Table of Content

10 July 2021, Volume 43 Issue 7

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The tuberculosis drug-resistance and transmission surveillance network based on whole genome sequencing data

YANG Ting-ting, GAO Qian

Chinese Journal of Antituberculosis. 2021, 43(7):  645-648.  doi:10.3969/j.issn.1000-6621.2021.07.001

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The surveillance of tuberculosis drug-resistance and transmission provide important information to making up public health policies. Whole genome sequencing (WGS) of Mycobacterium tuberculosis (MTB) has an advantage over the traditional phenotypic drug susceptibility test and genotyping in drug resistance detection and transmission identification, and has been introduced into the health system of some developed countries. The establishment of the WGS data analysis platform, SAM-TB, makes it possible to construct a national tuberculosis drug-resistance and transmission surveillance database base on MTB WGS data. The authors suggest that this work should be carried out step by step at the provincial level, and finally a nationwide surveillance network of tuberculosis drug resistance and transmission can be formed.

Issues that need attention in the multi-sector approaches on providing anti-tuberculosis treatment for patients with diabetes mellitus-tuberculosis

LIN Yan, DENG Guo-fang

Chinese Journal of Antituberculosis. 2021, 43(7):  649-652.  doi:10.3969/j.issn.1000-6621.2021.07.002

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Both diabetes mellitus (DM) and tuberculosis (TB) are significant public health problem worldwide. Multi-sector approaches are recommended to treat patients with DM-TB. However, the multi-sector approaches should be patient-centered and supported with sufficient scientific evidences. This paper aimed to preliminary address issues in the multi-sector approaches during anti-TB treatment for patients with DM-TB. Views expressed in this paper are truly for discussion in the clinical practice.

Analysis of screening of latent tuberculosis infection in hospitalized children

QI Xue, WU Xi-rong, GUO Ya-jie, WANG Yong-hong, MA Qi, CHEN Yu-ying, SUN Lin, SHEN A-dong

Chinese Journal of Antituberculosis. 2021, 43(7):  653-658.  doi:10.3969/j.issn.1000-6621.2021.07.003

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Objective To analyze the screening of latent tuberculosis infection (LTBI) in children with diseases of different systems. Methods Clinical information of 19093 children hospitalized in Beijing Children’s Hospital, Capital Medical University and tested by tuberculin skin test (TST) or interferon-gamma release assay (IGRA) between January 2013 and December 2015 were retrospectively analyzed. The diseases were classified according to clinical diagnosis, including respiratory diseases, rheumatic and immune diseases, hematologic/tumor diseases and renal diseases. The positive rate, consistency and the risk factors of the consistency of TST and IGRA were analyzed in children with diseases of different systems. Results Among children with diseases of different systems, when using TST to screen LTBI, the positive rates were 4.56% (205/4492), 3.01% (41/1361), 2.82% (170/6039) and 1.78% (19/1070) in children with rheumatic and immune diseases, renal diseases, respiratory diseases and hematologic/tumor diseases, respectively, the difference was statistically significant (χ ²=34.383, P<0.01). When using IGRA to screen LTBI, the positive rates were 1.13% (36/3191), 1.06% (66/6215), 0.93% (19/2039) and 0.90% (69/7648) in children with hematologic/tumor systemic diseases, rheumatic and immune diseases, renal diseases and respiratory diseases, respectively. However, the difference was not statistically significant (χ ²=1.608, P=0.658). The consistency between test results of TST and IGRA was poor in children with diseases of different systems (respiratory diseases: consistency rate was 96.92% (5853/6039), Kappa=0.193; rheumatic and immune diseases: consistency rate was 95.19% (4276/4492),Kappa=0.165; hematologic/tumor systemic diseases: consistency rate was 97.48% (1043/1070), Kappa=0.169;renal diseases: consistency rate was 96.77% (1317/1361), Kappa=0.173). Conclusion Compared to children with respiratory diseases, the rates of LTBI and the inconsistent results of TST and IGRA were higher in children with rheumatic and immune diseases, renal diseases and hematologic/tumor diseases. The combination of TST and IGRA was suggested to be used to screen LTBI in children with respiratory diseases.

