Table of Content

10 June 2012, Volume 34 Issue 6

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Analysis of the prevalence of tuberculosis disease among health care workers in three regions and its associated factors

HOU Yue-yun, TAN Ji-bin, HE Guang-xue, GAO Tie-jie, XIONG Yong-chao, HONG Feng, HE Xiao-xin, ZHANG Wei-min, ZHANG Zhong-shun, CUI Zhen-ling, REN Yu-lin, REN Li-ping, GUO Hui, ZHAO Fei, LI Meng

Chinese Journal of Antituberculosis. 2012, 34(6):  341-345. 

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Objective  This study aims to summarize the evidence on the prevalence of tuberculosis (TB) disease among health care workers (HCWs), and to evaluate its associated factors. Methods  According to purposive sampling method，select 22 health institutions in Beijing, Inner Mongolia and Shanghai. Analyze data collected from HCWs who were investigated by questionnaires about TB infection control status between October and December in 2010. Results  A total of 5235 HCWs were investigated, the annual TB prevalence is 664.76/100 000(174/26 175) and the annual prevalence of smear-positive TB is 191.02/100 000(50/26 175).The result of logistic regression analysis indicates that male(Adjusted OR=1.9, 95%CI=1.3-2.7,P<0.05)、working in TB institutions (Adjusted OR=1.8, 95%CI=1.1-2.8,P<0.05)or lung hospitals(Adjusted OR=2.5, 95%CI=1.1-3.6,P<0.05)、working in TB out-patient(Adjusted OR=2.3, 95%CI=1.3-4.1,P<0.05)、the time of close contact with TB patients up to 15 hours per week (Adjusted OR=2.2, 95%CI=1.1-4.3,P<0.05)、without the system of TB infection control (Adjusted OR=1.7, 95%CI=1.2-2.3,P<0.05)、smoke(Adjusted OR=2.8, 95%CI=1.2-2.9,P<0.05) can increase the risk of Mycobacterium tuberculosis infection. Conclusion  The prevalence of TB in HCWs investigated was high, which indicates that the TB infection control measures are not enough. There is a need to strengthen the TB infection control practice to lower the Mycobacterium tuberculosis infection.

Analysis on registration and treatment outcome of patients discharged from TB hospital

LIU Xiao-qiu, JIANG Shi-wen, WANG Li-xia

Chinese Journal of Antituberculosis. 2012, 34(6):  346-349. 

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Objective  To understand the registration status of TB specialist hospitals inpatients in local TB dispensaries, as well as the results of follow-up treatment after discharge.  Methods  This is a cross-sectional study. Through the purposive sampling, 597 TB inpatients from 4 TB specialist hospitals were recruited and followed up. The status of patients’ notification in local TB dispensaries and their treatment completion were collected. The notification rate and treatment success rate (including cured and treatment completion) were analyzed. According to the management method after discharge, patients were divided into self-management group (269 cases) and Directly Observed treatment (DOT) group (213 cases). Treatment success rates were compared between the two groups.  Results  After discharge from TB specialist hospitals, 12 were excluded from TB by TB institution, 213 cases were confirmed to be TB cases. The overall notification rate of inpatients from 4 TB hospitals was 36.4% (213/(597－12)). The overall treatment success rate of the patients with available treatment outcome was 57.5% (277/482); the treatment success rate of the patients in DOT group was significantly higher than those in self-management group (χ²=201.9, P<0.01).  Conclusion  The deficiencies of TB specialist hospitals lie in the local registration and management of follow-up treatment.

Relationship between gene thyA mutation with para-aminosalicylic acid resistance in Mycobacterium tuberculosis

SUN Yong, HONG Feng, XU Shao-fa, XING Qing, LIU Yi, REN Wei-cong, SUN Zhao-gang, GAO Tie-jie, ZHANG Zhi-guo, YI Jun-li, WANG Su-min, LI Chuan-you

Chinese Journal of Antituberculosis. 2012, 34(6):  350-353. 

