Chinese Journal of Antituberculosis

Expert consensus on the estimation of the national burden on latent tuberculosis infection

Institute of Pathogen Biology, Chinese Academy of Medical Sciences and Peking Union Medical College , Chinese Center for Disease Control and Prevention , Union Medical Institute of Geographic Sciences and Natural Resources Research, Chinese Academy of Sciences

Chinese Journal of Antituberculosis. 2022, 44(1): 4-8. doi:10.19982/j.issn.1000-6621.20210662

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Preventive treatment for high-risk population with latent tuberculosis infection (LTBI) is an effective tool to reduce the incidence rate of tuberculosis (TB), and also an important strategy for achieving the global goals of the End TB Strategy. As a high burden country of TB, how to achieve the goal of rapid decline in TB incidence by carrying out LTBI treatment is worth exploring in China. First of all, accurately mastering the burden and epidemic characteristics of LTBI in China is the premise to discuss the feasibility and scientific of the strategy. In the absence of nationwide epidemiological investigation of LTBI, the LTBI burden in China was estimated by small sample spatial statistical model based on the epidemiological LTBI survey data of interferon-gamma release assay and the nationwide incidence of reported TB. The results showed, in 2013, the prevalence of LTBI in people aged 5 years old and above was 18.1% (95%CI: 13.7%-22.4%) and in people aged 15 years old and above was 20.3% (95%CI: 15.6%-25.1%), respectively. The LTBI prevalence showed a trend of increasing with age and it was significantly higher in men than that in women at the same age group. Experts in the field have extensively demonstrated the results and formed the Expert consensus on the estimation of the national burden on latent tuberculosis infection as reference for improving Chinese TB control.

Expert consensus on immune function assessment and immunotherapy in patients with active tuberculosis (2021 Edition)

Tuberculosis Prevention and Control Key Laboratory/Beijing Key Laboratory of New Techniques of Tuberculosis Diagnosis and Treatment/Institute for Tuberculosis Research of the 8th Medical Center of Chinese PLA General Hospital, Editorial Board of Chinese Journal of Antituberculosis , Basic and Clinical Speciality Committees of Tuberculosis Control Branch of China International Exchange and Promotive Association for Medical and Health Care

Chinese Journal of Antituberculosis. 2022, 44(1): 9-27. doi:10.19982/j.issn.1000-6621.20210680

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Tuberculosis is not only a bacterial infectious disease but also an immune disease. The occurrence, development, and prognosis of tuberculosis are closely related to the anti-tuberculosis immunity of the patients. Patients with active tuberculosis usually have abnormalities in the function of innate immune and adaptive immune. Detecting the number of immune cells and immune function can evaluate the immune status of active tuberculosis patients, to provide evidence for clinical immune intervention. The immune intervention using immune agents can enhance immunity function, improve the cure rate and shorten the course of treatment, eliminate the persistent Mycobacterium tuberculosis and reduce the recurrence rate. Although the immunodiagnosis of tuberculosis is widely used in the clinic, the mechanisms of anti-tuberculosis immunity and immune abnormality and their role in tuberculosis are not well understood and lack in-depth research. There is no consensus on the indication of immune function evaluation, the application of the evaluation index, and their clinical significance in active tuberculosis patients. In addition, the application of immune agents is limited by the policy, and there is also no consensus on immune intervention or not, the indication of immunotherapy and selection of immune agents for active tuberculosis patients. Therefore, the experts were organized to draw up “Expert consensus on immune function assessment and immunotherapy in patients with active tuberculosis (2021 Edition)” by the Eighth Medical Center of Chinese PLA General Hospital, Editorial Board of Chinese Journal of Antituberculosis, Basic and Clinical Speciality Committees of Tuberculosis Control Branch of China International Exchange and Promotive Association for Medical and Health Care. This expert consensus outlines the mechanism of anti-tuberculosis immunity and immune abnormality in tuberculosis patients; introduces the immunological detection methods commonly used in tuberculosis clinic practice; puts forward the indications, methods, and strategies for evaluating the immune status of active tuberculosis patients; systematically introduces the clinical immunotherapy preparations available in clinic practice, and puts forward the indications and contraindications of immunotherapy for active tuberculosis patients, to help clinicians timely and reasonably carry out the immunotherapy in the patients with active tuberculosis.

