Table of Content

10 July 2020, Volume 42 Issue 7

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New Technology and Method

Evaluation of the application of Foshan Tuberculosis Surveillance and Management Platform in tuberculosis prevention and treatment

ZHONG Qian-hong, MA Xiao-hui, LIN Zhi-hao, LI Yi, ZHOU Jie, DENG Dong-hua, DENG Ci-xi, LIANG Xiao-min

Chinese Journal of Antituberculosis. 2020, 42(7):  653-656.  doi:10.3969/j.issn.1000-6621.2020.07.002

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Objective To evaluate the application effect of “Foshan Tuberculosis Surveillance and Management Platform” in the prevention and treatment of tuberculosis (TB), and provide new ideas and references for the information management of tuberculosis prevention and treatment. Methods In this study, a descriptive study was used to compare the data of referral tracking, patient discovery, and treatment management in the five counties and districts of Foshan City.The data came from the first two years (2015, 2016) and the next two years (2017, 2018) of the application of “Foshan Tuberculosis Surveillance and Management Platform”. SPSS 20.0 was used for statistical analysis. Chi-square test was used to compare the count data and P<0.05 meant the difference was statistically significant. Results Two years before and after the application of the “Foshan Tuberculosis Surveillance and Management Platform”, the actual number of patients with tuberculosis or suspected tuberculosis reported by non-TB prevention organizations in Foshan was 16914 and 15124, respectively, and the number of referral patients was 16588 and 15121 cases, the referral rate increased from 98.07% (16588/16914) in 2 years before application to 99.98% (15121/15124) in 2 years after application, the difference was statistically significant (χ ²=285.86,P<0.001). The tracking rate of the TB prevention organization increased from 99.11% (7421/7488) in 2 years before application to 99.63% (7459/7487) in 2 years after application, the difference was statistically significant (χ²=16.11,P<0.001). The tracking availability rate increased from 83.87% (6280/7488) in 2 years before application to 86.82% (6500/7487) in 2 years after application, the difference was statistically significant (χ²=26.04, P<0.001), and the overall availability rate increased from 91.02% (15395/16914) in 2 years before application to 93.98% (14214/15124) in 2 years after application, and the difference was statistically significant (χ ²=100.10, P<0.001). The loss rate of patients decreased from 3.92% (300/7654) in 2 years before application to 3.10% (210/6785) in 2 years after application, the difference was statistically significant (χ ²=7.18, P=0.007). The regular medication rate increased from 93.01% (7119/7654) in 2 years before application to 94.22% (6393/6785) in 2 years after application, the difference was statistically significant (χ ²=8.80, P=0.003). The overall drug missed rate decreased from 4.08% (56210/1377720) in 2 years before application to 3.10% (37860/1221300) in 2 years after application, the difference was statistically significant (χ ²=1782.19,P<0.001). Conclusion The application of “Foshan Tuberculosis Surveillance and Management Platform” improves the efficiency and quality of tuberculosis patient management in Foshan City, and provides a basis and reference for the information management of tuberculosis prevention and treatment.

Review and prospect of tuberculosis management information surveillance and monitoring in China

LI Tao, DU Xin, CHEN Wei, HUANG Fei, ZHAO Yan-lin, ZHANG Hui

Chinese Journal of Antituberculosis. 2020, 42(7):  657-661.  doi:10.3969/j.issn.1000-6621.2020.07.003

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Surveillance is a major component in modern tuberculosis (TB) control strategies. Timely, accurate and complete TB medical records and patients registration could promote the diagnosis and treatment of patients and public health system response. Therefore, a reliable TB management information surveillance system is important to monitoring and evaluating TB control and the progress, as well as to formulating policies and making decisions. Based on this, the authors reviewed the history and development of China’s TB management information surveillance system.

Pilot exploration of a New TB Surveillance System based on the National Health Security Project Construction Plan

DU Xin, LI Tao, LI You, SUN Miao-miao, WANG Ni, ZHANG Hui, ZHAO Yan-lin, HUANG Fei

Chinese Journal of Antituberculosis. 2020, 42(7):  662-666.  doi:10.3969/j.issn.1000-6621.2020.07.004

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According to the requirements of the National Health Security Project Construction Plan, the responsibilities and work processes of relevant institutions under different tuberculosis control service systems were sorted out, and the basic data set and business application scenarios of tuberculosis surveillance were determined, and then a new type of Tuberculosis Surveillance System was developed. This system could automatically exchange data with information systems in different regions, which will provide experience and reference for the construction of national health informatization.

