Chinese Journal of Antituberculosis

The confusion and thinking about clinical diagnosis and treatment of tuberculous meningitis

YAN Shi-ming

Chinese Journal of Antituberculosis. 2011, 33(12): 777-779.

Abstract ( 1492 )

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The clinical research of cerebrospinal fluid cytology in tuberculous meningitis

YAN Shi-ming，QIN Gui-xiang，ZHAO Yun-hong，HAN Li-jun，WANG Li，CUI Wen-yu，LIANG Hong-mei

Chinese Journal of Antituberculosis. 2011, 33(12): 780-784.

Abstract ( 1677 )

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Objective To study the diagnostic and prognostic value of cerebrospinal fluid (CSF) cytology in tuberculous meningitis.
Methods CSF cells were collected with FMU-5 were evaluated with optical microscope after May-Grunwald-Giemsa(MGG) staining.
Results In 91.38% (700/766) of patients with tuberculous meningitis, CSF cytology demonstrated a mixed cell profile, and in 8.62% (66/766) a lymphoid cell profile was shown, whereas neutrophils in purulent meningitis and lymphocytes in viral meningitis predominated. Large lymphoid cells were seen in 97.52% (747/766) of tuberculous meningitis, but rarely seen in purulent meningitis or viral meningitis. The number of neutrophils and large lymphoid cells gradually decreased with the improvement of tuberculous meningitis; persisted existence of neutrophils and large lymphoid cells predicted a poor prognosis.
Conclusion CSF cytology of tuberculous meningitis is a mixed cell and lymphoid cell profile. Large lymphoid cells are characteristic features of tuberculous meningitis; dynamic changes in CSF cytology can be used for differentiating different types of meningitis and for evaluating the prognosis.

The value of contrast-enhanced MRI and diffusion weighted imaging in 82 cases differentiating parenchymal tuberculosis from brain metastases from lung cancer

GUO Li-fang, ZHOU Xin-hua, XIE Ru-ming, LV Yan, HE Wei

Chinese Journal of Antituberculosis. 2011, 33(12): 785-789.

Abstract ( 2217 )

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Objective To explore the value of MRI，especially contrast-enhanced MRI and diffusion weighted imaging (DWI) in differentiating parenchymal tuberculosis from brain metastases of lung cancer. Methods The conventional MRI and DWI were performed in 82 cases (42 cases with parenchymal tuberculosis, and 40 cases with brain metastases from lung cancer). The mean apparent diffusion coefficient (ADC) values and relative apparent diffusion coefficient (rADC) values were calculated from the lesions. Datas are analyzed by SPSS 13.0 software packet, and using t test. Results Forty-two cases of parenchymal tuberculosis all showed multi-focus, 82.56% (374/453) of lesions were smaller than 1.0 cm,33.77% (153/453) of lesions were evenly enhanced with nodosity, the others showed ring-like contrast enhancement on Gd-DTPA enhanced T₁WI,and the rim had uniform thickness, the inner and outer walls were smooth. About 36.42% (165/453) of lesions had mild or moderate edema. 32.50% (13/40) of brain metastases from lung cancer showed solitary, 41.01% (57/139) of lesions were smaller than 1.0 cm, 4.32% (6/139) of lesions were evenly enhanced with nodosity, the others showed ring-like or patchy contrast enhancement on Gd-DTPA enhanced T₁WI, About 19.17% (23/120) of the rims showed uniform thickness, the others were coarse or accompanied by a nodule. About 75.54% (105/139) of lesions had moderate or severe edema.The ADC values of the solid center and the rim of parenchymal tuberculosis were (0.97±0.15）×10^-3mm²/s,（1.07±0.20）×10^-3mm²/s, they were lower than the ADC values from the solid and cystic lesions of brain meta-stases from lung cancer which were（1.10±0.25）×10-³mm²/s and（1.28±0.32）×10^-3mm²/s respectively, there was statistical significance. Conclusion Contrast-enhanced MRI could clearly display the morphological features, size and adjacent relationships of parenchymal tuberculosis and brain metastases from lung cancer, DWI and the ADC values could display the alterations of the microscopic structure of the tissue. Combination of contrast-enhanced MRI and DWI are helpful in diagnosis and differential diagnosis of these two diseases.