Expert consensus on the rational use of glucocorticoids in tuberculosis treatment

Tuberculosis Prevention and Control Key Laboratory/Beijing Key Laboratory of New Techniques of Tuberculosis Diagnosis and Treatment /Institute for Tuberculosis Research/Department of Tuberculosis of the 8th Medical Center of Chinese PLA General Hospital, Editorial Board of Chinese Journal of Antituberculosis

Chinese Journal of Antituberculosis. 2022, 44(1): 28-37. doi:10.19982/j.issn.1000-6621.20210683

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Glucocorticoids have pharmacological effects of anti-inflammatory, anti-allergic, anti-bacterial endotoxin and immunosuppression, and can reduce immune damage caused by an allergic reaction to Mycobacterium tuberculosis.Glucocorticoids can quickly control the disease, but also can lead to adverse reactions such as dysbacteriosis, peptic ulcer, osteoporosis, and so on. There is still unreasonable use of glucocorticoids in the adjuvant treatment of tuberculosis in the clinic. Therefore, it is urgent to standardize the application of glucocorticoids in the treatment of tuberculosis.This consensus briefly introduces the advantages and basic principles of glucocorticoid therapy for tuberculosis, provides a recommendation of glucocorticoids used in the adjuvant treatment of tuberculous meningitis, tuberculous pericarditis, tuberculous pleuritis, tuberculous peritonitis, acute disseminated pulmonary tuberculosis, and caseous pneumonia under the strong and effective anti-tuberculosis treatment when necessary, and forwards the precautions, adverse reactions, and solution for the application of glucocorticoids. It is emphasized that more strict indications, the balance of advantages and disadvantages, rational use of glucocorticoids in the adjuvant treatment of tuberculosis.

Recommendations on pretomanid (PA-824) in the treatment of multidrug-resistant tuberculosis

Chinese Antituberculosis Association , National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention

Chinese Journal of Antituberculosis. 2022, 44(1): 38-44. doi:10.19982/j.issn.1000-6621.20210655

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The duration of treatment of multidrug-resistant tuberculosis (MDR-TB) is 18-24 months, and severe adverse effect, poor treatment compliance, and no second-line anti-tuberculosis drugs to form an effective treatment regimen for some patients due to the wide drug resistance spectrum and led to high mortality always happened in the treatment. Therefore, the research of new drugs for MDR-TB treatment is an important issue for global tuberculosis control, as well as the key to improve the status of MDR-TB control and prevention in China. Pretomanid (PA-824), which was developed by the TB Alliance, combined with bedaquiline and linezolid to form the BPaL regimen. The new regimen had advantages of short course, oral drugs in the whole treatment, improved treatment compliance, high cure rate, brings new hope for severe MDR-TB patients, and was recommended by World Health Organization in 2020. Currently, bedaquiline and linezolid are available in China and used as second-line anti-tuberculosis drugs for the MDR-TB treatment. Therefore, it is urgent for PA-824 to be approved in China to save more MDR-TB patients. The Chinese Antituberculosis Association and the Chinese Center for Disease Control and Prevention co-organized domestic experts on TB control, clinical and basic research to write Recommendations on pretomanid (PA-824) in the treatment of multidrug-resistant tuberculosis after discussions, to provide reference for accelerating the registration and application of PA-824 and BPaL regimen in China.

Tuberculosis research and innovation: Interpretation of the WHO Global Tuberculosis Report 2021

SHU Wei, SUN Yu-xian, ZHANG Li-jie, XIE Shi-heng, GAO Jing-tao, LIU Yu-hong

Chinese Journal of Antituberculosis. 2022, 44(1): 45-48. doi:10.19982/j.issn.1000-6621.20210685

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Tuberculosis research and innovation is one of the three pillars to achieve the targets of End TB Strategy set by World Health Organization (WHO). On October 14, 2021, WHO released the Global tuberculosis report 2021, updating the newest progress of global tuberculosis research and innovation. This paper reviews the key achievements in the areas of research and innovation for new diagnostic, new drugs and new vaccines introduced in the global report, and discuss with consideration of China’s situation in related areas. The aim of this paper is to facilitate the better understanding to global research feature and development trend, and to provide reference for further China original scientific research and innovation.

