Table of Content

10 May 2008, Volume 30 Issue 5

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WHO TB drug resistant survey in Heilongjiang province

Xie Yanguang, Li Fabin, Yan Xinglu

Chinese Journal of Antituberculosis. 2008, 30(5):  395-398. 

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Objective To understand the status of drug resistant in M. tuberculosis in Heilongjiang province, to evaluate the quality and effectiveness of TB control and provide evidence for TB control policy development in Heilongjiang province. Methods According to the Guidelines for Surveillance of Drug Resistance in Tuberculosis of WHO/IUATLD, sampling method of layered group, thirty counties/districts were selected as surveillance sites. All smear positive cases on each surveillance site were included in the surveillance, 56 new smear positive cases were selected. Proportion method was used to conduct DST of INH, SM, RFP, EMB. Results 2 144 cases were included in the period in surveillance of drug resistance in 2004, among which the culture pollution rate was 2.1%, the culture negative rate was 3.8%. 2 019 cases had DST, among which the Results of 1 995 cases were analyzed. 78.9% was new cases and 21.10% was re-treatment cases. The proportion of primary drug resistant was 36.2%, the proportion of acquired drug resistant was 67.7%, the proportion of primary MDR was 7.2% and the proportion of acquired MDR was 30.4%. Conclusion Heilongjiang province is one of the higher drug resistant provinces where the surveillance of drug resistance has carried out. The high level of drug resistance was a big challenge in the work of tuberculosis control in Heilongjiang province. This suggested that on one hand the quality of DOTS should be improved in all of province, drug resistance cases would be reduced gradually through carrying out basic DOTS; on the other hand, the supports came from all levels of government and foreign aid project should be actively strived to solve the problem of the existing drug-resistant tuberculosis treatment, to reduce the drug resistance cases in farthest and achieve the goal of Tuberculosis Control Program on time.

Investigation on the knowledge of tuberculosis prevention and control among the public in Zhejiang Province

Wang Xiaomeng,Liu Beidou,Chen songhua

Chinese Journal of Antituberculosis. 2008, 30(5):  399-402. 

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Objective To provide basic information for health education about tuberculosis, conduct investigation on the knowledge of tuberculosis prevention and control among the public in Zhejiang province. Methods Multistage layered systemic random sample was used and 6 000 sampled cases were investigated through normal questionnaires by face to face. Results The average rate of the core knowledge of tuberculosis prevention and control among the public was 36.9%. There was significant difference among different education level and profession. There was direct ratio between the knowledge of tuberculosis prevention and control and education level. The rate of doctor was highest, teacher next, peasant and student were last. Conclusion We should promote public protection knowledge of tuberculosis through health education. It is important to take different action for different education level and the profession.

Study on case-finding and effective treatment for pulmonary tuberculosis patients among prisoners

Fu Yanyong,Li Shanglun,Zou Yiwei,et al.

Chinese Journal of Antituberculosis. 2008, 30(5):  402-405. 

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Objective To summarize and evaluate the way to find pulmonary tuberculosis (PTB) patients and the effectiveness of TB treatment in Tianjin prison system between 2004 and 2006. Methods The PTB cases in prison were found through overall survey, passive case finding and physical examination. The confirmed cases were carried out standardized chemotherapy regimen under directly observed treatment, short-course (DOTS). The effectiveness of management and treatment for TB was assessed and analyzed at the end of the treatment. Results Within three years a number of PTB patients found by overall survey, passive case-finding and physical examination were 269, 111 and 113 respectively. The number of PTB cases increased by physical examination. The treatment success for new smear positive cases and re-treatment smear positive cases were 78.8% and 72.7% respectively. The uncured cases accounted for 60% of smear positive PTB cases because of the failure of treatment. The uncompleted cases accounted for 62.7% of smear negative PTB cases because of the release from the prison. Conclusion Through three kinds of case-findings and work of case management and surveillance, it improves case-finding and case management to prisoner, effectively controls source of infection and reduces transmission of TB in prison.

