Table of Content

10 December 2020, Volume 42 Issue 12

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Expert Forum

Review of major achievements and problems to be solved in tuberculosis control and suggestions in China

XU Cai-hong, ZHOU Xiang-mei, FAN Wei-xing, ZHAO Yan-lin

Chinese Journal of Antituberculosis. 2020, 42(12):  1263-1267.  doi:10.3969/j.issn.1000-6621.2020.12.002

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Tuberculosis is a major public health problem of great concerns in China and the whole world. This article reviews and summarizes the main progress and achievements of tuberculosis control and prevention in China. Systematically analyzes the major issues and challenges of tuberculosis control and prevention in China, especially in the multi-sector cooperation, zoonotic tuberculosis, the role of Chinese traditional medicine in tuberculosis control and prevention et al. And finally, proposes the countermeasures and suggestions in the future.

Legislative considerations on traffic travel of MDR-TB/XDR-TB patients from the perspective of infectious disease prevention and control

SUN Ming-lei, GUAN Li, ZHAO Juan, WANG Chen, ZOU Dan-dan, LIANG Li-bo

Chinese Journal of Antituberculosis. 2020, 42(12):  1268-1271.  doi:10.3969/j.issn.1000-6621.2020.12.003

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MDR-TB and XDR-TB patients have always been a major problem in the prevention and control of tuberculosis. Travel by public transportation for MDR-TB/XDR-TB patients during the active period may increase the probability of transmission of tuberculosis. There is an urgent need to control MDR-TB/XDR-TB patients on traffic from a legislative perspective. Formulate and improve the travel laws and regulations for MDR-TB/XDR-TB patients, use the internet and big data as the support to realize the information sharing and online tracking of MDR-TB/XDR-TB patients in multiple departments and fields, and give full play to the active role of basic public health and primary medical institutions to achieve dynamic management of MDR-TB/XDR-TB patients. Improve the dynamic management system for registration, reporting, travel and treatment records and supervision of MDR-TB/XDR-TB patients. With strong legal support, using the advantages of network information technology, multiple departments coordinated and cooperated, give full play to the functions of tuberculosis patient management personnel and information monitoring personnel, and establish a complete patient network management procedure to promote the management and prevention and control of travel of patients with MDR-TB/XDR-TB.

Must value nutritional treatment of tuberculosis patients

ZHANG Sheng-kang, TONG Zhao-wei, TANG Han-mei, YAN Mi, YUAN Dan, TANG Xi-liang, SHEN Sheng-rong

Chinese Journal of Antituberculosis. 2020, 42(12):  1272-1275.  doi:10.3969/j.issn.1000-6621.2020.12.004

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Malnutrition is an important factor affecting the treatment effectiveness and prognosis of tuberculosis. At present, with the increase of diabetes, HIV infection patients getting tuberculosis and drug-resistant tuberculosis, nutrition issue have attracted more and more scholar’s attention. Evidence from multiple clinical studies shows that using certain nutrients or immune enhancers during the treatment of tuberculosis can improve the immunity of patients, promote calcification and repair of tuberculosis lesions, and reduce the incidence complications such as lung infections, lower death rate. Clinical nutrition has gradually changed from nutritional support to nutritional therapy.

Special Articles

Interpretation of Expert consensus on detection and clinical application of peripheral blood lymphocyte subsets in patients with tuberculosis

LIANG Jian-qin, WU Xue-qiong

Chinese Journal of Antituberculosis. 2020, 42(12):  1276-1279.  doi:10.3969/j.issn.1000-6621.2020.12.005

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The occurrence, development and prognosis of tuberculosis (TB) are closely related to immune resistance. The detection of peripheral blood lymphocyte subsets in TB patients is one of the methods to evaluate immune function, but the clinical application of this detection in TB is limited and the understanding is not uniform. “Expert consensus on detection and clinical application of peripheral blood lymphocyte subsets in patients with tuberculosis” published in No.10 of 2020 in Chinese Journal of Antituberculosis proposed specific suggestions and reached consensus on correct interpretation and clinical application of lymphocyte subsets detection results. This interpretation emphasizes that we should pay attention to the standardization and normalization of detection methods for peripheral blood lymphocyte subsets in TB patients, pay attention to the comprehensive, correct and objective analysis of the detection results, and put forward brief suggestions on the existing problems, to provide the reference of TB clinical workers of our country.

