Table of Content

10 January 2012, Volume 34 Issue 1

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Survey on the awareness status of key messages on tuberculosis prevention and control among the floating population of different occupations in Tianjin

WAN Ying, XU Ying, YANG Hui-jun

Chinese Journal of Antituberculosis. 2012, 34(1):  6-9. 

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Objective  To explore the awareness status of knowledge on TB control and prevention among the floating population of different occupations, and provide scientific evidences for TB health education. Methods  Cluster random sampling method was used in the study, 512 floating people from the industry of garment，food service，construction and waste recycling participated in the questionnaire survey. Results  The total awareness rate of the key messages on TB control and prevention in the respondents was 36.7％（939/2560）.The rate was 32.1%（511/1590）for the male and 44.1%（428/970）for the female. There was a significant statistical difference between genders （χ²=37.262，P＜0.01）. The awareness rate of TB knowledge was 60.4%（317/525）for people from food service,44.8%（278/620）for people from garment，34.3%（139/405）for people from waste recycling and 20.3%（205/1010）for people from construction. There was a significant statistical difference in different occupations（χ²=262.434，P＜0.01）. The top 3 ways to get the message were radio broadcast（23.6%，121/512），chatting with others（21.5%，110/512）, and newspapers and journals（21.3%，109/512）. People of different occupations got message from different ways. People from the industry of garment and food service got the message mostly from radio broadcast and for people from the industry of construction, it was chatting with others，and leaflets for people from waste recycling. Conclusion  The awareness level of TB knowledge and the approach of TB knowledge acquisition among the floating population of different occupations were different, and provided scientific evidences for TB health education in floating population.

Analysis on multidrug-resistant tuberculosis surveillance under DOTS implementation in Xinmi county

LI Hui, JIN Hong-jian, MA Xiao-guang, CHEN Ai-ling, JIN Xiao-wei, YANG Hong-yi

Chinese Journal of Antituberculosis. 2012, 34(1):  10-14. 

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Objective  To understand the epidemic of multidrug-resistant tuberculosis(TB) under the DOTS (directly observed treatment short-course)implementation in Xinmi county of Henan province. Methods According to the inclusion criteria defined by the guidelines for national drug-resistant tuberculosis baseline survey, a total of 333 cases, including 295 cases of new and 38 cases of retreatment smear positive pulmonary tuberculosis patients, were enrolled successively for multidrug-resistant tuberculosis (MDR-TB) surveillance from March 1, 2007 to February 28, 2010; 100,135 and 98 cases in each year respectively. According to the criteria set by the quality control manual for national drug-resistant tuberculosis baseline survey, sputum culture and strain identification were done for the included patients. All the contaminated samples,  those that did not grow and those were not Mycobacterium tuberculosis were ruled out. 296 isolated strains were acquired eventually, including 261 strains from new cases and 35 strains from retreatment cases. These strains were performed first line TB drugs (INH, RFP, EMB, S) susceptibility test. Results The overall smear positive drug-resistant rate were 28.57%（26/91）, 30.43%（35/115）, 27.78%（25/90）and multidrug-resistant rate were 5.49%（5/91）, 7.83%（9/115）, 4.44%（4/90）for 3 years respectively. Among the 86 drug-resistant Mtb strains isolated from the smear positive TB patients, 47 strains（15.88%，47/296）resisted to one kind of drugs, 20 strains （6.76%，20/296）resisted to two kinds of drugs, 12 strains（4.05%，12/296）resisted to three kinds of drugs, 7 strains（2.36%，7/296）resisted to four kinds of drugs, 18 strains（6.08%，18/296） resisted to both RFP and INH. Conclusion  The epidemic of MDR-TB was lower than that of the whole country. The epidemic remained in the same level in Xinmi county in the past 3 years. Effective measures to detect and treat drug-resistant TB patients should be taken to reduce the rate of drug-resistant tuberculosis.

