Table of Content

10 December 2013, Volume 35 Issue 12

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Analysis of the characteristics of national TB epidemic situation in schools from 2008 to 2012

CHEN Wei, CHEN Qiu-lan, XIA Yin-yin, CHENG Shi-ming

Chinese Journal of Antituberculosis. 2013, 35(12):  948-954. 

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Objective  To analyze the characteristics of TB in students.  Methods We collected the pulmonary TB(PTB) reporting data from the Infectious Diseases Reporting System(IDRS), and TB outbreak investigating report from Emergency Public Health Events Reporting System, analyzed the distribution of reported PTB in students and the characteristics of TB outbreak. The total number of students in mainland China were 240320175 in 2008, 238547238 in 2009, 237235870 in 2010, 235770400 in 2011 and 235770400 in 2012 respectively.  Results  A total of 39198 cases of PTB cases in students were reported in 2012 with the reported incidence of 16.63/100000, decreasing by 39.28% in comparison with 2008(65815 cases，27.39/100000). In terms of the reported cases by quarter, the highest was in the second quarter, accounting for 30.43%（12662/41608）-32.38%（21313/65815）of the whole year. The top five school TB incidence provinces were Tibet（79.95/100000，415/519042）,Qinghai(59.09/100000，607/1027309),Guizhou(36.54/100000，2956/8089905) and Chongqing (33.06/100000，1778/5377413),Xinjiang(26.08/100000,1082/4147979). Students PTB in 2012 accounted for 4.12% （39198/951508）in the whole patients, highest in 15-20 years group（54.12%，21215/39198）. From January 2009 to June 2013, a total of 21 cases of TB outbreak nationwide were reported in schools, 14 cases (66.67%) happened in senior high school with an average of 25 patients in each case.   Conclusion  From 2008 to 2012, the TB epidemic in schools had a declining trend by year, the reported incidence peaked in the second quarter and relatively high in the western provinces. The majority of TB cases were around 15-20 years old. The TB epidemic in schools in recent years revealed that some problems existed in TB control in schools, and we need to further strengthen TB control in schools.

Case finding of multidrug-resistant tuberculosis through PPM-DOTS in 4 sites in China

LV Cheng-fei, SUN Qiang, WANG Li-xia, CHEN Ming-ting, LI Ren-zhong, RUAN Yun-zhou, ZHAO Jin, CHEN Cheng, SU Wei

Chinese Journal of Antituberculosis. 2013, 35(12):  955-959. 

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Objective  To analyze the effect of PPM-DOTS(public TB control institution-public hospital mix for DOTS, PPM-DOTS) in case finding of multidrug-resistant tuberculosis (MDR-TB) cases and to explore the suitable strategy for MDR-TB case finding. Methods  The routine records for screening suspected MDR-TB patients in 2011 to 2012 were collected. Screening rate, detection rate and diagnosis time were used to evaluate the effect of PPM-DOTS in MDR-TB case finding. There were 2365 suspected MDR-TB cases detected in four program cities: 774 in Kaifeng, 761 in Lianyungang, 700 in Yongchuan district, Chongqing and 581 in Hohhot; the number for smear positive MDR-TB patients who came from CDC with complete dignosis time was 1608. Kruskal-Wallis H  was used to compare the case detection situation in different sites, 0.05 was set as the significance level. Results  The overall screening rate in the four sites was 83.98%(2365/2816). The detection rate with rapid test was 6.22%(147/2365). Generally, the medians of diagnosis time, time for sputum transportation, rapid test and information feed-back were 7 d, 2 d, 5 d and 0 d, respectively in four sites. The medians of dignosis time in Kaifeng, Lianyungang, Yongchuan district and Hohhot were 6 d, 7 d, 9 d and 14 d（H=275.19, P<0.001）. The medians of time for sputum transportation were 1 d, 2 d, 2 d and 2 d（H=104.92, P<0.001）, the medians of time for rapid test were 5 d, 4 d, 5 d and 6 d（H=8.19，P=0.042）, and the medians of the time for information feed-back were 0 d, 0 d, 0 d and 5 d（H=580.32, P<0.001）.   Conclusion  The screening rate and detection rate were in good levels, and the MDR-TB patients can be found in time. It is feasible and effective to identify MDR-TB cases by rapid diagnostic method to screen smear positive TB patients in PPM-DOTS settings, and this detection model is worthy learning and expanding.

Analysis of tuberculosis epidemiological survey conducted in 2010—2011 in Xinjiang Uygur autonomous region

YANG Jin-ming, Jie’ensi·SIMAHULE, TAI Xin-rong, LI Yue-hua, ZHAO Zhen

Chinese Journal of Antituberculosis. 2013, 35(12):  960-964. 