Original Articles

Preliminary study on detection method of MTB DNA by PCR amplification combined with CRISPR-Cas13a system

YU Jia-jia, ZHANG Xu-xia, ZHANG Yu-qing, REN Wei-cong, YAO Cong, LI Chuan-you, LIU Yi, TANG Shen-jie

Chinese Journal of Antituberculosis. 2020, 42(12):  1280-1288.  doi:10.3969/j.issn.1000-6621.2020.12.006

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Objective To establish a method for detection of Mycobacterium tuberculosis deoxyribonucleic acid (MTB DNA) by polymerase chain reaction (PCR) combined with CRISPR (clustered regularly interspaced short palindromic repeats)-Cas13a to identify target gene nucleic acid sequence. Methods IS6110 fragment of MTB conserved sequence was inserted into pMD ^TM19-Tsimple Vector cloning vector to construct simulated MTB plasmid containing the target sequence to be detected. At the same time, according to the conserved sequence IS6110 of MTB, three different specific probes (IS6110-1crRNA,IS6110-2crRNA,IS6110-3crRNA) of detecting MTB DNA with clustered regularly interspaced short palindromic repeats RNA (CRISPR RNA, crRNA) were designed, and used to guide CRISPR-Cas13a to recognize transcripts. PCR-CRISPR reaction system was constructed by mixing selected specific crRNA, PCR amplified transcripts of different samples, Cas13a, crRNA and Background RNA in proportion. Plasmid templates containing MTB DNA with different dilution concentrations, standard strain H37Rv and six kinds of non-tuberculous mycobacteria were detected by the fluorescence quantitative PCR instrument. The sensitivity and specificity of detection were analyzed by the measured relative fluorescence intensity (A value), and finally the PCR-CRISPR detection method based on MTB CRISPR-Cas13a system was established. Results IS6110-1crRNA with the strongest relative fluorescence intensity (A value:197680.64 (98364.94, 304271.25)) was selected as crRNA probe for subsequent MTB DNA detection. PCR-CRISPR detection of low copy number of 10¹ copies/μl plasmid and 10⁰ copies/μl H37Rv relative fluorescence intensity of amplification products (A values: 38655.34 (31975.51, 45410.32) and 17691.50 (17612.36, 17793.29), respectively) was obviously higher than that of negative control (29989.48 (29435.72, 30263.20) and 13725.83 (13652.43, 13804.95);Z=-6.713,-9.448;Ps<0.001), with better sensitivity.Negative control (37635.57 (37168.74, 38199.20)), Mycobacterium gordonae (39351.83 (38903.70,39769.53)),Mycobacterium intracellulare (39191.30 (39018.51,39434.95)), Mycobacterium kansasii (25172.20 (24586.95,26046.45)),Mycobacterium abscessus (37328.03 (36959.01,37546.78)),Mycobacterium avium (37942.29 (37455.63,38401.13)),Mycobacterium fortuitum (29491.19 (29148.63,30058.62)) were significantly lower than the 10⁶ copies/μl MTB DNA plasmid of relative fluorescence intensity (89204.07 (66253.60,108819.13))(Zs=-9.448,Ps<0.001), showing good specificity. Conclusion For the first time, we established and verified the PCR-CRISPR detection scheme and technology for MTB, which could be used to detect the presence of MTB in samples. The detection method is characterized by high sensitivity, high specificity, good stability and low cost, and is expected to be further used in the detection of clinical samples.

Drug resistance analysis of 154 Mycobacterium tuberculosis strains in southern Qinghai

JIANG Ming-xia, CHAO Xiu-zhen, WANG Zhao-fen, MA Bin-zhong, MA Yong-cheng, WANG Rong, WANG Chao-cai, LI Er-chen, WEI Yu-jia, LI Yong-xue, ZHANG Qi

Chinese Journal of Antituberculosis. 2020, 42(12):  1289-1293.  doi:10.3969/j.issn.1000-6621.2020.12.007

