Table of Content

10 March 2007, Volume 29 Issue 3

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Analysis of the situation of register on the nationwide smear-negative pulmonary tuberculosis cases

Ma Yan¹,Cheng Shiming,Zhou Lin

. 2007, 29(3):  207-211. 

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Objective To analyze the situation of register on the nationwide smear-negative pulmonary tuberculosis(PTB) cases,to provide relevant evidence in order to evaluate the quality of diagnosis on initial smear-negative TB cases. Methods According to data from register of initial smear-negative PTB and initial smear-positive PTB from report forms of the National TB Control Programme(NTP) from 2004 to 2005,the change of the notification rate on initial smear-negative PTB cases and its increased range of the every province during the two years were analyzed;proportion of the notification rate of smear-negative TB cases and smear-positive TB cases among every province and different area were calculated;linear regression analysis was done for the notification rate of both smear-negative and smear-positive TB. Results The number of registered initial smear-negative TB case in the country in 2005 was 316 405 with the notification rate of 24.27/100 000,rang of the notification rate of different provinces was 6.01/100 000～72.17/100 000.The number of notified smear-negative TB cases increased 19.9% compared to 2004 among which two provinces decreased compared to 2004,while the number in other provinces increased between the range of 0.5%～62.3%;the notification rate of initial smear-positive TB was as 1.5 times as that of smear-negative TB,among which notification rate of smear-positive TB was higher than that of smear-negative TB in 22 provinces and lower in 8 provinces;the proportion of the notification of initial smear negative TB to initial smear positive TB was 149.28% in Beijing,Tainjin and Shanghai,83.6% in non-project area and 50.3% in project area.Linear regression analysis on notification rate of smear-negative TB and smear-positive TB was done and the linear regression equation was Y= 22.342+0.563 6 x. Conclusion The notification rate of smear-negative TB has increased after the policy of providing free treatment to initial smear negative TB was implementing.However,the notification of smear-negative TB,its incremental range and the proportion of the notification of smear negative TB to smear positive TB are substantially different among provinces.Due to the difficulty in diagnosis of smear-negative cases,it is necessary to examine and evaluate the quality on the diagnosis of smear-negative cases in the areas of higher notification or substantial incremental range,especially in the areas where DTOS have carried out for short period of time and with limited human resource.

Analysis of survey on the mid term evaluation of the World Bank Loaned/DFID granted TB control program in Chongqing

Liu Ying,Hu Daiyu,Liu Li,et al

. 2007, 29(3):  212-215. 

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Objective To evaluate the implementation of World Bank Loaned/DFID granted TB control program,and to provide scientific evidence for adjusting mid term plan of program. Methods According to the questionnaire on the mid-term evaluation of MOH,the routine supervision data and some other relevant materials in 40 districts counties of Chongqing municipality from 2002 to 2005 were collected,summarized and analyzed. Results The project was fully carried out in 40 districts/counties of Chongqing municipality and the DOTS coverage rate is 100%.Over the past 4 years,the visiting rate of suspects was increased by 67.8% from 16.90/10 000 to 28.38/10 000,and the notification rate of new smear-positive TB was also increased by 40.4% from 31.54/100 000 to 44.27/100 000.The cure rate reached 94.8% among new smear-positive TB,and 90.3% among repeated smear-positive TB. Conclusion The implementation of World Bank Loaned/DFID granted TB control program in Chongqing has reached the mid term goals and goals of the stage in the global TB control.This requires much more effort in the coming several years to control the spread of TB and assure the program goals to be fully realized.

Developing status and tendency of drug resistant tuberculosis in Zhejiang

Miao Ziping,Li Qun,He Haibo,et al.

. 2007, 29(3):  215-218. 

