Table of Content

10 July 2009, Volume 31 Issue 7

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Evaluation of antigenicity of 5 Mycobacterium tuberculosis specific proteins

Yang Liu,Su Mingquan, Yue Qiaohong, Zhang Jianfang, Ma Yueyun,Liu Jiayun, Hao Xiaoke

Chinese Journal of Antituberculosis. 2009, 31(7):  381-383. 

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ObjectiveTo evaluate antigenicity of 5 Mycobacterium tuberculosis specific proteins including 14, 16, 38 kD, Mtb81 and ESAT-6. MethodsAll the recombinant proteins of 14, 16, 38 kD, mtb81 and ESAT-6 were generated, and employed in ELISA to detect the antibodies in serum samples of 120 TB patients, 30 non-TB patients and 30 normal human. ResultsThe Results showed that all 5 proteins gave above 95% specificity, while 38 kD showed 80.8% sensitivity which was more sensitive than any other assays using 14, 16 kD, Mtb81 and ESAT-6 recombinant proteins. ConclusionAll 5 specific proteins of Mycobacterium tuberculosis showed different levels of antigenicity. It was useful for TB diagnosis, and improved assay might be helpful to detect the antigens or antibodies against them.

Effect of Mycobacterium tuberculosis 6-kilodalton early secreted antigenic target (ESAT-6) on IL-12 production from THP-1 monocytes

Liu Yaoting¹，Hu Zhongyi²，Feng Yonghong²，Liu Zhonghua, Shi Li

Chinese Journal of Antituberculosis. 2009, 31(7):  384-388. 

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ObjectiveTo study the effect of Mycobacterium tuberculosis 6-kilodalton early secreted antigenic target (ESAT-6) on interleukin 12 (IL-12) production from human THP-1 monocytes. MethodsExpression and purification of ESAT-6 in E.Coli. Recombinant ESAT-6 was purified by nickel-nitrilotriacetic acid metal affinity chromatography under native conditions. Human monocytes were treated with ESAT-6, in present of LPS or not at different culture periods or dose. Supernatants were collected for IL-12 detection by ELISA. Signaling pathway inhibitors was used to find the signaling pathway of ESAT-6. ResultsMycobacterium tuberculosis ESAT-6 antigen dose-dependently induced IL-12 release from THP-1 monocytes; Lipopolysaccharide (LPS) had synergic effect on ESAT-6 induced IL-12 production from THP-1 monocytes.1； The enhancement effect of ESAT-6 on IL-12 production was promoted by selective inhibitor of JNK MAPK, SP600125, while it was inhibited by PKR selective inhibitor, 2-AP. ConclusionESAT-6 may induce monocytes activation and enhance IL-12 release. This may have important significance of protection in the early period of infection.

High-level expression of Mycobacterium tuberculosis phoS2 gene in E.coli and antigenicity analysis of the recombinant protein

Su Rui^{1, 2}，Li Bangyin²，Wang Zhen³，Wang Zhongyuan, Cheng Xiaoxing, Zhang Lingxia, Li Guoli

Chinese Journal of Antituberculosis. 2009, 31(7):  389-392. 

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Objective To express phoS2 in Escherichia coli，purify the recombinant protein，preliminary evaluate its antigenicity and specificity by Western blot. MethodsExpression plasmid of phoS2 was constructed with DNA recombinant technique. Positive clones were chosen using emzyme digestion and polymerase chain reaction. Recombinant plasmid was transformed into E.coli. Then phoS2 was induced to express. The expression of phoS2 was identified by SDS-polyacrylamid gel electrophoresis (SDS-PAGE); the recombinant protein was purified; the antigenicity and specificity of phoS2 protein was analyzed by Western blot. ResultsphoS2 was highly expressed in E.coli，the amount of phoS2 protein in E.coli BL21 occupied more than 40% of total bacterial proteins. Purified protein could react strongly with serum samples from the patients with tuberculosis, but could not react with serum samples from healthy control. ConclusionThe recombinant phoS2 protein was expressed mostly in inclusion body form in E.coli. The Results indicated that the recombinant phoS2 antigen showed higher antigenic specificity and immunoreactivity，had potential application value in diagnosis of tuberculosis.