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Objective To understand the present situation and characteristics of Mycobacterium tuberculosis (MTB) drug resistance and to obtain the drug resistant spectrum of southern Qinghai Province, so as to provide reference for the prevention and control of the epidemic of drug-resistant tuberculosis in southern Qinghai. Methods One hundred and fifty-four strains were identified as MTB from 518 pulmonary tuberculosis patients with positive etiology who were detected in the south of Qinghai (Yushu Prefecture, Guoluo Prefecture, Huangnan Prefecture) from 2018 to 2019. The drug susceptibility tests of the above strains to 6 commonly used anti-tuberculosis drugs (isoniazid, rifampicin, ethambutol, streptomycin, kanamycin and ofloxacin) were carried out, and the drug resistance results were statistically analyzed. Results The overall drug resistant rate of the 154 MTB strains was 37.01% (57/154).The mono-resistant rate, poly-resistant rate and multi-drug resistant rate and rifampicin resistant rate were 23.38% (36/154), 3.25% (5/154), 10.39% (16/154) and 18.18% (28/154) respectively. The overall drug resistant rate (64.52% (20/31)), multi-drug resistant rate (35.48% (11/31)) and rifampicin resistance rate (38.71% (12/31)) among retreated patients were significantly higher than those among new patients (30.08% (37/123), 4.07% (5/123), 13.01% (16/123)) (χ ²=123.00, P<0.05; χ ²=11.68, P<0.01; χ ²=24.07, P<0.01). The drug resistant rate of male (37.89% (36/95)) was significantly higher than that of female (35.59% (21/59)) (χ ²=57.00, P<0.01), and the overall drug resistant rate of middle-aged (45-<60 years old) group (50.00% (7/14)) was significantly higher than that of youth (<45 years old) group (37.50% (48/128)) and elderly (≥60 years old) group (16.67% (2/12)) (χ ²=118.51, P<0.01). The overall drug resistant rate of students (47.22% (17/36)) was significantly higher than that of farmers (34.38% (11/32)), herdsmen (33.93% (19/56)) and other occupations (33.33% (10/30))(χ ²=371.17, P<0.01). Conclusion The drug resistance rates of MTB strains to 6 commonly used anti-tuberculosis drugs are high in the southern area of Qinghai, and it is necessary to strengthen the drug resistance surveillance and treatment to the young and middle-aged groups, students, farmers and herdsmen and other key groups.

Value of DNA real-time fluorescence isothermal amplification method in clinical detection of tuberculosis

YANG Han, LI Ai-fang, WANG Pei, DANG Li-yun

Chinese Journal of Antituberculosis. 2020, 42(12):  1294-1298.  doi:10.3969/j.issn.1000-6621.2020.12.008

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Objective To analyze the application value of DNA real-time fluorescence isothermal amplification method in the clinical detection of tuberculosis. Methods A total of 2421 patients with suspected pulmonary tuberculosis in Xi’an Chest Hospital from January to June 2019 were checked. Sputum samples collected from 356 patients were simultaneously subjected to BACTEC MGIT 960 liquid culture, real-time fluorescent quantitative nucleic acid detection of rifampicin resistance (GeneXpert MTB/RIF method), traditional real-time fluorescent quantitative nucleic acid detection of DNA (FQ-PCR method), detection of M.tuberculosis RNA by real-time fluorescence constant temperature amplification (SAT-RNA method) and isothermal amplification method. Taking the MGIT 960 test results as the gold standard, we calculated the sensitivity, specificity, positive predictive value, negative predictive value, coincidence rate, and Kappa value of the other four tests. The melting curve method was used to detect rifampin ropB gene in 121 nucleic acid samples positive for isothermal amplification method, to study the value of extracting nucleic acid with isothermal amplification method for drug resistance gene detection. Results Taking MGIT 960 test results as the gold standard, the sensitivity of isothermal amplification method (78.83%, 108/137) was lower than GeneXpert MTB/RIF (95.62%, 131/137), higher than FQ-PCR (74.45%, 102/137) and SAT-RNA (59.12%, 81/137), differences were statistically significant (χ ²=47.437, 43.654, 29.467; P values were all <0.001).The area under curve of the ROC curve for GeneXpert MTB/RIF was the largest (0.910), followed by the isothermal amplification method (0.860), FQ-PCR (0.854) and SAT-RNA (0.789). Conducting melting curve test on isothermal amplificated nucleic acid samples, when the dt value (detection time,1 dt=1 min) of the original nucleic acid and the 5 times diluted nucleic acid was 26-30, the detection rates of the ropB gene were 93.55% (29/31) and 90.32% (28/31) respectively; when the dt value was 15-25, the detection rates were 94.44% (34/36) and 100.00% (36/36) respectively. Conclusion Comparing with various detection technologies, the isothermal amplification method has clinical application value and is suitable for tuberculosis diagnosis in primary hospitals.

Analysis on risk factors associated with false negative results of interferon-gamma release assay in active tuberculosis

MA Jin-bao, MA Ting-ting, REN Fei, YANG Han, TAN Gan-wen

Chinese Journal of Antituberculosis. 2020, 42(12):  1299-1304.  doi:10.3969/j.issn.1000-6621.2020.12.009