Establishment and validation of the standard basic dataset for tuberculosis surveillance

WANG Ni, HUANG Fei, LI Tao, LI You, SUN Miao-miao, ZHANG Hui, ZHAO Yan-lin, DU Xin

Chinese Journal of Antituberculosis. 2020, 42(7):  667-670.  doi:10.3969/j.issn.1000-6621.2020.07.005

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To adapt to the new service model of tuberculosis control, and guide the transformation of tuberculosis information system in different regions, Chinese Center for Disease Control and Prevention designed the standard basic dataset for tuberculosis surveillance, according to the basic idea of the national health security project. This paper we mainly introduced the principle, basic structure, standard of data element, range standard and the validation of the basic dataset, also the practice in programmatic settings.

Design and application of Tuberculosis Designated Hospital Information Management Platform in Changchun

LI Xiao-kun, YUAN Yan-li, YANG Guang-xu, WU Yuan-yuan

Chinese Journal of Antituberculosis. 2020, 42(7):  671-675.  doi:10.3969/j.issn.1000-6621.2020.07.006

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Linking up the hospital information system (HIS) in the Infectious Disease Hospital of Changchun with the data from the local network of designated hospitals at the county and district levels under its jurisdiction, and forming the Integrated Medical Service “Changchun Tuberculosis Designated Hospital Information Management Platform”, so as to realize the information digitalization of tuberculosis patients’discovery, management, treatment and prognosis in Changchun area, and to improve the speed of tuberculosis prevention and control mode. In 2018, we started to design and set up the data center of the municipal management platform in the city-level designated hospitals (Changchun Infectious Disease Hospital), set up the application service and the database service, and get the basic information of patients directly from the hospital’s HIS system, at the same time, through the application (APP)+WeChat client, we can receive the data of 11 local area networks of the drug-resistant outpatient clinic and each county/district anti-drug clinic in real time. Establish VPN channel, link up with provincial system platform to verify real-time national data and grasp the statistical changes of epidemic situation in our city. Through this platform, 11 departments, including county-level TB clinics and drug-resistant outpatient clinics, can obtain the complete diagnosis and treatment data of patients in designated hospitals at the municipal level in their jurisdiction in real-time, and complete the management of follow-up precise treatment. In December 2018, the Changchun Tuberculosis Designated Hospital Information Management Platform was established, and in April 2019, it was connected with the hospital area network through HIS system port and PC port, automatic storage of basic information, diagnosis and treatment of tuberculosis patients (common and drug-resistant patients) found in inpatient and out-patient departments of infectious diseases hospitals in Changchun. In September 2019, the VPN channel was successfully connected with the lower-level drug-resistant outpatient clinic, and the doctors of the drug-resistant outpatient clinic could grasp the basic and clinical information of the new drug-resistant patients and the patients with drug-resistant in the follow-up visit in real time by using the database, reducing the time and cost of inclusion and improving the accuracy of treatment.

Application of “Internet+Medical Treatment” model in tuberculosis prevention and treatment in Ningxia

LIU Guang-tian, LIU Tao, WANG Xiao-wei, LEI Juan, TIAN Xiao-mei, WANG Xiao-lin

Chinese Journal of Antituberculosis. 2020, 42(7):  676-681.  doi:10.3969/j.issn.1000-6621.2020.07.007

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At the beginning of 2019, Ningxia Autonomous Region has set up the “Information System for Ningxia Tuberculosis Prevention and Treatment Management”, which effectively integrated the technical work of the tuberculosis (TB) designated medical institutions, the disease prevention and control centers, the grass-roots health care institutions and other health service facilities. In this information system, with the patient’s treatment timeline as the axis, an electronic medical record, which contains more than 530 information items, is formed for each patient, including the patient’s basic personal information, disease history, previous diagnosis and treatment results and cost information, etc. Among those information items, 91 items (e.g. the patient’s basic information, physical examination and screening results and disease history, etc.) can be automatically transferred to the National New TB Monitoring System managed by the Chinese Center for Disease Control and Prevention. By the end of 2019, the Ningxia TB Prevention and Treatment Management Information System has been linked with the 19 designated TB hospitals’ information system (HIS system) in Ningxia, accounting for 95.00% (19/20) of the total number of the TB designated hospitals in the whole region; in 2019, a total of 3258 TB suspects, who were eligible, were captured by this information system, while 2445 TB patients were reported in the “infectious disease surveillance system” and 85.60% (2093/2445) of the reported patients came form the captured TB suspects. As of May 2020, 43 medical institutions have installed the artificial intelligence (AI) image system and 3639 persons with TB symptoms got screening, then 987 TB suspects were detected and 433 cases were confirmed as TB, the diagnosis rate was 43.87% (433/987). 100 chest films of the 3639 persons with TB symptoms were randomly extracted and read by the radiologists. Based on the radiologists’ reading results, the sensitivity and specificity of the AI image system were 90.91% (10/11) and 89.89% (80/89) respectively, the Kappa value was 0.61 (0.60-0.62), which effectively improved the medical service efficiency. As of May 2020, more than 2130 health staff have registered in this information system with an effective follow-up rate of 61.78% (1125/1821) to the patients under treatment; 28 patients with pulmonary TB who installed smart phone sync APP and 33 patients who did not install sync cell-phone APP were randomly selected from the information system, and the average treatment adherence rate at the first six months of treatment in the patients using sync APP was 96.93% (15396/15883), which was significantly higher than that in the patients without using sync APP (92.99% (11411/12271))](χ ²=236.17, P=0.000), the treatment adherence of the patients was significantly improved.

