Table of Content

10 August 2014, Volume 36 Issue 8

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Chinese Journal of Antituberculosis 80 years of glorious history and prospects

Chinese Journal of Antituberculosis. 2014, 36(8):  617-629.  doi:10.3969/j.issn.1000-6621.2014.08.001

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Development and prospect of tuberculosis control strategy in China

WANG Li-xia， JIANG Shi-wen

Chinese Journal of Antituberculosis. 2014, 36(8):  630-633.  doi:10.3969/j.issn.1000-6621.2014.08.002

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This paper introduces the development process of global tuberculosis control strategy and the framework of new tuberculosis control strategy, it presents the development history of tuberculosis control strategy in China and its grant achievements. The current issues and challenges of tuberculosis control strategy in China is explored and the development direction is put forward as well.

The past, present and future of study in the chemotherapy of drug-resistant tuberculosis

XIAO He-ping, FANG Yong, FAN Lin, LIU Yi-dian

Chinese Journal of Antituberculosis. 2014, 36(8):  634-637.  doi:10.3969/j.issn.1000-6621.2014.08.003

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The prevalence of drug-resistant tuberculosis (TB) is one of the main challenges on current TB control which seriously influences the achievement people had made in this field. Anti-TB drugs are the most effective weapons in controlling TB, however, they have been obviously not enough to deal with multidrug-resistant TB, especially extensively drug-resistant TB, TB is more likely to become the incurable disease again because of this reason. Therefore, it is urgent to develop more effective anti-TB drugs, design the chemotherapy regiment on drug-resistant TB and solve the difficulty in treating drug-resistant TB. The authors reviewed the history, focused on the present and looked ahead the future, elucidated several issues about treatment on drug-resistant TB and had expectation that readers would have a comprehensively understanding of chemotherapy for drug-resistant TB and make efforts altogether to explore the possibility of controlling the epidemic of drug-resistant TB by chemotherapy.

Imaging diagnosis of pulmonary tuberculosis— from the morphological analysis to the diagnosis of molecular imaging

ZHOU Xin-hua

Chinese Journal of Antituberculosis. 2014, 36(8):  638-642.  doi:10.3969/j.issn.1000-6621.2014.08.004

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Medical imaging has become an important and indispensable diagnostic method in pulmonary tuberculosis and lung disease. Lesions morphological analysis is one of the important methods for the imaging diagnosis and differential diagnosis of pulmonary tuberculosis, enhanced CT scanning is the important supplement methods for the diagnosis of lesions morphology, magnetic resonance imaging (MRI) is the important diagnostic technology both morphology and molecular imaging, positron emission computed tomography computed tomography(PET-CT) imaging is also the important molecular imaging technology, and the value of these methods is to diagnose differentially and evaluate active tuberculosis lesions. Skillful mastering the purpose and meaning of different imaging techniques used in the diagnosis of pulmonary tuberculosis, pay great attention to imaging diagnosis and differential diagnosis in atypical pulmonary tuberculosis and smear negative pulmonary tuberculosis, and promoting multidisciplinary combine diagnosis including imaging morphological analysis, bacteriology, pathology,immunology, will be the main effort direction now and in the future.

Current situation and suggestions on tuberculosis infection control for Chinese health care facilities and tuberculosis care workers

HE Guang-xue, SONG Yu-dan, YANG Xi, WANG Ji-chun, ZHAO Fei

Chinese Journal of Antituberculosis. 2014, 36(8):  643-645.  doi:10.3969/j.issn.1000-6621.2014.08.005

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There were little information and relevant data on tuberculosis (TB) infection control, its relevant health care facilities and health care workers in China. Some TB infection control efforts have been made recently, including issued “Chinese TB Infection Control Manual”, “Chinese TB Infection Control Standardized Operational Procedure”, and conducted a series of trainings and investigations in China. The studies show that most areas in China have not carried out standardized TB infection control measures, health care facilities lack of full-time or part-time infection control staff, lack of funds, the architectural design and functional partition do not meet the TB infection control requirements in some health care facilities, short of and inappropriate use of personal protective equipment. Mycobacterium tuberculosis infection and disease rates were higher among TB prevention and control staff, mainly associated with their occupation exposures, moreover, the awareness level of TB infection control knowledge was generally low among health care workers. In view of the current TB infection control situation of health care facilities and TB control and prevention staff, China should strengthen its TB infection control efforts, make TB infection control policy, increase expenditure on infection control in health care facilities, establish a systematic screening system for medical staff to receive regular TB infection and disease examinations, and strengthen the education and training on TB infection control knowledge.

