Table of Content

10 August 2009, Volume 31 Issue 8

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Analysis of the effectiveness of treatment and management of pulmonary tuberculosis in Minhang district of Shanghai

Cheng Yuping,Ni Zheng,Tang Lihong,Yan Huiqin,Zhang Jinlan

. 2009, 31(8):  441-445. 

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ObjectiveTo evaluate the quality and effectiveness of treatment and management of pulmonary tuberculosis in Minhang district,Shanghai, so as to provide scientific evidence for further implementation of treatment and management. MethodsA questionnaire survey was conducted among the new TB patients who registered in 2007. Four hundred and thirty-seven (140 household people and 297 people of floating population)valid questionnaires were recovered. ResultsDuring the treatment of the TB patients, community physicians carried out regular visits and multi-directional guidance to patients through a variety of ways. The majority of patients were willing to accept the doctor’s regular supervision, but there is no need for DOT management. The patients’ awareness rates of the relevant information of tuberculosis prevention and control were better, but the overall awareness was low. There were no significant difference in supervision will and awareness rates between the patients of the household register and the floating population. 43.3% patients selected the district hospital for treatment as the first health care seeking, and only 10.3% patients selected TB dispensary. 38.2% patients were care seeking delay while 23.6% were diagnosis delay. The successful treatment rate was 92.2%, which was higher in floating population than household registration patients, and there was significantly difference between these two groups. ConclusionsThe management Methods of TB patients in Minhang district are successful, which effectively improve the patients’ compliance and successful treatment rate. But public awareness of tuberculosis should be enhanced, and TB suspects and patients should be informed to visit TB dispensary for diagnosis. This can improve the centralized management efficiency.

Analysis of factors on the failures in referring TB suspects from third grade class A hospital in Tianjin

Li Shanglun, Ju Hanfang, Li Guilian,Yang Guangwei

. 2009, 31(8):  446-448. 

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ObjectiveTo analyze the causes for which the TB suspects who had been transferred, but did not arrive at TB control institute for clinical consultation, and to discuss the measure for improving the arrival rate of referral. MethodsThe trained investigators interviewed 315 TB suspects who did not go to TB control institute for clinical consultation after referring during family visits with questionnaire, SPSS 10.0 software was used to analyze the data. ResultsOne hundred and eighty-one questionnaires were finished. Most cases were vulnerable group of low income (94.1%) and low education (80.7%). The main reasons were that the suspects had been diagnosed as other diseases except TB in other hospitals (54.5%); the symptom had alleviated or healed (17.4%); with poor condition (6.6%), mobility disabled (6.0%), with poor traffic condition (4.8%); the patients had bought TB drugs in drugstore (4.2%). ConclusionsBy means of increasing the activity and initiative of TB institute, strengthening health promotion activities, especially propagandizing free diagnosis and treatment policy, improving the cooperation between TB dispensaries and hospitals, enhancing the quality of filling in infection card and strengthening management of TB drug, the arrival rate of referral will be improved.

Analysis of cost for TB patients in 10 counties, Hunan

Huang Fei¹,Wang Lixia¹,Yang Hualin², Bai Liqiong²

. 2009, 31(8):  449-453. 

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ObjectiveTo find out various costs for TB patients from the very beginning to the end of the disease, and to provide scientific proof for the whole country to develop control and prevention policy. Methods100 smear positive pulmonary TB patients were selected from 10 counties in Hunan, these patients were interviewed with questionnaire and collected data were analyzed. Results(1) Medical facilities where smear positive pulmonary TB patients admit first when they have symptoms are general hospital, TB dispensary, township hospital and private clinic in sequence, and their ratios are 43%, 20%, 16% and 11% respectively; (2) The total cost for TB patient is about 3678.8 RMB, among which direct cost is 2724.8 RMB and indirect cost is 954.0 RMB. The cost for TB after diagnosis accounts for about half of the total cost; (3) Most patients’ income and their families’ income reduced after the patients were diagnosed with TB; (4) Patient delay is 1.5 months and diagnosis delay is 1.6 months. ConclusionsFund investment on TB control and prevention should be strengthened to alleviate economic burden of TB patients.

Investigation of the tuberculin reactivity in the junior middle school students of four middle schools

Wang Xing,Li hai,Chai Zhiying,Gao Yongxiang,Pang Chunping,Chen Xiangdong,Hao Shijia,Li Xiaoguang,Yu Shaoqing,Yang Lihua,Sun Bin

. 2009, 31(8):  454-456. 