Analysis of using electronic pillbox to assist the medication management of pulmonary tuberculosis patients

WANG Ni, ZHANG Hui, ZHANG Tie-juan, CHEN Bin, LEI Juan, SUN Miao-miao, HUANG Fei

Chinese Journal of Antituberculosis. 2020, 42(7):  682-686.  doi:10.3969/j.issn.1000-6621.2020.07.008

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We analyzed the implementation result of using electronic pillbox to assist the medication management for people with pulmonary tuberculosis (PTB) in Jilin, Zhejiang and Ningxia among July 2018 to March 2019. Of 22229 patients, 14657 used electronic pillbox, the rate of electronic pillbox using in the third quarter of 2018 was 57.9% (2138/3695), but 78.9% (4774/6071) in the second quarter of 2019. During the treatment process, the uptake rate of pillbox decreased by month, 95.3% (13965/14659) at the end of second month and 85.0% (12454/14659) at the end of six month. 72.5% (10622/14659) of the patients using pillbox had adherence medication records, of which the adherence medication rate was 82.3% (8746/10622). The results of this study further proved the feasibility for implementing the new method of patient management, and provide implementation experience for the further scale up of electronic pillbox in China.

Original Articles

Effect of bedaquiline-containing regimen on QT interval in patients with multidrug-resistant tuberculosis

XIE Li, GAO Jing-tao, MA Li-ping, ZHANG Li-qun, KONG Zhong-shun, WU Xiao-guang, LIU Rong-mei, CHEN Hong-mei, SONG Yan-hua, LI Xue-lian, Huang Mai-ling, LI Qiang, Lv Zi-zheng, LIu Yv-hong, Gao Meng-qiu

Chinese Journal of Antituberculosis. 2020, 42(7):  687-694.  doi:10.3969/j.issn.1000-6621.2020.07.009

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Objective To explore the effect of bedaquiline-containing regimen on QT interval in patients with multidrug-resistant tuberculosis (MDR-TB), with the purpose to provide evidence for clinical safe use and monitoring of the drug. Methods One hundred and twenty eligible patients were enrolled from Feb.2018 to Oct.2019 according to the inclusion and exclusion criteria in Beijing Chest Hospital, provided with bedaquline-containing treatment regimen. The QTcF values of electrocardiograph (ECG) were monitored and recorded at baseline before treatment and then serial follow-up ECG were done at the end of week 2,4,8,12,16,20,24 after treatment initiation. Thereafter once per 12 week for 1 year after bedaquiline duration was completed. Firstly, t-test, ANOVA test and Mann-Whitney U test were applied to analyze the distribution of baseline QTcF values among groups with age, gender, body mass index and drug resistance type. Secondly, independent sample t-test was used to compare the QTcF values at different time points during the treatment with that at baseline. Finally, multi-variate logistic regression analysis was performed to analyze the risk factors associated with QT interval prolongation. Results The mean value of QTcF of 120 patients at baseline was (404.90±19.27) ms. During exposure of bedaquiline-containing regimen, QTcF prolongation from baseline value ≥60 ms occurred in 23 cases (19.2%) while QTcF ≥500 ms occurred in 10 patients (8.3%). The mean value of QTcF increased gradually with the increase of bedaquiline administration duration and hit the peak at the end of week 20, and the QTcF monitored at each time point before it presented significant difference compared with that at baseline: at the end of week 2,QTcF was (413.51±22.69) ms (t=4.064, P=0.000);at the end of week 4,QTcF was (413.38±17.81) ms (t=4.022, P=0.000);at the end of week 8,QTcF was (414.78±23.71) ms (t=3.796, P=0.000);at the end of week 12,QTcF was (416.23±25.06) ms (t=3.752, P=0.000);at the end of week 16,QTcF was (419.23±29.18) ms (t=4.584, P=0.000);at the end of week 20,QTcF was (425.45±30.84) ms (t=5.865, P=0.000). Within the 6 months after bedaquiline duration was completed, the mean QTcF was (419.10±31.38) ms and (419.60±27.74) ms at the end of week 36 and 48 respectively with statistically significant differences compared with that at baseline (at the end of week 36, t=3.698, P=0.000; at the end of week 48, t=2.790, P=0.007). However, within the 6-12 months after bedaquiline duration was completed, there was no significant difference at the end of week 60 and 72 respectively compared with that at baseline (at the end of week 60, QTcF was (409.70±19.60) ms (t=0.759, P=0.453);at the end of week 72,QTcF was (412.77±15.96) ms (t=2.051, P=0.051)). No serious ventricular arrhythmia was found in all patients during the above observation period. Multivariate analysis showed that the risk of QT interval prolongation was 4.473 times (95%CI: 1.614-12.401) higher in patients with age no less than 45 years compared with that between 18-<45 years. Conclusion The occurrence of QT interval prolongation caused by bedaquiline-containing regimen is relatively high. Moreover, the QTcF values of MDR-TB patients increased with the increase of bedaquiline exposure. However, the QTcF values returned to the baseline level around 6 months after completion of bedaquiline administration. Multivariate analysis indicated that age ≥45 is the risk factor for occurrence of QT interval prolongation. The effect of QT prolongation during treatment did not lead to severe ventricular arrhythmia.

