Table of Content

10 December 2009, Volume 31 Issue 12

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Analysis on treatment failure in drug-resistance surveillance project in Heilongjiang

Fan Jiliuan¹， Xie Yanguang² , He Guangxue³, Yan Xinglu²，Li Fabin²

. 2009, 31(12):  681-685. 

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Objective To learn the drug resistance situation of new and re-treatment TB cases，as well as the influencing factors of treatment failure，and to provide evidence for the case treatment and management in Heilongjiang. Methods The information of treatment and drug-resistance of patients enrolled in the drug resistance surveillance project in 2004 was analyzed. Results (1)There was an significant difference between new and re-treatment patients on drug-resistant (P<0. 001) ； (2) The major factors of treatment failure in new cases were place of residence (PP<0.05，adj C)R=4.70，95%CI[1. 76 — 12. 5])，and high sputum smear load (P<0. 05, adj OR = 5.52, 95% CI[1. 84-16. 61])； (3) The main factors of treatment failure in re-treated patients were MDR-TB (P<0. 05, adj OR = 5. 58，95% CI[1.44-21.69])，and the times of re-treatment (P<0. 05, adj OR = 3.34，95%CI[1. 31 — 8. 5]).Conclusions The difference of drug resistance between new and re-treatment patients shows thatchemotherapy should be chosen based on the result of drug sensitivity test ； these data suggest thatstandard short-course chemotherapy，based on first-line drugs, is inadequate for some patients，especially MDR-TB cases. Besides，the risk factors of treatment failure should be concerned to improve the measures of management and treatment and to reduce the emergence of treatment failure and drug resistance.

Analysis on the effects of implementation of CI DA WHO project in China

Cheng Shiming¹，Liu Eryong¹，Du Xin¹，Huang Fei¹，Liu Xiaoqiu¹，Liu Zhimin² , Xu Weiguo³ , He Tieniu⁴, Wang Lixia¹

. 2009, 31(12):  686-689. 

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Objective To analyze and evaluate the implementation effect of CIDA/WHO TB Control project in China. Methods National TB program quarterly report of Shandong，Jiangsu and Zhejiang province from September 2002 to December 2005 were collected and analyzed. as well as specific project budgeted work plan and quarterly monitoring report to evaluate the overall imple mentation effect of CI DA project. Results (1) During the period of project implementation，the project detected a total of 66 859 new smear positive pulmonary tuberculosis cases, which corresponded to 105. 3% of planned target. The registration rate of smear positive pulmonary TB cases increased from baseline 13. 65/100 000 to 33. 95/100 000 in 2005. (2) The cure rate for smear positive pulmonary cases reached 92. 1%. (3) DOTS coverage rate of three whole provinces increased from before-project 65. 2% to 100% in the first implementation year. Conclusions CIDA project promoted the DOTS expansion. For the first time in China, the target-oriented budgeted work plan management model is adopted and it greatly promoted the achievement of project target. Now.budgeted work plan model has been successfully applied in other TB control project and National TB program.

The survey report of the situation about sputum smear spots at township level in Shanxi

Fan Yueling

. 2009, 31(12):  690-692. 

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Objective Through analyzing the situation of sputum smear spots at township level established from 2005. to provide the base for development the next-step TB work plan in Shanxi. especially in enhancing the work of sputum smear spots at township level. Methods The basic document on sputum smear spots at township level was collected and analyzed, including general in-formation, funding, case-finding, etc. Results Four hundred and eighty-four sputum smear spots at township level were established and 309 worked well. The smear positive rate of TB patients examined from 2005 to 2008 was 4. 6 % ； the percentage of smear positive cases funded in sputum smear spots at township level was 1.1%； the coincidence rate of positive and negative smear were 73 % and 91 % respectively. Conclusions Although township sputum smear spot has contributed to the case finding in Shanxi, it is important to enhance the work of sputum spots at township level in township doctor training, clarifying the township sputum smear spot's duty and monitoring the fund usage.

Clinical analysis of pulmonary fungous infection in 51 cases of mu 11 id rug- resist ant pulmonary TB( MDR-PTB)

Ye Mengh ua¹，Zhang Zhongshun², Yang Yan²， Liu Zhibin²

. 2009, 31(12):  693-696. 

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Objective To study the risk factors,clinical characteristics and Methods of diagnosis and treatment of secondary fungal infection in MDR-PTB cases in order to improve the recognition and treatment of the coexistence of two diseases. Methods Fifty-one cases of MDR-PTB compli-cated with fungi infection in our department from 2002 were retrospectively analyzed. Results Fifty-one cases had susceptible factors of fungus infection. The major clinical features were as follows： they had a long history of tuberculosis； usually occurred in older patients；they had extensive range of lesions and many cavities in lungs； Their diagnosis depended on the examination of pathogenic organisms, type of fungi in 51 cases was Candida Albicans. Conclusion It is common that fungal infection occurred in MDR-PTB cases. Improving the recognition on the two diseases will be contribute to MDR-PTB control and reduce death rate.

Clinical and radiographic characteristics of 24 pregnancy complicated with pulmonary tuberculosis

Li Li¹，He Wei²

. 2009, 31(12):  697-700. 

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Objective To analyze the clinical and radiographic characteristics of pregnancy associated with pulmonary tuberculosis. Methods The clinical and imaging data of 24 women were analyzed retrospectively. Results The systemic toxic symptoms were significant. X-ray and CT showed bilateral multiple lobes involved, air space consolidation,cavities and nodules are most common. The acute and subacute hematogenous dissemination accounted for 20. 8 %, the positive rate of sputum culture was 42.1% , and the rate of misdiagnodid was 54. 1 %. Conclusions Pregnancy can agreevate tuberculosis. We should pay attention to the understanding of pregnancy with tuberculosis, and increase the rate of early diagnosis.