Evaluation of the quality control of sputum examination in general hospitals of Xinjiang Uygur Autonomous Region

Jia Wei, Ding Xiongjie, Liu Nianqiang

Chinese Journal of Antituberculosis. 2009, 31(7):  393-395. 

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ObjectiveTo analyze the quality control work of sputum smear examination in general hospitals and to explore effective measures for improving TB infection source detection. MethodsThe monitoring reports and smear recheck quality control Results of all general hospitals were analyzed and evaluated. ResultsIn 2007, 21313 TB suspects were registered in 53 basic-level general hospitals, among which 403 cases were smear-positive pulmonary tuberculosis, smear positive rate was 5.7%; 6989 smear negative and no smear Results cases were referred to tuberculosis control institutes, with 5972 cases received smear Results and 2030 cases were smear-positive pulmonary tuberculosis, smear positive rate was 33.9%. 3940 smear-negative TB patients were referred to TB control institutes and examined sputum smear, among which 893 were smear-positive pulmonary tuberculosis cases, smear positive rate was 22.6%. 29048 patients received their smear Results in TB control institutes with 9896 smear positive pulmonary tuberculosis cases, smear positive rate was 34.1%, there were significant differences compared with general hospitals (P<0.05). ConclusionsStrengthening the cooperation between general hospitals and TB control institutes, improving the training and retraining of lab technicians in general hospitals to increase quality control and detection rate in order to improve the detection of TB infection source.

Analysis of tuberculosis patients registered in Enshi Tujia and Miao Autonomous Prefecture of Hubei Province in 2007

Peng Zaisheng, Wang Kekun, Liu Wensheng, Chen Siqiang, Qian Cengshang, Mei Gongchao, Xiong Changfu, Lu Xianji

Chinese Journal of Antituberculosis. 2009, 31(7):  396-401. 

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ObjectiveTo explore the features of pulmonary tuberculosis prevalence in Enshi Autonomous Prefecture, and to provide scientific evidence for development of TB control policy. MethodsQuestionnaire specifically for tuberculosis patients was designed and filled by trained doctors. All TB cases registered in TB control institutes in 2007 were interviewed and the data were entered in EXCEL worksheet and analyzed by SPSS12.0 software. Results(1) The incidence of ethnic minorities was significantly higher than that of Han (P<0.001)，Tujia>Han>Miao=other minority (Miao and other Chi-square partition P=0.518, P=0.000 for others); (2) The incidence rates of men and women of the minority were respectively higher than those of Han (P_M=0.000; P_F=0.000), the highest incidence age group was 15～64 years, and the top three in both Han nationality and minority age group were above 65 years,55～65 years and 45～55 years; (3) The greatest incidence among various occupations was farmers, that of students’ was the second； (4)There was a high negative correlation between the morbidity of tuberculosis and annual income (r_Han=-0.930, r_minority=-0.920)，and also between the incidence of tuberculosis and the level of education in both nationalities(r_Han=-0.953, r_minority=-0.995); (5) The most common source of patients was positive consultation, the average patient delay was 45.21 days, and the delay in the minorities was 9.56 days longer than that in Han， 50.7% of the patients sought for health care after 30 days’ symptoms emergence. ConclusionsEconomic factors remains the most important factor for the incidence of tuberculosis in Enshi Autonomous Prefecture, so the strengthening Government’s commitment, increasing financial input and policy development are crucial for controlling the infection source of tuberculosis and reducing incidence.

Effects on tuberculosis case finding in floating population of program management

Pang Xuewen，Li Shanglun

Chinese Journal of Antituberculosis. 2009, 31(7):  404-406. 

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ObjectiveTo analyze the function of China Global Fund R5 TB Control Program on tuberculosis case finding in floating population and to provide scientific evidence for tuberculosis control in the group. MethodsThe data of tuberculosis case finding of floating population before and after the program were collected and compared for research evaluation. ResultsThe best way for tuberculosis case finding in floating population was referring，but the proportion of the clinical consultation raised from 33.4% to 39.6%. More suspect cases were found by referring and the total arrival rate raised from 83.7% to 91.0%.The number of active tuberculosis cases was as 1.88 times as the last year. ConclusionSome measures of the program are effective in tuberculosis case finding in floating population.

