Table of Content

10 October 2014, Volume 36 Issue 10

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Comments to amendment of instructions of BCG vaccine for intradermal injection

ZHAO Ai-hua, KOU Li-jie, XU Miao, WANG Guo-zhi

Chinese Journal of Antituberculosis. 2014, 36(10):  863-867.  doi:10.3969/j.issn.1000-6621.2014.10.001

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In this paper, authors proposed amendments to instructions of BCG vaccine for intradermal injection using in China, including eligibles, adverse reactions, contraindications, and other project content,such as drug interactions should be increased, hoping to provide a reference manual for the new revision.

Resource allocation analysis of China Global Fund TB Program for Tuberculosis prevention and control

WANG Dong-mei，ZHANG Li-jie，LI Tao，JIANG Shi-wen，LIU Xiao-qiu，LI Jun，WANG Jia，WANG Li-xia，ZHANG Hui

Chinese Journal of Antituberculosis. 2014, 36(10):  868-873.  doi:10.3969/j.issn.1000-6621.2014.10.002

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Objective To understand the funding input, distribution, and related factors of China Global Fund （GF）TB Program, in order to provide basis for Government funding allocation after the closure of China GF TB Program in middle of 2014. Methods National and 31 provincial （prefectural and county, except for Hong Kong, Macao and Taiwan）GF TB program investment and allocation data from 2003 to 2013 were collected. Several factors in each province were analyzed through Pearson correlation analysis in order to determine whether they had a statistical correlation to the distribution of GF TB program resources in China，including：the Per Capital Gross Domestic Product (GDP)，the number of TB registration, and TB registration rate were calculated at each provincial level and compared with related GF investment. The Z values were calculated at each provincial level and compared with the per capita of GF investment. The resource allocation in different program areas were compared with the level of resource input by GF and the central transfer payments. SPSS 18.0 software was adopted to carry out the data processing and analysis, and the correlation between the resource input of China GF TB Program and related indicators was analyzed by Pearson correlation. P<0.05 was considered a significant difference.  Results The total expenditure for China TB prevention and control by GF reached US 238 million from 2003 to 2013, 67.68% corresponding to US162 million was funded TB dispensaries under the central. Positive correlation (r is 0.626 and 0.765 and P<0.01 both) was identified between GF resource input and the “TB resource needs combined index”, the number of TB registration. However, there was no statistical correlation (r is 0.039 and P=0.833) between GF resource input and the GDP. There was negative correlation (r is -0.18 and P=0.924) between GF resource input and TB registration rate of each province．The GF TB program investment and need in different province could not meet completely．The rank of Z value in Xinjiang Uygur Autonomous Region were 8，but the rank of GF TB program in same province was 16.  Conclusion Though in comparison with the central transfer payment, the global fund funding covered different working content, the overall allocation of funds was fair.

The cause analysis of the inconsistency in the outcomes of drug susceptibility test for Mycobacterium tuberculosis by different report time

GU Yun-ting, YU Xia, LI Yun-xu, ZHAO Li-pin, WANG Gui-rong, CHEN Su-ting, HUANG Hai-rong

Chinese Journal of Antituberculosis. 2014, 36(10):  874-879.  doi:10.3969/j.issn.1000-6621.2014.10.003

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Objective To determine when the susceptibility of the colony forming on the slants performed by absolute concentration method the cause analysis of the inconsistency in the outcomes of drug susceptibility test for Mycobacterium tuberculosis by different report time. Methods  Thirteen isolates on the INH containing medium from 11 patients with colony forming after six weeks were collected and the strains on the drug free L-J medium were also collected.All 24 collected strains were performed PCR species identification, MIRU and spoligotying gene typing, drug susceptibility tests (DST), INH resistant gene and randomly selected 3 strains （7019H0.2,7285H0.2 and 7325H1）to do DST for Simulation mixed population of INH susceptible and resistant strains.Observe the  results in differert report time (4 and 6 weeks). All the patients were recived telephone follow-up about treatment and drug resistance results. Results  All 13 isolates from INH contain medium were INH resistant when the proportion method was performed after subculture while all 11 strains from drug free medium were all INH susceptible.All the 13 isolates from INH containing medium and 11 isolates from control medium were identified as Mycobacterium tuberculosis complex (MtbC). Of 13 isolates from INH resistant strains, 10 strains (10/13,76.92%)had mutation in the katG gene (S315T). Among the 11 patients, 3 patients were proved to be INH resistant in the following DST.Three patients owned the different genotype between the drug containing medium and control medium.The genetype were Beijing and T2,Beijing and H3, Beijing and T2.Three strains mixed with H37Rv grown after 6 weeks instead of 4 weeks when the proportion was less than 1;128 (clinical isolate:H37Rv). Conclusion Case of mixed infection of different drug sensitivity caused by Mycobacterium tuberculosis, when the proportion of resistant strains is low,it may cause inconsistent results in different report time.

