Chinese Journal of Antituberculosis

The awareness of tuberculosis infection control knowledge in Beijing health care workers

HONG Feng, ZHANG Wei-min, HE Xiao-xin, XIA Yun, HE Guang-xue

Chinese Journal of Antituberculosis. 2012, 34(2): 69-72.

Abstract ( 2912 )

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Objective To learn the awareness status of Beijing health care workers’ (HCWs) knowledge about tuberculosis(TB) infection control in TB facilities and general hospitals. Methods A cross-sectional study was conducted among 1390 HCWs in 3 TB facilities and 4 hospitals in Beijing. Questionnaires were used to learn about the HCWs’ knowledge of tuberculosis infection control. Results HCWs have a good awareness of isolation and ventilation, the rate of correct cognition are 98.2%(1365/1390) and 98.1%(1363/1390) respectively in all HCWs; but the cognitive status about the knowledge of personal protection, especially about triage(72.0%(1001/1390)), disinfection(54.0%(751/1390)), are dissatisfied. There is a significant difference between the knowledge of four aspects of TB infection control among doctors and nurses, that is,triage, disinfection, whether we should wear masks or not when contacting with suspected or confirmed TB patients and what type of masks we should choose when contacting with these patients. As for triage, 68.1%（320/470）doctors know correctly about it compared with 74.0%（681/920）nurse(χ²=5.374, P=0.020);As for disinfection, 46.0%(216/470)doctors know correctly about it compared with 58.2%(535/920) nurses(χ²=18.608, P<0.01);As for whether we should wear masks when contacting with suspected or confirmed TB patients,78.1%(367/470)doctors know correctly about it compared with 87.5%(805/920)nurses(χ²=20.050, P<0.01);As for the right type of masks to choose, 34.9%(164/470)doctors know correctly about it compared with 41.1%(378/920)nurses(χ²=5.053, P=0.025). Nurses have a higher correct response rate than doctors. Conclusion We should strengthen the knowledge and skills about TB infection control among the HCWs. Importance should be attached to the knowledge of triage, disinfection, the type of masks and the wearing condition in personal protection.

The analysis of long-term treatment outcome of TB patients with or without multidrug-resistance under DOTS management in Heilongjiang province

XIE Yan-guang, FANG Hong-xia, YAN Xing-lu, SUN Yan-bo, LI Hong-hai, LI Fa-bin, ZHANG Xue-zhi

Chinese Journal of Antituberculosis. 2012, 34(2): 73-78.

Abstract ( 2599 )

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Objective To evaluate the long-term treatment outcome of TB patients with or without multidrug-resistance after they were successfully treated by first-line TB drugs under DOTS strategy. Methods This is a retrospective cohort study design. The cohort study followed up the MDR-TB patients who were diagnosed in a drug-resistance survey in Heilongjiang province in 2004 and were later successfully treated under DOTS strategy. Of the 194 cases of MDR-TB patients successfully treated under the DOTS treatment, 111 were followed up including 40 died during the 4 years and 71 still alive. One survival MDR-TB patients were matched with one Non-MDR-TB patients in control group (71 patients in control group, among which 41 were drug sensitive to any TB drugs, 30 drug resistance cases were drug-resistant but non MDR-TB). The patients were observed for TB recurrence 4 years after successful completion of treatment. We analyzed the influence of MDR (71 MDR-TB cases, 41 drug sensitive cases, 30 non-MDR-TB cases), treatment classification (80 initial treatment cases, 62 retreatment cases), treatment regimen (124 cases with NTP regimens, 18 with research regimens) on the recurrence. Results In the exposed group, MDR TB recurred in 52 (46.85%) of the 111 patients. This recurrence rate was 67.50% in the dead(27/40), and 35.21%（25/71）in survival 71 cases. In 71 controls, the recurrence rate was 23.94% (17/71). The risk of 4 year recurrence in living MDR-TB patients was significantly higher than those drug sensitive to any TB drugs （χ²=4.19，P=0.041；RR=2.06,95% CI＝0.98-4.34).The risk of recurrence in retreatment TB patients （40.32%，25/62）was significantly higher than those of initial treatment cases （21.25%，17/80）（χ²=6.10，P=0.014；RR=1.90, 95%CI：1.13-3.19). NTP regimen and research regimen had no significant impact on the long-term recurrence 29.84%（37/124）versus ［27.78%（5/18）, χ²=0.02，P=0.894］.Conclusion The study showed that the 4 years recurrence rate of MDR-TB patients was high. The risk of recurrence is high in retreatment than initial treatment cases.