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Objective  To study para-aminosalicylic acid (PAS) resistance rates in M. tuberculosis isolates and the relationship with thyA gene mutation.  Methods  Ninety-six M. tuberculosis strains were isolated and identified from the sputa or throat swab specimens of tuberculosis patients. M. tuberculosis strains resistance to PAS was determined by the proportional method, and their thyA gene mutation was detected by PCR-DNA sequencing.  Results  Of 96 M. tuberculosis isolates, 65 were PAS-sensitive, and 31 were PAS-resistant. Using M. tuberculosis H37Rv as a control, the thyA gene mutation rate in PAS-sensitive and PAS-resistant strains of M. tuberculosis were 46.15% (30/65) and 70.97% (22/31), respectively. Most of stains showed single base deletion and insertion mutations, in which C deletion at codon 19 and codon 168 were 54.84% (17/31), 25.81% (8/31) in PAS-resistant stains respectively, and 35.38% (23/65) and 12.31%(8/65) in PAS-sensitive strains respectively.  Conclusion  The frequency of the thyA gene mutation in PAS-resistant strains was significantly higher than that in PAS-sensitive strains. The thyA gene could be a potential target for the development of PAS resistance. But there were not any site with specific mutation found in this study.

Correlation between levels of isoniazid and rifampicin resistance and targeted gene mutations in Mycobacterium tuberculosis

LI Gui-lian, ZHANG Jing-rui, ZHAO Xiu-qin,YANG Ao, LIAN Lu-lu, WAN Kang-lin

Chinese Journal of Antituberculosis. 2012, 34(6):  354-359. 

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Objective  To determine the correlation between isoniazid resistance level and the mutations in katG, inhA promoter and oxyR-ahpC, and the correlation between rifampicin resistance level and the mutations in rpoB in Mycobacterium tuberculosis.  Methods  Microplate alamar blue assay was used to determine the isoniazid MIC in 59 isoniazid-resistant Mycobacterium tuberculosis clinical isolates and the rifampicin MIC in 30 rifampicin resistant isolates, and direct sequencing was used to detect the mutations of katG, inhA promoter and oxyR-ahpC in isoniazid-resistant isolates and the mutations of rpoB in rifampicin-resistant isolates.  Results  Among isoniazid-resistant isolates with MIC from 0.2500 to 1.0000 μg/ml and MIC≥2.0000 μg/ml, 7 out of 13 and 2 out of 46 isolates carried mutations in inhA promoter respectively，and 2 out of 13 and 35 out of 46 isolates carried mutation in codon katG 315 respectively, the χ² values were 15.57 and 13.48, respectively, the P values were all 0.000. Among rifampicin-resistant isolates with MIC from 0.5000 to 16.0000 μg/ml and MIC≥32.0000 μg/ml, 5 out of 8 and 21 out of 22 isolates carried mutations in codon rpoB 531 and 526, the exact P value was 0.048.   Conclusion  Mutations in inhA promoter and katG 315 were correlated with low level and high level of isoniazid resistance respectively. rpoB mutations in codon 531 and 526 were associated with high level of rifampicin resistance.

Gene polymorphisms of LTA4H and susceptibility to tuberculous meningitis

YANG Jing-hui, YUE Jun, CHEN Jin, WANG Hong-hai, XU Ying, LIU Li-rong, HAN Min

Chinese Journal of Antituberculosis. 2012, 34(6):  360-363. 

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Objective  To investigate the association between the gene polymorphisms of leukotriene A4 hydrolase （LTA4H）and tuberculous meningitis.  Methods  The genotypes and haplotype frequency of LTA4H rs1978331，rs2247570，rs2660898，rs2660845 alleles from 48 patients with tuberculous meningitis and 70 health controls were analyzed by SNaPshot. Differences in allelic and genotypic distributions between the case group and health control group were analyzed by the χ² test, and were considered to be significant when P values were less than 0.05. All data were analyzed using SHEsis software.  Results  The following  frequencies of 3 LTA4H alleles or genotypes between the controls and the cases had all significant differences: rs1978331 alleles between the controls（frequency of C alleles was 59.3% and of T alleles was 40.7%）and the cases(frequency of C alleles was 41.7% and of T alleles was 58.3%) (χ²=7.080, P=0.008), rs1978331 genotypes between the controls(frequency of CC genotype was 17.1%,of CT genotype was 47.1% and of TT genotype was 35.7%) and the cases(frequency of CC genotype was 41.7%,of CT genotype was33.3% and of TT genotype was 25.0%) (χ²=8.670,  P=0.013), rs2660898 genotypes between controls(frequency of AA genotype was 40.0%,of AC genotype was 45.7% and of CC genotype was 14.3%) and cases(frequency of AA genotype was 41.7%,of AC genotype was25.0% and of CC genotype was 33.3%) (χ²=7.980,  P=0.019). The frequency of CACT haplotypes between controls (26.3%) and cases(45.8%) had also a significant difference (χ²=7.349, P=0.007).  Conclusion  One allele(rs1978331),two genotypes(rs1978331,rs2660898) and one haplotype (rs1978331, rs2247570, rs2660898, rs2660845: CACT)in LTA4H gene were correlated with tuberculous meningitis susceptibility in Chinese Han population.

