Table of Content

10 March 2020, Volume 42 Issue 3

Previous Issue    Next Issue

Standard·Guide·Consensus

Guidelines on surgical treatment of osteoarticular tuberculosis in facing novel coronavirus pneumonia

The Group of Osteoarticular Tuberculosis

Chinese Journal of Antituberculosis. 2020, 42(3):  185-190.  doi:10.3969/j.issn.1000-6621.2020.03.001

Abstract ( 473 )   HTML ( 20 )   PDF (1156KB) ( 338 )   Save

References | Related Articles | Metrics

In December 2019, a novel coronavirus pneumonia (NCP) caused by the SARS-CoV-2 was first reported in Wuhan, China, then spread domestically and internationally. As the epidemic quickly develops, some health care providers were infected, which had significant impacts on hospital activities, including routine work in the departments of respiratory, tuberculosis, and thoracic surgery. Likewise, the epidemic makes a significant effect on health care for osteoarticular tuberculosis. In order to prevent the SARS-CoV-2 infection, here we provide some necessary suggestions for health care providers in the department of osteoarticular tuberculosis surgery. (1) During the epidemic, the NCP screening and diagnosis should be performed routinely, in-home treatment is preferred while in-hospital treatment should be a subordinary option. (2) All clinical practices should be performed based upon the “One Patient One Room” principle. (3) Elective operations are not recommended and should be postponed. (4) In cases when the operation is required, the patient should be isolated for at least 2 weeks and tested negative for SARS-CoV-2 RT-PCR twice. (5) If patients have spinal cord injury and other life-threatening complications that requires emergency operation, the RT-PCR test must be performed before the operation. Regardless of the results, grade 3 protection should be applied in the operation, and negative pressure operating room is recommended. Disinfection and isolation measures should be implemented strictly. (6) After the operation, take precautions with postoperative complications, especially with screening suspected patients for NCP.

Expert Note

Reflections on the prevention and control of tuberculosis among Chinese students

Qian GAO,Jian MEI

Chinese Journal of Antituberculosis. 2020, 42(3):  195-199.  doi:10.3969/j.issn.1000-6621.2020.03.003

Abstract ( 660 )   HTML ( 41 )   PDF (1059KB) ( 527 )   Save

References | Related Articles | Metrics

Tuberculosis prevention and control in school is one of the critical tasks in China’s tuberculosis prevention and control program. School tuberculosis control involves thousands of families, has strong political significance, with any slightly inappropriate policy, which will cause significant social impact. This article puts forward some different perspectives on the critical population of school tuberculosis, the definition of public health outbreaks, and the issue of student patients returning to school. We are advocating the attention and discussion among colleagues and provide a scientific basis for the government to formulate a practical and effective school tuberculosis control strategy.

Application status and suggestion of quality of life scale for pulmonary tuberculosis patients

Xi-fang LIU,Gai-xia MA,Jie GAN,Zhen-hui LU,Hui-yong ZHANG,Xiao-yan GUO

Chinese Journal of Antituberculosis. 2020, 42(3):  200-203.  doi:10.3969/j.issn.1000-6621.2020.03.004

Abstract ( 621 )   HTML ( 12 )   PDF (1117KB) ( 402 )   Save

References | Related Articles | Metrics

Pulmonary tuberculosis is a chronic infectious disease that seriously affects the quality of life of patients. Truly and accurately reflecting the quality of life of pulmonary tuberculosis patients is an important means to evaluate the clinical efficacy of pulmonary tuberculosis. Through reviewing relevant literatures, the current quality of life scale for pulmonary tuberculosis patients is divided into two categories, including the universal scale and the specific scale for tuberculosis patients. The universal scale mainly includes 36-item Short Form Health Survey (SF-36), World Health Organization Quality of Life Scale (WHOQOL-100), Symptom Check List 90 (SCL-90), Karnofsky Performance Status (KPS) Scale, European Five-dimensional Health Scale (EuroQol, EQ-5 d), Kessler Psychological Distress Scale (Kessler-10, K-10). The specific scale for tuberculosis patients mainly includes Health Behavior Scale of Tuberculosis (HBSOT), Quality of Life Assessment Tools (QLI-TB), DR-12 Scale, and Quality of Life Instruments for Chronic Disease-Pulmonary Tuberculosis Scale (QLICD-PT). The specific scales for tuberculosis patients are introduced in this paper. Some comments and suggestions are proposed to better realize clinical application and evaluation.

Original Articles

Analysis of CT imaging findings appearing as focal ground glass opacity in patients with pulmonary tuberculosis

Yan LYU,Jue WANG,Fang LI,Wei HE,Zhen ZHOU,Jing MU,Xin-hua ZHOU

Chinese Journal of Antituberculosis. 2020, 42(3):  204-209.  doi:10.3969/j.issn.1000-6621.2020.03.005

