Table of Content

10 January 2019, Volume 41 Issue 1

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Expert Consensus

Expert consensus on epidemiology investigation and scene disposal of tuberculosis in schools

Chinese Journal of Antituberculosis. 2019, 41(1):  9-13.  doi:10.3969/j.issn.1000-6621.2019.01.004

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School students in crowed environment are susceptible to tuberculosis(TB), often resulting outbreaks and public health emergencies. We give further advices on the investigation of index cases and their close contacts, diagnosis and treatment of active TB patients and latent TB infection and their standardized management, aiming at facilitating TB epidemiology investigation, scene disposal and related effect evaluation.

Expert Forum

To pay more attention to diagnosis and treatment of tuberculous meningitis

Hong-fei DUAN

Chinese Journal of Antituberculosis. 2019, 41(1):  14-17.  doi:10.3969/j.issn.1000-6621.2019.01.005

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Tuberculous meningitis is the most serious form of tuberculosis. In the past several years, scientists investigated modified Z-N stain, molecular method, brain MRI and clinical scoring system to improve diagnosis of tuberculous meningitis, and studied fluoroquinolone and high-dose rifampin to improve prognosis of this disease. It is clear that corticosteroid could reduce risk of death among patients with tuberculous meningitis. In addition, drug-resistant tuberculous meningitis has become a problem worthy of being noticed and clinicians should pay more attention to the treatment of the disease.

Original Articles

Analysis on clinical characteristics and prognostic of human immunodeficiency virus infected patients with tuberculous meningitis

Gui-hui WU,Tao HUANG,Yao CHENG,Xiao-qiu HUANG,Xiao-yan FU,Yao MA,Peng LI,Wei HE

Chinese Journal of Antituberculosis. 2019, 41(1):  18-23.  doi:10.3969/j.issn.1000-6621.2019.01.006

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Objective To analyze the clinical characteristics, short-term prognosis and influencing factors of patients with human immunodeficiency virus (HIV) infection complicated with tuberculous meningitis (TBM).Methods One hundred and forty-eight cases of TBM patients were retrospectively collected from Chengdu Public Health Clinical Medical Center between January 2017 and December 2017. Among them, 52 were infected with HIV (HIV+/TBM group) and 96 were not infected with HIV (HIV-/TBM group). The clinical manifestations, cerebrospinal fluid (CSF) examination results, skull imaging and clinical outcomes of the patients in the two groups were compared.Results The incidences of malnutrition, anemia, and complication with other extrapulmonary tuberculosis in the HIV+/TBM group were 78.8% (41/52), 51.9% (27/52), and 73.1% (38/52), respectively, which were higher than those in the HIV-/TBM group (39.6% (38/96), 30.2% (29/96), and 30.2% (29/96)), and the differences were statistically significant (χ ² values were 20.89, 6.76, and 8.27; P values were <0.05). The median (quartile) of CSF pressure, white cell count, protein content, sugar and chloride levels were 185.0 (141.0, 225.0) mm H₂O (1mm H₂O=0.0098 kPa), 30.0 (4.0, 175.0)×10 ⁶/L, 1141.2 (762.8, 1548.6) mg/L, 2.3 (1.7, 2.7) mmol/L, and 117.0 (111.1, 121.9) mmol/L in the HIV+/TBM group and 284.0 (197.5, 315.0) mm H₂O, 360.0 (280.0, 415.0)×10 ⁶/L, 1660.0 (1270.0, 1900.0) mg/L, 1.4 (1.2, 1.8) mmol/L, and 105.1 (102.6, 112.4) mmol/L in the HIV-/TBM group; the differences were statistically significant (Z values were 3.63, 4.79, 2.57, 4.17, and 4.19; P values were <0.05). The incidence of cerebral infarction was 46.2% (24/52) in the HIV+/TBM group and 28.1% (27/96) in the HIV-/TBM group; the difference was statistically significant (χ ²=4.85, P=0.028). In the HIV+/TBM group, 20 cases (38.5%) improved and 32 cases (61.5%) deteriorated or died at discharge, and in the HIV-/TBM group, 62 cases (64.6%) improved and 34 cases (35.4%) deteriorated or died, showing significant difference (χ ²=9.32, P<0.05). In the HIV+/TBM group, among the patients who deteriorated or died, patients with BMI<18,severe anemia (hemoglobin <60g/L), CD4 ⁺T lymphocyte count <50/μl, standard anti-tuberculosis treatment and standard antiviral treatment accounted for 56.3% (18/32), 43.8% (14/32), 53.1% (17/32), 28.1% (9/32), and 40.6% (13/32), respectively, and those among patients who improved accounted for 25.0% (5/20), 15.0% (3/20), 20.0% (4/20), 60.0% (12/20), and 75.0% (15/20), showing significant differences (χ ²=4.87, 4.62, 5.61, 5.19, and 5.85, respectively, all P<0.05). Multivariate logistic regression analysis showed that CD4 ⁺T lymphocyte count <50/μl (OR(95%CI)=4.21(1.15-15.45)) was risk factor, whereas receiving standard anti-tuberculosis (OR(95%CI)=0.28(0.05-0.94)) and standard antiviral therapy (OR(95%CI)=0.13(0.04-0.47)) were protective factor for the prognosis of patients. Conclusion HIV infected TBM patients are more likely to have altered clinical manifestations, CSF indexes, cranial imaging and prognosis. Timely initiation of standardized anti-tuberculous treatment and anti-viral therapy could improve the prognosis of patients.

