Table of Content

10 May 2018, Volume 40 Issue 5

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Expert Forum

Detection and preventive treatment of latent tuberculosis infection in children

Xue QI,Jian-ling TIAN,Lin SUN,A-dong SHEN

Chinese Journal of Antituberculosis. 2018, 40(5):  447-454.  doi:10.3969/j.issn.1000-6621.2018.05.003

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Latent tuberculosis infection (LTIB) seriously endangers children’s health. In children, LTBI is mostly transmitted from adult, which reflects the spread of Mycobacterium tuberculosis, disease control and epidemic situation of adult tuberculosis (TB). Therefore, strengthening the management of LTBI in children is of great significance to the prevention and control of global TB. However, there is still a lack of uniform standards and consensus for the selection of the screening indications and methods for children LTBI and the selection of preventive treatment options. The author summarizes the WHO guidelines, guidelines and recommendations of different countries and relevant clinical studies to help clinical doctors understand children LTBI high-risk groups and the screening process, and recommends relevant preventive intervention plan, so as to promote the management and diagnosis of children LTBI.

Original Articles

Clinical diagnosis and surgical treatment of Staphylococcus aureus spondylitis:report of 14 cases

Jun FAN,Ting-long LAN,Wei-jie DONG,Kai TANG,Yuan LI,Guang-xuan YAN,Shi-bing QIN

Chinese Journal of Antituberculosis. 2018, 40(5):  455-461.  doi:10.3969/j.issn.1000-6621.2018.05.004

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Objective To investigate the clinical diagnosis of pyogenic spondylitis caused by Staphylococcus aureus, the differential diagnosis with spinal tuberculosis, the operative effect and the related risk factors.Methods We analyzed retrospectively clinical data in 14 cases with pyogenic spondylitis caused by Staphylococcus aureus, which was misdiagnosed as spinal tuberculosis in other hospital, from January 2004 to December 2016. There were 9 males and 5 females, disease involved cervical vertebrae in 2 cases, thoracic vertebrae in 5 cases and lumbar vertebrae in 7 cases. According to the neurological function grade in the American Spinal Injury Association (ASIA), there were grade B in 1 case, grade C in 2 cases, grade D in 5 cases and grade E in 6 cases. Of 14 cases, all were complicated with one or more other diseases including diabetes mellitus in 8 cases, chronic nephritis in 2 cases, ankylosing spondylitis in 2 cases, liver cirrhosis in 1 case, hypertension in 6 cases and severe pulmonary infection in 5 cases. Surgical effect and related risk factors were evaluated with some characteristics such as postoperative complication, visual analogue scale(VAS) before and after operation, postoperative bone graft fusion rate and the changes of postoperative Cobb angle and so on.Results All the cases were misdiagnosed as spinal tuberculosis before operation, and were diagnosed as pyogenic spondylitis caused by Staphylococcus aureus with indications of preoperative pain and paraplegia. Surgical methods were performed with simple posterior internal fixation and debridement in 9 cases, posterior internal fixation and anterior debridement in 3 cases, anterior internal fixation and debridement for cervical spondylosis in 2 cases. All cases were followed up average 22 months ranged from 12 to 36 months. All operations were completed successfully in 14 cases with average operative time (187.8±67.5) min and average intraoperative bleeding volume (460.5±86.4) ml. Postoperative complications were occurred in 5 cases including delayed incision healing in 3 cases, transient septic toxic shock after operation in 1 case and postoperative bacteremia in 1 case. Bone graft fusion was in all case at the last follow-up. Of all cases at the last follow-up, the neurological function grade were improved significantly including grade D in 3 cases and grade E in 11 cases. VAS were improved significantly after operation ranged from (7.4±1.4) scores to (2.3±1.1) scores with significant difference(t=13.60,P=0.000).Conclusion Pyogenic spondylitis caused by Staphylococcus aureus is easily misdia-gnosed as spinal tuberculosis before operation. Operative risks include incision nonunion and bacteremia after operation. Operative effect can be satisfactory when preoperative diagnosis, operative indication and management of related complications is accurate and timely.

Efficacy analysis of posterior lumbar interbody fusion for lumbar Brucellar spondylitis

,Wei TANG,Abulizi Dilixiati,Liang MA,Jie. SHENG

Chinese Journal of Antituberculosis. 2018, 40(5):  462-465.  doi:10.3969/j.issn.1000-6621.2018.05.005

