Table of Content

10 June 2007, Volume 29 Issue 6

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Report of WHO survey on drug-resistant tuberculosis in Beijing

An Yansheng,Ding Beichuan,Zhu Jianhua,et al.

Chinese Journal of Antituberculosis. 2007, 29(6):  475-478. 

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Objective To obtain the data on drug resistances(DR) of Mycobacterium tuberculosis complexes(MTBC) strains isolated from the patients of Beijing in 2004.Methods All new registered bacterium-positive patients were selected in 2004.One percent proportion method was used for drug susceptibility testing of isoniazid,rifampicin,streptomycin and ethambutol,according to the Guidelines for surveillance of drug resistance in tuberculosis of WHO/lUATLD. Results 1197 TB cases were enrolled.The total DR rate was 20.1% and total multi-drug resistance(MDR) was 3.5%.The initial DR rate was 17.9% and initial MDR rate was 2.3%.The acquired DR rate was 35.1% and acquired MDR rate was 11.7%.Conclusions All types of DR rates of MTBC strains isolated from the patients of Beijing were lower than the reports of other provinces of China,especially in the initial MDR rate.There are higher relativity between acquired drug resistance and acquired MDR resistance.

Report of the pilot project on Public-Public Mix DOTS in China cooperation of general hospitals and TB dispensaries on reporting,referring and tracing TB patients

Wang Lixia¹,Cheng Shiming,Xu Min,et al.

Chinese Journal of Antituberculosis. 2007, 29(6):  479-483. 

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Objective To test the feasibility of the interventions on reporting,referring and tracing of tuberculosis patients and to determine the impact of the interventions on case finding in a pilot area.Methods Perspective study was carried out in the counties(districts) with acceptable DOTS implementation quality in three provinces.A package of interventions focused on improving reporting,referring and tracing tuberculosis patients through the cooperation between hospitals and tuberculosis dispensaries were implemented in the pilot area for 6 months.The qualitative and quantitative data collected from the same period of previous year of the pilot and from the duration of the pilot were compared and analyzed.Results Compared with the previous year of the pilot,the mechanism of cooperation between hospitals and tuberculosis dispensaries has been established and improved,and the standardized working procedures on reporting,referring within hospitals and tracing from tuberculosis dispensaries has been implemented and improved.The data from target hospitals showed that not only the absolute number of identified patients,reported patients,and referred patients but also the percentage of reported patients,referred patients increased significantly comparing with the data before the pilot.The overall arrival rate of the reported patients from the Internet Based Communicable Diseases Reporting System that should be referred was 82.6%.The overall impact result showed that among registered tuberculosis patients in tuberculosis dispensaries,the number of confirmed TB patients from all hospitals increased 1.4 times.This contributed to the overall patients finding in the pilot area.Conclusion The package of approaches to strengthen the cooperation between hospitals and tuberculosis dispensaries focused on improving reporting,referring and tracing are feasible.Case finding increased significantly through the related interventions.The experiences and some key parameters could be applied in the planning process of PPM-DOTS expansion.

Sentinel surveillance: HIV/AIDS incidence among inpatients with tuberculosis

Bai Liqiong,Xiao Shuiyuan,Liu Fengping,et al.

Chinese Journal of Antituberculosis. 2007, 29(6):  484-486. 

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Objective To determine the incidence of HIV/AIDS co-infection among inpatients with tuberculosis in a hospital-based sentinel site in Hunan province. Methods The inpatients with tuberculosis were consecutively enrolled and screened for HIV infection using ELISA assay over 3 year period.Positive Results were repeated by a second HIV ELISA testing and confirmed by a western blotting.Results Total 3345 eligible tuberculosis patients were admitted and screened for HIV test during 3 years observation period,2257(67.5%) were male and 1088(32.5%)were female with the mean age(SD) 41.1(±13.0) years.64.5% of them were farmers,24.6% were staff and workers,10.1% were commercial servers and the rest were students in high school or college.3274 of the participants(97.9%) were diagnosed as pulmonary tuberculosis,50 tuberculous pleurisy and 21 extra-pulmonary tuberculosis cases.Of pulmonary tuberculosis cases,598(18.3%) were sputum smear positive for acid-fast bacilli and 2676(81.7%) were negative,1057(32.3%) were new cases and 2217(67.7%) retreatment cases.Total 2 cases with pulmonary TB were confirmed HIV-seropositive,both were male with the age of 49 and 40,respectively.They was infected HIV by sexual transmission.HIV/AIDS incidence among inpatients with tuberculosis was 0.06%.Conclusions The incidence of HIV/AIDS among inpatients with tuberculosis in a hospital-based sentinel site approximates 0.05%,which was estimated among general population.