Abstract ( 1084 )   HTML ( 8 )   PDF (1477KB) ( 388 )   Save

Figures and Tables | References | Related Articles | Metrics

Objective To investigate the characteristics of CT images of focal ground glass opacity (fGGO) in patients with pulmonary tuberculosis in order to improve the understanding of rare signs. Methods Eleven cases of pulmonary tuberculosis admitted in Beijing Chest Hospital from 2009 to 2019 were collected as pulmonary tuberculosis group (totally 11 fGGO lesions) including 7 cases by composite reference standard (CRS), 3 cases by surgical pathology and 1 case by percutaneous lung puncture. According to the ratio of 1∶4, 44 cases with lung cancer confirmed by surgical pathology in our hospital during the same period were selected as the lung cancer group (totally 44 fGGO lesions). The CT image characteristics of fGGO lesions in the two groups were analyzed. Results The fGGO lesions in patients with pulmonary tuberculosis and lung cancer were distributed in the upper lobe (63.6% (7/11) vs. 65.9% (29/44)), the middle lobe (9.1% (1/11) vs. 11.4% (5/44)), and the lower lobe (27.3% (3/11) vs. 22.7% (10/44)) without statistically significant difference (χ ²=2.608,P=0.106). The characteristics of fGGO imaging with round or oval (36.4% (4/11)), clear interface between lesion and lung tissue (9.1% (1/11)), and the lobulation sign (0.0% (0/11)) in the pulmonary tuberculosis group were significantly lower than those (77.3% (34/44),93.2% (41/44),43.2% (19/44)) in the lung cancer group with statistically significant differences (χ ²=5.114,P=0.024;χ ²=29.974,P=0.000;χ ²=5.473,P=0.019). The features of fGGO imaging with internal homogeneous density (9.1% (1/11)), bronchial shadow or vacuoles (0.0% (0/11)), thickened or twisted vessels (0.0% (0/11)) in the pulmonary tuberculosis group were significantly lower than those (54.5% (24/44), 38.6% (17/44) and 77.3% (34/44)) in the lung cancer group with statistically significant differences (χ ²=7.333,P=0.007;χ ²=4.475,P=0.034;χ ²=19.108,P=0.000). However, the frequency of the multiple nodular lesions (90.9% (10/11)) in the pulmonary tuberculosis group were significantly higher than that (0.0% (0/44)) in the lung cancer group with statistically significant difference (χ ²=42.969,P=0.000). Conclusion The distribution of fGGO lesions is not specifically different in two groups. But the characteristic of fGGO imaging with blurred edges, no lobulation sign, no pleural depression, internal inhomogeneous density inside the lesion, no bronchial shadow or vacuoles, no thickened or twisted vessels, and multiple cluster-like noduleshave certain reference value for differential diagnosis in pulmonary tuberculosis from lung cancer.

Diagnostic value of pulmonary tuberculosis with cluster-like micronodule in chest CT imaging

Fang LI,Ping-xin LYU,Wei HE,Yan LYU,Cheng-hai LI,Xin-hua ZHOU

Chinese Journal of Antituberculosis. 2020, 42(3):  210-214.  doi:10.3969/j.issn.1000-6621.2020.03.006

Abstract ( 1402 )   HTML ( 11 )   PDF (1326KB) ( 484 )   Save

Figures and Tables | References | Related Articles | Metrics

Objective To investigate the value of diagnosis and differential diagnosis in pulmonary tuberculosis patients with cluster-like micronodular lesions in chest CT imaging. Methods A retrospective analysis was performed in 74 patients with cluster-like micronodule confirmed by CT from January 2016 to August 2019 in Beijing Chest Hospital including 70 patients diagnosed as active tuberculosis by clinical or laboratory examination, two cases diagnosed as non-specific inflammation and two cases diagnosed as sarcoidosis. This study focused on the CT scan features in 70 patients diagnosed as pulmonary tuberculosis including the distribution of cluster-like micronodular lesions, distribution patterns, morphological features, and CT signs of other morphologic lesions coexisting in the lungs Results The CT scan of 70 patients with pulmonary tuberculosis showed that cluster-like micronodular lesions were distributed in the apicoposterior segment of the upper lobe in both lungs in 49 (70.0%) cases and multiple nodules in 49 (70.0%) cases. The image features showed in four patterns: homogenous pattern (47.1%,33/70), halo pattern (25.7%,18/70), reversed halo pattern (18.6%,13/70) and mixed pattern (8.6%,6/70). There were 29 cases (41.4%) with uniform nodule size and 41 cases (58.6%) with different sizes which partial focus were fused. Except the cluster-like micronodular lesions, in other parts of lung there were coexisting one morphology lesions showing consolidation-like shadows, cavities, nodular-like lesions or fibrous cord-like lesions in 10 cases (14.3%), two kinds of the forms (as above)in 15 cases (21.4%),three kinds of the forms (as above) in 16 cases (22.9%) and four kinds of the forms (as above) in 6 cases (8.6%). Mediastinal and/or hilar lymphadenopathy occurred in 14 cases (20.0%). There were pleural effusion in 9 cases (12.9%). Sarcoidosis and non-specific inflammation also showed cluster-like micronodular lesions in each two cases which were similar to the imaging features of pulmonary tuberculosis. Conclusion CT scans show cluster-like micronodular lesions, whether single localization or multiple distribution, they should be considered as a more common and atypical form of secondary tuberculosis. It should be paid more attention in practice.

Analysis of CT signs of ileocecal tuberculosis, carcinoma and lymphoma

Meng HONG,Li-fang GUO,Jia GUO,Xiao-jiao GUAN,Ren-gui WANG

Chinese Journal of Antituberculosis. 2020, 42(3):  215-221.  doi:10.3969/j.issn.1000-6621.2020.03.007

