Chinese Journal of Antituberculosis

Expert consensus on polymorphism detection of N-acetyltransferase-2 encoding gene and appropriate isoniazid dosing for tuberculosis patients

Beijing Chest Hospital,Capital Medical University,Editorial Board of Chinese Journal of Antituberculosis

Chinese Journal of Antituberculosis. 2021, 43(11): 1107-1112. doi:10.3969/j.issn.1000-6621.2021.11.001

Abstract ( 944 )

HTML ( 40 )

PDF (1290KB) ( 844 )

Save

Figures and Tables | References | Related Articles | Metrics

Isoniazid (INH) is one of the core drugs in the anti-tuberculosis (anti-TB) treatment regimens, and its catabolic speed is dependent on the activity of N-acetyltransferase-2 (NAT2). According to polymorphisms of the enzyme encoding gene NAT2, patients could be categorized as slow, intermediate or fast acetylators. The significant blood concentration difference was found in the deployment of uniform INH dosage for different TB patients, it could influence the treatment outcome and the occurrence of adverse drug reactions. To promote more scientific and canonical NAT2 gene polymorphism detection and acetylator type judgement, and then guide the appropriate isoniazid dosing for tuberculosis patients, experts in the field of tuberculosis treatment and pharmacology organized by Beijing Chest Hospital and the Editorial Board of Chinese Anti-tuberculosis Journal composed a consensus with the existing guidelines and published professional literature. This consensus includes the method of acetylator type categorization, the pharmacokinetic features, the influences on treatment outcome and adverse drug reactions, the dose adjustment principle of isoniazid for different acetylator types, and the important concerns on NAT2 polymorphism detection.

Interpretation of Rifampicin-resistant pulmonary tuberculosis diagnostic process

LI Ren-zhong, RUAN Yun-zhou, SU Wei, HE Yu-ying, LIU Kuang-yi

Chinese Journal of Antituberculosis. 2021, 43(11): 1113-1115. doi:10.3969/j.issn.1000-6621.2021.11.002

Abstract ( 1087 )

HTML ( 37 )

PDF (1068KB) ( 1120 )

Save

References | Related Articles | Metrics

The Rifampicin-resistant Pulmonary Tuberculosis Diagnostic Process is a group standard issued by Chinese Antituberculosis Association on May 12, 2021 and implemented since then. The standard specifies the diagnostic algorithms of rifampicin resistant pulmonary tuberculosis patients under different technical conditions: the drug resistance diagnosis process of traditional drug sensitivity detection technology, the drug resistance diagnostic progress of combination of molecular biology drug resistance detection technology and traditional drug sensitivity detection technology, multi-color nested real-time fluorescence quantitative PCR, molecular biology drug resistance detection technology and drug resistance diagnosis process of combination of traditional drug sensitivity detection technology. The main contents and applicable conditions of this standard are hereby interpreted.

Interpretation of the Diagnosis process for etiology negative pulmonary tuberculosis (T/CHATA 008—2020)

YANG Chun-long, ZHOU Lin, CHEN Ming-ting

Chinese Journal of Antituberculosis. 2021, 43(11): 1116-1119. doi:10.3969/j.issn.1000-6621.2021.11.003

Abstract ( 1055 )

HTML ( 38 )

PDF (1078KB) ( 1397 )

Save

References | Related Articles | Metrics

Based on the Diagnostic for pulmonary tuberculosis (WS 288—2017) and Classification of tuberculosis (WS 196—2017), the Diagnosis process for etiology negative pulmonary tuberculosis (T/CHATA 008—2020) is the diagnostic criteria specifically developed for etiology negative tuberculosis. The guideline is so instructional and practical that it can help medical care institutions and their staff across the country to standardize the diagnostic performance for etiology negative tuberculosis. In this article we describe the background, the main contents and the matters need attention of the guideline in detail, with the aim of facilitating medical staff to better apply the algorithms in their clinical practice.

