Table of Content

10 March 2002, Volume 24 Issue 3

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Evaluation of the effect of quality control system for sputum smears microscopic examination laboratory with double blind methods in 1998～2000

ZHAO De-fu,WU Zhen-ping,WU Hong,et al.

. 2002, 24(3):  113-115. 

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Objective To discuss a new model of Quality control (QC) system for sputum smear microscopic examination laboratory in tuberculosis.Methods The sputum smears of newly registered tuberculosis patients were key points of QC system.To carry out elementary QC with double blind in district (county) class sputum smear microscopic examination laboratory .The province class reference laboratory was set for final QC exam.Results In keeping current cost,local QC rate could reach to 100%,about 50% sputum smears of newly registered tuberculosis patients were supervised under QC system every year.The positive detection rate was decreased from 99.0%～100% to 97.1%～98.3%,and the negative detection rate was decreased from 99.4%～99.9% to 98.5～99.1%.Conclusion Using double blind to carry out QC in equal class examination laboratory is an economical supervise method.It can spread QC scope and QC frequency efficiently.Two different class examiniation laboratory mate the QC process more strictly,which can play an important role in tuberclosis programe.

Study on DTH reaction of guinea-pig induced by several recombinant antigen of M.tuberculosis

ZHANG Ling-xia,WU Xue-qiong,SHI Ying-chang,et al.

. 2002, 24(3):  116-118. 

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Objective To observe the DTH reaction induced by recombinant antigen of M.tuberculosis MPT64(M)、Ag85A(A)、ESAT6(E) and the mixture of two of them.Methods Normal skin test:The guinea-pig were sensitived by all body of dead H₃₇R_v.We used water as negative control,5U PPD as positive control,0.8μgE、0.8μgM、0.8μgA、0.4μgA+0.4μgM、0.4μgA+0.4μgE、0.4μgE+0.4μgM were injected on guinea-pig’s back respectively.The Results were observed 24、48、72h after injection.Alternative skin test:water、5U PPD、0.8μgE、0.8μgM、0.8μgA、0.4μgA+ 0.4μgM、0.4μgA+ 0.4μgE、0.4μgE+ 0.4μgM were injectecd on the back of the same guinea-pig.The Results were observed 24、48、72h respectively after injection.Results Normal skin test showed:the DTH reaction of guinea induced by 0.8μgM、A、M+E、E+A mixture respectively was no real difference with the DTH reaction induced by PPD (P＞0.05).But the DTH reaction induced by 0.8μgE and M+A mixture respectively was stronger than the Results induced by PPD (P＜0.05).24h after injection was the best observing time of the test.The Results of alternative skin test were coincidence with normal skin test.Conclusion The DTH reaction induced by ESAT6 and A+M compounds was stronger than the DTH Results induced by PPD.

The analysis of 38 patients who were misdiagnosed to be tuberculosis meningitis

KONG Wen-qing,Lü Qing,ZHANG Pei-yuan.

. 2002, 24(3):  119-121. 

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Objective To develop the differential diagnosis level for the tuberculosis meningitis (TM).Methods 38 patients were misdiagnosed to be TM in all of 342 patients who were diagnosed to be TM from Jan for 1985 to Oct of 2000.The 38 misdiagnosed TM patients were summarized and retrospectively analyzed.Results The overall missed rate was 11.1%(38/342).The differential diagnoses for the 38 missed patients were respectively virus meningitis 19 (50%),cryptococcus meningitis 7(18.4%),cerebral cysticercosis 3(8.0%),erythema lupus for brain 2(5.3%),acute disseminated encephalomyelitis 2(5.3%),cerebral abscess,cyst beside epiphysis,meningioma,gliocytoma,non-specific narrow of cerebral duct respectively 1(2.6%).The delayed time from 2 days to 360 days,the average was 37 days.Conclusion (1)Tuberculosis physician should know the clinical manifestation of other brain diseases,so that can develop the level of diagnosis or differential diagnosis for tuberculosis meningitis.(2)We should pay attention to these patients whose clinical manifestations and CSF tests are atypical,and the patients who are not effect to the anti-tuberculosis chemotherapy.For these patients,we should further differentiate it from cryptococcus meningitis and cerebral cysticercosis or other brain diseases.(3)The acute disseminated encephalomyelitis should be considered if the patient’s disease occurred urgently and progressed rapidly,or in the early stage occrurred consciousness obstruction,paraplegia and sphincter’s function failure,but the CSF changed slightly.(4)CT (especially concentration) or MRI tests for brain can play a very important role of diagnosis and differentiation for TM.

The influence of drug taking on the seriousness of pulmonary tuberculosis

LIU Kun,SUN Jian,CEN Wen-chang,et al.

. 2002, 24(3):  122-124. 

