Table of Content

10 April 2003, Volume 25 Issue 4

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Trends of tuberculosis incidence in Beijing

ZHANG Li-xing,TU De-hua,AN Yan-sheng, et al.

. 2003, 25(4):  204-208. 

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Objective To study the evolutive trend of the sputum positive tuberculosis incidence in Beijing.Methods To summarize the evolutive trend and its main explanations through analyzing the epidemical characteristics of sputum positive tuberculosis incidence and tuberculous infection, the implement of DOTS strategy, and the relationship among them in Beijing in 1980—2002.Results The sputum positive tuberculosis incidence had dropped significantly in 1980—2002; and the incidence dropping resulted mainly from notable declining of the incidence in low age groups (30 below people); the tuberculous infection descending in low age groups had caused the incidence declining; by controlling the infection sources, DOTS strategy had significantly reduced the tuberculous infection and tuberculosis incidence in low age groups, but had little effect on the infected people.Conclusion The sputum positive tuberculosis incidence in Beijing wouldn’t decline notably in near future.

Analysis on the result of Inner Mongloia random survery for the epidemiology of tuberculosis in 1998

REN Yu-lin,FAN Jing-qing.

. 2003, 25(4):  209-211. 

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Objective To realize the dynamic status of the epidemiological situation of tuberculosis in Inner Mongolia and evalute the efficacy of control measures as well as to provide the scientific basis for the prepation of Inner Mongolia Tuberculosis Control Program (2001—2010).Methods According to “Implementing regulation of national epidemiological sampling survey of tuberculosis in 1990",the multi-stratified groupsing random sampling method was used and the proportional sampling was utilized for Inner Mongolia as a whole.A total of 30 investigation points was sampling.Results The actual examined population in this survey was 53826 and occupied 97.1% of the eligible population.The prevalence of active,smear positive and bacteriological positive pulmonary tuberculosis were 687.40/10⁵,161.63/10⁵ and 183.93/10⁵ respectively.The annal reduction rates between 1990 and 1998 for active,smear positive and bacteriological positive pulmonary tuberculosis were 2.6%, 7.3% and 6.9%. Conclusion The magnitude of tuberculosis in Inner Mongolia was still serious.The improvement of Inner Mongolia epidemiolgical situation was rather sluggish.

Report on random survey for tuberculosis epidemiology of district of Qingdao in 2000 and 2001

PANG Zeng-chang,GE Deng-tai,CHENG Xin zhi,et al.

. 2003, 25(4):  212-215. 

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Objective To realize the dynamic status of the epidemiological situation of tuberculosis in district of Qingdao and improve the control measures as well as to provide the scientific basis for the preparation of Tuberculosis Control program objectives of district of Qingdao.Methods The multi-stratified grouping random sampling method was used and the 9 investigation points was sampled.Results The actual exampled population in the survey was 14?355 and accounted for 97.2% of the eligible population. The standardized incidence of active and bacteriological positive pulmonary tuberculosis were 202.02/10⁵ and 27.86/10⁵ respectively. The annual reduction rates between 1990 and 2000—2001 for active and smear positive pulmonary tuberculosis were 1.8%,0.8% respectively.Conclusion The epidemiological situation of tuberculosis of District of Qingdao is still very severe.So, propagandizing the knowledge about preventing tuberculosis and DOTs policy need enhanced.At the same time,the surveys to the crowds who are prone to tuberculosis and the increased invests must be stressed.

Impact resulting from funding shortage on TB management in project counties

WANG Lan-xiang,WANG Guang-xin,HAN Lian-tang,et al.

. 2003, 25(4):  216-218. 

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Objective To study the influence of funding shortage on treatment management of tubercle patients.Methods Data from 9 years annual regular and financial reports were collected to study funds input.Staff of TB dispensary,township and village TB doctors,TB patients were interviewed to know the supervisory course of tuberculosis.Results Health staff could not carry out DOTS strategy and their earning behavior appeared in TB institution caused of financial shortage.Conclusion It is important for government to commit more on TB control.Multiple investment to implement sustainable development on TB control program should also be strengthened.