End tuberculosis epidemic by establishing zero tuberculosis community

CHENG Jun, ZHAO Yan-lin

Chinese Journal of Antituberculosis. 2021, 43(11): 1120-1124. doi:10.3969/j.issn.1000-6621.2021.11.004

Abstract ( 968 )

HTML ( 74 )

PDF (1154KB) ( 704 )

Save

References | Related Articles | Metrics

Community is the basic unit of society and the main place of implementing tuberculosis (TB) patients treatment and management. Active case finding and preventive therapy are the core elements of TB control action 2.0, guided by End TB Strategy. Public’s knowledge, attitude and practice for TB control are key points for eliminating hazard resulted from TB by spreading over whole area from one point gradually. Authors describe the importance of establishing Zero TB community, and suggest all effective measurements should be integrated into a package. Comprehensive measurements including active case finding and preventive therapy should be implemented at community level, and spread gradually to establish Zero TB county and/or Zero TB city, by which lay a solid foundation for End TB.

Stages in the natural history of tuberculosis and the current status and prospect of diagnosis

LI Meng, GAO Qian

Chinese Journal of Antituberculosis. 2021, 43(11): 1125-1131. doi:10.3969/j.issn.1000-6621.2021.11.005

Abstract ( 1038 )

HTML ( 41 )

PDF (1244KB) ( 1042 )

Save

Figures and Tables | References | Related Articles | Metrics

From Mycobacterium tuberculosis infection to active disease, it is a complex continuous process that has been artificially separated into many stages. The focus of past studies, diagnostic tests, and pharmacological therapy are mainly on latent infection or active disease. The continuing high epidemic of tuberculosis has led to a gradual focus on other stages. Understanding the definition and characteristics of the different stages in the natural history of tuberculosis is essential for developing new diagnostic techniques and developing more rational interventions. This article provided a review of the definitions and characteristics of the various stages in the natural history of tuberculosis and the current status and prospect of its diagnosis, with the hope to aid in the development of early diagnostic tools and tuberculosis prevention strategies.

The status quo and thinking on the implementation of health education for patients with pulmonary tuberculosis during clinical practice

LI Zhen, CHANG Li-yang, WANG Ling-hua

Chinese Journal of Antituberculosis. 2021, 43(11): 1132-1138. doi:10.3969/j.issn.1000-6621.2021.11.006

Abstract ( 554 )

HTML ( 31 )

PDF (1173KB) ( 704 )

Save

References | Related Articles | Metrics

Tuberculosis (TB) is a chronic infectious disease seriously affecting human health. The huge number of tuberculosis patients in our country shows that it still does not get effectively control. The main factor influencing TB cure rate is patients’ poor compliance. Health education is a relatively economical and effective measure to improve patients’ compliance. We thus summarized contents, implementing ways, effect evaluation measures of TB patient health education in this article.

Analysis of efficacy in the treatment of 44 pulmonary tuberculosis patients with mycobacterium culture-positive multidrug-resistant/extensively drug-resistant with bedaquiline-containing regimen for 24 weeks

PEI Yi, GAO Jing-tao, HUANG Yun-hui, HE Fang, FENG Wen-jun, YANG Xiao-yun, HU Yu-meng, LEI Li-ping, SHI Li

Chinese Journal of Antituberculosis. 2021, 43(11): 1139-1145. doi:10.3969/j.issn.1000-6621.2021.11.007

Abstract ( 1052 )

HTML ( 14 )

PDF (1033KB) ( 451 )

Save

Figures and Tables | References | Related Articles | Metrics

Objective To evaluate the efficacy and safety of 24-week bedaquiline (Bdq)-containing regimen on multidrug-resistant pulmonary tuberculosis and extensively drug-resistant pulmonary tuberculosis (MDR/XDR-PTB) patients and provide clinical evidence for further safe and effective use in more Chinese MDR/XDR-PTB patients. Methods Forty-four patients with mycobacterium culture-positive MDR-TB and XDR-TB were enrolled in Changsha Central Hospital Affiliated to University of South China from March 2018 to March 2020 and then treated with Bdq-containing regimen. Out of them, 31 were males and 13 were females with a median age of 38.2 (26, 49) years in the whole, while 25 with pulmonary cavities. The efficacy of the regimen was evaluated by culture conversion rates and pulmonary cavity closure rate at the end of 24 weeks, and the safety was evaluated by the incidence of adverse events, especially the occurrence of QT prolongation. Results Out of 44 patients, 38 achieved successful culture conversion, 2 failed sputum conversion, 2 died, 1 dropped out, and 1 lost to follow-up, with favorable outcome at 86.4% (38/44). Forty patients completed 24 weeks of Bdq treatment, and the culture conversion rates were 45.5% (20/44), 72.5% (29/40), 95.0% (38/40), 100.0% (40/40) and 95.0% (38/40) at the end of 2, 4, 8, 12 and 24 weeks, respectively, with the median conversion time at 22 days (interquartile range IQR18-59). Among the 25 patients with pulmonary cavities, 23 completed 24 weeks of treatment, and the rate of pulmonary cavity closure was 39.1% (9/23) and 82.6% (19/23) at the end of 12 and 24 weeks, respectively. Twenty-nine patients (65.9%, 29/44) reported a total of 81 adverse events (AEs), 72.8% (59/81) of which were grade 1 or 2.QT prolongation was the most common one probably associated with Bdq (40.9%,18/44). Conclusion Inclusion of Bdq in the regimen can achieve higher rates of culture conversion and cavity closure at the end of 24 weeks with acceptable safety profiles in MDR/XDR-TB patients.