Abstract ( 1201 )   HTML ( 5 )   PDF (1563KB) ( 447 )   Save

Figures and Tables | References | Related Articles | Metrics

Objective To investigate the characteristics of CT signs in ileocecal tuberculosis, cancer and lymphoma, and to improve the diagnosis and differential diagnosis of ileocecal diseases. Methods The data of 16 cases of ileocecal tuberculosis (tuberculosis group), 40 cases of ileocecal carcinoma (cancer group) and 14 cases of ileocecal lymphoma (lymphoma group) from the imaging database of Beijing Shijitan Hospital affiliated to Capital Medical University from February 2008 to September 2019 were retrospectively analyzed, and the CT features of the three groups of diseases were compared. Results (1) The intestinal length of ileocecal tuberculosis, cancer and lymphoma were (9.5±2.9) cm, (4.7±1.4) cm, and (9.0±2.7) cm respectively, and the differences of intestinal length were statistically significant (t=8.046, P=0.000; t=7.309, P=0.000).The thicknesses of diseased intestine in three groups were (1.6±0.3) cm, (2.3±0.7) cm, and (2.3±0.6) cm, and the differences of thickness of diseased intestine were statistically significant, between the tuberculosis group and the cancer group, the tuberculosis group and the lymphoma group (t=3.177, P=0.002; t=2.082, P=0.037).(2) The tuberculosis group and the lymphoma group mainly showed uniform thickening of the intestinal wall. The incidence rates of homogeneous thickening of the intestinal wall in the three groups were 62.5% (10/16), 22.5% (9/40) and 57.1% (8/14), and the differences were statistically significant between the tuberculosis group and the cancer group, the cancer group and the lymphoma group (χ ²=8.157, P=0.004; χ ²=5.770, P=0.016).The main manifestation of the cancer group was irregular lump-like lesions in the intestinal wall. The incidence rates of irregular thickening of the intestinal wall in the three groups were 37.5% (6/16), 77.5% (31/40) and 42.9% (6/14), and the differences were statistically significant between the tuberculosis group and the cancer group, the cancer group and the lymphoma group (χ ²=8.157, P=0.004; χ ²=5.770, P=0.016). The incidence rates of fuzzy boundary between healthy and pathologic intestinal canal were 87.5% (14/16), 30.0% (12/40) and 21.4% (3/14) respectively, and the differences were statistically significant (χ ²=15.190, P=0.000; Fisher P=0.001) between the tuberculosis group and the cancer group, the tuberculosis group and the lymphoma group. The incidence rates of mild misty mesentery were 25.0% (4/16), 77.5% (31/40) and 92.9% (13/14), and the differences were statistically significant between the tuberculosis group and the cancer group, the tuberculosis group and the lymphoma group (χ ²=13.440, P=0.000; Fisher P=0.000).The incidence rates of severe misty mesentery were 75.0% (12/16), 22.5% (9/40), 7.1% (1/14) respectively, and the differences were statistically significant between the tuberculosis group and the cancer group, the tuberculosis group and the lymphoma group (χ ²=13.440, P=0.000; Fisher P=0.000). Conclusion The length and thickness of the diseased intestine, the boundary between lesions and normal intestine, mild or severely turbidity of the mesentery, and other CT signs were different in ileocecal tuberculosis, cancer and lymphoma, and CT scans help clarify the diagnosis.

Magnetic resonance neuroimaging differential diagnosis of tuberculous meningitis and toxoplasmosis encephalopathy in HIV infected individuals

Qi-yi CHEN,Jing-jing LI,Yun-liang XU,Zhi-bin LYU,Lian-gui WEI,Dong-hai XU,Ru-ming XIE,Bu-dong CHEN

Chinese Journal of Antituberculosis. 2020, 42(3):  222-226.  doi:10.3969/j.issn.1000-6621.2020.03.008

Abstract ( 567 )   HTML ( 3 )   PDF (2788KB) ( 182 )   Save

Figures and Tables | References | Related Articles | Metrics

Objective To summarize the MR imaging characteristics of tuberculous meningitis (abbr. “TBM”)and toxoplasmosis encephalopathy(abbr. “TE”) in HIV infected individuals with different CD4 ⁺ T cell levels. Methods From January 2008 to January 2018, 46 patients with central nervous system infection were selected among HIV-infected patients admitted to Beijing Ditan Hospital, Capital Medical University. Among them, 21 cases were TE patients with a total of 89 lesions (TE group), 25 cases were TBM patients with a total of 174 lesions (TBM group). Differences in MR images between CD4 ⁺ T cells less than 15 and more than 15 cells/μl were evaluated, inclding lesion distribution, morphology, size, DWI and ADC characteristics, and degree of peripheral edema. Results The proportion of lesions in cortex and subcortex among all lesions within TE group and TBM group were: CD4 ⁺ T cells less than 15 cells/μl, 83.0% (44/53) and 45.8% (33/72), with statistically significant difference (χ ²=24.203, P=0.000); CD4 ⁺ T cells more than 15 cells/μl, 77.8% (28/36) and 59.8% (61/102), with no statistically difference (χ ²=5.076, P=0.079). When CD4 ⁺ T cells were less than 15 cells/μl, the proportion of nodular lesions among all lesions within TE group and TBM group were 54.7% (29/53) and 75.0% (54/72) respectively, with statistically significant difference between the two groups (χ ²=5.629, P=0.018). When CD4 ⁺ T cells were more than 15 cells/μl, the proportions of plaque-shaped circular lesions in those two groups were 88.9% (32/36) and 64.7% (66/102) respectively, with statistically significant difference between the two groups(χ ²=7.560, P=0.006). When CD4 ⁺ T cells were more than 15 cells/μl, the proportion of lesions with low and high DWI signal were 41.6% (15/36), 27.8% (10/36) within TE group, and 7.8% (8/102), 41.2% (42/102) within TBM group,difference of low, middle and high DWI signal proportion between TE and TBM group was statistically significant(χ ²=21.964, P=0.000). Additionally, proportion of lesions with low and high DWI signal were 22.2% (8/36), 41.7% (15/36) within TE group, and 40.2% (41/102), 9.8% (10/102) within TBM group, differences were statistically significant too(χ ²=18.440, P=0.000). Conclusion The MR images of TBM and TE patients in HIV infected individuals with different CD4 ⁺ T cell count levels are different in lesion distribution, morphology, DWI and ADC signal characteristics.