Pay attention to the extrapulmonary tuberculosis and standard to the clinical diagnosis and treatment of tuberculosis of bone and joint

QIN Shi-bing

Chinese Journal of Antituberculosis. 2014, 36(8):  655-658.  doi:10.3969/j.issn.1000-6621.2014.08.011

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The efficacy of single-stage posterior instrumentation through the Wiltse approach combined with anterior debridement and internal fixation for the surgical management of thoracic-lumbar tuberculosis

WANG Chuan-qing, LI Jing-chao, HOU Dai-lun, ZHANG Qiang, WANG Qing, ZHAO Yao

Chinese Journal of Antituberculosis. 2014, 36(8):  659-665.  doi:10.3969/j.issn.1000-6621.2014.08.012

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Objective To evaluate the efficacy of single-stage posterior pedicle screw instrumentation tho-rough Wiltse approach followed by anterior debridement and internal fixation for the surgical management of thoracic-lumbar tuberculosis. Methods One hundred and twenty-eight cases with thoracic-lumbar tuberculous spondylitis admitted in Shandong Provincial Chest Hospital were collected for the observational study from March 2011 to February 2013. There were 73 males and 55 females, and the lesion located at thoracic spine T_5-11 level in 35 cases, T₁₂—L₂ in 45 cases and L_3-5 in 48 cases. They were undergone posterior pedicle screw instrumentation thorough Wiltse approach combined with anterior radical debridement, decompression and internal fixation. All patients were treated with standard anti-tuberculosis chemotherapy through oral administration for a minimal length of 4 weeks before surgery and lasted 12 to 18 months after surgery(3HRZE/9—15HRE). All patients were followed up for 12 to 36 months, average （24±9） months. The laboratory examination including blood routine, ESR and CRP, body temperature and imaging evaluation were undergone at the 1st, 3rd, 7th day, 2 and 4 weeks postoperatively. Imaging examination was carried out at 2^nd and 4^th weeks and per 3 months postoperatively. The changes of clinical symptom, status of internal fixation, degree of kyphosis and grade of neurologic function were assessed.  Results No case was died and suffered from spinal cord, nerve, great vessel or organ injury during surgery. The complications were happened in 11 patients (18.6%). The average operating time and blood loss were (270±110) minutes and (360±210) ml including (70±25) minutes and (100±65) ml in posterior procedure, respectively. The body temperature and pain were the most serious in 1 to 3 days after operation. While the numerical value of WBC, ESR and CRP were highest. The Cobb’s angle was corrected 18.6° after surgery immediately, however, 1.9° loss was observed at the final follow-up before deinstrumentation and 1.1° loss after 3 months deinstrumentation. The ASIA Impairment Scale scores demonstrated significant improvement (95.3%, 102/107). All patients showed evidence of successful bone fusion by radiological evaluation and 115 patients (89.8%, 115/128) were at grade Ⅰor Ⅱ. They were achieved 97.7% (125/128) cure rate.  Conclusion The results demonstrates that cases with thoracic-lumbar tuberculosis，which treatment with posterior pedicle screw instrumentation thorough Wiltse approach combined with anterior debridement, decompression and interbody fusion, can achieve good clinical efficacy and get rapid postoperative recovery. It is a safe and effective method in the surgical management of thoracic-lumbar tuberculosis.