Analysis of drug resistance trend of Mycobacterium tuberculosisin in Nanjing region

Wang Shengwei,Zhang Xia

Chinese Journal of Antituberculosis. 2008, 30(5):  406-408. 

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Objective To analyze the drug resistance trend of Mycobacterium tuberculosis in Nanjing region. Method Absolute concentration method was used to detect the sensitivity of the 10 most used mycobacterium drugs. Results Resistance rate of each anti-tuberculosis drug fluctuated in some range, while resistance rate to multi-drug increased year by year. The resistant rate to first-line anti-tuberculosis drugs was fairly higher than to second-line anti-tuberculosis drugs. Conclusion The trend of resistance rate has been a serious threat to current therapy protocol of tuberculosis. It was imperative that new generation anti-tuberculosis drugs, with little adverse effect, should be developed to solve current dilemma of tuberculosis therapy.

The study of molecular epidemiology under the quality control of DOTS strategy in tuberculosis

Wang Shichang¹, Ma Xin, Deng Yunfeng, et al.

Chinese Journal of Antituberculosis. 2008, 30(5):  408-410. 

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Objective To make use of Methods of molecular epidemiology to evaluate the comprehensive effect of tuberculosis control under the implementation of the quality control of DOTS strategy in tuberculosis. Methods Retrospective study was adopted to research the positive sample of tuberculosis patients by the molecular epidemiology, as well as to investigate patients clustered to look for the epidemiology link. Results During the period of a study of molecular epidemiology under the implementation of the quality control of DOTS strategy in tuberculosis, in terms of the MIRU-VNTR examination, the cluster rate was 70%,of which the Shandong cluster accounted for 22%, and the proportion was significantly decreased compared with it was in 2002(P<0.005); the epidemiological correlation rate was 32.5%. Conclusion The Results of the study of molecular epidemiology would be one of the Methods to evaluate the effectiveness as the Objective under the implementation of quality control of DOTS strategy in tuberculosis.

Study on the diagnostic value of tuberculosis antibody and the like five detection methods for retreated pulmonary TB

Liu Yidian, Xiao Heping

Chinese Journal of Antituberculosis. 2008, 30(5):  411-414. 

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Objective To evaluate the diagnostic value of tuberculosis antibody, CRP, ESR, PPD skin test, PCR and combined the five method in the diagnosis of retreated pulmonary tuberculosis. Methods Tuberculosis antibody were measured by DIGFA (dot immunogold filtration assay), PCR by hybridization method, ESR by Westergram method, CRP by lmmunoturbidimetry Assay, and PPD skin test according to the national guideline. The sensitivity and specificity of single method and the diagnostic value of single and combined method were evaluated. Results The sensitivities of tuberculosis antibody, CRP, ESR, PPD skin test, and PCR were 92.0%,81.3%, 80.05,68.3%,66.7%, respectively;their specificities were 94.0%,87.0%,32.0%,72.0%,75.0%, respectively. In random combined 2 Methods the sensitivity increased markedly, the specificity of tuberculosis antibody combined with PCR was higher than that of other combinations(P<0.05).The sensitivities in combinations of 3 and more than 3 Methods reached approximately 100%,but their specificities decreased significantly. Conclusion The combination of tuberculosis antibody and PCR was more valuable among 5 methods. The other combination of more Methods couldn’t increase the diagnostic value for retreated pulmonary TB.

The relationship between the examine results of acid-fast bacillus of the sputum collected in different time and the nature of specimens

Song Kai

Chinese Journal of Antituberculosis. 2008, 30(5):  414-416. 

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Objective To evaluate the relationship between the sputum collected in different time and the nature on the determination of acid-fast bacillus. Methods The sputum specimens were dyed with Ziehl-Neelsen anti-acid dyeing method,and observed with the microscope. The positive rate and the distribution of acid-fast bacillus at different sputum time and in different nature were studied. Results The positive rate of 7305 sputum specimens varies evidently at different time, such as at once, at night, and in the morning; and the rate also varies for the sputum specimens with different nature, such as caseous, bloody, mucopurulent and saliva. The distribution of 518 smear positive cases at different time and in different nature has great difference. Conclusion The caseous sputum collected in the morning was detected with highest number of bacteria and should be used for diagnosis.