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Objective To investigate the surgical efficacy of posterior lumbar interbody fusion (PLIF) in treating lumbar Brucellar spondylitis patients with single-segment involvement.Methods The clinical data were collected from 67 lumbar Brucellar spondylitis patients with single-segment involvement who received PLIF surgery in Xinjiang Uygur Autonomous Region Chest Hospital from January 2010 to January 2015. Among them, 49 patients were male, and 18 were female. The mean age was (49.9±13.0) years. There were 24 cases with Frankel Grade E, 24 with Grade D, and one with Grade C before the surgery. Under general anesthesia, all patients underwent posterior pedicle screw fixation, unilateral laminectomy and fenestration, debridement, and autologous bone interbody fusion. Patients were followed up postoperative. The visual analogue scale score (VAS) and Frankel classi-fication were evaluated, rythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were measured, and Brucella serum agglutination test was conducted. Also, frontal and lateral X-ray and CT scan were performed to assess the extent of postoperative bone graft healing.Results All of the 67 patients were confirmed Brucella infection by postoperative pathology. The mean operation time was (101±23) minutes and the mean blood loss was (95.22±56.87) ml. No spinal cord, nerve and blood vessel injury occurred during operation. Three to 7 days after surgery, frontal and lateral X-ray results showed no loosening of the internal fixation and good position of the bone graft. Three patients experienced (cerebrospinal fluid) CSF leakage after operation, but all were cured after 2 weeks of treatment. The patients were followed up for 9 to 24 months. At the last follow-up, no internal fixation was loosened, and no nail or rod was broken. No patient recurred. There was no delayed healing and sinus formation. The VAS score was (7.16±0.91) before surgery, and (4.19±0.92), (3.06±0.92), (1.48±0.59) and 0 at 1-, 3-, 6- and 12-month time-point after surgery; significant improvement in VAS score was observed after operation at different time points (F=355.95, P<0.01). The ESR and CRP levels became normal 6 months later after operation. The result of Brucella serum agglutination test 9 months postoperatively indicated that all patients became negative. Frontal and lateral X-ray and CT scan showed that all patients achieved good bone graft fusion. According to the Bridwell criteria for postoperative graft bone healing, all patients achieved Grade I. The neurological function was significantly improved: the Frankel’s Grade was restored from Grade C to E in one patient and from Grade D to E in 24 patients.Conclusion PLIF is a safe and effective method in treating lumbar Brucellar spondylitis.

Single-stage debridement, spinal fusion and internal fixation through a posterior approach for eradication of pyogenic spondylodiscitis: a clinical observational study

Kai TANG,Shi-bing QIN,Wei-Jie DONG,Ting-long LAN,Jun FAN,Guang-xuan YAN,Heng. WANG

Chinese Journal of Antituberculosis. 2018, 40(5):  466-471.  doi:10.3969/j.issn.1000-6621.2018.05.006

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Objective

To evaluate the feasibility, clinical and radiological outcome of single-stage debridement, spinal fusion and internal fixation through a posterior approach in the surgical management of patients with pyogenic spondylodiscitis.Methods From January 2012 to December 2016, 31 inpatients (19 males and 12 females; aged 33-79 years; mean age, 60.7±11.2 years) suffering from pyogenic spondylodiscitis were included. All the patients received a single-step radical debridement of the infected intervertebral disc space, posterior screw-and-rod instrumentation and spinal fusion. Intravenous or oral antibiotics were continued for 12 weeks postoperatively and patients were followed up routinely after the operation. The lesion was located in lumbar spine in 23 patients and thoracic spine in 8 patients. There were 17 patients with neurological dysfunction before the operation, among which 15 cases of ASIA D, 1 case of ASIA C and 1 case of ASIA B. At 1, 3, 6 and 12 months after surgery, X-ray, three-dimensional CT scan and MRI were performed. The changes in pain scores (visual analogue score, VAS) and nerve function based on ASIA classification and the correction of Cobb’s angles were assessed for efficacy evaluation.Results The operation time ranged 112-300 min (mean (184.9±46.9) min). The intraoperative blood loss was 200-1400 ml (mean (537.1±286.6) ml). All patients were followed up for (42.3±15.4) months on average (ranged 12-71 months). One of the 31 patients demonstrated of recurrent infection (3.2% (1/31)). The postoperative VAS scores of pain at 3 months (3.06±1.59), 6 months (1.77±1.28), 12 months (1.03±1.22), and last follow-up (0.42±0.85) were significantly decreased when compared with preoperative score (6.74±1.13) (t values were 13.15, 19.73, 18.12, 24.73, all P values <0.05). Postoperative neurological function was improved after surgery, 16 cases were restored to ASIA E and 1 was restored to ASIA D. The preoperative Cobb’s angle was (26.4±16.8)°in thoracic spine and (31.0±3.2)° in the lumbar spine. One month after operation, these Cobb’s angles improved to (21.4±14.6)° and (21.3±5.2)°, representing mean corrections of 5.0° and 9.7° in the thoracic and lumbar spines, respectively. The differences were statistically significant (t values were 4.41, 13.09, all P values <0.05). At last follow-up, these Cobb’s angles were (22.5±15.0)° and (23.8±4.8)°, representing mean losses of 1.1°(t=3.81, P<0.05) and 2.5° (t=15.30, P<0.05) in the thoracic and lumbar spine, respectively.Conclusion Single-stage debridement, spinal fusion and internal fixation through a posterior approach is an effective and feasible surgical method for pyogenic spondylodiscitis.

Surgical curative effects of Gram-negative bacterial suppurative vertebral osteomyelitis:report of 13 cases

Guang-xuan YAN,Shi-bing QIN,Ting-long LAN,WEI-jie DONG,Jun. FAN

Chinese Journal of Antituberculosis. 2018, 40(5):  472-478.  doi:10.3969/j.issn.1000-6621.2018.05.007