Research on the rend of drug resistance of the smear positive tuberculosis and tuberculosis control project

Yang xiao-ming,LU Xi-wei.

. 2003, 25(4):  219-222. 

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Objective To evaluate 1993—2000 Dalian tuberculosis prevention and treatment result and the trend of drug resistance of the smear positive tuberculosis.Methods Statistics the date to proceed the brigade row the analysis to epidemic situation.All of the strains of M .tuberculosis from new register smear positive tuberculosis were test for resistance to INH,RFP,EMB and SM by absolute concentration methods.Results In 1993—2000 DOTS persistence rate were 7.0%,27.0%,41.4%,35.1%,68.4%,73.8%,77.6%,89.6% respectively.The cure rate were 54.0%,67.1,73.2%,84.3%,91.1%,93.5%,94.0%,92.7% respectively.The rate of initial resistance was declined from 34.6% in 1993—1994 to 18.2% in 1999—2000.The rate of acquired resistance declined form 52.1% in 1993—1994 to 35.7% in 1999—2000.Conclusion The rate of initial and acquired resistance was declined.The main reason is due to the convergence case-management and the DOTS strategy.

The evaluation of implementation of a World Bank loan tuberculosis control project from 1992 to 2001 in Rizhao prefecture

WANG Yun-mian¹, LU Ji-xu,ZHANG Yong-bao,et al.

. 2003, 25(4):  223-226. 

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Objective To analyze the effectiveness of implementation of a World Bank loan tuberculosis control project.Methods The tuberculosis control project seasonal reports and HS-14 registration were collected from 1992 to 2001. Results The project was able to improve the case-finding, namely the new register rate of newly detected smear positive patients increased from 9.70 to 13.87 per hundred thousand; the ration of both new and retreatment patients annually increased,and which decreased 82.04% in 2001 than in 1993; there increased markedly in the regulation treatment and cure rate, the cure rate of the newly detected smear positive patients was 97.43%.Conclusion The implementation of the World Bank loan tuberculosis control project has made big progress in Rizhao prefecture,it can provide available basis for the sustainable development of tuberculosis control.

Effect of newly smear positive tuberculosis delayed diagnosis with convergence case-management

WU Hong-mei,JIN De-fu,MENG jin-nv.

. 2003, 25(4):  227-228. 

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Objective To research the effect of new smear positive tuberculosis delayed with convergence case-management in yanbian region.Methods To survey the data of pulmonary tuberculosis patient’s convergence case-management and their cards、medical records from 1993 to 2001 in yanbian, and analysed the effect on delayed diagnosis before and after implementing convergence case-management.Results Convergence transferring diagnosis rate raised from 48.5% to 89.0%, convergence successfully rate raised from 29.0% to 72.4%, while the rate of delayed diagnosis reduced from 29.4% to 10.6%, the average of delayed days reduced from 22.2 d to 7.7 d. On the other hand, the rate of delayed seeking medical advice was 63.4% and 68.8% respectively, and the average of delayed days was 48.9 d and 50.3 d respectively. there is a top-cusp at the 20th week in the date of delay.Conclusion Convergence case-management have significantly effect on delayed diagnosis, while have no effect on the delayed seeking medical advice.It is the key point that reduce delayed diagnosis dependent on improving people in mind to keep heath from tubercle.

Effective evaluation on tuberculosis control project in Wenzhou

YU Xiao-hua,ZHANG Shu-lan,ZHAO Xiao-chuan.

. 2003, 25(4):  229-231. 

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Objective The achievements of tuberculosis control item for seven years were analysed.Methods Summary and analysis on tuberculosis control project in Wenzhou from 1996 to 2002 were carried out.Results Tuberculosis control project was carried out throughout Wenzhou.The comprehensive prevention and control measures were strenghthened.The discovery and treatment of infectious resource were elevated year by year.The registration rate of newly-discovered smear-positive patients rise from 7.54/ 100000 in 1996 to 20.98/100000 in 2002.The cure rate of tuberculosis rised from 71.3/100000 in 1996 to 92.3/100000 in 2001.Conclusion Zhejiang provincial tuberculosis control project and China tuberculosis control project CIDA-WHO carried out throughout Wenzhou were quite effective.DOTS strategy expanded in Wenzhou.