Value of CT scan for diagnosis and differential diagnosis of diffuse peritoneal lesions

Meng HONG,Li-fang GUO,Jian-mei ZHANG,Meng-jun WANG,Ren-gui WANG

Chinese Journal of Antituberculosis. 2020, 42(3):  227-232.  doi:10.3969/j.issn.1000-6621.2020.03.009

Abstract ( 572 )   HTML ( 6 )   PDF (1583KB) ( 222 )   Save

Figures and Tables | References | Related Articles | Metrics

Objective To analyze CT imaging characteristics of three common diffuse peritoneal lesions,and to explore the value of CT in the diagnosis and differential diagnosis of diffuse peritoneal lesions. Methods We retrospectively analyzed characteristics of CT imaging in 72 cases with diffuse peritoneal lesions, including 16 cases with tuberculous peritonitis (TBP), 34 cases with peritoneal metastasis (PM),22 cases with peritoneal mesothelioma (PMM). Results (1) The incidence rates of uniform peritoneal thickening were 62.5% (10/16) in TBP, 23.5% (8/34) in PM, 27.3% (6/22) in PMM, the differences between TBP and PM, TBP and PPM were statistically significant (χ ²=5.221,P=0.022; χ ²=10.795,P=0.010); the incidence rates of omentum majus dirt-like thickening were 43.8% (7/16) in TBP, 2.9% (1/34) in PM, 13.6% (3/22) in PMM, the differences between TBP and PM, TBP and PPM were statistically significant (χ ²=14.567,P=0.000; χ ²=4.332,P=0.037); the incidence rates of “omentum cake sign” were 6.2% (1/16) in TBP, 50.0% (17/34) in PM, 27.3% (6/22) in PMM, there was statistically significant difference between TBP and PM (χ ²=9.039,P=0.003), but difference was not statistically significant between TBP and PMM (χ ²=1.216,P=0.270); the incidence rates of nodules or mass thickening of greater omentum were 12.5% (2/16) in TBP, 14.7% (5/34) in PM, 50.0% (11/22) in PMM, the differences were statistically significant between TBP and PMM,PM and PMM (χ ²=5.788,P=0.016;χ ²=8.153,P=0.004). (2) The incidence rates of medium and small amount of ascitic fluid were 75.0% (12/16) in TBP, 32.4% (11/34) in PM, 40.9% (9/22) in PMM, there were statistically significant differences between TBP and PM,TBP and PMM (χ ²=7.966,P=0.005;χ ²=4.354,P=0.037); the incidence rates of large amount of ascitic fluid were 25.0% (4/16) in TBP, 67.6% (23/34) in PM, 59.1% (13/22) in PMM,there were statistically significant differences between TBP and PM,TBP and PMM (χ ²=7.966, P=0.005; χ ²=4.354, P=0.037). (3) The incidence rates of cardiac phrenic angle lymphadenopathy were 6.2% (1/16) in TBP, 5.9% (2/34) in PM, 40.9% (9/22) in PMM, the incidence differences between PMM and TBP, PMM and PM were statistically significant (χ ²=5.739,P=0.017;χ ²=10.382,P=0.001). Conclusion The specific visual characteristics on CT imaging, such as the location of peritoneal lesions, morphology, ascitic fluid and lymph nodes are of great value in the differential diagnosis of peritoneal diffused lesions.

Study on chest CT findings of 55 patients with HIV-negative pulmonary cryptococcosis

Ming-hui ZHANG,Qiu-di ZHANG,Su-juan ZHANG,Yi-fang SUN

Chinese Journal of Antituberculosis. 2020, 42(3):  233-239.  doi:10.3969/j.issn.1000-6621.2020.03.010

Abstract ( 529 )   HTML ( 7 )   PDF (1653KB) ( 283 )   Save

Figures and Tables | References | Related Articles | Metrics

Objective The aim of the study is to explore the characteristics of chest CT in patients with HIV-negative pulmonary cryptococcosis (PC) and patients with different immune status. Methods The clinical data and chest CT manifestation of 55 patients with clinical diagnosed HIV-negative PC from January 2012 to August 2018 in the Third affiliated Hospital of Soochow University and the People’s Hospital of Linyi of Shandong Province were collected, including 36 immunocompetent patients and 19 immunocompromised patients. Fifty cases were pathologically diagnosed after biopsy or surgery, one case was diagnosed by bronchoscopic alveolar lavage fluid culture, four cases were diagnosed by cryptococcus capsule polysaccharide antigen latex agglutination test and successful antycryptococcal therapy. The types, characteristics, distribution, accompanying signs of lung lesions and the incidence of imaging signs in immunocompetent patients and immunocompromised patients were analyzed. Results Among the 55 patients, single/multiple pulmonary nodules/masses were the most common (76.4%, 42/55), followed by 10 cases (18.2%) of patchy consolidation, and only 3 cases (5.4%) of mixed type; 39 (70.9%) cases lesions were distributed in a single lobe, of which, 24 (61.5%) were located in the lower lobe; 45 (81.8%) cases were located in the lung periphery; 22 (40.0%) cases were surrounded by satellite foci and ground glass opacity (4 cases, 7.3%), and pleural effusion (2 cases, 3.6%), mediastinal or hilar lymphadenopathy (3 cases, 5.4%) were rare. In 45 cases of nodules/masses, 29 (64.4%) cases were well-defined, 25 (55.6%) cases accompanied with halo sign, 17 (37.8%) cases showed air bronchogram, and 19 (42.2%) cases had spiculation sign, including 4 (21.0%) cases with spinous process and 8 (17.8%) cases with cavity. Among the 29 lesions involving the pleura, 18 (62.1%) were adjacent to the pleural with a wide base. According to the contrast-enhanced CT, 88.2% (15/17) cases were uniformly enhanced, and 76.5% (13/17) were mildly enhanced. Compared with the immunocompromised patients, single nodules/masses were more common (50.0% (18/36) vs. 21.0% (4/19), χ ²=4.342, P=0.037), while the satellite opacities and cavity formation rate were significantly lower (30.6% (11/36) vs. 57.9% (11/19), χ ²=3.873, P=0.049; and 9.4% (3/32) vs. 38.5% (5/13), Fisher’s exact test, P=0.034, respectively) than those in immunocompetent patients. Conclusion Single or multiple pulmonary nodules/masses were the most frequent CT findings in patients with HIV-negative PC. The lesions were more common in the lower lobe and peripheral zone. Halo sign and air bronchogram were more common CT signs. Nodules or masses were more frequently adjacent to the pleural with wide base. Immunocompetent patients were more likely to have a single pulmonary nodules/masses but not satellite opacities and cavity.