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Objective To understand the developing status and tendency of drug resistant tuberculosis in Zhejiang,and to evaluate the effect of ongoing DOTS strategy. Methods The Guidelines for Surveillance of Drug Resistance in Tuberculosis of WHO/IUATLD were followed in registration smear positive TB and comparing the result of surveillance for tuberculosis bacteria drug resistance with the Results of the first drug resistance surveillance in 1998/1999. Results 1 127 TB patients were enrolled in 30 counties.Drug susceptibility testing against streptomycin(S),isoniazid(H),rifampicin(R) and ethambutol(E) were performed in 988 cases.The total drug resistance rate was 30.6%,the initial drug resistant rate was 26.6%,the initial multi-drug resistance was 3.7%,the acquired drug and multi-drug resistant rates were 51.9% and 29.2%,respectively.Among the new cases with drug resistant tuberculosis,65.8% of the cases showed resistance to single drug.The order of initial drug resistance rate from high level to low level was S(19.2%),H(12.4%),R(5.0%),E(4.0%).The initial drug resistant rates of single drug and at least 2 drugs were 17.5%% and 9.0% respectively.The initial drug resistant rates was increasing(χ²=34.606,P=0.000)while the initial multi-drug resistance showed a decreasing trend in comparison with 1998/1999,which will produce more Mycobacterium tuberculosis strains of single drug resistance in a specific number of strains in Zhejiang.Conclusion The MDR-TB epidemic was improved,but drug resistant TB was still quite serious in Zhejiang.It is the top priority to further improve DOTS quality.

Burden of diseases contributed to pulmonary tuberculosis

Wang Jiansheng¹,He Xiaoxin,Jin shuigao

. 2007, 29(3):  219-221. 

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Objective To give an overview of burden of diseases contributed on tuberculosis. Methods Based on the data published by MOH,prevalence rate,mortality rate,cause eliminated life year were used to calculate the health burden of disease.Meanwhile, direct economic burden of diseases was presented. Results According to the calculation,about 4.4 million of people suffer from the tuberculosis and 67 thousands died from tuberculosis.The cause eliminated life year attributed to tuberculosis is different between male and female,0.135 years for male and 0.077 years for female.Moreover,the direct economic burden reached 3.62 billion RMB. Conclusion The burden of tuberculosis,based on calculation of both health and economic burden,will give a heavy pressure to the government and society.

Guangdong Province Middle Evaluation Report on Implementing National Tuberculosis Program during 2001—2010

Huang Guiqing¹,Zhong Qiu,Tang Darang,et al.

. 2007, 29(3):  222-225. 

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Objective To analysis and evaluate implement the National Tuberculosis Control Plan from 2001 to 2005 in Guangdong Province. Methods According to the mid-term assessment programme for national tuberculosis control plan(2001—2010),each city completed self-examination.Then provincial tuberculosis dispensary carried out spot checks,collected and analyzed the relevant tables. Results Above 94% of cities and counties formulated and issued their respective tuberculosis control plan(2001—2010) and established leading groups.All levels governments have invested a total of more than 200 million Yuan.The ability of tuberculosis prevention and treatment was reinforced.During the five years,125,232 new smear positive tuberculosis cases were detected by all level dispensaries.The detection rate of tuberculosis was increased from 68.3% to 80%;the average cure rate of initial and re-treatment smear positive cases was 95.9% and 89.1% respectively. Conclusion Guangdong province has reached or surpassed the medium-term targets of National Tuberculosis Control Plan.With the implementation of the planning,it promoted Guangdong TB prevention and control work effectively.

Analysis on the factors that influence the treatment failure and death of smear-positive pulmonary tuberculosis patients in Guangzhou city

Du Yuhua¹,Lu Ciyong,Chen Qichen

. 2007, 29(3):  226-229. 

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Objective To explore the epidemiological characteristics and the factors influencing the treatment failure and death of smear-positive pulmonary tuberculosis patients in Guangzhou city. Method Cluster sampling was used to randomly sample registered cases of 2 districts from 8 districts in Guangzhou from 1994 to 2003. Results Age,standardized treatment,lung cavernous tuberculosis and complications were risk factors for treatment failure.The OR of standardized treatment was 409.5,significantly higher than those of other risk factors,indicating the standardized treatment was the main influential factor.Sex was protective factor.Age,lung cavernous tuberculosis,and positive smear sputum were risk factors for death,and treatment time was protective factor. Conclusion Standardized treatment was the main risk factor for treatment failure.It is important to strengthen the supervision and to ensure high cure rate.The old patients with cavernous lung tuberculosis are with high risk of treatment failure and death.They are the priority population to be managed,supervised and provided with the specific treatment regimen.