Analysis on the anti-tuberculosis treatment outcome of 192 Mtb/HIV co-infected patients in Anhui province

LI Ling, YAO Song, CHEN Jing

Chinese Journal of Antituberculosis. 2012, 34(1):  15-18. 

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Objective  To understand the impact of active interventions on improving TB cure rate and reducing the fatality rate among Mtb/HIV co-infected patients in HIV high epidemic areas in Anhui province.  Methods   Information of the anti-TB treatment outcome of 199 Mtb/HIV co-infected patients registered from October 1 2006 to June 30 2009 in 7 high HIV epidemic counties was collected and analyzed. Results  Among the 199 Mtb/HIV co-infected patients,135 cases received antiretroviral therapy,192 cases received anti-TB treatment and 181 cases accepted full course supervision. Within 1 year after the completion of anti-TB treatment, of co-infected patients 48 cases recovered from TB, 113 cases completed the treatment course, 4 cases were transferred out, 4 cases died of TB, 21 cases died of non-TB diseases,1 case failed and 1 case was lost. The treatment success rate of Mtb/HIV co-infected patients was 83.9%（161/192）,the total fatality rate was 13.0%（25/192）while the fatality rate of TB was 2.1%（4/192）.Conclusion  The active cooperation between TB institutes and AIDS institutes of different levels would improve the detection of Mtb/HIV co-infected patients and provide timely diagnosis and treatment of both diseases which could effectively increase the TB cure rate and reduce the fatality rate among Mtb/HIV co-infected patients.

Analysis of the factors affecting the treatment outcome of 116 multidrug-resistant pulmonary tuberculosis patients

DU Yu-hua，SU Ru-zhao，ZHOU Hui-xian，TAN Shou-yong

Chinese Journal of Antituberculosis. 2012, 34(1):  19-22. 

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Objective  To explore the treatment outcome and related influencing factors of multidrug-resistant pulmonary tuberculosis (MDR-TB) in Guangzhou. Methods  Logistic regression analysis was adopted to analyze the factors affecting the chemotherapeutic results of 116 MDR-TB patients registered in Guangzhou Chest Hospital and Guangzhou Center for TB Control and Prevention from January 2003 to December 2007. Results  There were 75 male patients accounting for 64.7% and 41 female patients accounting for 35.3% of 116 patients. The age ranged from 20 to 84 years old and the average age was (44.26±17.57) years old. The cure rate of MDR-TB patients was 55.2%（64/116）and the failure rate was 25.0%（29/116）.Eight patients died of TB and 5 patients died of other diseases, the death rate was 11.2%（13/116）.Multivariate logistic regression analysis showed that irregular treatment（OR=13.745；95%CI:3.147-60.034）, irrational chemotherapy regimens（OR=9.897；95%CI:2.528-38.747）and with lung cavitary lesions（OR=10.295；95%CI:2.002-52.949）were risk factors for treatment failure and death of MDR-TB. Conclusion  Based on the drug susceptibility results and the extent of lung cavity,  to developing the reasonable treatment regimens and strengthen the treatment supervision of MDR-TB patients could reduce the treatment failure and mortality of MDR-TB and control the epidemic of MDR-TB.

Study on the effects of blood concentration of anti-tuberculosis drugs in pulmonary tuberculosis patients with diabetes

LI Yan-jing, GAO Wei-wei, CHANG Zhan-ping, SUN Rui-min, HAN Xi-qin, LI Zhan-ling

Chinese Journal of Antituberculosis. 2012, 34(1):  23-25. 