Clinical characteristics of tuberculous meningitis complicated with cranial nerve injury

Xue-lian LI,Jie LI,Hong-mei CHEN,Rong-mei LIU,Li-ping MA,Li-qun ZHANG,Meng-qiu GAO

Chinese Journal of Antituberculosis. 2019, 41(1):  24-30.  doi:10.3969/j.issn.1000-6621.2019.01.007

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Objective To investigate the clinical features of tuberculous meningitis (TBM) complicated with cranial nerve injury.Methods A total of 486 clinical diagnosed TBM patients in Beijing Chest Hospital of Capital Medical University from June 2014 to December 2017 were collected. Of these, 414 (85.2%) cases had no cranial nerve injury (no cranial nerve injury group) and 72 (14.8%) cases with cranial nerve injury (with cranial nerve injury group). The clinical characteristics and outcomes of the two groups of patients were analyzed, as well as the risk factors for concurrent cranial nerve injury.Results Seventy-two patients with cranial nerve injury had fever (90.3%, 65/72), headache (90.3%, 65/72), nausea and vomiting (56.9%, 41/72), disturbance of consciousness (54.2%, 39/72), misdiagnosis rate (38.9%, 28/72) were higher than those without cranial nerve injury (77.3% (320/414), 66.7% (276/414), 22.7% (94/414), 31.4% (130/414), 26.6% (110/414), respectively) (χ ²=6.280, P=0.012;χ ²=16.334, P=0.000; χ ²=35.840, P=0.000; χ ²=14.015, P=0.000; χ ²=5.201, P=0.023, respectively); logistic regression analysis showed that the risk factors for cranial nerve injury in patients with TBM were symptom of headache (OR (95%CI)=4.109 (1.806-9.349), Wald χ ²=11.353, P=0.001), and disturbance of consciousness (OR (95%CI)=2.531 (1.493-4.290), Wald χ ²=11.901, P=0.001). Seventy-two patients with cranial nerve injury were more likely to have optic nerve (52.8%, 38/72) and oculomotor nerve (56.9%, 41/72) injury. Sixteen (22.2%) cases had two groups of cranial nerves involved and 3 (4.2%) cases had three groups of cranial nerves involved. After 2 months of anti-tuberculous drug treatment, 69 patients (95.8%) had complete recovery of cranial nerve injury, 1 patient (1.4%) died of serious illness, and only 2 patients (2.8%) left oculomotor and optic nerve sequelae. Conclusion It is not uncommon for patients with TBM to have cranial nerve injury. The rate of misdiagnosis is high. The symptoms of fever, headache, nausea and vomiting, and disturbance of consciousness are obvious. However, headache and consciousness disorder are closely related to the occurrence of cranial nerve injury. The cranial nerve injury can be recovered well after effective anti-tuberculosis treatment.

Analysis of prognostic factors in HIV-negative tuberculous meningitis patients

Lin YAO,Xiang-yu XI,Xia-fang WANG,Xing-hua SHEN,Jian-ping ZHANG,Zhi-jian YE,Mei-hua SHI,Mei-ying WU,Pei-jun TANG

Chinese Journal of Antituberculosis. 2019, 41(1):  31-35.  doi:10.3969/j.issn.1000-6621.2019.01.008

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Objective To analyze the clinical characteristics and prognostic factors of human immunodeficiency virus (HIV)-negative tuberculous meningitis (TBM) patients.Methods The clinical data of 77 patients with HIV-negative TBM clinically diagnosed in the Department of Tuberculosis of The Fifth People’s Hospital of Suzhou from January 2012 to December 2017 were retrospectively analyzed. According to the modified Rankin scale (mRS) score at discharge, patients were divided into the group with good prognosis (mRS score: 0-2) and the group with poor prognosis (mRS score: 3-6). The clinical characteristics of patients in the good prognosis group and the poor prognosis group were compared, and the risk factors affecting the prognosis of patients were analyzed by conditional logistic stepwise regression.Results Among the 77 patients, the common clinical symptoms were headache (68 cases, 88.3%), fever (75 cases, 97.4%) and night sweats (69 cases, 89.6%). Cerebrospinal fluid glucose levels (median (quartile): 1.8 (1.4, 2.3) mmol/L), chloride ((109.37±13.68) mmol/L) increased, and protein level (median (quartile): 1994.5 (1257.5, 2888.3) g/L) decreased. Among the 77 patients, 41 had a good prognosis and 36 had a bad prognosis. The incidence of paralysis in the good prognosis group was 7.3% (3/41), significantly lower than that in the poor prognosis group (41.7%, 15/36), and the difference was statistically significant (χ ²=12.63, P=0.000). According to Glasgow coma score (GCS), patients with mild coma (13-14 points), moderate coma (9-12 points) and severe coma (3-8 points) in the group with good prognosis accounted for 34.1% (14/41), 61.0% (25/41) and 4.9% (2/41), respectively. The patients with mild coma, moderate coma and severe coma in the group with poor prognosis accounted for 0.0% (0/36), 55.6% (20/36) and 44.4% (16/36), respectively. The differences between the two groups were statistically significant (χ ²=4.99, P=0.000). Logistic regression analysis showed that HIV-negative TBM patients with paralysis (OR (95%CI): 10.75 (1.53-76.92)) and severe coma (OR (95%CI): 10.42 (2.11-52.63)) had poor prognosis. Conclusion Fever, night sweats and headache are the most common clinical symptoms of HIV-negative TBM. Paralysis and poor GCS score are independent risk factors for poor prognosis in HIV-negative TBM patients.

