Table of Content

10 February 2007, Volume 29 Issue 2

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Operational research of use Fixed-Dose Combination in national tuberculosis programme in China

Cheng Shiming¹,Zhong Qiu,Zheng Jinfeng.et al.

Chinese Journal of Antituberculosis. 2007, 29(2):  111-116. 

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Objective To explore the feasibility of treating new smear positive TB patient with Fixed-Dose Combination(FDC) in NTP in China,to provide evidence for the decision-maker to develop the policy on FDC use and supply. Methods Case-control study was conducted in 17 DOT counties in 4 provinces,with the case group using FDC and control group using the blister pack.The treatment outcome,side-effect and patient’s compliance were compared and the demand of the drug was calculated according to the weight of the patients in different area. Results For the new smear positive patients treated with FDC,the conversion rate at the end of 2nd and 3rd month were respectively 91.1% and 95.0% and the cure rate was 94.6%,the conversion rate at the end of 2nd and 3rd month in control group were respectively 90.2% and 92.9% and cure rate was 89.4%.Cure rate was higher in case group than control group(P<0.05).90 of 484 occurred side-effect of all kinds of drug and its frequency was 18.6% in case group.89 of 482 occurred side-effect of all kinds of drug and its frequency was 18.5%in control group. 37 of the total number of patient stopped the treatment due to the side-effect and among which 10(2.1%) was in case group and 27(5.8%) was in control group(P<0.05).According to the survey in different time of the treatment,patient’s compliance was different.The percentage of the patient with the weight was different between provinces.The number of drug tablets used in FDC was fewer than that of blister pack. Conclusion By using FDC,the cure rate of new smear positive patient has achieved the target of NTP,as the defaulted cases due to severe adverse side effect was less in case group than the control group and the number of drug tablet was fewer in case group than in control group.Therefore,FDC can play an important role in reducing MDR-TB and the cost of the drugs.The use of FDC should be further expanded in next step.

Comparison analysis on Fixed-dose Combination and blister pack drug in treating tuberculosis patients

Tan Weiguo¹,Yang Yingzhou,Wu Qingfang,et al.

Chinese Journal of Antituberculosis. 2007, 29(2):  117-121. 

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Objective To study the effects and safety of fixed-dose combinations(FDC) in treatment of tuberculosis,and to explore good medication and measure which is fitted for anti-tuberculosis chemotherapy in Shenzhen. Methods Two hundred new smear-positive pulmonary tuberculosis patients(PTB) randomly selected from Luohu district and Nanshan district were allocated into two groups with 100 into FDC treatment group and 100 into controlled group.DOT was adopted in both groups.The following issues were compared between the two groups including drug dosage,clinical manifestation,treatment outcome and adverse reaction. Results (1) The incidence of clinic symptoms such as night sweating,fever,cough,emptysis,chest pain,dyspnea and fatigue were gradually declined at the end of 1st,2nd,3rd and 6th month in both groups,but there was no significant difference between the two groups(P<0.05).(2) The negative conversion rates of sputum at the end of 2nd month were 88% and 84% in the FDC group and the control group and 98% and 97% at the end of 6th month.Chest radiography showed remarkable improvement.The cavity closure rates at the end of 6th month were 58.3% in the FDC group and 48.6% in the control group.No significant difference was found between them(P<0.05).(3) In FDC group and control group,the rate of adverse reactions was 25% and 18%,abnormity rate of WBC was 18% and 11%,abnormity rate of was 16% and 9% and abnormity rate of BIL was 19% and 15%.There was no significant difference between the two groups.(4) The relation efficient between weight and dosage of RFP in the FDC group and the control group were 0.804 and 0.781 respectively.The per dose/kg of INH,RFP,PZA and EMB in FDC group was lower than those in the control group and there was significant difference between them(P<0.05). Conclusion The treatment outcome and adverse reaction FDC are similar as blister pack drug in treating smear-positive TB.While the dosage of FDC is lower than blister pack,the expanded use of FDC is promising.

Evaluation on status and distribution of district-based human resources in district institutions of TB prevention and control in Wuhan

Zhou Guichang¹,Fu Zhijun,Xie Hong,et al.

Chinese Journal of Antituberculosis. 2007, 29(2):  122-126. 