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Objective To analysis risk factors associated with false negative result of interferon-gamma release assay (IGRA) in pulmonary tuberculosis with positive sputum smear. Methods A total of 196 pulmonary tuberculosis patients with positive sputum smear were collected from June to December 2019 in Xi’an Chest Hospital, including 145 males (74.0%) and 51 females (26.0%); the median age (M(Q₁,Q₃)) was 38 (26, 53) years. They were divided into IGRA positive group (n=106) and false negative group (n=90). Data of general information, clinical symptoms, results of laboratory test and chest CT findings were collected. Multivariate logistic regression analysis was used to analyze the risk factors associated with false negative result of IGRA in pulmonary tuberculosis patients with positive sputum smear. Results Among the 196 patients, 106 cases were IGRA positive (54.1%). The white blood cell count (M(Q₁,Q₃)) of IGRA positive group was 6.3 (5.0, 7.5)×10⁹ cells/L, which was statistically lower than that of IGRA false negative group (7.4 (5.8, 9.2)×10⁹ cells/L) (Z=-3.464, P=0.001); the erythrocyte sedimentation rate (M(Q₁,Q₃)) in IGRA positive group was also statistically lower than that in IGRA false negative group (34.5 (16.0,58.0) mm/1 h vs. 53.0 (31.8, 84.3) mm/1 h, Z=-3.492, P=0.000); however, the number of CD4⁺T lymphocytes in IGRA positive group was statistically higher than that in IGRA false negative group (553 (371,737) cells/μl vs. 432(320, 645) cells/μl, Z=-2.080, P=0.038). Using multivariate logistic regression analysis, it was showed that white blood cell count ≥7.0×10⁹ cells/L (OR(95%CI)=3.003 (1.618-5.572)), erythrocyte sedimentation rate ≥40mm/1 h (OR(95%CI)=2.270 (1.228-4.195)), CD4⁺T cell <400 cells/μl (OR(95%CI)=2.198(1.155-4.181)) were dependent risk factors for false negative result of IGRA in pulmonary tuberculosis with positive sputum smear. Conclusion The increase of white blood cell and erythrocyte sedimentation rate, as well as the decrease of CD4 ⁺T cell are dependent factors for false negative result of IGRA, the clinical application of IGRA to aid tuberculosis diagnosis should combine with other factors of patients.

A comparative study of relevant clinical indicators in elderly hospitalized pulmonary tuberculosis patients with or without nutritional risk

YIN Chun-yang, FANG Gang, HUANG Li-li, ZHANG Xia, HU Chun-mei

Chinese Journal of Antituberculosis. 2020, 42(12):  1305-1309.  doi:10.3969/j.issn.1000-6621.2020.12.010

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Objective To investigate the correlation between nutritional risk situation and laboratory test results, length of stay and hospitalization expenses of elderly patients with pulmonary tuberculosis aged ≥65 years. Methods A total of 89 patients ≥65 years old who were diagnosed as pulmonary tuberculosis and admitted in the First Department of Tuberculosis, the Second Hospital of Nanjing from September 1st, 2019 to May 31st, 2020, were screened for nutritional risk according to NRS 2002. On the basis of the NRS score, the patients were divided into two groups with different NRS score: the nutritional risk group (NRS ≥3, 42 cases) and the non-nutritional risk group (NRS <3, 47 cases). At the same time, hemoglobin content, blood lymphocyte count, blood C-reactive protein, blood albumin, blood retinol binding protein, number of pulmonary lobes involved in chest CT at the beginning of admission, days of hospitalization and its cost were collected, and the indexes of two groups were compared. Linear correlation analysis was used for correlation analysis between NRS 2002 score and the observed indexes. Results The hemoglobin of the 47 patients in non-nutritional risk group was (124.4±21.8) g/L, hemolyte number was 1.3 (0.9, 1.8) ×10 ⁹/L, serum albumin was (37.5±4.5) g/L, hemretinol binding protein was 28.7 (23.2, 35.0) g/L, which were significantly higher than those of the nutrition risk group ((108.0±18.3) g/L, 0.9 (0.6, 1.2)×10⁹/L, (34.9±5.0) g/L and 18.4 (13.8, 28.0) g/L) (t=3.834, P<0.001; Z=3.017, P=0.003; t=2.602, P=0.011; Z=3.846, P<0.001). C-reactive protein was 5.7 (2.4, 15.0) mg/L and hospitalization expenses were 19163.4 (15293.1, 24597.5) yuan, which were significantly lower than those of the nutrition risk group (35.3 (6.0, 76.9) mg/L and 22022.1 (18298.7, 29410.2) yuan) (Z=3.090, P=0.002; Z=2.367, P=0.018). There was no significant difference in the number of pulmonary lobes involved (5 (5, 5)), length of stay (14 (11, 21) d) between patients with nutritional risk and those without nutritional risk (5 (3, 5), 15 (12, 22) d) (Z=0.892, P=0.372; Z=1.182, P=0.237). Nutritional risk was negatively correlated with hemoglobin, blood lymphocyte count, serum albumin and serum retinol binding protein (correlation coefficients were -0.419, -0.240, -0.308 and -0.392, P values were <0.001, 0.024, 0.003 and <0.001 respectively), and positively correlated with C-reactive protein and hospitalization expenses (correlation coefficient were 0.226, 0.279, P values were 0.033, 0.008). Conclusion Patients with nutritional risk are more likely to develop anemia, decreased lymphocyte count, hypoalbuminemia, infection, decreased retinol binding protein, and increased hospitalization costs.