Experimental study on prevention effect of aged mice complicated with tuberculosis by mycobacterium vaccae

Xu You,Zhang Bingfang,Zhang Zenxian,et al

. 2007, 29(3):  230-232. 

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Objective To explore the protective effect of mycobacterium vaccae to pulmonary tuberculosis of the experimental aged mice. Methods 30 aged C57BL/6J mice were randomly divided into three groups: the non-immunity protective group(group C);the mycobacterium vaccine preventative group(group M),and the Bacillus Calmette-Guerin(BCG)protective group(group B).All the subjects were injected subcutaneously 0.1 ml Physiological saline,22.5 μg mycobacterium vaccine,and 0.1 mg BCG respectively at the 0 week. Four weeks later,0.2 ml standard vaccine of H37Rv with concentration of 5×10⁵/ml was injected through the lateral tail vein to attack the toxin.Six weeks later after the infection,the mice were killed.The Flow Cytometer was used to test the Peripheral blood T lymphocyte sub-groups of the mice and to count the numbers of mycobacterium tuberculosis in the alveolus macrophages,quantitative culture of mycobacterium tuberculosis of lung tissue and the histopathological changes were analyzed. Results the ratio of CD4T lymphocyte and CD4/CD8 were(48.81±3.10、3.84±0.37) and(48.08±3.72、4.16±0.24) respectively and significantly higher than that in group C which is(38.97±3.03、3.25±0.26)(P<0.01).However,the ratio of CD4/CD8 of group M was lower than that in group B(P<0.05).The numbers of mycobacterium tuberculosis in the alveolus macrophages,quantitative culture of mycobacterium tuberculosis of lung tissue were(2.3±0.5、(1.06±0.25)×10⁵cfu) and(2.7±0.6、(1.21±0.37)×10⁵cfu)respectively and decreased significantly than that in group C(5.4±0.9、(4.07±0.97)×10⁵cfu)(P<0.01).The histopathological changes show that the tuberculosis in group M and group B was mainly proliferation without necrosis;the tuberculosis in group C was mainly lymphocyte tuberosity and necrosis. Conclusion Mycobacterium vaccine can enhance the activity of CD4T lymphocyte and can prevent preferably the pulmonary tuberculosis of aged mice.

The level of ADA and PPD-IgG in CSFs of patients with tuberculous meningitis

Wang Li,Yan Shiming,Wu jiang

. 2007, 29(3):  233-235. 

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Objective To explore the method to diagnose tuberculous meningitis(TBM) at earlier period. Methods The level of ADA and anti-TB antibodies in cerebrospinal fluid(CSF) of patients with TBM was determined by the biochemical Methods and ELISA. Results The level of ADA in CSF of all patients suffering from TBM increased markedly compared with those from the patients with viral meningitis(P<0.05) and the normal(P<0.01).The positive ratio of anti-TB antibody was 80.4% in the early stage of diseases,and 100% at the following clinical observation,but negative in all patients with viral meningitis and all normal controls. Conclusion The elevation of ADA level and the positive PPD-IgG in CSF of patients might be helpful to diagnose TBM.

The extraction of Mycobacterium tuberculosis lipopolysaccharide and the detection of anti-lipopolysaccharide antibody in sera

Zhou Lirong,Luo Yongai,Wang Guozhi

. 2007, 29(3):  235-237. 

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Objective To obtain the lipopolysaccharide of Mycobacterium tuberculosis to detect TB refference sera,and to evaluate its potential value for serodiagnosis of tuberculosis. Methods Lyse Mycobacterium tuberculosis in ice by sonication,and then treat with phenol/chloroform,chloroform/methanol,DNase I and RNase.Remove proteins,lipide and nucleotides from the cellular glycans and lipopolysaccharide(LPS-1) by a step of dialysis.LPS-1 was separated into a aqueous phase(LPS-2) containing arabinomannan(AM) and an amphipathic detergent-rich phase(LPS-3)containing lipoarabinomannan(LAM) and lipomannan(LM) by Triton-X114 phase separation technique.These LPSs were used as antigens to detect TB postive and negative refference sera by indirect ELISA method. Results The sensitivity and the specificity of LPS-1 used as antigen were 71.7% and 96%,those of LPS-3 used as antigen were 43.9% and 100%,respectively. Conclusions Using LPS as antigen to detect anti-TB antibodies in sera had satisfactory the specificity.LPS might be selected as one of serodiagnostic antigens of tuberculosis.