The value of energy spectrum CT imaging in the differential diagnosis of pulmonary tuberculosis nodules and silicosis nodules

Yi ZHU,Rong-rong LIU,Jing LIU,Min LI

Chinese Journal of Antituberculosis. 2020, 42(3):  240-244.  doi:10.3969/j.issn.1000-6621.2020.03.011

Abstract ( 492 )   HTML ( 9 )   PDF (2718KB) ( 289 )   Save

Figures and Tables | References | Related Articles | Metrics

Objective To explore the value of energy spectrum CT imaging in differential diagnosis of pulmonary tuberculosis nodules and silicosis nodules. Methods Thirty-five cases of pulmonary tuberculosis (127 nodules; PTB group) and 30 cases of silicosis (180 nodules; silicosis group) diagnosed by energy spectrum CT scan from February to December 2018 in the Fifth People’s Hospital of Suzhou were enrolled in this study. The concentration of SiO₂ (H₂O) based substances, effective atomic number (EAN) and slope of curve in 40-70 keV range were obtained by energy spectrum analysis. Results The median (quartile) concentration of SiO₂ (H₂O) based substances in PTB group and in silicosis group were 170 (101,241) mg/cm ³ and 353 (260,454) mg/cm ³ respectively, with statistically significant difference (Z=-24.95, P=0.000); the mean EAN in PTB group and silicosis group were 9.29±0.83 and 10.68±0.98 respectively, with statistically significant difference (t=29.96, P=0.000); the average slope of the energy spectrum curve in PTB group and silicosis group were 5.95±2.19 and 10.80±2.48, the difference between those two groups was statistically significant (t=-17.96, P=0.000). When the threshold of the concentration of SiO₂ (H₂O) based substances was 275 mg/cm ³, the area under the ROC curve was the largest (0.95), and the sensitivity and specificity were 87.40% and 90.56% respectively. Conclusion The concentration of SiO₂(H₂O)based substances, EAN and slope of energy spectrum curve in energy spectrum CT are helpful for differential diagnosis of PTB nodules and silicosis nodules, among them the concentration of SiO₂ (H₂O) based substances is of higher value especially.

Comparative analysis of two-dimensional ultrasonography and pathology in cervical lymph node tuberculosis

Shuang-shuang JIANG,Hai-lun ZHENG,Li-ya CAO,Ping LUO

Chinese Journal of Antituberculosis. 2020, 42(3):  245-248.  doi:10.3969/j.issn.1000-6621.2020.03.012

Abstract ( 1043 )   HTML ( 7 )   PDF (1936KB) ( 536 )   Save

Figures and Tables | References | Related Articles | Metrics

Objective This study aimed to analyze the two-dimensional ultrasonographic manifestations of cervical lymph node tuberculosis and then compare with pathological results. Methods A total of 101 lymph nodes in 63 patients with cervical lymph node tuberculosis who were admitted to Beijing Research Institute for Tuberculosis Control from September 2015 to August 2019 were collected, including 16 males (25.4%) and 47 females (74.6%); with age from 18 to 70 years, and the median age (quartile) was 29 (25, 43) years. The ultrasonographic manifestations and pathological results of patients with cervical lymph node tuberculosis were retrospectively analyzed. Results In 63 patients, 27 cases (42.9%) involved bilateral neck, 14 cases (22.2%) involved left, and 22 cases (34.9%) involved right. According to the international general 7 partition method, among these 101 involved lymph nodes, 3 (2.9%) lymph nodes were located in the submandibular and submental region (level Ⅰ), 84 (83.2%) lymph nodes were located around the sternocleidomastoid muscles (level Ⅱ, Ⅲ,Ⅳ), 14 (13.9%) lymph nodes were located in the supraclavicular region and posterior triangle (level Ⅴ), and none was located in the anterior region of neck (level Ⅵ) and the high mediastinum region (level Ⅶ). The involved lymph nodes were mostly elliptic and quasi-circular, and most of them were scattered, while a few of them were fused with each other. According to the ultrasonographic manifestations, 101 involved lymph nodes could be divided into five types, including 18 (17.8%) of solid inflammatory type, 39 (38.6%) of caseous necrosis type, 19 (18.8%) of peripheral inflammatory type, 6 (6.0%) of abscess sinus type, and 19 (18.8%) of healing calcification type. Conclusion The two-dimensional ultrasonographic manifestations of cervical lymph node tuberculosis are closely related to its pathological changes The ultrasound sonogram can intuitively reflect the various stages of the lesion, and can be used as the preferred imaging method for the disease.

Analysis of influencing factors of medication adherence among 120 newly diagnosed patients with multi-drug resistant pulmonary tuberculosis

Yuan-yuan YOU,Guo-long ZHANG,Yu CHEN

Chinese Journal of Antituberculosis. 2020, 42(3):  249-254.  doi:10.3969/j.issn.1000-6621.2020.03.013