Analysis of status and risk of nutrition of inactive tuberculosis patients complicated with chronic obstructive pulmonary disease

LYU He, WANG Zheng, WANG Ting, YAN Ya-geng, DONG Feng-li, YANG Xiao-wei, ZHANG Lin, GUO Xiao-wei, WANG Hong-mei, XU Huan

Chinese Journal of Antituberculosis. 2020, 42(12):  1310-1312.  doi:10.3969/j.issn.1000-6621.2020.12.011

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Objective To analyze the status and nutritional risk of nutrition of patients with inactive tuberculosis patients complicated with chronic obstructive pulmonary disease (COPD). Methods A fixed-point continuous sampling method was adopted to sample 356 inactive tuberculosis patients with COPD (observation group) and 384 COPD patients (control group) who were hospitalized in the Department of Respiratory Medicine of the First Affiliated Hospital of Harbin Medical University from January 2017 to May 2018. The basic information (age, height, weight, etc.) and biochemical indicators (hemoglobin, serum total protein, serum albumin, serum prealbumin, etc.) of patients in the two groups were collected. Results The incidence of nutritional risk in the observation group was 36.8% (131/356), which was significantly higher than that in the control group (32.6% (125/384), χ ²=18.350, P=0.000). The length of hospital stay in the observation group was (12.6±4.4) days, which was significantly longer than that of the control group ((11.5±5.1) days, t=3.097, P=0.002). The levels of hemoglobin, total protein, albumin and prealbumin in the observation group were significantly lower than the control group, which were (114.3±10.4) g/L vs. (117.7±9.4) g/L (t=4.602, P=0.000), (55.0±7.9) g/L vs. (58.9±8.0) g/L (t=6.631, P=0.000), (29.7±4.6) g/L vs. (31.0±4.0) g/L (t=4.075, P=0.000), and (112.6±35.0) mg/L vs. (118.0±35.7) mg/L (t=2.083, P=0.038), respectively. Conclusion Inactive tuberculosis increases the incidence of nutritional risk in COPD patients and prolongs the hospital stay, it has an adverse effect on the nutritional indicators of COPD patients.

Investigation of the acceptance of mobile internet technology for the health management of tuberculosis patients in the community

LI Ya-min, GAO Zhi-dong, CHEN Xi, ZHAO Xin, TAO Li-ying, LI Yan-yuan

Chinese Journal of Antituberculosis. 2020, 42(12):  1313-1317.  doi:10.3969/j.issn.1000-6621.2020.12.012

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Objective To investigate the acceptance of mobile internet technology for the health management of tuberculosis patients among general practitioners in communities in Beijing, in order to provide basis for the selection of tuberculosis patients management methods. Methods In May 2020,through the “www.wenjuan.com”, the questionnaire of “Application of mobile internet technology in promoting management of tuberculosis patient in Beijing preliminary investigation-general practitioners” in Beijing was conducted in 378 community medical staff from 316 community health care in 13 districts, where tuberculosis patients management was operated without mobile internet technology, including web site, mobile phone application (APP), WeChat programs and/or electric pillbox. A total of 235 community medical staff from six urban districts (Dongcheng District, Xicheng District, Chaoyang District, Fengtai District, Shijingshan District and Haidian District) and 143 medical staff from seven other districts (Shunyi District, Daxing District, Fangshan District, Mentougou District, Huairou District, Miyun District and Yanqing District) were investigated. The Chi square test was used for comparison of counting data. And P<0.05 was considered statistically significant. Results The proportion of acceptance of mobile internet technology using in one or more tuberculosis patient management work was 76.5% (289/378). Especially for the “receive the notice” and “fill out and submit the feedback sheet”, the intentions of adopting mobile internet technology in community medical staff in six urban areas (40.9% (96/235) and 42.6% (100/235), respectively) were significantly higher than those in suburbs (23.2% (33/142), χ ²=12.197, P=0.001; and 23.8% (34/143), χ ²=13.698, P=0.000, respectively). The intention increased with the management patient number (<10, 10-, >20), which were 75.1% (130/173), 76.7% (102/133) and 79.2% (57/72), respectively. The difference compared to that with the traditional way (24.9% (43/173), 23.3% (31/133) and 20.8% (15/72), respectively)was not significant (χ ²=0.463, P=0.793). Conclusion The intention of adoption mobile internet technology to strengthen management for tuberculosis patients among community medical staff was high. The mobile internet technology could be gradually promoted to the whole city from the six urban districts.