Clinical value of triple-drug adjuvant therapy for tuberculous pleurisy via chest wall ultrasound

ZHENG Ya-mei, XIE Tian, WU Zhuo-le, CHEN Yong-xing

Chinese Journal of Antituberculosis. 2020, 42(7):  695-700.  doi:10.3969/j.issn.1000-6621.2020.07.010

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Objective To explore the clinical value of triple-drug adjuvant therapy for tuberculous pleurisy (TBP) via chest wall ultrasound. Methods A total of 76 eligible TBP patients admitted to Hainan General Hospital from January 2016 to December 2018 were collected and randomly divided into the observation group and the control group according to the order of admission, with 38 cases in each group. Both groups were treated with 2H-R-Z-E/10H-R systemic chemotherapy+thoracentesis and drainage. On this basis, the observation group was supplemented with a triple-drug treatment of isoniazid+rifampicin+urokinase via transthoracic ultrasound, and the control group was given the same triple-drug treatment applied to the skin of the chest wall. The therapeutic efficacy of patients was compared between the two groups. The count data were represented by $\bar{x}$±s and analyzed using t test; and the measurement data were represented by rate (%) and analyzed using χ² test. P<0.05 was considered statistically significant. Results The total effective rates of the observation and the control groups were 94.74% (36/38) and 78.95% (30/38), respectively, with the statistically significant difference (χ ²=4.146, P=0.042). The thickness of the parietal pleura in the observation and the control groups was (5.29±0.21) mm and (5.98±0.25) mm at 2 months of treatment, respectively; (3.25±0.39) mm and (3.75±0.41) mm at 6 months of treatment, respectively; and (2.15±0.25) mm and (2.62±0.34) mm at 6 months after treatment, respectively; with the statistically significant differences (t=13.028, 29.669 and 47.132, P=0.000, 0.000, and 0.000, respectively). The ratios of the complete absorption of pleural effusion in the observation and the control groups were 65.79% (25/38) and 42.11% (16/38) at 6 months of treatment, respectively; and 94.74%(36/38) and 78.95% (30/38) at the end of 6 months, with the statistically significant differences (χ ²=4.290 and 4.146, P=0.038 and 0.042, respectively). The forced vital capacity (FVC) of the observation group and the control group was (3.86±0.68) L and (3.51±0.61) L at 2 months of treatment; (4.28±0.90) L and (3.74±0.84) L at 6 months of treatment; and (4.68±0.75) L and (3.98±0.79) L at the end of 6 months of treatment, respectively; with the statistically significant difference between the two groups (t=5.578, 4.894, and 35.307, P=0.021, 0.000, and 0.000, respectively). The 1s forced expiratory volumes (FEV₁) of the observation group and the control group were (3.54±0.67) L and (3.38±0.69) L at 2 months of treatment, respectively; (3.89±0.72) L and (3.38±0.69) L at 6 months of treatment, respectively; (4.23±0.75) L and (3.54±0.71) L at the end of 6 months of treatment, respectively, with the statistically significant difference (t=4.541, 3.153, 16.962, P=0.036, 0.000, 0.000, respectively). The inspiratory capacity (IC) of the observation group and the control group was (2.76±0.42) L and (2.30±0.38) L at 6 months of treatment, respectively; (2.98±0.45) L and (2.49±0.43) L at the end of 6 months of treatment, respectively; with the statistically significant difference (t=5.007 and 23.551, P=0.000 and 0.000, respectively). Conclusion The triple-drug treatment of isoniazid+rifampicin+urokinase via chest wall ultrasound can further improve the clinical efficacy of tuberculous pleurisy, significantly reduce the thickness of the pleura, accelerate the absorption of pleural effusion and improve lung function.