Comparison with sputum smear by control membrane model and sputum smear by sight in detecting mycobacteria

LIU Qing-fu，LIU Yu-dong，YAN Xiu-li

Chinese Journal of Antituberculosis. 2012, 34(6):  364-368. 

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Objective  To evaluate the value of the sputum smear by control membrane model in detecting mycobacteria. Methods  1089 sputum samples from new patients diagnosed with active pulmonary tuberculosis were detected mycobacteria with the sputum smear by control membrane model and the sputum smear by sight. We compared them with Lowenstein-Jensen (L-J) culture method.  Results  The positive rate was 31.68%（345/1089）in sputum smear by control membrane model. It was higher than that (24.24%,264/1089）in sputum smear by sight (χ²=14.955; P<0.05), but was close that in the L-J culture(38.20%,416/1089）(Z=-8.310, P=0.001). The quality of the sputum smear by control membrane model was improved in cells of sputum smear, sputum membrane size,sputum membrane thickness, acid fast stain and sputum membrane falling off. With the L-J culture as standard, the sensitivity and kappa value of sputum smear by control membrane model were 82.69%（344/416）and 0.853, respectively. They were better than those(63.46%, 0.680) of sputum smear by sight. It showed that there were consistent with the sputum smear by control  membrane model and the L-J culture.  Conclusion  The sputum smear by control membrane model is not only simple and rapid but also high quality in smear and high positive rate. It is suit for microscopy laboratory application.

Evaluation of the galactomannan assays for the diagnosis of invasive pulmonary aspergillosis in the patients with respiratory disease

GE Wei, LIU Zhi-min, JIANG Cai-hua, HU Hua, WANG Hai-ying

Chinese Journal of Antituberculosis. 2012, 34(6):  369-373. 

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Objective  To assess the diagnostic value of detecting aspergillus galatomannan (GM) antigen in the patients with invasive pulmonary aspergillosis (IPA).  Methods The asepergillus GM antigen in the sera from 135 patients was detected by enzyme-linked immunosorbent assay (ELISA). The receiver operating characteristic curve (ROC curve) was generated, and the area under the curve was revealed. The sensitivity and the specificity of GM assay were evaluated and the best cut-off value was chosen.  Results GM level in the sera from 24 IPA patients （1.37±1.21）was significantly higher than 63 non-IPA patients（0.49±0.18）(F=31.10，P＜0.05). The area under the curve was 0.746 (95% CI=0.621-0.872). When the cut-off value was set at 0.63, the sensitivity and the specificity of GM assay were 66.7% and 73.0% respectively.  Conclusion GM assay showed the higher sensitivity and specificity. It is useful for the early diagnosis of IPA.

Analysis of quality control results of drug susceptibility testing on Mycobacterium tuberculosis in Henan province

YANG Hong-yi, MA Xiao-guang, LI Hui, ZHAO Yu-ling,YAN Guo-rui, SHI Jie

Chinese Journal of Antituberculosis. 2012, 34(6):  374-376. 

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Objective  To evaluate the quality control results of drug susceptibility testing (DST) of MTB in order to standardize and improve the external quality assurance (EQA)system of DST in Henan province.   Methods  In accordance with the TB diagnostic laboratory testing procedures, six laboratories intend to be evaluated performed the proportional method for DST proficiency testing. A total of 58 strains were issued by Henan provincial reference laboratory (PRL) to each testing laboratory, and the results were reported to PRL and made comparison with the standard results.  Results  The consistency of first line drug INH,RFP, S and EMB was 91.0%（151/166）,95.8%(159/166),89.2%(148/166) and 77.1%(128/168) respectively. The average consistency of second-line drugs reached 94.9%(683/720).  Conclusion  The DST for first line INH and RFP and four second line drugs in six laboratories evaluated met the WHO and national requirement. However, the EMB testing should be further improved.

Diagnostic value of simultaneous amplification and testing in patients with pulmonary tuberculosis

SHA Wei, HE Ya, JIANG Rui-hua, FANG Yong, JING Ling-jie, HAN Min, XIAO He-ping

Chinese Journal of Antituberculosis. 2012, 34(6):  377-379. 