Analysis on epidemic and management of tuberculosis among senior middle school students from Qinghai Tibetans in a school of Daxing District of Beijing from 2010 to 2019

LI Chun, ZHENG Hai-lun, LUO Ping, LI Ya-min, ZHAO Shu-juan, GUO Jin-hong, ZHANG Li, XU Jing, TU Xia

Chinese Journal of Antituberculosis. 2020, 42(12):  1318-1322.  doi:10.3969/j.issn.1000-6621.2020.12.013

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【Abstract】 Objective To analyze the epidemic and management of tuberculosis among students coming to Beijing from Yushu Tibetan Autonomous Prefecture, Qinghai Province (a region with a high prevalence of tuberculosis in western China) in a senior middle school in Daxing District, so as to provide information for tuberculosis prevention and control in schools. Methods Pulmonary tuberculosis epidemic in a middle school in Daxing District from 2010 to 2019 and relevant management were retrospectively analyzed. Students of this school included 83.19% (10687/12847) of local residents and 16.81% (2160/12847) from Qinghai Tibetan. Preventive measures for this group of Tibetan students consisted of Chest X-ray photography (referred to as “chest radiograph”) on their entering (returning after holidays) to school and preventive medications for those with moderate or above positive PPD tests. The above data was analyzed using SPSS 21.0 software. The enumeration data was tested by χ² or Fisher’s exact test when the theoretical frequency was less than 1, or the total number of analyses was less than 40. P<0.05 was considered as statistically significant. Results From 2010 to 2019, 31 cases of active pulmonary tuberculosis were reported in these senior middle school students, including 23 cases of Tibetan students, with a reported incidence of 1064.81/100000 (23/2160), and eight cases of local students, with a reported incidence of 74.86/100000 (8/10687) (Fisher exact probability method, P=0.000). All 23 Tibetan patients lived in school dormitory, including 13 males (56.52%), 10 females (43.48%) with a male to female ratio of 1.3∶1. As of September 2019, chest X-ray examination was carried out in 1518 Tibetan students among whom 9 were diagnosed as pulmonary tuberculosis after comprehensive clinical evaluation giving a detection rate of 0.59% (9/1518), and accounting for 39.13% (9/23) of all Tibetan students with tuberculosis within the 10 years. Among the 9 students, 6 were diagnosed in February 2017 when returning to school after winter holidays, with a detection rate of 3.03% (6/198). Among the 91 students who were moderate or above positive in PPD test from 2016 to 2019, the incidence of tuberculosis in those received preventive medications (4.17% (3/72)) was lower than those did not (10.53% (2/19)) (Fisher exact probability method, P=0.280). While all the above 5 patients developed symptoms within 1 year after screening or preventive medications. From January 2019 to May 2020, there were no new reported tuberculosis cases among these school students. Conclusion Students are an important population for the prevention and control of tuberculosis. Chest radiograph for students coming or back to Beijing from high prevalent areas of tuberculosis in western China are a proactive measure for prevention and control of the spread of tuberculosis on campus.

A comparative analysis of the epidemic characteristics of tuberculosis in elderly and non-elderly in Jing’an District, Shanghai from 2014 to 2019

YAO Jing, GU Kai-kan, LI Zhi-hong, HAN Zhi-ying, ZHANG Huai-qing

Chinese Journal of Antituberculosis. 2020, 42(12):  1323-1328.  doi:10.3969/j.issn.1000-6621.2020.12.014