Analysis of gene polymorphism of Mycobacterium tuberculosis with negative MPT64 antigen in culture filtrate

ZHAO Guo-lian, TAN Xiao-wen, CUI Xiao-li, DANG Li-yun

Chinese Journal of Antituberculosis. 2021, 43(7):  659-663.  doi:10.3969/j.issn.1000-6621.2021.07.004

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Objective To analyze the gene polymorphism of Mycobacterium tuberculosis (MTB) with negative MPT64 antigen in culture filtrate. Methods A total of 1962 mycobacteria clinical isolates were collected from Xi’an Chest Hospital between January 2018 and June 2020 were retrospectively analyzed. The samples were from sputum, bronchoalveolar lavage fluid and pleural effusion, positive in BACTEC MGIT 960 and confirmed by Ziehl-Neelsen anti-acid dyeing method. They were also tested by MPT64 antigen detection (colloidal gold immune-chromatography), p-nitrobenzoic acid/thiophene-2-carboxylic acid hydrazide (PNB/TCH) growth test and mycobacterial species identification (DNA microarray chip method). When results of MPT64 antigen test and the mycobacterial species identification was not inconsistent, GeneXpert MTB/RIF and PNB culture test were performed. MPT64 gene sequencing was performed on 14 strains identified as MTB but negative in MPT64 antigen test. Results Among the 1962 clinical isolates of mycobacteria, 88 (4.5%) were NTM and 1874 (95.5%) were MTB. By MPT64 antigen detection, 87 non-tuberculous mycobacteria (98.9%) and 14 MTB (0.7%) were negative. The results of MPT64 gene sequencing showed that 92.9% (13/14) of the 14 MTB clinical isolates negative in MPT64 antigen detection had mutations in nucleotides 197-259 and amino acid deletions at positions 66-86 of the MPT64 protein gene, and the other one had an IS6110 gene fragment of 1361 bp inserted at position 587. Conclusion The main reason for the false negative detection of the MTB strain in MPT64 antigen test might be the deletion mutation of nucleotides 197-259 of the MPT64 protein gene, and the insertion of IS6110 fragment might also cause the false negative detection.

Application value of fluorescence PCR melting curve method in the identification of non-tuberculous mycobacteria

LI Ai-fang, TAN Xiao-wen, CUI Xiao-li, KANG Lei, DANG Li-yun, ZHANG Yao-hui, YANG Han

Chinese Journal of Antituberculosis. 2021, 43(7):  664-669.  doi:10.3969/j.issn.1000-6621.2021.07.005

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Objective To explore the application value of fluorescent PCR melting curve method in the identification of non-tuberculous mycobacteria (NTM), and to provide scientific basis for rapid and accurate diagnosis. Methods A total of 71 suspected NTM clinical isolates with positive BACTEC MGIT 960 liquid culture and negative MPB64 rapid antigen test were collected from Xi'an Chest Hospital from April to October 2020. Each clinical isolate was identified using the same specimen by fluorescent PCR melting curve method, gene chip method and 16S rRNA gene sequencing. The 16S rRNA gene sequencing results were used as reference standards to evaluate the detection efficiency of the fluorescent PCR melting curve method for strain identification. Results Detected by the melting curve method, the 67 NTM strains were mainly Mycobacterium tortoise/abscess (37.3%, 25/67) and Mycobacterium intracellular (25.3%, 17/67). The sensitivity, specificity and coincidence rate of Mycobacterium tortoise/abscess by fluorescence PCR melting curve method were 100.0% (24/24), 97.7% (42/43) and 98.5% (66/67), respectively; and those of Mycobacterium intracellular were 94.4% (17/18), 100.0% (49/49) and 98.5% (66/67), respectively. The consistency was 97.0% (65/67) rate between the fluorescence PCR melting curve method and the 16S rRNA gene sequencing method, and was 83.6% (56/67) between the gene chip method and the 16S rRNA gene sequencing method. Conclusion The fluorescence PCR melting curve method has high consistency with the gene sequencing method, it could be used for the rapid detection of mycobacterial species identification with good clinical application value.

Diagnostic accuracy of Xpert MTB/RIF Ultra for tuberculous meningitis

HUANG Mai-ling, SUN Qing, WANG Gui-rong, LI Wen-sheng, DU Ya-dong, CAI Bao-yun, HUANG Hai-rong, LI Qi, CHU Nai-hui

Chinese Journal of Antituberculosis. 2021, 43(7):  670-676.  doi:10.3969/j.issn.1000-6621.2021.07.006