Analysis of the promotion to tuberculosis prevention and cure by the set up of tuberculosis special out-patient clinic in general hospital

Xu Bin¹, Tan Yiyun, Sun Jiayuan, et al.

Chinese Journal of Antituberculosis. 2008, 30(5):  417-420. 

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Objective To evaluate the benefit to tuberculosis (TB) prevention and cure by the set up of tuberculosis special out-patient clinic in general hospital. Methods Annul TB surveillance data in Minhang district of 2003 and 2005 were analyzed. Results Three TB special out-patient clinics were set up in general hospital of Minhang district in 2004. The number of confirmed TB cases increased 118% in 2005 compared with it was in 2003, and the sputum smear positive rate increased from 31.6% to 42.4%, the case cure rate was from 83.3% to 81.7%. Conclusion The number of confirmed TB cases was increased while the cure rate was not declined by setting up TB special out-patient clinic in general hospital.

Value of protected bronchoalveolar lavage (PBAL) in diagnosing sputum-negative pulmonary tuberculosis

Li Xingbin¹,Zhang Guangyu,Du Xiuran, et al.

Chinese Journal of Antituberculosis. 2008, 30(5):  421-423. 

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Objective To explorethe value of Protected Bronchoalveolar Lavage (PBAL) in diagnosing sputum-negative pulmonary tuberculosis. Method 96 sputum-negative pulmonary tuberculosis patients were investigated. All patients underwent flexible bronchoscopy examination by protected bronchoalveolar lavage (PBAL). The specimen of the PBAL was detected by acid-fast bacilli (AFB), Lowenstein-Jensen culture and BACTEC rapid culture technique. Results The positive rate of PBAL specimen acid-fast bacilli positive was 20.8% (20/96), of Lowenstein-Jensen culture was 31.3% (30/96), of BACTEC MGIT 960 culture was 61.5% (59/96). Finally, 62(64.6%)patients were diagnosed. Conclusion PBAL has an important role in the diagnosis of sputum-negative pulmonary tuberculosis, and multi-techniques may improve the diagnostic value.

The clinical Application value of TB-SA genes of Mycobacterium tuberculosis for the tuberculosis diagnosis

Zhu Fan,Zhao Qingrong,Luo Tao, et al.

Chinese Journal of Antituberculosis. 2008, 30(5):  424-426. 

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Objective To study the application value of testing TB-SA genes of Mycobacterium tuberculosis in tuberculosis diagnosis. Methods Of 371 tuberculosis cases, 307 cases with pulmonary tuberculosis and 64 cases with nonpulmonary tuberculosis were selected. Sixty-one cases suffered from non-tuberculosis respiratory diseases such as pneumonia or lung cancer. Forty cases were selected as healthy control. The TB-SA gene was amplified by PCR, bacteriologic (smear and culture) using same sputum,thoracic,abdominal or cerebrospinal fluid. Result 259 of 307 cases PCR positive, sensation is 84.4% (259/307), and that the bacteriologic sensation is 62.5%(192/307). Among the 64 extra-pulmonary patients, TB-SA gene positive 35 cases, sensation is 54.7% (35/64); and the bacteriologic sensation is 7.8%(5/64). Meanwhile the result of 61 cases non-tuberculosis respiratory patients and the 40 healthiness, the especial are 96.7%(59/61) and 100%(40/40). Conclusion The especial and sensation of this kit was content. operating easily and could be apply popularly.

Correlation between AIDS with tuberculosis and CD4T lymphocyte count

Sun Yan,Zhao Qingxia,He Yun,et al.

Chinese Journal of Antituberculosis. 2008, 30(5):  427-430. 