The screening value of cranial MR enhancement scan for tuberculous meningitis in patients with acute hematogenous disseminated pulmonary tuberculosis

Mai-ling HUANG,Yan MA,Gui-rong WANG,Dai-lun HOU,Jun-lan FENG,Li-qun ZHANG,Meng-qiu GAO,Qi LI

Chinese Journal of Antituberculosis. 2019, 41(1):  36-41.  doi:10.3969/j.issn.1000-6621.2019.01.009

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Objective To explore the screening value of cranial MR enhancement scan for tuberculous meningitis in patients with acute hematogenous disseminated pulmonary tuberculosis.Methods The clinical data of 415 patients with acute hematogenous disseminated pulmonary tuberculosis admitted to Beijing Chest Hospital from January 2012 to May 2018 were collected. Two hundred and thirty-five patients with cranial MR enhancement scan and cerebrospinal fluid routine and biochemistry were selected, the ratio of male to female was 1.12∶1 (124/111), age ranged from 15 to 87 years, mean age was (36±18) years, and patients aged 15-35 years accounted for 62.1% (146/235). We used Chi-square test to compare the count data. The corrected Chi-square test was used when the total number was >40 and 1P<0.05.Results Of 235 patients with acute hematogenous disseminated pulmonary tuberculosis, the abnormal rate of cranial (89.8%,211/235) was higher than that of cerebrospinal fluid (63.0%,148/235), the difference was statistically significant (McNemar test,P=0.000). The abnormal rate of cranial MR enhancement scan (96.3%,211/219) was higher than that of cerebrospinal fluid (67.6%,148/219) in 219 cases with tuberculous meningitis, and the difference was statistically significant (McNemar test,P=0.000). Of 143 patients with central nervous system symptoms, the abnormal rate of cranial MR enhancement scan (95.8%,137/143) was significantly different from that of cerebrospinal fluid (88.1%,126/143) (McNemar test,P=0.035). Of 76 patients without central nervous system symptoms, the abnormal rate of cranial MR enhancement scan (97.4%,74/76) was higher than that of cerebrospinal fluid (28.9%,22/76), the difference was statistically significant (McNemar test,P=0.000). There was no significant difference in abnormal rate of cranial MR enhancement scan between patients with and without central nervous system symptoms (95.8%(137/143) vs 97.4%(74/76)) (adjusted χ ² test,P=0.834).The abnormal rate of cerebrospinal fluid (88.1%(126/143) vs 28.9%(22/76)) was higher in patients with central nervous system symptoms than that without central nervous system symptoms, and the difference was statistically significant (χ ²=79.286,P=0.000). Conclusion Granial MR enhancement scan has a high rate of detection of intracranial lesions in patients with acute hematogenous disseminated pulmonary tuberculosis. Especially for patients with tuberculous meningitis without neurological symptoms, the abnormal rate of cerebrospinal routine and biochemical fluid is low, and the abnormal rate of cranial MR enhancement scan is still higher than 95%.

Comparative analysis of common laboratory diagnostic methods for tuberculous meningitis

Hui-qiang ZHENG,Xiao-li CUI,Quan-li DOU,Lei KANG,Ai-fang LI,Han YANG,Yuan LIU,Xiao-wen TAN,Li-yun DANG

Chinese Journal of Antituberculosis. 2019, 41(1):  42-47.  doi:10.3969/j.issn.1000-6621.2019.01.010