Investigation and analysis on the knowledge of tuberculosis prevention and control among elderly close contacts of tuberculosis patients

WU Yu-mei, LIU Bin-bin, GONG De-hua, CHEN Lu, FENG Dan, WU Ran-che

Chinese Journal of Antituberculosis. 2020, 42(7):  701-706.  doi:10.3969/j.issn.1000-6621.2020.07.011

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Objective To investigate the awareness of knowledge on tuberculosis (TB) prevention and treatment among elderly close contacts with TB patients, so as to provide evidences for formulating the TB prevention and treatment measures among these people. Methods Elderly close contacts (age ≥60 years) with TB patients hospitalized Hunan Chest Hospital from June to December 2019 were selected as respondents for a questionnaire survey, which used a self-designed questionnaire including the general condition of the respondent, awareness of core knowledge on TB prevention and treatment, and accesses to these knowledge as the survey items. A total of 199 questionnaires were distributed and 193 were recovered after excluding the invalid ones, with the validity of 97.0%. The awareness of core knowledge on TB prevention and treatment among the respondents and its influencing factors were analyzed. Results The 193 subjects were mainly primary school educated (47.2% (91/193)), and their occupations were mainly farmers (62.2% (120/193)); the total awareness rate of 7 TB prevention and control core knowledge was 56.3% (760/1351). Among the seven core knowledge of TB prevention and control, the single awareness rate of “TB is a serious infectious disease that endangers human health”, “cough and expectoration for more than two weeks should be suspected to have TB” was higher (74.1% (143/193) and 60.1% (116/193), respectively). The single awareness rate of “TB diagnosis method” and “TB prevention and treatment of designated medical institutions to check whether there is a policy of remission knowledge” were the lowest, both of which were 47.7% (92/193). Univariate analysis showed that the score (M(Q₁, Q₃)) of TB prevention and control core knowledge among college education or above was 85.7 (74.9, 85.7), which was significantly higher than that among primary school education (57.1 (28.5, 85.7)); the score among those who obtained knowledge through publicity activities (85.7 (67.8, 100.0)) was significantly higher than those who did not (57.1 (28.5, 85.7)), and the difference was statistically significant (H=9.87, P=0.020; Z=-3.70, P=0.000). Multivariate logistic regression analysis revealed that compared with subjects with primary school education, those with college education or above had a higher awareness level of TB core knowledge (OR (95%CI)=7.44 (1.81-30.58)); those with knowledge acquired through publicity activities had a higher awareness level of TB core knowledge (OR (95%CI)=3.71 (1.68-8.19)). Conclusion The awareness rate of knowledge on TB prevention and treatment is low among elderly close contacts with TB patients. Educational attainment and access to knowledge are the influencing factors for awareness of knowledge on TB prevention and treatment among elderly close contacts with TB patients.

Analysis on the effect of talents training project in Beijing Chest Hospital

XIE Na, MA Qian-hui, LI Yan-hong

Chinese Journal of Antituberculosis. 2020, 42(7):  707-711.  doi:10.3969/j.issn.1000-6621.2020.07.012

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Objective To evaluate the effect of talents training project and provide the evidence for perfection of talent training program by describing and analyzing scientific research performance in talents from high-level talent team (212 talent project for short) in Beijing Chest Hospital, Capital Medical University from 2011 to 2015. Methods All of scientific research performances from 28 talents including 10 discipline leaders and 18 discipline backbones recruited in 2012 as “212 talent project” were enrolled and compared with absolute number and average value collected before (during 2003 to 2012) and after (during 2013 to 2015) the project implementation. The achievements including before and after the project implementation from different level talents were analyzed using the SPSS software with 19.0 version. Results After the implementation of the project, 28 talents successfully applied for 82 scientific research projects, published 272 publications, and held 52 academic positions. The average number of research projects undertaken per person per year after the implementation was 2.88 times higher than that before the implementation (0.34 before implementation and 0.98 after implementation). The difference was statistically significant (Z=-3.773, P=0.000). The average number of publications per person per year after project implementation was 5.89 times higher than that before implementation (0.55 before implementation and 3.24 after implementation).The difference was statistically significant (Z=-4.623, P=0.000). Conclusion The “212 talent project” has achieved rich achievements. We should further strengthen the talents training, play to the talent value of discipline leaders, establish a talent contact system, form a long-term talent training mechanism, improve the talent training management system, and do a good job of the talent services.