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Objective To evaluate the performance of Xpert MTB/RIF Ultra (Xpert Ultra) for tuberculous meningitis (TBM) diagnosis. Methods All of 189 TBM suspected patients were consecutively enrolled from January 2017 to December 2018 at Beijing Chest Hospital. According to the clinical reference standard, the final sample size for analysis was 151 patients, which included 32 definite TBM, 55 probable TBM, 19 possible TBM, and 45 non-TBM patients. Uncentrifuged CSF specimens collected from each patient were subjected to smear, culture, Xpert and Xpert Ultra. The sensitivity and specificity of all the tests were assessed against uniform clinical case definitions of TBM. Results The direct head-to-head diagnostic performance comparison showed higher sensitivity of Xpert Ultra in contrast with Xpert (44.3% (47/106) vs. 24.5% (26/106); χ²=16.000, P<0.01) among 106 TBM patients. Xpert Ultra also produced a higher sensitivity than culture (44.7%, (34/76)vs. 18.4% (14/76); χ²=12.893,P<0.01) in 76 having culture results patients. When Xpert Ultra outcomes were integrated, the percentage of definite TBM cases increased from 30.2% (32/106) to 50.0% (53/106). Besides, among 62 patients with CSF culture-negative, the positive rate of Xpert Ultra was also higher than Xpert (38.7% (24/62)vs. 21.0% (13/62);χ²=7.692,P=0.003). Both Xpert Ultra (76.1% (35/46) vs. 20.0% (12/60); χ²=33.189, P<0.01) and Xpert (39.1% (18/46)vs. 13.3% (8/60); χ²=9.360, P=0.002) produced higher positive rate in patients without prior anti-TB treatment than those under anti-TB therapy. The positive rate of Xpert Ultra was higher than Xpert in patients without prior anti-TB treatment (χ²=15.059,P<0.01). Both Xpert Ultra and Xpert accurately identified the one rifampicin (RFP)-resistant and the 5 RFP-sensitive cases defined by phenotypic drug sensitivity test. Xpert Ultra outperformed both Xpert and culture for TBM diagnosis, especially for CSF culture negative TBM patients, making it a useful tool for rapid diagnosis of TBM.

Analysis of drug resistance of 1156 clinical isolates of Mycobacterium tuberculosis

YI Jun-li, YANG Xin-yu, CHEN Hao, ZHAO Yan-feng, CHEN Shuang-shuang, ZHANG Jie, DING Bei-chuan, DAI Xiao-wei, SUN Shan-hua, WU Wen-qing, LI Chuan-you

Chinese Journal of Antituberculosis. 2021, 43(7):  677-681.  doi:10.3969/j.issn.1000-6621.2021.07.007

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Objective Analyze the drug resistance of clinical isolates of Mycobacterium tuberculosis(MTB) in pulmonary tuberculosis patients managed by the Beijing tuberculosis prevention and control institutions to support the prevention and treatment of tuberculosis in Beijing. Methods The 1241 positive isolates of mycobacteria from January to December in 2019 all came from the Beijing tuberculosis prevention and control institutions. Identification (PNB/TCH growth test) and drug susceptibility tests of M.tuberculosis (the proportion method for 8 anti-tuberculosis drugs) were carried out. Drugs for sensitivity tests included INH,RFP,Sm,EMB,Lfx,Am,Cm and PAS. Results Among the 1241 mycobacteria positive isolates in 2019,1156 (93.15%) strains were MTB, and 85 (6.85%) strains were non-tuberculous mycobacteria (NTM). Among the 1156 MTB isolates, the total drug resistant rate was 24.83% (287/1156). The drug-resistant rate was 7.27% (84/1156), 6.75% (78/1156),5.28% (61/1156),1.73% (20/1156) and 0.17% (2/1156) for RFP, PDR, MDR, Pre-XDR and XDR respectively. The order of resistance to 8 anti-tuberculosis drugs was Sm (17.91%,207/1156) > INH (11.76%,136/1156) > RFP (7.27%,84/1156) > EMB (4.84%,56/1156) > Lfx (4.76%,55/1156) > PAS (2.16%,25/1156) > Cm (1.47%,17/1156) > Am (0.69%,8/1156). There were 43 types of drug-resistant profiles, including 7 monoresistant, 6 MDR,8 Pre-XDR,1 XDR, 21 PDR. Conclusion The drug resistance profiles of clinical isolates of tuberculosis patients managed by the Beijing tuberculosis prevention and control institutions are diverse and complex. We should strengthen the screening of drug-resistant tuberculosis patients for the management and treatment of drug-resistant tuberculosis patients preferably.

Analysis of clinical characteristics and prognosis of 21 pregnant women complicated with tuberculosis after in vitro fertilization-embryo transfer

QIN Yao, CAI Qing-shan, BAO Zhi-jian

Chinese Journal of Antituberculosis. 2021, 43(7):  682-688.  doi:10.3969/j.issn.1000-6621.2021.07.008