Studying different nursing ways on the clinical effect of tuberculous meningitis

ZHANG Xin-wei, SUN Li, ZHANG Xin-yan

Chinese Journal of Antituberculosis. 2011, 33(12): 790-793.

Abstract ( 1613 )

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Objective To study different nursing ways on the clinical effect of tuberculous meningitis patients. Methods Six hundred and eighty patients were divided into 2 groups, 257 in the control group and 423 in the experimental group. Patients in the experimental group were given common and professional nursing as well as comprehensive nursing including psychological nursing, rehabilitation nursing and guidance after discharge. The investigated indexes included regular review rate after care, giving up treatment or treatment interruption rate，recovery rate，sequelae occurrence rate and death rate. Results The regular review rate and recovery rate in the experimental group were markedly higher. The differences were statistically significant (χ²=8.38，P<0.05); giving up treatment or treatment interruption rate，recovery rate，sequelae occurrence rate and death rate in the experimental group were markedly lower. The differences were statistically significant (χ²=11.61，P<0.05). Give up or interrupt therapy, sequelae incidence, mortality in the experimental group were lower than the control group, the difference were statistically significant (χ²=30.41，15.07，6.65, respectively, P<0.05).Conclusion Common and professional nursing accompanied by comprehensive nursing such as psychological nursing, rehabilitation nursing and guidance after discharge are helpful to urge the patients to do regular review, completing the course of treatment and to enhance the recovery rate.It is also to decrease the death rate and prevent the occurrence of sequellae. 

Analysis of influencing factors of death of patients with tuberculous meningitis

MAO Xiao-hui, WANG Bo, WU Xuan

Chinese Journal of Antituberculosis. 2011, 33(12): 794-797.

Abstract ( 1753 )

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Objective To evaluate the influencing factors of the prognosis of patients with tuberculous meningitis. Methods A retrospective study was conducted in Tuberculosis and Thoracic Tumor Hospital of Xi’an from January 2006 to December 2010, the clinical data (age of onset, duration, treatment of disease, radiographic changes, whether regular treatment, with or without coma and other relevant factors) of 84 cases patients with tuberculous meningitis (A group of 58 patients survived, B group, 26 patients died) were analyzed. Results The influencing factors of the prognosis of patients with tubercular meningitis were coma in treatment(RR=2.658), hydrocephalus(RR=4.338);having received informal anti-TB treatment outside(RR=3.551);liver damage(RR=2.046).The above 4 factors increased risk of death in patients with tuberculous meningitis (P<0.05). Conclusion Coma in treatment, liver damage occurred during the treatment, hydrocephalus, having received informal anti-TB treatment outside are the influencing factors of the prognosis of patients with tuberculous meningitis. 

Multicenter study to evaluate the smear and culture result of Mycobacteria tuberculosis

OU Xi-chao, LI Qiang, XIA Hui, WANG Sheng-fen, ZHOU Yang, PANG Yu, ZHAO Bing, SONG Yuan-yuan, ZHAO Yan-lin

Chinese Journal of Antituberculosis. 2011, 33(12): 798-802.

Abstract ( 1582 )

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Objective To analyze the smear and culture results of patients from county TB dispensaries. Methods A total of 3550 smear positive specimens from 1230 new and retreatment patients recruited in eighteen county TB control institutions according to stratified cluster sampling method from April to December 2007, three specimens for smear and two specimens for culture experiment. The positive rates of smear and culture result among the spot, evening and morning specimens were analyzed and the correlation of smear and culture results were observed. Results The positive rates of smear result for morning, spot and evening specimen were 78.8%（917/1164）, 87.0%（1070/1230） and 90.0%（1040/1156）. The positive rates of culture result for morning, spot and evening specimen were 96.9%（504/520）, 97.1%（881/907） and 97.8%（709/725）. The level of smear and culture result in 2147 specimens were analyzed by trend χ² test, we found there was linear trend of correlation between smear and culture results(χ²=206.2, P<0.01). Conclusion Smear results can provide some hint for culture results in some extent. If the smear positive level is high,the culture positive level will also high.

Analysis of pulmonary tuberculosis patient health seeking delay and diagnosis delay in Kashgar in Xinjiang

YANG Tai-hua, Wahafu·Shali, YANG Jin-min,TAI Xin-rong

Chinese Journal of Antituberculosis. 2011, 33(12): 803-805.

