Table of Content

10 February 2009, Volume 31 Issue 2

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Investigation of human resource for Shanghai tuberculosis prevention and control

Wang Lin, Xiao Heping, Mei Jian, Wang Xuezhi, Shen Mei

. 2009, 31(2):  64-67. 

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Objective To study current status of human resource for Shanghai tuberculosis (TB) prevention and control system. MethodsA self-completed questionnaire investigation on human resource was conducted among 870 medical staff for TB prevention and control(called “TB workers”) in Shanghai. Results642 (73.8%) effective questionnaires were received. 77% TB workers worked in urban designated hospital or community health center (CHC). About 1/3 TB workers were less than 30 years old while 1/4 more than 50 years old. 220 (34.2%) interviewees were undergraduate or above, of which 52% had received professional continuous education. 172 (26.8%) TB workers were in sub-health. 178 interviewees thought their unit didn’t pay enough attention to TB control, for which the main reasons were poor economic benefit (47.5%), heavy workload (30.4%), small space for major development (30.2%), etc. The income of more than half of the TB workers was lower than the unit’s average. Only 46% of the TB workers got the post allowance for TB from the government.Conclusions“Three in one” prevention and control model improved the structure and quality of the human resource of Shanghai TB prevention and control system. However, more works should be done for further improvement, especially on concerning the TB worker’s health, protecting their rights and interests, promoting working enthusiasm and professional sense of honor.

Dynamic analysis of the status of drug resistance of Mycobacterium tuberculosis of pulmonary tuberculosis cases from 2001 to 2005 in Quanzhou

Cheng Yumei， Zeng Xiaorong， Wu Yanhong

. 2009, 31(2):  68-70. 

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Objective To analyze and evaluate the trend of drugs resistance of Mycobacterium tuberculosis, and to provide evidence for tuberculosis (TB) control. MethodsThe strains of in-patients and out-patients during the years of 2001—2005 were consecutively collected, and drug susceptibility test (DST) was conducted on the strains. ResultsThe drug resistance rates were 26.2%、29.1%、27.2%、30.9% and 25.6% respectively; the rate of initial resistance were 14.9%、17.9%、12.8%、9.3% and 9.5% respectively; acquired resistance rate were 67.6%、69.7%、57.4%、61.9% and 68.3%. The single-drug resistant rate to INH, RFP and SM were higher than that to other drugs, The multi-drug resistant rate to SH, SR, HR, SHR, HRE, SHRE combination were higher. ConclusionThe total drug resistant rate of TB in Quanzhou is very high and the situation is quite serious, the keys of drug resistance control are early detection and treatment to completely cure infectious TB with DOTS strategy, and improve the evaluation of drug resistance monitoring.

Analysis of the source of the smear positive tuberculosis patients in Chenzhou City from 2003 to 2007

Su Xiaoke¹, Liu Songshan¹, Yao Linghui¹, Kuang Xuzhong²

. 2009, 31(2):  71-74. 

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Objective To analyze the source of the smear positive tuberculosis (TB) patients, and to provide scientific evidence for further promotion of case finding of smear positive TB patients in Chenzhou.MethodsThe data of the source of the smear positive TB patients from 2003 to 2007 in Chenzhou city was collected, the types of the source and the influencing factors were analyzed.Results11600 smear positive TB patients were detected from 2003 to 2007 in Chenzhou city, among whom 37.3% was care seeking, 52.3% was referring, 9.7% was recommended because of symptom and 0.7% for other reasons. The proportion of cases from referral increased year by year, and the difference among 5 years was statistically significant (χ²=279.8，P<0.01). ConclusionReferral has been an important source of the smear positive TB patients in Chenzhou city, which plays a dominant role in case finding of the smear positive TB patients. Strengthening TB case management, strengthening cooperation between hospital and TB control institution and promoting health education are effective measures of achievement of smear positive TB patients “high case detection”.

Co-expression of protein of M. tuberculosis with molecular chaperone

Huang Hairong¹, Dong Xu, Zhang Zongde, Zhao Yanlin, Jiang Guanglu, Li Qiang

. 2009, 31(2):  76-79. 