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Objective To analyze the clinical characteristics of pregnant women complicated with tuberculosis after in vitro fertilization-embryo transfer (IVF-ET). Methods Clinical data, including the clinical manifestation, medical information, laboratory examinations, imaging features, clinical diagnosis, treatment outcome and fetal outcome, of 21 pregnant women complicated with tuberculosis after IVF-ET admitted to the Tuberculosis Department of Hangzhou Chest Hospital, Zhejiang University School of Medicine from January 2013 to December 2020 were retrospectively analyzed. Results Among the 21 patients, 8 were in early pregnancy and 13 were in second trimester, with an average age of (29.57±4.20) years old (ranged from 23 to 42 years old). The most common clinical symptoms were fever (95.2%, 20/21), cough (85.7%, 18/21) and vaginal bleeding (71.4%, 15/21). Patient delay was found in all the 21 patients, the longest delay was 90 days, and the misdiagnosis rate of the first diagnosis was 100.0%, the average diagnosis time was 21 days (ranged from 15 to 30 days). T-SPOT.TB in peripheral blood was positive in 18 patients, sputum/cerebrospinal fluid GeneXpert MTB/RIF was positive in 4 patients; 20 patients had anemia, and 21 patients had hypoproteinemia. Chest CT scan mainly showed miliary nodules in both lungs in 18 cases. Eighteen patients were diagnosed with hematogenous disseminated tuberculosis, of whom two were complicated with tuberculous meningitis, one was complicated with tuberculous peritonitis; one was diagnosed as subacute disseminated tuberculosis; one was diagnosed with tuberculous meningitis; one was diagnosed with tuberculous pleurisy. During the treatment, six patients were transferred to ICU, four were due to respiratory failure, one was due to electrolyte disorder, and one was due to unconsciousness. Threatened abortion, inevitable abortion or incomplete abortion occurred in 9 cases 9-20 weeks after onset; 11 cases underwent induced abortion to terminate pregnancy, including one coma patient; one patient asked for fetal protection and was lost to follow-up. All the 21 patients underwent anti-tuberculosis treatment, 19 were cured after being discharged from hospital, one was still in anti-tuberculosis treatment, and one was in coma due to tuberculous meningitis. Conclusion Hematological disseminated tuberculosis and extra-pulmonary tuberculosis were commonly occurred in pregnant patients with tuberculosis after IVF-ET, and the conditions were always serious. When fever, cough, vaginal bleeding, headache occurred, and the anti-infective treatment effect was not good, tuberculosis related examinations should be carried out in time for pregnant patients.

Study on arterial embolization for massive hemoptysis due to pulmonary tuberculosis when proper esophageal artery participates in blood supply

FENG Yan, LI Ying, LI Qiang, ZHANG Dan, LIN Hu, GUO Xian-li

Chinese Journal of Antituberculosis. 2021, 43(7):  689-693.  doi:10.3969/j.issn.1000-6621.2021.07.009

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Objective To explore the safety and efficacy of proper esophageal artery (PEA) embolization in the treatment of massive hemoptysis due to pulmonary tuberculosis when PEA participates in blood supply, as well as the characteristics of lesions. Methods Clinical data of 11 patients confirmed that PEA participate in blood supply for the massive hemoptysis due to pulmonary tuberculosis by PEA angiography from the 8th Medical Center of Chinese PLA General Hospital between June 2017 and July 2020 were analyzed. CT scan was performed before the procedure and PEA arteriography were performed during the interventional procedure. Once the blood supply was identified, catheterization and embolization were selectively inserted into the main artery for embolization with PVA particle. The distribution and characteristics of the lesions, angiographic findings and treatment results were analyzed. Results All the 11 patients were complicated with thickening of the left mediastinal pleura. The damaged upper lobe of left lung was found in 3 patients, 7 patients were complicated with the bronchiectasis of left lower lobar, and the cavity of left lung was found in 5 patients. In 3 patients, the origin of PEA was on the level of T₆; in 8 patients, the origin of PEA was on the level of T_7-8. Enlargement of trunk, increase and disorder of branches, as well as neovascularization were found in angiography. PEA-pulmonary artery shunt was found in 5 patients. Communication between the esophageal artery and the left bronchial artery was observed in 1 patient, and between the esophageal artery and the right bronchial artery was observed in another patient. Hemoptysis stopped immediately after treatment in all the patients. Recurrent hemoptysis was observed in 3 patients 2 days, 22 months and 37 months after the treatment, respectively, which were considered to be unrelated to the PEA. There was no recanalization of the PEA. No serious complications were observed. Conclusion PEA participating in blood supply for tuberculosis lesion always occurred in patients complicated with thickening of the left mediastinal pleura, and lesions mainly located in the lower lobe and lingual lobe of left lung. PEA embolization is technically feasible and safe.

Analysis of CT findings in patients with initial and retreated cavernous rifampicin-resistant tuberculosis

CAO Pan, LIANG Kuang-li, YUAN Ji-xin, LI Yong-bo, CHEN Rui, ZHANG Zhi-fei, WU Qian-hong

Chinese Journal of Antituberculosis. 2021, 43(7):  694-701.  doi:10.3969/j.issn.1000-6621.2021.07.010