Sixty-seven MDR-,and XDR-PTB cases with sputum culture conversion then treated with bedaquiline-containing regimens: A singal arm, single center observational study

TIAN Dan, HU Xiao-meng, JIN Wu, CHENG Chang-hao, XIONG Lei-qun, HU Rong-hua, JIN Qian, LIU Yun, DU Juan

Chinese Journal of Antituberculosis. 2021, 43(11): 1146-1152. doi:10.3969/j.issn.1000-6621.2021.11.008

Abstract ( 830 )

HTML ( 14 )

PDF (821KB) ( 559 )

Save

Figures and Tables | References | Related Articles | Metrics

Objective To observe the effectiveness and safety of bedaquiline in the treatment of multidrug-resistant/extensively drug-resistant tuberculosis (MDR/XDR-PTB) patients with sputum culture negative conversion. Methods From September 1,2018 to March 31, 2020, 67 culture-confirmed pulmonary TB cases who had gotten sputum culture conversion with anti-tuberculosis treatment in Wuhan Pulmonary Hospital were enrolled, including 2 MDR-PTB cases, 58 pre-XDR-PTB cases and 7 XDR-PTB cases. All patients were treated with bedaquiline-containing regimens. Adverse reactions and outcomes of treatment were analyzed. Results Fifty-nine patients completed the whole course of treatment with a cure rate of 82.1% (55/67) and a treatment success rate of 88.1% (59/67). Adverse outcomes (death, lost to follow-up) accounted for 11.9% (8/67) of all patients. At the end of the 12th week, the proportion of patients with obvious absorption or absorption of lesions was 74.6% (50/67), and 96.5% (55/57) at the end of treatment. At 12 weeks, the percentage of patients with cavity shrinking or closing reached 75.0% (15/20), this proportion then stabilized at 94.1% (16/17) from the end of the 36th week till the end of the whole treatment. A total of 182 adverse events occurred among 53 cases (79.1%,53/67) during the whole course of treatment, including 45 (24.7%) over grade Ⅲ events, and 4 (2.2%) serious adverse events. Adverse events mainly were impaired liver function (66 cases, 36.3%) and prolonged QTc (21 cases, 11.5%). Conclusion Bedaquilin-containing treatment for MDR/XDR-PTB patients with sputum culture conversion can promote lesion absorption at early stage, and can bring high treatment success rate with a low incidence of adverse events over Ⅲ grade.

Efficacy evaluation of short-course chemotherapy in patients with retreated pulmonary tuberculosis for the first time

CHEN Shuang-shuang, SHA Wei, LIU Xiao-ning, MA Rong, CHENG Jie, LI Ye, WANG Xin-qiang, KAN Xiao-hong

Chinese Journal of Antituberculosis. 2021, 43(11): 1153-1158. doi:10.3969/j.issn.1000-6621.2021.11.009

Abstract ( 662 )

HTML ( 18 )

PDF (804KB) ( 359 )

