Table of Content

10 February 2013, Volume 35 Issue 2

Previous Issue    Next Issue

The effect of different sputum processing methods on the results of Lowenstein-Jensen medium culture

ZHAO Li-ping, ZHU Ma, JIANG Guang-lu, YU Xia, HUANG Hai-rong

Chinese Journal of Antituberculosis. 2013, 35(2):  93-96. 

Abstract ( 3241 )   PDF (721KB) ( 757 )   Save

References | Related Articles | Metrics

Objective  To evaluate the effect of different sputum processing methods on the results of Lowenstein-Jensen（L-J）medium culture.  Methods  198 sputum specimens from suspected tuberculosis (TB) patients were collected, in which 99 samples were smear-positive and the others were smear-negative. Each sputum specimen was performed L-J medium culture simultaneously using the simple method and the centrifugal method,in which there were 5 following centrifugal conditions to be simultaneously used: 3000×g for 15 min, 3000×g for 8 min, 3000×g for 25 min, 2000×g for 15 min, 5000×g for 15 min.  Results  Of 198 sputum specimens, 126 were culture-positive, in which 97 originated from smear-positive sputa, and 29 originated from smear-negative sputa. The positive rates for the simple method and centrifugal method (3000×g for 15 min) were 93.65%（118/126）and 96.03%（121/126）.The average culture time for the simple method ［(20±8.56) days］ was 2 day shorter than that for centrifugal method［(22±9.10) days］. Of 125 culture-positive specimens by the centrifugal method, the positive rates at 5 centrifugal conditions mentioned above were 96.03%(121/126), 89.68%(113/126), 95.24%(120/126), 92.06%(116/126) and 96.03%(121/126), respectively.  Conclusion  The sensitivity of L-J medium culture by the simple method was similar with the centrifugation method. The simple method has the advantages of simple operation, lower contamination rate, shorter culture time, and was adaptable to be used widely. The centri fugal force and centrifugal time of the centrifugal method had some effect on the positive rate of culture.

Analysis of the drug resistance patterns and resistance rates among smear positive TB patients in Wuhan city

ZHOU Mei-lan, CHEN Zi, WANG Jian-jie, CHEN Cong, PAN Hong, JIAO Xin-guang

Chinese Journal of Antituberculosis. 2013, 35(2):  97-102. 

Abstract ( 2168 )   PDF (749KB) ( 623 )   Save

References | Related Articles | Metrics

Objective  To analyze the resistance characteristics of different registration classification smear positive TB patients (especially MDR-TB) and to understand the risk factors in order to provide reliable references for development of drug-resistant TB control strategy. Methods  Two sputum samples were collected from each smear positive patient in 3 categories-new, re-treatment (relapse, transfer in and others) and treatment failure (failure of new patient, retreatment patient and new patients who remain smear positive after 3 months of treatment) for sputum culture by proportional method, six kinds of anti-TB drugs (INH, RFP, EMB, S, Km, Ofx) were tested for susceptibility. Between December 2006 and March 2012, a total of 2110 cases of smear positive TB patients were sputum cultured, in which 1947 cases (92.3%) were culture positive; through drug susceptibility test (DST) and bacterial typing, 1800 cases of Mtb (92.4%) were identified eventually.  Results  Among the 1800 Mtb cases, a total of 794 cases (44.1%，794/1800) were identified as drug-resistant TB, out of which, 244 cases (13.6%,244/1800) were single-drug-resistant (SDR) TB, 155 cases (8.6%,155/1800) were poly-drug-resistant (PDR) TB, 395 cases (21.9%,395/1800) were MDR-TB, the detection rate of MDR-TB is significantly higher than SDR-TB and PDR-TB (χ²=43.4, χ²=123.6，P＜0.01).The detection rate of SDR for new, re-treatment and treatment failure TB patients was 11.9%(57/480), 14.4%(159/1107)and 13.1%(28/213) respectively, the difference is not statistically significant (χ²=0.33, P=0.85); the detection rate of PDR for new, re-treatment and treatment failure TB patients was 5.4%(26/480), 9.8%(109/1107) and 9.4%(20/213) respectively, the difference is not statistically significant between retreatment and treatment failure cases (χ²=0.04, P=0.84). however, they are higher than that of new TB cases (χ²=8.53, P=0.01); the detection rate of MDR for new, re-treatment and treatment failure TB patients was 14.4%(69/480)，22.5%(249/1107) and 36.2%(77/213)respectively, the detection rate of treatment failure TB patients is higher than that of new and re-treatment TB patients (χ²=17.92, χ²=42.07, P＜0.01). Conclusion  The detection rate of drug resistant TB is high among smear positive TB patients in Wuhan. The diversity and complexity of drug resistant spectrum poses a threat to TB control in China.