Treatment of multi-vertebral spinal tuberculosis by posterior instrumented fusion with short segment pedicle screws fixed on pathologic vertebrae

FAN Jun，QIN Shi-bing，DONG Wei-jie，LAN Ting-long，XU Shuang-zheng，TANG Kai

Chinese Journal of Antituberculosis. 2014, 36(8):  666-670.  doi:10.3969/j.issn.1000-6621.2014.08.013

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Objective To evaluate the feasibility of treatment of multi-vertebral spinal tuberculosis by posterior instrumented fusion with short segment pedicle screws fixed on pathologic vertebrae. Methods Thirty-two patients with spinal tuberculosis of 2 or more vertebral body destruction, who were admitted in Beijing Chest Hospital Capital Medical University from July 2010 to July 2012, confirmed by surgery and follow-up completed. According to the nerve function classification standard from American Spinal Injury Association(ASIA), there were grade A: 2 cases, grade B: 1 case, grade C: 7 cases, grade D: 14 cases and grade E: 8 cases. The Cobb angle were compared with pre- and postoperative short segment pedicle screws fixation at the end of the second and the eighteenth month. The excellent and good rate of operation was evaluated according to the marking standard from Japanese Orthopaedic Association(JOA). The recovery of nerve function pre- and postoperation and postoperative complications were observed.  Results All patients were followed-up completely at least 2 years and no patients were relapsed in this period. Meanwhile, no patients were observed with pus, sinus tract formation and complications associated with pedicle screw implantation. The Cobb angle became smaller obviously at the end of two weeks from (19.8±6.1) degree preoperation to (7.8±3.1) degree postoperation(t=9.9，P=0.00) and at the end of eighteenth month from (7.8±3.1) degree postoperation to (8.8±4.3) degree postoperation(t=1.2，P=0.09). The score of JOA was improved obviously from (8.7±6.3) to (25.2±2.8) (t=13.6，P=0.00). The improvement rate was 75.0%(24/32). The ASIA classification was grade D 7 cases and grade E 25 cases after operation.  Conclusion The short segment pedicle screws fixed on pathologic vertebrae to treat multi-vertebral spinal tuberculosis is not only satisfactory on efficacy, but also reduces Cobb angle loss and improves comfortableness. It is worth to extend application.

The application of selective lobar blockade in thoracic vertebrae tuberculosis anterior approach operation via right thoracotomy

WANG Chun, LIU Wei, GENG Wan-ming, GAO Guang-kuo, ZHAI Wen-ting, SHI Zhi-guo

Chinese Journal of Antituberculosis. 2014, 36(8):  671-674.  doi:10.3969/j.issn.1000-6621.2014.08.014

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Objective To evaluate selective lobar blockade in non-upper thoracic vertebrae tuberculosis anterior approach operation via right thoracotomy. Methods Thirty-eight patients with non-upper thoracic vertebrae tuberculosis admitted in Beijing Chest Hospital from May, 2012 to September,2013 undergoing anterior approach spinal operation via right thoracotomy were randomly divided to the double-lumen tube (OLV) group(n=19) and the selective lobar blockade(SLB) group(n=19). Anesthesia was induced and maintained routinely. The patients were intubated with F35 or F39 double-lumen tube in OLV group and were intubated with ID 7.5 or ID 8.0 enforced single-lumen tube and a endobronchial blocker into the bronchus intermedius in SLB group. The position of all endobronchial tube was ensured with fiberoptic bronchoscope. Ppeak, Pplat, Comp and arterial blood gas analysis was performed and recorded at the following time point: 10 mins after two lung ventilation on left lateral decubitus position(T₁), 30 mins after one lung ventilation or selective lobar blockade ventilation (T₂), 15 mins after two lung ventilation resumed(T₃).  Results PaO₂ and SaO₂ of group SLB were higher than those of group OLV(P<0.05) at 30 mins after one lung ventilation or selective lobar blockade ventilation (PaO₂: (189.4±58.2) mm Hg，(145.6±50.4) mm Hg, t=4.28, P=0.00); SaO₂: 99.6%±0.3%, 97.5%±1.0%,(t=8.21, P=0.00). Ppeak and Pplat of group SLB were lower than those of group OLV(P<0.05) at 30 mins after one lung ventilation or selective lobar blockade ventilation (Ppeak: (18.1±3.2) cm H₂O，(20.5±4.1) cm H₂O，t=2.15，P=0.04); Pplat: (16.3±3.2) cm H₂O, (20.2±2.4) cm H₂O，(t=3.94, P=0.00). Comp of group SLB were higher than those of group OLV at 30 mins after one lung ventilation or selective lobar blockade ventilation ((34.8±14.5) ml/cmH₂O, (26.4±15.2) ml/cmH₂O，t=6.07, P=0.00). No statistical difference existed in surgery field (χ²=0.36, P=0.55).  Conclusion Selective right lower lobar blockade can improve oxygenation and indexes of respiratory mechanics of patients undergoing non-upper thoracic vertebrae tuberculosis anterior approach operation via right thoracotomy. It doesn’t affect the operation field exposure and operative procedure.