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Objective To comparatively analyze the CT findings in patients with initial and retreated cavernous rifampicin-resistant tuberculosis. Methods From January 2020 to January 2021, 72 cavernous rifampicin-resistant tuberculosis patients confirmed by drug sensitivity test at Tuberculosis Hospital of Shannxi Province were collected and divided into initial treatment group (n=34) and retreatment group (n=38) according to the treatment history. Differences in the general clinical data, cavernous and non-cavernous CT findings between two groups were analyzed. Besides, CT findings in two groups, including cavity number, maximum inner diameter of cavity, cavity wall calcification, lung consolidation, destructive lung, emphysema and intrapulmonary calcification were comparatively analyzed. Results As revealed by comparisons of cavity lesion CT findings between two groups, the median cavity number in retreatment group was 5.0 (2.0, 10.0), while that in initial treatment group was 2.0 (1.0, 5.0), and the difference was of statistical significance (Z=2.020, P<0.05). The maximum inner diameter of cavity in retreatment group was 19.40 (13.09,34.09) mm, while that in initial treatment group was 12.31 (5.35,22.97) mm, and the difference was of statistical significance (Z=2.662, P<0.05). The rate of cavity wall calcification in retreatment group was 42.11% (16/38), while that in initial treatment group was 17.65% (6/34), and the difference was statistically significant (χ ²=5.059, P<0.05). When comparing the CT signs of non-cavity lesions between two groups, the rates of lung consolidation, destroyed lungs, emphysema and intrapulmonary calcification in retreatment group were 78.95% (30/38), 39.47% (15/38), 39.47% (15/38), 52.63% (20/38), respectively; while those in initial treatment group were 52.94% (18/34), 17.65% (6/34), 14.71% (5/34), 23.53% (8/34), separately, and the differences were of statistical significance (χ ² values were 5.461, 4.138, 5.487 and 6.395, respectively; allP<0.05). Conclusion Compared with initial treatment patients, retreated cavernous rifampicin-resistant tuberculosis patients had more cavities, greater maximum inner diameter of cavity, along with more severe CT findings of cavity wall calcification, lung consolidation, destroyed lungs, emphysema and intrapulmonary calcification.

Analysis on funding input and benefit output for tuberculosis control and prevention in China from 2011 to 2019

LI Xue, RUAN Yun-zhou, LIU Xiao-qiu, XU Cai-hong, CHEN Wei, DU Xin, HU Dong-mei

Chinese Journal of Antituberculosis. 2021, 43(7):  702-707.  doi:10.3969/j.issn.1000-6621.2021.07.011

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Objective To explore the social benefit generated by the funding for tuberculosis (TB) control and prevention from 2011 to 2019. Methods The data of smear positive TB patients treatment outcome and proportion of TB labor population from 2011 to 2019 were collected from theNational Tuberculosis Information Management System, and funds input of the government(including local and central government), international projects, and relevant data such as per capita GDP from 2011—2019 were collected as well. The most common methods in health economics such as cost-effectiveness, cost-utility, cost-benefit were applied to assess TB control social effect, social utility and social cost during 2011-2019. Results The total of 16.45 billion yuan of a variety of resources was invested during the year of 2011-2019, 2.473 million smear positive TB patients were treated successfully, 18.544 (11.127-27.816) million healthy people were protected from infection and 7.42 (4.45-11.13) billion yuan of medical expenses were saved, 714.57 billion yuan of social and economic losses were recovered. On the basis of current staff and facilities, every additional input of government with 1 yuan produced 43.9 (43.7-44.1) yuan economic benefits. It cost only 886.9 (591.3-1478.0) yuan for each healthy person to avoid infection. Only 933.5 yuan was needed to save the loss of a DALY. Conclusion From 2011 to 2019, the investment of governments and international projects in TB prevention and control has high health and economic benefits. It is suggested that governments at all levels continue to increase investment in TB prevention and control in order to achieve sustainable social benefits.

Spatial and temporal distribution characteristics and correlation analysis of HIV/AIDS and tuberculosis in Liangshan Yi Autonomous Prefecture, Sichuan from 2013 to 2019

LI Jing, YUAN Feng-shun, LI Ting, LI Yun-kui, GAO Wen-feng, YANG Cheng-bin, HE Jin-ge, YANG Wen

Chinese Journal of Antituberculosis. 2021, 43(7):  708-715.  doi:10.3969/j.issn.1000-6621.2021.07.012