Analysis of the effect of the designated hospitals model on tuberculosis control at county level

Zhao Yaling¹, Lin Xinqin, Ge Lihui, Qin Xuan, Zhou Mingneng, Liu Yujian

Chinese Journal of Antituberculosis. 2009, 31(7):  407-409. 

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ObjectiveTo evaluate the TB control effect of the model of designated hospitals at county level. MethodsThe data from TB monthly, quarterly and annual reporting system during 2004—2006 were collected and analyzed. ResultsAfter the implementation of the model of designated hospitals, the registration rate of active tuberculosis and smear positive cases were significantly increased from 118.12/100000,36.95/100000 to 143.59/100000 and 52.38/100000 respectively, and the cure rate was 92.8% in average, which had no significant difference between the two models(P>0.005). ConclusionsResults shows that the model of designated hospitals at county level is successful. Furthermore, it is necessary to perfect the model and develop relevant standards and measures.

Clinical study of interventional treatment under CT-guided percutaneous puncture for severe cavitary pulmonary tuberculosis.

Zheng Yongli,Tian Zigang,Song Weifeng,et al.

Chinese Journal of Antituberculosis. 2009, 31(7):  410-413. 

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ObjectiveTo evaluate the feasibility, clinical efficacy and treatment value of interventional treatment under CT-guided percutaneous puncture for severe cavitary pulmonary tuberculosis.MethodsThirty-two patients with severe cavitary pulmonary tuberculosis were randomly assigned to a treatment group and a control group. All patients received chemotherapy with 3VHPThZAk/15VPaTh.Meanwhile,patients in the treatment group were given interventional treatment with administration of antituberculosis agents under CT-guided percutaneous puncture.ResultsAt the end of the course, the rates of sputum negative and foci absorption were,75.0% (12/16)and 62.5% (10/16)in the treatment group,respectively, which were higher than those of the control with statistical significance(P<0.05).After 3 months treatment，the rate of sputum negative was 56.3% (9/16), which was higher than that of the control（31.3%，P<0.05).There was no significant difference in cavities closure and cavities shrunk between two groups(P>0.05),the closure rate of smaller thin-walled cavity and caseous cavity were hige. The rate of air-fluid level in cavity was 9.1% in the treatment group, which was lower than that of the control(80%, P<0.01). ConclusionsThe interventional treatment under CT-guided puncture for severe cavitary pulmonary tuberculosis is a new method.It has the same therapeutic efficacy compared with other interventional treatment, icluding the role of cleaning up cavity,converting sputum negative, promoting foci absorption, and shrunking and closing cavity.It is safe, minimally invasive, less painful, low-cost, and no side effect.This therapy will play an important role in controlling the origin of infection and tuberculosis epidemic. It is Worth to be applied clinically.

Meta-analysis on clinical efficacy of combination regimens with levofloxacin in retreatment of pulmonary tuberculosis

Yang Lijuan

Chinese Journal of Antituberculosis. 2009, 31(7):  415-419. 

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ObjectiveTo assess the clinical efficacy of combination regimens with Levofloxacin(LVFX) in retreatment of pulmonary tuberculosis. MethodsWe searched CBM, CNKI, Wan Fang Digitalization Periodical, and Wei Pu Chinese technology periodical from 1994 to 2006 for randomized controlled trials(RCTs), which were enrolled according to the criteria for inclusion and exclusion, the quality were evaluated and meta-analysis performed by RevMan4.2.7 software. ResultsWe found 8 trials including 791 patients with poor qualities. The meta-analysis showed that there were statistically significant differences on the rates of sputum negative and radiographic improvement between containing Levofloxacin group and control group (OR 3.70, 95% CI 2.59 to 5.27, and OR3.10, 95% CI 2.25 to 4.28). The rate of cavities closure in the study group maybe higher than that of the control(OR 2.41, 95% CI 1.50 to 3.89, RR 1.63, 95% CI 0.99 to 2.68) There was no difference on side effects(OR 0.94,95% CI 0.58 to 1.53). ConclusionsSo far, there are a few evidences to support the result, which the clinical efficacy on the rates of sputum negative and the radiographic improvement in the study group is better than that of the control.Due to few studies, potential publication bias, and low quality of trails, we could not draw reliable conclusions from the present data. High quality RCTs should be performed further.

