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10 October 2023, Volume 45 Issue 10

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Interpretation of Standards

Interpretation of the World Health Organization's Use of targeted next-generation sequencing to detect drug-resistant tuberculosis Rapid communication, 2023

Huang Hairong

Chinese Journal of Antituberculosis. 2023, 45(10):  921-924.  doi:10.19982/j.issn.1000-6621.20230311

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The World Health Organization released “Use of targeted next-generation sequencing to detect drug-resistant tuberculosis Rapid communication,2023” recently, in order to timely share the important data and opinions formed accordingly on drug resistance detection by the targeted next-generation sequencing technique. Therefore, facilitate the understanding of this new technique and accelerate its promotion. This note interpreted the key data and the opinions in the rapid communication, so as to help the reader to recognize the value of the targeted next-generation sequencing technique in the diagnosis of drug resistant tuberculosis.

Original Articles

Effect of Mycobacterium vaccinae on T Lymphocyte subsets in peripheral blood of HIV patients complicated with latent Mycobacterium tuberculosis infection

Yang Zhenggui, Jiang Zeshun, Liu Lan, Han Xue

Chinese Journal of Antituberculosis. 2023, 45(10):  925-931.  doi:10.19982/j.issn.1000-6621.20230124

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Objective: To investigate the effects of Mycobacterium vaccinae on T Lymphocyte subsets in HIV patients complicated with latent tuberculosis infection (LTBI) and its safety. Methods: Using a multicenter prospective cohort study method, 96 HIV patients complicated with LTBI who were confirmed through tuberculin skin test screening and managed by the AIDS management agency in Yinchuan City, Ningxia Hui Autonomous Region from June 2003 to June 2020 were continuously included as the study subjects. The research subjects were divided into experimental group (n=63) and control group (n=33) according to the counties and districts. Based on efficient antiretroviral therapy, the experimental group was injected with Mycobacterium vaccinae (22.5 μg, once every two weeks for three times), and the control group received oral isoniazid (300 mg, once a day, continuously for 6 months). Levels of immune cells such as CD4⁺, CD8⁺, and CD3⁺T cells, as well as changes in liver function indicators between the two groups were measured and compared before treatment and at 1-month and 3-month follow-up after treatment. In addition, the occurrence of adverse reactions in both groups was evaluated. Results: One month after the end of treatment, the level of CD3⁺T cells in the experimental group was (1583.83±584.69) cells/μl, significantly higher than that before treatment ((1221.20±399.52) cells/μl; t=-2.962, P=0.004). Three months after the end of treatment, the levels of CD3⁺, CD4⁺, and CD8⁺T cells were (1816.67±736.86) cells/μl, (674.10±282.30) cells/μl and (833.21±314.11) cells/μl, significantly higher than those before treatment ((1221.20±399.52) cells/μl, t=-4.460, P<0.001; (588.71±273.44) cells/μl, t=-2.801, P=0.044; and (609.65±267.71) cells/μl, t=-3.801, P<0.001, respectively). Three months after the end of treatment, the levels of CD3⁺, CD4⁺T cells, and CD4⁺/CD8⁺ ratio (0.86±0.54) in the experimental group were significantly higher than those in the control group ((1716.47±689.07) cells/μl, t=2.209, P=0.034; (559.11±187.14) cells/μl, t=3.666, P=0.008; 0.82±0.74, t=3.502, P=0.001, respectively). One month after the end of treatment, the level of aspartate aminotransferase in the control group was (33.15±11.70) U/L, significantly higher than that in the experimental group ((26.54±9.63) U/L, t=2.624, P=0.011). Three months after the end of treatment, the levels of alanine aminotransferase ((52.58±27.72) U/L) and alanine aminotransferase ((33.74±11.89) U/L) in the control group were significantly higher than those in the experimental group ((35.29±21.16) U/L, t=2.563, P=0.013; and (26.67±11.07) U/L, t=2.172, P=0.034, respectively). The experimental group had no adverse reactions and no patients withdrew from treatment, with a treatment completion rate of 100.0% (63/63), significantly higher than that of the control group (84.9% (28/33), χ²=7.235, P=0.007). Conclusion: The use of Mycobacterium vaccinae for anti-tuberculosis prophylactic treatment in HIV patients complicated with LTBI can improve the cellular immune levels and cause less damage to liver function, indicating good safety.