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Objective To compare the temporal and spatial distribution of reported cases of HIV infection and AIDS (HIV/AIDS) and tuberculosis in Liangshan Yi Autonomous Prefecture (Liangshan Prefecture) in Sichuan from 2013 to 2019, and analyze the temporal and spatial correlation of the two diseases and the hot areas of the disease, so as to provide reference for formulating prevention and control strategies. Methods Numbers of reported HIV/AIDS and tuberculosis cases between 2013 and 2019 were collected from internet-based reporting system of Chinese Center for Disease Control and Prevention. The temporal and spatial correlation of the two diseases was analyzed by simple correlation, linear regression and spatial autocorrelation. SPSS 23.0 software was used to analyze the simple correlation and linear regression, ArcGIS 10.0 software was used to analyze the global spatial autocorrelation and local spatial autocorrelation, and the dual variable spatial autocorrelation analysis was carried out using GeoDa 1.1.4 software. Results HIV/AIDS and tuberculosis patients were reported from all the 17 counties (districts) in Liangshan Prefecture. The numbers in each year were 4139, 4406, 4005, 4802, 5570, 10105 and 4694, respectively, and the increasing rates were 6.5%, -9.1%, 19.9%, 16.0%, 81.4% and -53.5%, respectively. Numbers of reported tuberculosis cases in each year were 4590, 4323, 4453, 5931, 6748, 6432 and 6893, respectively, and the increasing rates were -5.8%, 3.0%, 33.1%, 13.8%, -4.7% and 7.2%, respectively. The results of linear regression analysis showed that the correlation coefficient (r_s) between numbers of reported cases of HIV/AIDS and tuberculosis in Liangshan Prefecture according to a linear distribution with the year (x). The linear regression equation was: r_s=-106.602+0.53x (regression coefficient test: t=3.109, P=0.027), the goodness of fit was average (determination coefficient R ²=0.659, correction coefficient R ²=0.591). Global spatial autocorrelation analysis showed that there was a positive spatial correlation between the reported incidence of HIV/AIDS from 2013 to 2018 (Moran’sI values were 0.213, 0.194, 0.342, 0.368, 0.271 and 0.180, respectively; P values were 0.028, 0.033, 0.003, 0.002, 0.008 and 0.027, respectively); the reported incidence of tuberculosis from 2013 to 2019 had a positive spatial correlation of medium degree and above (Moran’sI values were 0.374, 0.500, 0.451, 0.347, 0.487, 0.472 and 0.532, respectively; all P<0.05). Local spatial autocorrelation analysis showed that, from 2013 to 2018, Zhaojue County, Butuo County, and Jinyang County in Liangshan Prefecture were hot spots for reported cases of HIV/AIDS. From 2013 to 2015, the hot spots for tuberculosis were mainly concentrated on Leibo County, Meigu County, and Jinyang County; Ganluo County was a hot spot from 2015 to 2017; Zhaojue County became the hot spot in 2014 and had continued to be a hot spot since 2016, and it had spread to Yuexi County. The bivariate global spatial autocorrelation analysis showed that the reported incidence of HIV/AIDS and tuberculosis were positively correlated from 2013 to 2019 (Moran’sI values were 0.312, 0.345, 0.385, 0.419, 0.388, 0.345 and 0.293, respectively; all P<0.05). Conclusion There was a strong positive correlation between HIV/AIDS and tuberculosis reported cases in the temporal and spatial distribution, which suggested that Liangshan Prefecture should pay equal attention to the two diseases in the prevention and control of these two infectious diseases, close combination were needed, the diagnosis and treatment of HIV/AIDS and tuberculosis patients should be improved, the prevention and control measures for key areas and groups should be strengthened, and the diagnosis, treatment and health care should be improved.

Analysis on characteristics of reported pulmonary tuberculosis among students in Chongqing from 2008 to 2019

FAN Jun, ZHANG Wen, ZHANG Ting, WANG Qing-ya, YU Ya, CHENG Jun

Chinese Journal of Antituberculosis. 2021, 43(7):  716-723.  doi:10.3969/j.issn.1000-6621.2021.07.013

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Objective To analyze the characteristics of reported pulmonary tuberculosis (PTB) in students in Chongqing during 2008-2019. Methods The epidemiological data of reported PTB in students and population data of Chongqing during 2008-2019 were collected from Infectious Diseases Reporting System (IDRS) and Chongqing Statistical Yearbook respectively, and the spatial, temporal and population distributions of reported PTB in students were analyzed. Results A total of 25918 PTB cases in students in Chongqing were reported from 2008 to 2019, with an average annual reported incidence of 40.36/100000 (25918/64222000). The reported PTB incidence decreased from 58.72/100000 (3067/5223100) in 2008 to 34.30/100000 (1959/5710600) in 2019, which showed a reduction trend by year (X ²_trend=414.882,P<0.001). March was the peak period for students to report PTB, accounting for 15.70% (4069/25918) of total cases. However, there was a slightly difference before and after 2017. The reporting peak period was March from 2008 to 2017, with an average percentage of 17.42% (3781/21711) in all reported PTB. While the reporting peak periods were in September and December from 2018 to 2019, with an average percentage of 12.50% (526/4207) and 13.00% (547/4207) in all reported PTB, respectively. Southeast district had the highest reported PTB incidence in students, with an average annual reported incidence being 88.31/100000 (5281/5980400), followed by Northeast district (49.08/100000, 8737/17802100). Central district (32.24/100000, 5572/17283600) and West district (27.33/100000,6328/23155500) had the lowest incidence. The top five counties with highest reported incidence of PTB in students were Pengshui county (153.40/100000,1707/1112800), Wuxi county (102.47/100000,889/867600), Qianjiang district (102.25/100000,1010/987800), Youyang county (88.69/100000,1074/1210900) and Wushan county (82.45/100000,837/1015200). The ratio of male to female students with PTB was 1.29∶1. PTB patients in senior high school age group (16-18 years old) accounted for the highest proportion (46.92%,12161/25918) in all cases. Conclusion The reported PTB incidence among students in Chongqing showed a decreasing trend from 2008 to 2019, and PTB patients aged 16-18 years old had the highest percentage. The reporting peak period changed from March to September and December from 2018, and southeast district in Chongqing had the highest reported incidence of PTB. More attention should be paid to high TB epidemic areas, and physical examination should be continuously strengthened in students.

