Table of Content

10 May 2006, Volume 28 Issue 5

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Tuberculin reactivity criteria for chemoprophylaxis in college students

Tu Dehua,Liu Yuqing,Zhang Lixing,et al.

Chinese Journal of Antituberculosis. 2006, 28(5):  265-268. 

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Objective To determine the relationship between tuberculin reactivity and tuberculosis incidence,and to propose the tuberculin reactivity criteria for chemoprophylaxis. Methods A 4-year follow-up to fresh college students at different level of tuberculin reactivity was conducted,the corelation of tuberculin reactivity with tuberculosis risk and disease time were analyzed,and the difference in the incidence of subjects at different level of reactivity towards chemoprophylaxis was compared. Result Tuberculin testing and the 4-year follow-up were conducted for 26 543 eligible subjects.Tuberclusis risks for the subjects with tuberculin reactivity of 0～4 mm,5～9 mm,10～14 mm,15～19 mm and more than 20 mm or with blister/papula were 12.97/100000,13.32/100000,50.21/100000,167.56/100000 and 250.21/100000 respectively.For the subjects with 0～4 mm and 5～9 mm tuberculin reactivity,tuberclusis risks were very low in the first 2 years,and increased in the 3 rd and 4th year,while for the subjects with 15～19 mm and more than 20 mm or with blister/papula tuberculin reactivity,tuberclusis risks were very high in the first 2 years,but decreased with time goes on.Calculating the tuberculosis incidence for different tuberculin reactivity criteria when increasing 1 mm interval or above,showed that tuberculosis incidence were simialr and high for all those with 15 mm or above on tuberculin reactivity criteria.The tuberculin reactivity criteria at 15 mm or above covered 80.8% patients,and the case-finding efficiency was at highest level. Conclusion Tuberculosis risk coorelated with tuberculin reactivity positively,espacially in the first 2 years.PPD reacter at the 15 mm or above had significantly high risk to develop tuberculosis,and it can cover more than 80% patients with the the case-finding efficiency at highest level.Therefore,tuberculin reactivity criteria at more than 15 mm or with blister/papula was more reasonable for chemoprophylaxis.

Operational research on implementation of the referral system of pulmonary tuberculosis in Hunan province

Chinese Journal of Antituberculosis. 2006, 28(5):  269-273. 

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Objective To explore the management Methods of referring TB cases and suspects from general hospital to TB dispensary. Methods An operational research was conducted in 3 cities with 38 jurisdiction counties in Hunan province.Compare the case-finding level and the source of TB case and suspect before and after the implementation of the referral system during the study period. Results After the implementation of the referral system,the number of initial consultation cases were 51 468,increased by 71.8% compared with the level of 29 953 before the implementation of the referral system in the 3 prefectures.Among the initial consultation cases,13 056 arrived TB dispensary directly,increased by 51.0% and the number of cases referred by general hospital increased 21 515(194.0%).The registered new smear positive pulmonary TB cases increase by 103.7% with absolute number from 5 201 to 10 956.Among the new smear positive cases,the number of cases arrived TB dispensary directly increased by 1 944(47.3%) and the number of cases referred by general hospital increased by 3 451(315.2%).The number of cases referred by county hospital and township hospital increased by 1 932(337.8%) and 1 385(324.4%) respectively The notification of new smearpositive pulmonary TB was 58.47/100 000 in the project area and 30.13/100 000 in the non-project area in the same duration.The notification in project area was 94.4% higher than it was in non-project area. Conclusion In order to improve the case-finding level of pulmonary TB,the referring system implementation is a feasible and effective strategy.

Study on using fixed-dose combinations in Provincial Tuberculosis Programe

Zhong Qiu¹,Huang Guiqing,Zhang Ming,et al.

Chinese Journal of Antituberculosis. 2006, 28(5):  274-277. 

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Objective To study the feasibility of using fixed-dose combinations in Provincial Tuberculosis(TB) Programe. Method According to the registered serial number,the new smear-positive pulmonary TB cases were distributed into study group(odds number) and control group(even number).The treatment success rate,treatment outcome,patients’ compliance and side-effect were analyzed in the two groups. Result There was no significant difference between the two group on sex,age,weight,treatment success rate,management method and patients’ compliance(P>0.05).The sputum conversion rate at the end of 2 nd month and 3 rd month were 87.0% and 93.5% in study group,and were 89.4% and 93.5% in the control group.The cure rate was 93.5% in the study group and 87.0% in the control group.The difference on the treatment outcome between the two groups was not statistically significant(P>0.05).Except for tinnitus caused by streptomycin(Fisher’s exact P=0.024),other side-effect caused by anti-TB drug were not significant different between the two groups(P>0.05). Conclusion In the developed area,applying fixed-dose combination in regional TB programe is feasible.