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Objective  To understand the tuberculosis (TB) epidemic situation, to evaluate the implementation of Xinjiang TB control programme, and to develop scientific TB control programme.  Methods  According to the implementation regulation of 5th national TB epidemiology survey, totally 22 TB epidemiology survey points (survey point) were selected by stratified cluster sampling method. Of the 22 survey points, 6 located in urban area, 7 in town and 9 in rural area. The ratio of sample population to the whole population in Xinjiang was 1∶417. Overall 52 361 people were selected, among which 31 081 should be investigated and 29 834 were actually investigated, the investigation rate was 95.99% which met the requirement of epidemiology survey.  Results  The standardized pre-valence rate of active pulmonary tuberculosis (PTB) in the population above 15 years of age was 1526.12/100 000, standardized prevalence rate of smear positive PTB was 196.41/100 000, and 433.44/100 000 for bacteriologically positive. The prevalence in male (1673.72/100 000) was significantly higher than female (1372.70/100 000) (χ²=15.89, P<0.001). The standardized prevalence rate was 1817.32/100 000 in village area 1727.62/100 000 in town and 600.80/100 000 in urban area, and that in village area was much higher than urban area (χ²=32.77, P<0.001). The standardized prevalence rate was 1919.77/100 000 in southern Xinjiang, 1043.24/100 000 in northern Xinjiang and 720.90/100 000 in eastern Xinjiang, and that in southern Xinjiang was significantly higher than that in northern and eastern Xinjiang (χ²=41.56 and 35.93, both P<0.001). The standardized prevalence rate was 1964.26/100 000 in Uygur nationality and 1244.11/100 000 in other minority nationalities and 612.38/100 000 in Han nationality, that in Uygur was significantly higher than the other two (χ²=29.64 and 83.29, both P<0.001). The overall public awareness rate of TB was only 47.60%（70 998/149 170）.   Conclusion  The epidemic of TB is still serious in Xinjiang. The epidemic is higher in rural area than urban area, and is also higher in Uygur nationality than other minority and Han nationality, and the public awareness on TB needs to be improved.

Analysis of sputum conversion after two months treatment in retreated smear-positive pulmonary tuberculosis patients

LIANG Bing, HE Qing-qiu, HUANG Rui-xia, WU Hong, OU YANG Cai-hong, HE Li-yan, PENG Feng-ling, LIN Yin

Chinese Journal of Antituberculosis. 2013, 35(12):  965-968. 

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Objective  To investigate the situation of the sputum conversion after two months treatment of retreated smear-positive pulmonary tuberculosis patients registered in 2011—2012, and to explore the influencing factor and their effects on treatment outcome. Methods  Acid-fast staining and microscopic examination were performed twice on 131 retreated smear positive tuberculosis patients registered in the Second Outpatient Department of Guangzhou Thoracic Hospital. Absolute concentration method was used on the culture positive samples for drug resistance test and related factors on sputum conversion were also investigated.  Results  Among the 131 retreated patients, 91 showed sputum conversion, and 27 showed non-conversion after 2 months of treatment (sputum examinations were not performed on 13 of the patients due to their unavailability of the patients). There were 15, 6, and 6 patients showed sputum conversion after 3 months, 4 months, and 5 months treatment respectively. After analyzing 5 variable factors, we found that the main reasons for non-conversion after 2 months treatment in retreatment smear-positive pulmonary tuberculosis were poly resistance (5.3%，3/57) for patients with sputum conversion and 10.0% (2/20) for non-conversion patients) (χ²=4.457, P<0.05) or multidrug-resistance (28.1%，16/57) for patients with sputum conversion and 70.0% (14/20) for non-conversion patients) (χ²=5.456, P<0.05), or with diabetes mellitus (12.1%，11/91) for patients with sputum conversion and 25.9% (7/27) for non-conversion patients) (χ²=3.973, P<0.05). Conclusion sputum non-conversion after 2 months treatment is found to be closely related to drug resistance or with diabetes mellitus.

Analysis of drug susceptibility profiles of Mycobacterium tuberculosis in Lianyungang of Jiangsu province

WANG Qian，SHI Jin-yan，MENG Er-wang，SONG Hong-huan，SHAO Yan，YANG Dan-dan，LU Wei，QU Yan

Chinese Journal of Antituberculosis. 2013, 35(12):  969-972. 