Evaluation and observation of serum thd parathyroid hormone in patients with severe acute respiratory syndrome

WANG Wei,YE Yi-xiu,YAO Hao,et al.

. 2003, 25(4):  232-234. 

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Objective To evaluation and observe the levels of serum throid hormone and parathyroid hormone (PTH) of the patients with severe acute respiratory syndrome (SARS).Methods The levels serum of throid hormone and parathyroid hormone (PTH) in 48 patients with severe acute respiratory syndrome (SARS) were measured by electrochemiluminescence.Results The Results showed that levels of serum T₃,T₄,FT₃ and TSH in patients with SARS were significantly lower than those in controls,the level of T₃ in severe patients was also significantly lower than those in general patients.There were no significant difference in livel of PTH between patients and controls.Conclusion The change of levels serum of throid hormone and TSH in patients with SARS may be an important manifestation on cours of diseases.

Chest image feature and mobile changes of 86 SARS cases

CHENG Gang.

. 2003, 25(4):  235-237. 

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Objective To observe the chest image features and mobile changes of SARS cases.Methods To observe the chest image features in the different time of the disease course of 86 clinical diagnosed SARS cases hospitalized.Results In most cases (73.3%),the chest X-ray changes appeared in the 4～7 days.At the early stage,the most common X-ray appearance was mottling shadow in one side (53 cases,took 61.6%) or both sides (33 cases,took 38.4%) of the lung.The 8～14 days was the most severe stage of the disease in most cases.The X-ray appearance in this stage showed uni-or bilateral patchy shadows in most cases and in some cases the changes was migrating.The X-ray changes were usually seen in the middle or lower lung field in 73 cases (84.9%).In majority cases (51.4%), the X-ray changes disappeared in the 15～21 days.CT had been proved to be more sensitive in finding the changes.Conclusion The X-ray changes of SARS cases are different in the different stage of the disease.Notification of the changing X-ray appearances of the patients is very important in guiding the treatment of the disease.

Risk factors analysis of serious SARS cases

FENG Li,XU Jian-hua,XU Yu-hua,et al.

. 2003, 25(4):  238-240. 

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Objective Informing and providing help for the clinicians to judge the state of SARS cases punctually and actually by analyzing the risk factors of serious SARS cases.Methods Making comparison of 40 serious cases with 43 ordinary SARS cases retrospectively.Results In ordinary cases 98.2% of the cases were under 40 years old.All serious cases were over 50 years old.Most serious SARS cases had longer fever time with an average of 7.7 days.36.4% of the cases got fever lasted for more than 3 days or rose after descending on steroid therapy.45.0% of the cases companied with diarrhea for the average period of 6 days.The lymphocyte counting (L-cell<1.0×10⁹/L) took 91.7% and 38.0% separately in serious and ordinary cases with 41.2% of the serious cases showed steady descending in 15 days.The decrease of T cell subgroup,CD₄ and CD₃ in serious SARS cases (81.3% and 52.9% separately) was much higher than that in ordinary cases (50.0% and 22.2% separately).Conclusion The risk factors of serious SARS cases include age over 50 years,continuous fever with no effect on steroid therapy for 3 days or the temperature raises after descending,diarrhea over 6 days,lymphocyte counting descending steadily in 2 weeks period and serum enzyme raise twice over normal level.

Clinical study of low tidaltion in elder patients with respiratory failure complicated by pulmonary tuberculosis

DU Zhong-zhen,LIU Rong,XUE Hui,et al.

. 2003, 25(4):  241-243. 