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ObjectiveTo find out tuberculin reactivity of the students from the local junior middle school. Methods5153 students of Grade 1 from 4 middle schools of Huailai were taken the standardized PPD and invested on the age, sex, residence and tuberculosis epidemiological characteristics of these students. Results80.2% students were at the age group 13～14, 57.6% students living in rural areas, total positive rate (≥5mm and ≥15mm) were 23.1% and 7.4% respectively. The positive rate of PPD test (≥5mm、≥10mm、 ≥15mm and≥20mm) in 2219 students without BCG scare were 16.5%、10.9%、5.9% and 2.9% respectively. The positive rate in students with BCG scar was higher than that of students without, and that in students with TB contact history and TB history was higher than that of student without. ConclusionsThe junior high school students should be the target of local tuberculin tests and tuberculin positive reaction≥15mm can be classified as preventive therapy target to prevent TB emergence.

The external quality assessment of TB sputum smears between province and county in Gansu

Mu Taojun, Si Hongyan, Li Qing, Ma Ling

. 2009, 31(8):  457-460. 

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ObjectiveTo evaluate the quality of laboratory at all levels in Gansu for effective TB control. MethodsAccording to the instructions of The manual of examination quality assurance of sputum smear in China Tuberculosis Programme, external quality assessment has been implemented in TB laboratories at all levels and the acquired Results have been analyzed. Results From 2004 to 2007, the consistency positive rate of sputum smear between province and county was 89.0%, the consistency negative rate was 99.7%,the five quality indexes of sputum smear were lower than national standards, laboratory which had an serious error accounted for 39.4%, Results of on-site evaluation and volume testing were well. ConclusionsThe implementation of external quality assessment raises the review rate of sputum smear in Gansu, which improves the construction of laboratory, increases operational capacity of sputum smear technician and makes the external quality assessment more scientific.

Analysis on the use of Health Promotion Toolkit of Chinese TB Control and Prevention in Guangdong province

Jiang Li, Zhong Qiu, Li Jianwei, Chen Yuhui, Wen Lianghuan

. 2009, 31(8):  461-463. 

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ObjectiveTo learn the use of the Health Promotion Toolkit of Chinese TB Control and Prevention (Toolkit for short) in Guangdong and provide scientific evidence for the update. MethodsThe questionnaire was used to investigate the usage of Toolkit from July 2007 to June 2008 in all TB institutes in Guangdong. 106 valid questionnaires were recovered. The recovery rate was 87.6%. ResultsThe total use rate was 37.5%, and the use rate of the plane material was higher than that of the materials for mass media. Among the plane materials, the single color leaf materials were printed in the largest quantity. 30.5% of the video and radio program were broadcasted on prime time. ConclusionsTB control institutes at all levels should use Toolkit reasonably to increase the awareness of the publics on TB control in order to achieve the NTP targets.

Genotypes of M tuberculosis from the TB patients with recurrence or treatment failure

Wang Shengfen, Zhao Yanlin, ZhouYang, Zhao Bing, Zhao Liping, XiaHui, Dong Lingling.

. 2009, 31(8):  464-468. 

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ObjectiveTo analyze the genotypes of M. tuberculosis from the TB patients with recurrence or treatment failure. MethodsTuberculosis (TB) inpatients who had strains isolated from two successive episodes separated for at least 6 months were selected from Beijing Tuberculosis & Thoracic Tumor Institute during January 2000 to December 2007. The sequential isolates from the patients were analyzed by M. tuberculosis genotyping Methods to find out if the profiles matched. Results24 patients recruited into the study. The genotype patterns of recurrent M.tuberculosis isolates from the 5 patients previously completed treatment exhibited identical genotypes, indicating endogenous reactivation. Of 19 isolates from 8 patients defaulted from treatment and 11 patients with treatment failure, genotype patterns of 2 isolates (10.5%) did not match with those of the corresponding initial isolates, indicating reinfection. Isolates from the remaining 17 （89.5%） patients had identical genotype profiles results, suggesting treatment failure.ConclusionsThe endogenous reactivation and treatment failure may be a main cause for the recurrence of TB cases.

Study on the cross-resistance of moxifloxacin and levofloxacin in Mycobacterium tuberculosis

Zhao Weijie，Li Peng，Lu Yu

. 2009, 31(8):  469-472. 