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Objective To explore the surgical curative effect of Gram-negative bacterial vertebral osteomyelitis (GNB VO).Methods Between Jan 2007 and Dec 2016, 13 GNB VO patients underwent surgery in Beijing Chest Hospital were analyzed in this study. All of the 13 cases had high risk factors or history of infection. The pathogenic bacteria include 9 cases of escherichia coli, 2 cases of klebsiella pneumoniae, 1 case of pseudomonas aeruginosa and 1 case of enterobacter cloacae. The changes of visual analogue scale score (VAS), WBC, neutrophile granulocyte, ESR, CRP before and after surgery were evaluated. Bone fusion at 12 months follow-up has also been observed. The paired samples t-test was performed to assess the differences,which were considered statistically significant at P<0.05.Results The VAS, WBC, neutrophile granulocyte, ESR, CRP ((1.46±0.78) score, (7.14±1.20)×10 ⁹/L, 0.69±0.03, (10.29±4.82) mm/1 h, (3.57±2.07) mg/L) at the final follow-up were significantly improved than that before surgery ((7.38±1.19) score, (15.93±2.82)×10 ⁹/L, 0.80±0.02, (72.71±18.45) mm/1 h, (53.20±18.25) mg/L) (t were 33.34, 8.99, 6.40, 9.21 and 6.67, respectively;Ps=0.000).Thirteen patients who received sensitive antibiotic combined surgery were cured after 12-16 weeks treatment. One case with klebsiella pneumoniae infection which turned into fistula at 2 weeks after surgery, was cured after 3 times vacuum sealing drainage dressing treatment. All cases had bone fused without recurrence at 12 months follow-up.Conclusion The cases of GNB VO could be cured by combination of sensitive antibiotic and surgery, and the duration of sensitive antibiotic is no less than 12-16 weeks.

One stage debridement and internal fixation of bone combined with drainage in treating non-specific primary thoracolumbar infection

Feng-sheng LIU,Chen-guang JIA,Zhuo LI,Li-ming YAO,Xiao-wei YAO,Wei LIU,Lian-bo WANG,Zhao-liang DONG

Chinese Journal of Antituberculosis. 2018, 40(5):  479-484.  doi:10.3969/j.issn.1000-6621.2018.05.008

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Objective To investigate the effect and value of one stage debridement and internal fixation of bone combined with drainage on treating non-specific primary thoracolumbar infection.Methods The pre- and post-operation clinical data were collected from 46 patients with primary thoracolumbar non-specific infection admitted in the department of orthopedics of the Chest Hospital of Hebei Province from July 2012 to June 2016. Those patients included 4 cases with infection in thoracic, 5 cases in thoracolumbar, 33 cases in lumbar, and 4 cases in lumbosacral. All patients received anti-inflammatory treatment for 2 to 4 weeks before operation. One stage debridement and internal fixation of bone combined with drainage was conducted. The average drainage time after operation was (14.0±4.3) days, ranged from 3 to 28 days. Pain relief, infection control situation, time to getting the patient out of bed after surgery, recovery of neurological function, and bone graft fusion were observed, and the efficacy was evaluated.Results Among the 46 cases in this study, 15 cases were bacterial culture positive, with a positive rate of 32.6%. The visual analogue scale (VAS) score at the third week was (2.59±0.20); compared with preoperative (7.09±0.25), the difference was statistically significant (t=11.35, P<0.05). The erythrocyte sedimentation rate (ESR) at the third week after operation was (43.30±3.13) mm/1 h; compared with preoperative (65.98±4.56 mm/1 h), the difference was statistically significant (t=5.45, P<0.05). The C-reactive protein (CRP) at the third week after operation was (17.15±1.10) mg/L; compared with preoperative (34.54±2.43 mg/L), the difference was statistically significant (t=9.63, P<0.05). One case received a second surgery, and the second surgery rate was 2.2% (1/46). Postoperative, the mean time of patients wearing a brace out of bed was (12.6±4.7) days, ranged from 5 to 21 days. Among the 12 patients with preoperative spinal cord nerve dysfunction, American Spinal Injury Association (ASIA) grade recovered form Grade A to Grade B in 1 case, and form A to C in 1 case, from B to C in 1 case, from B to D in 1 case, from C to D in 3 cases, and from C to E in 5 cases. The fusion time of interbody bone graft ranged from 3 to 12 months in 46 cases, and the mean fusion time was (7.6±1.8) months. According to the fusion standards, 35 cases were excellent, 9 were better, and 2 were good, resulting in an excellent and better rate of 95.7% (44/46).Conclusion For patients with non-specific primary thoracolumbar infection who has surgical indication, one stage debridement and internal fixation of bone combined with drainage is safe and feasible. It has the advantages of rapid infection control, pain relief, neurological recovery, and early ambulation and is an effective method in treating non-specific primary thoracolumbar infection.

Clinical analysis of lumbar Brucellar spondylitis treated by anterior oblique lumber interbody fusion

Ming-wei ZHAO,Wei-dong ZHOU,Quan-jun HU,Lei LI,Ming-lei ZHANG,Zhao-yang. LIU

Chinese Journal of Antituberculosis. 2018, 40(5):  485-489.  doi:10.3969/j.issn.1000-6621.2018.05.009