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Objective To discuss the effect of BGA by using low tidal volume maintained mechanical ventilation in elder patients with respiratory failure complicated by pulmonary tuberculosis.Methods Compared with the BGA Results in different tidal volume as 10 mL/kg,8 mL/kg,6 mL/kg for one hour and 6 mL/kg for 12 hours with the invariable mode and other parameters.Results PaCO₂ and PaO₂/FiO₂ was improved obviously when tidal volume was 6 mL/kg than before the mechanical ventilation ( P＜0.05).Conclusion Using low tidal volume mechanical ventilation can correct the respiratory failure effectively in the elder patients complicated by pulmonary tuberculosis.

Diagnostic yield of fiberoptic bronchoscopy(FB) in evaluating solitary pulmonary nodules

CAO Wen Li ,WU Yin ,XU Yu hua ,

. 2003, 25(4):  244-246. 

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Objective To evaluate factors affecting the diagnostic yield of FB in evaluating solitary pulmonary nodules (SPNs) .Methods Retrospective analysis of bronchoscopies performed 54 cases of pa tients with solitary pulmonary nodules .Results The diagnostic accuracy of bronchos copy in lesions were 6 8.5 % (37of 5 4) ,There were 23 malignant(42 .6 % ) .The yield of bronchoscopy was directly related to lesionsiza(P＜0 .0 5 ) .When lesions were stratifled distance from the hilum by lesion size ,the difference in yield was no significant .However ,lesions <2cm had a diahnostic yield of 3.4 % (1of 2 9)when located in the peripheral third vs 6 8.0 % (17of 2 5 )when located in the inner two thirds of the lung .There was a higher combined diagnostic yield in middle and lower lobe basal segment lobes when compared to all other segments .Conclusion Location and Size are the yield of deter minant of diagnostic yield in bronchoscopy when evaluating SPNs Transbronchial lung biopsy ,washing ,brushing and sputum examination after FB were complementary in improving the yield of bronchoscopy .The yield of brinchoscopy is particularly low in lesions <2cm that are located in the outer third of the lung .Thus alternative diagnostic approaches may bepreferable in this situation .

Clinical analyses of 62 cases with atypical tuberculosis meningitis

ZHU Min.

. 2003, 25(4):  247-249. 

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Objective To summarize the diagnosis and treatment of atypical tuberculosis meningitis.Methods The clinical data of 62 cases with atypical tuberculosis meningitis were retrospctively analyzed.Results The group of cases does not show any tupical symptoms of tuberculosis meningitis.Their clinical manifestations were as follows:disturbance of consciousness in 17 cases(27.4%),dizziness and low fever in 47 cases(75.8%),tiredness and depression in 13 cases(21.0%),limbs numbness in 21 cases(33.9%),paralysis in 5 cases(8.1%),damage of cranial nerve in 18 cases(29.0%),urinary retention in 10 cases(16.1%),epileptic-like attack in 4 cases(6.5%).Thoracic iconography examination are positive in 37 cases(59.7%),Skull iconography examination are positive in 13 cases(21%).The Results of cerebrospinal fluid examination are as follows:content of glucose decreasing in 30 cases(48.4%),content of chloride decreasing in 32 cases(51.6%),content of protein increasing in 36 cases(58.1%);adenylate deaminase (ADA) being positive in 58 cases(93.5%);tuberculosis antibody being positive in 48 cases(77.4%);smear acid-fast bacillus being positive in 2 cases(3.2%).62 patients were cured of and 1 patient died.Conclusion The clinical manifestation of atypical tuberculosis meningitis lacked of specificity,and the changes of cerebrospinal fluid are atypical.But positive reaction of tuberculosis antibody in cerebrospinal fluid could act as a reference in diagnosing tuberculosis of central nervous system,and adenylate deaminase is a sensitive and specific indes in diagnosis.Examinations of laboratory and iconography are important to confirmed diagnosis,standard antituberculosis treatment combined with intrathecal injection will have satisfied ellect.

Study on clinical application of rapid diagnostic tuberculosis by Taq Man-PCR

ZHANG jin-fu, LI chuan-you, CHEN xiao-you, et al.

. 2003, 25(4):  250-253. 