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Objective  To investigate the prevalence of drug-resistant tuberculosis (TB) in Lianyungang and provide the evidence for strategy development of TB control and prevention.  Methods  Five hundred and twenty-two smear positive pulmonary TB patients registered from January to September 2011 in the counties were consecutively enrolled, among whom 396 new cases and 126 re-treat cases. Solid culture method was used for sputum culture. The proportion method was used to detect the drug susceptibility of Mycobacterium tuberculosis (M. tuberculosis).  Results  Out of 479 isolates in the present study, there were 151 (31.5%) strains resistant to any anti-tuberculous drug. The drug resistant rates to any anti-TB drug among new and re-treated cases were 20.9% (76/363) and 64.7% (75/116), respectively, and the difference between the two groups was significant (χ²=77.84, P<0.001). In addition, the drug resistant rates to single drug were similar among new (11.6%，42/363) and re-treated cases (11.2%,13/116) （χ²=0.011，P=1.000）, while there were more strains resistant to two drugs (18.1%, 21/116), three drugs(17.2%, 20/116) and more than three drugs(18.1%, 21/116) in the re-treated group than new group (χ²=28.11，41.61，24.69；all P<0.001).  Conclusion  The epidemic situation of smear-positive pulmonary tuberculosis patients with drug resistance is serious, and re-treated patients are the main population with drug resistance.

Analysis of tuberculosis control in Qingshan district of Wuhan city from 2005 to 2012

SU Ya-wen, ZHONG Hong-hui

Chinese Journal of Antituberculosis. 2013, 35(12):  973-978. 

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Objective  To investigate the tuberculosis control situation in Qingshan district of Wuhan city from 2005 to 2012 in order to provide evidence for the implementation of 5 years TB program between 2011 and 2015. Methods  Data was collected through the quarterly and annual TB report and the National TB Information System between 2005 and 2010. χ² test is used for rates comparison. Results  A total of 2848 cases of active pulmonary tuberculosis (APTB) were registered between 2005 and 2012, among which 2100 male and 748 female cases. In terms of the number of APTB, new smear-positive PTB, retreatment smear-positive PTB and smear-negative PTB, male cases were 2.8 (2100/748), 3.3 (949/289), 5.3 (159/30) and 2.3 (992/429) times of the female cases. Over 65 years old elderly patients accounted for the largest proportion in both new and retreatment smear positive patients, 263 and 52 cases respectively. Ranking the number of cases in each age group, the first three group were 65- years (52 cases), 45- years (49 cases) and 55- years (33 cases) for retreatment smear positive cases, while 25- years (268 cases), 15- years (259 cases), 35- years (242 cases) were the top three age groups for smear-negative cases. As for the occupational distribution, the retirees were highest up to 711 cases, followed by workers of 647 cases and the housekeeper of 489 cases. The annual average registration rates were 78.6/100 000 for active PTB, 34.2/100 000 for new smear positive PTB, 5.2/100 000 for retreatment PTB and 39.2/100 000 for smear-negative PTB. In total, 962 smear-positive patients were clinically cured between 2005 and 2010 with the cure rates up to more than 90% after 2008. 1073 PTB patients were detected by passive identification. The proportion of active PTB and smear positive PTB detected by passive identification decreased from 41.0% (133/324) and 52.6% (70/133）in 2005 to 11.9%（40/336） and 47.5%（19/40） in 2012, respectively. A total of 1477 cases of active PTB and 722 cases of smear positive PTB were detected by non-TB institutions. Conclusion  More TB patients were male and the elderly retirees in Qingshan district. The TB registration rate is not high. The proportion of patients detected by passive identification has declined.

Analysis on the health education for TB cases of floating population in Guangzhou city

GAO Yan-bo, GAO Cui-nan, XU Zhuo-wei, LIAN Yong’e, SHU Yang, ZHOU Lin

Chinese Journal of Antituberculosis. 2013, 35(12):  979-982. 