Construction of pulmonary rehabilitation nursing program of integrated traditional Chinese and Western medicine for patients with tuberculous empyema under thoracoscopic clearance

Gao Dan, Wang Linghua, Huang Jinpeng, Zhang Yue, Mao Xiaoxiao

Chinese Journal of Antituberculosis. 2023, 45(10):  932-939.  doi:10.19982/j.issn.1000-6621.20230203

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Objective: To construct a pulmonary rehabilitation nursing program of integrated Traditional Chinese Medicine (TCM) and Western medicine for patients with tuberculous empyema undergoing thoracoscopic clearance. Methods: Based on literature research, patient interview, case review and group discussion, the pulmonary rehabilitation nursing program of integrated TCM and Western medicine for patients undergoing thoracoscopic tuberculous empyema removal was established. Using the Delphi method, 15 experts were consulted, and the items of the program were modified to determine the final nursing program. Results: The recovery rates of the two rounds of expert consultation questionnaires were 100.0% (15/15) and 93.9% (14/15), respectively, and those who making recommendations were 60.0% (9/15) and 14.3% (2/14), respectively. After two rounds of expert consultation, the experts’ authority coefficient was 0.96, among which the experts’ judgment basis coefficient was 0.95, and the familiarity coefficient of the consultation content was 0.96. Of the two rounds of expert consultation, the coefficients of variations were 0.00-0.45 and 0.00-0.14, respectively; and the Kendall's coefficients of concordance were 0.336 and 0.119, respectively (χ²=176.340 and 99.910, P<0.001). The final plan includes 3 primary indicators (preoperative, postoperative, and discharge), 14 secondary indicators and 47 tertiary indicators for preoperative, postoperative and discharge stage. Conclusion: The construction of pulmonary rehabilitation nursing program of integrated TCM and Western medicine for patients with tuberculous empyema undergoing thoracoscopic clearance has high enthusiasm and authority of experts, and the coordination of expert opinions is satisfactory. The constructed nursing program is reliable and feasible.

Analysis of the application effect of integrated traditional Chinese and Western medicine pulmonary rehabilitation nursing program for patients with tuberculous empyema undergoing thoracoscopic clearance

Gao Dan, Wang Linghua, Huang Jinpeng, Zhang Yue, Mao Xiaoxiao

Chinese Journal of Antituberculosis. 2023, 45(10):  940-948.  doi:10.19982/j.issn.1000-6621.20230125

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Objective: To explore the application effect of integrated traditional Chinese medicine (TCM) and Western medicine pulmonary rehabilitation nursing program in patients with tuberculous empyema undergoing thoracoscopic clearance. Methods: Using a prospective research method, 66 newly admitted patients with tuberculous empyema who met surgical indications in Hangzhou Chest Hospital Affiliated with Zhejiang University School of Medicine from October 2021 to December 2022 were enrolled. They were randomly divided into observation group (33 cases) and control group (33 cases) using a random number table method. The control group received routine care, while the observation group received the Pulmonary rehabilitation nursing program of integrated traditional Chinese and Western medicine for patients with tuberculous empyema under thoracoscopic clearance in addition to the routine care. Lung function, daily living ability, anxiety level and postoperative chest tube indwelling time of the two groups on the day of admission, the second day after surgery, the day of discharge, and one month after discharge were compared, and the pain level on the second day after surgery were also compared. Results: One month after discharge after treatment, of the study subjects, 28 cases in the control group completed the intervention, with a completion rate of 84.8% (28/33), and 31 cases in the observation group completed the intervention, with a completion rate of 93.9% (31/33). The median (quartile) levels of forced expiratory volume in one second in the observation group before discharge and one month after discharge were 1.83 (1.60, 2.29) L and 2.20 (2.00, 2.32) L, respectively, which were significantly higher than those in the control group (1.58 (1.43,1.83) L and 1.91 (1.88, 2.04) L), with statistical significance (Wald χ²=8.947, P=0.003; and Wald χ²=7.285, P=0.007, respectively); the forced vital capacity levels in the observation group were 2.50 (2.30,2.64) L and 2.65 (2.45,2.79) L, respectively, significantly higher than those in the control group (2.21 (2.20,2.49) L, Wald χ²=10.072, P=0.002; 2.55 (2.35,2.69) L, Wald χ²=5.708, P=0.017, respectively). On the second day after surgery, the median (quartile) Barthel index in the observation group was 55.0 (55.0, 70.0), which was significantly higher than that in the control group (50.0 (40.0, 53.8), Wald χ²=14.009, P<0.001). The anxiety scores of the observation group before discharge and one month after discharge were 54.52±4.89 and 49.58±3.91, respectively, which were significantly lower than those of the control group (57.43±4.77, t=5.338, P=0.025; 54.61±3.98, t=23.907, P<0.001, respectively). The postoperative thoracic tube retention time in the observation group was 9 (7, 9) d, significantly shorter than that in the control group (9 (8, 10) d, Z=-2.076, P=0.038). Conclusion: The intervention of the integrated TCM and Western medicine pulmonary rehabilitation nursing program can improve the lung function of patients undergoing thoracoscopic clearance surgery for tuberculous empyema, reduce anxiety levels, enhance postoperative daily living ability, and shorten postoperative chest tube retention time, which is worth promoting.

