Chinese Journal of Antituberculosis

Expert consensus on the application of the concept of enhanced recovery after surgery in spinal tuberculosis surgery

The Group of Osteoarticular Tuberculosis of Chinese Antituberculosis Association, Editorial Board of Chinese Journal of Antituberculosis

Chinese Journal of Antituberculosis. 2023, 45(3): 225-234. doi:10.19982/j.issn.1000-6621.20220493

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Spinal tuberculosis is the most common bone tuberculosis. Implementation of enhanced recovery after surgery (ERAS) management can shorten hospitalization, reduce incidence of complications and readmissions rate, and reduce medical costs of patients with spinal tuberculosis. Currently, ERAS had been accepted by more and more spinal tuberculosis surgeons. However, there is no expert consensus has been formed, which severely limits the application of ERAS in spinal tuberculosis surgery. Therefore, the Group of Osteoarticular Tuberculosis of Chinese Antituberculosis Association, in conjunction with the Editorial Board of Chinese Journal of Antituberculosis, organized experts to write the Expert consensus on the application of the concept of enhanced recovery after surgery in spinal tuberculosis surgery on the basis of the characteristics of spinal tuberculosis disease and the previous research results of ERAS mode in the diagnosis and treatment of spinal tuberculosis, with a view to further standardize and guide the application of ERAS concept in spinal tuberculosis surgery, and promote the further development of spinal tuberculosis surgery.

Comparison and enlightenment of international legislation experience on tuberculosis control

Jia Fei, Cao Yanlin, Jiang Shiwen, Zhang Ke, Yi Min

Chinese Journal of Antituberculosis. 2023, 45(3): 235-239. doi:10.19982/j.issn.1000-6621.20220528

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Tuberculosis (TB), a chronic infectious disease mainly transmitted by respiratory tract, has been a serious threat to human health for thousands of years. And it remains a public health and social issue of global concern. At present, the global TB epidemic is still serious. In order to understand the legal experience of international TB control, this paper focuses on searching the laws, regulations and related guidelines of some international organizations and countries, such as WHO, Japan, South Korea and Russia, making a comparative study on the following six aspects: legislation model, government responsibility, TB service system, prevention and control measures, protection of patients’ rights and coercive administrative measures, to provide reference for China’s TB control legislation construction.

Analysis of the current situation of local legislation on tuberculosis prevention and control in China

Zhang Ke, Cao Yanlin, Jiang Shiwen, Chen Mingting, Jia Fei, Yi Min

Chinese Journal of Antituberculosis. 2023, 45(3): 240-243. doi:10.19982/j.issn.1000-6621.20220539

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Controlling the epidemic of tuberculosis is an inevitable requirement for implementing the Healthy China strategy and safeguarding the rights and interests of Chinese people’s life and health. Therefore, many local laws and regulations on tuberculosis prevention and control have been formulated in China, including government responsibilities, tuberculosis prevention and control measures, management measures for tuberculosis patients, and legal responsibilities, etc. However, challenges of tuberculosis prevention and control legislation still exist. Some provinces with high incidence of tuberculosis still have no local legislation on tuberculosis prevention and control, and some local laws and regulations need to be revised urgently. Based on the analysis of the current effective local laws and regulations for tuberculosis prevention and control, this paper puts forward suggestions to deal with the above challenges.

Current status of tuberculosis prevention and control in China and the legislative countermeasures

Cao Yanlin, Jiang Shiwen, Jia Fei, Zhang Ke, Chen Mingting, Chen Wei, Li Xue, Yang Jian, Zhang Yi

Chinese Journal of Antituberculosis. 2023, 45(3): 244-247. doi:10.19982/j.issn.1000-6621.20220529

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Tuberculosis is a chronic infectious disease caused by Mycobacterium tuberculosis. At present, the tuberculosis epidemic is still relatively serious in China, and there is a big gap between China’s status and the global target set by World Health Organization to end tuberculosis. In the new situation that rule by law has become basic strategy of governance in China, there is no special legislation on tuberculosis prevention and control at the national level. The existing legal policies have problems such as low legal rank, early legislative time and lagging legislative content. Based on the international and domestic experience, the author believes that it is necessary to promote the legalization of tuberculosis prevention and control. It also puts forward some suggestions on the key points that need to be solved by legislation in tuberculosis prevention and control and how to promote legislation.