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Objective To compare the performance of common laboratory techniques in the diagnosis of tuberculous meningitis (TBM) in order to improve early diagnosis of TBM.Methods Five techniques including BACTEC MGIT 960 liquid culture method (MGIT 960 method), modified acid-fast staining (MZN method), GeneXpert MTB/RIF (GeneXpert method), fluorescent probe polymerase chain method (PCR-fluorescence probe method), and tuberculosis infection T cell spot test (T-SPOT.TB) were conducted with cerebrospinal fluids of 224 adult suspected TBM patients who admitted in Xi’an Chest Hospital from January 2017 to April 2018. There were 71 patients in the TBM group (36 in the confirmed group, 23 in the strongly probable group, and 12 in the possible group) and 33 in the non-TBM group. Performance of the above five laboratory techniques for diagnosing TBM were assessed. The values of bacteriological method (MGIT 960 and MZN methods), molecular biology method (GeneXpert and PCR-fluorescence probe method), immunology method (T-SPOT.TB), and combination of all five techniques in early diagnosis of TBM were compared.Results Taking the clinical diagnosis results as standard, the specificity and positive predictive value of the five detection techniques for TBM diagnosis were all 100.0%. The sensitivity of MGIT 960, MZN, GeneXpert, PCR-fluorescence probe and T-SPOT.TB method were 19.7% (14/71), 26.8% (19/71), 42.3% (30/71), 35.2% (25/71), and 29.6% (21/71), respectively. The sensitivity of the GeneXpert method and the PCR-fluorescence probe method was higher than that of the MGIT 960 method, and the differences were statistically significant (χ ²=8.43, P=0.004; χ ²=4.28, P=0.039). The sensitivity of the bacteriological method, molecular biology method, the immunology method, and the combined method were 31.0% (22/71), 50.7% (36/71), 29.6% (21/71), and 73.2% (52/71), respectively. The sensitivity of the molecular biology method and the combined diagnosis method were higher than that of the bacteriological method, and the differences were statistically significant (χ ²=5.71, P=0.017; χ ²=73.20, P=0.000). Conclusion In the early diagnosis of TBM, the sensitivity of GeneXpert and PCR-fluorescence probe method is higher compared with MGIT 960 method. The combined detection of experimental methods can improve the sensitivity of TBM diagnosis. Compared with the bacteriological method, the sensitivity of the biological method and combined diagnosis method is higher.

Diagnosis and differential diagnosis of cryptococcus neoformans meningitis and tuberculous meningitis

Yao CHENG,Tao HUANG,Hong-de CHEN,Gui-hui WU

Chinese Journal of Antituberculosis. 2019, 41(1):  48-52.  doi:10.3969/j.issn.1000-6621.2019.01.011

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Objective To summarize and analyze the clinical features of cryptococcus neoformans meningitis (CNM) and tuberculous meningitis (TBM), and to improve the diagnosis and differential diagnosis of CNM and TBM. Methods From January 2016 to December 2017, 32 CNM patients and 171 TBM patients who admitted to Chengdu Municipal Public Health Clinical Medical Center were included in this study. General information (including age, gender, living area, and whether complicated with low immune function or not), clinical symptoms (including headache, fever, vomiting, respiratory symptoms, convulsions, meningeal irritation, and pathology), cerebrospinal fluid (CSF) laboratory test indicators (including CSF pressure, cell number, lymphocyte proportion, protein level, and glucose content), and CT scan results (normal, cerebral edema, hydrocephalus, brain parenchymal nodular changes, and multiple softening lesions) were compared between CNM and TBM patients.Results The age of patients with TBM was (39.23±12.77) years old, greater than that of CNM patients ((28.71±11.29) years old), and the difference was statistically significant (t=4.35, P=0.000). The occurrence rate of respiratory symptoms, convulsions, change in brain parenchymal nodules, and multiple softening lesions indicated by cranial CT scan in patients with TBM were 94.74% (162/171), 35.09% (60/171), 41.52% (71/171), and 38.01% (65/171), which were significantly higher those in CNM patients (34.38% (11/32), 15.62% (5/32), 6.25% (2/32), and 9.38% (3/32)), and the differences were statistically significant (χ ² values were 73.26, 4.69, 13.07, and 8.68; P values were 0.000, 0.030, 0.000, and 0.003). The rate of low immune function (including complication with HIV infection, urinary glucose disease, organ transplantation, long-term oral glucocorticoids or immunosuppressive agents) and cerebral edema indicted by cranial CT scan in CNM patients were 34.38% (11/32) and 46.88% (15/32), respectively, which were higher than those in TBM patients (18.13% (31/171) and 25.15% (43/171)); the differences were statistically significant (χ ² values were 4.34 and 6.24; P values were 0.037 and 0.013). Regarding the CSF laboratory examination, the number of CSF cells, protein level (median (quartile, Q₁, Q₃)), and glucose content in the TBM patients were 208.00 (178.00, 240.00)×10 ⁶/L, 1058.00 (940.00, 1204.00) mg/L, and (1.77±0.79) mmol/L, respectively, which were significantly higher than those in patients with CNM (64.50 (51.00, 81.00)×10 ⁶/L, 764.00 (608.00, 894.50) mg/L, and (0.25±0.17) mmol/L); the differences were statistically significant (Z=-76.77, P=0.000; Z=-6.83, P=0.000; t=10.82, P=0.000). The CSF pressure of CNM patients was ((273.42±71.58 mm H₂O) (1mm H₂O=0.098 kPa)), which was signi-ficantly higher than that of TBM patients (214.22±88.38 mm H₂O). The difference was statistically significant (t=3.57, P=0.000). Conclusion Compared with TBM patients, CNM patients have higher occurrence rates of complication with low immune function and cerebral edema indicated by cranial CT scan, but lower occurrence rate of respiratory symptoms and convulsions, as well as parenchymal nodule changes and multiple softening lesions indicated by cranial CT scan.