Analysis of TB case-finding among students in Xi’An University of Finance and Economics during 2008—2013

ZHOU Wei, LI Hai-jun, CHEN Guang-hua, YANG Xiao-min, LIU Wu-lu

Chinese Journal of Antituberculosis. 2014, 36(10):  880-883.  doi:10.3969/j.issn.1000-6621.2014.10.004

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Objective To analyze the effect of case-finding among students with tuberculosis (TB) in Xi’An University of Finance and Economics from 2008 to 2013. Methods  The TB patients were usually detected by the following four ways in the university: annual medical examinations for new students, annual medical examinations for graduates, seeking health care of students with symptoms and TB screening for close contacts of pulmonary TB patients. In six years (from 2008 to 2013), the number of TB patients who were detected by those four ways were 39, 31, 49 and 2 respectively. The information of all detected TB patients were collected and analyzed. A Chi-square test and linear trend Chi-square test were used to analyze TB prevalence and notification rate among students and the level of significance was set to P<0.05. Results  In 6 years, the average prevalence of active TB among new students and graduates were 115.69/100 000 (39/33 711) and 101.81/100 000 (31/30 450) respectively; the average prevalence of smear-positive TB were 5.93/100 000 and 0 (0/30 450) respectively. The TB prevalence of new students from 2008 to 2013 were 133.89/100 000 (7/5228), 135.99/100 000 (8/5883), 56.34/100 000 (3/5325), 73.27/100 000 (4/5459), 126.84/100 000 (8/6307) and 163.37/100 000 (9/5509) respectively, and the chi-square test and linear trend Chi-square test of had no statistically significant difference (χ²＝3.985, P>0.05; χ²_trend＝0.134, P>0.05). The TB prevalence of graduates from 2008 to 2013 were 169.40/100 000 (9/5313), 120.92/100 000 (6/4962), 111.09/100 000 (6/5401), 79.78/100 000 (4/5014), 87.73/100 000 (5/5699) and 24.62/100 000 (1/4061) respectively, and the Chi-square test had no statistically significant difference (χ²＝4.436, P>0.05) while the linear trend Chi-square test had statistically significant difference (χ²_trend＝4.744, P<0.05) which indicated a decreasing trend of TB prevalence. The average notification rate of active TB among students by seeking health care and close contacts screening were 41.15/100 000 and 80.19/100 000 respectively and the notification rate of smear-positive TB were 1.68/100 000 (2/119 069) and 0 (0/2494). The Chi-square test and linear trend chi-square test of the TB notification rate had no statistically significant difference (χ²＝10.197, P>0.05; χ²_trend＝1.667, P>0.05 ). Conclusion A combination of various methods on TB case-finding is not only feasible in college, but also effective on early diagnosis of TB and prevention of spread of TB among students.