The inspiration of bundled payment for chronic diseases in Netherlands and the United States for tuberculosis payment reform in China

Zhang Jingyi, Hu Xingyu, Gao Guangying, Chen Yingchun, Zhang Xin, Deng Qian

Chinese Journal of Antituberculosis. 2023, 45(3): 248-252. doi:10.19982/j.issn.1000-6621.20220444

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Tuberculosis (TB) is a chronic infectious disease caused by Mycobacterium tuberculosis (MTB) infection. TB patients need to take multiple drugs and stay in treatment for a long time, which places a great burden on individuals and their families, and even the whole society. Measures which can reduce the economic burden of disease are urgently needed. The payment system has a restrictive effect on medical expenses by influencing the behavior of the supplier. However, the current payment methods for TB in China are inconsistent with the characteristics of the diagnosis and treatment of the disease, and it has not yet achieved the expected goal of effective fee reduction. In such a general background, the authors summarized and studied the internationally popular bundling payment mode for chronic diseases, systematically analyzed the specific practices of bundling payment for chronic diseases in the Netherlands and the United States, and analyzed the adaptability of bundling payment for tuberculosis based on the characteristics of tuberculosis diagnosis and treatment and the prevention and treatment system, so as to provide a valuable reference for the reform of payment methods for TB.

Differential diagnosis between latent tuberculosis infection and active tuberculosis

Xia Hui, Wang Ruibai, Zhao Yanlin

Chinese Journal of Antituberculosis. 2023, 45(3): 253-259. doi:10.19982/j.issn.1000-6621.20220391

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China is a country with a high burden of tuberculosis and latent tuberculosis infection. The treatment and prognosis of latent tuberculosis infection and active tuberculosis are completely different. The current available diagnostic tools for tuberculosis infection cannot effectively predict the progress of infection and differentiate it from active tuberculosis, therefore, more accurate biomarkers need to be developed. The research progress, challenges and prospects of biomarkers for differential diagnosis between latent tuberculosis infection and active tuberculosis were reviewed in the present study.

Analysis of latent Mycobacterium tuberculosis infection and influencing factors in student contacts after tuberculosis epidemic in school in Fujian Province

Du Yongcheng, Lin Shufang, Dai Zhisong, Chen Daiquan, Chen Jiangfen

Chinese Journal of Antituberculosis. 2023, 45(3): 260-264. doi:10.19982/j.issn.1000-6621.20220461

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Objective: To explore the prevalence of latent tuberculosis infection (LTBI) and the influencing factors among student contacts after the epidemic of tuberculosis in the school of Fujian Province, to provide reference for tuberculosis prevention and control strategies in school. Methods: Through the Quarterly Report of Contacts Screening of School Tuberculosis Patients of Fujian Province, data of 31589 student contacts routinely screened from 362 schools (included nursery and kindergarten) where active pulmonary patients were found in 2021 in Fujian were collected, including gender, age, boarding or not, LTBI occurrence, and pathogenic results and occupation of exposed patients. The LTBI of student contacts was analyzed, and univariate and multivariate logistic regression were used to analyze the influencing factors of latent infection in students. Results: There were 3785 LTBI students among 31589 student contacts, the rate was 12.0%. Multivariate logistic analysis showed that the LTBI rates of female students, boarders and students exposed to patients with positive etiology were relatively higher (OR (95%CI): 1.139 (1.063-1.221), 1.325 (1.181-1.486), and 1.093 (1.017-1.172), respectively). Compared with group aged <5 years, the risk of LTBI in other age groups increased with the age, and the highest were group aged 20-24 years (OR (95%CI): 4.633 (2.557-8.395)). Conclusion: The incidence of LTBI among students exposed to active pulmonary tuberculosis patients in school in Fujian was at a low level. Female, boarding, contact patients with positive etiology and the increase of age were the risk factors of LTBI among students.