Clinical analysis on the value of bronchoscopy in pulmonary tuberculosis patients with frequent cough

Wang Decui, Gao Yong, Wang J un ling, Jin Shu Hang , Zhang Hongjun ,Sun Xixia , Tian Tian , Wa ng Yan fang

. 2009, 31(12):  703-705. 

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Objective To investigate the relationship between frequent cough and bronchial tuberculosis in patients with pulmonary tuberculosis. Methods 185 cases of pulmonary tuberculosis underwent bronchoscopy and bronchial brushing, biopsy and bacterial detection were further performed for patients with bronchial lesion. The group of patients with frequent cough was compared with the control. Results Of 96 cases with frequent cough. 86 cases combined with bronchial tuberculosis. The rate of combination was 89. 6% in the group of frequent cough. 14. 6% in the control. Conclusions Pulmonary tuberculosis patients with frequent cough should be underwent bronchoscopy in order to detect bronchial tuberculosis early, and to treat in time.

Analysis on Surgical Treatment in 205 Patients wilh Pulmonary Tuberculosis Combined with Bronchial Tuberculosis

Gong Chang fan，Bai Lianqi 9 Yan Dongji?，Don Xuejun

. 2009, 31(12):  706-708. 

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Objective To investigate the effect and indications of surgical resection in pulmonary tuberculosis combined with bronchial tuberculosis. Methods From January 1973 to December 2007，205 patients with pulmonary tuberculosis combined with bronchial tuberculosis underwent surgical resection therapy. According to classification of pulmonary tuberculosis，there were 3 cases of primary pulmonary tuberculosis, 19 infiltrative pulmonary tuberculosis，53 cavitary pulmonary tuberculosis 9 45 chronic fibro-cavernous pulmonary tuberculosis，48 tuberculosis tumor or caseous pneumonia，27 tuberculous tracheobronchial stenosis，10 destroyed lungs. According to Chinese classification of bronchial tuberculosis, there were 30 cases of type Ⅰ.91 type Ⅱ，50 type Ⅲ，34 type IV. Result The modes of surgical treatment included： pneumonectomy in 15 cases. pneumonectomy combined with thoracoplasty in 32 cases，lobectomy in 106 cases, lobectomy combined with thoracoplasty in 29 cases, lobectomy or pneumonectomy combined with bronchoplasty in 14 cases，Other operations in 9 cases. The overall clinical cure rate was 95. 0%. The rate of complication was 11. 2%. The operation mortality was 0. 05%. Conclusion Although chemotherapy is an important treatment for pulmonary tuberculosis combined with bronchial tuberculosis，the operation is necessary for pari of the patients. Surgical operations may increase cure rates of the patients.

Evaluation of MTBDR-Plus assay for rapid deteclion of rifampin and isoniazid resistance in 197 M. tuberculosis clinical isolates

Li Qiang，Zhao Yanlin

. 2009, 31(12):  709-712. 

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Objective To evaluate the value of MTBDR-Plus assay on the detection of rifampin (RIF) and isoniazid (INH) resistance in M. tuberculosis clinical isolates. Method 197 M. tuberculosis clinical isolates were collected to do conventional drug susceptibility testing and MTBDR-PluvS assay. The sensitivity and specificity of MTBDR-Plus assay were analyzed and compared with conventional drug sensitivity testing. Results The sensitivities of MTBDR-Plus assay for detecting RIF and INH were 88. 6% and 79.3%，respectively. Their specificity were 98. 8% and 98.8%，respectively. Conclusion MTBDR-Plus assay is a rapid and reliable method with high sensitivity and specificity.

Efficacy of Intravenous co-therapy and extended initial phase therapy on retreatment pulmonary tuberculosis

Gu Jin,Xiao He ping, Wang Kai,Tang Shengjie

. 2009, 31(12):  713-717. 

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Objective To study the clinical value of intravenous co-therapy and extended initial phase therapy in first retreatment pulmonary tuberculosis patients. Methods The cases were randomly divided into therapy group 1(132 cases) and therapy group 2 (95 cases) , group 1 was treated with 2AHPRZE/6HRE. and received intravenous co-therapy in initial phase，while group 2 was treated with 2SHRZE/1HRZE/5HRE. Resulls Within 1 month, symptoms were effectively alleviated in group 1. The symptoms of fever, cough，sputum and weak were greatly improved, the disappeared rate was from 76. 23% to 87. 50%，P<0. 01. After 1 month of treatment, the tuberculosivs sputum smear negative conversion rate in group 1 was 80. 90%，while the group 2 was 59. 02 %，PP<0.05. Although the final conversion rate in group 1 was higher than that in group 2，there was no statistical difference between the two groups. Throughout the course of treatment,the effective rate of focus absorption in group 1 was 73. 48% which was better than group 2 (51. 58%) ,P<0. 01. After 1 month of treatment, the rate of cavity shrankage in group 1 was 66. 07%, while group 2 was 36.36 % , P<0. 01. At the end of treatment, the rate of cavity closure was 62. 50%，higher than that in group 2，which was 36. 36 % , P<0.05. Conclusions Both intravenous co-therapy and extended initial phase therapy can improve the therapeutic effect, the former is better.