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Objective To explore the clinical value of anterior oblique lumber interbody fusion in the treatment of lumbar Brucellar spondylitis.Methods A retrospective analysis of 20 cases of lumbar Brucellar spondylitis treated by anterior oblique lumber interbody fusion from March 2015 to October 2017 was studied. The clinical symptoms, operative time, bleeding volume, complications, outcome, and bone graft fusion were investigated. The visual analogue score (VAS), white blood cells (WBC), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) before and after the operation were also analyzed.Results The operation time of the anterior opera-tion was 40-90 minutes, with an average of (65.00±8.21) min; the amount of bleeding was 200-400 ml, with an average of (290.53±37.25) ml. One case had peritoneal injury during exposure and received intraoperative repair; 1 case had sympathetic nerve injury resulted from lumbar 4/5 operation, 1 case had reoperation for post-operative contralateral nerve root pain, all were cured. The last follow-up VAS score (1.31±0.96; t=29.37, P=0.000), WBC ((4.56±1.02) ×10 ⁹/L; t=12.49, P=0.034), ESR ((25.53±3.56) mm/1h; t=39.93, P=0.000), and CRP ((13.61±7.65) mg/L; t=15.82, P=0.008) were significantly improved compared with the preoperative VAS score (7.43±1.07), WBC ((9.65±2.38)×10 ⁹/L), ESR ((81.22±12.27) mm/1h), and CRP ((59.08+20.39) mg/L). Follow up for 6 to 18 months, no recurrence occurred, and 20 cases were satisfied with bone graft fusion.Conclusion Lumbar interbody fusion with anterior oblique approach is an ideal minimally invasive technique for lumbar Brucellar spondylitis with less trauma, less bleeding, and rapid recovery.

A prospective study on occurrence of venous thromboembolism after spinal tuberculosis surgery

Jian-dong CHEN,Chen ZHANG,Rui-rui MIAO,Wen-long ZHANG

Chinese Journal of Antituberculosis. 2018, 40(5):  490-493.  doi:10.3969/j.issn.1000-6621.2018.05.010

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Objective To investigate the incidence of deep venous thromboembolism (DVT) after the operation of the patients with spinal tuberculosis, and to explore the necessity of adopting relevant measures to prevent occurrence of DVT during perioperative period.Methods This study was conducted in 146 patients with spinal tuberculosis who underwent surgery from the same group of physicians and did not receive anticoagulation from May 2012 to August 2017 in Haihe Hospital. Preoperative blood routine examination, coagulation index and double lower limb venous color Doppler ultrasonography were performed; after the operation, the double lower extremity venous color Doppler ultrasound were repeated, and follow-up for 3 months.Results Among the 146 patients who were confirmed to have no DVT before operation, the DVT was found in 11 cases and no pulmonary embolism (PE) cases were diagnosed. The spontaneous incidence of DVT after spinal tuberculosis surgery was 7.53%. All patients with postoperative DVT after 7-10 days of operation had the calf muscle venous thrombosis which located in the far beyond the knee. The patients had no obvious clinical symptoms and did not receive related treatment. The DVT disappeared after 3 months of review of doppler ultrasound.Conclusion In the perioperative period of spinal tuberculosis operation, DVT have a higher natural incidence without anticoagulation. All patients with DVT do not have serious consequences, and the perioperative period of spinal tuberculosis do not need conventional drugs to prevent DVT.

The effect of 3D printing technology and education on preoperative improvement of negative emotion in patients with thoracic tuberculosis

Jia-mei ZHENG,Li-xia HUANG,Min WANG,Yang-hui JIN

Chinese Journal of Antituberculosis. 2018, 40(5):  494-498.  doi:10.3969/j.issn.1000-6621.2018.05.011

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Objective To explore the influence of 3D printing technology and education on preoperative improvement of negative emotions in thoracic spinal tuberculosis patients.Methods Between January 2016 and December 2017 in Orthopedics Department of Integrated Chinese and Western Medicine Hospital of Zhejiang Province, 42 patients with thoracic tuberculosis were enrolled. By the coin cast method, two wards were randomly divided into control group and observation group (21 cases in each group). Patients in the control group were given routine nursing, whereas patients in the observation group were given routine care and individual education using 3D print model. The average number of preoperative daily wakes, self-rating anxiety scale (SAS), self-perceived burden scale (SPBS), and self-rating depression scale (SDS) scores were compared, and the influence of 3D printing technology and education on preoperative improvement of negative emotions was assessed in patients with thoracic spinal tuberculosis.Results The number of daily wakes of the observation group was (0.95±0.86), lower than that in the control group (3.66±1.31)(t=7.90, P<0.05). The preoperative SAS score of the observation group (43.40±6.53) was significantly lower than that of the control group (58.45±7.78), the SPBS score (27.09±6.13) was significantly lower than that of the control group (34.43±5.97), and the SDS score (41.45±5.72) was significantly lower than that of the control group (53.26±7.53) (t=6.79,t=3.93,t=5.72,P<0.01). The satisfaction scores of the preoperative care and education in the control group and the observation group were (85.56±7.97) and (94.35±7.56), respectively; the difference was statistically significant (t=3.67, P=0.001).Conclusion Using 3D printing technology to produce equal proportion models and then performing preoperative education can reduce the number of patients’ daily wakes, improve the patients’ negative emotions, and enhance the patients’ satisfaction with nursing staff.