Investigation and analysis of knowledge, attitude and practices of tuberculosis prevention and control among college students in Guiyang City

Ye Zi, Yang Juan, Guo Peng, Luo Jieya, Feng Yonghong, Kang Yingqian, Huang Jin

Chinese Journal of Antituberculosis. 2023, 45(3): 265-270. doi:10.19982/j.issn.1000-6621.20220429

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Objective: To understand the knowledge, attitude and practices (KAP) towards tuberculosis prevention and control among college students in Guiyang City, and to provide reference for conducting timely and effective tuberculosis health education with innovative approaches in college. Methods: From March 7 to April 7, 2022, 2894 college students from Guizhou Medical University, Guizhou Institute of Technology and Guiyang University were randomly selected with multi-stage stratified cluster sampling method to carry out an electronic questionnaire survey on KAP towards tuberculosis prevention and control. Finally 2801 students were investigated, and a total of 2608 pieces of valid questionnaire were obtained. The questionnaire is a self-designed electronic questionnaire. χ² test and multivariable logistic regression analysis were used to explore the influencing factors of knowledge awareness rate. Results: The total awareness rate of knowledge concerning tuberculosis prevention and control among college students in Guiyang city was 69.14% (27048/39120), of which the awareness rate of core knowledge was 79.00% (10301/13040) and the awareness rate of extended knowledge was 64.21% (16747/26080). Univariable and multivariable logistic regression analysis showed that gender, grade and major were the influencing factors of awareness rate of core knowledge (χ²=12.376, 77.729, 38.480, all Ps<0.001) and extended knowledge (χ²=27.993, 21.616, 40.999, all Ps<0.001). Female (OR=1.462, 95%CI: 1.242-1.721), grade 3 (OR=1.291, 95%CI: 1.039-1.604), grade 4 or 5 (OR=2.697, 95%CI: 2.118-3.435) and medical (OR=1.880, 95%CI: 1.594-2.216) students had higher knowledge awareness rates than male, freshman (grade 1) and non-medical students, respectively. In terms of attitude and practices towards tuberculosis, 96.13% (2507/2608) of the students got high willingness on participating in the publicity activities of spreading tuberculosis prevention and control knowledge. Conclusion: College students have certain knowledge of tuberculosis prevention and control, and have relatively positive attitudes and practices towards tuberculosis prevention and control, but there are still insufficiencies. More accurate health education should be provided to male, junior and non-medical students.

Analysis of the detection delay and influencing factors of student with pulmonary tuberculosis in Hunan from 2011 to 2020

Gong Dehua, Tan Wenqian, Huang Juan, Wan Yanping, Xu Zuhui, Liu Zhaochun

Chinese Journal of Antituberculosis. 2023, 45(3): 271-278. doi:10.19982/j.issn.1000-6621.20220392

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Objective: To analyze the current situation and influencing factors of the detection delay among student with pulmonary tuberculosis in Hunan from 2011 to 2020, and to provide reference for decision of school tuberculosis prevention and control. Methods: The medical records of 17365 student with pulmonary tuberculosis in Hunan from January 1, 2011 to December 31, 2020 were collected from the “Tuberculosis Management Information System”, a subsystem of the “China Disease Prevention and Control Information System”, including gender, age, patient of origin, diagnosis results, level of diagnosis unit, severe condition, treatment classification, time of registration, date of occurrence of symptoms, first diagnosis and diagnosis, etc. Univariate analysis was used to compare the differences between groups of different factors, and multivariate logistic regression analysis was used to analyze the influencing factors of the detection delay among student with pulmonary tuberculosis. Results: From 2011 to 2020, the median (quartile) time of visit, diagnosis and detection of pulmonary tuberculosis patients among students were 12 (3, 33) d, 2 (0, 18) d and 27 (11, 53) d, respectively; the rate of rist, diagnosis and the delay of detection were 45.8% (7955/17365), 28.6% (4965/17365) and 48.6% (8438/17365); and the delay rate of detection decreased from 49.1% (774/1575) in 2011 to 43.6% (1064/2438) in 2020, showing a slow downward trend ( $χ t r e n d 2$ =25.203, P=0.000), and there were regional differences (34.4% (303/881)-63.9% (1664/2606); $χ t r e n d 2$ =451.797, P=0.000). Among 8438 patients with detection delay, the delay rate of visit (71.6% (6042/8438)) was significantly higher than that of diagnosis (48.0% (4048/8438))(χ²=979.975, P=0.000), and 64.2% (5267/8438) of the patients with detection delay were found that the visit days was 28 days or more. Multivariate logistic regression analysis showed that the risk of detection delay was relatively low in those who younger than 15 years old, aged at 15-19 years or 20-24 years, physical examination, or contact inspection (OR (95%CI): 0.679 (0.495-0.932), 0.576 (0.424-0.782), 0.707 (0.519-0.964), 0.213 (0.138-0.328) and 0.214 (0.118-0.388), respectively), but the risk of detection delay of the follow up and severely patients were relatively high (OR (95%CI): 2.061 (1.405-3.022) and 1.475 (1.244-1.750), respectively). Conclusion: From 2011 to 2020,the detection delay among student with pulmonary tuberculosis in Hunan was relatively high, but showed a slow downward trend, the delay was mainly visit delay, and there were regional differences. Attention should be paid to patients who was upperclassman, did not receive physical examination and contact inspection, and who found by follow-up, so as to achieve early detection and diagnosis and avoid the occurrence of severe tuberculosis.