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Objective To explore the epidemic characteristics of elderly (≥60 years old) and non-elderly (<60 years old) pulmonary tuberculosis patients in Jing’an District, Shanghai, providing reference for the prevention and treatment of tuberculosis in the elderly. Methods Data of the tuberculosis patients first managed and registered in Jing’an District from April 1, 2014 to March 31, 2019 were collected from China Information System for Disease Control and Prevention (subsystem “TB Management Information System”), including the medical records, diagnosis and treatment information, 0-month laboratory and imaging examination results, treatment effect and prognosis.These data were divided into ≥60 years old group and <60 years old group, and the characteristics of pulmonary tuberculosis patients in the two groups were compared and analyzed. Results From April 1, 2014 to March 31, 2019, a total of 1563 pulmonary tuberculosis patients in the whole population were registered, of whom 555 patients (35.51%) were ≥60 years old, and the composition ratio increased from 27.62% (95/344) to 41.30% (114/276) in the past five years, showing an increasing trend (χ²=7.501, P=0.006). Of the patients ≥60 years old, the local household registration (95.86% (532/555)) and male (74.59% (414/555)) of the patients were significantly higher than those in the <60 years old group (61.71% (622/1008), 68.35% (689/1008)) (χ ²=2.160, 6.713; P=0.000, 0.010). Most pulmonary tuberculosis patients of the two groups in Jing’an District were passively screened through symptom visits (67.21% (373/555) vs. 69.35% (699/1008)) and referrals (30.27% (168/555) vs. 28.37% (286/1008)). The complication rate of other diseases, positive etiological test, re-treatment, positive rate of 0-month sequence sputum smear and abnormal rate of chest film in the ≥60 years old group were all higher than those in the <60 years old group (26.13% (145/555) vs. 14.19% (143/1008), χ ²=33.946, P=0.000; 46.67% (259/555) vs. 35.32% (356/1008), χ ²=19.318, P=0.000; 14.59% (81/555) vs. 9.23% (93/1008), χ ²=10.427, P=0.001; 41.62% (231/555) vs. 25.69% (259/1008), χ ²=42.189, P=0.000; 99.10% (550/555) vs. 96.73% (975/1008), χ ²=8.496, P=0.004; respectively). The negative conversion rate of sputum smear at the end of the 2nd month and the cure or completion of treatment of patients aged ≥60 years were both lower than those of patients aged <60 years (73.59% (170/231) vs. 85.33% (221/259), χ ²=10.430, P=0.001; 80.18% (445/555) vs. 92.86% (936/1008), χ ²=57.199, P=0.000; respectively). Conclusion The registered tuberculosis patients in the whole population decreased year by year in Jing’an District, however, the proportion of the elderly patients increased year by year. The male elderly population with local household registration and complicated diseases should be paid more attention. Considering the high positive rates of sputum bacteria test and chest X-ray, and poor treatment effect of the elderly population, active screening and standard treatment should be carried out.

Analysis of the types and expense of therapeutic drugs for pulmonary tuberculosis in Songjiang District of Shanghai

LI Meng, LU Li-ping, JIANG Qi, HONG Jian-jun, GAO Qian, YANG Chong-guang, GUO Xiao-qin

Chinese Journal of Antituberculosis. 2020, 42(12):  1329-1332.  doi:10.3969/j.issn.1000-6621.2020.12.015

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Objective To analyze the usage and expense of therapeutic drugs in pulmonary tuberculosis patients, and to provide the basis for improving the policy of reducing the economic burden of tuberculosis patients. Methods A total of 248 tuberculosis patients registered for treatment in Songjiang District, Shanghai and met the enrollment criteria were included from Dec 1, 2014 to Dec 31, 2015. The bills of expense for the whole treatment of all the patients were collected to analyze the usage and expense of therapeutic drugs. Non-normally distributed data such as drug expenditures and the proportions were all described as median (quartile) (M(Q₁,Q₃)). Data were compared using Mann-Whitney U test and P<0.05 was considered statistically significant. Results The average total drug cost of the 248 patients was 3719.0 (2483.4, 5634.9) yuan per case. Among them, anti-tuberculosis drugs accounted for 16.8% (11.5%, 24.0%), 62.1% (47.5%, 74.6%) was liver protection drugs, and 23.0% (12.2%, 40.7%) was other adjuvant drugs. Except for anti-tuberculosis drugs, all patients were treated with hepatoprotective drugs: 241 patients (97.2%) started to use hepatoprotective drugs within one month after diagnosis and initial treatment, 179 patients (72.2%) regularly used hepatoprotective drugs every month after consultation. Eighty-two patients used two or more kinds of hepatoprotective drugs during treatment. Most patients used other adjuvant medications intermittently, of which the costs of Chinese medicines, antibiotics and immune-modulators accounted for 14.8% (5.9%, 28.9%), 9.7% (5.3%, 17.2%) and 8.6% (0.7%, 14.0%). The proportions of patients who used the above drugs were 58.1% (144/248), 40.3% (100/248) and 27.0% (67/248), respectively. The average total cost of medicines and other adjuvant medications for per case in municipal designated hospitals were 6392.7 (3371.5, 9769.0) yuan and 2097.6 (789.0, 3828.0) yuan, which were significantly higher than those in the district-level designated hospitals (3424.1 (2362.0, 4796.1) yuan, Z=-3.534, P<0.001; 889.2 (305.5, 1826.0) yuan, Z=-3.113, P=0.002). Conclusion The expense of hepatoprotective drugs and other adjuvant drugs was higher than that of anti-tuberculosis drugs. However, and these two kinds of drugs were not allowed or highly limited to get reimbursement form the free tuberculosis treatment policy and hence the usage of these drugs were the main cause of the economic burden on tuberculosis patients. The use of these drugs should be regulated and the related health policy need to be further concerned to reduce the financial burden on patients.