Socio-economic study on 166 retreated smear-positive patients with pulmonary tuberculosis

You Yongyi,Huang Ruie,Wang Lin.

Chinese Journal of Antituberculosis. 2007, 29(6):  487-490. 

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Objective To realize the socio-economic situation of retreated smear-positive patients with pulmonary tuberculosis to revise drug-resistant tuberculosis control strategies and policy of the tuberculosis control program as well as to improve tuberculosis control services.Methods The retreated smear-positive inpatients with pulmonary tuberculosis were surveyed by questionnaire during Jan.to Sept.,2006.Results(1) The economic situation of the retreated smear-positive inpatients with pulmonary tuberculosis was rather poor.The annual average income per family member for 79.5% cases was lower than that of the local family member.(2) Only 20.5% of the cases investigated were covered by various kinds of medical insurances.(3) The local clinic was too far for 60.2% cases.(4) 85.5% patients had not been followed up during the therapeutic course.(5) 43.9% patients were on intermittent treatment.(6) 27.1% patients had not received any health education on tuberculosis.(7)The rates of resistance to INH was 69.6%,to RFP was 61.7%,to INH and RFP was 47.8%.Conclusion It is important to establish surveillance of drug resistance for smear-positive cases.The government should put high attention on treatment and management of smear-positive patients with pulmonary tuberculosis,improve the quality of tuberculosis control.

Analysis on human resources of county level of tuberculosis prevention and control department in hebei province

Zhang Huimin,Xu Hua,Li Guogang,et al.

Chinese Journal of Antituberculosis. 2007, 29(6):  491-494. 

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Objective To understand the human resources of county level of Tuberculosis Control Department in Hebei province.Methods Investigation about human resources of county level of tuberculosis control department was made in 146 counties/districts in June to July,2005.Results The constituent ratio of gender and age was reasonable.But the number of staff was inadequate,the ratio of staff in tuberculosis control department to tectorial population was 1∶70239,there were medially 2.2 posts for one person,53.2% staff had 3 posts.The rate of staff having bachelor degree was 3.9%,and the rate of staff having high professional title was 2.1%.In all kinds of jobs,more staff participated diagnosis-treatment and supervision,which were the major burden in county level of tuberculosis control department.The rate of staff being trained was 61.3%,various in different kinds of jobs,and higher in program management,diagnosis-treatment and laboratory.30.3% of staff have worked in TB control organization for less than 2 years,which means the TB control ranks instable.Conclusion The human resource of the county level of TB control department in Hebei province was inadequate.The personnel,finance and public health departments of government should give more attention to this state,strengthen TB control organization and improve the TB control program.

Immunotherapeutic effects of mannan-binding lectin on murine with pulmonary tuberculosis

Qiu Yunqing,Tian Miao,Zhang Haiqing,et al.

Chinese Journal of Antituberculosis. 2007, 29(6):  495-498. 

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Objective To study the immunotherapeutic effects of MBL(mannan-binding lectin) on murine infected with Mycobacterium tuberculosis.Methods Eighteen BALB/ c mice were randomized into 3 groups,One group treated with mannan-binding lectin,another group treated with vaccae vaccine,The third group treated with PBS(n=6).1×10⁶ bacili in a volume of 300 μL PBS were injected into the tail vein of mice in each group.The mice from each group were treated intraperitoneally with MBL,Vaccae(freeze-dried M.vaccae vaccine for therapy) and PBS at 2 weeks postinfection,respectively.The animals were sacrificed at 2 weeks after treatment.The weights of mice,lungs and spleens were measured.Then the lungs and spleens of mice were processed for histological examination.The numbers of viable bacteria in lungs and spleens were counted.Results At 2 weeks after therapy,the body weights of mice in treatment groups were higher than that in control group,the lung weights of mice in treatment groups were lower than that in control group,the spleen weights of mice in treatment groups were higher than that in control group.The numbers of viable bacteria in lungs and spleens of mice from treatment groups were lower than that in control group,respectively.MBL could improve host defense against Mycobacterium tuberculosis and reduce mycobacteria outgrowth on murine with tuberculosis.Conclusion MBL had immunotherapeutic effects on murine with tuberculosis.