The analysis of pulmonary tuberculosis report influenced by Chinese tuberculosis control project in Qiandongnan,Guizhou province

Hou Xinhua.

Chinese Journal of Antituberculosis. 2006, 28(5):  278-280. 

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Objective To analyse the influence of Chinese Tuberculosis Control Project(CTCP) on pulmonary tuberculosis report. Methods The progress of tuberculosis prevention and control in Qiandongnan,was reviewed and the data of pulmonary tuberculosis reports and project work report of CTCP during 2002 to 2004 in Qiandongnan were analyzed. Results The smear-positive pulmonary tuberculosis reporting rate has increased annually from 4.84/100 000 in 2002 to 25.37/100 000 in 2004 since CTCP was conducted in Qiandongnan.Pulmonary tuberculosis reporting rate did not increase substantially,which was 22.0% higher in 2003 compared with it in 2002,but was 4.7% lower in 2004 lower compared it in 2003.The increase of smear-positive pulmonary tuberculosis reporting rate was due to the increase of sputum examination rate in the project counties.The sputum examination rate in project counties was 60% and 35.9% in 2002 and 2003 respectively,which was significantly higher than the level of 6.3% and 5.8% in the non-project counties in 2002 and 2003(P<0.01).The pulmonary tuberculosis reporting rate in project counties was 132.7/100 000 and 165.3/100 000 in 2002 and 2003,significantly higher than the level of 109.6/100 000 and 89.4/100 000 in the non-project counties in 2002 and 2003(P<0.05).The pulmonary tuberculosis reporting rate and smear-positive pulmonary tuberculosis reporting rate were higher in the project counties than the pulmonary tuberculosis reporting rate and notification of smear positive tuberculosi in the TB dispensary. Conclusion CTCP has positive effect on pulmonary tuberculosis reporting in Qiandongnan,with the annual increase in smear-positive pulmonary tuberculosis reporting rate and smear-positive pulmonary tuberculosis reporting rate.Howver,the referral and reporting should be further strengthened to improve the tuberculosis control in Qiandongnan

The analysis of the register,reporting and treatment outcome of pulmonary tuberculosis in Fujian province in eight years

Zheng Jinfeng,Ou Jianming,Liu Tanye,et al.

Chinese Journal of Antituberculosis. 2006, 28(5):  281-284. 

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Objective To analyze the data of registration,reporting and treatment outcome of pulmonary tuberculosis(TB) in Fujian province and to provide evidence to evaluate the sustainable development of TB control program. Method The data on communicable disease report and TB report from 1997 to 2004 in Fujian province were collected and analyzed. Results From 1997 to 2004,the number of reported TB cases increased annually.The registration rate of new cases was only second to hepatitis during the eight years.Adult and those at the age of 60-70 are two groups with highest incidence.Farmer and worker were the two occupations with higher rate than other occupation groups.The pulmonary TB cases in the floating population mainly resided in Chunzhou,Xiamen and Fuzhou and most of them were from other province.The registration rate of new smear positive case increased from 7.2/100 000 in 1997 to 41.0/100 000.Cure rate of smear positive increased from 82.0% in 1997 to 89.8%. Conclusion The performance of TB control in Fujian has been improved.Implementing of DOTS(directly observe therapy,short-course) and improving the qualities of DOTS are still the key to accomplish the tenth five-year plan.

The study of rpoB gene mutation of Mycobacterium tuberculosis

Li Fujian¹,Li Feng,Li Jum.

Chinese Journal of Antituberculosis. 2006, 28(5):  285-287. 

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Objective To investigate the characteristics of rpoB gene mutation of Mycobacterium tuberculosis in local area. Methods 65 Mycobacterium tuberculosis strains were isolated.The rpoB genes containing codon 509 to codon 631 were detected with PCR-SSCP and gene sequencing. Results The mutation rate of rpoB gene from RFP-resistant strains was 96.4%(27/28),which contained 64.3%(18/28)mutation in codon 526,21.4%(6/28)in codon 513,7.1%(2/28)in codon 531,3.6%(1/28)in codon 529.The mutation rate of rpoB gene from RFP-sensitive but other drugs-resistant strains was 18.5%(5/27)and the mutation site was irregular.None mutation was found in drug-sensitive strains. Conclusion The mutation of rpoB is correlative with RFP resistance.Codon 526 and codon 513 are the most frequent in local area.rpoB mutation is also found in other drug-resistant strains.

The influence on Isoniazid and Rifampicin drug susceptibility of the different bacterium quantity in Mycobacterium tuberculosis

Li Youlun,Chen Baowen,Shen Xiaobing,et al.