Treatment of upper thoracic vertebral tuberculosis by one-stage posterior focus debridement, bone graft and internal fixation surgery

TANG Kai, DONG Wei-jie, LAN Ting-long, FAN Jun, XU Shuang-zheng, QIN Shi-bing

Chinese Journal of Antituberculosis. 2014, 36(8):  675-678.  doi:10.3969/j.issn.1000-6621.2014.08.015

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Objective To explore the indications, efficacy and treatment outcomes of one-stage posterior focus debridement, bone graft and internal fixation operation for the patients with upper thoracic vertebral tuberculosis (TB). Methods The information of the patients with upper thoracic vertebral TB and in different degrees of paraplegia, who received one-stage posterior focus debridement, bone graft and internal fixation operation in Beijing Chest Hospital between March 2006 and October 2012, were collected. There were 17 patients in total, including 12 males and 5 females with ages ranged from 4 to 67 years (median: 49 years). Combination chemotherapy with 4-5 anti-TB drugs (isoniazid, rifampicin or rifapentine, ethambutol, pyrazinamide, or/and levofloxacin) were administered to all patients before and after the operations. The duration of the pre-operative anti-TB treatment were 2-96 weeks (mean: 10.3 weeks); the duration of the post-operative anti-TB treatment were 12-18 months.  Results The operation time ranged from 165 minutes to 300 minutes, with an average of (224.11±41.35) minutes. The intra-operative blood loss was 300-1500 ml, with an average of (752.94±435.70) ml. The major complications after operations were incision effusion (4 cases) and bedsore (1 case). The average of Cobb’s angle was (23.96±6.67)°and (19.21±5.97)°respectively before and after operations. The mean follow-up duration was 14 months (range: 12-30 months). All the patients were cured after treatment. The rate of inter-body fusion was 100.00% and no relapse by the end of follow-ups. Ten patients with paraplegia recovered to degree D or E according to the neurological classification of American Spinal Injury Association (ASIA).  Conclusion One-stage posterior focus debridement, bone graft and internal fixation is an effective and feasible treatment for the patients with upper thoracic vertebral TB.

Clinical analysis of a short segment of spinal tuberculosis combined with tuberculous empyema

ZHANG Hui-jun,LU Zeng-hui,ZHU Chang-sheng

Chinese Journal of Antituberculosis. 2014, 36(8):  679-683.  doi:10.3969/j.issn.1000-6621.2014.08.016

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Objective To explore the clinical effect and operation for patients with a short segment of spinal tuberculosis combined with tuberculous empyema.  Methods Clinical effects of the short segment of spinal tuberculosis combined with tuberculous empyema patients, which have been accepted in Xi’an Tuberculosis and Thoracic Tumor Hospital, were retrospectively analyzed from 2009 January to 2013 August. Preoperative anti-tuberculosis treatment was conducted with isoniazid (0.40 g intravenous qd), rifampicin(0.4 g/0.60 g oral qd)，amikacin sulfate(0.40 g intravenous qd), pyrazinamide(0.50 g oral bid) and ethambutol hydrochloride(0.75 g oral qd) at least 2-4 weeks, while also given oral hepatoprotective therapy (compound glycyrrhizin capsules, 2 capsules, bid). Pleural decortications and debridement of empyemas were performed for the first ipsilateral pleural, and then debridement of spinal tuberculosis, bone graft fusion and internal fixation operation were performed. Seventy-four cases were all completed in one stage. Results All 74 cases in this group were cured without recurrence, except for 6 cases of postoperative sinus formed skin, which were healed after long term dressing with gauze of isoniazid injection. And all patients with the pain of the chest and back were disappeared after operation. Conclusion For patients with a short segment of spinal tuberculosis combined with tuberculous empyema, surgical operation should be performed as soon as possible and the clinical curative effect was good and most patients can be cured after antituberculous treatment were administered for at least 2-4 weeks.