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ObjectiveTo investigating the cross resistance of moxifloxacin and levofloxacin in M. tuberculosis, gene mutations of quinolone-resistant isolates to provide a theoretical basis for clinical treatment. MethodsM. tuberculosis strain H₃₇Rv and 78 multidrug-resistant M. tuberculosis clinical isolates (73 LVF-resistant and 5 LVF-sensitive) were studied. The MICs of these isolates to moxifloxacin and levofloxacin were determined by the tube doubling dilution method on 7H9 media. The quinolone resistance-determining region (QRDR) mutations of gyrA genes from M. tuberculosis isolates were detected with DNA sequencing. ResultsThe MICs of MXF were lower 4 to 8 fold than that of LVF. The strain H₃₇Rv wasn’t found any gyrA gene mutation. 78 MDR-TB isolates have Ser95Thr gyrA mutations. Of 73 MDR-TB isolates with LVF resistance, 35（47.94%）were low-resistant to LVF （MICs 1 to 8μg/ml）, 31 （42.46%）were high-resistant to LVF. Four isolates have only gyrA Ser95Thr mutation, the other isolates had combinative gene mutations as follow: Ala90Val, Asp94His, Asp94Asn, Asp94Gly, Asp94Ala, and Asp94Tyr. ConclusionsThe MXF and LVF presented a incomplete cross-resistance. The mutation of gyrA gene correlates with the LVF and MXF resistances in M. tuberculosis.

Clinical observation of Rifapentine as an alternative to Rifampin in 129 elderly patients with new smear-positive pulmonary tuberculosis

Li Jinsheng，Wang Fusheng

. 2009, 31(8):  473-476. 

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ObjectiveTo observe the efficacy and safety of Rifapentine to patients with new smear-positive pulmonary tuberculosis. Methods129 elderly patients with new smear-positive pulmonary tuberculosis were enrolled and randomized into the treatment group（2HL₂ZE/4HL₂） and the control group（2HRZE/4HR）. We observed the sputum negative conversion rate, chest X-ray improvement rate, one-year relapse rate and the side effects of anti-tuberculosis drugs. ResultsThe sputum negative conversion rates in the treatment group were 87.19% at 3 months, and 98.4% at the end of therapeutic course, while those of the control group were 85.2% and 96.3% respectively. The difference in the sputum negative conversion rates between the two groups were not statistically significant（χ²₁=0.09，χ²₂=0.02，P＞0.05）. The improvement rates of chest X-ray were 90.3% and 87.0% respectively without significant difference（P＞0.05）. The cavity closure rate were 36.7% in the treatment group, and 32.6% in the control group without statistical difference between two groups（P＞0.05）. One-year bacteriological relapse rate were 6.4% and 7.4% respectively without significant difference（P＞0.05）. The gastroinsterstinal reaction rate were 19.4% in the treatment group and 38.9% in the control group with statistically significant difference（χ²=5.41 P＜0.05），and the rate of liver function damage were 4.8% in the treatment group and 24.1% in control group with statistically significant difference（χ²=7.44 P＜0.01）. ConclusionsThe treatment efficacy of regimen including Rifapentine was the same as that of regimen including Rifampin to elderly patients with new smear-positive pulmonary tuberculosis. The side effects rate of Rifapentine was very lower than that of Rifampin. It could be recommended to use widely further.

Clinical monitor and analysis on Ofloxacin resistance of pulmonary tuberculosis

Yan Liping, Xiao Heping

. 2009, 31(8):  477-480. 

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ObjectiveTo investigate the resistant situation of Ofloxacin to mycobacterium tuberculosis isolated from sputum of patients with pulmonary tuberculosis and to provide scientific evidence for utilizing Ofloxacin in antituberculosis regimen. MethodsAll strains isolated from patients hospitalized in Shanghai Pulmonary Hospital Affiliated Tongji University from August 2007 to March 2008 were conducted to strain identification and drug susceptibility tests with Ofloxacin, Isoniazid, Rifampin, Streptomycin and Ethambutol. ResultsThe total Ofloxacin resistant rate was 24.9% among 233 mycobacterium tuberculosis strains, lower than those of the first-line drugs. The difference of Ofloxacin resistant rates between in the initial treatment group (12.3%) and in the retreatment group (46.0%) were significant statistically (χ²=31.16,P<0.01), but there was no statistically significant difference about the Ofloxacin resistant rates between in the first-time retreatment group (41.7%) and in the other retreatment group (49.0%) (χ²=0.46,P=0.50). The Ofloxacin resistant rates were 57.8% in the multi-drug resistant (MDR) group, 35.1% in the poly-drug resistant (PDR) group, 6.3% in the single-drug resistant group, and 5.2% in the first-line drug susceptible group. The difference of resistant rates between the multi-drug resistant group and the other three groups was significant statistically（χ²=6.04、10.52、59.87, all P<0.05）, the difference of resistant rates between the poly-drug resistant group and the first-line drug susceptible group was also significant statistically(χ²=17.97，P<0.05）. The rates of Ofloxacin resistance in the youth group, the middle age group and the elder group were 24.5%, 26.5%, and 14.0%,respectively. There was statistically significant difference between the youth group and the elder group (χ²=2.741,P>0.05). Primary Ofloxacin resistant rate was 9.9％ and secondary Ofloxacin resistant rate was 78.4％ with significant difference（χ²=96.47, P<0.01）. ConclusionsThe Ofloxacin resistance rate in the MDR group was much higher than that of in the other groups. The secondary Ofloxacin resistant rate was much higher than that of the primary Ofloxacin resistant rate. Unreasonable utilization of Ofloxacin can easily lead to its resistance.