Save

Figures and Tables | References | Related Articles | Metrics

Objective To investigate the efficacy, compliance and adverse reactions of short-course chemotherapy in the patients with retreated pulmonary tuberculosis for the first time, and to provide evidence for clinical diagnosis and treatment. Methods A total of 101 eligible retreated tuberculosis patients admitted to Anhui Chest Hospital from June 2018 to March 2021 were enrolled and randomly divided into two groups. The short-course regimen group (73 cases) was given moxifloxacin, rifambutin, isoniazid aminosalicylate, pyrazinamide and ethambutol for 6 months, and the 28 patients in standard treatment group were treated with isoniazid, rifampicin, pyrazinamide and ethambutol for 3 months during the intensive phase, and isoniazid, rifampicin and ethambutol for 6 months during the continuation period. The 2-month sputum conversion rate, treatment success rate, imaging focus absorption rate and adverse reactions were compared between the two groups. Results The 2 month sputum negative conversion rate (69.0%, 29/42) in short-course regimen group was higher than that in standard regimen group (41.2%, 7/17), the difference was statistically significant (χ²=3.952, P=0.047).The treatment success rate of the short-course regimen group was 78.1% (57/73), which was higher than that of the standard regimen group (60.7%, 17/28), the difference was statistically significant (Fisher’s test, P=0.039). The absorption of the lesions in the short-course regimen group was significantly better than that in the standard control group. In the short-course regimen group, there were 4 cases of total absorption (7.0%), 24 cases of obvious absorption (42.1%), 29 cases of absorption (50.9%), 0 case of constant absorption (0.0%), and 0 case of deterioration (0.0%). In the standard treatment group, there were 0 case of total absorption (0.0%), 3 cases of obvious absorption (17.6%), 13 cases of absorption (76.5%), 1 case of constant absorption (5.9%), and 0 case of deterioration (0.0%), and there was a significant difference between the two groups (Fisher’s test, P=0.046). The incidence of adverse reactions was 11.0% (8/73) in the short-course regimen group and 14.3% (4/28) in the standard course group, with no significant difference (χ²=0.014, P=0.905). Conclusion In the treatment process of the first retreatment of pulmonary tuberculosis patients, patients in the short-course regimen group have higher compliance compared with the standard regimen group, and the short-course regimen is conducive to sputum negative conversion and lesion absorption, and could significantly shorten the treatment time and improve the efficacy.

Analysis of phenotypic drug sensitivity test of rifampicin-resistant Mycobacterium tuberculosis by GeneXpert MTB/RIF

FANG Mu-tong, SU You-feng, MAO Zhi, ZHANG Hong-yi, ZENG Jian-feng, ZENG Jian, CAO Wei-peng, WANG Zhong-yuan

Chinese Journal of Antituberculosis. 2021, 43(11): 1159-1163. doi:10.3969/j.issn.1000-6621.2021.11.010

Abstract ( 1453 )

HTML ( 20 )

PDF (801KB) ( 435 )

Save

Figures and Tables | References | Related Articles | Metrics

Objective To analyze the drug resistance and types of phenotypic drug sensitivity test (phenotypic drug sensitivity test) of rifampicin-resistant Mycobacterium tuberculosis (MTB) isolates diagnosed by GeneXpert MTB/RIF (Xpert). Methods A retrospective study was conducted in which 346 rifampicin-resistant pulmonary tuberculosis (RR-PTB) patients (142 new cases and 204 re-treated cases) from the Third People’s Hospital of Shenzhen between January 2015 and December 2020. The drug resistance and types of phenotypic drug sensitivity test of clinical isolates of MTB strains to 10 anti-tuberculosis drugs (rifampicin, isoniazid, streptomycin, rifabutin, ethambutol, levofloxacin, p-aminosalicylic acid, amikacin, protionamide, capreomycin) were analyzed. Results The resistance rates of the 346 strains to 10 anti-tuberculosis drugs from high to low were rifampicin (95.95%, 332/346), isoniazid (84.68%, 293/346), streptomycin (58.38%, 202/346), rifabutin (57.23%, 198/346), ethambutol (50.29%, 174/346), levofloxacin (34.39%, 119/346), p-aminosalicylic acid (11.85%, 41/346), amikacin (10.69%, 37/346), protionamide (5.78%, 41/346) and capreomycin (5.20%,18/346). In the re-treated cases, the resistant rates to isoniazid, levofloxacin, ethambutol and amikacin were significantly higher than those in the new cases (88.24% (180/204) vs. 79.58% (113/142), χ ²=4.838, P=0.028; 40.69% (83/204) vs. 25.35% (36/142),χ ²=8.725, P<0.01; 55.39% (113/204) vs. 42.96% (61/142), χ ²=6.372, P=0.012; 13.73% (28/204) vs. 6.34% (9/142), χ ²=4.784, P=0.029, respectively). Analysis of drug resistance types showed that the multi-drug resistant (MDR) rate was 84.68% (293/346), the pre-extensive drug resistance rates (pre-XDR) of levofloxacin resistance and second-line injection resistance were 26.30% (91/346) and 5.20% (18/346), and the extensive drug resistance (XDR) rate was 6.65% (23/346). The MDR and pre-XDR rate in re-treated cases were significantly higher than those in the new cases (88.24% (180/204) vs. 79.58% (113/142), χ ²=4.147, P=0.042; 37.75% (77/204) vs.22.54% (32/142), χ ²=8.976, P<0.01), while the single resistance rate of rifampicin in the re-treated was significantly lower than that in the new cases (11.76% (24/204) vs. 20.42% (29/142),χ ²=4.838,P=0.028). Conclusion The rifampicin-resistant tuberculosis strains showed a higher rate of resistance to isoniazid and levofloxacin, especially in re-treated cases. It was necessary to detect resistance to isoniazid and fluoroquinolones as early as possible in rifampicin-resistant pulmonary tuberculosis patients, to optimize the treatment regimen.