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Objective  To understand the health education for TB cases of floating population in Guangzhou city, and provide scientific basis for the development of relative strategies. Methods A total of 1002 TB cases were surveyed by questionnaire and received 972 valid questionnaires. We analyzed the length of time TB cases living in Guangzhou, and TB knowledge they have received and ways of TB message dissemination.  Results  The length of time staying in Guangzhou and the health education are closely related. For TB cases living than 2 years have more chance to get TB knowledge health education than the TB cases living between 3 months to 2 years and there was significant difference between 2 groups (99.3%(685/690),92.7%(101/109), χ²=25.73,P<0.01). For patients living between 3 months to 2 years have more chances than those living less than 3 months and there was significant difference between 2 groups (92.7%(101/109)，56.6%（98/173）, χ²=41.76,P<0.01). The study showed only a few TB cases knew the free TB treatment policy. The proportion（70.5%，623/884） lowered than the proportion of patients who have received TB basic knowledge（100.0%，884/884）, TB prevention and control know-ledge（99.8%，882/884）and TB treatment knowledge（98.8%，873/884）29.5%, 29.3% and 28.3% respectively. 53.8%（476/884） TB cases received the TB health education from the doctors and 12.1%（107/884） cases knew TB knowledge by health education materials. The radio and television programs, wall advertising, school education, picture poster and others were 10.9%(96/884), 8.0%(71/884), 6.2%(55/884), 5.1%(45/884) and 3.8%(34/884) respectively. Conclusion  We should pay attention to the health education methods and health education effects for TB patients in floating population. Especially we should focus on patients staying short, and provide more health education for the free policies in order to achieve good effects.

Pharmacokinetics comparison of pyrazinamide once and three times daily in mice and its influence on isoniazid-rifampicin

ZHU Hui, WANG Bin, FU Lei, LIU Cheng-cheng, LU Yu

Chinese Journal of Antituberculosis. 2013, 35(12):  983-987. 

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Objective  To standardize and rationalize the pyrazinamide (PZA) treatments, pharmacokinetic methods were used to evaluate once-daily and thrice-daily regimens in mice. Methods  One hundred and fifty BALB/c mice (18±2 g, 6 weeks) were divided into 5 groups, 30 mice in each group. Group 1 and 2 treated with PZA, once-daily and 3 times/day separately, group 3 treated with isoniazid (INH) and rifampicin (RFP), group 4 and 5 treated with INH-RFP and once-daily or 3 times/day PZA. Blood samples were collected from 3 mice of each group at different time point after the seventh dose and pooled separately. Serum INH, RFP and PZA levels were determined by HPLC-MS/MS methods. Pharmacokinetic parameters (AUC, C_max, T_max and T_1/2) were calculated.  Results  Without INH-RFP, C_max and AUC_{0~8 h} of PZA in once-daily regimen were（155.3±5.1）μg/ml and 269.5 mg·h/L separately, at least 3.5 folds than in 3 times/day group (C_max （43.2±2.6）μg/ml, AUC_{0~8 h} 70.9 mg·h/L, t=27.71，P<0.01). When combined with INH-RFP, C_max (151.8±17.3)μg/ml and AUC_{0~8 h} (383.1 mg·h/L) of PZA in once-daily group is much higher than thrice-daily regimen group (C_max（45.1±1.0）μg/ml, AUC_{0~8 h} 81.0 mg·h/L, t=8.718，P<0.05). Also, PZA antagonized INH in thrice-daily regimen when combined with INH-RFP, accompanied by decreased C_max (from（6.1±0.9）μg/ml to（0.05±0.001）μg/ml) and AUC_{0~8 h} (from 6.6 mg·h/L to 0.2 mg·h/L) of INH.  Conclusion  In mice, pharmacokinetic parameters once-daily regimen for PZA is better than 3 times/day regimen, especially in concomitant treatment with INH-RFP.

A preliminary study of clinical specimens pretreated by magnetic nanoparticle in mycobacteria culture

WANG Xiang-dong, SHAO Ji-bao, SHI Xu-dong

Chinese Journal of Antituberculosis. 2013, 35(12):  988-991. 

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Objective  In the course of culture, adopting a way of using magnetic nanoparticle to concentrate mycobacteria, and evaluated its feasibility. Methods  Ninety-four clinical specimens from outpatients and inpatients with pulmonary tuberculosis were collected during December 2012 to March 2013 in Nanjing Chest Hospital and were concentrated by PEG600 magnetic nanoparticle self-made or centrifugation (3000×g, 20 min), and inoculated. After incubating, we compared their results of positive rate, contamination rate and average culture time with the way of direct inoculation. For count data, the chi-square test was used for statistical analysis. Kolmogorov-Smirnov normality test was performed, and data non-normally distributed was analyzed by using the Wilcoxon rank sum test, P<0.05 was considered statistically significant. Results  The positive rates of direct, centrifugal, bead enrichment method were 29.79%(28/94), 43.62%(41/94) and 41.49%(39/94) respectively; Contamination rates were 2.91%(3/103), 4.85%(5/103) and 3.88%(4/103) respectively; Average culture time(day)［Median(upper and lower quartile)］ were 28(21，40), 21(21，35), 21(21，35), respectively. The positive rates of bead enrichment and centrifugal method were statistically higher than simple method, their values ofχ² were 9.09, 11.08 respectively, both P<0.01. The average culture times of bead enrichment and centrifugal method were statistically shorten than simple method, their values of Z were －3.983 and －3.980 respectively, both P<0.01. There did not show significantly difference between centrifugal and bead enrichment method about their positive rates and average culture times(about positive rate：χ²＝0.25，P=0.62；about average culture times：Z=－0.557，P=0.577). Conclusion  The bead enrichment method had a higher positive rate and a shorten average culture time than simple method, and had the similar results gotten from the centrifugal method, little contamination to environment and easy batch processing; therefore had good prospects for clinical application.