Study on the role of the prefectural tuberculosis designated hospital to improve the case finding of pulmonary tuberculosis in economic undeveloped areas of Jiangxi Province

Liu Yueyuan, Su Wei, Zheng Jiangang, Wang Meng, Zeng Zhong, Huang Qin, Xie Tian, Li Renzhong

Chinese Journal of Antituberculosis. 2023, 45(3): 279-284. doi:10.19982/j.issn.1000-6621.20220436

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Objective: To explore the role of prefectural tuberculosis designated hospital to improve the case finding of pulmonary tuberculosis (PTB) and rifampicin-resistant pulmonary tuberculosis (RR-PTB). Methods: The information on tuberculosis diagnosis and drug resistance testing of active PTB patients (excluding patients with simple tuberculous pleurisy) in Ganzhou were derived from the Tuberculosis Management Information System, a subsystem of China Disease Control and Prevention Information System before (2017—2018) and after (2019—2020) the implementation of the project “Study on improving the case finding of pulmonary tuberculosis in poor areas”. While, the diagnosis and drug resistance test information of suspected PTB cases in the Fifth People’s Hospital of Ganzhou (Ganzhou Fifth Hospital) were derived from the Hospital Information System. The differences of detection in PTB and RR-PTB cases were analyzed and compared before and after the implementation of the project. Results: From 2017 to 2020, a total of 9279 suspected PTB cases were treated in Ganzhou Fifth Hospitals, and 7619 cases of PTB patients were diagnosed, including 385 RR-PTB cases. The proportion of GeneXpert MTB/RIF testing and the rate of bacteriologically confirmed PTB in patients with suspected PTB increased from 7.71% (361/4682) and 36.39% (1383/3801) before the project to 66.70% (3066/4597) and 52.46% (2003/3818) after implementation, respectively, with statistically significant differences (χ²=3464.784, P<0.001; χ²=199.388, P<0.001). After the implementation of the project, the proportion of bacteriologically confirmed PTB and RR-PTB cases detected in Ganzhou Fifth Hospitals reached 33.97% (2003/5897) and 81.31% (248/305) of the whole prefecture, respectively. Among them, 34.55% (692/2003) of bacteriologically confirmed PTB and 28.63% (71/248) of RR-PTB were smear-negative cases detected by GeneXpert MTB/RIF test. Conclusion: The case finding of PTB and RR-PTB in the whole city can be improved if the prefectural designated hospitals could adopt appropriate tuberculosis diagnosis techniques and the strategy of case finding, provide free screening for all suspected tuberculosis cases regardless of region, and interconnect tuberculosis diagnostic information with the medical and health institution in county.

Establishment of national reference panel for Mycobacterium tuberculosis antibody detection kits

Shi Dawei, Wang Wei, Yang Xiao, Yu Li, Huang Jiawei, Zhang Chuntao, Xu Sihong

Chinese Journal of Antituberculosis. 2023, 45(3): 285-291. doi:10.19982/j.issn.1000-6621.20220435