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Objective  To study the effects of blood concentration of 2 anti-tuberculosis drugs, levofloxacin (Lfx) and pyrazinamide (PZA) in pulmonary tuberculosis patients with diabetes.  Methods  The levels of serum Lfx and PZA were measured by high performance liquid chromatography (HPLC) in pulmonary tuberculosis patients with diabetes, and compared with patients without diabetes. The data were calculated by SPSS 13.0 software. The drug concentration of Lfx and PZA were analyzed in pulmonary tuberculosis patients with diabetes, and compared with patients without diabetes.  Results  The drug concentration of Lfx was higher in pulmonary tuberculosis patients with diabetes than that in the patients without diabetes, (8.03±2.60) μg/ml and (6.66±1.76) μg/ml，t=2.39，P=0.02）. There was no significant difference between the 2 groups on the drug concentration of PZA((14.24±4.79) μg/ml and (14.86±5.74) μg/ml；t=0.37，P=0.71).  Conclusion  The drug peak concentrations of Lfx were affected by the factors of diabetes. The peak drug concentrations of PZA were not affected by diabetes.

Analysis of ventilator-associated pneumonia occurring in patients with pulmonary tuberculosis

HAN Fen， LUO Bao-jian， LIU Qiu-yue，WU En-dong，ZHANG Nan， KANG Nai-min

Chinese Journal of Antituberculosis. 2012, 34(1):  26-28. 

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Objective  To analyze the clinical characteristics of pathogens spectrum of ventilator-associated pneumonia(VAP) occurring in patients with pulmonary tuberculosis in the intensive care unit (ICU) and to provide a clinical strategy of using antibacterial agents. Methods  Fifty-eight pulmonary tuberculosis patients with VAP from January 2007 to January 2011 were retrospectively analyzed in clinical features，bacterial culture of sputum and results of drug sensitiveness test.  Results  One hundred and four bacterial strains were isolated in the sputum from the 58 pulmonary tuberculosis patients with VAP, which gram-negative bacilli，gram-positive cocci，and fungi accounted for 68.3%（71/104）, 7.7%（8/104）and 24.0%（25/104）, respectively. The major pathogens were acinetobacter baumannii (26.0%, 27/104）, pseudomonas aeruginosa(21.2%, 22/104）and candida albicans(14.4%, 15/104）. Twenty-six cases(44.8%, 26/58) had co-infections with at least 2 kinds of pathogens. Conclusion  The main pathogens in VAP with pulmonary tuberculosis are gram-negative bacilli and fungi, mixed infection is high．

Analysis on the efficacy of airway obstruction through interventional therapy under bronchoscope in 82 patients with endobronchial tuberculosis

TAO Hong-yan, WAN Yi-xin, WEI Hai-dong, WANG Hong, HUANG Hui-rong, LI Fang-wei, WU Hong-yan, WANG Xiao-ping

Chinese Journal of Antituberculosis. 2012, 34(1):  29-31. 

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Objective  To discuss the efficacy of airway obstruction suffered from endobronchial tuberculosis through interventional therapy under bronchoscope.  Methods  Eighty-two patients with airway obstruction suffered from endobronchial tuberculosis were given normal antituberculosis treatment, in the same time they received interventional therapy under bronchoscope. According to the degree of obstruction, flushing, removing by forceps clip, or highfrequency electric coagulation were chosen and then isoniazid was administrated in bronchial lumens.  Results  Of 82 patients, 54 cases had airway complete unobstruction, 26 had mild airway narrow, and 2 had no improvement.  Conclusion  The efficacy of intervention therapy under electronic bronchoscope in patients with endobronchial tuberculosis is definite．This method has few complications，it can improves effectively the airway obstruction．

Analysis of culture and drug-resistance of  Mycobacterium tuberculosis in Kunming

SU Jun-hua, LIANG Gui-liang, BAO Ling, YANG Hui-xian, LI Xiao-fei, DUAN Zhi-mei

Chinese Journal of Antituberculosis. 2012, 34(1):  32-35. 