Study of Alamar blue and MTT assays for determining the MIC of anti-tuberculosis drugs

Lu Yu,Wang Bin,Zheng Meiqin,et al.

Chinese Journal of Antituberculosis. 2007, 29(6):  499-501. 

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Objective To set up and assess Alamar blue and MTT assays for determining the MIC of the anti-tuberculosis drugs to Mycobacterium tuberculosis.Methods MIC of 12 anti-tuberculosis agents to Mycobacterium tuberculosis H₃₇R_V were determined by Alamar Blue assays and MTT,and compared to the conventional two folds dilutions.Results For Alamar blue assays and MTT,the time for obtaining Results were 6 days and 8 days,respectively.MICs determined by MTT or Alamar blue assay were highly correlated with those determined in the two folds dilutions.Conclusion Alamar blue and MTT assays are sensitive,rapid,inexpensive,and promising new alternative Methods for performing rapid high-throughout screening of compounds against Mycobacterium tuberculosis.

Detection of mutidrug-resistant Mycobacterium tuberculosis using DNA fingerprinting technique

Zhou Lin,Tan Shouyong,Tang Linguo,et al.

Chinese Journal of Antituberculosis. 2007, 29(6):  502-507. 

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Objective To investigate genotypes of mutidrug-resistant(MDR) M.tuberculosis strains By DNA fingerprinting technique,and to discuss their role in molecular epidemiology.Methods A pair of outer primers for the amplification of IS6110 sequence from M.tuberculosis was designed.DNA fingerprinting method was established and used to analyze the genotypes of 220 MDR-resistant M.tuberculosis clinical isolates.The data from all of the tests were performed cluster analysis,and molecular epidemiology analysis.Results According to analysis of the DNA fingerprinting patterns,220 strains of Mycobacterium tuberculosis isolated were all shown specific DNA fingerprinting patterns,which were highly variable.The number of DNA copies per strain varied from 3 to 18.The majority(205,93.2%) of the strains contained 6-13 copies,with a mean of 11 bands.Of 205 DNA fingerprinting patterns observed,162 were unique,indicating epidemiological independence.However,58(26.4%) strains clustered in 15 groups,each cluster consisted of 2-8 isolates with identical patterns,presumably representing cases of recent transmission.In particular,one distinct pattern within this DNA fingerprint group was shared,220 strains of M.tuberculosis isolated all found one 200bp molecular weight of pattern.Conclusion DNA fingerprinting technique might be effectively applicable as a tool for the detection of genotype of drug-resistant M.tuberculosis,and for the survey on molecular epidemiology of multidrug resistance tuberculosis(MDR-TB).

Detection of the mutations of katG,rpoB and embB Genes in Mycobacterium tuberculosis from sputum specimens with PCR-SSCP technique

Zhu Min¹,Li Feng,Sheng Guoping,et al.

Chinese Journal of Antituberculosis. 2007, 29(6):  508-510. 

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Objective To detect the mutations of katG,rpoB and embB genes in Mycobacterium tuberculosis(MTB) from sputum specimens by PCR-SSCP method,and to evaluate the clinical value of this method.Methods 110 MTB isolates from sputum specimens were detected by PCR-SSCP and conventional drug susceptibility testing.The sequences of katG,rpoB and embB were also analyzed.Results The sensitivities of mutations of katG,rpoB and embB genes analyzed by PCR-SSCP were 55.9%,76.0% and 46.4%,respectively.Their specificities were 70.0%,90.0% and 60.0%,respectively.Conclusions PCR-SSCP technique is a rapid,simple,high sensitive and strongly specific method for detection of mutations of katG,rpoB and embB genes in MTB from sputum specimens.

A clinical observation on ultrashort wave for treatment in tuberculous pleuritis

Han Fengman,Ma Jinhua,Wang Lihua

Chinese Journal of Antituberculosis. 2007, 29(6):  511-513. 