Diagnostic value of T-SPOT.TB and tuberculosis antibody for osteoarticular tuberculosis

FAN Jun，QIN Shi-bing，JIA Hong-yan，PAN Li-ping，LAN Ting-long

Chinese Journal of Antituberculosis. 2014, 36(10):  884-887.  doi:10.3969/j.issn.1000-6621.2014.10.005

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Objective Diagnosis of osteoarticular tuberculosis (TB) remains a challenge for clinician. The aim of the present study was to evaluate the utility of T-SPOT.TB assay and tuberculosis antibody for diagnosing osteoarticular tuberculosis.  Methods  From July 2011 to October 2013, 92 patients with confirmed osteoarticular TB and 64 patients without active osteoarticular TB were enrolled. All patients came from Department of Orthopedics，Beijing Chest Hospital.All patients underwent T-SPOT.TB assay to measure the interferon gamma (IFN-γ) response to the TB-specific antigens early secretory antigenic target-6 (ESAT-6) and culture filtrate protein-10 (CFP-10) in T cells in samples of peripheral blood mononuclear cells（PBMCs）, meanwhile serum tuberculosis antibody was detected using western blot method.  Results The sensitivity and specificity for T-SPOT.TB assay were 93.5%（86/92） and 78.1%（50/64）, for tuberculosis antibody were 64.1%（59/92） and 81.3%（52/64）, respectively. The positive rate of T-SPOT.TB assay was significantly higher than tuberculosis antibody method, and the difference was statistically significant (χ²=23.72，P<0.01).  Conclusion The data on this subject suggested that the T-SPOT.TB assay is a useful adjunctive tool for the diagnosis of osteoarticular TB.

The diagnosis analysis of 96 cases of cervical tuberculous lymphadenitis

ZHOU Wei-dong, WEI Guang-xi, WANG Jun, ZHAO Ming-wei

Chinese Journal of Antituberculosis. 2014, 36(10):  888-892.  doi:10.3969/j.issn.1000-6621.2014.10.006

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Objective To evaluate diagnostic methods of cervical tuberculous lymphadenitis (CTL).  Methods The clinical data of 128 patients with neck masses from April 2012 to December 2013 were summarized, in which 96 cases with CTL and 32 cases with cervical non-tuberculous lymphadenitis (non-CTL) has been confirmed. The positive rates of purified protein derivative (PPD) skin test, anti-tuberculosis antibody (TB-Ab), concentrated acid fast bacilli examination, the neck CT enhancement scan, T-SPOT.TB assay, Mtb-DNA-PCR were compared in the diagnosis of CTL. Statistical analysis was done by SPSS 13.0, comparisons between observation group and control group were performed using Chi-squared test. P<0.05 was considered statistically significant.  Results  The positive rates of TB-Ab in control group and observation group was respectively 46.88% (15/32) and 56.25% (54/96), the difference was not statistically significant (χ²＝0.849，P=0.357). The positive rates of PPD test, concentrated acid fast bacilli examination, CT enhanced scan, T-SPOT.TB assay, Mtb-DNA-PCR in the control group were respectively 25.00%（8/32）, 0%（0/32）, 15.63%（5/32）, 9.38%（3/32） and 0%（0/32）; while those in the observation group were 84.38%（81/96）, 13.54%（13/96）, 92.71%（89/96）, 98.33%（59/60）and 97.92%（94/96）, the differences had statistical significance (χ²＝39.938，P<0.01；χ²＝4.823，P=0.028；χ²＝73.105，P<0.01；χ²＝75.154，P<0.01；χ²＝117.961，P<0.01).  Conclusion The positive rates of CT enhancement scan, T-SPOT.TB assay and Mtb-DNA-PCR are higher than other methods in the diagnosis of CTL. Combination of a variety of inspection methods may help to diagnosis of CTL and differential diagnosis of neck mass.

Comparative analysis of human resources before and after the model transformation of the trinity tuberculosis prevention new service in three areas

QU Yan, ZHANG Hui, HUANG Fei, LIU Xiao-qiu, ZHAO Fei, WANG Li-xia

Chinese Journal of Antituberculosis. 2014, 36(10):  893-896.  doi:10.3969/j.issn.1000-6621.2014.10.007