Comparison of traditional method and PCR method in the identification of M. tuberculosis complex

Aminaguli TAXITIEMUER， HU Xin， WANG Jing，Muyeshaer PIDAYI，XU Zhi-guang，ZHANG Wen-bao，Qimanguli WUSHOUER

Chinese Journal of Antituberculosis. 2013, 35(2):  103-107. 

Abstract ( 3080 )   PDF (1112KB) ( 891 )   Save

References | Related Articles | Metrics

Objective  To compare and analyze the traditional method of identifying M.  tuberculosis complex with PCR method, and to provide a scientific basis for clinical application.  Methods  The isolates of 313 sputum samples from patients diagnosed with pulmonary tuberculosis in Kashgar Thoracic Hospital from April 2010 to May 2011 were identified M. tuberculosis complex using traditional method (p-nitrobenzoic acid and thiophene-2-carboxy-lic acid hydrazide) and PCR method, respectively. 100 isolates including M. tuberculosis, M. bovis and M. africanum type Ⅰ were chosen purposely to examine the reliability of these two methods using the spoligotyping test.  Results  253 M. tuberculosis, 60 M. bovis were identified by the traditional method. 306 M. tuberculosis, 1 M. bovis and 6 M. africanum type Ⅰ were identified by PCR method. The accordance rate of these two methods was 79.87% (250/313). Although there was no statistical difference between the two methods in the identification of M. tuberculosis complex (χ²=5.05, P=0.08), the difference was statistically significant in the identification of M. bovis (χ²=4.16, P=0.04). 100 isolates purposively chosen were further identified as 90 M. tuberculosis, 2 M. bovis and 6 M. africanum type Ⅰ by Spoligotying test. According to the result of the Spoligotyping test, the accordance rates by the traditional method and PCR were 38.78% ［(2+36)/98］ and 98.98% ［(1+90+6)/98］, respectively.  Conclusion  The traditional method of strain identification of M. tuberculosis complex is  time consuming, tedious, and inaccurate, and the PCR method can accurately and quickly identified M. tuberculosis complex to subspecies.

Auxiliary diagnostic value of interferon-γ inducible protein 10 in tuberculous pleural effusions

REN Wei-cong, NIE Li-hui, JIANG Xiao-ying, LIU Yi，SUN Zhao-gang, ZHANG Xu-xia, TIAN Miao, CHENG Jun, ZHANG Jian-yuan, LI Chuan-you

Chinese Journal of Antituberculosis. 2013, 35(2):  108-110. 

Abstract ( 1727 )   PDF (852KB) ( 360 )   Save

References | Related Articles | Metrics

Objective  To study the diagnostic value of interferon-γ inducible protein 10 (IP-10) level in tuberculous pleural fluid.  Methods  Between October 2010 and October 2011,195 patients adimitted to Beijing Chest Hospital were recruited consecutively, 112 tuberculous pleural effusions and 83 malignant pleural effusions were measured the IP-10 level by enzyme-linked immunosorbent assay（ELISA）.  Results  The IP-10 levels were significantly higher in tuberculous pleural effusions compared with malignant pleural effusions, and their difference  was significant ［196 855（4518-1 512 550） pg/ml vs. 7432（173-97 881） pg/ml, U=575.00, P<0.001］. Using a cut off value of 10 964 pg/ml estimated from IP-10 receiver operating characteristic analysis, the sensitivity, specificity and efficiency of IP-10 were 82.14%（92/112）, 93.98% (78/83)and 87.18%(170/195),respectively. Conclusion  The IP-10 level in pleural effusion is significant for the early diagnosis and differential diagnosis.