Clinical study of plasma human neutrophil peptides1-3 in patients with pulmonary tuberculosis

Zhu Liming¹,LI Chunxiang,Chen Ping,et al.

. 2007, 29(3):  238-241. 

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Objective To investigate the role of human neutrophil peptides1-3(HNP1-3) in patients with pulmonary tuberculosis(PTB) and multidrug-resistant pulmonary tuberculosis(MDR-PTB). Methods Concentrations of HNP1-3 in plasma were measured by ELISA in control group(20 healthy subjects),sensitive group(21 patients with drug-sensitive cases) and MDR group(21 patients with multidrug-resistant pulmonary tuberculosis).We also detected the change of plasma HNP1-3 in patients with tuberculosis both sensitive and MDR after treated with anti-tuberculosis-drugs for six months. Results Before treatment,mean plasma concentrations of HNP1-3 in control group,sensitive group and MDR group were 87.6±8.7,141.7±21.3 and 41.0±10.9 ng/mL respectively.Plasma concentrations of HNP1-3 in sensitive group were much higher than control group(p<0.05).Control group’s were higher than MDR group (p<0.05).After treatment,Mean plasma concentrations of HNP1-3 in sensitive group and MDR group were 76.5±7.1 and 53.2±7.1 ng/mL respectively.Plasma HNP1-3 in sensitive group was decreased compared with before treatment(p<0.01).But there was no difference in MDR group before and after treatment(p>0.05).There was a negative relationship between plasma HNP1-3 before treatment and persistence time of mycobacterium tuberculosis in sputum(r=-0.635,p<0.01),and between the radiographic score before treatment(r=-0.465,p<0.01).Plasma concentrations of HNP1-3 in all investigated subjects correlated positively with their count of peripheral blood leucocyte and neutrophil(r=0.594,0.728,p<0.01). Conclusion HNP1-3 plays important role in pathogenesis of pulmonary tuberculosis and MDR pulmonary tuberculosis.The decreased of plasma HNP1-3 may be one of major reasons in the formation of MDR-PTB.

Discussion on the clinical characteristics of skin rash caused by the anti-tuberculosis drugs and its indicators to stop using the drugs

Du Debing,Luo Xiaoling,Li Meiqiong

. 2007, 29(3):  241-243. 

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Objective To study the clinical characteristics of skin rash caused by the anti-tuberculosis(TB) drugs and its indicators to stop using the drugs. Methods 296 TB patients with skin rash caused by anti-TB drugs out of the 3 082 hospitalized TB patients admitted during 1998 and 2005 were analyzed. Results The total rate of metamorphic reaction was 10.3%.The rate of skin rash was 9.6%(296 cases),among whom 88 were pure skin rash accounting for 2.9%,208 were the skin rash with one or more other systemetical symptomes,accounting for 6.7%;22 were without skin rash,accounting for 0.7%.The total rate of stopping the use of the drug was 61.5%. Conclusion Most of the allergic reactions caused by anti-TB drugs were systematic.With anti-allergy treatment,most patients with pure skin rash can continue the previous treatment,while the patients with other symptoms such as obvious abnormal liver function,arrhythmia,joint pain and allergic shock must stop using the anti-TB drugs immediately,and avoid using the drugs any more.

Combined bronchial-intercostal arterial embolization for treating heavy hemoptysis from pulmonary tuberculosis

Wang Zhifeng¹,Wang lizhang²,Yu fangrong²,et al.

. 2007, 29(3):  244-246. 

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Objective To evaluate the clinical value of combined bronchial-intercostal arterial embolization(CBIAE) for treating heavy hemoptysis from pulmonary tuberculosis. Methods After the selective arteriography,arterial embolization with 2 mm silk thread was performed in 19 patients with heavy hemoptysis from pulmonary tuberculosis. Results In 19 patients,58 responsible arteries were embolized.CBIAE was performed in 17 patients,and only bronchial arterial embolization was performed in 1 patient and only intercostal arterial embolization in another patient.Bleeding stopped within 24 hours in 16 patients of the 17 patients treated with CBIAE(94.18%) and bleeding stopped within one week in another patient.The total effective rate of CBIAE was 100%(17/17).Only bronchial or only intercostal arterial embolization was ineffective in 2 patients.Recurrence of hemoptysis was found in 2 patients in 3 to 6 months.No serious complication related to embolization occured. Conclusion CBIAE is a fast,safe and effective way for treating heavy hemoptysis from pulmonary tuberculosis.