Expert interpretation of “Handbook of Care for Tuberculosis Patients in China”

WANG Qian, WANG Jia, LIU Er-yong, CHEN Ming-ting, ZHOU Lin.

Chinese Journal of Antituberculosis. 2022, 44(1): 49-53. doi:10.19982/j.issn.1000-6621. 20210613

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In order to further reduce the risk of tuberculosis and comprehensively improve the quality of tuberculosis diagnosis and treatment services at all levels, to implement whole-process, full-cycle, and full range of patient care from prevention, diagnosis, treatment, management to health education. The Chinese Center for Disease Control and Prevention organized domestic experts to compile the Handbook of Care for Tuberculosis Patients in China. The manual is based on the International Standards for Tuberculosis Care,in combination of the work practice and relevant policies, technical strategies, new technologies and new tools of tuberculosis control in China in the past 10 years, further standardize and refine the prevention and control measures for patient care, with strong guidance and operability. The author explains in detail the background, main content and characteristics of its formulation with a view to promoting standardized diagnosis, treatment and management of tuberculosis in medical and health institutions at all levels and of all types, and to improve the quality and level of “patient-centered” services.

Estimation of the national burden on latent tuberculosis infection based a multi-center epidemiological survey and the space statistics model

GAO Lei, ZHANG Hui, HU Mao-gui, XU Cheng-dong, XIA Yin-yin, LI Tao, CHEN Wei, HE Yi-jun, CAO Xue-fang, XIN He-nan, ZHANG Hao-ran, ZHAO Yan-lin, WANG Jin-feng, CHENG Shi-ming, JIN Qi, LIU Jian-jun

Chinese Journal of Antituberculosis. 2022, 44(1): 54-59. doi:10.19982/j.issn.1000-6621.20210661

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Objective: To estimate the prevalence of latent tuberculosis infection (LTBI) in China, which would provide essential evidence for improving the comprehensive strategy of tuberculosis (TB) control. Methods: The data of multi-center LTBI epidemiological survey in 2013 and the nationwide incidence of reported TB by counties between 2013-2019 were collected, and the prevalence of LTBI was estimated by using the Biased Sample Hospital-based Area Disease Estimation (B-SHADE). The accuracy was verified by using cross validation method with the survey data of two additional study sites. Results: In 2013, the prevalence of LTBI in people 5 years old and above was 18.08% (95%CI: 13.73%-22.42%) and in people 15 years old and above was 20.34% (95%CI: 15.63%-25.06%), respectively. The LTBI prevalence showed a trend of increasing with age and it was significantly higher in men (24.02% (95%CI: 18.27%-29.77%)) than that in women (16.91% (95%CI: 12.13%-21.70%)) at 15 years old and above group. The average absolute error of the estimations of two additional verification sites by B-SHADE model was found to be 0.95%. Conclusion: The prevalence of LTBI estimated by using the results of multi-center epidemiological survey and B-SHADE method makes up the lack of relevant data in recent years, which will provide evidence for China to timely strengthen LTBI management in target populations and to improve the prevention based TB control strategy.

Evaluation of the effect of a new domestic improved Middlebrook liquid culture reagent on the culture of Mycobacterium tuberculosis

XU Yin-juan, ZHAO Guo-lian, CUI Xiao-li, WANG Pei, TAN Xiao-wen, YANG Shan-shan, WU Hao.