Abstract ( 514 )   HTML ( 27 )   PDF (803KB) ( 240 )   Save

Figures and Tables | References | Related Articles | Metrics

Objective To analyze the influencing factors of medication adherence among patients with multidrug-resistant pulmonary tuberculosis (MDR-PTB) and to provide a basis for exploring and formulating diagnosis and treatment, management policies and measures for patients with MDR-PTB. Methods The cluster sampling method was used to collect the medical records and follow-up records of 120 newly diagnosed MDR-PTB patients who were diagnosed and treated and completed 24 months of follow-up at Henan Infectious Diseases Hospital during October 2015 to March 2017. A questionnaire survey on core knowledge of tuberculosis prevention was conducted by trained questionnaire surveyors to 120 newly diagnosed MDR-PTB patients, the valid withdrawal of the questionnaire was 120 with the withdrawal rate of 100.00%.The treatment compliance and its influencing factors were analyzed by unconditional dichotomous logistic regression analysis of univariate and multivariate. Results Among the 120 cases of newly diagnosed MDR-PTB, 85 cases had good medication adherence and 35 cases had medication adherence. Multivariate regression analysis showed that: poor family economic status (Wald χ ²=5.483, P=0.019, OR=6.27, 95%CI=2.51-13.92), adverse drug reactions (Wald χ ²=7.038, P=0.008,OR=4.73, 95%CI=1.95-10.17), poor awareness of core knowledge on tuberculosis prevention (Wald χ ²=4.621, P=0.032, OR=2.07, 95%CI=1.03-5.65) and self-medication (Wald χ ²=5.925, P=0.010, OR=2.45, 95%CI=1.92-7.01) were the main risk factors for treatment compliance. Conclusion Poor family economic status, adverse drug reactions, self-medication and poor awareness of core knowledge on tuberculosis prevention were the main risk factors for medication adherence, which can be used for reference in exploring and formulating MDR-PTB patients diagnosis and treatment, management policies and measures.

Clinical characteristics and treatment outcomes of 18 patients with non-tuberculosis mycobacteria concerning eyes, ears, nose and throat

Yi-luan JIAN,Long-zhang WU,Zhuo-yun GU

Chinese Journal of Antituberculosis. 2020, 42(3):  255-258.  doi:10.3969/j.issn.1000-6621.2020.03.014

Abstract ( 478 )   HTML ( 12 )   PDF (722KB) ( 191 )   Save

Figures and Tables | References | Related Articles | Metrics

Objective To analyze the clinical characteristics, therapeutic schemes and treatment effects of non-tuberculosis mycobacteria (NTM) diseases concerning eyes, ears, nose and throat (EENT). Methods Retrospective analysis on clinical data of 18 patients diagnosed with NTM diseases concerning EENT from January 2010 to January 2013 in Guangzhou Chest Hospital was performed, including five cases with cornea NTM, six with auris media NTM, two with nasopharynx NTM and the rest five with larynx NTM. Summary analysis was carried out based on the detailed record of strain identification, drug sensitivity results, clinical characteristics, therapeutic schemes and treatment effects. Results Patients with cornea NTM were mainly characterized with the clinical manifestation of corneal ulcers, those with auris media NTM were primarily accompanied by tympanic membrane perforation and purulent discharge, and the rest with nasopharynx NTM and larynx NTM mainly presented with neoformations, local ulcers and increasing secretions in nasopharynx and larynx. A total of 39 NTM strains were isolated from the secretions of 18 patients, of which 9, 7 and 2 were Mycobacterium chelonae-abscessus complex, Mycobacterium avium-intracellulare complex and Mycobacterium fortuitum, respectively. Result of drug sensitivity indicated that the strains were resistant to isoniazide, rifampicin, ethambutol, streptomycin, levofloxacin, moxifloxacin, pasiniazid, rifabutin, protionamide, capreomycin and ciprofloxacin. Oral treatment was performed with levofloxacin or moxifloxacin, amikacin sulfate, clarithromycin sustained release tablets, clindamycin palmitate hydrochloride dispersible tablets and ethambutol, and local therapy was also performed with macrocyclic lipids and aminoglycosides according to the drug sensitivity. All the 18 patients finally got better with symptoms disappearing and lesion sites healing. Conclusion Most NTM diseases concerning EENT had resistance to the antituberculosis drugs. In light of the characteristics and treatment effects of lesion sites, local application of amikacin sulfate was adopted accordingly before the drug sensitivity result. When the result was obtained, a good treatment effect could be achieved by systemic medication and local therapy with sensitive drugs.

Analysis of clarithromycin resistance and its influencing factors in 254 patients with drug-resistant tuberculosis

Tian-hui GAO,Wei SHU,Jing-tao GAO,Yu LU,Qi LI

Chinese Journal of Antituberculosis. 2020, 42(3):  259-265.  doi:10.3969/j.issn.1000-6621.2020.03.015

Abstract ( 946 )   HTML ( 8 )   PDF (773KB) ( 290 )   Save

Figures and Tables | References | Related Articles | Metrics

Objective To analyze the clarithromycin resistance and related risk factors in drug-resistant tuberculosis patients, and provide reference for the clinical application of clarithromycin. Methods The clinical data and drug sensitivity test results (referred to as “drug sensitivity tests”) of 254 patients diagnosed with drug-resistant tuberculosis in Beijing Chest Hospital affiliated to Capital Medical University from January 2017 to January 2018 were collected for retrospective analysis. Among them, the sensitivity of 16 kinds of antituberculosis drugs including clarithromycin was tested using the proportional method. Logistic regression was used to analyze clinical relevant influencing factors for clarithromycin resistance. Results (1) Among 254 patients with drug-resistant tuberculosis, 17 multi-drug resistant/extensive drug-resistant patients were resistant to clarithromycin, and the drug resistance rate was 6.69% (17/254), which was lower than the remaining 15 anti-tuberculosis drugs (12.60% (32/254) to 95.67% (243/254)). (2) The drug resistance rates of moxifloxacin (47.06%, 8/17), clofazimine (70.59%, 12/17), ethambutol (82.35%, 14/17), amikacin (52.94%,9/17), p-aminosalicylic acid (76.47%,13/17), para-aminosalicylic acid isoniazid (88.24%,15/17), and capreomycin (76.47%,13/17) of MDR/XDR-TB patients were higher in the clarithromycin-resistant group than that in the sensitive group (moxifloxacin (11.32%, 24/212), clofazimine (9.91%, 21/212), ethambutol (41.51%, 88/212), amikacin (21.70%, 46/212), P-aminosalicylic acid (35.85%, 76/212), para-aminosalicylic acid isoniazid (52.83%, 112/212), capreomycin (28.77%, 61/212), the differences were statistically significant (χ ² values were separately 16.721,46.987,10.628,6.793,10.930,7.986,16.370,P values were all <0.05). (3) Logistic regression results showed that the number of resistant drugs exceeding seven (OR(95%CI)=9.328 (2.058-42.290) was the risk factor for clarithromycin resistance. Conclusion The drug resistance rate of clarithromycin in drug-resistant tuberculosis patients is lower than that of other commonly used anti-tuberculosis drugs. It occurs more common in multidrug-resistant/extensive multidrug-resistant patients. The number of resistant drugs exceeding 7 is the main risk factor for patients resistant to clarithromycin.