Analysis of the therapeatical effect of levofloxacin on superficial lymphous tuberculosis

Xu Jintian

. 2007, 29(3):  247-249. 

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Objective To analyze the therapeatical effect of levofloxacin on superficial lymphous tuberculous ulcer. Methods 117 cases with superficial lymphous tuberculous ulcer were divided into two groups randomly.The control group used routine treatment(2HRZ/4HR),and the treatment group used levofloxacin(cravit)in addition during the intensive phase. Results The clinical cure rate of the treatment group after two months and four months was 36.1% and 73.8%,so it was obviously higher than that of the control group of which the rate was 16.1% and 46.4%(p<0.01).The clinic cure rate of the treatment group at the end of sixth month was 88.5%,which was also higher than that of the control group of which the rate was 71.1%(p<0.05).The average cure time of the treatment group was 56 days.It was obviously shorter than that of the control group of which the time was 79 days(p<0.01). Conclusion Routin anti-tuberculosis drug with levofloxacin in addition to treat superficial lymphous tuberculous ulcer can obviously shorten treatment duration,improve the therapeutically effect and increase the clinic cure rate.

Studies on the relationship between serum fibrosis markers and pulmonary ventilation function of pulmonary tuberculosis cases

Chen Yulong¹,Ge chuan

. 2007, 29(3):  249-251. 

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Objective To explore the possibility to use serum fibrosis markers as the diagnostic and remedial index of lung fibrosis in pulmonary tuberculosis. Methods Serum fibrosis markers and pulmonary ventilation function of the selected cases were detected.According to the pulmonary ventilation function,these cases were divided into pulmonary function normal group(group A with 20 cases),pulmonary function mildly decrease group(group B with 35 cases),pulmonary function moderately decrease group(group C with 46 cases) and pulmonary function severely decrease group(group D with 29 cases). Results In group A,the average level of PⅢP,HA,LN,and cⅣ was separately 16±2 ng/ml,88±6 ng/ml,98±15 ng/ml,and 120±26 ng/ml.In group B,that was 19.5±4 ng/ml,92.6±12 ng/ml,102±16 ng/ml,and 141±31 ng/ml.In group C,that was 25.4±4 ng/ml,95±21 ng/ml,111.8±30 ng/ml,and 158±39 ng/ml.In group D,that was 28.9±5 ng/ml,108±18 ng/ml,132±37 ng/ml,and 193±46 ng/ml.Statistical analysis showed that the differences of PⅢP,and cⅣ among the four groups were significant(p<0.001),and the differences between any two groups were significant.The differences of HA and LN among the four groups were mildly significant(p<0.05,p<0.01).Analysing the relationship between forced expiratory volume in one second(FEV_1.0) and cⅣ,PⅢP,HA,LN,the positive correlation was found between FEV1.0,cⅣ,and PⅢP(p<0.05,p<0.01).There was no direct relationship between FEV1.0,HA and LN. Conclusion There is significant correlation between serum fibrosis markers and pulmonary function in pulmonary tuberculosis.Serum fibrosis markers can partially indicate the degree of lung fibrosis.The relationship between cⅣ,PⅢP and lung fibrosis is strongest in all.

Clinical analysis on 368 pulmonary tuberculosis cases with hepatic lesion caused by anti-tuberculosis drugs

Wang Qingfeng,Song Yanhua,Gao Mengqiu,et al.

. 2007, 29(3):  252-255. 

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Objective To explore the status of hepatic lesion caused by first-line anti-tuberculosis(TB) drugs. Method 368 cases with hepatic lesion caused by anti-TB drugs were observed to explore the relationship between the infection status of hepatitis virus(Band C) and the hepatic lesion. Result Of 368 cases,the general rate of hepatic lesion was 16.4%(59/358).The rate of hepatic lesion among patients with HBsAg(+) HBeAg(+) and HCV was significant higher than that of patients with HBV negative.There was no significant difference between HBV negative and only HBsAg(+) group in the rate of hepatic lesion.Meanwhile,the rate of hepatic lesion among patients over 60 years was higher than that of patients less than 60 years. Conclusion Hepatic lesion is liable to occur among patients with hepatitis virus infection and the elderly patients.The hepatic function of these patients should be paid close attention to monitor after they take the first-line anti-TB drugs.