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Objective To evaluate the actualities of human resource of district level TB institutions in Wuhan and impartiality of demographic and geographic distribution. Methods The questionnaire was used to collect the information of TB staff at district level,including age,gender,educational background,professional title in distinct TB institutions in Wuhan.The information on the population and geographical acreage in the current year was collected to estimate the impartiality with Gini Coefficient and Llrenz Curve. Results Among the 177 TB staff in district institutions in Wuhan,the ratio of male to female is 1∶1.72,the mean age is 41.46 years(41.46±1.38) with an elder age in urban area and a younger age in suburban area.Most staff are graduates from senior middle school and technical secondary school that accounts for 52%.There is no postgraduate. The educational background of the staff in urban area is higher than that of suburban area.Most of the staff are majored in clinical medicine and nursing,accounting for 42.9% and 30.5% respectively,and only 7.9% are majored in public health.44.6% staff are with primary professional title of position and only 5.1% are with senior title.Professional posts are mainly for diagnosis and treatment(32.8%) and no people are full-time staff for health education.The training rate is 81.4% in Wuhan,while the rate is only 68.5% in suburban area.The training rate for nurse and drug manager is lower.The service population and service radius in suburban area are 1.6 and 3.1 times as those in urban area,respectively.According to the demographic and geographic distribution,the Gini Coefficient are 0.17 and 0.59 respectively. Conclusion In TB institutions at district level in Wuhan,the general qualification of the TB staff is not high,the job structure is not reasonable and the area distribute is not equitable,which influence the National TB Programme,the implementation quality of DOTS strategy directly and the development of tuberculosis prevention and cure.

A descriptive study on diagnostic delays and factors impacting accessibility to diagnosis among TB patients in floating population in Shanghai

Huang Leqing¹,Wang Weibing,Li Hongdi,et al.

Chinese Journal of Antituberculosis. 2007, 29(2):  127-129. 

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Objective To describe the access to TB diagnosis among floating TB patients with different demographic,socioeconomic and clinical characteristics in Shanghai,and to study the impact of these factors. Methods A total of 116 newly diagnosed TB patients were registered in the study site from Sept.1.2003 to Aug.30.2004.The subjects were interviewed using a structured questionnaire. Results The first health seeking delay,patient’s delay,doctor’s delay and treatment delay were 18.0,20.0,13.0 and 0 days in median,respectively.Lower income,first visiting to non-hospital,newly moving into Shanghai are significantly related to longer patient’s delay;whereas emptysis shortened the delay to the first health facility. Conclusion In order to detect TB patients timely,it is urgent to provide health education on TB knowledge for floating population,to promote the awareness of the disease.Lower income,unemployed and new immigrants should be given a priority in TB case detection.

The dynamic evaluation model for prediction the result of chemotherapy in new smear positive pulmonary tuberculosis cases

Jiang Li,Zhong Qiu,Huang Guiqing,et al.

Chinese Journal of Antituberculosis. 2007, 29(2):  130-132. 

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Objective To explore a dynamic evaluation model for prediction the result of chemotherapy in new smear positive pulmonary tuberculosis cases. Methods The case-control study and mathematical statistic were used to analyze 118 new smear positive pulmonary tuberculosis cases who were registered in 2005 to develop Logistic regression mode. Results The logistic analysis was used to make the dynamic evaluation model for prediction the result of chemotherapy in new smear positive pulmonary tuberculosis cases.The mode is ln (p/1-p)=4.135-3.963·Z3-2.319·Z11-3.686·Z13-2.058·Z14,and the accuracy of the model is up to 79.2%. Conclusion The model provides a reliable method for the dispensary to evaluate and predict the work of tuberculosis control in Guangdong province.

Study on the relevant factors of compliance that affect the regular treatment for pulmonary TB

Shen Jian’en,Lei Tao,Wang Zu’en,et al.

Chinese Journal of Antituberculosis. 2007, 29(2):  133-135. 

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Objective To study the relevant factors of compliance that affect the treatment for TB. Methods Questionnaire survey was conducted among the hospitalized TB patients who have taken anti-TB treatment in our hospital from Mar.1,2004 to Jun.30,2006 to understand the drug-taking of TB patients and the influential factors.The compliance of TB patients were also evaluated and summarized. Results The rate of regular drug-taking was 58.9%.The factors influencing the compliance of treatment were mainly subjective factors and related with the patients’ age,TB knowledge,the quality of supervised treatment and adverse drug reaction. Conclusion Strengthening health education on TB knowledge to TB patients and doctors in general hospitals,increasing the awareness of TB among patients and paying attention to supervised treatment are the main interventions to improve the compliance to treatment among TB patients.