Establishment and preliminary evaluation of a diagnostic model for the new patients with pathogen-negative pulmonary tuberculosis

Zhen-hua CHEN,Bin-bin LIU,Zhong-nan CHEN,Yun-hong TAN

Chinese Journal of Antituberculosis. 2020, 42(3):  266-271.  doi:10.3969/j.issn.1000-6621.2020.03.016

Abstract ( 514 )   HTML ( 13 )   PDF (834KB) ( 360 )   Save

Figures and Tables | References | Related Articles | Metrics

Objective To establish a diagnostic model for new patients with pathogen-negative pulmonary tuberculosis and improve the standardization and accuracy of clinical diagnosis. Methods From August 2017 to July 2019, the case information of 200 new patients with pathogen-negative pulmonary tuberculosis and 212 patients with non-tuberculous pulmonary disease who had been confirmed in Hunan Chest Hospital were collected. Inclusion criteria of patients were as follows: (1) age ≥15 years old; (2) pathogen-negative Mycobacterium tuberculosis; (3) never been treated with antituberculosis drugs or nonstandard chemotherapy for less than one month. These patients were divided into training and verification groups by a simple random number table, with the proportion of 3∶1. Univariate and multivariate unconditional logistic regressions were used to analyze main clinical observation indicators of training samples, and then the independent predictors were screened out and the diagnostic model was established. The receiver operating characteristic (ROC) curve analysis was used to evaluate the diagnostic performance of the model, taking the clinical diagnosis results of the training samples as the gold standard. A prospective assessment of the established diagnostic model was performed using the validation samples. Results Multivariate unconditional logistic regression analysis showed that serum albumin/globulin ratio (A/G)>1.2 (Wald χ ²=7.264, P=0.007, OR (95%CI)=3.433 (1.400-8.417)), serum carbohydrate antigen-125 (CA-125)>35 kU/L (Wald χ ²=17.114, P=0.000, OR (95%CI)=6.980 (2.780-17.524)), positive interferon-gamma release assay (IGRA) for whole-blood Mycobacterium tuberculosis (Wald χ ²=63.643, P=0.000, OR (95%CI)=19.283 (9.320-39.894)), coughing time ≥2 weeks (Wald χ ²=5.557, P=0.018, OR (95%CI)=0.434 (0.217-0.869)), hemoptysis or bloody phlegm (Wald χ ²=6.237, P=0.013, OR (95%CI)=0.255 (0.087-0.745)), poisoning symptoms of tuberculosis (Wald χ ²=24.930, P=0.000, OR (95%CI)=0.126 (0.056-0.284)), complicating with other diseases (Wald χ ²=12.062, P=0.001, OR (95%CI)=10.139 (2.743-37.746)), lesion site in the posterior segment of the upper lobe tip and/or the dorsal portion of the lower lobe on one or both sides of the lung (Wald χ ²=16.224, P=0.000, OR (95%CI)=4.428 (2.147-9.135)), and cavity formation (Wald χ ²=16.228, P=0.000, OR (95%CI)=14.437 (3.939-52.919)) were independent factors in the identification of pathogen-negative pulmonary tuberculosis and non-tuberculous pulmonary disease. The ROC curve analysis showed that area under the ROC curve (AUC) was 0.881 (95%CI: 0.839-0.915), the optimal cut-off value was 0.42, and the sensitivity and specificity for the diagnosis of pathogen-negative pulmonary tuberculosis were 86.67% and 76.10%, respectively. The total accurate discrimination rate of the diagnostic model in the validation group was 79.61% (82/103). Conclusion The diagnostic model shows high sensitivity and accuracy, and can be used as a reference tool for clinicians to diagnose new patients with pathogen-negative pulmonary tuberculosis.

Analysis of drug resistance in patients with smear-negative and culture-positive pulmonary tuberculosis in Guangdong province in 2016

Yan-mei CHEN,Xin-chun HUANG,Qi SUN,Chen-chen ZHANG,Wen-pei WEN,Liang CHEN

Chinese Journal of Antituberculosis. 2020, 42(3):  272-275.  doi:10.3969/j.issn.1000-6621.2020.03.017