To compare the therapeutic effect of thymic peptide and Mycobacterium Phlei in treating initial smear positive tuberculosis patient

Liu Jianqiang,Li Xiuwu,Li Xianglan,et al

. 2007, 29(3):  255-257. 

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Objective To observe and evaluate the therapeutic effect of thymic peptide and Mycobacterium Phlei in treating initial smear positive tuberculosis patient. Methods 150 initial smear prositive tuberculosis patients were divided into three groups,named group A,group B and group C randomly.There are 50 patients in each group.Group A was treated with anti-tuberculosis drugs and thymic peptide;Group B was treated with anti-tuberculosis drugs and Mycobacterium Phlei;and Group C was simply treated with anti-tuberculosis drugs.The quantity of T leukomonocyte subgroup and NK-cell in peripheral blood were calculated,the change of the absorption of the focus and sputum conversion were observed before the treatment,after one month and two-month treatment. Results There was no difference for the absorption of the focus and sputum conversion rate among the three groups after one month treatment.The absorption of the focus and sputum conversion rate in group A and B were higher than group C after two-month treatment.The quantity of CD3 and CD4 increased,CD8 declined,CD4/CD8 increasesd,and NK-cell declined in three groups.The effect of group A and B were better than group C. Conclusion Thymic peptide and Mycobacterium Phlei can improve tuberculosis patients’ cellular immune function obviously,accelerate sputum conversion rate of mycobacterium tuberculosis patients,and the absorption of focus.However,there is no different between group A and B.

The role of Nanning Infectious Disease Hospital in implementing DOTS strategy in Guang

Lin Dingwen¹,Li Guoxing,Tang zhuo.

. 2007, 29(3):  258-260. 

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Objective To analyze the effect of Nanning Infectious Disease Hospital as a project implementation unit in two years,and to explore its role in implementing DOTS strategy in Nannning. Method Retrospective analytical method was to be used to analyze the Nanning Health Ⅹ project in 2003—2004. Results The rate of sputum examination,the rate of smear positive,the rate of treatment management for smear positive patient,and the cure rate were respectively 99.3%,98.7%,38.2% and 47.4% in Nanning Health Ⅹ project in 2003,and in 2004 the rates were respectively 96.8%,99.5%,91.5% and 93.2%.The rate of case detection for smear positive patient were 64.4% and 77.7%.3.1-4.8 smear positive patients in ten suspects were identified.The clinical symptomatic inspection contributed 72% to the detection of pulmonary tuberculosis patients,and the referral management contributed 25%. Conclusions Nanning Infectious Disease Hospital has predominant superiority in detecting and treating TB patients.Nanning Infectious Disease Hospital plays a central role in implementing DOTS strategy,and specifically provides the service for diagnosis,treatment,and case management.

Immunologic Thrombocytopenic Purpura as Prominent Manifestation of Lymphoid Tuberculosis and Literature Review-A Case Report

Wang Yongren,Lu Hua,JI Ou,et al.

. 2007, 29(3):  261-263. 

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Objective To investigate the clinical features of immunologic thrombocytopenic purpura(ITP) induced by lymphoid tuberculosis(TB). Methods The clinical data of a case of ITP induced by lymphoid TB which presented with generalized petechiae and sporadic purpura were retrospectively analyzed,and literatures review about this case was conducted. Results A male patient of 48 years old presented as generalized petechiae,sporadic purpura,night sweating and weight loss.Platelets count in peripheral blood was 6×10⁹/L,and pathological examination revealed the existence of supraclavicular lymph node TB.The patient was diagnosed lymphoid TB complicated with ITP. Conclusion ITP can be one of the hematologic abnormalities induced by TB and TB should be thought as one of the etiology of ITP.Platelets count can be recovered in a short time as the glucocorticosteroid and anti-TB drugs administrated