Analysis of risk factors for tuberculous abscess in patients with tuberculous cervical lymphadenitis

Lan YAO,He-ping XIAO

Chinese Journal of Antituberculosis. 2019, 41(1):  53-56.  doi:10.3969/j.issn.1000-6621.2019.01.012

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Objective To investigate the risk factors for tuberculous abscess in patients with tuberculous cervical lymphadenitis. Methods We collected the clinical data of 280 patients who were admitted to and diagnosed with tuberculous cervical lymphadenitis in Shanghai Pulmonary Hospital affiliated to Tongji University from July 2013 to June 2016 and met the inclusion criteria of this study. Then we prospectively analyzed the risk factors of tuberculous abscess in cervical lymph node. Results Of the 280 patients with tuberculous cervical lymphadenitis, 52 cases (18.6%) formed tuberculous abscess that could spontaneously rupture or needed drainage of lymph nodes. Among the patients with abscess, 38.5% (20/52) received irregular treatment, 76.9% (40/52) had lymph nodes ≥2 cm, and 90.4% (47/52) were aged ≤45 years old; among the patients without abscess, 24.6% (56/228) cases received irregular treatment, 55.3% (126/228) had lymph nodes ≥2 cm, and 77.6% (177/228) were aged ≤45 years old. The differences between the two groups were statistically significant (χ² values were 4.14, 8.23, and 4.30, respectively, P values were <0.05). Multivariate logistic regression analysis showed that irregular treatment (OR=2.53,95%CI: 1.31-4.89), lymph nodes ≥2 cm (OR=2.29, 95%CI: 1.12-4.66) and age ≤45 years old (OR=3.68, 95%CI: 1.21-11.17) were independent risk factors for tuberculous abscess. Conclusion The irregular treatment, lymph nodes ≥2 cm and age ≤45 years old are independent risk factors for tuberculous abscess in patients with tuberculous cervical lymphadenitis. Be alert to the possibility of tuberculous abscess when these risk factors are present in patients with tuberculous cervical lymphadenitis.

Original Articles

Comparative analysis of CT findings between Mycobacteria intracellulare lung disease and pulmonary tuberculosis both with cavitation

Jia YANG,Sheng-xiu LYU,Chun-hua LI,Wei-qiang SHU,Hui-qiu WANG,Guang-xiao TANG,Xue-yan LIU

Chinese Journal of Antituberculosis. 2019, 41(1):  57-63.  doi:10.3969/j.issn.1000-6621.2019.01.013

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Objective To discuss the difference in CT manifestations of Mycobacteria intracellulare lung di-sease and pulmonary tuberculosis both with cavitation.Methods Twenty-six cases of Mycobacteria intracellulare lung disease(Observation group) and 40 cases of pulmonary tuberculosis (Control group) accompanied by a cavitation of above 10 mm were studied. Forty patients with pulmonary tuberculosis included in the study were chosen randomly from 862 cases of secondary pulmonary tuberculosis, which were diagnosed with clinical examinations and lab tests in the Chongqing Public Health Medical Center from June 2016 to March 2018. The cases all had complete clinical and imaging data before treatment, and did not receive anti-NTM and tuberculosis treatments. Cases combined with pneumoconiosis, diabetes, HIV or other infections were excluded. Statistical analysis was conducted on CT findings of the two groups, including classification and distribution of bronchiectasis, cavitation morphology and neighboring pleural thickening, lung volume reduction,emphysema and mediastinal lymph node enlargement.Results In the observation group, bronchiectasis (92.3%, 24/26) including varicose bronchiectasis and cystic bronchiectasis (88.5%, 23/26), calcification of lung lesions (57.7%, 15/26), lung volume reduction (69.2%, 18/26), emphysema (57.7%, 15/26), thin-walled cavities (73.1%, 19/26), and pleural thickening adjacent to the cavities (80.8%, 21/26) were all more than those in the control group (60.0% (24/40), 35.0% (14/40), 15.0% (6/40), 15.0% (6/40), 10.0% (4/40), 25.0% (10/40) and 37.5% (15/40)), which were statistically significant (χ ²=8.29, 18.28, 13.24, 20.03, 17.48, 14.79 and 11.90 respectively, P<0.05); in the observation group, large nodules (diameter ≥10 mm) 19.2% (5/26), infiltrates around the nodules (34.6%, 9/26), single cavities (7.7%, 2/26), thick-walled cavities (26.9%, 7/26), mediastinal lymph node enlargement (23.1%, 6/26) and pericardial effusion (7.7%, 2/26) were all significantly lower than those in the control group (57.5% (23/40), 72.5% (29/40), 37.5% (15/40), 75.0% (30/40), 47.5% (19/40), and 30.0% (12/40)) (χ ²=9.45,9.26,7.32,14.79,3.99 and 4.69 respectively, P<0.05). In the observation group, the incidences of 0-lobe and 1-2-lobe bronchiectasis 11.5% (3/26) and 19.2% (5/26) respectively were lower than those in the control group 40.0% (16/40) and 50.0% (20/40) respectively, the differences were statistically significant (χ ²=6.23 and 6.34, P<0.05); the incidence of 3-4-lobe and ≥5-lobe bronchiectasis 30.8% (8/26) and 38.5% (10/26) respectively were higher than those in the control group (5.0% (2/40) and 5.0% (2/40) respectively), the differences were statistically significant (continuity correction χ ²=6.26 and 9.72, respectively, P<0.05); In the observation group, the incidence of 3-4-lobe bronchiectasis which were varicose and cystic types 26.9% (7/26) was higher than those in the control group 5.0% (2/40) (continuity correction, χ ²=4.70, P<0.05). Conclusion The thin-walled cavities, lung volume reduction, emphysema, extensive varicose bronchiectasis and cystic bronchiectasis of Mycobacteria intracellulare lung disease with cavitation are all more than pulmonary tuberculosis, large nodules (diameter ≥10 mm), infiltrates around the nodules, single cavities, thick-walled cavities, mediastinal lymph node enlargement and pericardial effusion are all significantly lower than pulmonary tuberculosis in the CT manifestations, which is helpful for differentiation between the two groups.