The value of T-SPOT.TB assay in the diagnosis of tuberculosis

WANG Li-hong, FU Xiu-hua, ZHANG Gui-zhi, LI Guo-hua, GU Yan, GAO Jun-zhen

Chinese Journal of Antituberculosis. 2013, 35(12):  992-996. 

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Objective  To evaluate the value of T-SPOT.TB assay in the diagnosis of tuberculosis (TB). Methods  Five hundred and eighty-seven cases of hospitalized patients (128 TB cases including 103 cases with active TB and 25 cases with old TB; 459 non-TB cases including 241 cases with immune impairment and 218 cases without immune damage) from 2011 July to 2012 April in Affiliated Hospital of Inner Mongolia Medical University were analyzed retrospectively in their age, gender, course of disease, clinical manifestations, the results of T-SPOT.TB assay, pathological examination, purified protein derivative (PPD) skin test, acid-fast bacilli smear and anti-TB antibody. The data were analyzed with software SPSS 16.0. The measurement data were compared with Wilcoxon rank test, and the count data were analyzed using chi square test. P<0.05 was considered as significant difference.  Results  Of 187 T-SPOT.TB-positive cases, 106 cases were diagnosed as TB, the positive predictive value was 56.68% (106/187). Of 400 T-SPOT.TB-negative cases, 378 cases were diagnosed as non-TB diseases, the negative predictive value was 94.50% (378/400). Of 587 cases, 128 cases were diagnosed as TB, the sensitivity of T-SPOT.TB assay was 82.81% (106/128), which was higher than that of PPD (35.71%, 30/84), acid-fast bacilli smear (8.74%, 9/103) and anti-TB antibody (14.06%, 9/64). The sensitivities of T-SPOT.TB in active TB and old TB were 93.20% (96/103) and 40.00% (10/25), respectively. Of 459 cases with non-TB diseases, the specificities of T-SPOT.TB in immune impairment group and non immune damage group were 71.37% (172/241) and 94.50% (206/218). The sensitivity of T-SPOT.TB in tuberculous pleurisy and peritonitis was 100.00% (37/37). The median count of T cell spots in active TB and old TB were 502/10⁶ PBMCs and 430/10⁶ PBMCs, respectively, four quartile range (P₂₅, P₇₅) were 217/10⁶ PBMCs, 1287/10⁶ PBMCs and 140/10⁶ PBMCs, 1303/10⁶ PBMCs, respectively. There were no significant difference between the 2 groups using the Wilcoxon rank test (U=429.5, P=0.585). The median count of T cell spots in pulmonary TB and extrapulmonary TB were 456/10⁶ PBMCs and 528/10⁶ PBMCs, respectively, four quartile range (P₂₅, P₇₅) were 264/10⁶ PBMCs, 950/10⁶ PBMCs and 186/10⁶ PBMCs, 1244/10⁶ PBMCs, respectively. There were no significant difference between the 2 groups (U=1083.0, P=0.871).  Conclusion  T-SPOT.TB assay has higher specificity in the low-risk population, while lower specifi-city in the high-risk population with latent tuberculosis infection, higher sensitivity in the patients with tuberculous effusion of serous cavity compared with PPD, acid-fast bacilli smear and antibody. But it cannot identify active TB with inactive TB.

Optimization of culture for THP-1 derived macrophages induced by PMA and establishment of autophagy model

CHEN Liang，SUN Yi-fan，CHEN Tao，LI Hai-cheng，JIANG Zhen-you，ZHOU Lin，ZHONG Qiu

Chinese Journal of Antituberculosis. 2013, 35(12):  997-1002. 