Analysis of indications and outcomes of conservative treatment for the patients with spinal tuberculosis

XUE Hai-bin, ZHANG Cong, GU Su-xi, XIE Ming-jiu, TIAN Bin, JIAN Wei, LI Da-wei

Chinese Journal of Antituberculosis. 2014, 36(8):  684-690.  doi:10.3969/j.issn.1000-6621.2014.08.017

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Objective To evaluate the efficacy of conservative treatment in patients with tuberculosis (TB) of the spine, and to explore the indications for non-surgical treatment of the spinal TB. Methods  A prospectively study was conducted. Fifty-four patients with active TB of the spine who initially received non-surgical treatment in the Orthopaedic Department of the 309^th Hospital of Chinese People’s Liberation Army from January 2007 to January 2012 were recruited in the study. The diagnosis of TB was based on clinical presentation, findings on imaging, laboratory examinations and experimental anti-TB chemotherapy. The image-guided biopsies were also performed if needed. The patients received anti-TB combination drug chemotherapy for 9-18 months and the treatment durations were adapted individually according to the treatment outcomes during the follow-up, such as the clinical manifestation, progress of healing of the focus and change of spinal physiological curvature. The liver function, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels were tested regularly. The image-guided percutaneous catheter drainage was performed in 6 patients who had huge abscess. The follow-up duration was 1.5-5.5 years, mean (3.0±0.8) years. Results Patient ages ranged 12-74 years (mean: (42.5±3.5) years). The duration of prodromal symptoms before admission ranged 2-8 months (mean: (4.5±1.2) months). The infection was localized to a single vertebra in 2 patients, localized to 2 contiguous vertebras in 28 patients, and localized to more than 3 vertebras in 24 patients. All patients presented with abscesses, had no neurological deficits or severe back pain, the kyphotic angles were smaller than 30°. Out of 54 patients, 49 patients were healed by conservative treatment with anti-TB drugs, and none of them had residual instability or neurological compromise. Among 49 patients, the local pain released in 45 patient while 4 patients only had mild back pain and no need to take analgesic drugs; bony fusion and fibrosis was observed on radiographic or CT films in 32 and 17 patients respectively, the average increase of kyphotic angle was (5.5±0.8)°. The levels of ESR and CRP decreased to the normal range in 47 patients. Eighteen patients were found to have drug side-effects during treatment, but they were manageable by stopping to take the related anti-TB drugs or by applying the corresponding pharmacological treatment. Five patients received operation due to severe back pain, neurological deficit or progressing kyphosis.  Conclusion Patients with TB of the spine, who have no severe back pain, neurological deficits or unacceptable sagittal alignment, can be well ma-naged through conservative treatment with anti-TB drugs.

Analysis of nutritional risk screening in hospitalized patients with bone tuberculosis

MA Jiao-jie, HE Hong, LI Bao-yue, LEI Guo-hua, QIN Shi-bing

Chinese Journal of Antituberculosis. 2014, 36(8):  691-695.  doi:10.3969/j.issn.1000-6621.2014.08.018