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Objective To evaluate the clinical value of rapid diagnostic tuberculosis using TaqMan polymerase chain reaction(TaqMan-PCR) technique.Methods It was detected to the specimens of the peripheral blood from 155 patients with active pulmonary tuberculosis, 130 patients with tuberculous pleurisy, 61 patients with tubercular meningitis, 52 patients with lung cancer and 33 healthy adults by TaqMan-PCR, and the specimens of pleural effusion from 130 patients with tuberculous pleurisy and 50 patients with malignant pleurisy, the specimens of cerebrospinal fluid from 61 patients with tubercular meningitis and the specimens of sputum from patients with 155 patients with active pulmonary tuberculosis and 52 patients with lung cancer by TaqMan-PCR and smear respectively. The specimens of sputum from patients with active pulmonary tuberculosis were detected simultaneously by culture with BACTEC and Lowenstein-Jensen. Results The positive rates of sputum and peripheral blood from patients with active pulmonary tuberculosis and of pleural effusion and operipheral blood from patients with tuberculous pleurisy and of cerebrospinal fluid and peripheral blood from 61 patients with tubercular meningitis detected by TaqMan-PCR were 49%, 51.6%, 45.4%, 38.5%, 51%and 42.6%, respectively. The positive rates detected by TaqMan-PCR were higher significantly than those detected by smear, culture with BACTEC and Lowenstein-Jensen(P<0.05). The specificity of TaqMan-PCR detecting for sputum, pleural effusion and peripheral blood were 96.2%, 98% and 96.5%.Conclusion TaqMan-PCR method showed higher sensitivity and specificity. It is a useful tool for rapid diagnosis of tuberculosis.

The effect of Levofloxacin on treating MDR-TB

GUO Lei, MA Juan-mei , YUAN Jun-ping.

. 2003, 25(4):  254-256. 

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Objective To observe the effect of Levofloxacin on treating MDR-TB. Methods Divide 92 cases into two groups in a randomized way , 50 of them was study group , the rest was control group. Therapy for 2 groups were 3HKZThV/18HZTh and 3HKZTh/18HZTh respectively, then observe the changes in sputum bacteria , focus and symptoms of two groups.Results The rate of sputum bacteria negtive , focus shrinking and symptoms improving of study group were 40.0%,58.0%; 54.0% ,72.0%; 66.0%, 76.0% respectively after three months and six months. That of control group were 19.0%,35.7%;33.3%,42.9%;38.1%,45.2% respectively .There is significant difference between two groups(P<0.05).Conclusion Significant Results were achieved when choosing Levofloxacin combined with other medicine for treating MDR-TB enforcedly.

Clinical Analysis of 66 cases with pulmonary disease caused by Nontuberculosis Mycobacteria

WU Long-zhang, CAI Xing-shan, GUAN Yu-hua, et al.

. 2003, 25(4):  257-259. 

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Objective To research on the clinical symptom of pulmonary disease caused by Nontuberculosis Mycobacteria(NTM). Methods Bacteria type identifications have been performed with 4129 cases of positive culture which have been isolated in Guangzhou from 1998 to 2002. 66 cases in final diagnosis were pulmonary disease caused by NTM and the full data about it were analyzed. Results 40 of the 66 cases were infected with rapid growth Mycobacteria , 29 of which were M.abscessus , 7 were M.chelonae , 3 were M.smegmatis and 1 was M.fortuitum . 26 of the 66 cases were infected with slow growth mycobacteria, 18 of which were M.avium , 6 were M.intracellulare , 1 was M.xenopi and 1 M.marinum .There were 10 Mycobacterium mixed infection. 16 cases were discovered lately, 31 cases have suffered for 1 to 10 years, 11cases for 11 to 25 years and 8 cases for over 30 years. The main symptoms were cough, expectorate white phlegm, hemoptysis and fever, respectively. Thoracic cavity with X-ray Irradiation showed that 69.69 percent of it were damaged in the both sides, 21.21 percent in the right, only 4.54 percent in the left, and 4.54 percent of it without focus. 26 cases involved in thoracic cavity membrane, 7 of which occurred in gathering liquid, NTM showed highly original resistance to the anti-tuberculosis drugs, but the ratio of resistance to quinolones, macrolides and aminogiycosides was lower.Conclusion The clinical symptom of pulmonary disease caused by NTM is not characteristic and has a long progress. There is a inferior effect of therapy with routine anti-tuberculosis drugs.