Analysis of the diagnosis and treatment of early lung cancer complicated with pulmonary tuberculosis manifested as ground-glass opacities

Da-wei LIU,Jian-kun ZHU,Feng JIN,Cheng WANG,Yun-zeng ZHANG,Gao-feng QIAO,Bin ZHAO

Chinese Journal of Antituberculosis. 2019, 41(1):  64-68.  doi:10.3969/j.issn.1000-6621.2019.01.014

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Objective To analyze the clinical characteristics of early lung cancer complicated with pulmonary tuberculosis manifested as ground-glass opacity (GGO) in order to achieve the purpose of early identification and treatment.Methods We analyzed retrospectively the clinical manifestation, CT imaging features, operative method and pathological types in 14 cases of lung cancer complicated with pulmonary tuberculosis manifested with GGO diagnosed in Shandong Provincial Chest Hospital Affiliated to Shandong University during Jan. 2013 to Feb. 2018.Results Of 14 cases of early lung cancer complicated with pulmonary tuberculosis manifested with GGO, there were found by health examination in 9 cases, CT signs with obsolete tuberculous lesion manifested as mixed density GGO (mGGO) in 12 cases, GGO and tuberculous lesion located at the ipsilateral lung and same lobe in 4 cases. Nine patients were received standard chemotherapy before operation and 6 patients continued to chemotherapy after operation. Lung cancer was diagnosed by CT-guided puncture lung biopsy in 3 cases before operation, while the other 11 cases were confirmed by intraoperative frozen section pathological examination.Lung lobectomy and mediastinal lymph node dissection were performed in 10 cases, lobectomy (GGO location) plus local resection for tuberculoma located at ipsilateral lung different lobe in 2 cases, segmentectomy in 1 case, wedge resection in 1 case.Pulmonary tuberculosis was diagnosed by pathological examination in 10 cases, and by composite reference standard (CRS) based on medical history and CT imaging features in 4 cases. Samples from early lung cancer manifested GGO were diagnosed by pathological examination as adenocarcinoma in 11 cases, squamous cell carcinoma, adenosquamous squamous cell carcinoma and large cell carcinoma in each one cases. No metastasis was found by pathological examination in mediastinal lymph nodes. All the patients recovered well after operation. Norecurrence, metastasis of tumor and tuberculosis relapse occurred in the short term follow-up.Conclusion The clinical manifestations of early lung cancer patients complicated with pulmonary tuberculosis manifested by GGO are not specific. Thin-slice CT scanning and dynamic observation are helpful for diagnosis. Surgical method needs to give consideration to tumor resection and tuberculous foci management. It is satisfactory for efficacy that standard chemotherapy and surgical resection be performed in these patients,

Short term efficacy evaluation of total hip arthroplasty for the treatment of advanced active hip tuberculosis

Hai LI,Yu PU,Min HE

Chinese Journal of Antituberculosis. 2019, 41(1):  69-73.  doi:10.3969/j.issn.1000-6621.2019.01.015

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Objective To evaluate the short-term effect of one-stage and staged artificial joint replacement in the treatment of active hip tuberculosis.Methods The clinical data of 25 patients with active hip tuberculosis admitted to Chengdu Public Health Clinical Medical Center from January 2013 to December 2016 were analyzed retros-pectively. There were 15 males and 10 females, aged 23-77 years, with an average age of (50.3±2.1) years. Sixteen patients were operated with primary tuberculosis focus clearance and artificial joint replacement (stage Ⅰ), 9 patients with primary tuberculosis focus clearance and stage artificial joint replacement (stage Ⅱ). At 1, 2, 3, 6, 12, 18, and 24 months follow-up, the X-ray and CT were carried on, and the Harris hip function score was calcula-ted to evaluate the initial fixation, early survival and tuberculosis recurrence.Results Twenty-five cases were followed up. The preoperative Harris hip function score was (46.7±7.6) and (88.2±4.2) at 3 months follow-up. The difference was statistically significant (t=-12.745, P<0.001). During the follow-up period, the X-ray films of 25 patients showed that the femoral stalk and femur were well matched, and no loosening or subsidence of the femoral stalk were observed. Twenty-five patients were not complicated infection, deep vein thrombosis, pulmonary embolism and also they weren’t observed tuberculosis recurrence.Conclusion One-stage and staged arthroplasty have a effective short-term effect in the treatment of active hip tuberculosis.

