningitis cases with multidrug-resistant tuberculosis usually are serious disease, rapid deterioration and high mortality. There is no uniform therapeutic regimen to treat at present.

Diagnostic value of multi-slice spiral CT(MSCT) for sputum smear- and culture- negative pulmonary tuberculosis with solitary node in chest DR X-ray

Li Huiru, Liu Wen

Chinese Journal of Antituberculosis. 2011, 33(8):  505-508. 

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Abstract：Objective  To evaluate the diagnostic value of multi-slice spiral CT(MSCT) for sputum smear- and culture-negative pulmonary tuberculosis with solitary node shown in chest digital radiography(DR) X-ray. Methods   Solitary node shown in chest DR X-ray and MSCT among 180 cases with smear- and culture-negative pulmonary tuberculosis were analyzed retrospectively and solitary node shown in different section thickness of MSCT and chest DR X-ray were compared. Results   Chest DR X-ray showed cavities in 6 cases and 5 mm section thickness MSCT showed in 15 cases (χ²＝4.096，P=0.043) and 1 mm section thickness MSCT in 16 cases (χ²＝4.841，P=0.028). Satellites were seen in 50 cases with 5 mm section thickness MSCT(χ²＝65.616，P=0.001) and in 55 cases with  1 mm section thickness MSCT(χ²＝68.882，P=0.001), but no satellite was observed in chest DR X-ray. Calcification  was found in shadow among 120 cases with 5  mm section thickness multiplanar reconstruction MSCT(χ²＝116.883，P=0.001) and among 140 cases with 1mm section thickness multiplanar reconstruction MSCT(χ²＝162.000，P=0.001). However, there were only 20 cases found calcification in shadow with chest DR X-ray. There were also statistical differences in calcification of shadow between  5 mm and 1 mm section thickness multiplanar reconstruction MSCT(χ²＝5.538，P=0.019).  Enlarged lymph nodes were observed in 30 cases with  5 mm (χ²＝33.750，P=0.001)or 1 mm(χ²＝33.750，P=0.001) section thickness multiplanar reconstruction MSCT. There was no enlarged lymph node observed in Chest DR X-ray. Tree-in-bud sign was not shown with Chest DR X-ray in all patients and was shown with 1 mm MSCT among 10 patients (χ²＝9.907，P=0.007). Ground-glass opacities was not shown with chest DR X-ray in all patients and was shown with 1 mm MSCT among 10 patients(χ²＝15.882，P=0.001). Conclusion   MSCT is better in diagnosis of smear- and culture-negative pulmonary tuberculosis with solitary nodes than chest DR  X-ray. 