Study on epidemiological characteristics and influencing factors of pathogen positive hospitalized pulmonary tuberculosis patients with extrapulmonary tuberculosis

XU Zu-hui, LIU Li-qin, WANG Qiao-zhi, XU Sheng-hui, BAI Li-qiong

Chinese Journal of Antituberculosis. 2021, 43(11): 1164-1170. doi:10.3969/j.issn.1000-6621.2021.11.011

Abstract ( 514 )

HTML ( 17 )

PDF (805KB) ( 346 )

Save

Figures and Tables | References | Related Articles | Metrics

Objective To analyze the epidemiological characteristics and influencing factors of extrapulmonary tuberculosis (EPTB) in pathogen positive pulmonary tuberculosis (PTB) patients in Hunan Province. Methods The cluster sampling method was used to collect the diagnosis and treatment information of pathogen positive inpatient PTB patients in Hunan Chest Hospital in 2016, totally 2532 cases were included. The incidence, location, frequency, etc. of EPTB in PTB patients were described. Univariate and multivariate logistic regression analyses were carried to explore the association between sex, age, occupation, place of residence, marital status, smoking history, drinking history, treatment history, sputum smear results, hematogenous disseminated tuberculosis, diabetes, rifampicin resistance with EPTB. Results 574 (22.7%) EPTB patients were found among 2532 cases of pathogen positive PTB, 114 (19.9%, 114/574) of EPTB occurred in two or more tissues or organs. The top five forms of EPTB occurred on cervical lymph nodes (12.1%, 306/2532), larynx (3.9%, 98/2532), abdomen (2.6%, 65/2532), pericardium (2.4%, 62/2532), and intestinal (1.3%, 33/2532). The incidence rate of EPTB in age groups of 6-19 years old, 20-39 years old, 40-59 years old, 60-90 years old were 32.6% (42/129), 31.1% (216/695), 20.3% (201/991), 16.0% (115/717), respectively, trend Chi-square test showed that the incidence of EPTB decreased with the increase of patients’ age ( $χ trend 2$ =51.731, P<0.001). Multivariate analysis showed that the incidence rate of EPTB in patients of 6-19 years old (OR=2.64, 95%CI: 1.46-4.78), 20-39 years old (OR=2.32, 95%CI: 1.73-3.12), 40-59 years old (OR=1.42, 95%CI: 1.10-1.85; 60-90 years old as age group reference), sputum smear positive (sputum smear negative or untested group as reference, OR=1.29, 95%CI: 1.05-1.58), hematogenous disseminated tuberculosis (without hematogenous disseminated tuberculosis group as reference, OR=5.91, 95%CI: 2.94-11.86) and non-diabetic group (with diabetes group as reference, OR=1.64, 95%CI: 1.20-2.22) was significantly higher than that of the reference group. Conclusion The proportion of hospitalized PTB patients with EPTB is relatively high, with lymphatic tuberculosis higher than other forms of EPTB. The younger patients have a higher incidence of EPTB. Attention should also be paid to EPTB screening in patients with smear-positive, hematogenous disseminated tuberculosis and non-diabetic tuberculosis.