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Objective  To understand the culture and drug-resistance of  Mycobacterium tuberculosis in Kunming area. Methods  The specimens from the tuberculosis (TB) patients and suspected TB patients were examined by BACTEC MGIT 960, Roche culture and acid-fast bacilli (AFB) smear. The incubation time, culture positive rate, and contamination rate were analyzed. The 5 first-line anti-TB drug (streptomycin, isoniazid, rifampin, ethambutol, pyrazinamide) resistances were detected, respectively. Results  The culture positive rate was 38.2%（782/2046），by BACTEC MGIT 960. Roche culture positive rate was 32.6% (666/2046). The TB diagnosis rate was 37.3% (719/1928). First-line anti-TB drug-resistant rate was 41.9% (212/506)，and multidrug-resistant rate was 20.0% (101/506). Conclusion  Tuberculosis patients resistence is serve to first-line anti-TB drug in Kunming area.

Expression and serodiagnosis of recombinant protein Rv0222 from  Mycobacterium tuberculosis

WANG Qing, YANG Hua, JIN Rui-liang, HU Zhong-yi，LIU Zhong-hua

Chinese Journal of Antituberculosis. 2012, 34(1):  36-39. 

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Objective  To construct the recombinant plasmid of  Mycobacterium tuberculosis Rv0222 in E.coli, and to study its potential value for serodiagnosis of pulmonary tuberculosis (TB). Methods  The gene coding Rv0222 protein was amplified by polymerase chain reaction (PCR) from genome of  Mycobacterium tuberculosis H37Rv，and then cloned into vector pMD18-T and subcloned into expression vector pET30a. Recombinant Rv0222 was expressed and purified. The antigenicity of the recombinant protein was analyzed by using Western blot. The purified recombinant Rv0222 protein was evaluated with the sera from pulmonary TB patients (n=82), the other pulmonary disease patients (n=28), and the healthy controls (n=32) by ELISA. The data were analyzed using professional medical software MedCalc 11.5.0. Results  Recombinant plasmid of Rv0222 was established, and the relative molecular mass was about 27 000 by SDS-PAGE analysis. The protein purified by Ni-NTA was in a purity over 95%, which was confirmed by western blot. The results from ELISA showed that its sensitivity and specificity were 69.5% (57/82) and 90.0% (54/60)，respectively. There was significant difference between TB patients and the controls (t=25.78，P＜0.0001). Conclusion  The recombinant protein Rv0222 was successfully obtained and might be used as a potential candidate antigen for TB serodiagnosis.

Preliminary study on the application of protein fingerprinting technology for multidrug-resistant tuberculosis patients

FANG Su-fang, WENG Li-zhen, HUANG Ming-xiang, LI Xue-ling, GUO Qiao-ling, ZHENG Xiao-hu, CHEN Xiao-hong, ZHANG Li-shui, LIN Min-fang, LIU Tan-ye

Chinese Journal of Antituberculosis. 2012, 34(1):  40-44. 

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Objective  To evaluate the value of applying serum protein fingerprinting technology for multidrug-resistant tuberculosis patients. Methods  Sputum cultures identified 70 cases positive for  Mycobacterium tuberculosis, 35 cases were multidrug-resistant and were classified as group A, 35 non drug-resistant cases were classified as group B, 35 healthy volunteers were classified as group C. Groups B and C were used as comparative control groups,  utilizing surface-enhanced laser desorption/ionization time-of-flight mass spectrometry(SELDI-TOF-MS) and protein chips to examine serum proteins. Ciphergen protein chip 3.2.1 software is then used to analyze protein peak values and carry out statistical analysis. Results  Based on the comparison of protein chip data between MDR-TB groups and controls, 4 protein peak showed significant deviations (P＜0.01). m/z (mass to charge ratio)for 1369 and 3400 showed low expression while those for 8700 and 22 794  showed high expression. Their sensitivities are 77.1%（27/35），71.4%（25/35），80.0%（28/35），74.3%（26/35）, respectively, specificity were 72.9%（51/70），74.3%（52/70），75.7%（53/70），81.4%（57/70）, respectively, all possess statistical significance (All P＜0.01; χ²=23.7，20.2，29.6，31.0，respectively). Conclusion  Serum protein fingerprinting technology is easy, fast, and uses small sample sizes. It has the potential to become the new diagnostic standard for MDR-TB.