The analysis of medical expense and economic burden in new smear positive pulmonary tuberculosis cases from 4 prefecture level designated TB hospitals

WANG Na, WANG Li-xia, LI Ren-zhong

Chinese Journal of Antituberculosis. 2012, 34(2): 79-84.

Abstract ( 2667 )

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Objective To analyze the medical expense and the family economic burden of new smear positive pulmonary tuberculosis cases in TB designated hospitals. Methods Four TB designated hospitals in 4 cities were selected, and 106 new smear positive patients in these hospital before August 2009 were investigated by questionnaire and medical record review. Information about the social economic conditions and medical expenses was collected. Descriptive analysis was done for patients’ social economic conditions and medical expenses. Results The median of the medical expense of the new smear positive patients in 4 designated hospitals is 11 282 RMB. 90.8%（69/76）patients have a catastrophic expenditure. The economic burden decreased after the reimbursement of the people with health insurance, but 68.4%（52/76）patients still have a catastrophic health expenditure. The percentage of people who were in debt caused by TB is 47.2%（50/106）.Among them, 76.0%（38/50）have not yet pay off their debt by the investigation day. 58.5%（62/106）new smear positive pulmonary tuberculosis patients feel a heavy economic burden. Conclusion The medical expense of new smear positive patients in designated hospital is high, leading to the catastrophic health expenditures for their family.

Analysis on the impact of systematic management on increasing the cure rate of pulmonary tuberculosis patients

LIN Sen, MA Ying-zi, WANG Ying-zi, WANG Cui-hua, LI Jun-juan, WANG Li-fang, LI Hai-feng, XUE Wan-you, ZHANG Guo-hui, WANG Wei，WEI Feng

Chinese Journal of Antituberculosis. 2012, 34(2): 85-89.

Abstract ( 2310 )

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Objective To analyze the impact of systematic management on the cure rate of pulmonary tuberculosis patients. Methods Data related the treatment management and treatment outcome of the new smear positive TB patients were compared and analyzed before (from 1994 to 2002, 6745 cases) and after (from 2003 to 2010, 11 426 cases)the implementation of systematic management in Chengde city. Results After implementation of systematic management, the annual average rate of full course supervision,systematic management rate, the standardized treatment rate, the cure rate of new smear positive TB patients increased from 71.55%（4826/6745）to 92.69%（10 591/11 426）,78.30%（5281/6745）to 93.22%（10 651/11 426）,81.94%（5527/6745）to 93.18%（10 647/11 426）,81.84%（5520/6745）to 93.06%（10 633/11 426）, respectively; the treatment completion rate and the loss rate decreased from 4.57%（308/6745）to 0.15%（17/11 426）, 5.69%（384/6745）to 0.46%（52/11 426）, respectively. Conclusion The implementation of the systematic management dramatically improves the cure rate of new smear positive TB patients in Chengde city.

Application of Kriging interpolation analysis in the distribution of tuberculosis in China

KANG Wan-li, ZHENG Su-hua

Chinese Journal of Antituberculosis. 2012, 34(2): 90-92.

Abstract ( 2168 )

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Objective Application of Kriging interpolation analysis to study the spatial distribution of the prevalence rate of active pulmonary tuberculosis in China and to provide scientific basis for prevention tuberculosis. Methods Data were collected from the fourth national TB epidemiological surveys, relevant databases were set up. A total of 365 097 people were investigated in the fourth survey, 1340 active pulmonary TB patients were found. The prevalence rate of active pulmonary tuberculosis in China was 367.03/100 000(1340/365 097). Kriging interpolation analysis was applied to analyze the spatial distribution of the prevalence rate of active pulmonary tuberculosis. Results 1)The semivariogram analysis showed that there was moderate spatial autocorrelation of the prevalence rate of active pulmonary tuberculosis in China C₀/（C₀+C）=66.14%. 2)The spatial distribution of the prevalence rate of active pulmonary tuberculosis was unbalanced in China by the disjunctive Kriging interpolation analysis. Conclusion Kriging interpolation analysis was helpful in making overall estimate of nationwide prevalence of active pulmonary TB through sampling survey data.

Analysis of TB information management system in Zhabei district of Shanghai city

DENG Yan, CHEN Hong,LI Zhi-hong,XU Min-gang

Chinese Journal of Antituberculosis. 2012, 34(2): 93-95.