The value of fluorescent PCR probe melting curve analysis in detection of Mycobacterium tuberculosis complex for rifa-mpicin and isoniazid resistance

Hui-na WU,Fu-sheng SUN,Qing-wen LIU,Zhong-lu RONG,Ji-dong ZHANG,Yang GAO,Yong-fu LI,Fei CHANG

Chinese Journal of Antituberculosis. 2019, 41(1):  74-79.  doi:10.3969/j.issn.1000-6621.2019.01.016

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Objective To evaluate the value of fluorescent PCR probe melting curve analysis (MeltProTB) in detecting the resistance of Mycobacterium tuberculosis complex to rifampicin (RFP) and isoniazid (INH).Methods Eight hundred and eighty-three pulmonary tuberculosis patients with multidrug-resistant tuberculosis (MDR-TB) admitted in Heze City Infectious Diseases Hospital in Shandong Province were enrolled during January 2015 to July 2018. Two hundred and fifteen patients with sputum smear positive were selected for further culture. Two hundred strains identified as Mycobacterium tuberculosis complex (MTBC) were tested for drug resistance to RFP and INH by proportional drug susceptibility testing (DST) and MeltPro TB method. The sensitivity, specificity, coincidence rate and consistency (Kappa test) of resistance to RFP and INH detected by MeltPro TB were analyzed using DST results as gold standard.Results Of the 200 MTBC isolates, the sensitivity, specificity and coincidence rate of RFP resistance were 96.4% (106/110; 95%CI: 90.7%-98.9%), 80.0% (72/90; 95%CI: 70.5%-87.1%) and 89.0%(178/200) by MeltPro TB based on DST as the standard. The sensitivity, specificity and coincidence rate of RFP resistance were 85.4% (123/144; 95%CI: 78.6%-90.7%), 96.4% (54/56; 95%CI: 87.7%-99.6%) and 88.5% (177/200) by MeltPro TB based on DST as the standard. The Kappa value of MeltPro TB and DST for RFP resistance in MTBC was 0.78, and was 0.74 for INH resistance in MTBC.Conclusion MeltPro TB has high sensitivity and specificity in detecting drug resistance of MTBC to RFP and INH, and it has good consistent with DST in detecting MTBC resistance to RFP and INH, which is helpful for early detection and treatment in patients with drug-resistant tuberculosis.

Study on the relationship between the implementation of pulmonary tuberculosis control objective and the social determinants in China

Man-hui ZHANG,Jian-jun LIU,Hong-yan YAO,Qi-qi WANG,Jin-fang SUN,Shi-cheng YU,Hui ZHANG

Chinese Journal of Antituberculosis. 2019, 41(1):  80-87.  doi:10.3969/j.issn.1000-6621.2019.01.017

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Objective To estimate the difficulty of pulmonary tuberculosis prevention and control objective implementation in various parts of China (excluding Chinese Taipei, Hongkong China and Macao China) and analyze its related factors.Methods Based on the reported incidence data of PTB in provinces and related social and economic indicators (including per capita GDP, registered unemployment rate in cities and towns, forest coverage rate, rural population proportion, child dependency ratio, elderly dependency ratio, illiteracy ratio, sex ratio, number of beds in health care institutions per 1000 persons, number of medical technical personnel in health care institutions per 1000 persons, per capita water consumption) from 2004 to 2016, standardized incidence ratio was used to estimate the difficulty of PTB control objective implementation in different regions in China. The related factors were discussed by using multi-level random intercept model.Results Over time, the distance between the incidence of PTB and the planning goals in 28 areas of China has gradually narrowed (between 0.39 and 2.49, year 2016). The gap between the incidence of PTB and planning objectives in Xinjiang Uygur Autonomous Region (SIR=3.38, year 2016), Tibet Autonomous Region (SIR=2.89, year 2016), Qinghai Province (SIR=2.36, year 2016), Guizhou Province (SIR=2.49, year 2016) is still large. In space, the farther distance changed from generally to individually, and the overall performance was farther in the west than in the east. The results of multi-level random intercept model revealed that there was a correlation between the control objective and per capita GDP (β=-0.055, t=-6.74), forest cover rate between 17.70% and 38.40% (β=-0.035, t=-2.05), forest cover rate >38.40% (β=-0.059, t=-2.08), illiteracy ratio >8.14% (β=0.048, t=3.41), per capita water consumption >520.70 m ³/person (β=-0.060, t=-2.33), the proportion of rural population (β=0.112, t=6.57; all P<0.05). Conclusion The distance between incidence and control planning of PTB is shortened, although it is still difficult for individual regions to achieve the planning objectives. The distance of tuberculosis control objective is negatively correlated with per capita GDP, per capita water consumption and forest coverage, and positively correlated with the proportion of rural population and illiteracy.

Analysis of the quality of life and its influencing factors in patients with multidrug-resistant tuberculosis

Yu-jie ZHAO,Kai YAN,Jin-ou CHEN,Ling LI,Yun-bin YANG,Lin XU

Chinese Journal of Antituberculosis. 2019, 41(1):  88-94.  doi:10.3969/j.issn.1000-6621.2019.01.018