Status and influencing factors of discharge readiness of patients with drug-resistant pulmonary tuberculosis

TANG Jing, CHEN Dan-ping, FANG Xue-e, WU Ying, XU Yi

Chinese Journal of Antituberculosis. 2021, 43(11): 1171-1175. doi:10.3969/j.issn.1000-6621.2021.11.012

Abstract ( 566 )

HTML ( 9 )

PDF (778KB) ( 307 )

Save

Figures and Tables | References | Related Articles | Metrics

Objective To investigate the discharge readiness of patients with drug-resistant tuberculosis and analyze the influencing factors. Methods A total of 117 patients with drug-resistant pulmonary tuberculosis hospitalized in Shanghai Pulmonary Hospital Affiliated to Tongji University from May 2020 to March 2021 were collected using convenience sampling method. General data questionnaire, discharge preparation scale and discharge guidance quality scale were used to conduct a questionnaire survey on the subjects. A total of 117 questionnaires were distributed, and 117 valid questionnaires were received with effective recovery rate of 100.0%. The scores of discharge readiness and discharge guidance quality of the subjects were analyzed. Linear regression was used to analyze the factors influencing the level of discharge readiness of patients with drug-resistant tuberculosis. Results The overall score of the study subjects’ discharge readiness was 91.03±16.06, and the item average score was 7.59±1.34, which was at the medium level; the overall score of discharge guidance quality was 142.09±18.76, and the items average score was 7.91±1.52, which was above average level. Multiple linear regression analysis showed that aged over 60 years old (standard regression coefficient=-0.209, t=-2.345, P=0.021), primary school education and below (standard regression coefficient=0.216, t=2.199, P=0.030), family per capita monthly income less than RMB 2000 yuan (standard regression coefficient=0.210, t=2.411, P=0.018), and poor quality of discharge guidance (standard regression coefficient=0.229, t=2.857, P=0.005) would cause bad discharge prepare. Conclusion For patients with drug-resistant tuberculosis, discharge guidance should be strengthened for patients with older age, low education level and poor economic conditions, and the quality of discharge guidance should be improved, and targeted intervention measures should be given according to the situation of patients.

Analysis of influencing factors of tuberculosis recurrence among primary treated pulmonary tuberculosis patients in Kashgar, Xinjiang

Diermulati ·Tusun, Maiweilanjiang ·Abulimiti, LIU Zhen-jiang, Xirizhati ·Mamuti, LI Guan-zhen, LI Tao, CHEN Jin-ou, Liwayiding ·Aersila, ZHAO Yan-lin, ZHANG Li-jie, OU Xi-chao

Chinese Journal of Antituberculosis. 2021, 43(11): 1176-1182. doi:10.3969/j.issn.1000-6621.2021.11.013

Abstract ( 619 )

HTML ( 26 )

PDF (802KB) ( 310 )

Save

Figures and Tables | References | Related Articles | Metrics

Objective To understand the influencing factors of tuberculosis (TB) recurrence among primary treated pulmonary TB patients in Kashgar, Xinjiang from 2011 to 2020, and provide scientific evidence for formulating and improving intervention strategies to reduce local TB recurrence rate. Methods From January 2011 to December 2020, medical records of 100699 primary treated TB patients registered in Kashgar were derived from TB Information Management System which was a subsystem of the “China Disease Prevention and Control Information System”. Cox proportional hazard regression model was used to analyze the general information, clinical data, etiological results, and treatment outcomes of 15730 patients with recurrent TB. Results Among 100699 primary treated pulmonary TB patients registered and successfully treated, 15730 patients recurrent with a recurrence density of 4.13/100 person-years. The 3-year cumulative recurrence accounted for 69.69% (10962/15730) of all recurrences, and the 5-year cumulative recurrence accounted for 89.04% (14006/15730). The Cox proportional hazards regression model showed that: 15-64 years old (aHR=2.37, 95%CI: 1.50-3.76), ≥65-year-old (aHR=2.44, 95%CI: 1.54-3.87), Miao ethnic group (aHR=3.46, 95%CI: 2.20-5.44), Uyghur ethnic group (aHR=2.39, 95%CI: 2.01-2.84), farmers (aHR=1.98, 95%CI: 1.70-2.31), unemployed (aHR=1.51, 95%CI: 1.28-1.77), sputum smear positive at the end of fifth month after treatment (aHR=1.59, 95%CI: 1.18-2.14) were independent risk factors for TB recurrence. Conclusion The risk of recurrence for primary treated TB patients in Kashgar was relatively high. We should focus on providing standardized treatment and follow-up management for patients over 65 years old, patients who were farmers or unemployed, and patients with sputum smear positive results at the end of fifth month of anti-TB treatment. Targeted intervention measures should be imposed on these high-risk groups at early stage.