The value of CT radiomics in differentiating the mediastinal lymph node tuberculosis and mediastinal lymph node metastasis of non-small cell lung cancer

Yuan Xiaoji, Sun Xiubin, Han Rong, Ni Conghui, Wang Wuzhang, Yu Dexin

Chinese Journal of Antituberculosis. 2023, 45(10):  949-956.  doi:10.19982/j.issn.1000-6621.20230186

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Objective: To explore the value of CT radiomics in differentiating the mediastinal lymph node tuberculosis and mediastinal lymph node metastasis of non-small cell lung cancer. Methods: From September 2017 to November 2021, CT imaging data of 109 patients with mediastinal lymph node tuberculosis (tuberculosis group) and 65 patients with mediastinal lymph node metastasis of non-small cell lung cancer (metastasis group), who were diagnosed in Shandong Public Health Clinical Center and Qilu Hospital of Shandong University, were retrospectively collected. The CT images were observed and delineated with a double-blind method, and the radiomics features were extracted from the volume of interest (VOI) of the delineated lymph node by using the Radcloud platform. The feature normalization method, univariate and multivariate logistic regression models were used to analyze the characteristics with differential diagnosis capacity and the influence of collinearity between characteristics. Using the selected radiomics characteristics, the patient data of Shandong Public Health Clinical Center was used as a training set to establish a 5-fold cross-validation model of six machine learning methods (including k-Nearest Neighbor (KNN)), Support Vector Machine (SVM), eXtreme gradient boosting (XGBoost), Random Forest (RF), Logistic Regression (LR), and Decision Trees (DT)), and the model with the best diagnostic effect was selected. Then the patient data of Qilu hospital of Shandong University was used as a validation set to verify the diagnostic effect of the model. Results: Two hundred and eighty-one VOIs on CT images were delineated in 174 patients including 196 VOIs in tuberculosis group and 85 ones in metastasis groups. The median (quartile) VOI (1 (1, 8)) of the tuberculosis group was significantly higher than that of the metastasis group (1 (1, 3))(Z=2.827, P=0.005). A total of 1409 radiomics features were extracted, and eight mutually independent radiomics features were selected for modeling after feature standardization, univariate and multivariate logistic regression analysis. After 5-fold cross-validation modeling diagnosis using training group data, the area under the ROC curves of SVM and LR models (0.834 and 0.821, respectively) were superior to the other four models. Furthermore, LR and SVM models were established using training set data with AU values of 0.809 and 0.911, respectively. Then, the external validation was also achieved using the validation set data with AUC values of 0.804 and 0.851, respectively. The results showed that the two models still had a diagnostic effect in extrapolation. Conclusion: Regardless of whether age or gender feature are included or not, the LR model and SVM model established by CT radiomics have good and stable effect in differential diagnosis of mediastinal lymph node tuberculosis and non-small cell lung cancer mediastinal lymph node metastasis, and the SVM model is superior to the LR model.

Construction and validation of a nomogram for predicting unfavorable treatment outcomes among patients with rifampicin-sensitive tuberculosis

Chen Daiquan, Lin Shufang, Dai Zhisong, Zhou Yinfa, Chen Kun

Chinese Journal of Antituberculosis. 2023, 45(10):  957-966.  doi:10.19982/j.issn.1000-6621.20230141