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Objective  To evaluate the value of simultaneous amplification and testing（SAT）in diagnosis of patients with pulmonary tuberculosis.  Methods Sputum smear, culture with species identification, and TB-SAT were studied in 172 patients with suspected pulmonary tuberculosis. The samples, which had inconsistent results between culture and SAT, should be rechecked with fluorescent quantitative PCR（FQ-PCR).  Results 156 patients were clinically diagnosed with pulmonary tuberculosis. If taking the culture plus FQ-PCR as the gold standard, the sensitivity and specificity of TB-SAT were 97.8%（89/91）and 97.5%（79/81）,respectively. However, the sensitivity and specificity of TB-SAT were 58.3% （91/156）and 100.0%（16/16）with the clinical diagnosis as standard. The positive rates of TB-SAT were 84.9%（79/93） for sputum positive patients and 19.0%（12/63） for sputum negative patients.  Conclusion  TB-SAT is an effective method for diagnosis of patients with pulmonary tuberculosis.

An analysis on drug-resistance status and clinical characteristics in 115 tuberculosis cases with collapsed lung

CAI Bao-yun, CHU Nai-hui, KANG Wan-li, ZHENG SU-hua, LI Qi

Chinese Journal of Antituberculosis. 2012, 34(6):  380-383. 

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Objective  To analyze the drug-resistance status and clinical characteristics in 115 tuberculosis cases with collapsed lung and provide the evidence for diagnosis and treatment for drug-resistant tuberculosis.  Methods  115 tuberculosis cases hospitalized with collapsed lung were enrolled from May 2005 to May 2011 and we analyzed the relationship between drug-resistance with types of drug-resistance, distribution, lesions status, duration, and relationship between drug-resistance with treatment of drug-resistant tuberculosis and lung lesions. And according to the duration of three types of longer than 5 years, shorter than or equal to 5 years, shorter than of equal to 1 year, 60 cases with drug-resistance tuberculosis collapsed lung were analyzed the relationship between duration and drug-resistance.  Results  Among 115 cases with collapsed lung, 60(52.2%) cases were drug-resistant, 55 were not. Of the 60 cases with drug-resistant collapsed lung, 3（5.0%） cases had single drug resistance, 15(25.0%) cases had polydrug resistance, 29(48.3%) had multidrug resistance(MDR), 13(21.7%) cases had extensively drug resistance(XDR). Compared with the status of single drug-resistance, polydrug resistance, MDR and XDR，the cases with MDR were prone to develop collapsed lung (χ²=22.933, P<0.001）. Of the 60 cases with drug-resistance, the rates of resistance to anti-tuberculosis drugs were Rifapentine (90.0%, 54/60）, Rifampin(86.7%, 52/60）, isoniazid(71.67%, 43/60），streptomycin(68.3%, 41/60）, Levofloxacin(53.3%, 32/60）, Protionamide (40.0%, 24/60），Ofloxacin (13.3%, 8/60）, capreomycin (10.0%, 6/60）, in which Rifapentine were highest and Ofloxacin and capreomycin were lower. Of the 60 cases with drug-resistance, cases with duration shorter or equal to 1 year were prone to develop drug-resistance, compared with the other two types of duration（χ²=38.800，P<0.001）.Of the cases who showed drug-resistance collapsed lung, the rate of drug-resistance was higher in those whose treatment was irregular than those who received regular treatment, with 43cases（71.7%）and 17 cases （28.3%）,respectively（χ²=11.267，P<0.05）. The cases with multidrug resistance without regular treatment were prone to develop collapsed lung.  Conclusion  The situation of drug-resistance to tuberculosis collapsed lung is very serious, especially for multidrug resistance. It would be better to master the first-year which is the key time for treatment drug resistant tuberculosis to decrease the development of collapsed lung. The high rate of drug resistance of collapsed lung and itself is a reciprocal causation.

The clinical analysis of 28 cases of primary Sjogren’s syndrome complicated with tuberculosis

LIU Lin，WANG Zhong-yuan，ZHANG Tao，WANG Tao，AN Hui-ru，HE Lu-xing，LIU Xiao

Chinese Journal of Antituberculosis. 2012, 34(6):  384-388. 