Chinese Journal of Antituberculosis. 2022, 44(1): 60-63. doi:10.19982/j.issn.1000-6621.20210459

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Objective: To evaluate the effect of a new domestic improved Middlebrook liquid culture reagent on the culture of Mycobacterium tuberculosis in clinical. Methods: Sputum and alveolar lavage fluid samples of suspected pulmonary tuberculosis patients diagnosed and treated in Xi’an Chest Hospital from March to April 2021 were collected. Eighty-nine sputum samples and 61 alveolar lavage fluid samples were qualified and cultured with mycobacterium modified reagent and BACTEC MGIT 960 (MGIT 960). The positive rate, positive reporting time and contamination rate of mycobacterium detection by the two methods were compared, and the detection efficiency of the improved reagent method was evaluated refered to the culture results of MGIT 960. Results: The total positive rate and positive reporting time (median (quartile)) of sputum and alveolar lavage fluid samples detected by mycobacterium modified reagent method were not significantly different from the culture results of MGIT 960 ((44.7% (67/150) vs. 42.7% (63/150), χ²=0.571, P=0.453; 13.0 (8.5, 17.0) d vs. 13.0 (8.0, 17.5) d, Z=-1.344, P=0.179). There was no contamination in alveolar lavage fluid samples detected by the two methods, but the contamination rate of sputum samples detected by the improved reagent method (12.4% (11/89)) was significantly higher than that of MGIT 960 culture (4.5% (4/89))(χ²=4.000,P=0.039). The cost of the improved culture reagent (RMB (49.6±10.5) yuan/person) was only about 60% of that of MGIT 960 culture reagent (RMB (75.4±15.8) yuan/person). Using MGIT 960 culture results as the standard, the total sensitivity and specificity of the improved reagent method for sputum and alveolar lavage fluid samples were 96.9% (62/64) and 94.2% (81/86), the Kappa value was 0.905, showing excellent consistency. Conclusion: Mycobacterium modified Middlebrook liquid culture reagent has the good consistency of MGIT 960 culture in the detection of sputum and alveolar lavage fluid, however, attention should be paid to the high contamination rate of sputum specimens.

Study on influencing factors of anti-tuberculosis drug-induced liver injury in pulmonary tuberculosis patients complicated with diabetes mellitus

ZHANG Yang-ting, LU Xue-zhao, LI Xiao-na, ZHONG Zhao-yi, WANG Na, CAI Jing, MA Ai-guo, LIU Yu-feng, WANG Qiu-zhen

Chinese Journal of Antituberculosis. 2022, 44(1): 64-70. doi:10.19982/j.issn.1000-6621.20210545

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Objective: To analyze the influencing factors of anti-tuberculosis drug-induced liver injury (ATB-DILI) in patients with pulmonary tuberculosis complicated with diabetes mellitus (PTB-DM). Methods: A prospective cohort study was conducted to continuously enroll 458 inpatients with PTB-DM who met the enrollment criteria from October 2017 to March 2019 in the North Branch of Qingdao Central Hospital. Before their treatment, we collected information of age, gender, marital status, education level, occupation, diet, smoking, drinking, physical activity level, clinical symptoms of tuberculosis, body mass index, blood biochemical index, blood routine index, blood glucose control level,usage and types of liver protection drugs through a self-designed structured questionnaire; after following-up for eight months, a multivariate Cox proportional hazard regression was done to analyze the occurrence of ATB-DILI and its influencing factors. Results: Among 458 PTB-DM patients,53 patients developed ATB-DILI, with an incidence rate of 11.6%. After adjusting for confounding factors such as smoking, physical activity, liver protection drugs and anemia, it was found that poor glycemic control (HR (95%CI)=2.787 (1.256-6.183)), drinking (HR (95%CI)=2.159 (1.097-4.251)), low weight (body mass index <18.5) (HR (95%CI)=2.808 (1.391-5.670)) and insufficient dietary diversity (HR (95%CI)=3.199 (1.372-7.459)) were risk factors for ATB-DILI in PTB-DM patients. Conclusion: Patients with PTB-DM were prone to develop ATB-DILI after anti-tuberculosis treatment, especially for those who had drinking habits, with low weight and inadequate dietary diversity, they were associated with a higher risk of ATB-DILI.