Clinical analysis of 72 cases with active caseation endobronchial tuberculosis

Bu Fanjin¹,Gu Jin,Zhang Shaojun,et al.

Chinese Journal of Antituberculosis. 2007, 29(2):  136-138. 

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Objective To study the clinical features,bronchoscopy manifestations,CT manifestation,and prognosis of active caseation endobronchial tuberculosis(EBTB). Methods Clinical symptoms,chest X-ray/CT manifestations and fiberoptic bronchoscopic findings of 72 cases diagnosed with EBTB were analyzed retrospectively. Results Main features were as followed: stimulating cough,non-specific fever,increased risk of lung infection,high sputum positivity,increased erythrocyte sedimentation rate(ESR) and C-reactive protein(CRP).CT is less effective than bronchoscopy to diagnose this type of EBTB.Active treatment could yield a positive result. Conclusion Active caseation endobronchial tuberculosis EBTB has specific clinical features.Bronchoscopy is the key method for detection.Active treatment may improve the outcome,however,difficulties are still existing in treating active caseation endobronchial tuberculosis.

CT differentiation of consolidative lung cancer and tuberculous consolidation

Lv Pingxin,Zhou Xinhua,Xie Ruming,et al.

Chinese Journal of Antituberculosis. 2007, 29(2):  139-142. 

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Objective To analyze the CT features of consolidative lung cancer and tuberculous consolidations for differential diagnosis. Methods The CT scans of 50 patients with consolidative lung cancer and 50 patients with tuberculous consolidation between 1998 and 2005 were reviewed and the following CT signs of two groups were compared,including the location of consolidation,cavity,air bronchogram,ground-glass opacity surrounding the consolidation,bulging of the interlobar fissure,and characteristics of disseminations through the airway. Results Male(cancer group n=24,tuberculosis group n=29),female(cancer group n=26,tuberculosis group n=21),and average age(cancer group is 50,tuberculosis group is 45).There is a significant difference between two groups in the following signs,such as multi-lobar consolidation(cancer group n=22,tuberculosis group n=9),lower lobe distribution of the isolated consolidation(cancer group n=17,tuberculosis group n=10),homogenous consolidation(cancer group n=36,tuberculosis group n=17),liquefaction(cancer group n=3,tuberculosis group n=33),cavity or cyst(cancer group n=10,tuberculosis group n=28),clear boundary of ground-glass opacity(cancer group n=7,tuberculosis group n=0).Narrowing of the involved bronchi(cancer group n=18,tuberculosis group n=7),dilatation of the involved bronchi(cancer group n=4,tuberculosis group n=15).Airway dissemination(cancer group n=15,tuberculosis group n=43),and among them various airway dissemination in same patient(cancer group n=0,tuberculosis group n=33). ConclusionThe signs are helpful for differential diagnosis,including localities of the consolidations,multi lobar or segmental distribution,density of consolidation,liquefaction,cavity,clear boundary of ground-glass opacity and various airway dissemination in same patient.However,many signs and symptoms should be considered together for diagnosis.

Twelve cases with pulmonary arteriovenous fistula are misdiagnosed as pulmonary tuberculosis for long term

Rong Xuedong,Guo Xinmei,Song Minjuan,et al.

Chinese Journal of Antituberculosis. 2007, 29(2):  143-146. 

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Objective To improve the differential diagnosis level of pulmonary arteriovenous fistula(PAVF) and pulmonary tuberculosis(PTB). Methods Retrospective analysis was conducted on 12 PAVF cases diagnosed in our hospital who were misdiagnosed as PTB for long term in other hospitals from January,1990 to October,2005. Results 12 cases were misdiagnosed as PTB in other hospitals for long term and had anti-TB treatment for different duration and was confirmed as PAVF in our hospital. Conclusion As the TB incidence increased,clinical doctor’s vigilance to TB strengthened generally.The atypical clinical manifestation of PAVF and PTB and variety of chest lX-ray films increased the misdiagnosing rate.TB doctors should break the regular thought of TB,including the understanding of different pulmonary diseases such as PAVF and increase the level of diagnosis and differential diagnosis of PAVF and PTB.Attention should be paid to the diagnosis of smear negative PTB and the confirmation of the diagnosis should be made through other approach.The anti-TB treatment based on experience should be followed by re-examination of Chest X-ray to confirm the diagnosis.Chest CT(strengthened) or lung artery radiography play an important role on diagnosis and differential diagnosis of PAVF.