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Objective: To develop a predictive model for unfavorable outcomes in patients with pulmonary tuberculosis, evaluate the predictive effect and practical value of the model, and provide a theoretical basis for further improvement of the success rate of pulmonary tuberculosis treatment. Methods: A retrospective study was conducted to analyze the treatment outcomes of rifampicin-sensitive active pulmonary tuberculosis patients registered in Fujian Province from 2016 to 2020. All the cases were randomly divided into the development cohort and the validation cohort at a ratio of 1∶1. A multivariate logistic regression was used to develop a predictive model for adverse outcomes in the development cohort, and a nomogram was used to display the predictive model. The ROC curve, calibration curve, and DCA curve were used to evaluate the discrimination, calibration, and clinical net benefit of the model, respectively. The model was internally validated in the validation cohort. Results: The average rate of adverse outcomes in Fujian Province from 2016 to 2020 was 9.15% (6872/75063). Multivariate logistic regression showed that female (OR=0.772, 95%CI: 0.705-0.845), with current addresses in Xiamen City (OR=0.823, 95%CI: 0.704-0.961), Nanping City (OR=0.571, 95%CI: 0.468-0.699) and Ningde City (OR=0.701, 95%CI: 0.583-0.843) were the protective factors of adverse outcomes of pulmonary tuberculosis. Age (OR=1.028, 95%CI: 1.025-1.030), occupation in public places and commercial services (OR=1.496, 95%CI: 1.007-2.223), manual labor (OR=1.438, 95%CI: 1.039-1.989), retirement and unemployed (OR=1.738, 95%CI: 1.250-2.416) and occupation unknown (OR=1.658, 95%CI: 1.161-2.369), the treatment classification was retreatment (OR=1.810, 95%CI: 1.606-2.041) and the current address was in Putian City (OR=1.647, 95%CI: 1.420-1.911), Quanzhou City (OR=1.194, 95%CI: 1.060-1.345), Zhangzhou City (OR=1.158, 95%CI:1.009-1.329) and Longyan City (OR=1.264, 95%CI: 1.073-1.488) were risk factors for adverse outcomes of pulmonary tuberculosis. The predictive model had an AUC of 0.674 (0.665-0.683), and the C-index is 0.674 in the validation cohort. The model calibration was high (Hosmer-Lemeshow test, χ²=3.091, P=0.929). When the threshold probability was within the range of 0-32%, the predictive model could obtain a positive net benefit greater than that of the full intervention and no intervention model. Conclusion: The predictive model constructed in this study has good availability of predictors and certain net benefits of prevention and control, and can be used to classify the risk of adverse outcomes of patients, strengthen the supervision and management of high-risk group, and then improve the successful treatment rate of patient.

An operational research of enhancing tuberculosis laboratory quality management by implement the Strengthening Laboratory Management Toward Accreditation (SLMTA) project

Zheng Yang, Xia Hui, Ou Xichao, Song Yuanyuan, Zhao Yanlin

Chinese Journal of Antituberculosis. 2023, 45(10):  967-973.  doi:10.19982/j.issn.1000-6621.20230212

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Objective: To assess the impact of the Strengthening Laboratory Accreditation Administration (SLMTA) program interventions on strengthening quality management in tuberculosis laboratories. Methods: Three laboratories (randomly numbered 1, 2, and 3) in Baoshan, Nanjing, and Chengdu were selected as pilot laboratories according to the selection criteria and voluntary declaration principle. Intervention measures, including training, communication, improvement actions, etc., were implemented in three pilot laboratories (baseline, intermediate, and terminal phases), followed by field assessment using standardized checklists at different phases. The differences in assessment results were analyzed by 12 quality system element. Results: At baseline assessment, the average score rate of three laboratories was (43.17±2.48) %, with 0 star for each laboratory. In the mid-term assessment, the average score rate of the three laboratories was (70.19±4.16) %, with laboratories 1 and 3 achieving 2 stars and laboratory 2 achieving 3 stars. At the final assessment, the average score rate of the three laboratories was (87.88±1.37) %, and all achieved 4 stars. The average scoring rate of the three project laboratories showed significant differences between different project phases (F=165.700, P<0.001). Among the 12 quality system elements, the average score rates of “Documentation and Records” “Organization and Personnel” “Equipment” “Process Control and Internal/External Quality Assessment” “Information Management” “Internal Review” “Management Review” “Internal Review” “Occurrence/Incident Management & Process Improvement” and “Corrective Actions” showed significant difference between baseline and final assessment, increasing from (46.43±0.00) %, (42.42±5.67) %, (43.31±8.07) %, (52.09±3.90) %, (71.35±5.42) %, (2.22±3.14) %, (25.00±13.61) % and (21.05±15.49) % at base line assessment to (83.33±1.68) %, (87.88±11.34) %, (93.66±0.40) %, (88.55±2.95) %, (89.81±0.48) %, (91.11±12.57) %, (88.89±10.39) % and (78.95±0.00) % at final assessment, respecively (t=31.010,P=0.001; t=10.010, P=0.010; t=9.108, P=0.012; t=9.709, P=0.010; t=4.559, P=0.045; t=11.090, P=0.008; t=4.600, P=0.044; t=5.284, P=0.034). Conclusion: SLMTA project implementation helps to improve the quality management of Tuberculosis laboratories, indicating that the intervention measures in the project can be more widely implemented in China.