The similarities and differences of HRCT imaging features between nontuberculous mycobacterial lung diseases and active pulmonary tuberculosis

Fang LI,Wei HE,Xin-hua ZHOU,Chun-sheng ZHAO,Yan LYU,Cheng-hai LI,Dong-po. WANG

Chinese Journal of Antituberculosis. 2018, 40(5):  499-505.  doi:10.3969/j.issn.1000-6621.2018.05.012

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Objective To investigate the similarities and differences of imaging features between nontuberculous mycobacterial (NTM) lung diseases and pulmonary tuberculosis(PTB).Methods CT features of 74 inpatients from Jan,2012 to Dec,2017 with pulmonary NTM infection were retrospectively analyzed and compared with that of 100 case with PTB in random selection in the corresponding period. The sites and morphological features of the lesion were analyzed.SPSS 17.0 software was used, count data using χ ² test. P<0.05 was considered to be statistically different.Results Comparing the image types of the two group, nodular bronchiectsis type in NTM group (51.4%,38/74)were more than in tuberculosis group(14.0%,14/100), there was a significant difference between the two groups (χ ²=28.316, P=0.000), the nodular/mass type in tuberculosis group (21.0%,21/100)was more than that in the NTM group(8.1%,6/74), there was a significant difference between the two groups(χ ²=5.392,P=0.020). The dominant sites in the upper lobe of pulmonary tuberculosis(82.0%,82/100)was more than that of NTM group (59.5%,44/74), there was a significant difference(χ ²=10.817,P=0.001). The detection rate of NTM in middle lobe of right lung and (or)pulmonary lingual segment (16.2%,12/74) was higher than that of pulmonary tuberculosis (5.0%,5/100),there was a significant difference(χ ²=6.069,P=0.014);and the detection rate of bronchiectasis of tuberculosis group(61.0%,61/100) was less than that of NTM group(93.2%,69/74);the dominant sites of bronchiectasis in NTM group(39.1%,27/69) in middle lobe and(or)pulmonary lingual segment was more than that of pulmonary tuberculosis group (13.1%,8/61)(χ ²=11.138,P=0.001),the dominant sites of bronchiectasis in pulmonary tuberculosis group (70.5%,43/61)in upper lobe was more than that of NTM group (39.1%,27/69) (χ ²=12.813,P=0.000),the detection rate of consolidation in pulmonary tuberculosis group(86.0%,86/100) was higher than that of NTM group (67.6%,50/74)(χ ²=8.465,P=0.004),the subpleural cavity in NTM group(95.1%,39/41) was significantly more than that in pulmonary tuberculosis group(61.8%,42/68)(χ ²=14.909,P=0.000);There were differences in the size of nodules in the lung between two groups, nodules <1cm were more common in NTM group(88.5%,54/61)than that in pulmonary tuberculosis group (54.9%,50/91),there was a significant difference(χ ²=19.059.P=0.000),various size nodules was more common in PTB group(41.9%,29/91) than that in NTM group(8.2%,5/61),there was a significant difference(χ ²=11.784.P=0.001).In addition the detection rate of complicated pleural effusion in pulmonary tuberculosis group(34.0%,34/100)was higher than that of NTM group(20.3%,15/74), there were signifcant differences(χ ²=3.963, P=0.047). Conclusion Chest HRCT image features are similar in NTM lung disease and PTB, but there are differences.The image classification,the distribution and dominant sites of bronchiectasis, the incidence of consolidation and the size of nodules may be helpful to differential diagnosis. The detailed analysis of image features and closely combining with the clinical data can be helpful to diagnosis.

Resistance of MDR-TB and XDR-TB strains to SQ109 and the relationship with Beijing genotypes

Wen-zhu DONG,Zheng WANG,Shu-an WEN,Ting-ting ZHANG,Feng-min HUO,Ling-ling DONG,Yun-xu LI,Li-ping ZHAO,Hai-rong HUANG,Fei GAO,Yu PANG

Chinese Journal of Antituberculosis. 2018, 40(5):  506-511.  doi:10.3969/j.issn.1000-6621.2018.05.013

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Objective To evaluate the susceptibility of multi-drug resistant tuberculosis (MDR-TB) and extensively drug-resistant tuberculosis (XDR-TB) strains against SQ109, an analogue of ethambutol (EMB, a new anti-TB drug), and to provide evidence for the clinical application of SQ109.Methods Two hundred and twenty three strains including 109 MDR-TB and 114 XDR-TB were collected from the patients seeking health care in Beijing chest hospital from July 2014 to December 2016. The minimum inhibitory concentrations (MIC) of MTB isolates against SQ109 were detected by broth dilution micro-plate alamar blue assay. The epidemiological cutoff (ECOFF) value was determined on the basis of distribution of MIC values. RD207 gene was used to distinguish Beijing genotype and non-Beijing genotype. Difference in SQ109 resistance rates between groups was compared. According to the results of clinical drug sensitivity test, the EMB resistant strains were isolated, and SQ109 resistance rate was compared between EMB resistant and sensitive strains.Results The ECOFF value was determined to be 1.000 mg/L according to the frequency distribution of MIC against SQ109. The resistance rate was 4.4% (5/114) and 0.0% among XDR-TB and MDR-TB isolates, respectively. There was no statistical difference in SQ109-resisitant rate between MDR-TB and XDR-TB (Fisher exact probabilities, P>0.05). Eight isolates out of 109 MDR strains and 10 isolates out of 114 XDR strains were classified as non-Beijing genotype. The resistant rate of the Beijing geno-type strain was 2.4% (5/205), while no non-Beijing genotype strain harbored SQ109 resistance. Statistical analysis revealed that no significant difference was observed in SQ109 resistance rate between Beijing and non-Beijing group (Fisher exact probabilities, P>0.05). Of the 223 strains, there were 138 EMB sensitive strains and 85 EMB resistant strains. Among EMB sensitive strains, only one was resistant strain against SQ109, and the resistance rate was 0.7% (1/138). Among the EMB resistant strains, 4 strains were resistant to SQ109, and the resistance rate was 4.7% (4/85). The difference in SQ109 resistance rate between EMB sensitive and resistant strains was not statistically significant (Fisher exact probabilities, P>0.05).Conclusion SQ109 exhibits favorable efficacy against MDR- and XDR-TB isolates in vitro. In addition, there is no statistical correlation between SQ109 resistance and Beijing genotype or between EMB resistance and SQ109 resistance.