Retrospective study on risk factors for concurrent intestinal perforation in patients with abdominal tuberculosis

LIANG Li, ZOU Li-ping, XIE Fang-hui, CHEN Qing, WU Gui-hui

Chinese Journal of Antituberculosis. 2022, 44(1): 71-77. doi:10.19982/j.issn.1000-6621.20210304

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Objective: To explore the risk factors for concurrent intestinal perforation in patients with abdominal tuberculosis. Methods: The clinical data of 37 abdominal tuberculosis patients with concurrent intestinal perforation (intestinal perforation group) treated in Chengdu Public Health Clinical Medical Center from January 2013 to December 2020 were analyzed retrospectively. Thirty-nine abdominal tuberculosis patients without intestinal perforation were randomly selected with random number table as the control group during the same period. Univariate and multivariate logistic regression analysis were conducted to summarize the risk factors of abdominal tuberculosis patients with intestinal perforation. Results: Thirty-five patients received surgical treatment and two patients did not receive surgical treatment due to septic shock in the intestinal perforation group. Eight patients died and the mortality rate was 21.6%. The control group patients were all successfully treated and discharged from hospital. Among intestinal perforation group, 54.1% (20/37) had a history of tuberculosis ≤3 months, 29.7% (11/37) had AIDS, 64.9% (24/37) had anemia,86.5% (32/37) had hypoproteinemia, 51.4% (19/37) CD4⁺ T lymphocyte count <150 cells/μl, 45.9% (17/37) had intestinal obstruction, 73.0% (27/37) had abdominal symptoms as initial symptoms. Among the control group, 79.5% (31/39) had a history of tuberculosis ≤3 months, 5.1% (2/39) had AIDS, 33.3% (13/39) had anemia, 43.6% (17/39) had hypoproteinemia, 7.7% (3/39) CD4⁺ T lymphocyte count <150 cells/μl, 20.5% (8/39) had intestinal obstruction, 46.2% (18/39) had abdominal symptoms as initial symptoms.The differences between the two groups were statistically significant (χ² values were 5.564, 8.104, 6.541, 15.263, 17.565, 5.564, 5.650, respectively, all P values <0.05). Abdominal symptoms as initial symptoms, intestinal obstruction, hypoproteinemia, CD4⁺ T lymphocyte count< 150 cells/μl were independent risk factors for intestinal perforation in patients with abdominal tuberculosis (OR=23.828,95%CI:2.946-192.744; OR=10.292,95%CI:1.607-65.899; OR=43.455,95%CI:3.697-510.796; OR=25.706,95%CI:2.231-296.223). A history of tuberculosis ≤3 months was protective factor for intestinal perforation in patients with abdominal tuberculosis (OR=0.026,95%CI:0.003-0.247). Conclusion: Abdominal symptoms as initial symptoms, intestinal obstruction, hypoproteinemia, CD4⁺ T lymphocyte count <150 cells/μl were independent risk factors for intestinal perforation in patients with abdominal tuberculosis. When these risk factors were present in patients with abdominal tuberculosis, we should be alert to the risk of intestinal perforation.

Changes of CD cells in peripheral blood of tuberculous meningitis patients with negative HIV antibody before and after treatment

WANG Xin, Maierdan·Abulai, LIN Yi-hong, ZHANG Wen-tao

Chinese Journal of Antituberculosis. 2022, 44(1): 78-82. doi:10.19982/j.issn.1000-6621.20210349