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Objective To understand the basic situation of the nutritional risk occurrence in hospitalized patients with bone tuberculosis, and the differences in the occurrence of nutrition risk rate among different sex and age. Methods We collected the basic information of all patients with bone tuberculosis in our hospital from January 2014 to March 2014. A total of 64 patients (male 31,female 33) were collected. The age ranges from 19 to 87 years old, 20 cases fell in 19- age group, 27 cases in 41- age group, 17 cases in 61-87 age group. We made nutritional risk screening and measurement based on NRS2002 (the highest score is 7, ≥3 is considered having nutritional risk).We used the Spearman’s rank correlation to measure nutritional risk and analyze the correlation among those indexes. The Chi-square test is used for comparison and P<0.05 is considered statistically significance.  Results Nutritional risk score has a positive correlation with age (the age range was （43.3±16.9） to （81.7±5.0）years old when the score was between 1 to 5), CRP (the range of CRP was between （16.0±16.2） to （21.1±18.2）mg/L when the score was between 1 to 5), days of hospitalization (the days of hospitalization was between （17.7±7.4） to （21.3±12.1）d when the score was between 1 to 5) (r=0.304,0.352,0.370; P<0.05 or P<0.01); Nutritional risk score has a negative correlation with body weight (the body weight was between （66.3±11.9） to （49.0±9.6）kg when the score was between 1 to 5), BMI (the BMI value was between （23.5±3.8） to （18.6±1.5）kg/m² when the score was between 1 to 5), Hb (the Hb value was between （134.3±18.5） to （106.3±24.8）g/L when the score was between 1 to 5), L% (the L% value was between （26.5±7.3)% to （17.3±4.0）% when the score was between 1 to 5), Alb (the Alb value was between （41.5±3.3） to （31.4±4.7）g/L when the score was between 1 to 5), Na⁺ (the Na⁺ value was between （138.7±2.6） to （139.7±1.1）mmol/L when the score was between 1 to 5), K⁺ (the K⁺ value was between （4.5±0.4） to （4.1±0.5）mmol/L when the score was between 1 to 5) (r=-0.419,-0.469,-0.418,-0.279,-0.556,-0.255,-0.433; P<0.05 or P<0.01). In our statistical analysis, the occurrence of nutritional risk of patients with bone tuberculosis was 37.5% (24/64), compared with female patients (45.5%,15/33), male patients is lower (29.0%,9/31), but there was no statistically difference between the two groups (χ²=1.839，P>0.05). The occurrence of nutritional risk of patients in 19- age group was 25.0%(5/20), which was 29.6% (8/27) in 41- age group, and the rate was 64.7%(11/17) in 61-87 age group, there was statistically difference among different age groups（χ²=7.416，P<0.05）.  Conclusion Nutritional risk occurrence among our hospitalized patients with bone tuberculosis is high, and we should early screen for nutritional risks and carry on active intervention.

Comparative study of two different nursing methods of defecation in patients with lumbar tuberculosis during perioperative period

LEI Guo-hua, WANG Qian, CHEN Xiang-jun, WU Zeng-rui, WANG Hong-lian, DUAN Zhen-lan

Chinese Journal of Antituberculosis. 2014, 36(8):  696-699.  doi:10.3969/j.issn.1000-6621.2014.08.019

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Objective To compare the effects of two nursing methods of defecation by using the disposable plastic bag and the ordinary bedpan respectively among the patients with lumbar tuberculosis (TB) during the perioperative period. Methods From January 2012 to June 2013, a total of 160 patients with lumbar TB and received internal fixation operation were recruited in the study. Those patients were randomly divided into two groups according to the odd number and even number with the patients’ ID number and the two different nursing cares of de-fecation were respectively used for the patients in each group: disposable plastic bag was used for 80 patients in one group and ordinary bedpan was used for another 80 patients in the other group. The following variables were evaluated and compared between the two groups byχ² test: degree of comfort, taking care independently, exposure of pe-rineum, clothing contamination and convenience of disposal. The degree of the low back pain was graded on a scale of 10 based on the NPRS: 0=no pain, 1-3=little pain; 4-6=moderate pain, 7-10=painful. The degree of skin damage was graded by 3 levels: normal, reddening and bruising. The Wilcoxon rank-sum test was used to compare the degree of the low back pain and the skin damage between the two groups. A P-value of <0.05 was regarded as statistically significant difference.  Results The rates of patients who felt comfortable, could manage independently and conveniently were 72.50% (174/240), 44.17% (106/240) and 95.00% (228/240) respectively in the disposable plastic bag group, which were much higher than the rates in the bedpan group (14.47% (33/228), 18.42% (42/228) and 8.33% (19/228)). The difference had statistic significant (χ²=159.60, 35.84 and 352.38, P<0.001). The rates of perineum exposure and clothing contamination were 29.58% (71/240) and 12.08% (29/240) respectively in the disposable plastic bag group, which were lower than that in the bedpan group (81.14% (185/228) and 26.32% (60/228)). The difference had statistic significant (χ²=125.43 and 15.38, P<0.001). In the disposable plastic bag group, the number of patients who did not feel lower back pain was 138 person-times, which was significantly higher than that in the bedpan group (33 person-times only; Z=-9.16, P<0.001). The number of patients without buttock skin damage after defecation was 227 person-times in the disposable plastic bag group, which was significantly higher than that in the bedpan group (156 person-times; Z=-8.10, P<0.001).  Conclusion The nursing of defecation by using the disposable plastic bag can reduce the low back pain and buttock skin damage of the patients with lumbar TB during the perioperative period; it also makes the patients to feel more comfortable and dignified, to improve the patient’s self-management capacity and reduce the workload of paramedic. It is a good perioperative nursing method for the patients with lumbar TB.