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Objective To evaluate the therapeutic effect of ultrashort wave on the cases with tuberculous pleural effusion.Method 60 cases of inpatients with tuberculous pleural effusion in our hospital were involved in,and divided randomly into treatment group and control group,each group contained 30 patients,respectively.The dosage and duration of antituberculosis drugs and the way of suction of pleural effusion were similar in the two groups.But the cases in treatment group were treated with ultrashort wave.Results Compared with the therapeutic effects on large volume,mediate volume and small volume of pleural effusions between the treatment group and the control group,there were significant differences in the mean days in hospital,the mean number of suction of pleural effusion and the volume of pleural effusion(t=3.836,P＜0.01). Conclusion Ultrashort wave is an effective way for treatment of the tuberculous pleural effusion,especially for intractable,wrapround pleural effusion with multi-compartment.

Clinical analysis of pneumonectomy in 655 patients with lung cancer

Yan Dongjie,Dou Xuejun,Bai Lianqi,et al.

Chinese Journal of Antituberculosis. 2007, 29(6):  514-516. 

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Objective To investigate the role of pneumonectomy in the treatment on patients with lung cancer.Methods We reviewed 655 consecutive patients with lung cancer treated with pneumonectomy between October 1994 and November 2003.Results The survival rates for 1,3,5 years in these patients were 88.02%,50.09% and 24.1%,respectively.The 5-year survival rates for different pTNM stage of cases were as follows: stage Ⅰa 37.0%,Ⅰb 40.6%,Ⅱa 0%,Ⅱb 37.9%,Ⅲa 19.3%,Ⅲb 7.0%,Ⅳ17.7%.The 5-year survival rate for NSCLC was 24.5%,and that for SCLC was 22.0%.The postoperative mortality and complication were 2.4% and 10.4%,respectively.Conclusion On the basis of strict indication and practiced thoracic operation,the pneumonectomy showed acceptable postoperative complication and mortality,it would be a effective method in treatment on middle and advanced stage of lung cancer.

The effects of intrapleural urokinase on tuberculous pleurisy in rat model

He Qiao,Xie Canmao,Tan Shouyong,et al.

Chinese Journal of Antituberculosis. 2007, 29(6):  517-522. 

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Objective To observe the effects of intrapleural urokinase on the inflammatory reaction of tuberculous pleurisy.Method Ninety Wistar rats were intrapleurally injected with 0.03mg of Mycobacterium tuberculsis standard strain H₃₇R_V,respectively.At 24 hours later,the rats were randomized into two groups:the urokinase group(UKG): 600U/ml of urokinase was intrapleurally injected in each rat.the control group(CG): 1ml of saline was intrapleurally injected in each rat.The rats were killed in batch at 8 hours,24 hours,32 hours,2 days,3 days,5 days,7 days and 10 days after the second injection.5 rats were killed each time.Then the thoraxes were opened and the amount of pleural effusion was recorded,gross pathology of thoracic cavity and histopathology of pleural tissues were observed.The white blood cell(WBC) count and differentials,levels of total protein(TP),glucose(Glu) and lactic dehydrogenase(LDH) in pleural effusions were determined.Pleural fluid was analyzed for the levels of soluble intercellular adhesion molecule-1(sICAM-1),transforming growth factor β₁(TGF-β₁) and interferon γ(IFN-γ).The prothrombin time(PT),thrombin time(TT) and activated partial thromboplastin time(APTT) of peripheral blood were simultaneously determined.The thickness of pleura was measured and the pathology of pleural and lung tissues was observed. Results The amount of pleural effusions on days 1 and 2 was significantly greater in the UKG than in the CG [(6.1±0.6、7.0±0.2) vs(5.4±0.5、5.2±0.2)ml](P＜ 0.01).While on days 7 and 10 the amount of effusions was significantly lower in the UKG than in the CG[(2.4±0.4,0.3±0.1vs5.2±0.5,3.3±0.6)ml](P＜0.01).The WBC in the UKG were lower at 8 hours and after 48 hours than those in the CG,as well as the neutrophil percentage(P＜0.01).The level of inflammatory marker LDH at hours 8,24 and 32 was significantly lower in the UKG than that in the CG[(15.5±0.7,16.1±1.2,17.5±1.4 vs18.0±0.9,18.4±0.6,18.5±1.2)μmol·s^-1·L^-1,P＜0.01].During the whole observation period,the level of sICAM-1 in pleural effusion was significantly lower in the UKG than in the CG(P＜0.01),while the TGF-β₁ was lower merely on the days 5 and 7 [(29.4±3.3,22.7±3.4 vs 45.8±7.7,45.2±6.4)ng/ml,P＜0.01].IFN-γ was lower in the UKG than CG only on day 7 [(151.6±21.4 vs178.2±18.6)pg/ml,P＜0.01].On days 3 later,IFN-γ/TGF-β₁ in the UKG was significantly higher than that in the CG and reached the highest level on Day 7(6.74±0.9 vs3.15±1.8,P＜ 0.01).The formation of adhesion was slower and the extent of adhesion was lesser in the UKG than those in the CG,with less thickening of pleura was observed in the UKG(P＜0.01).No significant difference in coagulation time of peripheral blood was found between the two groups.Conclusions Intrapleural urokinase could lead to more pleural effusion and subsequent faster pleural fluid absorption in tuberculous pleurisy.The inflammatory reaction in thoracic cavity could be relieved by intrapleural urokinase,and thus the adhesion and thickening of pleura could be reduced.It suggests that intrapleural urokinase is effective in the treatment of tuberculous pleurisy.