Cost analysis of fluorescence PCR probe melting curve technique for the detection of Mycobacterium tuberculosis resistance in China

SONG Yi-meng, LI Yuan-chun, HE Wen-cong, HE Ping, BAO Jing-jing, LIU Chun-fa, LIU Dong-xin, WANG Xin-yang, ZHAO Yan-lin, LI Yan-ming

Chinese Journal of Antituberculosis. 2020, 42(7):  712-717.  doi:10.3969/j.issn.1000-6621.2020.07.013

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Objective Through the comparison of the cost of MGIT 960 and melting curve technology, to evaluate the feasibility of melting curve technology in detection of MTB drug resistance at tuberculosis control and prevention institutions in different regions and levels in China. Methods Six TB designated hospitals were selected, including Xi’an Chest Hospital, Xinjiang Uygur Autonomous Region Chest Hospital, Shenyang Chest Hospital, Nanyang Sixth People’s Hospital, Zunyi Medical College Affiliated Hospital and Hangzhou Red Cross Hospital. Cost data of MGIT 960 and melting curve techniques were collected for three times, according to three workloads of high, medium and low. The unit detection cost of each method and the unit cost of one MDR-TB patient detection were calculated by “element method”. Results The average unit detection costs of MGIT 960 and melting curve technique were 702.6 yuan (4215.8/6) and 440.7 yuan (2644.3/6), respectively. When the sensitivity of the melting curve technique was greater than 70% and the prevalence of MDR-TB was ≤50% in TB patients, the average cost of one MDR-TB patient detected by the melting curve technique (when the sensitivity of the melting curve technique was 70.0%, the prevalence of MDR-TB in TB patients were 1.0%, 5.0%, 10.0%, 15.0%, 20.0%, 30.0%, 50.0%) were 62957.1, 12591.4, 6295.7, 4197.1, 3147.9, 2098.6, and 1259.1 yuan. When the sensitivity of the melting curve technology was 80.0%, the average cost were 55087.5, 11017.5, 5508.8, 3672.5, 2754.3, 1836.3, 1101.8 yuan respectively, which was lower than that of MGIT 960 (the average cost were 70260.0, 14052.0, 7026.0, 4684.0, 3513.0, 2342.0, and 1405.2 yuan). Conclusion Compared with MGIT 960, melting curve technology is a more cost-effective diagnostic method, and has the value of detecting MTB resistance in TB control institutions with different levels in different regions in China.

Analysis of the clinical isolation rate, population distribution and drug resistance of non-tuberculous mycobacteria in Anhui

BAO Xun-di, JIANG Yue, LIANG Suo, CHENG Hong-yan, XIA Guang-xiu, WANG Chao, YE Qian, WANG Shu, WANG Qing

Chinese Journal of Antituberculosis. 2020, 42(7):  718-724.  doi:10.3969/j.issn.1000-6621.2020.07.014

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Objective To analyze the clinical isolation rate, population distribution and drug resistance of non-tuberculous mycobacteria (NTM) in Anhui to provide a scientific basis for the prevention and treatment of NTM. Methods Using the stratified cluster sampling method, 42 investigation points were collected from 86 tuberculosis clinics in Anhui, and 3047 cases of smear-positive suspected pulmonary tuberculosis patients from September 15, 2015 to August 31, 2016 were continuously included. The 2652 positive strains with acid L-G medium were identified for strains (p-nitrobenzoic acid (PNB) culture and early secreted protein (MPB64) colloidal gold method) and gene sequencing (16S rRNA and hsp65 DNA sequencing), and then the NTM was clinically isolated. The distribution characteristics and drug resistance detection (microplate method) of strains in different populations were studied and analyzed. Results The 2652 culture-positive strains obtained 122 NTM strains through preliminary strain identification; and by genetic sequencing, 107 NTM clinical isolates (the coincidence rate was 87.70% (107/122), and the isolation rate was 4.03% (107/2652)), 12 strains of Mycobacterium tuberculosis, 1 strain of Nocardia, and 2 strains of contaminated bacteria were further obtained. Among them, a total of 6 dominant bacterial species were isolated from the 107 strains of NTM, mainly of Mycobacterium intracellulare (65.42% (70/107)) and Mycobacterium abscessus (25.23% (27/107)). The rate of NTM isolation in retreatment (9.26% (41/443)), female (6.32% (39/617)), 40 years old and above (5.11% (100/1956)), retirement (8.82% (12/136)) and farmers (4.38% (86/1965)), junior high school and below (4.43% (97/2189)) and family annual income <20000 CNY (4.98% (75/1506)) were significantly higher than those in the initial treatment (2.99% (66/2209)), male (3.34% (68/2035)), under 40 years old (1.01% (7/696)), workers (0.96% (1/104)), high school and above (2.16% (10/463)), and family annual income ≥20000 CNY (2.83% (27/955)) (χ ² values were 37.434, 10.854, 36.387, 17.021,18.995 and 8.748, respectively; P values were 0.000, 0.001, 0.000, 0.002, 0.001 and 0.033, respectively). The drug susceptibility test results of 104 strains (excluding 1 strain of Mycobacterium intracellulare, 1 strain of Mycobacterium phlei, and 1 strain of Mycobacterium marseille which were failed to recover) showed that amikacin, rifabutin, clarithromycin and rifampicin were more sensitive (87.50% (91/104), 86.54% (90/104), 83.65% (87/104) and 75.00% (78/104), respectively), the resistance rates to imipenem/cilastatin sodium, cefoxitin, minocycline, doxycycline, etc. were higher (100.00% (104/104), 95.19% (99/104), 94.23% (98/104) and 93.27% (97/104), respectively). Conclusion The isolation rate of NTM in Anhui is lower, mainly in the retreatment, females, 40 years old and above, farmers, less educated and low income. The drug resistance rate is high, the laboratory identification and monitoring of NTM should be improved.