Comparison of imaging manifestations between Mycobacterium avium-intracellulare complex and Mycobacterium abscessus pulmonary diseases

HE Wei，NING Feng-gang，LI Cheng-hai，LI Fang，ZHOU Zhen，LV Yan，ZHOU Xin-hua

Chinese Journal of Antituberculosis. 2014, 36(8):  700-705.  doi:10.3969/j.issn.1000-6621.2014.08.020

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Objective To compare the computed tomography (CT) manifestations of non-tuberculous mycobacterium （NTM） pulmonary diseases caused by Mycobacterium avium-intracellulare complex (MAC) and Mycobacterium abscessus. Methods The CT findings of 16 patients with MAC pulmonary disease and 15 patients with Mycobacterium abscessus pulmonary disease confirmed by clinical and laboratory test who admitted in Beijing Chest Hospital, Capital Medical University from Jan. 2011 to Oct. 2013 were reviewed retrospectively．CT and high resolution computed tomography (HRCT) findings of all patients were analyzed. χ² test was used to analyze the difference of imaging between MAC and Mycobacterium abscessus pulmonary disease.  Results CT manifestations of air space consolidation (28/31), bronchiectasis (28/31), centrilobular nodules or “tree in bud” (28/31) were common in these 2 pulmonary diseases.The upper lobes were more frequently involved in MAC（10/16） than in Mycobacterium abscessus pulmonary disease（2/15）（P<0.01）. The cavity pattern were more frequently observed in MAC（11/16） and nodular bronchiectatic pattern was found more in Mycobacterium abscessus pulmonary disease（11/15）（P<0.05）.Air space consolidation, cavity and centrilobular nodules or“tree in bud” distributed more lung zones in MAC（55/96，33/96，68/96, respectively） than in Mycobacterium abscessus pulmonary disease（26/90，18/90，48/90, respectively）（P<0.01,P<0.01,P<0.05）. Consolidation was more common in the middle of the right lung (11/16，P<0.05) and the left lung ligule (12/16, P<0.05) in MAC pulmonary disease than in Mycobacterium abscessus pulmonary disease（4/15）.   Conclusion The CT imaging findings of MAC pulmonary disease and Mycobacterium abscessus pulmonary disease have certain similarities, but have different features. It helps for early diagnosis and treatment in clinical practice.

Imaging findings of nontuberculous mycobacterial lung diseases: a comparison with findings of secondary pulmonary tuberculosis

DAI Jie，SHI Jing-yun，LIANG Li，TANG Shen-jie，YAO Lan，ZHOU Liang

Chinese Journal of Antituberculosis. 2014, 36(8):  706-709.  doi:10.3969/j.issn.1000-6621.2014.08.021

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Objective To explore and compare the characteristics of CT imaging in nontuberculous mycobacterial (NTM) lung disease with secondary pulmonary tuberculosis. Methods From July 2009 to Dec 2012, 41 patients which were confirmed as nontuberculous mycobacterial lung disease admitted in Shanghai Pulmonary Hospital were enrolled as study group, and 41 patients with smear- or culture- positive secondary pulmonary tuberculosis were enrolled from 1026 patients admitted in the same hospital using systematic random sampling as control. The data of thin-section chest CT imaging were analyzed retrospectively. The patterns of lung lesions, including centrilobular nodules, large nodules, cavity, consolidation, bronchiectasis, distribution of lesions, were compared. Statistical comparisons were performed with the t-tests for univariate analysis, and a logistic regression method was used for multivariate analysis.  Results Based on univariate analysis, bronchiectasis ((95.1%, 39/41) vs (12.2%, 5/41), χ²=53.408, P<0.001) was more frequently seen in NTM patients. On the other hand, consolidation ((7.3%, 3/41) vs (31.7%,13/41), χ²=6.290, P=0.012) were more frequently seen in secondary pulmonary tuberculosis patients. A logistic regression analysis demonstrated that bronchiectasis was significant CT fin-dings associated with NTM (β=5.613, Waldχ²=22.717, P<0.001, OR=273.843, 95%CI=27.237-2753.221). Conclusion The thin section CT finding of NTM has certain characteristics which may be helpful to clinical diagnosis for NTM before bacteriological result.