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Objective To investigate the correlation between clinical features of AIDS with tuberculosis and CD4T lymphocyte count through retrospective analysis of the case of AIDS with tuberculosis. Methods the CD4T lymphocyte count of 95 cases AIDS with tuberculosis and 30 cases pure pulmonary tuberculosis were respectively detected and comparatively analyzed.. The correlation among PPD, MycoDot, TB typing and CD4T lymphocyte count in AIDS with tuberculosis cases were analyzed. Results The comparison of the level of CD4T lymphocyte count between AIDS with tuberculosis cases and pure pulmonary tuberculosis cases had statistical significance. There was correlation between CD4T lymphocyte count and the imaging show, PPD, MycoDot, positive rates of sputum smear and TB typing. Compared with CD4<100/mm³ and CD4>100/mm³, the imaging of patching consolidation shadows, multi-cavitates, mediastinum and (or) axillary lymphadenectasis and the test of PPD, MycoDot, positive rates of sputum smear had statistical significance, and there was an obvious difference in incidence of tuberculosis between Ⅱand Ⅴ, but the single-cavity, multiple nodules and pleural effusion had no statistical significance. Conclusion The incidence of AIDS with tuberculosis was high, specially among extrapulmonary tuberculosis and hematogenous dissemination tuberculosis. When CD4<100/mm³ the clinical manifestations were not typical. The radiology imaging manifestations were diversified and the positive rates of the tests of PPD, TB antibody and sputum smear were low.

Analysis the effect of the tuberculosis case-finding mode in Zhengzhou city

Li Lei1,Liu Jianmin,Zheng Min,et al.

Chinese Journal of Antituberculosis. 2008, 30(5):  430-433. 

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Objective To analyse the effect of the tuberculosis case-finding mode in Zhengzhou city. Methods To collect and analyze the quarterly reports of the project in 7 districts from 2004 to 2006,the data of 2000 tuberculosis epidemiological survey in Zhengzhou in 2000 and other relevant materialS. Results The four-level tuberculosis control network haS been established in 3 years in the urban area of Zhengzhou city. The average success rate of referred TB patients from hospitals increased from 32.4% during 1996—2001 to 75.9% during 2004—2006(P<0.01). New notification rate of smear-positive pulmonary tuberculosis cases increased from 3.4/105 during 1996—2002 to 40.4/105 during 2004—2006. Conclusion The four-level tuberculosis control network effectively increased the case-finding rate and the referring rate in hospital. It is important to utilize the existing medical care felicities for tuberculosis control.

Multivariate analysis of acute respiratory distress syndrome in patients with pulmonary tuberculosis

Zhang Jing¹, Xi Xiuming, Han Fen, et al.

Chinese Journal of Antituberculosis. 2008, 30(5):  434-438. 

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Objective To evaluate the risk factors of acute respiratory distress syndrome (ARDS) in patients with pulmonary tuberculosis(PTB). Method Retrospective study of disease history, clinical and laboratory data of hospitalized adult patients with pulmonary TB from Jan 2006 to Oct 2007 treated in our hospital. The observed data was identified by univariate and multivariate analysis. Result Of 1931 pulmonary TB patients, 91 developed ARDS. 184 patients who did not developed ARDS were randomized chosen to constitute the control group. The pulmonary TB patients with retreatment, Chronic Obstructive Lung Disease(COPD), shock, elevated leukocyte count and neutrophilic percent are prone to develop ARDS. Conclusion The patients with retreatment pulmonary tuberculosis, COPD, shock, sepsis, are associated with ARDS development in pulmonary TB patients.

Pulmonary Alveolar Proteinosis with Pulmonary Tuberculosis:A Case Report and Literature Review

Yin Wanhong¹, Chen Xuerong, Zhu Hui, et al.

Chinese Journal of Antituberculosis. 2008, 30(5):  439-442. 

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Objective To investigate the pathogenesis, diagnosis and treatment of pulmonary alveola proteinosis with pulmonary tuberculosis. Methods The clinical data of a case of pulmonary alveola proteinosis with pulmonary tuberculosis were retrospectively analyzed,and literature review about this case was conducted. Results A female patient of 19 years old presented acough, expectoration,dyspnea on exertion, hectic fever,night sweating. The patient was diagnosed as pulmonary alveolar proteinosis with pulmonary tuberculosis through transbronchial biopsy etc and improved after treated with antituberculous drugs and lung lavage. Conclusion The condition of pulmonary alveolar proteinosis complicated with tuberculosis should be attached with importance. The diagnosis is supported by the combination of clinical manifestation, imaging, pulmonary function, transbronchial biopsy etc. The available treatment is antituberculous chemotherapy and lung lavage.