Analysis of nutritional status of 900 elderly inpatients with tuberculosis in Shanghai

CHEN Wei, DING Qin, GU Ying, QI Zhi-yan, CHEN Yan-hong, FAN Lin

Chinese Journal of Antituberculosis. 2020, 42(7):  725-730.  doi:10.3969/j.issn.1000-6621.2020.07.015

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Objective To investigate the nutritional status of elderly tuberculosis inpatients in Shanghai and its impact on clinical treatment and provide a reference for early nutrition intervention for elderly tuberculosis inpatients. Methods Of the 1100 elderly tuberculosis inpatients admitted in Shanghai Pulmonary Hospital Affiliated of Tongji University over 24 hours from August 1st, 2018 to August 1st, 2019 were, 900 patients without serious diabetes, serious hypertension, liver and kidney dysfunction, or unconsciousness were collected, and their BMI were recorded. Clinical data, including gender, age, diagnosis, complication, times of treatments, date of discharge and admission, NRS 2002 score and nutrition relative indicators (Hb, TP, ALB, PAB, RBP, PNI, and NLR), were compared to analyze the risk factors of elderly tuberculosis inpatients. The 900 elderly tuberculosis patients were divided into nutritional risk group (n=443 (49.22%), NRS 2002 score ≥3) and non-nutritional risk group (n=457 (50.78%), NRS 2002 score<3). Results The constituent ratio of nutritional risks in the nutritional risk group with patients aged 75- and 80-90 years old, BMI<18.5,2 or more times of treatments,tuberculous pleurisy were significantly higher than the non-nutritional risk group (18.28% (81/443) and 18.51% (82/443) vs.9.19% (42/457) and 8.75% (40/457), (40.41% (179/443) vs. 0.00% (0/457),25.51% (113/443) vs. 17.51% (80/457),21.67% (96/443) vs. 13.13% (60/457);χ²=51.350,299.500, 8.818, 16.280;P=0.000,0.000,0.012,0.000). The TP, ALB, PAB, Hb, RBP, PNI in nutritional risk group were lower than those in non-nutritional risk group ((64.88±0.34) g/L vs. (67.30±0.28) g/L, (34.15±0.23) g/L vs. (38.18±0.16) g/L, (138.60±3.26) g/L vs. (194.10±3.22) g/L, (113.60±0.84) g/L vs. (126.70±0.79) g/L, (26.32±0.50) g/L vs. (34.32±0.22) g/L, (39.61±0.35) vs. (45.51±0.26); F=19.496, 79.334, 34.030, 22.808, 21.326, 72.464, respectively; all P=0.000). However, the NLR and duration of inhospital in nutritional risk group were significantly higher than those in non-nutritional risk group ((5.44±0.32) vs. (3.29±0.14), F=6.335, P=0.012; (6.61±0.17) d vs. (5.53±0.13) d, F=5.994,P=0.015). Conclusion Elderly tuberculosis patients have high incidence of nutritional risk and the incidence increase with age, times of treatment, decrease with BMI. The TP, ALB, PAB, Hb, RBP and PNI in nutritional risk group were significantly lower than those in non-nutritional risk group, which seriously affects the clinical treatment and leads to longer hospital stays directly.

Clinical analysis of 35 pregnant tuberculous pleurisy patients

LIU Lin

Chinese Journal of Antituberculosis. 2020, 42(7):  731-736.  doi:10.3969/j.issn.1000-6621.2020.07.016