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Objective  To explore the clinical features of TB complicated with primary Sjogren’s syndrome, and differentiate the interstitial lung disease caused by tuberculosis and primary Sjogren’s syndrome. Methods  A retrospective analysis of clinical data of 28 TB patients complicated with primary Sjogren’s syndrome in the 309 Hospital of People’s Liberation Army. Results  Among the 28 cases of TB patients, there were 2 males and 26 females. Twenty-one females were over 40 years old. The most common symptoms were throat dryness or coughing, dry eyes, dry mouth, fever. Six cases were diagnosed of primary Sjogren’s syndrome for the first time, and they were all administered autoantibody test and parotid gland X-ray enhanced angiography examination. Two cases had positive biopsies of labial gland. The remaining 22 cases had a history of Sjogren’s syndrome from a minimum of 1 year to maximum 14 years, with an average of （2.7±1.6）years. Ten cases established their diagnosis of TB by positive bacteriological evidence, 8 cases by histopathology, and 10 by clinical signs and symptoms. Among the 28 cases, 11 cases were classified as secondary pulmonary tuberculosis, 3 as hematogenous disseminated tuberculosis, 2 as tuberculous pleurisy, 2 as lymph node tuberculosis, 1 as secondary pulmonary tuberculosis complicated with endobronchial tuberculosis, 2 as secondary pulmonary tuberculosis complicated with lymph node tuberculosis, 2 as secondary pulmonary tuberculosis complicated with tuberculous pleuritis, 2 as secondary pulmonary tuberculosis complicated with tuberculous pericarditis, 2 as tuberculous serous cavity inflammation, 1 as secondary pulmonary tuberculosis complicated with endobronchial tuberculosis and accessories tuberculosis. All patients were given 2HRZE/4HR anti-TB treatment. So far, five cases are still on anti-TB treatment, the remaining 23 cases were all clinically cured of TB. All patients had not occurred serious adverse drug responses. Four cases of pulmonary tuberculosis were misdiagnosed as interstitial lung disease caused by primary Sjogren’s syndrome. Conclusion  Regarding the primary Sjogren’s syndrome complicated with TB, we should give special attention to the differentiation of the damage of the respiratory system caused by Primary Sjogren’s syndrome and by TB, reduce the occurrence of clinical misdiagnosis and missed diagnosis.

Analysis on nutrition status in 65 elderly patients with pulmonary tuberculosis and diabetes

LI Jin-sheng，CHEN Yu，WANG Fu-sheng

Chinese Journal of Antituberculosis. 2012, 34(6):  389-392. 

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Objective  To study the nutrition status of elderly patients with pulmonary tuberculosis (PTB) and diabetes mellitus (DM) and explore the nutrition improvement advice for them.  Methods  All patients were assigned to 3 groups: elderly PTB and DM as group A (n=65), elderly PTB as group B (n=65), and elderly normal public group as group C (n=65). Five parameters were chosen to analyze the nutrition status, including body mass index (BMI), hemoglobin (Hb), total lymphocyte count (TLC) of PBMC, serum albumin (Alb), and creatinine-height index using t test and χ² test.  Results   (1) These five parameters (BMI, Hb, TLC, Alb, and creatinine-height index) were measured in three groups: x±s of  the five parameters were (18.09±1.88), (119.30±13.51) g/L, (1.21±0.39)×10⁹/L, (29.76±4.88) g/L, and 75.44%±7.23% in group A, respectively;  x±s  were 18.53±2.05,(126.31±8.76) g/L,(1.28±0.13)×10⁹/L,(37.44±5.46) g/L, and 76.53%±8.44% in group B, respectively;  x±s were (21.11±2.11), (132.34±8.84) g/L, (2.93±0.53)×10⁹/L,(43.21±7.54) g/L, and 86.09%±6.75% in group C, respectively. Significant differences were found in these five parameters in the elderly PTB with DM group and elderly normal public group, also seen in elderly PTB group and elderly normal public group (t_AC=8.58,6.77, 6.76, 12.03, 8.66, respectively;  t_BC=7.05,3.89, 20.98, 4.98, 5.28, respectively, all P<0.01). The incidence of malnutrition according to HB, Alb of the elderly PTB with DM group was higher than that in the elderly PTB group（t=3.51, 8.43 respectively, all P<0.01）.  (2) The incidence of malnutrition according of group A was 44.6%, 52.3%, 80.0%, 64.6%, 46.2%, respectively; the incidence of malnutrition according of group B was 38.5%,49.2%,76.9%,46.2%,41.5%, respectively; and the incidence of malnutrition according of group C  was 6.2%, 6.2%, 0%, 4.6%, 7.7%, respectively. The incidence of malnutrition in group A and B were both higher than that in group C (χ²_AC=23.4, 31.3, 79.7, 44.0, 24.4, respectively;  χ²_BC=17.8, 28.0, 74.3, 27.5, 20.1, respectively，all P<0.01）.  Conclusion  The incidence of malnutrition is higher in the patients of the elderly PTB with DM and these patients should balance their food choices.

Annual report on clinical diagnosis and treatment progress of tuberculosis (2011)

Chinese Journal of Antituberculosis. 2012, 34(6):  393-403. 

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