Analysis of stressors of nurses in tuberculosis department in a hospital in Beijing

GAO Shu-hong, SHI Wen-wen, ZHAO Yan-li, DUAN Zhen-lan

Chinese Journal of Antituberculosis. 2014, 36(8):  710-713.  doi:10.3969/j.issn.1000-6621.2014.08.022

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Objective To understand the work stressor of nurses in tuberculosis (TB) department and to explore positive solutions to promote mental and physical health of nursing staff. Methods  Eighty-eight nurses of TB department in Beijing Chest Hospital, Capital Medical University were selected by convenience sampling and investigated with questionnaire on work stressors. The average age, years of working and number of night shift monthly were (33.04±9.07) years, (12.70±9.04) years and (4.25±2.25) respectively. There were 8 dimensions and 61 entries in the questionnaire. Component method was used to score. One score for no pressure, two score for general pressure, three for high pressure and 4 for very high pressure. The possible score ranged 61-244, the higher the score, the more pressure on the nurse. The purpose and methods of the survey were introduced to the respondents before informed consent obtained. Ninety questionnaires were distributed and 88 valid questionnaires were reco-vered, the valid returned rate was 97.8%.  Results (1) The overall stressor score of nurses in TB department was (154.81±36.03). (2) The stressor score of each dimension from high to low was special questions on TB nursing (3.07±0.81), questions on working environment and resources (2.88±0.81), workload and time allocation questions (2.67±0.78), social and environmental questions (2.63±0.78), questions on nursing development (2.55±0.74), patient nursing questions (2.52±0.68), nursing and working questions (2.45±0.74) and management and interpersonal questions (1.89±0.64). (3) The entries scoring in the top 10 stressors were long-term exposure to bacteria excreted, drug-resistant TB patients (3.55±0.78), worrying about suffering from TB (3.47±0.88), partner was diagnosed with TB (3.36±0.89), worrying about the disinfection effect of protective facilities (3.28±0.94), worrying about an accident at work (3.21±0.95), poor working environment (3.18±0.92), crowded ward (3.02±1.07), wide income gap (2.98±0.94), heavy workload (2.97±0.94) and frequent shift (2.94±1.03).  Conclusion Nurses in TB department are under high working pressure, nursing managers should take targeted measures and guide the nurses actively respond to reduce the work pressure.

Annual report on clinical diagnosis and treatment progress of tuberculosis (2013)   (Part 1 clinical diagnosis)

Clinic Society of Chinese Antituberculosis Association

Chinese Journal of Antituberculosis. 2014, 36(8):  714-740.  doi:10.3969/j.issn.1000-6621.2014.08.023

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Much progress has been made on the clinical diagnosis of tuberculosis (TB) in recent one year by series studies. In bacteriological diagnosis, novel sputum-smear techniques such as mobile digital fluorescence microscopy can clearly show and save the images of bacteria, light-emitting diode (LED) fluorescence microscopy (FM) can greatly shorten the time of detection and increase the detection rate compared with conventional acid-fast staining methods. Particular studies had been made on the difficulties of TB diagnosis in radiology, for example, the clinical stages of lung cancer with pulmonary TB (PTB) and differential diagnosis of multidrug-resistant PTB and nontuberculosis mycobacterium (NTM). IGRAs (interferon gamma release assay) have great advantage in diagnosis of latent TB infection. Its diagnosis value has been further re-evaluated in this year. Rapid development was obtained in molecular biological diagnosis of TB, the value of Xpert Mtb/RIF has been further evaluated; hyperbranched rolling circle amplification (HRCA) for direct detection of Mycobacterium tuberculosis proved to be simple, economic and fast, which has wide prospect of application in resource limited areas. In interventional diagnosis of TB, the combination of several techniques such as bronchoscopy, endoscope, molecular biology, ultrasonic guided technique, bacteriology and pathology made great progress in the diagnosis of TB, for example, the bronchial washing liquid from TB patients through bronchoscope was detected by Xpert Mtb/RIF. The development of molecular pathological diagnosis on TB is outstanding. Gene detection of Mycobacterium tuberculosis in the biopsy tissue remarkably increased the TB detection.