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Objective To investigate the clinical characteristics of pregnant tuberculous pleurisy patients. Methods We analyzed the retrospective clinical data from 35 cases with pregnancy complicated with tuberculous pleurisy admitted in the Tuberculosis Research Institute of the 8th Medical Center of Chinese PLA General Hospital during March 2011 to December 2018. Patients were 20-41 years old,average age was 27.60±5.45 years. 6 cases (17.1%) were during their early pregnancy,16 cases (45.7%) in mid-pregnancy, 12 cases (34.3%) in late pregnancy and 1 case (2.9%) in puerperium. Results Of 35 patients,13 definite cases were confirmed by histopathological examination with samples collected with ultrasound-guided pleural biopsy,22 cases were clinically diagnosed according to the clinical diagnostic criteria of tuberculous pleurisy. Fever occurred in 82.9% (29/35) of cases, dyspnea and cough accounted for 77.1% (27/35) and 57.1% (20/35) respectively. Among them,5 cases suffered early artificial abortion, 1 case got spontaneous abortion, 13 cases got induction of labor in mid-pregnancy,15 cases continued pregnancy until delivery (3 cases in mid-pregnancy and all 12 cases in late pregnancy), 1 case occurred in puerous period. All patients were treated with anti-tuberculosis drugs after the diagnosis was confirmed, then their clinical symptoms disappeared and pleural effusion were absorbed with no deaths. Patients were followed up for 6 to 55 months and no relapse cases were detected. One of the 16 newborns was premature with low birth weight,the other 15 were healthy term infants, no birth defects were found. The newborns were followed up for 7 to 55 months, no abnormality of growth or development, or tuberculosis were observed. Conclusion Pregnant tuberculous pleurisy patients are mainly diagnosed clinically. The anti-tuberculosis treatment is effective and no adverse effects on fetuses are found.

Review Articles

Application of whole genome sequencing in research of Mycobacterium tuberculosis

ZHANG Jie, REN Yi-xuan, PAN Li-ping, ZHANG Zong-de

Chinese Journal of Antituberculosis. 2020, 42(7):  737-740.  doi:10.3969/j.issn.1000-6621.2020.07.017

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Whole genome sequencing has been widely used in the research of Mycobacterium tuberculosis (M.tuberculosis), including classification of M.tuberculosis lineages or subspecies, differentiation of disease patterns, identification of putative source cases and super-spreaders, determination of the transmission chains and their directions, as well as prediction of drug resistance of M.tuberculosis and detection of microevolution of M.tuberculosis. Although the whole genome sequencing has played an important role in clinical and public health applications, many problems are still existed and should be resolved in future. Herein, the current research directions and achievements of whole genome sequencing are reviewed, and the future applications are prospected.

Research progress of clinical characteristics of malnourished patients with tuberculosis

JIANG Li, ZHANG Xiao-qiang, LIU Ling-li, WANG Han, LIU Feng, LI Zhi-yue, SHEN Sheng-rong

Chinese Journal of Antituberculosis. 2020, 42(7):  741-746.  doi:10.3969/j.issn.1000-6621.2020.07.018

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Malnutrition is one of the common outcomes of the patients with active tuberculosis (TB), and it is also a risk factor for early death of the TB patients. Without interventions, a vicious circle between TB and malnutrition will be formed, resulting in more serious clinical manifestations, higher incidence of adverse drug events (ADEs), and higher risk of death in TB patients. Along with the improvement of the Chinese average living level and the development of clinical nutriology, more and more attentions have been paid to the nutrition management of TB patients. In order to design more targeted nutrition supplement programs, it is necessary to determine the specific situation of various nutrients deficiency in TB patients. Based on the analysis of national and international researches about the nutrients of TB patients, the author comprehensively expounded the clinical characteristics of the TB patients when they were short of macronutrients, vitamins and minerals etc., combed the ideas of nutrition support treatment to the TB patients, and provided the targeted supplement indicators of various nutrients.

Clinical Case Discussion

Analysis on clinical diagnosis and treatment of two cases with mediastinal fibrosis caused by tuberculosis infection

ZENG Yi, GAO Wei-wei, GONG Su-gang, HOU Dai-lun

Chinese Journal of Antituberculosis. 2020, 42(7):  747-751.  doi:10.3969/j.issn.1000-6621.2020.07.019

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This study analyzed the clinical diagnosis and treatment of 2 patients with mediastinal fibrosis (MF) caused by tuberculosis, aiming to enhance the clinicians’ understanding of MF and improve the diagnosis ability of this disease. After multidisciplinary discussions, we found that these 2 patients had certain common characteristics in clinical manifestations, imaging features, bronchoscopy, diagnosis and treatment process. First, due to the chronic course and lack of specificity of clinical symptoms, it was easily misdiagnosed as chronic obstructive pulmonary disease (COPD). Second, imaging examination showed irregular soft tissue shadows in the mediastinum and hilar with calcification, and deformed stenosis of airways and pulmonary vessels. Third, tracheoscopy revealed multiple pigmentation of the mucous membranes, bronchial stenosis or occlusion. Fourth, according to the patient’s previous medical history, anti-tuberculosis irregular treatment history, and positive tuberculosis immunological indicators, it was suggested that MF might be related to tuberculosis infection. Fifth, although poor drug treatment, vascular interventional therapy had certain value for improving clinical symptoms. Thus, tuberculosis infection as a causative factor of MF should be taken seriously, and early detection and treatment are necessary.