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Objective To probe into the influence of drug taking on the seriousness of pulmonary tuberculosis.Methods To compare the chest X-ray,sputum examination and clinical symtoms before and after treatments between drug taking group and non-drug taking group.Results There were significantly increased the severity of clinical symtoms,the sputum positive rate,rate of cavitation and the scope of pathological changes were significantly increased comparing with control groups before treatment.The improvement of clinical symtoms,the sputum negative convertion rate,scope of pathological improvement,cavity reduce rate were signigicantly decreased after treatment.The differece between the two groups was significant.Conclusion Drug taking may aggravate the severity of pulmonary tuberculosis.

Tuberculosis control in university students in Beijing: Characteristic of tuberculin reactivity

LIU Yu-qing,TU De-hua,ZHANG Li-xing.

. 2002, 24(3):  125-129. 

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Objective To determine the characteristic of tuberculin reactivity in university students in Beijing,China.Methods Standardized tuberculin testing with PPD5TU,socio-demographic and epidemiological feature of tuberculosis were conducted in 51?699 students of 20 universities in Beijing.Results The university students come from 33 provinces and areas,of which 68% come from outside of Beijing.Students with 18 and 19 years old accounted for 79.9% of all.The Results of tuberculin testing in 15?203 students without BCG scar and who had ≥5mm,≥10mm,≥15mm and ≥20mm of duration of PPd were 38.9%,22.6%,12.4% and 6.0 respectively.Students coming from cities had greater PPD reaction than from rural areas.Students with history of tuberculosis contact had much more increase 38.7% and 48.5% PPD reaction in ≥15mm and ≥20mm of duration than those without history of tuberculosis contact.Conclusion Our Results show that univesity students are considered as subjects of targeted tuberculin testing and who have PPD reaction ≥15mm of duration should be given preventive chemotherapy of tuberculosis.

Socio-economic study on pulmonary tuberculosis patients

WANG Li-xia,YUE Shu-min,QIAN Yuan-fu,et al.

. 2002, 24(3):  130-133. 

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Objective To realize the socio-economic situation of pulmonary tuberculosis patients and provide the scientific data for the revision of tuberculosis control strategies and policy of the national tuberculosis control progarm as well as to improve tuberculosis control services.Methods All detected pulmonary tuberculosis patients in the fourth nationwide epidemiological sampling survey on tuberculosis were the target for this study.This study was carried out through questionnaire inquiry questioned and recorded by special trained health personnel.Results 1.The economic situation among pulmonary tuberculosis patients was rather poor.About 77.9% of them the annual average income per family member was lower than that of the lacal family member at the same site.55.5% of these patients their income was 60% lower than the average income and 22.4% of the patients their income was 61～99% lower than the average income.2.Only 7.9% of the detected patients covered by various kinds of medical insurance.3.The case-detection rate was low.Only 29.6% of the detected patients their diagnosis of tuberculosis had been confirmed before this survey.4.Health education on tuberculosis had not been popularized.Only 40.2% of the patients had received certain kind of health education on tuberculosis.5.The case-management on treatment among pulmonary tuberculosis patients was not sufficient.The regularity of chemotherapy was only 27.3%.Conclusion Free examination and free treatment services must be provided to all pulmonary tuberculosis patients.The accessibility of case-finding services must be improved.The health education on tuberculosis must be popularized to the community.The full course supervised chemotherapy must be widely expanded and must be supervised by doctor.

Analysis of misdiagnosis of 14 patients with polymyositis (PM/DM) complicated by interstitial lung disease

CAO Wen-li,MA Ying,XU Yu-hua,et al.

. 2002, 24(3):  134-136. 

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Objective To know more about polymyositis (PM/DM) complicated by interstitical lung disease (ILD).Methods Clinical analysis of 14 patients with PM/DM complicated by inters titial lung disease (ILD).Results Male to female ration was 8∶6,averge age is 43.7,and average duration of misdiagnosis was 6.2 months,there were 22 patients misdiagnosed for respiratory system diseases and 21 patients for inflammation diseases.Conclusion Misdiagnoses are unusual between age and sex.The syndromes of ILD,which occur before those of PM/DM easily.limitations of acknowledge of PM/DM,the low specificity and sensitivity of examination.Biopsy through video-assistant thorascope (VATS) can increase the diagnoses of PM/DM with ILD.

The therapeutic effect of chemotherapy combined with immunotheraphy on retreated pulmonary tuberculosis

JI Shu-yu¹,LIU Jin,YAN Hong-fei,et al.

. 2002, 24(3):  137-139. 

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Objective To observe the curative effect of the retreated pulmonary tuberculosis patients chemotherapy combined with immune regulation preparation.Methods 226 smear-positive cases were divided into trial group and control group at random.All patients were treated by the same chemotherapy regime,but the trial group was assistantly treated by immunotherapy with BCG vaccine polysaccharide nucleic acid (BCG-PSN).The effect was compared between the two groups.Results At the end of the course,the sputum negative conversion rates of the retreated pulmonary tuberculosis of the trial group and the control group were 80.0% and 65.2% respectively.As for MDR pulmonary tuberculosis,the rates were respectively 61.5% and 16.7% for the trial group and the control group.The information above was singnificant in statistics (P＜0.05).Conclusion The curative effect in the trial group was obvious superior to the control group.As indicated the immunotherapy was more effective in treating the retrated pulmonary tuberculosis.