Clinical value of percutaneous low-dose computed tomography-guided biopsy

TIAN Kui, SHA Jin-lu, YU Hui-shan

Chinese Journal of Antituberculosis. 2013, 35(2):  111-115. 

Abstract ( 1827 )   PDF (1044KB) ( 530 )   Save

References | Related Articles | Metrics

Objective  The purpose of this study was to evaluate the clinical value of pulmonary biopsy for lung occupying lesions  under low-dose computed tomography(CT)-guidance.  Methods  From January 1 2009  to December 31 2011, 200 consecutive patients with pulmonary occupying lesions prepared for lung biopsy were randomly assigned to either standard dose group or low-dose group that containing 100 patients in each group. Of these patients, 100 patients underwent percutaneous needle lung biopsy under low-dose CT guidance (30 mA, 3 mm reconstruction thickness), while the other 100 patients underwent standard CT-guided procedure (150 mA, 3 mm reconstruction thickness). Following steps of sterilization, puncture and biopsy, data from two groups were analyzed statistically including such parameters as radiation dose (CTDIw, DLP), score of image quality of pulmonary and mediastinal window (range from 1 to 4,＞2 as acceptance), successful puncture rate and histological result as well.  Results  The measured CTDIw (weighted CT dose index) was 1.48 mGy in low-dose CT lung biopsy group and 7.38 mGy in standard dose CT group; mean DLP (dose length product) was (11.52±1.72)mGy×cm and (67.25±4.69)mGy×cm, respectively, indicating significant difference between two groups（t=40.46, P<0.05）. However, acceptance rate in both groups was 100.0% with no significance (all patients’ score ＞2). Also, there was also no statistical difference on successful puncture rate (correction χ²value=0.00, P>0.05) in standard group (98.0%,98/100) compared to low-dose group (99.0%,99/100). In addition, accurate diagnosis rate and false diagnosis rate in malignancy were 82.8%(82/99), 13.7%(13/95) in low-dose group and 89.8%(88/98), 8.3%(8/96) in standard group, showing no differences (χ²_accuracy=2.02，χ²_false=1.39，P>0.05).   Conclusion  Percutaneous needle lung biopsy under low-dose CT-guidance which minimizes the radiation dose could provide high diagnostic accuracy for lung space occupying lesions, deserving to be applied comprehensively to clinical practice.

Multislice spiral CT imaging manifestations of pulmonary tuberculosis in children

ZHANG Xiao-ping，MA Hong-xia，GUO You-min

Chinese Journal of Antituberculosis. 2013, 35(2):  116-119. 

Abstract ( 2445 )   PDF (1158KB) ( 574 )   Save

References | Related Articles | Metrics

Objective  To explore imaging characteristics of plain and enhanced CT scan for pulmonary tuberculosis in children.  Methods  We analyzed retrospectively imaging data from 69 children patients with pulmonary tuberculosis hospitalized in Xinjiang Uygur Autonomous Region Chest Hospital from July 2008 to August 2011.All patients were confirmed diagnosis with clinical symptoms, TST result, CT imaging and clinical symptoms improved after antituberculous treatment.   Results  Different CT imaging were as follows：8 cases with primary pulmonary tuberculosis including 5 cases with primary syndrome and 3 cases with tuberculosis of intrathoracic lymph nodes. Primary syndrome was composed of primary tuberculosis focus, tuberculous lymphangitis and lymphadenitis. CT plain scan showed multiple lymphadenectasis in hilum of lung and mediastinal, axillary. Meanwhile, heterogeneous enhancement or lymph node center caseous necrosis zone without enhancement, edge ring enhancement features were showed in enhanced scan imaging. The miliary nodules in size, density, distribution were uniform in two lungs and the mediastinal lymph node was enlarged in 10 cases with hematogenous disseminated pulmonary tuberculosis. The imaging of infiltrative focus and caseous pneumonia presented scattered nodules and patchy shadow in two or more lobes in 43 cases. Caseous pneumonia or cavitation formation were based on the nodular, patchy, large patchy foci of tuberculosis. Eight cases with tuberculous pleurisy were presented with pleural effusion and pleural thickening.   Conclusion  Plain and enhanced CT have a certain value in the diagnosis of childhood pulmonary tuberculosis and in definition of lung lesions clearly various morphological, mild lesions, occult lesions, micro nodules and caseous pneumonia.It also provide strong basis for diagnosis.