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Objective To elucidate the effect of chaperones co-expression on increasing the expression of protein from M. tuberculosis encoding genes, and on enhancing biology activity of the protein expressed. MethodsCo-expressing the plasmids Rv3790::pET16b and Rv3791::pET16b which harbor protein encoding gene Rv3790 and Rv3791 of Mycobacterium tuberculosis with chaperones plasmid pkJE7 which can express 3 chaperones,DnaK,DnaJ,GrpE at the same time in E.coli.BL21(DE3).The yield of the expression was then checked by SDS-PAGE and Western Bloting. The biology activity of the expressed candidate proteins was analyzed by related activity assay. The expression system, which expressed the candidate genes alone in E.coli. BL21(DE3), was used as control. ResultsCompared with the control, the co-expression system could produce more soluble protein, less inclusion body and less degradation of protein. When same amount of protein was used in the activity assay, the protein from the chaperone co-expression system had higher activity than that from the non-chaperone co-expression system. ConclusionCo-expression with chaperone could increase protein expression and protein activity of M. tuberculosis.

The application of mycobacterial interspersed repetitive unit(MIRU) in M.tuberculosis genotying

Guo Yanling¹, Liu Yang，Wang Sumin, Li Chuanyou, Song Changxing

. 2009, 31(2):  80-84. 

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Objective To assess the application of mycobacterial interspersed repetitive unit(MIRU) in the epidemiology of tuberculosis, and to discuss its prospect. Method158 Mycobacterium tuberculosis isolates that had been typed by IS6110-RFLP were subjected to MIRU. ResultsThe Results were obtained by MIRU within 1 day. 105 patterns were produced, in which 65 patterns were unique. In MIRU loci, there were four loci(loci 4，10，26，40) with higher diversity. MIRU typing provided discrimination (Hunter-Gaston Index ［HGI］ of 0.978) compared with the IS6110 RFLP method (HGI=0.994). For those strains lower than 10 copies, MIRU typing provided discrimination (HGI=0.982) comparable to that of the RFLP method (HGI=0.98). ConclusionMIRU typing, which is simple, rapid, and easy to popularize, would exert important function in the epidemiological investigation of tuberculosis.

The clinical application of the liquid-based collecting bacterium technique in detecting the acid-fast bacilli

Liang Xianghui,Song Jie, Liu Wenen

. 2009, 31(2):  86-89. 

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Objective To investigate the application value of liquid-based collecting bacterium technique in detecting the acid-fast bacilli. Methods152 clinical samples (including 100 sputa, 23 bronchial lavage liquid, 7 cerebrospinal fluid and 22 pleural effusion) were all from the inpatients, outpatients and emergency patients, which were selected according doctor's advice. Every sample was dealed with parallel both by liquid-based collecting bacterium technique and direct-smear staining method. ResultsThe positive rate of liquid-based collecting bacterium technique was 15.8%, which was significant higher than that by the direct-smear staining method (6.6%,P<0.01). The positive samples detected by direct-smear staining method were the same as the Results obtained by liquid-based collecting bacterium technique. And the positive samples detected by liquid-based collecting bacterium technique were all from the patients with tuberculosis or the tuberculosis hypochondriasis. The result obtained by liquid-based collecting bacterium technique was accordant with the clinical diagnosis. The liquid-based collecting bacterium technique could find more bacilli, get better effect compared with the direct-smear staining method.ConclusionThe liquid-based collecting bacterium technique might be a simple, safe, sensitive, effective new bacteriological method. It is worthy to be recommended in clinical use.

Study on anti-tuberculosis therapeutic regimen in patients with high risk factors of drug-induced hepatitis

Bu Jianling, Gao Weiwei, Xie Li, Zhen Suhua

. 2009, 31(2):  91-93. 

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Objective To evaluate the effect on drug-induced hepatitis in patients with pulmonary tuberculosis and potential drug-induced hepatitis and its sputum smear negative conversion with interfered measures when anti-tuberculosis agent was given. MethodsThis retrospective study including 243 patients, who hospitalized in our hospital from January 1, 1996 to December 31, 2006, with initial treatment smear positive pulmonary tuberculosis and with potential drug induced hepatitis was performed. The incidence of drug induced hepatitis and the rate of sputum smear negative conversion were analyzed between the group patients with interfered measures and another group patients without interfere measures when they were given with first line anti-tuberculosis agent. ResultsThere were only 11 patients associated with drug induced hepatitis in 126 patients with interfered measures when given with anti-tuberculosis agent. However, 42 patients associated with drug induced hepatitis in 117 patients without interfered measures when given with anti-tuberculosis agent. The rate of drug induced hepatitis among the group patients with interfered measures was lower than that of group patients without interfered measures with statistically significant difference(P<0.01). But the rate of sputum smear negative conversion after two months treatment were 62.7% (79/126)and 64.1%(75/117) between two group patients with no statistically significant difference(P>0.05).ConclusionsInterfered measures should be performed in advance to patients with pulmonary tuberculosis associated with high risk factor of drug induced hepatitis, such as the elderly,and patients with virus hepatitis,hepatitis virus carrier,,malnutrition, fatty liver,alcohol addiction.