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Objective: To prepare a national reference panel for Mycobacterium tuberculosis antibody detection. Methods: The reference materials were screened and rechecked using colloidal gold and ELISA tuberculosis antibody detection reagents from 9 companies. After subpackage, 9 companies cooperated to calibrate, and finally determined the composition and quality standard of the national reference panel. At the same time, the homogeneity and stability of the reference panel was investigated. Results: The result of positive references varies from different companies and test kits. According to the cooperative calibration results and the principle of proper supervision, the reference panel was determined to be composed of 10 negative samples, 10 positive samples, 5 Limit of Detection (LoD) samples and 1 precision sample. The quality standard requirement of the reference panel was determined as follows: the agreement rate of the negative samples should be 10/10; the agreement rate of positive samples should ≥9/10; in the LoD samples S1-S5, S1 and S2 should be positive, while S3-S5 could be positive or negative. Precision reference sample R should be tested 10 times in parallel, and the results should be all positive, and the coefficient of variation value (CV value) of the test results shall be ≤15%. The homogeneity was that the difference among the sub-packaged samples was not more than 30%, and there was no difference between the stability condition group and the -20 ℃ control group. Conclusion: A set of national reference panel applicable to ELISA and solid-phase protein microarray for Mycobacterium tuberculosis antibody has been established for the first time, which could be used to evaluate the quality of the reagents.

Diagnostic value of metagenomic next-generation sequencing in hip or knee tuberculosis

Yao Liming, Yao Xiaowei, Dong Zhaoliang, Liu Fengsheng, Wang Lianbo, Jia Chenguang

Chinese Journal of Antituberculosis. 2023, 45(3): 292-296. doi:10.19982/j.issn.1000-6621.20220451

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Objective: To investigate the value of metagenomic next generation sequencing applied (mNGS) in diagnosis of hip or knee tuberculosis. Methods: A retrospective analysis was done for 34 cases of hip or knee joint infections who were treated in Hebei Chest Hospital from June 2019 to June 2021. According to the type of pathogenic bacteria, those enrolled patients were divided into two groups: the hip or knee joint tuberculosis group (16 cases) and the non-tuberculous infection group (18 cases). The tissue samples were obtained from infected sites in all patients and were subjected to routine culture of bacteria and mycobacterium (MGIT 960 culture), the gene amplification and mNGS for detection of Mycobacterium tuberculosis DNA (MTB-DNA). The diagnostic efficacy of the three methods was compared with clinical diagnosis as the gold standard. Results: The detection rates of pathogen bacterial by mNGS was 100.0% (18/18) in non-tuberculous infection group. The positive detection rate of MTB by mNGS was 93.8% (15/16) in the joint tuberculosis group, which was higher than that of MTB-DNA amplification (50.0% (8/16)) and MGIT 960 culture (25.0% (4/16)), with significant difference (χ²=7.575, P=0.015; χ²=15.676, P=0.000). With clinical diagnosis as the gold standard, the sensitivity (93.8% (15/16)), negative predictive value (94.7% (18/19)) and Kappa value (0.942) of mNGS in the diagnosis of hip or knee tuberculosis were significantly higher than those of routine culture (25.0% (4/16), 60.0% (18/30), 0.260, respectively) and MTB-DNA amplification (50.0% (8/16), 69.2% (18/26), 0.515, respectively). But the specificity and positive predictive value of the three detection methods were 100.0%. Conclusion: mNGS can effectively identify the pathogenic bacteria of hip or knee joint infections. The mNGS has higher diagnostic efficacy in the diagnosis of joint tuberculosis and can provide important clinical guidance.

Construction and validation of early diagnosis model of knee joint tuberculosis based on LASSO regression

Cai Yuguo, Zheng Yongli, He Min, Pu Yu

Chinese Journal of Antituberculosis. 2023, 45(3): 297-304. doi:10.19982/j.issn.1000-6621.20220370