Research on effective model of tuberculosis patients management

ZHOU Lin, XUE Xiao, WANG Fang, LIU Er-yong, CHENG Shi-ming, WANG Li-xia, WAN Li-ya

Chinese Journal of Antituberculosis. 2013, 35(2):  120-124. 

Abstract ( 1773 )   PDF (665KB) ( 757 )   Save

References | Related Articles | Metrics

Objective  To analyze the management strategies of tuberculosis (TB) patients in different countries, and to explore the effective management model.  Methods  Three databases (CHKD, Wanfang Data and PubMed), four websites of health institutions (WHO, USCDC, China MOH and CDC) and searching engine Google Scholar were applied with key words “tuberculosis, management, control, strategy, policy”.A total of 384 literatures were retrieved including both papers and policy documents, 25 papers were ultimately included in the analysis for the description or evaluation of TB management strategies according to the inclusion and exclusion criteria，of which 3 papers were related to TB legislation, 14 papers were related to the management of TB patients through Directly observed treatment(DOT) and 8 papers were related to public-private mix strategy and public-public mix strategy.  Results  Some countries such as Japan and Russia have developed special TB legislations to figure out the responsibility of government and major measures to control TB. The legislations were effective to control TB and the prevalence of TB decreased. There were 55 million TB patients received DOT during 1995 to 2011. DOT increased the cure rate (the cure rate of new pulmonary TB patients reached 96.8% and that of retreatment patients reached 91.1% in China), decreased the drug-resistant rate (which was decreased by 93% in USA) and improved the treatment completed rate of homeless with poor treatment compliance (which was 75.2% for DOT management group and 26.7% for self-management group in Spanish). In resource-limited region, family or community supervision can also achieve good effect. There were 15 countries implemented PPM-DOTS in 2009, which increased the registration rate (with 12% increased in India), the treatment successful rate (which exceeded 90% and the lost rate was lower than 1% in Nepal), the regular treatment rate (which reached 90% in China) and treatment compliance (which reached 98% in Bengal).  Conclusion  It is urgent to develop TB legislation, selecting suitable model of TB treatment management according to local situation and strengthening the public-public mix cooperation in order to control TB effectively and decrease the prevalence.

Study on the impact of rural pulmonary tuberculosis patient on household economy in Hunan province

FAN Jiang-jing, BAI Li-qiong, XIAO Shui-yuan,XU Hui-lan, CHEN You-fang, TANG Yi, WAN Yan-ping, TAN Zhen, XIAO Tao

Chinese Journal of Antituberculosis. 2013, 35(2):  125-129. 