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Objective To analyze the progress of human resources development before and after the model transformation of the trinity tuberculosis prevention new service, and to provide suggestions for the optimal human resources.  Methods Data of human resources in 26 counties (districts) in three areas was collected retrospectively by uniform questionnaire and comparative analysis was implemented based on the data of human resources before and after the model transformation of the trinity tuberculosis prevention new service. The significance of the difference was analyzed by Chi-square test on the distributions of gender, age group, title etc.   Results After the model transformation, the numbers of institutions and professional staffs that engaged in TB prevention, treatment and control were increased to 1.8 times and 1.7 times respectively. The percent of middle-aged staffs increased from 70.2% (125/178) to 71.8% (221/308) (χ²=7.930, P=0.02). The percents of postgraduate degree and bachelor degree increased from 1.1% (2/178) to 4.2% (13/308) and from 31.5% (56/178) to 44.8% (138/308) (χ²=21.271, P<0.01) respectively. The percent of senior position increased from 10.1% (18/178) to 19.8% (61/308) (χ²=8.227, P=0.04).  Conclusion The number of professional staffs increases and the compositions on education background and technical position are improved.

Analysis of tuberculosis screening in close household contacts of smear-positive TB patients

DU Yu-hua, JIANG Kun-hong, LIANG Cheng-shuang, ZHOU Hui-xian, HE Li-yan, TAN Shou-yong

Chinese Journal of Antituberculosis. 2014, 36(10):  897-900.  doi:10.3969/j.issn.1000-6621.2014.10.008

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Objective To understand the detection of active TB in household close contacts of the smear positive pulmonary tuberculosis patients in Guangzhou city and related influencing factors. Methods Through stratified random sampling method, we selected 6 districts from Guangzhou city, and screened a total of 5664 household close contacts of smear positive pulmonary tuberculosis registered between January 2011 and December 2011, 5206 contacts accepted the screening, 629 contacts younger than 15 years old received tuberculin pure protein derivatives (BCG-PPD) skin test among which 144 of them had tuberculin reaction ≥15 mm or with strong positive reactions such as blisters; 4577 contacts aged ≥15 received chest X-ray, for those with abnormal shadow received sputum smears and sputum cultures examination. SPSS 16.0 statistical analysis software was used for data analysis and P<0.05 is considered statistically significant.  Results  The active pulmonary tuberculosis detection rate among household close contacts was 3.6% (187/5206), the detection rate of smear-positive patients was 0.7% (36/5206), the detection rate of culture-positive patients was 1.3% (66/5206). Among 629 contacts of children below 15 years old, 485 had positive and moderate positive BCG-PPD skin test, 144 had strongly positive reaction. The detection rate of active pulmonary tuberculosis in children with strongly positive BCG-PPD skin test was 5.6% (8/144). Male and female active pulmonary tuberculosis detection rate among household contacts was 3.7% (86/2348) and 3.5% (101/2858) respectively, the difference is not statistically significant (χ²=0.062, P>0.05). In terms of the dif-ferent relationship with the index cases, the detection rate among couples, parents, siblings, children and other relation contacts was 4.4% (74/1675), 4.3% (34/794), 5.7% (29/507), 2.4%（40/1682） and 1.8%（10/548） respectively. The difference is statistically significant by relationship (χ²=23.119, P<0.01). The detection rate of close contacts of new smear positive index cases was 3.9% (160/4131), higher than 2.5% (27/1075) of those contacted with retreatment index cases. The difference is statistically significant (χ²=4.566, P<0.05).   Conclusion The screening of household contacts of smear positive pulmonary tuberculosis index cases is an effective method for active case detection; especially we should give attention to contacts of new patients, and the couples, parents, and siblings of the patients.

The clinical research on the application of dual-input lung perfusion CT technique to tuberculosis hemoptysis

QU Hai-xian，AO Guo-kun，YUAN Xiao-dong，LI Qiang，TAN Zhi-yuan, TIAN Yuan

Chinese Journal of Antituberculosis. 2014, 36(10):  901-904.  doi:10.3969/j.issn.1000-6621.2014.10.009