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Objective To understand the life quality of patients with multidrug-resistant tuberculosis and analyze its influencing factors.Methods A total of 46 patients with multidrug-resistant pulmonary tuberculosis who were registered for the Tuberculosis Management Information System in Yunnan Province from 2012 to 2015 were collected (referred to as “MDR-TB group”). A 1∶1matched case-control study was performed in 46 patients with tuberculosis who were sensitive to the treatment during the period. A cross-sectional study was carried with Quality of Life Instruments for Chronic Disease-Pulmonary Tuberculosis in two groups. And the quality of life of the two groups was measured and compared, and multiple linear regression analysis was used to analyze the factors affecting the quality of life of patients with MDR-TB.Results The total quality of life score, physiological function score, psychological function score, social function score were (152.11±17.04), (35.85±5.53), (39.65±6.84), (29.52±4.92) points in MDR-TB group respectively compared with (169.28±24.05), (41.39±5.53), (44.59±6.24), (32.91±5.66) scores in control group, (t values were 3.95, 4.81, 3.62, and 3.07, respectively, and the P values were <0.05), scores in control group were lower, the difference was statistically significant. Multiple linear regression analysis showed that the influencing factor of quality of life in patients with MDR-TB was correlated with the duration of treatment (β=15.17, t=2.28, P=0.028). Forty-six patients with MDR-TB had a life quality score of (139.33±12.86) for pre-treatment, a score of (151.75±16.56) for treatment, and a score of (169.67±17.67) after treatment. The quality of life of MDR-TB patients increases with the treatment time.Conclusion The quality of life of MDR-TB patients is lower than that of tuberculosis patients who are sensitive to anti-tuberculosis drugs. The duration of treatment is a possible influencing factor in the quality of life of MDR-TB patients.

Review Articles

Research progress on cerebrospinal fluid examinations in early diagnosis of tuberculous meningitis

Sai-sai WANG,Yan MA,Yang LIU

Chinese Journal of Antituberculosis. 2019, 41(1):  95-101.  doi:10.3969/j.issn.1000-6621.2019.01.019

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Tuberculous meningitis (TBM) is the most serious type of extra-pulmonary tuberculosis, which usually causes higher mortality and disability rate. So early and rapid diagnosis of TBM, as well as differential diagnosis with other diseases are crucial for TBM treatment and its prognosis. In this paper, we did a systemically review on the research progress of cerebrospinal fluid testing application in early diagnosis of TBM and in differential diagnosis with pyogenic meningitis, viral meningitis (VM) and cryptococcul neoformans meningitis (CNM) in recent years, aiming to provide some ideas or references for the early diagnosis and differential diagnosis of TBM.

Advances in the treatment of tuberculous meningitis

Ling-ling SHAO,Hong-fei DUAN

Chinese Journal of Antituberculosis. 2019, 41(1):  102-106.  doi:10.3969/j.issn.1000-6621.2019.01.020

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Tuberculous meningitis (TBM) is the most lethal form of tuberculosis, and its clinical incidence rate is gradually increasing. In the recent years, there are much progress in the treatment of TBM. This article reviewed the related research in the fields of chemotherapy, adjuvant therapy and the treatment of complications. We hope to provide help for the clinical treatment of TBM.

Research progress of anterior minimally invasive surgery in tuberculosis of the thoracic and lumbar spine

Jin-wen HE,Long-yun WU,Jian-dang SHI,Ning-kui NIU,Hui-qiang DING

Chinese Journal of Antituberculosis. 2019, 41(1):  107-111.  doi:10.3969/j.issn.1000-6621.2019.01.021

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In the surgical treatment of thoracic and lumbar tuberculosis, debridement of the lesion, bone graft and internal fixation can be done via anterior approach. The traditional anterior approach has disadvantages of long incision and big trauma though the lesion can be clearly revealed and removed. In recent years, minimally invasive technology has been gradually used in anterior thoracic and lumbar tuberculosis surgery because of its advantages of small trauma, rapid recovery. We reviewed the literature and discussed the best indications of minimally invasive surgeries such as modified small incision anterior surgery, real-time imaging guided percutaneous catheter drainage, endoscopic assisted surgery and lateral intervertebral fusion. The application of minimally invasive techniques in anterior surgery of thoracic and lumbar tuberculosis was discussed in this review. It is of great significance to select different minimally invasive surgical procedures for different patients.

Clinical Case Discussion

Analysis on diagnosis and treatment process of one patient with multiple osteoarticular tuberculosis complicated with multiple cutaneous tuberculosis

XIELong-zhou, ZHANG Yun-gang, XIANG Xue-ming, ZHAO Bei, ZHANG Xiu-qin, LI Hong, YUE Jin-cai, ZHU Gui-fang, TIAN Tian, ZHONG Ji-wei, ZHONG Jia-yong, SU Zhong-rui

Chinese Journal of Antituberculosis. 2019, 41(1):  112-117.  doi:10.3969/j.issn.1000-6621.2019.01.022

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Multiple sites of osteoarticular tuberculosis combined with multiple cutaneous tuberculosis is very rare and difficult to be early diagnosed. One patient with multiple tuberculosis of bone and joint with multiple skin tuberculosis was reported, who was diagnosed and treated via collaborations of multiple related departments. In order to enhance clinicians’ knowledge and raise up their awareness to atypical multiple osteoarticular tuberculosis and complicated with skin tuberculosis, this paper conducted deep analysis and discussion on clinical diagnosis and treatment process of this patient. Meanwhile, it is helpful to improve clinicians’ abilities of TB diagnosis and treatment, which will bring benefits to the patients on early diagnosis and early treatment.