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Objective: To analyze the changes and clinical significance of CD cells in peripheral blood of tuberculous meningitis (TBM) patients with negative HIV antibody before and after treatment. Methods: A prospective study was conducted in 102 TBM patients diagnosed in the Eighth Affiliated Hospital of Xinjiang Medical University from March 2016 to February 2020.All the cases met the inclusion criteria and were divided them into 3 clinical phases, 22 in phase Ⅰ, 37 in phase Ⅱ, and 43 in phase Ⅲ. The counts of CD3 ⁺, CD4⁺ and CD8⁺ T cells, and the ratio of CD4⁺/CD8⁺ T cells in peripheral blood of these cases were measured before and 2 weeks after anti-tuberculosis treatment. The changes of CD cells in peripheral blood before and after treatment, and their correlation with TBM clinical stages and therapeutic prognosis were analyzed. Results: Of these cases, the CD3⁺, CD4⁺ T cell counts and CD4⁺/CD8⁺ 2 weeks after anti-tuberculosis treatment were significantly higher than those before treatment ((808.27±183.25)×10⁶/μl vs. (631.38±150.14)×10⁶/μl, t=7.541,P=0.000; (413.09±134.53)×10⁶/μl vs. (366.78±98.03)×10⁶/μl, t=2.809,P=0.005; and 1.23±0.29 vs. 0.99±0.23, t=6.548,P=0.000; respectively). Two weeks after anti-tuberculosis treatment, the CD3⁺, CD4⁺ T cell counts and CD4⁺/CD8⁺ of patients in stage Ⅲ ((613.23±140.29)×10 ⁶/μl, (342.53±98.36)×10⁶/μl and 0.95±0.18, respectively) were significantly lower than those in stage Ⅱ ((753.33±153.47)×10⁶/μl, (399.57±112.26)×10⁶/μl and 1.22±0.21, respectively)and stage Ⅰ ((989.23±194.35)×10⁶/μl,(501.11±139.25)×10⁶/μl and 1.42±0.31, respectively)(F=40.875,13.372 and 32.151, respectively; all P=0.000). The CD3⁺, CD4⁺ T cell counts and CD4⁺/CD8⁺ of improved patients were significantly higher than those of patients with progressive forms of the disease ((941.25±204.17)×10⁶/μl vs. (683.43±155.76)×10⁶/μl, t=4.206, P=0.000; (487.35±134.25)×10⁶/μl vs. (389.64±120.38)×10⁶/μl, t=2.394, P=0.018; 1.36±0.31 vs. 1.02±0.19, t=3.698, P=0.000; respectively). Conclusion: Two weeks after anti-tuberculosis treatment, the immune function of TBM patients was significantly improved, and the improvement of immune function in improved patients was better than those with worse condition. For TBM patients, the higher the clinical stage, the more severe the impairment of immune function, and the higher the need to adjust the therapeutic regimen.

The mediating effect of psychological resilience between caregiver burden and quality of life of caregivers of tuberculosis patients

AN Xin, LI Yu-zhuo, ZHANG Dan, WANG Qiu-shuang, WANG Jian-mei, MA Jing-hua

Chinese Journal of Antituberculosis. 2022, 44(1): 83-90. doi:10.19982/j.issn.1000-6621. 20210442

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Objective: To explore the relationship among the caregiver burden, psychological resilience and quality of life in caregivers of pulmonary tuberculosis patients. Methods: From May to June 2021, the caregivers of tuberculosis patients hospitalized in Hebei Chest Hospital were selected as the research subjects by cluster random sampling method. The maximum number of items in this survey was 25, to assure the sample size to be 5-10 times the maximum number of items, and considering 20% questionnaires to be invalid, the sample size was estimated to be 150-300. The final sample size was 200. The researchers collected general information questionnaire, ZBI, CD-RISC and the FAMQOL. Results: Finally, 200 questionnaires were obtained. After removing 22 invalid questionnaires, the score of caregiver burden of 178 subjects was 36.50±12.77, the score of quality of life was 52.74±9.46 and the resilience was 57.51±15.91. Pearson correlation analysis showed that caregiver burden was negatively correlated with quality of life and resilience (r=-0.463, P<0.001; r=-0.400,P<0.001); quality of life was positively correlated with resilience (r=0.522, P<0.001). Resilience played a partial mediating effect between caregiver burden and quality of life (β (95%CI)=-0.119(-0.176--0.069)). Multiple linear regression analysis showed that the patient self-care ability (t=2.985, P=0.003), patients with chronic diseases (t=3.230, P=0.001), the caregiver’s education level (t=-2.146, P=0.033), financial level (t=-2.209, P=0.029), accompanying chronic diseases (t=3.286, P=0.001), and care time (t=2.458, P=0.015) were influencing factors of care burden. Conclusion: The caregivers of pulmonary tuberculosis patients had caregiver burden, medium level of psychological resilience and quality of life. Resilience played a partial mediating effect. Therefore, the caregiver burden in clinical nursing work should arouse attention, and positive psychological interventions can be taken to improve the psychological coping and adaptability of caregivers, reduce the level of caregiver burden, and improve quality of life.