Evaluation of the effect of vitamin D on adjuvant therapy in the Guinea Pig model of tuberculosis

Fei-yong RAN,Lei FU,Bin WANG,Shao-chen GUO,Yu LU,Xiao-you CHEN

Chinese Journal of Antituberculosis. 2018, 40(5):  512-518.  doi:10.3969/j.issn.1000-6621.2018.05.014

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Objective To establish the chronic Guinea Pig model of tuberculosis and to evaluate the role of adjuvant therapy with Vitamin D.Methods Forty-eight Guinea Pigs infected with Mycobacterium tuberculosis standard strain (H37Rv) were randomly divided into blank control group, daily regular dosage of vitamin D group, single high dosage of vitamin D group taken every other week, isoniazid and rifampicin group, isoniazid and rifampicin plus daily regular dosage of vitamin D group, and isoniazid and rifampicin plus high dosage of vitamin D taken every other week group according to different treatment plans. There were 8 Guinea Pigs in each group. Four weeks after infection, we initiated treatment. 4 Guinea Pigs in each group were weighed, sacrificed, and dissected 4 weeks and 8 weeks after treatment. Later we counted the colony forming unit (CFU). We also performed the pathological examination in lungs and spleens.Results Our model animals had good tolerance and there was no death in each group throughout the infection and treatment. When compared to the control groups, the CFU counts of lungs and spleens of the Guinea Pigs did not decline, and the pathological changes of lungs and spleens did not improve in the two groups treated with vitamin D alone. Besides, after 4 weeks of treatment the CFU of lungs and spleens were (4.98±0.26) lgCFU and (4.02±0.03) lgCFU in the group of isoniazid and rifampicin and (4.39±0.11) lgCFU and (2.30±0.43) lgCFU in the group of isoniazid and rifampicin plus a single high dosage of vitamin D. When compared the group of isoniazid and rifampicin plus a single high dosage of vitamin D every other week with the group of isoniazid and rifampicin alone, the CFU counts decreased by 0.59 lgCFU in lungs and 1.72 lgCFU in spleens. After 8 weeks of treatment the CFU of lungs and spleens were (3.73±0.23) and (2.26±0.24) lgCFU in the group of isoniazid and rifampicin, and the CFU of lungs were (3.21±0.23) lgCFU and spleens were amicrobic in the group of isoniazid and rifampicin plus a single high dosage of vitamin D. When compared the group of isoniazid and rifampicin plus a single high dosage of vitamin D every other week with the group of isoniazid and rifampicin alone, the CFU counts decreased by 0.52 lgCFU in lungs and 2.26 lgCFU in spleens. Also the pathological changes of spleens in the group of isoniazid and rifampicin plus a single high dosage of vitamin D after 4 weeks of treatment improved and so as the lungs in the same group but of 8 weeks of treatment. The CFU of spleens were (2.36±0.10) lgCFU in the group of isoniazid and rifampicin plus daily regular dosage of vitamin D after 4 weeks of treatment. When compared the group of isoniazid and rifampicin plus daily regular dosage of vitamin D with isoniazid and rifampicin alone, the CFU of spleens decreased by 1.66 lgCFU after 4 weeks of treatment.Conclusion In the chronic tuberculosis model of Guinea Pig, vitamin D shows the effect as an adjuvant therapy when combined with isoniazid and rifampicin. It can be further studied to be used for clinical practice.

The investigation of current status of administrative controls on tuberculosis infection control in tuberculosis outpatient departments and laboratories in 12 provinces and its principal component analysis

Xiao-ning WANG,Tian-lun HE,Meng-jie GENG,Yu-dan SONG,Fei ZHAO,Guang-xue HE

Chinese Journal of Antituberculosis. 2018, 40(5):  519-524.  doi:10.3969/j.issn.1000-6621.2018.05.015

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Objective To analyze the implementation status of administrative controls of tuberculosis (TB) infection control in TB outpatient clinics and laboratories at all levels, and to find the principal component index in order to provide references for regulating the implementation of administrative controls in these facilities.Methods On-site observation and inquiry were used to investigate the implementation of administrative controls in TB outpatient clinics and laboratories of 212 TB control facilities. The survey contents included totally 14 items, such as early detection, isolation, health promotion and the using of spittoon with cover, etc. Data were analyzed in descriptive analysis and principal component analysis.Results The rates of implementation of providing health promotion materials in TB outpatient clinics, cough screening for patients and preferentially accepting sputum sample of suspected TB patients in laboratories were higher, which were separately 88.2% (187/212), 85.4% (181/212) and 84.9% (180/212). The rates of implementations of providing separate waiting rooms and spittoons with cover in TB outpatient clinics for patients with cough were lower, which were 54.2% (115/212) and 47.6% (101/212) respectively. Fourteen items of administrative controls were generalized into seven principal components: the comprehensive factor of separating patients and preferentially seeing a doctor in TB outpatient clinics, the factor of early separating patients in TB outpatient clinics, the factor of self-separating of patients, the factor of TB health promotion in out-patient departments, the factor of preferentially accepting sputum sample of suspected patients in laboratories, the factor of placing spittoon with cover in outpatient department and the factor of designating sputum collection area in outpatient department.Conclusion The implementation of administrative controls in different level TB facilities are insufficient. The principal component analysis transforms factors into seven comprehensive factors to reflect the implementation of administrative controls in TB outpatient departments and laboratories of TB facilities, and a comprehensive evaluation model is made according to seven principal factors and their contribution rates.