Abstract ( 1985 )

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Objective To analyze the reasons of PTB patient health seeking delay and diagnosis delay in order to provide evidence for improving. Methods Except Taxkorgan County (a high altitude remote small county), all 43 832 cases of active PTB (of which, 7622 cases could not be evaluated due to lack of interval information between symptoms onset to initial health care seeking, accounting for 17.39%) registered from January 1, 2005 to September 30, 2010 in remaining 11 counties in Kashgar were analyzed for health seeking delay and diagnosis delay. In combination with the face-to-face questionnaire investigation for more than 20 cases of PTB patients who completed treatment in 2010 in each county, patient’s TB cognition and health seeking behaviors were analyzed. Meanwhile, the status of township and village hospitals were investigated. Results The average interval from symptom onset to initial health seeking was an average of 106.5 days. The overall health seeking delay was 91.98% (33 305/36 210); 51.43% (18/35) for patients who understood the relevant information before seeking health care, and 98.11% (52/53) for those who did not understand, the difference was statistically significant (χ² = 28.24, P<0.01); The average interval from initial health seeking to TB confirmation was an average of 80.1 days. The overall diagnosis delay was 33.25% (12 102/36 393); In township hospital, the sputum smear detection rate was 13.15% (43/327), 93.58% (306/327) of diagnosis rate; 72.64%(146/201) of X-ray quality passing rate, 76.03% (111/146) of diagnostic accuracy rate; village doctor had no ability in TB diagnosis. Conclusion Health seeking delay and diagnosis delay are common in local rural areas. Therefore, to strengthen the publicity of TB control strategies and measures for minority population, improve the diagnostic capacity and consciousness of TB referral is the current pressing problems in Kashgar.

The diagnosis value comparison of Mycobacterium tuberculosis by FQ-PCR in samples for smear-negative pulmonary tuberculosis

ZHANG Hong-ying, CHEN Li-zhou, LIN Min, LV Xiao, YANG Guo-yu, MAO Ya-yun, LI Tian-lin, WANG Gang-ling

Chinese Journal of Antituberculosis. 2011, 33(12): 806-809.

Abstract ( 1933 )

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Objective To evaluate the diagonsis value of M.tuberculosis DNA detected by fluorescence quantitative polymerase chain reaction(FQ-PCR) in sputum and bronchoalveolar lavage fluid(BALF) for patients with smear-negative suspicious pulmonary tuberculosis(PTB). Methods Fifty one suspicious lung tuberculosis patients from July to December in 2009 with at least three times negative sputum smear are divided into two groups: 24 cases with suspicious radiological features of pulmonary tuberculosis (suspicious PTB group) and 27 cases with radiological features of non-tuberculosis (excluding PTB group). All of patients underwent tuberculin skin test, anti-TB antibody and erythrocyte sedimentation rate(ESR) are detected, Mtb-DNA of sputum and BALF are detected qualitatively and quantitatively by FQ-PCR. Results Sputum specimens PCR has a sensitivity of 45.8%（11/24）, specificity of 96.3%（26/27）, and Youden’s index of 42.1%, whereas in BALF specimens, the sensitivity and Youden’s index are significantly higher at 75.0%（18/24）and 71.3% respectively, while the specificity is still high at 96.3%（26/27）. Conclusion Detecting Mtb-DNA in BALF by FQ-PCR is more sensitive than sputum specimens, and has a good diagnostic yield in patients with suspicious radiological features and sputum smear-negative pulmonary tuberculosis, especially without sputum production.

Analysis of TB infection risk and related factors on the closely contacts with smear positive TB patients

ZHANG Hui-min, ZHANG Lian-ying, LV Guang-bo, WANG Yong-hui, ZHU Yan-hui, XU Hua, LIN Sen

Chinese Journal of Antituberculosis. 2011, 33(12): 810-814.