Abstract ( 1837 )

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Objective To explore the application of TB information management system in the standardized management of pulmonary TB patients. Methods Chi-square test and comparative analysis between groups was done for the tracking arrival rate of the new suspected TB patients. The TB patients included three groups: Group Ⅰ comprised of 141 patients registered from June 2005 to August 2005; Group Ⅱ comprised of 112 patients registered from September 2005 to November 2005; Group Ⅲ comprised of 176 patients registered from September 2009 to November 2009. Descriptive analysis was made for the systematic management rate of the resident TB patients in Zhabei district and Chi-square test was done for the systematic management rate of 234 TB patients in 2005 and 219 patients in 2009. Results After using the TB information management system, the overall tracking arrival rate for new suspected pulmonary TB patients increased from 73.0% (103/141) in 2005 to 96.6% (170/176) in 2009. χ²=37.053, P<0.01,the difference is statistically significant. The pairwise comparison were made between three groups: OR=1.220 (95%CI＝0.687-2.168) between group Ⅱ and group Ⅰ; OR=10.453(95%CI＝4.271-25.585) between group Ⅲ and group Ⅰ; OR=8.566(95%CI＝3.397-21.598) between group Ⅲ and group Ⅱ. Systematic management rate rose from 95.3% (223/234) in 2005 to 100.0%(219/219) in 2009, χ²=10.551, P=0.001. Conclusion TB information management system in Zhabei district has great application value in the standardized management of pulmonary TB patients.

Significance in differential diagnosis of epidermal growth factor receptor autoantibodies expressed in sera in patients with lung cancer and tuberculosis

MA Li-ping, WU Xiao-guang, MA Li, YUE Wen-tao

Chinese Journal of Antituberculosis. 2012, 34(2): 96-99.

Abstract ( 2345 )

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Objective To investigate the expression of epidermal growth factor receptor(EGFR）autoantibodies in sera in healthy controls, patients with lung cancer and tuberculosis. Methods EGFR autoantibodies in the sera from 100 healthy controls, 112 patients with pulmonary tuberculosis, 317 patients with nonsmall-cell lung cancer were detected using indirect ELISA. Results There was no significant difference in the level of EGFR autoantibodies in sera between healthy controls (1.475±0.806) and patients with lung cancer (1.625±0.988) (t=1.533，P=0.127). There was significant difference in the level of EGFR autoantibodies in sera between healthy controls (1.475±0.806) and patients with pulmonary tuberculosis (2.298±1.414) (t=5.277，P=0.022), also between the patients with lung cancer (1.625±0.988) and the patients with pulmonary tuberculosis (2.298±1.414) (t=4.566, P=0.043). Conclusion The level of EGFR autoantibodies in sera from the patients with pulmonary tuberculosis is the highest, followed by lung cancer, and healthy controls with the lowest level. It may provide an evidence for the differential diagnosis of lung cancer and tuberculosis.

Diagnostic value of enzyme-linked immunospot assay for diagnosis of smear-negative pulmonary tuberculosis

ZENG Yi，FENG Xiao，SONG Mei-mei，LIN Yun-xia，FEI Xian-shu，YUAN Guang-qin

Chinese Journal of Antituberculosis. 2012, 34(2): 100-102.

Abstract ( 3065 )

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Objective To explore the value of enzyme-linked immunospot assay （ELISPOT）（ T-SPOT.TB ）in diagnosis of smear-negative pulmonary tuberculosis. Methods Rapid T-SPOT.TB assay was employed to detect Mycobacterium tuberculosis antigen specific T cells in blood samples from 55 cases with smear-negative pulmonary tuberculosis(A group) and 36 cases with non-TB pulmonary disease(B group)，The conventional PPD skin test and serum tuberculosis antibody were performed in two groups at the same time. Results By the T-SPOT.TB assay，the positive rate in A group was 89.1% (49/55)，it was significantly higher than that of B group 19.4% (7/36) （χ²=44.59，P<0.001）.In A group，the positive rate of T-SPOT.TB assay was much higher than the positive rate of PPD test and serum tuberculosis antibody and the positive rate of PPD test combination with serum tuberculosis antibody（χ²=12.13，χ²=7.08，χ²=21.54，P<0.01）.In B group，the negative rate of T-SPOT.TB assay was 80.6% (29/36)，it was no significant difference than the negative rate of PPD test and serum tuberculosis antibody and the negative rate of PPD test combination with serum tuberculosis antibody （χ²=0.39，χ²=0.41，P>0.05）. Conclusion T-SPOT.TB assay is superior specificity and sensitivity of PPD test and serum antibody. It will be a useful tool to diagnose early smear-negative pulmonary tuberculosis. T-SPOT.TB is worth further to expand in the clinical application.

Preliminary study on early diagnosis and efficacy evaluation of pulmonary tuberculosis based on molecular beacon real-time PCR

CAO Ran-ran, LIU Bang-ying, ZHOU Zi-ren, GAO Wen-feng, YANG De-hui, YANG Hong, LIU Heng-chuan

Chinese Journal of Antituberculosis. 2012, 34(2): 103-106.