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Objective  To optimized the conditions of PMA to stimulate THP-1 cell differentiation in order to establish a cell model of autophagy, which provides a scientific basis for the researches related to cell autophagy.  Methods  THP-1 cells differentiated into macrophages induced by PMA.Fusion protein pcDNA3.1-YFP-LC3 plasmid was transferred into THP-1 cell, and YFP(Yellow fluorescent protein) can trace the formation of autophagosome. Morphological changes of differentiated cells were photographed by inverted microscope respectively at diffe-rent PMA concentrations（0，10，20，50，100，200 ng/ml） and different times（0，24，48，60 h）. LC3 protein was traced by fluorescence microscopy in different conditions. The mRNA expression levels of autophagy-related genes were detected by RT-qPCR（reverse transcription-quantitative polymerase chain reaction ）. SPSS 17.0 was used to do statistical analyze, the relative amount 2^-ΔΔCt of mRNA was showed as “x±s”, and the difference between gene expression was analyzed by Ct value. Paired t-test (P＜0.5) was used to analyse the expression of mRNA induced by EBSS(earle’s balanced salts solution). Results  When the PMA concentration was 100 ng/ml and the induction time was 24-48 h, the state of THP-1 derived cells reached best condition. After deal with EBSS medium, the formulation of YFP-LC3 autophagy in THP-1 derived cells was enhanced, and the expression levels of autophagy-rela-ted genes LC3、Atg5、Atg7、Beclin1 were increased at the same time, which indicated that autophagy cell model was successfully constructed (2^-ΔΔCt value were 1.35±0.16,1.18±0.39,1.44±0.12,1.08±0.09，while t value were 4.00,2.90,5.16,3.57，P＜0.05). Conclusion  The optimization culture conditions were 100 ng/ml PMA and 24-48 h induced time. Based on this condition, an ideal autophagy model was established, which providing a solid scientific foundation for autophagy-related research.

Evaluation on effectiveness of manual MGIT system for detection of Mycobacterium tuberculosis in the primary tuberculosis laboratories

SUN Ling-li，ZHAO Ping，ZHANG Jian-hua，GUO Jiao，WANG Su-min

Chinese Journal of Antituberculosis. 2013, 35(12):  1003-1006. 

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Objective  To evaluate the effectiveness of manual mycobacteria growth indicator tube (M-MGIT) system for rapid detection of Mycobacterium tuberculosis. Methods  Five hundred and twenty-six sputa of newly diagnosed tuberculosis patients were collected from January 2012 to February 2013 in the tuberculosis clinic of Chaoyang District Center for Disease Control and Prevention. All the sputa were cultured by Lowenstein-Jensen (L-J) medium, M-MGIT system and automated BACTEC MGIT 960 (A-MGIT) system. Theχ² test and t test were used to analyze statistically the result, and if P<0.05, the results had the significant difference.  Results  Of the 526 sputa specimens, 261 (49.6%) were isolated as Mycobacterium tuberculosis strains. The positive culture rates of the M-MGIT, A-MGIT and L-J method were 48.7% (256/526), 49.0％(258/526) and 41.3% (217/526) respectively. The culture positive rates of M-MGIT and A-MGIT both were significantly higher than that of L-J method (χ²_{M-MGIT and L-J}=5.84，χ²_{A-MGIT and L-J}=6.45, both P<0.05), but the difference between M-MGIT and A-MGIT was not significant (χ²_{M-MGIT and A-MGIT}=0.02, P>0.05). The mean times of detection with M-MGIT system, A-MGIT system and L-J method were 13 (13±6) days, 12 (12±6) days and 24 (24±9) days，respectively. Comparing the mean detection times of M-MGIT with L-J method and A-MGIT with L-J method，both differences were statistically significant (t_{M-MGIT and L-J}=15.84，t_{A-MGIT and L-J}=18.32，P<0.05). Comparing the mean detection time of M-MGIT system with A-MGIT system, the difference had not statistical significance (t=1.89, P>0.05). The rates of contamination were 4.6% (24/526) with the M-MGIT system, 4.9% (26/526) with A-MGIT system and 4.1% (43/1052) with L-J medium, the difference was not statistically significant (χ²=0.64，P>0.05).  Conclusion  M-MGIT system is a rapid detection method of Mycobacterium tuberculosis with a higher positive detection rate, do not need expensive equipment, is suitable for the routine diagnosis in the primary tuberculosis laboratories.

Study on the influencing factors of whole blood gamma release assay in the patients with pulmonary tuberculosis

YANG Xin-ting, YANG Yang, DU Feng-jiao, BU Jian-ling, LIANG Qing-tao, LI Qi, CHEN Xiao-you

Chinese Journal of Antituberculosis. 2013, 35(12):  1007-1012. 