Analysis of chemotherapy efficacy and its influencing factors of multi-drug resistant pulmonary tuberculosis patients

Chang-lin BAO,Heng-zhong YI,Yi TANG,De-hua GONG,Zhen TAN,Yan-ping. WAN

Chinese Journal of Antituberculosis. 2018, 40(5):  525-530.  doi:10.3969/j.issn.1000-6621.2018.05.016

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Objective To Analysis of chemotherapy efficacy and its influencing factors of multi-drug resistant pulmonary tuberculosis patients.Methods Two hundred and sixty-senven patients with MDR-PTB of Hunan Chest Hospital were collected who conformed China Global Fund TB Program Inclusion Requirements Confirmed. The patients were adopted multi-drug resistant tuberculosis standardized chemotherapy(6Z-Km(Am,Cm)-Lfx(Mfx)-Cs(PAS,E)-Pto/18-Z-Lfx(Mfx)-Cs(PAS,E)-Pto) and individualized chemotherapy to treat. Treatment effect (including healing, completion of treatment, death, failure, loss and other) and influencing factors (Including gender, age, occupation, registration classification, drug resistance, history of previous anti-tuberculosis drug treatment, treatment options, complications, adverse drug reactions, and the medication was regular or not) of 267 patients were analyzed. Univariate analysis using χ ² test and multivariate analysis using binary logistic regression analysis, P<0.05 was considered statistically significant. Results The therapeutic effect of 267 patients with MDR-PTB included 138 cases cured (51.7%), 13 cases completed course of treatment (4.9%), 10 cases deaths (3.7%), 23 cases failed (8.6%), loss of 78 cases (29.2%) and other 5 cases (1.9%). Single factor analysis of affecting the cure rate showed treatment programs (individualized program: 38.0% (27/71), standard chemotherapy program: 56.6% (111/196)), complication (appeared 39.7%(27/68), not appeared 55.8%(111/199)), medical side effects (appeared 31.1%(32/103), not appeared 64.6%(106/164)), taking medicine regularly or not ( regular 94.9%(129/136); not regular 6.9%(9/131)). The four factors was a related factor affecting the treatment effect. (χ ²=7.224,P=0.007;χ ²=5.243,P=0.022;χ ²=28.545,P=0.000;χ ²=206.846,P=0.000). Conclusion Multivariate regression analysis showed that regular medication (Wald χ ²=84.656,P=0.000;OR(95%CI)=229.019(71.974-728.737)) was a protective factor for successful treatment of multidrug-resistant tuberculosis patients. Complication (Wald χ ²=9.652,P=0.002;OR(95%CI)=0.138(0.040-0.482)) and medical side effects (Wald χ ²=5.317,P=0.021;OR(95%CI)=0.313(0.117-0.840)) were risk factor for successful treatment of multidrug-resistant tuberculosis patients.

Conclusion

The efficacy of chemotherapy for MDR-TB patients was not ideal having More influencing factors. Adherence to regular medication, treating actively other diseases and reducing adverse drug reactions could improve the efficacy of chemotherapy in patients with multi-drug resistant tuberculosis.

Review Articles

Study progress on early diagnosis of spinal tuberculosis

Wei-guang WU,Hai-long GUO

Chinese Journal of Antituberculosis. 2018, 40(5):  531-534.  doi:10.3969/j.issn.1000-6621.2018.05.017

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Spinal tuberculosis commonly secondary to pulmonary tuberculosis. In the late stage of the disease, the large paraspinal abscess and fistula can be formed, the nervous system complications can be happened, even leading to paralysis. So early diagnosis of spinal tuberculosis is significantly important. With the deepening of understanding to spinal tuberculosis in recent years, many new findings have been made in early diagnosis of the disease. In this article, we presented the results of a literature review on the study progress of spinal tuberculosis early diagnosis.

Clinical Case Discussion

A case of hematogenous disseminated tuberculosis complicated with myelodysplastic syndrome

Yan-hua SONG,Rong-yan QI,Li-ping MA,Fan-yong LYU,Rong-mei LIU,Meng-qiu GAO

Chinese Journal of Antituberculosis. 2018, 40(5):  535-542.  doi:10.3969/j.issn.1000-6621.2018.05.018

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Hematogenous disseminated tuberculosis is a kind of severe tuberculosis. With hysteresis imaging performances, the symptoms are often untypical, it is difficult to diagnose early. MDS is malignant,without specific clinical manifestations and abnormal performance of the blood system. A case of disseminated tuberculosis complicated with severe hematogenous cell loss in our hospital in April 2017 was reported. The patient presented with “dizziness and fatigue for 3 months, fever for 2 month”was firstly treated with anti-tuberculosis treatment, and then the clinical symptoms, pulmonary lesions and the performance of the blood system improved. The pulmonary lesions were further improvingd, while the blood system abnormalities were aggravated again. Finally, the blood disease was diagnosed as MDS with repeated bone marrow examination. This report aimed to improve the diagnosis and share treatment experience of disseminated tuberculosis complicated with MDS.