Abstract ( 2226 )

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Objective To investigate early diagnosis and efficacy evaluation of pulmonary tuberculosis using molecular beacon real-time polymerase chain reaction(PCR). Methods Molecular beacon real-time PCR and acid-fast staining were used to detect Mycobacterium tuberculosis in 305 sputum specimens collected from pulmonary tuberculosis suspects at initial testing and 77 sputum specimens collected from pulmonary tuberculosis patients. Results Using acid-fast staining and molecular beacon real-time PCR, the positive rates were 12.6% (48/382), 42.4%（162/382）, respectively. The positive rates of detection of molecular beacon real-time PCR was significantly higher than that of acid-fast staining（χ²=74.5，P＜0.001). Conclusion Compared with acid-fast staining, molecular beacon real-time PCR shows higher sensitivity in detection of pulmonary tuberculosis. It enhances the detection rate and indirectly reflects efficacy of medications, thus showing promising in control and prevention of tuberculosis.

A clinical analysis of 62 cases of methadone replacement therapy associated with tuberculosis

ZHANG Xiao-li, WANG Fu-sheng

Chinese Journal of Antituberculosis. 2012, 34(2): 107-109.

Abstract ( 2006 )

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Objective We explored the clinic characteristics and efficacy in cases of methadone replacement therapy (heroin dependent patients) associated with tuberculosis in order to improve the diagnostic level on such disease. Methods We analyzed retrospectively our hospital’s clinic data of 62 cases of heroin dependent patients with tuberculosis (observation group) between January 2005 and December 2010, compared with the control group (72 cases with no drug use) in clinic symptoms, lesion distribution, sputum detection, and imagings of X ray or CT. Results In the observation group, the rate of over 2 lung fields was 82.3%(51/62）, 77.4%（48/62）patients had cavites and 71.0% （44/62）were sputum positive. In the control group, the rate of over 2 lung field was 54.2%（39/72）, 51.4%（37/72）had cavities and 44.4%（32/72）were sputum postive. There were statistically significant differences between two groups(χ²=11.92，9.73，9.54，P values were all less than 0.01). Conclusion Patients of methadone replacement therapy with tuberculosis are obviously more serious.The society should pay high attention to the prevention and treatment for these patients.

Follow-up on treatment outcome in 161 cases with multi-drug resistant pulmonary tuberculosis

YIN Hong-yun, HE Ya, ZOU Dan-feng, YANG Yan, ZHANG Qing, ZHANG Zhong-shun, YUE Jun

Chinese Journal of Antituberculosis. 2012, 34(2): 110-114.

Abstract ( 2808 )

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Objective To evaluate the efficacy and risk factors of prognosis in multidrug-resistant tuberculosis (MDR-TB). Methods One hundred and sixty-one patients conformed with MDR-TB, simultaneous resistance of isoniazid（INH）and rifampin（RFP）detected by BACTEC mycobacteria growth indicator tube（MGIT）960 culture system, received individualized protocol during hospitalization in Shanghai Pulmonary Hospital from 2006 to 2008. Data included demography, age, kinds and duration of antituberculosis drugs, and main complications, radiogrphy, the results of drug susceptibility test and follow-up. The risk factors were analyzed with Logistic regression by SPSS 15.0 software. Results The patients with MDR-TB included 116 males and 45 females （age ranged from 15 to 87 years old）. 67.08% of patients had a previous history of treatment with the second-line drugs. 68.94% cases were classified as advanced disease according to the pulmonary lesions before treament. Patients received anti-tuberculosis drugs including aminoglycoside antibiotics injection（59.0%，95/161）, polypeptide injection (80.12%，129/161), oral fluroquinolone (95.65%，154/161), prothionamide (72.67%，117/161）, isoniazid combined with para-amino salicylic acid （81.37%，131/161）, and pyrazinamide （62.11%，100/161）. 153 patients were available for evaluation, 29.41% (45/153）of patients were cured, 12.42%（19/153）died，and 58.17% (89/153) failed. Of 45 cured patients, there were 69.57% （16/23）in <30 years old, 18.75%（15/80）from 30 to 50 years old, 31.71%（13/41）from 50 to 70 years old, 11.11% （1/9）in ≥70 years. The risk factors of failure included the previous second-line drugs treatment (χ²=11.013，P<0.05), advanced pulmonary lesions (χ²=14.417，P<0.05) and age (χ²=14.969，P<0.05). Conclusion Age, the second-line drugs using or not and disease situation are risk factors of treatment outcome. In order to imporve the lower successful rate and high mortality and contorl tuberculosis, new anti-tuberculosis drugs with good efficacy and low toxicity should be developed.

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