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Objective  To evaluate the clinical influencing factors on the whole blood gamma release assay in the patients with pulmonary tuberculosis.  Methods  One hundred and six clinical diagnosed tuberculosis patients who included 44 smear- or culture-positive cases，47 smear- or culture-negative cases and 15 cases with non-active pulmonary tuberculosis and 35 healthy controls were enrolled in this study. The heparinized bloods from all participants were incubated with purified protein derivative (PPD) and M. tuberculosis-specific antigens early secretory antigen target 6 (ESAT-6) and ESAT-6/CFP-10 fusion protein encoded in the mycobacterial genomic region of difference (RD1). The production of interferon γ (IFN-γ) was detected with ELISA.  Results  There were no significant difference between smear-positive group and smear-negative group in the IFN-γ median stimulated by ESAT-6 (114.7 pg/ml vs 82 pg/ml, Z=－0.500, P>0.05), ESAT-6/CFP-10 (3488 pg/ml vs 2350 pg/ml, Z=－0.949, P>0.05) and PPD (4514 pg/ml vs 4326 pg/ml, Z=－0.822, P>0.05). The IFN-γ median stimulated by ESAT-6 (82 pg/ml vs 137 pg/ml, Z=－0.781, P>0.05) and ESAT-6/CFP-10 (2350 pg/ml vs 1784 pg/ml, Z=－1.685, P>0.05) had not significant difference between the smear-negtive pulmonary tuberculosis group and non-active pulmonary tuberculosis group. However, there were statistic difference between smear-positive pulmonary tuberculosis group and non-active pulmonary tuberculosis group in the IFN-γ median stimulated by ESAT-6/CFP-10（3488 pg/ml vs 1784 pg/ml, Z=－0.242, P<0.05). The patients with less than 4 segments of lesions on the X-ray had higher IFN-γ median than those with more than 4 segments of lesions ［ESAT-6 (117 pg/ml vs 42 pg/ml, Z=－2.341, P<0.05), ESAT-6/CFP-10 (3055 pg/ml vs 1562.5 pg/ml, Z=－2.850, P<0.05)］. There were also significant difference between the patients with higher peripheral blood lymphocyte count (≥1.0×10⁹/L) and those with lower peripheral blood lymphocyte count (<1.0×10⁹/L) in the IFN-γ median ［ESAT-6 (97.5 pg/ml vs 48 pg/ml, Z=－2.745, P<0.05), ESAT-6/CFP-10（3082 pg/ml vs 1190 pg/ml, Z=－2.911, P<0.05），PPD（4322 pg/ml vs 3200 pg/ml, Z=－2.216, P<0.05）］.  Conclusion The production of IFN-γ stimulated by M. tuberculosis-specific antigens was not influenced by the load of bacilli, and probably influenced by accumulated lesion in X-ray and peripheral blood lymphocyte count.

Clinical and radiological features of 38 pediatric AIDS complicated with pulmonary tuberculosis

LU Yi-bo, SONG Shu-lin, QIN Chun-le, LI Zhi-li, TENG Yi-bin, WEI Zhen-min

Chinese Journal of Antituberculosis. 2013, 35(12):  1013-1019. 

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Objective  To explore characteristics of clinical and imaging manifestations of children with AIDS complicated with pulmonary tuberculosis.  Methods  The retrospective analysis of clinical data and imaging manifestations of 38 children with AIDS complicated with confirmed pulmonary tuberculosis was conducted.  Results  All of the 38 children suffered from the disease through mother-to-child transmission (MTCT) (100.00%,38/38), with clinical manifestations of growth retardation and malnutrition with different degrees usually accompanied by fever(23), cough(22), dyspnea(9), diarrhea(8), skin rash(6), emesis(4), headache and somnolence(3) etc. Moreover, there were 7 cases of AIDS complicated with penicillium marneffei (PM) (18.42%,7/38) and 5 cases of AIDS complicated with pneumocystis carinii pneumonia (13.16%,5/38). Imaging manifestations were as follows: there were 25 children with lesions located in two lung fields (65.79%,25/38), 6 children with lesions in dorsal segment of upper lobe and (or) lower lobe (15.79%,6/38), 1 child with lesions in right middle lobe (2.63%,1/38), 2 children with lesions in basal segment of lower lobe lung (5.26%,2/38) and 4 children with lesions in basal segment of lower lobe of bilateral lung (10.53%,4/38). The morphological features were mainly displayed as follows: 22 cases of patch (57.89%,22/38) and 6 cases of large patch (15.79%,6/38), 4 cases of ground glass opacity (10.53%,4/38), 5 cases of nodule (13.16%,5/38), 1 case of streak form (2.63%,1/38), 2 cases complicated with cavity formation (5.26%,2/38), 25 cases of intrathoracic and extrathoracic lymphadenectasis (65.79%,25/38), 7 cases of little pleural effusion (18.42%,7/38), 2 cases of little pericardial effusion (5.26%,2/38). In the follow-up, 27 children took a change for the better (71.05%,27/38), where 3 children once suffered from immune reconstitution inflammatory syndrome (IRIS), 5 children were not healed (13.16%,5/38), 6 children were died (15.79%,6/38).  Conclusion  Clinical manifestations of children with AIDS complicated with pulmonary tuberculosis are diversified without specificity. Imaging examination has a value in diagnosing this disease and clearly indicating the distribution and patterns of intrapulmonary lesions, intrathoracic lymphadenectasis and pleural effusion etc. And might provide an important basis for the clinical diagnosis.