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Objective: To establish and verify the early diagnosis model of knee joint tuberculosis based on LASSO regression. Methods: One hundred and thirty-six patients with knee joint tuberculosis admitted to Public Health Clinical Center of Chengdu from January 2019 to January 2022 were selected as the case group; 136 patients with non-tuberculous knee disease in the same period were selected as the control group for modeling. In addition, 72 patients with suspected knee joint tuberculosis from February to October 2022 were selected as the validation group, 13 of whom were pathologically confirmed as having it. The general information, laboratory examination and MRI examination results of those patients were collected. The indicators of patients in the two groups were compared, and LASSO regression was used to screen factors that might be associated with knee joint tuberculosis and multivariable logistic regression was conducted to establish a nomogram model which then was verified internally. Results: LASSO regression model screened out 11 potential diagnostic factors (gender, age, IFN-γ release, LAM antibody, GeneXpert MTB/RIF result, bone marrow edema, meniscus injury, cartilage injury, swelling of surrounding tissue, bone destruction and periarticular abscess formation). The results of multivariable analysis showed that age (OR=0.977, 95%CI: 0.955-0.999), IFN-γ release level (OR=1.005, 95%CI: 1.001-1.009), LAM antibody positive (OR=15.348, 95%CI: 6.344-37.130), GeneXpert MTB/RIF (OR=21.073, 95%CI: 8.281-53.628), bone marrow edema (OR=2.996, 95%CI: 1.165-7.702), meniscus injury (OR=5.007, 95%CI: 1.868-13.425), cartilage injury (OR=4.117, 95%CI: 1.649-10.274), surrounding tissue swelling (OR=5.389, 95%CI: 2.059-14.102) and periarticular abscess formation (OR=7.570, 95%CI: 1.876-30.546) were independent influencing factors for knee joint tuberculosis. A nomogram model was established according to the results of multivariable analysis and a ROC curve was drawn according to the data of the validation group. Results showed that the AUC of the nomogram model for predicting the risk of knee joint tuberculosis was 0.927 (95%CI (0.898-0.957)); calibration curve analysis showed that the predicted risk probability of knee joint tuberculosis by the nomogram model was basically consistent with the actual probability. Decision curve analysis showed that when the probability threshold of nomograph model to predict the risk of knee joint tuberculosis was 0.15-0.90, the net profit rate of patients was greater than 0. Conclusion: With the increase of age, the risk of tuberculosis of knee joint decreases, IFN-γ release increasing, LAM antibody positive, GeneXpert MTB/RIF positive, as well as bone marrow edema, meniscus injury, cartilage injury, swelling of surrounding tissue and formation of periarticular abscess, increase the risk of knee tuberculosis. The nomograph prediction model established based on the above factors could be used for early diagnosis of knee joint tuberculosis.

Research progress of chemokines in the diagnosis of tuberculosis

Ma Zichun, Shang Yuanyuan, Pang Yu, Li Shanshan

Chinese Journal of Antituberculosis. 2023, 45(3): 305-310. doi:10.19982/j.issn.1000-6621.20220374

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Chemokines are a family of highly conserved proteins involved in many biological processes, including chemotactic cell migration, immune cell degranulation, hematopoiesis and angiogenesis, and play an important role in the human immune system. After being infected with Mycobacterium tuberculosis, the expression of chemokines and their receptors changes, and many chemokines have the potential to be used as biomarkers for the diagnosis of tuberculosis. The authors summarize the recent studies on chemokines in the diagnosis of tuberculosis, review the diagnostic value of several important chemokines from CC chemokine family, CXC chemokine family, CXCL chemokine family and their receptors, explore the application potential in the diagnosis of tuberculosis and provide valuable clinical reference for the diagnosis and prognosis assessment of tuberculosis in the future.

Progress on short-course regimens for the treatment of tuberculosis

Zhou Feng, Li Tongxin, Yang Song, Tang Shenjie

Chinese Journal of Antituberculosis. 2023, 45(3): 311-317. doi:10.19982/j.issn.1000-6621.20220447

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The treatment duration is a critical determinant for the cure of patients with tuberculosis. The long duration of treatment of drug-susceptible pulmonary tuberculosis is associated with nonadherence and loss to follow up, and the treatment success rate of multidrug-resistant pulmonary tuberculosis is lower with longer regimens. The current standard six-month regimen for drug-susceptible pulmonary tuberculosis are highly effective, however, challenges such as increasing drug resistance, poor treatment adherence, drug interactions, adverse effects or pharmacokinetic variability may result in suboptimal treatment outcomes. The development of safe and effective tuberculosis drug regimens that could shorten the time to sputum culture conversion, improve cure and treatment completion rates, reduce morbidity, mortality and relapse is critical. A shorter effective regimen for treating tuberculosis would be a boon for both patients and healthcare providers which could improve rates of adherence, reduce rates of adverse events, and lower costs. There were many methods to shorten the regimen course for the treatment of drug-susceptible pulmonary tuberculosis, e.g. a 4-month regimen of 2H-R-Z(E)/2H-R (isoniazid, H; rifampin, R; pyrazinamide, Z; ethambutol, E); a 4-month regimen of 2R₇-H₇-Z₇-E₇-Mfx₇/2R₇-H₇-Mfx₇ (moxifloxacin, Mfx); a 4-month regimen which modifies the standard 6-month regimen by replacing H or E with standard dose of Mfx. For drug-resistant tuberculosis, there were new treatment regimens like adding fluoroquinolones into the standard regimen; new regimens with new anti-tuberculosis drugs such as bedaquiline, delamanid or pretomanid; using high doses of old drugs and replacing injection drugs with all oral administration drugs. Thereby a review has been developed on the above-mentioned shorter course regimens for the treatment of drug-susceptible pulmonary tuberculosis and drug-resistant tuberculosis.