The study on antimycobacterial activities in vitro of the compounds that target Mycobacterium tuberculosis fabH

Wu Xueqiong¹,Zhang Xuehui,Zhang Junxian,et al.

Chinese Journal of Antituberculosis. 2007, 29(2):  147-150. 

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Objective To study antimycobacterial activities in vitro of the compounds that target Mycobacterium tuberculosis β-ketoacyl-acyl carrier protein(ACP) synthase Ⅲ(FabH),and to obtain a novel,effective,and safe antituberculous agent. Methods The inhibitory diameters of compounds effect on M.phlei on agar plate were determined.The inhibitory effect of compounds on M.tuberculosis strain H37Rv and MDR-strain was tested on L-J media. Results The inhibitory diameters of 18 kinds of 500μmol/L compounds effect on M.phlei on agar plate were 1.8 to 2.4cm,respectively.The inhibitory diameters of 7 kinds of 250μmol and 125μmol compounds effect on M.phlei on agar plate were 1.5 to 2.2cm,respectively.18 kinds of 3mmol/L compounds inhibited obviously the growth of M. tuberculosis strain H₃₇R_v on L-J media at 2 weeks,and the compounds No.115, No.131,No.128,No.129,and No.137 also inhibited at 4 weeks.The compounds No.115 exhibited obvious inhibitory activity on M.tuberculosis MDR-strain HB240 inoculated on L-J media containing 11 kinds of compounds for 2 weeks and 4 weeks,respectively. Conclusion The most of compounds targeted fatty acid synthase FabH exhibited different degree of antimycobacterial activities,especially compounds No.115 had obvious inhibitory effect on M.phlei,M.tuberculosis strain H₃₇R_v and MDR-strain HB240.

BacT/Alert 3D system versus Lowenstein-Jensen medium for isolation of mycobacteria from clinical specimens

Chen Jun,Wang Fei,Ren Yi,et al.

Chinese Journal of Antituberculosis. 2007, 29(2):  151-153. 

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Objective To evaluate the value of BacT/Alert 3D system for isolation of mycobacteria from clinical specimens. Methods 416 specimens were collected from December 2004 to April 2005 and inoculated in BacT/Alert 3D system(0.5ml) and on two Lowenstein-Jensen(L-J) slants(0.1ml each),respectively.Smears were stained by auramine O. Results Of 416 clinical specimens,144(34.6%) were isolated Mycobacterium strains.Of these 144 strains,130 strains were isolated by BacT/Alert 3D system,and 126 were isolated by L-J medium.The mean time of detection for BacT/Alert 3D system and L-J medium was 19.9 and 26.4 days,respectively.The overall contamination rates of BacT/Alert 3D system and on L-J medium were 3.6% and 5.8%,respectively. Conclusion Combination of BacT/Alert 3D system and L-J medium might raise isolation of mycobacteria and lower the contamination rate.

Identification of Nontuberculous Mycobacteria in Fish Tank Water by Phenotyping and PCR-RFLP and DNA sequencing of Mycobacterial hsp65 gene

Chen Xue¹,Cai Lin,Zhao Ting,et al.

Chinese Journal of Antituberculosis. 2007, 29(2):  154-159. 