Abstract ( 681 )   HTML ( 9 )   PDF (728KB) ( 336 )   Save

Figures and Tables | References | Related Articles | Metrics

Objective This study aimed to investigate the drug resistance status of patients with smear-negative while culture-positive pulmonary tuberculosis (PTB) in Guangdong province. Methods A total of 12323 newly diagnosed smear-negative PTB patients from 32 tuberculosis drug resistance surveillance sites in Guangdong province during January-December 2016 were collected as research subjects. After sputum culture, 1224 were culture positive, with culture positive rate of smear-negative of 9.9%. The results of strain identification tests indicated that 1177 cases (96.16%) were Mycobacterium tuberculosis complex, and 47 cases (3.84%) were nontuberculous mycobacteria (NTM). Then, drug sensitivity tests were performed on 1177 strains identified as Mycobacterium tuberculosis complex with 9 different anti-TB drugs, which were isoniazid (INH), streptomycin (Sm), rifampicin (RFP), ethambutol (EMB), kanamycin (Km), ofloxacin (Ofx), capriomycin (Cm), propionamide (Pto) and p-aminosalicylic acid (PAS). Results Totally, 12323 sputum isolates from newly diagnosed patients with smear-negative PTB were cultured, and the results showed that the total resistance rate was 29.57% (348/1177), including a multidrug resistance (MDR) rate of 2.38% (28/1177), extensive drug resistance (XDR) rate of 0.08% (1/1177), single drug resistance rate of 17.42% (205/1177), and a polyresistance rate of 9.77% (115/1177). We also found that the MDR rate (2.94%, 25/849) in men were significantly higher than those in women (0.91%, 3/328), with significant statistical differences (χ ²=4.19, P=0.040). There were 52 types of MDR spectrum, among which, INH+Sm resistant types were the most, accounting for 20.87% (24/1150, followed by Sm+Km resistant types, accounting for 9.57% (11/115). Conclusion Patients with smear-negative and culture-positive PTB in Guangdong province have a higher drug resistance rate. Monitoring and management should be strengthened to reduce the occurrence of drug-resistant tuberculosis.

Clinical Case Discussion

Clinical and CT characteristic of adrenal tuberculosis complicated with Addison’s disease

Cheng-qing YANG,Rong-hui DU,Tan-ze CAO,Meng ZHOU,Chun-lin MEI,Shu-fang CHEN,Jia-li OU

Chinese Journal of Antituberculosis. 2020, 42(3):  276-281.  doi:10.3969/j.issn.1000-6621.2020.03.018

Abstract ( 742 )   HTML ( 17 )   PDF (2006KB) ( 245 )   Save

Figures and Tables | References | Related Articles | Metrics

Addison’s disease is rare and in China, adrenal tuberculosis is the main cause. Clinical data of 2 cases of adrenal tuberculosis complicated with Addison’s disease in Wuhan Pulmonary Hospital and 135 cases of adrenal tuberculosis reported in literatures were collected. By analyzing the clinical characteristics, diagnosis and treatment, it is found that abdominal distention, accompanied with asthenia, poor appetite, nausea and vomiting, and pigmentation in the skin folds are the main clinical manifestations;and the enhanced and calcified peripheral ring is characteristic sign in CT scan.The manifestations of adreno-surgical tissue specimen, CT features of adrenal and extra-adrenal tuberculosis, evidence of tuberculosis infection in laboratory, and diagnostic anti-tuberculous drug treatment are all helpful to the diagnosis of adrenal tuberculosis. Besides the standardized anti-tuberculous drug treatment, the adrenal cortex replacement therapy is equally important.

Review Articles

Research progress of exosomal non-coding RNA as potential biomarkers of tuberculosis

Shu-hui GAO,Jun-wei ZHAO

Chinese Journal of Antituberculosis. 2020, 42(3):  282-285.  doi:10.3969/j.issn.1000-6621.2020.03.019

Abstract ( 508 )   HTML ( 4 )   PDF (736KB) ( 166 )   Save

References | Related Articles | Metrics

Tuberculosis is still a chronic infectious disease which is seriously harmful to human health. Exosome plays an important role in the occurrence and development of tuberculosis. Recently, more and more attention has been paid to the role of non-coding RNA in tuberculosis diagnosis. In this paper, the latest developments of exosome and Mycobacterium tuberculosis infection, exosomal non-coding RNA and tuberculosis diagnosis are reviewed, in order to provide a new idea for the study of early diagnosis, efficacy monitoring and prognosis estimation of tuberculosis from the perspective of exosomal non-coding RNA.

Research progress of new targets for antituberculosis agents

Hao CHEN,Nan-nan WU,Wen-hui HU,Zhong-jin YANG

Chinese Journal of Antituberculosis. 2020, 42(3):  286-292.  doi:10.3969/j.issn.1000-6621.2020.03.020

Abstract ( 814 )   HTML ( 26 )   PDF (2718KB) ( 543 )   Save

Figures and Tables | References | Related Articles | Metrics

Tuberculosis remains a health problem that threatens our country and the world. Bacterial resistance is becoming more and more serious due to bacterial mutations, irrational treatment options, and drug abuse, and drug-resistant tuberculosis has threatened the health and safety of all human beings. In the past decade,many new anti-tuberculosis drugs targeting various new targets of Mycobacterium tuberculosis have been gradually started clinical trials. This review analyzes the new targets for cell wall synthesis, protein synthesis and energy metabolism in the study of anti-Mycobacterium tuberculosis and briefly introduce some related new compounds,in order to provide reference for the development of anti-tuberculosis drugs.

Short Articles

Clostridium difficile-associated diarrhea caused by anti-tuberculosis drugs: a case report and literature review

Jing WANG,Meng ZHANG,Jian-qing HE

Chinese Journal of Antituberculosis. 2020, 42(3):  293-296.  doi:10.3969/j.issn.1000-6621.2020.03.021

Abstract ( 1019 )   HTML ( 18 )   PDF (1042KB) ( 293 )   Save

Figures and Tables | References | Related Articles | Metrics

Antimicrobial agent exposure is a risk factor for Clostridium difficile-associated diarrhea (CDAD), whereas the use of anti-tuberculous (anti-TB) drugs is rarely associated with it. This article reports a case of CDAD associated with anti-TB drugs, and reviews relevant literatures. A 32-year-old woman with pulmonary tuberculosis who had been treated with anti-TB agents for 9 months was admitted for abdominal pain and diarrhea. The test results of Clostridium difficile toxin and glutamate dehydrogenase (GHD) were both positive. Symptoms were relieved after anti-TB drugs were discontinued and treatment with vancomycin and bifidobacterium was given for 9 days. By reviewing literatures, the authors have discussed the pathogenesis, clinical manifestations, diagnosis and treatment of CDAD, in order to remind clinicians to understand the rare complications in the process of tuberculosis treatment, and to avoid pseudomembranous colitis (PMC) and other serious intestinal diseases by early diagnosis and intervention.