Short Articles

Application value of GeneXpert MTB/RIF system in diagnosis of pulmonary tuberculosis

Wei WANG,Qing-shan LYU,Qin-long YU,Heng-wei CHEN,Wei-feng SHEN

Chinese Journal of Antituberculosis. 2018, 40(5):  543-547.  doi:10.3969/j.issn.1000-6621.2018.05.019

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To evaluate the application value of GeneXpert MTB/RIF system in the diagnosis of pulmonary tuberculosis (TB) among the TB suspects who sought health care for the first time. A total of 361 TB suspects, who visited Jiaxing 1st Hospital to seek health care for the first time from Jan 2015 to Dec 2016, were consecutively enrolled in the study. The sputum specimens were collected from those patients and smear microscopy, liquid culture, GeneXpert MTB/RIF test and solid drug susceptibility testing (DST) by using proportion method were performed. Finally, 184 cases (50.97%) were confirmed to have pulmonary TB while 162 cases (44.88%) were diagnosed to be pulmonary infections and 15 cases (4.15%) were diagnosed to be pulmonary infections caused by atypical mycobacteria. Among 361 TB suspects, the positive rate of GeneXpert MTB/RIF was 32.41% (117/361), which was significantly higher than the smear-positive rate (22.71%, 82/361) (χ ²=8.49, P<0.05); but the difference of the positive rate between GeneXpert and liquid culture (26.32%, 95/361) was not statistically significant (χ ²=3.23, P=0.072); the smear-positive rate was lower than that of liquid culture (26.32%, 95/361), but the difference was not statistically significant (χ ²=1.26, P=0.261). Among 184 cases with pulmonary TB, the positive rate of GeneXpert MTB/RIF was 63.59% (117/184) which was significantly higher than the smear-positive rate (36.41% (67/184)) and the liquid culture positive rate (48.91% (90/184)) respectively (χ ²=27.17, P<0.01; χ ²=8.05, P<0.05). Among 117 smear-negative pulmonary TB patients, the positive rate of GeneXpert MTB/RIF was 42.74% (50/117), which was significantly higher than that of liquid culture (24.79%, 29/117) (χ ²=8.43, P=0.004). If the clinical diagnosis result was regarded as a standard, the sensitivity of GeneXpert in TB suspects, who sought health care for the first time, was 63.59% (117/184), its specificity was 100.00% (177/177) and its correct indices was 0.64; if the result of solid DST with proportion method was regarded as a standard, the sensitivity of GeneXpert in TB suspects, who sought health care for the first time, was 4/5, its specificity was 97.70% (85/87) and its correct indices was 0.97. GeneXpert MTB/RIF technique has demonstrated a high capacity on detection of tuberculosis and rifampicin resistant TB in TB suspects, especially in smear-negative pulmonary TB patients.

Analysis of pulmonary tuberculosis epidemics in Chongming District of Shanghai from 2011 to 2015

Huan LU,Cheng HUANG

Chinese Journal of Antituberculosis. 2018, 40(5):  548-552.  doi:10.3969/j.issn.1000-6621.2018.05.020

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There were 878 cases of pulmonary tuberculosis (PTB) patients in Chongming District registered in the National Tuberculosis Information Management System from 2011 to 2015, including 337 cases of smear-positive patients and 515 cases of smear-negative patients. The incidence rates of smear-positive and smear-negative cases were 9.57/100 000 (337/3 519 800) and 14.63/100 000 (515/3 519 800) respectively, and there was no statistically significant difference in the incidence of PTB in 5 years (χ ²=4.58, P=0.330). The registered death rate was 1.11/100 000 (39/3 519 800) and the registered mortality rate was 0.44/100 000 (39/878). There were 662 men and 216 women, constituted 75.40% (662/878) and 24.60% (216/878). There was statistically significant difference in the sources of PTB patients (χ ²=38.54, P=0.001). The main sources of PTB were “Symptomatic visit” and “Referral”, which accounted for 77.22% (678/878) and 21.07% (185/878) respectively. Among the 878 patients, the most frequent time of onset was in June, accounting for 10.36% (91/878), while the lowest incidence was observed in February, accounting for 5.92% (52/878). The incidence rates of PTB among floating population and household population in 5 years were 13.57/100000 (105/773 700) and 28.15/100000 (773/2 746 100) respectively, with statistically difference (χ ²=51.44, P<0.01). There was no statistically significant difference in the proportion of TB cases in all age groups (χ ²=26.84, P=0.310), and the higher number of cases was over 65 years and 55-65 years, which accounted for 29.84% (262/878) and 20.27% (178/878). Farmers (27.90%, 245/878) and retired (21.07%, 185/878)were main occupations. Among 337 smear positive cases, 297were cured, and the cure rate was 88.13%. Among 541 smear-negative patients, 496 were successfully treated, and the treatment success rate was 91.68%. In 2011-2015, the TB control in chongming district was slightly effective, and the incidences of male, household and middle aged people were higher, which should be paid more attention to.