Analysis on clinical correlated factors of pulmonary tuberculosis complicated by fungi infection

Cai Baoyun, Li Qi, Cao Min

Chinese Journal of Antituberculosis. 2009, 31(7):  421-424. 

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ObjectiveTo study the clinical features and the correlated factors of secondary pulmonary tuberculosis complicated by fungi infection. MethodsThe clinical features and types of fungi strain in 508 patients with secondary pulmonary tuberculosis complicated by fungi infection were analyzed retrospectively. Results1.The major type of fungi infected in the patients with secondary pulmonary tuberculosis were Candida albicans whether infected with single type or mixed type of fungi(62% and 72%,respectively). 2.Patients with old age and long history were the major cases with secondary pulmonary tuberculosis whether infected with single type or mixed type of fungi（49% single and 55% mixed infection in elderly patients, 56% single and 65% mixed infection in long history patients）. 3. Whether infected with single type or mixed type of fungi，the incidence of fungi infection increased with the increase of lung lesion areas, especially lesion areas were more than three lung fields(61% and 75%, respectively).The patients with pulmonary tuberculosis complicated with fibrosis were easily infected by fungi(69% and 75%,respectively). 4. Whether infected with single or mixed type of fungi in patients with secondary pulmonary tuberculosis, Rale and moderate anaemia were seen in up to 50% patients and moderate fever was in up to 10% patients. ConclusionsCandida albicans was the major type of infected fungi in patients with secondary pulmonary tuberculosis. Patients with old age, long history and severe illness are major suspected population. The clinical features of most patients are atypical. The incidence of mixed infection with fungi in patients with secondary pulmonary tuberculosis is higher than that of patients with community acquired pneumonia.

Analysis on 202 adult patients with hematogenous pulmonary tuberculosis

Han Xiqin,Gao Weiwei,Huang Xuerui,Ma Yu

Chinese Journal of Antituberculosis. 2009, 31(7):  425-429. 

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ObjectiveTo understand further hematogenous pulmonary tuberculosis with analysis on its clinical characteristics. MethodsWe analyzed retrospectively the clinical data,image characters,misdiagnosis and therapeutic response among 202 adult cases with hemotogenous pulmonary tuberculosis hospitalized from 1998 to 2008.Results（1）The young and the middle aged patients accounted for 80.2%, but the elderly patients have increased recently.（2） The rate of sputum smear positive was only 20.7%. However,the rate of AFB positive was 35.5% by fiberoptic bronchoscopy in 31 patients with sputum smear negative. （3）Patients with ground-glass opacity in chest X-rays accounted for 12.9% at the earlier stage. 51.5% cases manifested uniform miliary nodules in size, density and distribution in the chest X-rays. （4）Chest HRCT showed that 55.0% patients with acute hematogenous pulmonary tuberculosis had miliary nodules in the lungs and 45% patients with subactue and chronic hematogenous pulmonary tuberculosis had inconsistent nodules which distributed in the upper and middle zones. 46.8% patients with hematogenous pulmonary tuberculosis had patchy, nodular and fibrotic shadow, and 43.1% had hilar and mediastinal lymph node enlargement.（5）12 of 20 cases receiving biopsy had pathological positive result.（6）44.6% patients were complicated with extra-pulmonary tuberculosis such as meningitis,oromeningitis,tuberculous lymphadenitis,brain tuberculoma tuberculosis of liver, tuberculosis of spleen, bone tuberculosis and so on.（7）42.1% cases were misdiagnosed before hospitalization. （8）The temperature of all patients except 8 returned to normal from 3 days to 12 weeks after given anti-tuberculosis chemotherapy. （9）The lesions of 79.7% cases had various degree absorption in chest X-rays after 2 months therapy. ConclusionSputum smear, chest HRCT，fiberoptic bronchoscopy and biopsy are the key Methods for early diagnosis.