Clinical analysis on 50 cases with Nontuberculous Mycobacteria disease

Wu Xiaoguang,Gao Mengqiu,Ma Liping

. 2009, 31(8):  481-483. 

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ObjectiveTo study clinical features and improve level of diagnosis and treatment for nontuberculous mycobacteria(NTM) lung disease. Methods50 patients with NTM lung disease confirmed by culture with Lowestein-Jensen,medium in our hospital between August 1999 and March 2006 were carried out drug susceptibility test, and their clinical manifestation and therapeutic effects were analized.Results The strains isolated from patients with NTM lung disease were resistant to the first line anti-tuberculosis drugs in various degree with highest resistant rate to isoniazid(H) and streptomycin(S) and lower rate to Amikacin(Ak) and Kanamycin(Km).ConclusionsNTM lung diseaseshould be conformed by positive culture and strain identification. Early reasonable chemotherapy may offer satisfied efficacy.

A clinical analysis on 388 patients with pulmonary tuberculosis treated by surgical resection

Bai Lianqi

. 2009, 31(8):  484-486. 

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ObjectiveTo evaluate the efficacy and indication of surgical resection for pulmonary tuberculosis. MethodsFrom January 1999 to December 2007, 388 patients with pulmonary tuberculosis hospitalized in our hospital undergone surgical resection were enrolled. There were 116 cases with infiltrative pulmonary tuberculosis,85 cases with caseous pneumonia， 66 cases with chronic fibro-cavernous pulmonary tuberculosis,18 cases pulmonary tuberculosis complicated with aspergilloma,28 cases with tuberculous tracheobronchial stenosis,75 cases with tuberculous destroyed lungs. ResultsThe operative manners included: pneumonectomy in 95 cases,lobectomy in 217，tracheoplasty or bronchoplasty in 11 cases, and other manners in 65 cases. The total cure rate was 96% among 372 cases treated by operation. The rate of complication was 8.5% without dead case. ConclusionsChemotherapy is still main method to treat pulmonary tuberculosis，but the surgical operation is necessary for some patients with pulmonary tuberculosis to improve cure rate, especially for severe pulmonary tuberculosis and multidrug-resistant tuberculosis（MDR-TB）.

Intrathoracic cannula combining with sodium hyaluronate to prevent pleural thickening of tuberculous pleurisy: cost/effective analysis

Zhou Ailian¹, Sun Junsheng², He Jianyou³

. 2009, 31(8):  487-490. 

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ObjectiveTo explore the method of lower cost and better results.to prevent pleural thickening(PT) of tuberculous pleurisy. MethodsSixty-four patients with middle to large plerural effusions were randomly assigned to a treatment group and a control group. Patients in treatment group given with sodium hyaluronate via central venous catheter into the thoracic cavity after pleural effusion was drainaged completely，while patients in control group received routine thoracentesis. We calculated the cost after 3 months in two groups respectively and analyzed the cost-effectiveness and sensitivity. ResultsFifty-nine patients were available for final analysis. The incidence rate of PT at 3rd month were 6.7% in treatment group and 31.0% in control group（the effective rate: 93.3% vs. 69.0%,respectively）with statistically significant difference（P＜0.05）；The cost/effective rate were 35.2 in the treatment group and 47.5 in the control group. Sensitivity analysis showed 35.6 in the treatment group and 49.00 in the control group. ConclusionsIntrathoracic cannula combining with administration of sodium hyaluronate is a method of lower cost and better Results to prevent pleural thickening of tuberculous pleurisy.