Abstract ( 1551 )   PDF (654KB) ( 409 )   Save

References | Related Articles | Metrics

Objective  To analyze the impact of rural pulmonary tuberculosis (PTB) patient on their family economy in Hunan province，to build TB patients family economic burden index.  Methods  354 patients who registered consecutively as confirmed new active PTB in 6 sample county-level CDCs from Jul to Sep in 2005 were investigated. They were distributed in 354 families. In <30, 30-, 45- and 60- four age groups, there were respectively 78 cases,121 cases,89 cases and 66 cases. Under the premise of informed consent, each one was given an interview at the time of confirmed diagnosis and at the end of treatment by adopting self-designed tuberculosis socioeconomic questionnaire. Data related to the patients’ medical expenses after sick, and personal and family economic income, expenditure and other related information 1 year before and after the sick were collected.  Results  After illness, the total family income reduced 4.374 million in 354 patient families, averagely reduced 1235.6 Yuan (with a median of 625 Yuan). The proportion of patients whose annual income accounted more than half of family annual income reduced from 48.9%（173/354）to 27.1%(96/354) after illness. Compared with the total family income and expenditure, the deficit family increase to 69.5%（246/354） from 26.3%（93/354）after illness. The medical expenses of tuberculosis patients  accounted for (20.4±15.1)% of household expenditure; In <30, 30-, 45- and 60- four age groups, this proportion was (16.5±10.1)%, (17.9±12.4)%,(19.5±13.7)% and (30.6±21.2)% respectively. This proportion rises with the increasing in age group(H=26.788，P=0.0001). The medical expenses of tuberculosis accounted (89.6±18.9)% of household medical expenses, this proportion in 45- years old (84.9±24.6)% was lower than any other age groups （90.3±18.4)%, (90.5±15.9)% and (93.6±14.5)% respectively in <30、30-、60-years old group）（F=2.982，P=0.031. The average family economic burden index of TB patients is 0.33 years, and median burden index is 0.16 years（0.14-10.3 years）.  Conclusion  TB reduces the income of patients and their families. PTB not only led to the over expenditure in  70% PTB patient family, but also make some poor families become more impoverished.

Comparation and analysis of the tuberculosis mortality surveillance systems in China

CHEN Wei, HU Jia, CHENG Shi-ming

Chinese Journal of Antituberculosis. 2013, 35(2):  130-133. 

Abstract ( 1738 )   PDF (635KB) ( 424 )   Save

References | Related Articles | Metrics

Objective  To understand the characteristics of various surveillance systems in TB mortality evaluation and their pros and cons in TB mortality surveillance.   Methods  Using the descriptive method, three national disease surveillance systems including National Disease Surveillance Points System(DSPs), Disease Surveillance Information Management System(DSIMs), and Tuberculosis Management Information System(TBMIs) were compared and analyzed with the monioring purpose, covering population, data collecting, death judgement, ultilization of the data, and data quality control. Meantime, the TB mortality surveillance data in 2008 were compared between DSPs and TBMIs, and the TB death cases collected in two typical surveyed counties by DSPs and TBMIs were also compared.   Results  DSPs is a vital registration system with the purpose of death cause monitoring, and it is superior to other systems in TB mortality surveillance. The typical analysis showed that the number of TB deaths registered in DSPs, DSIMs and TBMIs in 2008 in Dongcheng district of Beijing were 9, 1, and 0 respectively, and 10, 2 and 2 respectively in Fuxin county of Liaoning. The registration number in DSPs were all higher than the other two systems.   Conclusion  The TB mortality data in DSPs could be used for analyze the characteristics and the trend of TB death.

Assessment of status of the human resources of county level TB dispensaries in Yichang city

LIU Xiao-jun,ZHANG Pei, CHENG Yun-fang, ZHOU Ping

Chinese Journal of Antituberculosis. 2013, 35(2):  134-137. 

Abstract ( 1588 )   PDF (632KB) ( 367 )   Save

References | Related Articles | Metrics

Objective  To investigate the status of human resources in county level TB dispensaries in order to assess its fairness in the demographic and geographic distribution, and provide a scientific basis for the rational allocation of human resources in county level TB dispensaries.  Methods  We designed a set of unified questionnaire, and issued to nine county level TB dispensaries. Information such as age, gender, education and title were collected, and Excel was used to set up the database and constitutions were calculated as the main evaluation indicators.  Results  There were a total of 57 TB staff at county level TB dispensaries in Yichang city with the male to female ratio of 1.59：1, the mean age was（45.51±2.67）years old. In terms of the average age, TB staff in plain and hilly areas was elder than mountainous area. Regarding the highest education level, undergraduate education accounted for 19.30%(11/57), tertiary education accounted for 31.58%(18/57), secondary education accounted for 43.86%(25/57), high school education accounted for 3.51%(2/57), and junior high school education accounted for 1.75%(1/57). As for the major of their education, staff specializing in public health accounted for 1.75%(1/57), the clinical medicine accounted for 56.14%(32/57), the radiology accounted for 8.77%(5/57), clinical test accounted for 10.53%(6/57), nursing accounted for 14.04%(8/57), and other non-medical major accounted for 8.77% (5/57). The proportion of staff with non-medical major in hilly areas was 12.50%（4/32）, higher than 4.00%（1/25） in plain areas. Ratio of senior to intermediate to junior titles was 1：6.8：3.4. Staff working in TB diagnosis and treatment position accounted for 38.60%(22/57). In plain and hilly areas, averagely one TB staff served a population of 75 500 people, and in mountainous areas, served 41 800 people per staff. The service population of plain and hilly areas was 1.81 times of that in mountainous areas.  Conclusion  The human resource in county level TB dispensaries are seriously scarce whether in quantity or in quality. It is urgent to strengthen the quantity and quality of TB staff in order to ensure the quality of TB control.