Analysis of reported incidence of pulmonary tuberculosis and cross-regional medical care seeking among students in Fujian Province from 2005 to 2021

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

Chinese Journal of Antituberculosis. 2023, 45(10):  974-980.  doi:10.19982/j.issn.1000-6621.20230164

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Objective: To analyze the reported incidence of pulmonary tuberculosis (PTB) and cross-regional health care seeking of students in Fujian Province from 2005 to 2021, to provide reference for effective tuberculosis control in schools. Methods: The reported incidence data of PTB among students in Fujian Province from 2005 to 2022 were retrieved from the National Health Security Information Project Disease Prevention and Control Information System-Surveillance Management System. After clearing data according to inclusion and exclusion criteria, patients with onset dates from 2005 to 2021 were retained as study subjects. Retrospective description and Joinpoint regression model were used to analyze the incidence change trend among different age groups, and patients’ cross-regional medical visits. Results: From 2005 to 2021, a total of 12529 student patients with PTB were reported in Fujian Province. The reported incidence rates of PTB among students showed a significant downward trend, from 17.00/100000 (1202/7069000) in 2005 to 5.12/100000 (466/9103300) in 2021, the average annual change was -6.79% (Z=-2.706, P=0.007). Among different age groups, the reported incidence rates of students ≤12 years old and 13-15 years old were relatively low, averaged as 0.84/100000 (595/71009200) and 5.95/100000 (1359/22829500) respectively, but showed a significant upward trend since 2012 (APC=6.40,t=2.526, P=0.027;APC=5.57, t=2.208, P=0.047), from 0.41/100000 (16/3927100) and 4.11/100000 (46/1120400) in 2012 to 0.56/100000 (29/5201700) and 5.90/100000 (90/1526100) in 2021, respectively. The reported incidence rates of students aged 16-18 years old was 24.93/100000 (5165/20715300) averagely which was at a higher level and the overall downward trend was not obvious. The reported incidence rates of students aged ≥19 years old was 38.97/100000 (5410/13881800), which was at a higher level but showed a large overall decline (Z=-3.836, P<0.001), from 102.60/100000 (494/481500) in 2005 to 11.77/100000 (139/1181400) in 2021. 94.43% (11831/12529) of the students with PTB were treated in the medical institutions of the city where their current address was located. 5.57% (698/12529) of patients made cross-regional medical visits, and the proportion showed an increasing trend, from 4.24% (51/1202) in 2005 to 7.51% (35/466) in 2021 (Z=-4.901, P<0.001), the cross-regional medical care seeking obviously happened mostly in nearby regions. Conclusion: The reported incidence of PTB among students in Fujian Province was low, and the overall trend was obviously decreasing. The proportion of cross-regional medical visits was relatively low. It is necessary to continue to strengthen the prevention and control of tuberculosis in schools, especially focusing on 16-18 years of high school students.

Risk factors of delayed sputum smear conversion in pulmonary tuberculosis patients after intensive treatment in Weifang City Shandong Province from 2019 to 2022

Zhang Bo, Li Li, Zheng Lijuan, Liu Xuefa

Chinese Journal of Antituberculosis. 2023, 45(10):  981-988.  doi:10.19982/j.issn.1000-6621.20230187

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Objective: To analyze the influencing factors of delayed sputum smear conversion after intensive treatment of pulmonary tuberculosis patients, and provide scientific evidence for promoting sputum conversion and improving treatment effectiveness. Methods: Through the TB Information Management System of the Chinese Disease Prevention and Control Information System, information of etiologically positive patients registered and reported in Weifang Second People's Hospital of Shandong Province from January 1, 2019 to December 31, 2022 were collected. With inclusion and exclusion criteria, a total of 455 patients with tuberculosis were included in the study. Basic information such as age, gender, height, weight, and diabetes history was collected. Data analysis were conducted using SPSS 20.0 software. Logistic regression analysis was used to investigate the factors that influenced delayed sputum smear conversion. Results: After receiving intensive treatment, 299 patients showed negative results in their sputum tests, while 156 patients still tested positive. The rate of sputum bacteria turning negative was 65.7%. Logistic regression analysis indicated that certain factors were associated with delayed conversion, including diabetes (OR (95%CI)=1.859 (1.096-3.153)), complications (OR (95%CI)=1.855 (1.117-3.082)), sputum bacillary load being ++++ (OR (95%CI)=3.529 (1.063-11.715)), hypoproteinemia (OR (95%CI)=1.749 (1.040-2.943)), and anemia (OR (95%CI)=2.398 (1.412-4.070)). Conclusion: Patients with tuberculosis who also have diabetes, complications, sputum bacillary load being ++++, hypoalbuminemia, and anemia are at a higher risk for delayed sputum smear conversion. Identifying and correcting these risk factors timely can help patients achieve sputum negative conversion, reduce the risk of transmission, and prevent adverse prognosis.