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Objective To investigate NTM distribution in fish tank water in Beijing area. Methods A total of 30 fish tank water samples were collected and incubated for NTM growth in Lowenstein-Jensen media at 28℃ and 37℃,respectively.NTM were further identified by three methods:(1)traditional phenotypic methods-growth and biochemical characteristics;(2)restriction fragment length polymorphism(RFLP) of a PCR-amplified 439-bp segment of the gene encoding the 65-kDa heat shock protein(hsp65);(3) PCR-sequencing. Results Thirty-five NTM strains were isolated in 29 out of 30 fish tank water samples.Traditional phenotypic Methods and genotypic characterization(RFLP and sequencing) revealed that 8 strains(23%) were M.Gordonae,8 strains(23%) belonged to M.fortuitum complex(2 strains M.fortuitum and 2 strains of M.peregrinum),9 strains(26%) were M.genavense, 1 strain was M.nonchromogenicum,and 9 strains were unidentified NTM. Conclusion NTM were wildly distributed in fish tank water that might be one of major sources for NTM infection.PCR-based molecular Methods showed high sensitivity and specificity in identification of NTMs.

Preliminary studies on inhibitory activity of Kanglemycin A,against Mycobacterium tuberculosis

Gao Linyu,Zhang Jianyuan,Li Chuanyou,et al.

Chinese Journal of Antituberculosis. 2007, 29(2):  160-162. 

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Objective To explore the bioactivities of Kanglemycin A,a novel ansamycin group antibiotic against M.tuberculosis(TB)in vitro. Methods Kanglemycin A was purified by silica gel chromatography and sephadex LH-20 chromatography,and its MICs to 20 strains including M.smegmatis,M.tuberculosis H₃₇Rv,M.tuberculosis H₃₇Ra,ofloxacin(OFLX)-sensitive M.tuberculosis clinical isolates and OFLX-resistant M.tuberculosis isolates were determined by equivalent serial dilution method. Results Kanglemycin A MIC to M.smegmatis was 64ug/ml,to M.tuberculosis H₃₇Rv and H₃₇Ra was 8ug/ml,to OFLX-sensitive M.tuberculosis isolates were 1-8?ug/ml,to OFLX-resistant M.tuberculosis isolates were 1-16ug/ml. Conclusion Kanglemycin A had strong inhibitory activity against M.tuberculosis,and might be a potential anti-TB drug candidate or leading compound.

The Detection of CD₄⁺ CD₂₅⁺ regulatory T cell and correlation factors in malignant and tuberculous pleural effusion

Zhang Xiaoju,Jin Yang,Xiong Xianzhi,el al.

Chinese Journal of Antituberculosis. 2007, 29(2):  163-166. 

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Objective To detect the proportion of CD₄⁺ CD₂₅⁺ regulatory T cell and the level of sIL-2R and TGF-βl in malignant and tuberculous pleural effusion to investigate the local immune mechanism. MethodsThe level of sIL-2R and TGF-βl in malignant and tuberculous pleural effusion were detected by ELISA.Mononuclear cells were separated on a ficoll density gradient.labelled with antibodies,and then analyzed by flow cytometry. Results The percentage of CD₄⁺ CD₂₅⁺ regulatory T cells in malignant pleural effusion was significantly higher than that in tuberculous pleural effusion(21.1±2.3% vs 8.7±0.6%,P<0.05).The levels of sIL-2R in malignant and tuberculous pleural effusion were 563.2±92.61ng/L,390.12±101.12ng/L(P<0.05),respectively.There were not correlation between the level of sIL-2R and TGF-βl and the proportion of D₄⁺ CD₂₅⁺ regulatory T cells in tuberculous pleural effusion.The level of TGF-βl in malignant pleural effusion was higher than that in tubereulous pleural effusion(88.4±16.7mg/L vs 40.3±3.6mg/L,P<0.05). Conclusion D₄⁺ CD₂₅⁺ regulatory T cell,sIL-2R and TGF-βl could be used to distinguish malignant and tuberculous pleural effusion.

Analyzing 984 drug resistant M. Tuberculosis

Liu zhengwei,He Haibo,Miao Ziping,et al.

Chinese Journal of Antituberculosis. 2007, 29(2):  167-170. 

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Objective To understand the levels of drug resistance and multi-drug resistance for the first-line anti-tubeculoais drugs in Zhejiang province, and to provide evidence for tuberculosis control. Methods The proportional method was used in drug sensitivity test according to the guidelines recommending by WHO. Results The total drug resistance rate was 30.6%,the initial and the acquired drug resistance rate was 26.6% and 52.3% respectively,and the multi-drug resistance rate was 7.6%. Conclusion The tuberculosis drug resistance was increasing in Zhejiang province,and the tuberculosis control departments should pay more attention to this situation.