Comparison of DNA sequencing and single-strand conformation polymorphism methods for identification of rpoB mutations in rifampin-resistant isolates of Mycobacterium tuberculosis

HUANG Hai-rong,HE Xiu-yun,ZHANG Zong-de,et al.

. 2003, 25(4):  260-263. 

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Objective To evaluate the significance of DNA sequencing and PCR-SSCP in susceptibility analysis of M.tuberculosis to rifampin.Methods Analyzed the susceptibility to refampin of 25 rifampin-sensitive and 41 rifampin-resistant clinical isolates of M.tuberculosis by DNA sequencing and PCR-SSCP.Results No mutation was found in 25 rifampin-sensitive strains by DNA sequencing.while 38 of 41 rifampin-resistant strains had mutations in rifampin resistant determination region (RRDR) of rpoB gene,the mutation rate was 92.7%(38/41);25 rifampin-sensitive strains had same PCR-SSCP gel profile with M.tuberculosis H₃₇R_v,while 38 of 41 rifampin-resistant strains showed different SSCP profile that could differentiate its from control,indicating the possible existence of sequence alterations in the region of rpoB gene.The accordance rate of DNA sequencing and PCR-SSCP was 93.9%(62/66),compared with DNA sequencing,the sensitivity of PCR-SSCP was 92.1%(35/38),the specialty of PCR-SSCP was 96.4%(27/28).Conclusion DNA sequencing is valuable in rifampin susceptibility test;PCR-SSCP is useful in rifampin resistance strains screening.

PCR microplate hybridization-ELISA for identification of tubercle bacillus DNA

XIANG Yan-gen,SHI Guo-min.

. 2003, 25(4):  264-266. 

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Objective To identify the tubercle bacillus DNA with PCR microplate hybridization-ELISA. Methods To use PCR technology to expand tubercle bacillus DNA,and add the expanded matter into microplate with tubercle bacillus probes,then add tubercle bacillus probes of color displaying,and conduct color displaying of ELISA of microplate hybirdizationg.510 patients with pulmonary disease were tested.Results The sensitivity of the method is 59.3%,and its specificity is 95.0%.Positive predictive value is 96.3%,negative predictive value is 51.4%.Conclusion PCR microplate hybirdizatin-ELISA can be used to test tubercle bacillus DNA quickly and accurately,it is a reliable laboratory method early to diagnose and differentiate tuberculosis.

The clinical function of C-reaction protein in the diagnosis of active-tuberculosis

ZENG Lin-hai,XU Jia-lian,CHEN Shou-jun.

. 2003, 25(4):  267-269. 

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Objective To study the clinical function of C-reaction in the diagnosis of active-tuberculosis.Methods 120 cases with active-tuberculosis in our hospital (from Mar.2002 to jun.2002) were divided into infection group and non-infection group,bacteriological positive group and bacteriological negative group .The control group included 20 cases with non -active tuberculosis.The Results of C-reaction protein (CRP) and erythrocyte sedimentation rate (ESR) in all groups were detected and compared.Results (1) The CRP and ESR in infection group were all higher than the non-infection group significantly(P<0.01) (2) The CRP of active-tuberculosis was higher than the control group significantly (p<0.01),while there was no significant difference of ESR in the two groups (P>0.05). (3)The CRP of the non-infection group and bacteriological negative was higher than the control group significantly (P<0.05),while there was no significant difference of ESR in the two groups(P>0.05). (4) The CRP and ESR in bacteriological-positive group were all higher than the bacteriological-negative ,but there was no significant difference in two groups.Conclusion The CRP was more positive and more significant than ESR in the diagnosis of active-tuberculosis.