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Objective  In contrast to DSA angiography, we prospectively analyze the accuracy of the dual-input lung perfusion CT technique (DICTp) to detect and locate hemodynamic abnormalities in tuberculosis hemoptysis patients and the correlation between the abnormal perfusion lung segments and the amount of hemoptysis.  Methods  Thirty-one consecutive cases of patients with tuberculosis complicated with hemoptysis underwent dual-input lung perfusion CT scan just before DSA. And then, the CT perfusion parameters at every segment of lung were recorded and compared with those of DSA, supposing DSA diagnostic imaging as the gold standard.  Results  We observed 558 lung segments in the 31 cases and found 200 positive lung segments in DSA imaging. DICTp disco-vered all the 200 positive lung segments.We considered the perfusion index (PI) as the most significant indicator for the diagnosis. When the critical value is 92.75, the sensitivity is 91.9% and specificity is 89.6%. The number of abnormal perfusion lung segment and the level of hemoptysis show medium correlation and the correlation coefficient is 0.605.  Conclusion DICTp can detect and locate pulmonary abnormal blood flow in hemoptysis patients with tuberculosis accurately and sensitively and the number of abnormal perfusion lung segment and the level of hemoptysis show medium correlation.

Clinical epidemiology of pediatric tuberculosis in Shandong Provincial Chest Hospital, 1992—2011

LI Shu-yan, LING Zai-qin, ZHAN Yun-fei, WANG Jun-sheng, LIU Guo-li, YANG Xiao-guang, GAO Da-chuan

Chinese Journal of Antituberculosis. 2014, 36(10):  905-910.  doi:10.3969/j.issn.1000-6621.2014.10.010

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Objective To analyze the clinical epidemiology situation (trend and characteristics) of pediatric tuberculosis (TB) among inpatients with TB in the Shandong Provincial Chest Hospital，to provide references for improving diagnosis, treatment and management of pediatric TB in the hospital.  Methods  The information and data of 916 TB cases aged below 14 years and stayed in Shandong Provincial Chest Hospital in 1992-2011 were analyzed retrospectively. Among them, 272 cases were in the 0- years age group，301 cases were in the 5- years age group，343 cases were in the 10-14 years age group. In order to do the trend analysis, the 20 years were divided into 4 periods, including 1992-1996, 1997-2001, 2002-2006 and 2007-2011.The following variables were analyzed: the proportion of pediatric TB inpatients among all inpatients with TB, and the trends by sex, age, resident place, type of TB and length of hospital stay. Linear regression method was used for the analysis of the overall trend of proportion of pediatric TB among all TB inpatients; χ² test was used for the analysis of the constituent ratios of different types of TB in different periods; By using SPSS 17.0, the analysis of variance was used to analyze the trends of the length of hospital stay and the proportion of age groups. A value of P<0.05 was regarded as a statistically significant difference.  Results  The proportion of pediatric TB among all inpatients with TB decreased from 3.74%（22/588）in 1992 to 2.82%（92/3258）in 2011, and the linear regression analysis results (y=－0.0549x+3.2578, r²=0.094) showed an overall decreasing tread；the proportion of male pediatric TB patients increased from 54.78%（86/157） in the period of 1992-1996 to 63.14%（221/350）in the period of 2007-2011；the proportion of TB patients in the 0- years age group increased from 15.29% （24/157）in the period of 1992-1996 to 41.14%（144/350） in the period of 2007-2011；the proportion of pediatric TB patients from the rural areas increased from 68.79% （108/157）in the period of 1992-1996 to 80.29%（281/350）in the period of 2007-2011；the proportion of pediatric pulmonary TB was 58.30%（534/916）；the proportions of different types of TB in different periods were as follows: tuberculous meningitis significantly reduced from 24.20% （38/157）in 1992-1996 to 14.00% （49/350）in 2007-2011（χ²=7.94，P<0.05）,but the lymphatic TB increased significantly from 3.82%（6/157）in 1992-1996 to 24.29% （85/350）in 2007-2011（χ²=32.82，P<0.05）.  Conclusion The overall trend of the proportion of pediatric TB among all inpatients with TB in Shandong Provincial Chest Hospital is reducing. However, the proportion of pediatric TB patients in the 0- years age group and the pediatric TB patients from the rural areas are increasing; pulmonary TB is the main type of TB among children.

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Chinese Journal of Antituberculosis. 2014, 36(10):  918-919.  doi:10.3969/j.issn.1000-6621.2014.10.015

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