Analysis of 57 pneumonia cases misdiagnosed as pulmonary tuberculosis

Lv Jialin,Sun Yifen,Hu Peian

Chinese Journal of Antituberculosis. 2007, 29(6):  523-525. 

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Objective To understand the factors that influence pneumonia patients to be misdiagnosed as pulmonary tuberculosis.Methods Retrospective analysis of 57 Cases of pneumonia who were misdiagnosed as pulmonary tuberculosis.Results The misdiagnosis rate was 22.3%（57/256）.Their clinical symptoms were as follow: 28% had sweats at night,56% had fever in the afternoon,17.5% hemoptysis.59.6% showed the pathological changes in the chest X-ray photos,which located in the apical and rear segments of the upper lobes or the superior segments of the lower lobes.Routine blood test showed that 64.9% patients’ WBC were 4.0×10⁹～10.0×10⁹/dl and 14% sputum cultures were positive.Conclusions （1） Cause of misdiagnosis: The clinical symptoms were atypical,chest X-ray appearance and routine blood test Results of pneumonia patients were difficult to differentiate with pulmonary tuberculosis.（2） Preventive interventions: The patients with patchy shadow in chest X-ray photos and atypical clinical symptoms should be treated with broad-spectrum antibiotics for at least two weeks,and SM and RFP should be avoided;sputum smear for acid-fast bacilli and sputum culture for mycobacteria should be done repeatedly.

The application of Maslow human needs in outpatients of pulmonary tuberculosis

Song Tao,Tao Shu,Gao Cuinan,et al.

Chinese Journal of Antituberculosis. 2007, 29(6):  526-528. 

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Objective To investigate the application of Maslow human needs in outpatients of pulmonary tuberculosis.Methods To choose 120 sputum-bacilli-positive TB cases with primary treatment during June and December 2006 in Yue Xiu district,Guangzhou.Maslow Human Needs Theory was used in the investigating group.After the corresponding nursing measures were finished,the situations of the patients were evaluated,and the nursing effects were compared with the control group.Results After the Maslow Human Needs Theory was used in patients with tuberculosis,their knowledges on tuberculosis and compliance with doctor were markedly increased.All of the observation indexes had significant difference between investigation group and control group,P＜0.001.Conclusions The Maslow Human Needs Theory is helpful to the recovery of patient with tuberculosis.

Diagnosis and treatment for pulmonary embolism in patients with pulmonary tuberculosis

Gai Qingling,Wang Lihua,Sun Jichang

Chinese Journal of Antituberculosis. 2007, 29(6):  529-531. 

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Objective To report the experience and to analyze current problems in the diagnosis and treatment of pulmonary embolism(PE) in patients with pulmonary tuberculosis.Methods We diagnosed and treated 5 patients with pulmonary embolism(4 male and 1 female,mean age 48 years old) from June 2003 to June 2006.Symptoms included cough,fever,suffocation,chest pain,palpitation,coma etc.physical signs included tachypnea,tachycardia.We utilized spiral CT pulmonary artery angiography(SCTPA) and Doppler echocardiography to judge PE.Because the chance of thrombolysis has been lost,the anticoagulating therapy was uesed in 5 cases.One of the cases was performed a surgical operation.Results 4 patients recovered with no complication,1 patient died from no using anticoagulant after two years.Conclusion PE is related to the pulmonary tuberculosis.The examination for PE is necessary in patients with pulmonary tuberculosis.The anticoagulating therapy is safe and effective to the patients with pulmonary tuberculosis complicated with PE.