Review Articles

Effects of anti-tubercular agents on intestinal flora and its influence on the organism

TANG Liang, BAO Yu-cheng, ZHANG Wen-long

Chinese Journal of Antituberculosis. 2020, 42(12):  1333-1338.  doi:10.3969/j.issn.1000-6621.2020.12.016

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The structure and metabolites of intestinal flora interact with the human body, to maintain the steady state of intestinal barrier, promote the balance of nutrition metabolism and immunity, and take participate in the pathological and physiological processes of various systems, tissues and organs. It has significant effect on the process of TB infection, pathogenesis, treatment and prognosis. However, the study of the effect of anti-tubercular agents on intestinal flora is limited. The authors reviewed the effect of intestinal flora on steady state of intestinal barrier, summarized the research results of the effect of anti-tubercular agents on intestinal flora, expanded related clinical issues, and discussed the extensive effect of intestinal flora changes on the organism.

Research progress on clinical application of traditional Chinese medicine appropriate technology in the treatment of tuberculosis

TANG Yu-ting, SANG Ying-ying, XIA Chao

Chinese Journal of Antituberculosis. 2020, 42(12):  1339-1342.  doi:10.3969/j.issn.1000-6621.2020.12.017

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Tuberculosis is a chronic consuming zoonosis caused by Mycobacterium tuberculosis, and is the most important fatal respiratory infectious disease in the world. Currently, most treatment regimens are composed of several western anti-tuberculosis drugs, and patients are prone to get multiple drug resistance, which leads to prolonged treatment course and great psychological pressure. At the same time, long-term chemotherapy increases the economic burden of patients and reduces their quality of life. The traditional Chinese medicine appropriate technology has the traditional Chinese medicine characteristics, using various traditional Chinese medicine diagnosis and treatment methods to consolidate the treatment effect, has advantages on safety and simplity. Taking nursing of tuberculosis symptoms as searching clue, the author searched and summarized the application status of traditional Chinese medicine appropriate technology in nursing of patients with relevant clinical symptoms in recent years, in order to expect traditional Chinese medicine appropriate technology to play a greater role in the treatment of tuberculosis.

The clinical diagnosis and treatment of pyogenic spondylitis and the differential diagnosis of atypical spinal tuberculosis

Maimaitiaili· Abudurexiti, Maierdan· Maimaiti

Chinese Journal of Antituberculosis. 2020, 42(12):  1343-1348.  doi:10.3969/j.issn.1000-6621.2020.12.018

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Pyogenic spondylitis is an infrequent infection. Its incidence is increasing because of the growing number of elderly people and immunocompromised patients. The diagnosis of pyogenic spondylitis is usually very difficult and appropriate imaging, blood cultures and/or biopsy are necessary for early diagnosis. Most cases can be treated with non-operatively, but patients with spinal cord or cauda equine compression with progressive neurological deficits and/or patients with failure of conservative treatment should receive surgical treatment. Because of the nonspecific clinical attack of pyogenic spondylitis, it is easy to be confused with spinal tuberculosis, brucellosis spondylitis and other degenerative diseases. The misdiagnosis and missed diagnosis rate is high, which can easily lead to spinal deformity and neurological impairment, paralysis, and even death. So early and accurate diagnosis of pyogenic spondylitis is important for timely and effective treatment and reducing the occurrence of spinal deformity and dysfunction.

Short Articles

Analysis of one case of esophageal tuberculosis and its diagnosis and treatment

CHEN Kai-li, WANG Xiao-hui, LIN Ming-gui, CHEN Hong

Chinese Journal of Antituberculosis. 2020, 42(12):  1349-1351.  doi:10.3969/j.issn.1000-6621.2020.12.019

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The incidence of esophageal tuberculosis is relatively low, which has been rarely reported. Clinical symptoms, auxiliary examination and differential diagnosis of esophageal tuberculosis have been poorly understood. It is highly likely to be misdiagnosed as esophageal carcinoma. In this paper, the author report one patient with chest pain after renal transplantation, who was confirmed to have esophageal tuberculosis by gastroscopy and molecular diagnosis technology (polymerase chain reaction-reverse dot line hybridization assay), and was cured by antituberculotic drugs. This case prompts that strengthen the understanding of the diagnosis and differential diagnosis of esophageal tuberculosis can improve the level of diagnosis, and plays a pivotal role in reducing misdiagnosis and improving clinical prognosis of patients.