The value of ultrasound-guided pleural biopsy with tru-cut needle in the diagnosis of geriatric tuberculous pleuritis

Li Yongjie, Zhang Yan, Chen Zhuo, et al.

Chinese Journal of Antituberculosis. 2008, 30(5):  442-444. 

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Objective To explore the effects of ultrasound-guided pleural biopsy with Tru-cut needle in the disgnosis of geriatric tuberculous pleuritis. Methods Fifty-eight patients with tuberculous pleuritis were taken ultrasonically guided percutaneous biopsy, and then pathologic analysis was conducted. The diagnosis value of percutaneous biopsy, the factors influencing the positive diagnosis and the complication of percutaneous biopsy were analyzed. Results The success rat of obtaining specimens by ultrasound-guided pleural biopsy with Tru-cut needle in tuberculous pleuritis was 91.5%(75/82), pathological positive diagnosis rate was 70.7%(41/58. The diagnosis success rate was increased with the increase of the times of the biopsy. Postoperative complications was seven cases (8.5%). Conclusion The ultrasound-guided pleural biopsy with Tru-cut needle is a safety and effective method, and can provide early diagnosis in geriatric tuberculous pleuritis.

Research on screening cases of double infection of TB and HIV in clinical TB patients

Li Guoxing¹, Lin Dingwen, Chen Chunhong,et al.

Chinese Journal of Antituberculosis. 2008, 30(5):  445-448. 

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Objective To research the HIV infection among clinical TB patients, in order to understand the relativity of TV and HIV double infection. Methods HIV test on 2074 clinically confirmed TB cases found from 2003 to 2006 were conducted, focus discussion on drug use history, frequent brothels, blood transfusion or donation history were interviewed. For the HIV positive cases, CD4 and CD8 Lymphatic Cell counts were done as well as PPD test. Results The double infection rate of TV and HIV/AIDS was 4.5%,and it was 6.8% among males and 0.3% among females. The average increase rate was 24.3%,and the age group from 20 to 40 was 95.7%. Among the HIV infected cases, 97.9% were infected through drug use, 2.1% were infected through sex among spouses. The HIV positive rate among the TB patients of drug users was 49.2%,which was 3.4 times of the other simple drug users. CD4/CD8 both below 1,and the average was 0.261. PPD test negative rate was 66.6%. Conclusion The TB and HIV double infection is spreading fast. TB patients who are also drug users should be the high risk group and target of the screening and HIV/AIDS control.

Pulmonary tuberculosis complicated with carcinoma:a clinical analysis of 89 cases

Ruan Junzhong, Wang Zitong, Li Shiye

Chinese Journal of Antituberculosis. 2008, 30(5):  448-451. 

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Objective To explore the association between pulmonary tuberculosis (PTB) and carcinoma, and study the clinical diagnosis and treatment of PTB complicated with carcinoma.Methods Eighty-nine PTB patients complicated with carcinoma were analyzed retrospectively. Results All patients were non-small cell lung cancer (81), and SCLC (8), the stage of NSCLC was Ⅰ(11), Ⅱ(4), Ⅲa (15), Ⅲb and Ⅳ (51). In all patients, 49 cases were treated by anti-tuberculosis ,9 cases quitted the treatment, and in 81 patients of NSCLC, 26 patients accepted operation. In 53 patients in late stage of NSCLC, 30 cases accepted mainly chemotherapy with synthetic method, 23 cases quitted the treatment. Conclusions PTB complicated with carcinoma is prone to miss diagnosis or misdiagnosis, because PTB is similar to carcinoma in clinical manifestation and chest radiological study. If the effective treatment could be chosen, the patients would survive longer.