Chinese Journal of Antituberculosis. 2006, 28(5):  288-290. 

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Objective To compare the difference of drug susceptibility of Mycobacterium tuberculosis（MTB） by using both absolute concentration method with different bacterium quantity and proportion method. Methods The 53 probable drug-susceptible or drug-resistant strains of MTB were selected.The bacterial suspensions of MTB were prepared using Mcfarland method.0.1 ml of bacterial suspensions(including 10^-4,10^-5,10^-6 mg/ml) was incubated for MTB CFU,respectively.0.1 ml of bacterial suspensions(including 10^-2,10^-3 mg/ml) was incubated for the drug susceptibility testing with absolute concentration method,respectively.0.1 ml of bacterial suspensions(including 10^-3,10^-5 mg/ml) was incubated for the drug susceptibility testing with proportion method,respectively. Results The number of MTB CFU was from 5×106 CFU/ml to 5×107 CFU/ml in Mcfarland method.The accordance rate of isoniazid and rifampicin drug susceptibility in 10^-2 and 10^-3 mg/ml of MTB was 98.1%,100.0% using absolute concentration method,respectively.The accordance rate of isoniazid and rifampicin drug susceptibility of MTB was from 90.6% to 100.0% with absolute concentration method and proportion method. Conclusion The result of drug susceptibility of MTB using absolute concentration method and proportion method is accordant.

The clinical study on treatment of giant pulmonary buila with encheiresis and negative pressure drainage combined with artificial pneumoperitoneum

Zhang Shouzhen,Liu Daoxi,Kong Bin,et al.

Chinese Journal of Antituberculosis. 2006, 28(5):  291-294. 

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Objective To study the change of cardiopulmonary function and life quality of patients with giant pulmonary bulla before and after the treatment with encheiresis in pulmonary bulla and negative pressure drainage(combined) with artificial pneumoperitoneum.Methods Eighteen giant pulmonary bulla patients were included.Measurement on their pulmonary function and 6一minute walk distance (6MWD) before and after treatment were conducted. Their dyspnea grade and life quality were assessed with the modified dyspnea scale of English Medical Research Council and short form 36 health survey questionnaire (SF-36) of American Medical Outcomes. Re-sults After the treatment, FVC，FEV!, MVV and 6MWD were all enhanced (P<0.01); RV,TLC and RV/ TLV were all decreased ( P<0.01)； dyspnea grade declined (P<0.01)； SF-36 score was improved (P<0.05, P<0.01). Conclusion The therapy of encheiresis in pulmonary bulla and negative pressure drainage combined with artificial pneumoperitoneum can effectively improve patient's cardiopulmonary function and life quality.

Comparison analysis of CT images of 31 active pulmonary tuberculosis case between the active and post-treatment phases

Lu Xiwei,Zhu Lijun,Quan Zhansheng,et al.

Chinese Journal of Antituberculosis. 2006, 28(5):  295-298. 

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Objective To study the change of pulmonary tuberculosis(TB) CT image in the active and post-treatment phases.Methods Thirty-one active TB patients were selcted to do spiral CT scan to observe the change of the image before and after treatment. Results It showed that check-out rate of active images was 100.0% before treatment and 35.5% after treatment.The most higher check-out rate of active image was ground-glass opacity(87.1%),followed by centrilobular nodules with segmental distribution(80.6%),lobular consolidation(80.1),tree in bud(61.3%),thickening of the bronchial walls(58.1%),thick-wall cavity(48.4%),segmental or lobar consolidation(32.3%) at the start of the treatment.While after completion of the treatment,the check-out rate of those image changed to 0,19.4%,0,0,12.9%,0,3.2% respectively.Many kinds of active CT image which can be found before treatment were reduced and mainly showed one single image in one patient after the treatment.The difference was significant(P<0.01). Conclusion CT was helpful to judge treatment effect of active TB with high sensitivity but low specificity.

Analysis of comprehensive treatment of pulmonary tuberculosis with massive hemoptysis after bronchial artery embolization(BAE)

Li Youcai¹ Shen Mingyan,Zhao Zegang,et al

Chinese Journal of Antituberculosis. 2006, 28(5):  299-300. 

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Objective To evaluate the effectiveness of comprehensive treatment of pulmonary tuberculosis with massive hemoptysis after BAE. Methods The patients’ outcome during 2nd hemoptysis after bronchial artery embolization (BAE) for pulmonary tuberculosis hemoptysis at outpatient clinic emergency were analyzed.Among 289 pulmonary tuberculosis massive hemoptysis patients,42 had 2nd hemoptysis after BAE from Aug.1997 to Feb.2006.20 cases of small hemoptysis were treated with Yunnan White Drug powder and tranexamic acid and 22 cases of massive hemotysis were treated with hemocoagulase and artificial hibernation combined. Results The haemostatic rate of patients treated with Yunnan White Drug powder and tranexamic acid was 95.0%,and hemocoagulase and artificial hibernation combination group was 86.4%. Conclusion Small hemoptysis during 2nd hemoptysis after bronchial artery embolization(BAE) for pulmonary tuberculosis may be treated regularly,but middle and massive hemoptysis can be more effectively treated with hemocoagulase and artificial hibernation combined.