Research and progress of early bactericidal activity of anti-tuberculosis drugs

YAO Rong, LU Yu

Chinese Journal of Antituberculosis. 2021, 43(7):  724-728.  doi:10.3969/j.issn.1000-6621.2021.07.014

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The early bactericidal activity of anti-tuberculosis drugs reflects the ability to kill Mycobacterium tuberculosis (MTB) with high metabolism and proliferation after entering the blood and tissues, to control the disease early and reduce the infectivity. Decurrently, commonly used methods for determining early bactericidal activity of drugs mainly include sputum colony forming units on solid medium and determining positive time on liquid medium. The results of the two methods are normally consistent. Early bactericidal activity research is currently an important part of the development of new anti-tuberculosis drugs, which can predict the bactericidal activity of the drug. However, it cannot measure the sterilization activity of the drug, which could only be estimated according to either the recurrence rate after routine clinical trials or the sputum conversion rate in 2 months. At present, the epidemic of tuberculosis is severe, and difficulties and challenges are found in the treatment. It is new drugs with high bactericidal activity are urgently to develop to actively inhibit the growth of MTB and the spread of tuberculosis. This review of the early bactericidal activity of the main anti-tuberculosis drugs and the main research methods aimed to provide reference for the better application of existing drugs and development of new drugs.

Research and development/exploitation of therapeutic drugs for NTM pulmonary disease:present situation and challenges

ZHENG Lu-yao, LU Yu, CHEN Xiao-you

Chinese Journal of Antituberculosis. 2021, 43(7):  729-734.  doi:10.3969/j.issn.1000-6621.2021.07.015

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Non-tuberculous mycobacteria (NTM) belongs to the genus mycobacterium,which is “close relative” to Mycobacterium tuberculosis. In recent years, the prevalence of chronic lung diseases caused by NTM is increasing at an alarming rate, even exceeding Mycobacterium tuberculosis in some countries. At present, the clinical treatment mainly relies on long-term therapy with combined medication, but the results are often unsatisfactory. Therefore, there is an urgent need for noval and more effective antimicrobials as well as new chemotherapy regimen. This article reviews the current situation and challenges in NTM drug development, in order to provide new insight for the treatment of NTM pulmonary disease.

Research progress on diagnosis methods of tuberculous meningitis

WANG Le-le, GUO Jian-qiong, YANG Song, TANG Shen-jie

Chinese Journal of Antituberculosis. 2021, 43(7):  735-740.  doi:10.3969/j.issn.1000-6621.2021.07.016

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Tuberculous meningitis (TBM) is the most common tuberculosis of the central nervous system and the most severe extra-pulmonary tuberculosis, which often onset with nonspecific symptoms. At present, all TBM diagnostic techniques are not perfect. Although the cerebrospinal fluid (CSF) of patients changes obviously, it is still not specific. In addition, the bacterial load in CSF is very low, the diagnostic sensitivity of relevant laboratory testing techniques is low, and the duration is long. This artical summarized problems of the diagnosis of TBM, reviewed the recent research progress and advantages or disadvantages of different diagnostic methods for TBM,in order to improve the diagnosis rate of TBM and avoid delay of treatment.

Analysis of the investigation results on the public awareness rate of key messages of tuberculosis prevention and treatment in Shandong in 2020

WEI Qian, WANG Shi-chang, CAO Chuan-bing

Chinese Journal of Antituberculosis. 2021, 43(7):  741-746.  doi:10.3969/j.issn.1000-6621.2021.07.017