Abstract ( 2023 )

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Objective To investigate TB infection risk and related factors on the closely contacts of smear positive TB patients. Methods 7884 persons closely contacted with smear positive pulmonary tuberculosis patients were checked-up by PPD tests within 1 month after the TB patients were diagnosed, and persons with negative result of PPD tests were checked-up again by PPD tests 3 months later. Results The infection rate of tubercle bacillus in contacts <15 years old was 39.03% (153/392), and in contacts ≥15 years old was 60.65% (4014/6618). The ratio of reaction size ≥15mm was 28.06% (110/392) in contacts <15 years old without BCG scar, it’s 1.67 times of contacts <15 years old who have BCG scar（16.82%,147/874）, and the ratio of reaction size ≥20mm in contacts ≥15 years old (13.55%,897/6618) was the lowest. The number of tubercle bacillus in sources patients sputum was high the infection rates of contacts was high, and they were different of having different number tubercle bacillus in sources patients sputum（χ²=38.42，P<0.01；χ²=235.11，P<0.01）. The infection rates in contacts who were spouse, parent, schoolmate, colleague of the sources patients were higher, and in contacts who were grandparent or grandchildren, brother or sister of the sources patients were lower. The infection rates and the ratio of reaction diameter ≥20mm in person<15 years and ≥20mm in person ≥15 years of PPD test in different relationship contacts were different separately（χ²=127.14，P<0.05；χ²=18.97，P<0.05）.Annual risk of contacts of sputum smear positive pulmonary TB was 3.53%. Conclusion Infection risk of tubercle bacillus in closely contacts of sputum smear positive pulmonary TB is higher than general population. It’s related with the number of tubercle bacillus in known patient’s sputum, the relationships between them and the age of contacts.

Association between the polymorphisms of interleukin-18 promoter gene -137 G/C and -607 C/A and the susceptibility of tuberculosis: a Meta-analysis

ZHANG Zhe, MA Hong-xia, YU Xue-wen, WANG Qiu-ping, YANG Jian, GUO You-min

Chinese Journal of Antituberculosis. 2011, 33(12): 815-819.

Abstract ( 1845 )

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Objective To provide a quantitative summary in estimating the association between the polymorphisms of two loci in interleukin-18 (IL-18) gene promoter and susceptibility of tuberculosis by Meta-analysis. Methods The polymorphisms of IL-18 promoter gene -137 G/C and -607 C/A were analyzed using the sequence specificity primer polymerase chain reaction (PCR-SSP) and gene sequencing analysis. Based on the strict quality evaluation, statistics was carried out for Meta analysis by Review Manager 5.0 software. Inclusion criteria were as follow: (1) the studies on the association between the polymorphisms of IL-18 promoter gene -137 G/C and -607 C/A and the tuberculosis susceptibility; (2) the gene distribution of the control group coincides to the law of genetic equilibrium of HardyWeinberg; (3) the original material was complete; (4) the study provided the genotype frequency or allele frequency; (5) the study was published in Chinese or English; (6) the polymorphisms were detected by PCR-SSP and gene sequencing or SNaPshot SNP technology. Exclusions criteria were as follow: (1) the repeated report; (2) the data were not clear; (3) the study was based on the family; (4) the gene distribution of the control group was not inspected by the law of H-W genetic equilibrium. Results According the established inclusion criteria，6 studies with a total of 695 cases and 879 controls were identified in the SNP -607 C/A of the promoter of IL-18 gene. The SNP -137 G/C was identified in 5 studies which contained 594 cases and 781 controls. The pooled odds ratios (ORs) for studies with -137 C and -607 A loci allele variants in the IL-18 promoter gene were 1.41（95% CI: 1.15～1.74，P=0.001）and 0.93（95% CI为0.81～1.08，P=0.36），respectively，compared with -137 G and -607 C alleles．Conclusion SNP -137G/C located in IL-18 promoter was associated with tuberculosis, and may be one of the susceptibility loci of tuberculosis. The association of SNP -607 C/A and tuberculosis susceptibility showed no statistically significant difference in our study.

The progress of laboratory diagnostic techniques of tuberculous meningitis

ZHU Chang-tai，HU Zhong-yi

Chinese Journal of Antituberculosis. 2011, 33(12): 822-824.

Abstract ( 1460 )

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The chemical treatment of tuberculous meningitis and the application of adrenal cortical hormones

ZHAO Yun-hong，YAN Shi-ming

Chinese Journal of Antituberculosis. 2011, 33(12): 825-827.

Abstract ( 1876 )

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The research advances and application of Mycobacterium tuberculosis early secreted protein ESAT-6

TAO Bo-shan

Chinese Journal of Antituberculosis. 2011, 33(12): 827-830.

Abstract ( 1779 )

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