The treatment for the destroyed lung pleuropneumonectomy postoperative patients in ICU

Kang Naimin¹,Zhang Xiujuan,Liu Liqun.

Chinese Journal of Antituberculosis. 2006, 28(5):  301-304. 

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Objective To improve the treatment for the destroyed lung pleuropneumonectomy postoperative patients in ICU.Methods 28 patients who suffered the destroyed lung by pulmonary tuberculosis have been selected to acceptthe surgical treatment,pleuropneumonectomy.All of themhave accepted the intensive caretreat-ment after operation including continuous monitoring patient’slife signs,the bleeding amount, the function of the lung,the blood gas analysis;treating the complicated diseases;getting rid of sputum by bronch of ibroscope; treatingthe acute respiratory failure by using ventilator.Results Through the treatment in ICU,20 patients smoothlyrecovered.8 patients complicated withthe acute respiratory failure accepted the ventilator, NPPV, or PSV+PEE Pventilation, and recovered. 2 patients complicated withinfectionandfistulae of bronchial stump,a-mong whomone patient died.Conclusions Duringthe postoperative treatment for patients who accept pleurop-neumonectomy, ICUdepartment plays animportant role in continuous monitoring and treatment, reducing stress,treating acute respiratoryfailure.

Paragonimiasis complicated with pulmonay tuberculosis: clinical analysis of 52 cases

Bao Senhe,Lu Jiliang,Su Jinliang,et al.

Chinese Journal of Antituberculosis. 2006, 28(5):  305-308. 

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Objective To explore the clinical symptoms and the treatment of paragonimiasis complicated with pulmonary tuberculosis and to enhance the understanding of the disease. Methods The clinical documents of 52 cases of paragonimiasis complicated with pulmonary tuberculosis treated during 1995-2002 were reviewed.Results The patients were all adults,with 67.3% of male(35 out of 52).76.9% patients (40 out of 52).were peasants from the epidemic-stricken area and 21.2% cases were misdiagnosed(11 out of 52) because of the complicacy and variety of the clinical symptoms.All patients ever ate half-raw Charybdis(Charybdis) natator or drank water from rivulets in the epidemic-stricken area.4 cases were contacts of pulmonay tuberculosis.The latency was not easily determined but in most cases it ranged from 30 days to one year. Conclusion Since there are many similarities in signs and symptoms for both paragonimiasis and pulmonay tuberculosis,when the two disease are complicated,it is difficult to differentiate them through radiographic technology and disease history and aetiological examination must be applied to confirm the diagnosis.

The effect of drug resistance on treatment of tuberculosis

Shen Xin,Mei Jian,Shen Mei,et al.

Chinese Journal of Antituberculosis. 2006, 28(5):  309-312. 

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Objective To evaluate the effect of drug resistance on treatment of tuberculosis.Methods The treatment outcome of sensitive TB cases and drug resistant TB cases that weren ewly registered between February 2004 and September 2004 were analyzed and compared. Results Among the 1597 retrieved TB cases,805 were culture positive cases from whom 731 were included in the mycobacterium tuberculosis group after isolate（identification.） The drug-resistant rate of 731 patients was 18.7% and the multi-drug-resistant rate was 6.7%.The assessment of one-year treatment outcomes showed that the treatment success rate was as high as 93.0%（among） the sensitive cases, the rate was more than 85.0% of patients who had drug-resistant but not MDR strains and the rate was 71.4% of MDR-TB patients.The χ² testing showed that the difference was significant（χ²=82.996 8,P<0.01）.Of the 68 patients who were not treated successfully,38.2% were drug-resistant（patients）, while of 30 patients who were failed in treatment,60% were drug-resistant patients..Retreatment sensitive（92.0%） patients had approximate success rate of one-year treatment with new sensitive patients（93.1%）,but retreatment drug-resistant patients had much lower success rate of treatment than drug-resistant new patients. Conclusion The performance of treatment and management of TB cases in Shanghai has achieved satisfied effect.Drug resistance is an important factor leading to the failure of the treatment and great efforts should be made to improve the treatment of drug resistant patients.There is big different between drug resistant patient and sensitive patient in the treatment outcome and further evaluation needed to be conducted.