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From November 2020 to March 2021, to investigate the public awareness rate of key tuberculosis (TB) messages and the status of receiving health education, so as to provide a scientific evidence for further strengthening on Health Promotion on Tuberculosis Control. Residents aged ≥15 years from 68 survey spots in Shandong was selected using multi-stage stratified cluster sampling method. The final evaluation plan and questionnaire of the 13th Five-Year Plan for national tuberculosis control and prevention were conducted face-to-face, 7065 residents were investigated, and 7065 valid questionnaires were collected, the effective rate was 100.00%. The awareness rate of the 5 key messages of tuberculosis prevention and treatment was 88.27% (31183/35325). The awareness rates of pulmonary tuberculosis about “it is a serious chronic infectious disease”, “route of transmission”, “suspicious symptoms”, “preventive measures” and “whether could be cured” were 85.42% (6035/7065), 91.48% (6463/7065), 92.20% (6514/7065), 91.79% (6485/7065) and 80.48% (5686/7065), respectively. Higher awareness rates were found in residents aged 15-29 years old (91.84%, 4468/4865), college degree (91.00%, 2994/3290) and soldiers (92.50%, 74/80). And lower awareness rates were found in residents aged 60-94 years old (82.74%, 7947/9605), illiterate and semi-illiterate (77.46%, 2932/3785), and farm workers (86.21%, 15198/17630). In 2020, the public awareness rate of the core information of tuberculosis prevention and treatment reached 85%, the goal of the final evaluation plan of the 13th Five-Year Plan for national tuberculosis control and prevention. In the future, effective health education measures should be taken to accurately convey the key information to the target population, especially the elderly and farm workers with low awareness rate.

The effect of joint relaxation training on pain, anxiety and sleep quality of postoperative patients with spinal tuberculosis

AI Ya-juan, HAN Xu, BI Na, YU Xing-yan, ZHANG Ying, ZHANG Ya-ru, WANG Pan, LUO Xiao-bo

Chinese Journal of Antituberculosis. 2021, 43(7):  747-750.  doi:10.3969/j.issn.1000-6621.2021.07.018

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This was a retrospective study. The information and data of 135 patients with spinal tuberculosis, who received treatment at the Minimally Invasive Spine Surgery Department of the 8th Medical Center, PLA General Hospital from January 2017 to July 2019, were analyzed. Among them, 72 patients received routine nursing care after surgery from January 2017 to June 2018 while 63 patients received joint relaxation training (including abdominal breathing, meditation, and muscles relaxation) as the postoperative nursing care method from July 2018 to July 2019. From each of the above-mentioned patient groups, 40 cases were randomly selected respectively as the control group and the observation group. Visual analogue scale (VAS) was used to evaluate the degree of postoperative pain in the patients. In the observation group, the VAS scores in the patients were 4.22±0.81 and 2.22±0.72 respectively on postoperative Day 3 and 1 week, which were lower than those in the control group patients (4.98±1.12 on postoperative Day 3 and 2.98±1.04 at 1 week after the operation), and the differences were statistically significant (t=3.478, P=0.001; t=3.800, P=0.000). At two weeks after the operation, the scores of self-rating Anxiety scale and self-rating Depression scale in the observation group patients were 44.68±3.47 and 44.74±3.53, which were lower than those in the control group patients (47.84±3.58 and 47.17±3.50). The differences were statistically significant respectively (t=4.009, P=0.000; t=3.092, P=0.003). The Pittsburgh sleep quality index (PSQI) scores in the observation group at 2 weeks after the operation was 5.65±2.40, the sleep time at 24 hours and 48 hours after the operation were (5.92±0.76) h and (6.47±0.96) h in the observation group, which were much better than those in the control group (6.98±1.12, (5.44±0.71) h, (5.71±0.81) h), and the differences were statistically significant (t=3.176, P=0.002; t=2.919, P=0.005; t=3.827, P=0.000). This study showed that the joint relaxation training with abdominal breathing, meditation and muscles relaxation to the postoperative patients with spinal tuberculosis can relieve pain and psychological pressure of the patients, improve their sleep quality.

Investigation and analysis of a cluster epidemic of rifampicin-resistant tuberculosis in a school

CHANG Jun-li, ZHANG Jian-hong, ZHANG Ying, ZHANG Hai-fang, FAN Peng-fei, LI Qiu-hua, DING Xue-ling

Chinese Journal of Antituberculosis. 2021, 43(7):  751-754.  doi:10.3969/j.issn.1000-6621.2021.07.019

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In May 2020, three student cases of active tuberculosis were reported in Yunhe County and Jinyun County of Lishui City in Zhejiang Province. Through field epidemiological investigation and follow-up laboratory test results, it was finally confirmed that the three student cases were a case of primary rifampicin-resistant tuberculosis aggregation epidemic. It is suggested that: taking various ways to strengthen the health education of tuberculosis prevention and control knowledge in schools, comprehensively promoting and strengthening the tuberculosis health screening of junior high school and senior high school freshmen, and early diagnosis and treatment of drug-resistant tuberculosis under the existing diagnostic technology and detection ability are important measures to improve the accurate prevention and control ability of drug-resistant tuberculosis in schools; At the same time, strengthening the network platform epidemic monitorning and the establishment of tuberculosis drug-resistant strains gene bank platform are the most powerful basis for drug-resistant tuberculosis traceability analysis.