The short-term and long-term clinical treatment outcome of CT-guided percutaneous lung centesis administration in treatment of cavernous multi-drug resistant pulmonary tuberculosis

Tang Shenjie, Xiao Heping,Li Hong,Gui Xuwei, Gu Jin, Liang Li, Sun Hua, Yan Liping

. 2009, 31(2):  94-99. 

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Objective To evaluate the clinical treatment value of CT-guided percutaneous lung centesis administration in treatment of cavernous multi-drug resistant pulmonary tuberculosis. Methods66 patients with cavernous multi-drug resistant pulmonary tuberculosis were randomized 1∶1 to experimental group and control group. 33 patients in experimental group received CT-guided percutaneous lung centesis administration combined with antituberculosis treatment, and 33 patients in control group received anti-tuberculosis treatment alone. The short-term and long-term clinical treatment outcomes were observed. ResultsAt the end of the treatment, the sputum negative conversion rate was 70%, foci absorption rate was 73.3%，and cavity closure rate was 50% in the experimental group, all of which were higher than those of the controls (41.9%，41.9%and 19.4%)(P<0.05). The patients with the sputum negative conversion at the end of the treatment in two groups were followed up for 1～2 years, and one case was recurrent in each group(4.8% and 6.3%). There was no statistically significant difference on recurrent rates in two groups(P>0.05). There were not severe adverse reactions observed in the experimental group. ConclusionThe short-term and long-term clinical treatment outcome of CT-guided percutaneous lung centesis administration in treatment of cavernous multi-drug resistant pulmonary tuberculosis were both better than those of the routine antituberculosis treatment alone. The combined treatment approach was safe and has few side effects.

Pulmonary epithelioid hemangioendothelioma with bilateral pleural effusion: a case report and review of the literature

Hu Hua, Ju Yunfei,Chi Jingyu, Lin Meiying, Li Lei

. 2009, 31(2):  100-102. 

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Objective To understand further and improve the diagnostic accuracy of pulmonary epithelioid hemangioendothelioma. MethodsWe analyzed the etiology, clinical manifestations, diagnosis,differential diagnosis, management and prognosis of pulmonary epithelioid hemangioendothelioma after diagnosing one case and reviewing some literatures. ResultsThe etiology remained unknown,and symptoms were scanty and usually mild. Chest X-ray or computed tomography usually revealed multiple nodules in bilateral pulmonary. Pleural effusions emerged due to pleura was invaded. Primitive lumen formed by a single cell was the pathological feature. Immunohistochemical stains showed that the cells were original from the endothelial type. There is no effective treatment for this disease and its prognosis is in between benign lession and malignant neoplasm. ConclusionPulmonary epithelioid hemangioendothelioma with bilateral pleural effusion is rare and often misdiagnosed as other pulmonary diseases.

The imaging analysis of gastrointestinal tuberculosis in 19 cases

Lan Jianfeng¹,Wu Guowei²,Ye Dongfang²,Tang Zhongming²

. 2009, 31(2):  103-105. 

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Objective To analyze the imaging features of gastrointestinal tuberculosis．Methods19 patients with gastrointestinal tuberculosis were analyzed retrospectively．The imaging changing in shape, location, edge and surrounding tissue of lesion were involved. ResultsWe found one stomach tuberculosis，one jejunum tuberculosis，15 terminal ileum or ileocecal junction tuberculosis，one terminal ileum and ascending colon tuberculosis， one transverse colon tuberculosis in 19 patients. Except for misdiagnosis in one ileocecal junction tuberculosis and one stomach tuberculosis，the other patients got a correct diagnosis in according with pathological diagnosis. The rate of misdiagnosis was 10.5% and the rate of accuracy was 89.5%．ConclusionGastrointestinal tuberculosis have some imaging features，but diagnosis should be identified according to clinical history, pathology and bacteriology detection．