Analysis on awareness of tuberculosis prevention and control knowledge and its influencing factors among pediatricians

Liu Cuiyu, Zhang Hui, Shen Adong

Chinese Journal of Antituberculosis. 2023, 45(10):  989-996.  doi:10.19982/j.issn.1000-6621.20230188

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Objective: To understand pediatricians’ knowledge of childhood tuberculosis control and prevention and its influencing factors, and to provide a scientific basis for the development of childhood tuberculosis control policy and training materials. Methods: A cross-sectional study was conducted using an online survey tool Wenjuanxing (https://www.wjx.cn/, in Chinese). A total of 2278 questionnaires were distributed, and 2138 valid questionnaires were received with effective rate of 93.85%. Multiple linear regression model was used to analyze the influencing factors of pediatricians’ knowledge on childhood tuberculosis prevention and control. Results: The overall awareness rate of childhood tuberculosis prevention and treatment was 34.36% (11753/34208). The awareness rate of the knowledge of tuberculosis prevention, diagnosis, treatment and management were 22.56% (1929/8552), 25.80% (2206/8552), 25.36% (2169/8552) and 63.72% (5449/8552), respectively. The results of multiple linear regression model showed that compared with pediatricians with secondary/tertiary education, in non-pediatric respiratory departments, without tuberculosis knowledge training, in secondary hospitals, and who did not treated children with tuberculosis, pediatricians with master's degrees or above, in pediatric respiratory departments, participated in tuberculosis knowledge training, in tertiary hospitals and receiving pediatric tuberculosis patients had better knowledge about tuberculosis prevention and control (t=2.888, P=0.004; t=4.466, P<0.001; t=7.459, P<0.001; t=2.707, P=0.007; t=3.296, P=0.001). Pediatricians participated in tuberculosis knowledge trainings knew more items of the knowledge of tuberculosis prevention, diagnosis, treatment and management (t=6.718, P<0.001; t=2.044, P=0.041; t=5.864, P<0.001; t=3.306, P=0.001). Pediatricians who treated children with tuberculosis had more knowledge about prevention, diagnosis and treatment (t=3.084, P=0.002; t=2.832, P=0.005; t=2.195, P=0.028). Conclusion: The overall knowledge of tuberculosis prevention and control among pediatric medical personnel was relatively low, especially in the knowledge of tuberculosis prevention, diagnosis and treatment. Strengthening the specialized training of pediatricians is an important issue that needs to be urgently addressed at present.

Review Articles

4-nitrobenzoic acid experiment of mycobacteria and research progress on its molecular mechanism of Mycobacterium differentiation

Li Yue, Xia Hui, Li Machao, Wang Ruibai

Chinese Journal of Antituberculosis. 2023, 45(10):  997-1002.  doi:10.19982/j.issn.1000-6621.20230191

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Mycobacterial disease is an important infectious disease threatening human health worldwide. The diseases caused by Mycobacterium tuberculosis (MTB) and non-tuberculous mycobacteria (NTM) are very similar in clinical symptoms, pathological manifestations and imaging features. However, there are inherent differences in the drug resistance spectrum between these two types of strains, resulting in significant differences in clinical treatment and management, therefore, rapid and accurate differentiation method is needed. PNB (4-nitrobenzoic acid) experiment is a selective culture method based on the different susceptibility of mycobacteria to PNB. It is widely used in clinical practice due to its simplicity, low price, and low technical requirements, but the mechanism involved in this experiment is unclear. This article reviewed the PNB experimental methods, reported researches on the PNB metabolic enzymes of mycobacteria and existing problems to provide ideas for elucidating the mechanism of mycobacteria PNB resistance, the principle of distinguishing MTB from NTM, and the new application value of PNB.