The effect analysis of global fund Mtb/HIV control project in Guangdong province

YIN Jian-jun, ZHONG Qiu, ZHOU Lin, LI Jian-wei, FANG Lan jun，WU Hui zhong

Chinese Journal of Antituberculosis. 2013, 35(2):  138-141. 

Abstract ( 1779 )   PDF (636KB) ( 438 )   Save

References | Related Articles | Metrics

Objective  To evaluate the effect of the Global Fund Mtb/HIV Control Project in Guangdong province in order to provide the basis for the development of relavant prevention and control measures.  Methods  We established the Mtb/HIV coordination mechanism and conducted HIV test for 2326 TB patients who registered in the 2 pilots from Jan 2011 to Jun 2012 and TB screening to HIV/AIDS patients for 8769 person-times. The data were collected from working report forms and supervision reports.  Results  During the implementation of Global Fund Mtb/HIV control project, 96.8%（2252/2326）TB patients were tested for HIV status, by which 12 Mtb/HIV cases were detected. Only 14.4%（1267/8769） TB screening questionnaires for HIV/AIDS cases were completed, by which 14 Mtb/HIV cases were detected. A total of 25 Mtb/HIV cases received anti-tuberculosis treatment，5 received anti-retroviral therapy.  Conclusion  The implementation of global fund project promoted the Mtb/HIV work in project areas, and provide useful reference for the extension of Mtb/HIV control in Guangdong.

Depression and social support status of multidrug-resistant tuberculosis patients

WANG A-mei，BAI Zhi-xian，LIU Jian-feng

Chinese Journal of Antituberculosis. 2013, 35(2):  142-145. 

Abstract ( 1440 )   PDF (646KB) ( 324 )   Save

References | Related Articles | Metrics

Objective  To investigate the depression and social support status of multidrug-resistant tuberculosis (MDR-TB) patients, and to explore the correlation between the two factors.   Methods  Ninety-four MDR-TB patients in case group and 94 people selected from the same area of MDR-TB patients’ household register in control group were investigated by Zung Self-Rating Depression Scale (SDS) and Social Support Rating Scale (SSRS). Ninety-six questionnaires were issued for MDR-TB patients and 94 valid were returned with the effective response rate of 97.9%. All these 94 patients were enrolled in case group. 718 questionnaires were issued for people selected from the same area of MDR-TB cases’ household register and 676 valid were returned with the effective response rate of 94.2%. Among these 676 people, 94 people were selected with the same gender and age (≤ 2 years’ difference) of cases (1∶1 matched pair). Bivariate correlation analysis, t-test and one-way analysis of variance were applied.   Results  The average SDS score of case group was (52.80±8.34), which was higher than the control group (41.81±10.26)(t=8.284, P<0.01), 45 patients were depressed; MDR-TB patients (35.65±5.47) received less support from the society than the control group (41.80±6.62)(t=6.457, P<0.01), the difference was statistically significant. The SDS score of MDR-TB patients was negatively correlated with the total score of social support (r=-0.520, P<0.01), which indicated the more social support the patients got, the less depressive symptoms they had.    Conclusion  Attention should be paid to the social support system and improvement of MDR-TB patients’ depression in order to improve the quality of their lives.