Detection of lipoarabinomannan-38kD-IgG in serum for the diagnosis of pulmonary and extrapulmonary tuberculosis

KONG Zhong-shun,GUAN Bo-qing,GU Shu-xiang,et al.

. 2002, 24(3):  140-142. 

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Objective To ascertain the value of lipoarabinomannan-38kD-IgG (LAM-38kD-IgG) determination in the diagnosis of smear negative pulmonary and extrapulmonary tuberculosis.Methods LAM-38kD-IgG in sera obtained from 57 patients with smear negative active pulmonary tuberculosis,52 patients with extrapumonary tuberculosis,32 patients smear positive pulmonary tuberculosis,29 patients with lung cancer and 33 healthy individuals were detected by dot immunogold filtration assay.Results The positive rate was 73.7% in smear negative pulmonary tuberculosis group and the positive rate was 71.2% in extrapulmonary tuberculosis group.The false positive rate was 31.0% in lung cancer group and 9.1% in healthy individuals group.Conclusion The Results suggested that the LAM-38kD-IgG detection was a useful supplementary tool for the diagnosis of smear negative pulmonary tuberculosis and extrapulmonary tuberculosis.

Quality control report of X-ray examination in fourth epidemiology survey of tuberculosis in Wuhan City

YU Hui-shan,QIN Li-xin,FU Zhi-jun,et al.

. 2002, 24(3):  143-145. 

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Objective To study and make a unified quality control standard of X-ray chest fluoroscopy,radiography and diagnose (SQCD-XR) to promote work quality of Large scale epidemiology survey of tuberculosis (TBES) and ensure it completed smoothly.Methods This work was done according to diagnosis Results of X-ray examination of the sample points in this epidemiology survey,by refering "Work handbook of national epidemiology survey of tuberculosis in 2000" and SQCD-XR made in last epidmiology survey of Wuhan city.Results The positive rate of chest fluoroscopy in higher 0.8% and the rate of high quality chest picture is higher 14% than last TBES by operating according to SQCD-XR at all of the 18 points.Conclusion To use unified SQCD-XR ensured the large scale epidemiology survey completed with ligh quality short time and lower cost.

Analysis of the mycobacterial strains depending on rifampin in growth by BACTEC

WANG Yi-wei,ZHONG Min,WANG An-rong.

. 2002, 24(3):  146-148. 

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Objective To analyze the growth and drug resistant characteristics of rifampin-depending Mycobacterium tuberculosis strains (rdm) in BACTEC in order to identify rdm in clinic.Methods The rdm was indentified by the previous L-J cultivation.Suspension (10^-4mg/ml 0.1ml) was inoculated in 7H12 liquid media containing lifampin.Their growth index (GI) was detected by BACTEC and the bacteria in the media were weighted and stained by acid-fast staining.Results The resistance to rifampin was detected in media containing 1～96μg/ml of rifampin.The sensitivity to rifampin was detected in the media containing 384μg/ml of rifampin.The weight of the rdm in the media containing 6,8,10,12 and 24μg/ml was 87、125、116、104 and 65mg respectively,that were marked higher than that of control (35mg).The weight of rdm in the media containing rifampin (192～384μg/ml) was 1.9～3.6 times that of control.The bodies of rdm in the media containing rifampin were larger and deeper stained in the acid-fast staining compared with the control.Conclusion The rdm grows vigorously in media containing rifampin of 6～24μg/ml,but it grows much weakly in the media containing no rifampin.

Evaluation of implementation of tuberculosis convergence case-management in Shandong province

WANG Shi-chang,GENG Hong,HAN Jian-ping.

. 2002, 24(3):  149-151. 

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Objective For evaluation of implementation of transferring case-management system in health administrative departments,tuberculosis control facilties and general hospitals.Methods To check all provincial health administrative departments,tuberculosis control units and general hospitals for implementing the transferring case-management since 1997.Results Health administrative departments applied law regulations and regular documents to intervene in the transferring case-management system.In 1998,among new registration smear-positive pulmonary tuberculosis cases from tuberculosis control units,42.2% was from general hospitals transferring diagnosis.New smear positive transferring diagnosis rate was 47.4%,and retreatment smear positive rate was 28.6%.Transferring diagnosis rate of general hospital and town hospital were 60.4% and 79.6%,respectively.Conclusion The implementing transferring case-management system,adopting administrative intervention measures,transferring diagnosis timely as well as reporting detected tuberculosis cases in general hospitals,registering timely from reported tuberculosis cases in tuberculosis control units are very important factors to raise detection rate for tuberculosis cases.