Application value of ¹⁸F-FDG PET/CT in diagnosis and treatment of tuberculosis

Hu Yujing, Bian Yanzhu

Chinese Journal of Antituberculosis. 2023, 45(3): 318-322. doi:10.19982/j.issn.1000-6621.20220500

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Tuberculosis is recognized as a major public health problem in the world. However, in the process of tuberculosis diagnosis and treatment, there are still many problems that are difficult to solve with conventional imaging. The uptake of ¹⁸F-FDG PET/CT is a relatively widely used multimodal imaging, which can simultaneously display both the anatomical and the metabolic information of the lesion. It is helpful in the diagnosis of tuberculosis, especially in the location of concealed tuberculosis lesions, which is superior to conventional imaging. In addition, the metabolism of lesions can reflect the activation of inflammatory cells, and ¹⁸F-FDG PET/CT can provide an objective assessment about the stable state of Mycobacterium tuberculosis and the activity of lesions. During the treatment of tuberculosis, ¹⁸F-FDG PET/CT has better predictive value than conventional imaging in evaluating the early therapeutic effect. ¹⁸F-FDG PET/CT can explore the mechanism of occurrence, development and treatment of tuberculosis from the metabolism perspective, improve the safety and individualization of treatment, and has important value in integrating the medical diagnosis and treatment strategy of tuberculosis. The main application of ¹⁸F-FDG PET/CT imaging in the diagnosis and treatment of tuberculosis was reviewed in order to further explore and tap its potential in the diagnosis and treatment of tuberculosis.

Analysis of drug resistance characteristics and treatment outcomes of 290 patients with high risk of drug-resistant pulmonary tuberculosis

Xu Jing, Jiang Shuangshuang, Zheng Hailun, Luo Ping

Chinese Journal of Antituberculosis. 2023, 45(3): 323-327. doi:10.19982/j.issn.1000-6621.20220485

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Using the method of retrospective investigation, data of 290 patients with high risk of drug-resistant tuberculosis registered in the Tuberculosis Outpatient Department of Beijing Center for Disease Prevention and Control from January 2012 to December 2021 were collected through the Tuberculosis Management Information System, a sub-system of Chinese Disease and Prevention Information System and Outpatient medical record system. The drug resistance of 9 kinds of drugs (isoniazid, rifampicin, ethambutol, streptomycin, levofloxacin, amikacin, capreomycin, protionamide, para-aminosalicylic acid) was analyzed. The drug resistance characteristics and treatment outcomes of high-risk groups were analyzed. The results showed that the sequence of single drug resistance of 9 antituberculosis drugs was isoniazid (35.93%, 60/167)>streptomycin (35.22%, 56/159)>rifampicin (24.04%, 50/208)>ethambutol (15.09%, 24/159)>levofloxacin (13.04%, 18/138)>capreomycin (7.25%, 10/138)>para-aminosalicylic acid (5.07%,7/138)>protionamide (4.35%, 6/138)>amycinkacin (3.62%, 5/138). The detection rate of multidrug-resistant tuberculosis was 26.95% (45/167). In Rifampicin-resistant patients, the screening rate of levofloxacin resistance was 90.00% (45/50) and the rate of levofloxacin resistance was 28.89% (13/45). Of the 290 patients, 50 changed to rifampicin-resistant treatment, 21 were re-diagnosed as suffering from non-tuberculous mycobacterium disease; The other 219 cases were still treated following the rifampicin sensitive treatment protocol, of which 194 cases were cured or completed their treatment, accounting for 88.58%. More efforts should be made to screen drug resistance among high-risk groups, especially for those who had failed treatment, should be fully screened.

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