Analysis of drug resistant surveillance results of Mycobacterium tuberculosis in Gansu Province from 2014 to 2017

LI Qing, SI Hong-yan, MA Ling, LI Yin-hua, GU Ji-xiu, WANG Dong-dong, HE Jian

Chinese Journal of Antituberculosis. 2021, 43(11): 1183-1193. doi:10.3969/j.issn.1000-6621.2021.11.014

Abstract ( 670 )

HTML ( 14 )

PDF (953KB) ( 302 )

Save

Figures and Tables | References | Related Articles | Metrics

Objective To analyze the drug resistance of Mycobacterium tuberculosis isolates from pulmonary tuberculosis patients in Gansu Province. Methods A total of 30 county-level designated tuberculosis medical institutions in Gansu Province were selected as surveillance sites by means of cluster stratified equal proportion random sampling method. Between Sep 2014 and Aug 2017, 1931 isolates from sputum culture positive pulmonary tuberculosis patients older than 15 years were detected by the proportional phenotypic drug sensitivity test which reported results for ten anti-tuberculosis drugs (isoniazid (INH), rifampicin (RFP), ethambutol (EMB), streptomycin (Sm), kanamycin (Km), amikacin (Am), ofloxacin (Ofx), capreomycin (Cm), isoniazid (Pto), and sodium p-aminosalicylate (PAS)). Results For the tested 1931 isolates, the overall resistance rate, multidrug-resistance rate, monoresistance rate, polydrug resistance rate, and widespread resistance rate was 26.26% (507/1931; 95%CI: 24.30%-28.22%), 8.44% (163/1931; 95%CI: 7.20%-9.68%),11.39% (220/1931; 95%CI: 9.98%-12.81%), 6.42% (124/1931; 95%CI: 5.33%-7.51%), and 0.41% (8/1931; 95%CI: 0.13%-0.70%), respectively. Among them, there were significant differences in the overall resistance rates (25.45% (462/1815; 95%CI: 23.45%-27.46%) and 38.79% (45/116; 95%CI: 30.10%-47.84%), respectively) and multidrug-resistance rates (7.82% (142/1815; 95%CI: 6.59%-9.06%) and 18.10% (21/116; 95%CI: 11.10%-25.11%), respectively) between isolates from initial-treatment and retreatment patients (χ ²=5.357,P=0.021;χ²=11.623,P=0.001); And the overall resistance rates of isolates from initial-treatment patients in males and central areas (26.22% (284/1083) and 24.96% (158/633), respectively) were significantly lower than those of isolates from retreatment patients (41.49% (39/94) and 51.43% (18/35), respectively), and the differences were statistically significant (χ²=5.241,P=0.022;χ²=5.888,P=0.015). The top three drug resistance rates to 10 anti-tuberculosis drugs were found to be INH (16.78%,324/1931), EMB (15.38%,297/1931), RFP (10.10%,195/1931). It is estimated that the number of new drug-resistant, multidrug-resistant and extensively drug-resistant patients in Gansu Province per year is 2341-2764, 665-940 and 5-70 respectively. Conclusion Drug resistance of tuberculosis is serious in Gansu Province, and the resistance to first-line anti-tuberculosis drugs is common. Furthermore, the drug resistance of newly treated patients should be paid more attention.

Epidemiological investigation on an outbreak of tuberculosis epidemic in school

WANG Da-kuan, HE Yi-jun, LIU Zi-sen, WANG Kun, WANG Jing, ZHANG Li-chao, LI Jie, GAO Lei, PAN Shou-guo

Chinese Journal of Antituberculosis. 2021, 43(11): 1194-1198. doi:10.3969/j.issn.1000-6621.2021.11.015

Abstract ( 1002 )

HTML ( 30 )

PDF (783KB) ( 568 )