Recent effect of interventional bronchoscopic treatment for tracheobronchial tuberculosis

CUI Jia, XU Jian-hua, LIU Fu-sheng, CHEN Li-gong

Chinese Journal of Antituberculosis. 2013, 35(12):  1020-1024. 

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Objective  To retrospectively analyze the clinical effect of interventional bronchoscopy for tracheobronchial tuberculosis.  Methods  From January 2010 to September 2012, sixty-seven patients in our hospital with initial tracheobronchial tuberculosis were enrolled. Thirty-four patients receiving interventional bronchoscopy and chemotherapy of tuberculosis(3HRZE/9HRE) were included in the treated group. Nineteen patients in the treated group received cryotherapy treatment only. Other fifteen patients in treated group received balloon dilatation after cryotherapy treatment. Thirty-three patients receiving chemotherapy of tuberculosis(3HRZE/9HRE) only were included in the control group. Both groups were treated with isoniazide aerosol inhalation. For these patients receiving 6 months treatment, we analyzed the sputum negative rates, the improvement rate of X-ray manifestations and the improvement rate of lesions founded by bronchoscopy. T-test and chi-square test were used for statistics.  Results  After 6 months, the treated group showed the sputum negative conversion rates was 89.7%（26/29）.It was higher than the control group(65.4%,17/26).There was statistical difference between the two groups （χ²=4.734, P=0.030). The treated group showed the improvement rate of X-ray manifestations was 85.3%（29/34）. It was higher than the control group(57.6%，19/33). There was statistical difference between the two groups （χ²=6.333,P=0.012). The treated group showed the improvement rate of lesions founded by bronchoscopy was 73.5%（25/34）.It was higher than the control group(48.5%,16/33).There was statistical difference between the two groups (χ²=4.423, P=0.035). The recovery rate receiving both cryotherapy and ballon dilatation was 93.3%(14/15). It was higher than that of only receiving cryotherapy by bronchoscopy (57.9%,11/19). There was statistical difference between the two groups (P=0.047).  Conclusion  This study suggests chemotherapy treatment combined with interventional bronchoscopy is superior to single chemotherapy treatment for granulation hyperplastic and ulcerative necrotizing bronchial tuberculosis, cryotherapy treatment by bronchoscopy combined with balloon dilatation is superior to single cryotherapy treatment.

Diagnosis and treatment of female mass with pelvic tuberculosis

SU Li

Chinese Journal of Antituberculosis. 2013, 35(12):  1025-1028. 

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Pelvic tuberculous mass is a clinically common gynecologic diseases, which is often to confound with other’s pelvic mass and tumor and easy to be misdiagnosed and missed diagnosed. To improve the diagnostic accuracy of female mass with pelvic tuberculosis, the patients’ history, symptoms and signs should be analyzed comprehensively. At the same time, we should perfect associated examinations, including tuberculin test, etiological examination, diagnostic curettage,cancer antigen 125, seroperitoneum and imaging examination. Tuberculosis immunological diagnosis and molecular biology detection provide fast examination technology for extrapulmonary tuberculosis. Laparoscope or exploratory laparotomy is necessary to patients who hard to make definite diagnosis. It is better to distinguish this disease from pelvic inflammatory disease, ovarian endometriotic cyst, benign and malignant ovarian tumors, especially from ovarian cancer, and it should be distinguished from abdominal tumor and febrile di-sease. The treatment of pelvic tuberculosis is totally based on chemical drug therapy. To highly suspected of genital tuberculosis, we can do diagnostic treatment. Surgical treatment can be used if necessary. When patients with severe tubercular toxic symptom, glucocorticoid adjunctive therapy should be used.