Save

Figures and Tables | References | Related Articles | Metrics

Objective The epidemiological investigation on an outbreak of school tuberculosis epidemic was conducted to explore the challenges and deficiencies in the management of the tuberculosis epidemic in schools. Methods Descriptive epidemiological tools were used to investigate and analyze an outbreak of school tuberculosis epidemic occurred between October 2020 and June 2021. Active case finding and close contacts tracing were conducted using the tools including tuberculin skin test (TST) and chest X-ray. Results After 1 case with sputum smear positive tuberculosis was diagnosed, a total of another 4 active tuberculosis cases were identified during 4 times of close contacts surveys. The first-round survey was conducted among 54 close contacts (47 students, 7 faculty) of the index case. The prevalence of TST≥15 mm was 4.44% (2/45) for students and 1/7 for faculty, and chest radiographs were found to be normal for all of them. None of the students with TST≥15 mm and without active pulmonary tuberculosis received preventive treatment on the basis of informed consent. In the subsequent survey, the TST conversion rate was 6/8 among students living in the same dormitory with the index case, 4/5 among the students studied in the same group with the index case and 3/3 among those ate together regularly with the index case. In addition, the 4 new identified cases were all TST converters. Conclusion Our results indicated that the investigation and management of close contacts need to be further strengthened in the process of handling tuberculosis epidemic in schools. To identify recent infections among close contacts and to improve the coverage of preventive treatment are key work should be improved.

Bibliometric analysis of tuberculosis in UK government website based on web crawler quantitative analysis of policy documents

HUANG Lie-yu, WANG Xi, CHEN Hao, HUANG Ruo-yao, ZUO Ling, GUO Yan

Chinese Journal of Antituberculosis. 2021, 43(11): 1199-1209. doi:10.3969/j.issn.1000-6621.2021.11.016

Abstract ( 488 )

HTML ( 13 )

PDF (3188KB) ( 380 )

Save

Figures and Tables | References | Related Articles | Metrics

Objective A multi-dimensional analysis of the United Kingdom (UK) government website tuberculosis (TB) issue record, reflecting the British government’s policy force and focus of TB prevention and control was conducted to provide reference for the TB prevention and control in China. Methods Web crawler operation in Python, a computer programming language, was carried out in UK government website (www.gov.uk) and 1530 records on TB were obtained. After deleting duplicate records, all the 1530 records and 331 records with high policy-relevance were analyzed, respectively, in terms of topics, types, and publishing authorities. Then, 113 bovine TB records and 111 human TB records were analyzed on content or keywords with high frequency, respectively. Results Of all the 1530 records, the top 3 topics were “Health and social care” (n=281), “Entering and staying in the UK” (n=144), and “Environment”(n=136), “guidance and regulation” (n=364) had the largest number of document types. The main type of 331 records with high policy relevance was “Guidance and regulation” (n=111), mainly found in year 2013 (n=31) and 2014 (n=30). During the same period, the number of TB cases reported in Britain (especially non-British-born population) significantly decreased. Among the 113 bovine TB records, the most mentioned infected animal species was “badger” (n=24). A total of 579 keywords were labeled in 111 human TB records and 24 keywords with high frequency were clustered into 3 topics, including TB prevention and control strategy (n=10), TB epidemiology (n=8), and TB clinical technology (n=6). Conclusion The focus of the UK government’s prevention and control of TB included the prevention and control mode of “external input” for the immigrant group, the comprehensive treatment of zoonosis combined with the concept of “the same health”, and the strengthening of multi-sectoral and multi-level joint action on social and economic factors. The concept and strategy of prevention and control provided a useful reference for China.

Research progress of correlation between pulmonary tuberculosis and intestinal flora

LI Kang, CHAI Ying-hui, BAI Guang-liang, DENG Xian-ping, LEI Hong

Chinese Journal of Antituberculosis. 2021, 43(11): 1210-1215. doi:10.3969/j.issn.1000-6621.2021.11.017

Abstract ( 738 )

HTML ( 23 )

PDF (810KB) ( 730 )

Save

References | Related Articles | Metrics

With the development of microbial detection technology, studies have found that there is a close relationship between intestinal flora and human diseases. At present, many studies have shown that the imbalance of intestinal flora exists in patients with pulmonary tuberculosis which may significantly increase the prevalence of pulmonary tuberculosis. They interact directly or indirectly through the metabolism of bacteria and the immune response of the body. The author reviews the relationship between pulmonary tuberculosis and intestinal flora, the possible mechanism of the interaction between them, and whether it is possible to prevent and treat pulmonary tuberculosis by regulating intestinal microflora.

Table of Content