Application of deep learning in pulmonary tuberculosis imaging diagnosis

WU Jian, HOU Dai-lun

Chinese Journal of Antituberculosis. 2022, 44(1): 91-94. doi:10.19982/j.issn.1000-6621.20210537

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The imaging morphology of pulmonary tuberculosis is often diversified, therefore, how to differentiate the diagnosis of pulmonary tuberculosis has always been the focus and difficulty of conventional imaging studies.In recent years, deep learning has made rapid development in assisted image diagnosis. Deep learning is good at identifying complex patterns in a large amount of image data, which can greatly improve the diagnostic accuracy and work efficiency of doctors.This paper reviews the application, deficiency and prospect of deep learning in pulmonary tuberculosis and imaging diagnosis.

A review of researches on heparin-binding adhesions of Mycobacteria

CHEN Yu-lan, LIU Yi-duo, ZHOU Xiang-mei

Chinese Journal of Antituberculosis. 2022, 44(1): 95-101. doi:10.19982/j.issn.1000-6621.20210593

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Tuberculosis is a worldwide zoonosis caused by mycobacteria. Heparin-binding adhesin (HBHA) is a protein produced by mycobacteria, with which the pathogenic strains can attach to epithelium cells and be disseminated to extra-pulmonary organs from lungs. The C terminal domain of it can induce Th1 responses of the body efficiently and a certain level of mucosal immune responses, suggesting its potential for developing a vaccine. Furthermore, the HBHA-specific immune responses in active tuberculosis patients differentiate from that in latent tuberculosis patients which indicates that it may work as a diagnostic antigen. At cellular level, HBHA can intrude into macrophages through complement receptors and turn them to M1 state while escaping from autophagy and triggering mitocondrial damage and endoplasmic reticulum stress. All of these provides more explanations for pathogenesis of tuberculosis. The constantly updated understanding of the interactions between HBHA and the host will provide inspirations for the application study of exploiting its immunogenic potential.

Research progress on genes and mechanism of Mycobacterium tuberculosis resistance to pyrazinamide

ZHOU Ting-ting, ZHENG Xiao-man, OUYANG Jing, LU Yan-qiu, CHEN Yao-kai

Chinese Journal of Antituberculosis. 2022, 44(1): 102-105. doi:10.19982/j.issn.1000-6621.20210511

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Pyrazinamide is one of the most important first-line therapeutic drugs for tuberculosis, but the resistance of Mycobacterium tuberculosis to this drug is increasing year by year. At present, molecular mechanisms and drug resistance related genes of pyrazinamide is still inconclusive. The authors review research progress of pyrazinamide resistance related genes, including pncA, rpsA, panD, fadD2 and FAS-I.

Preliminary study on the clinical characteristics of 41 children with retreated drug-sensitive tuberculosis

YANG Yang, YUAN Yuan, LU Shui-hua

Chinese Journal of Antituberculosis. 2022, 44(1): 106-109. doi:10.19982/j.issn.1000-6621.20210440

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To explore the clinical characteristics of children with retreated tuberculosis, we enrolled 41 children with retreatment drug-sensitive tuberculosis who were admitted to the Tuberculosis Department of Shanghai Public Health Clinical Center from January 2015 to June 2021 as the research objects. Data of their basic characteristics (sex, age), clinical diagnosis and classification, reasons for retreatment, chest CT manifestations of tuberculosis, treatment and prognosis were collected and analyzed. The results showed that among the 41 children, pulmonary tuberculosis accounted for 58.5% (24/41), and extrapulmonary tuberculosis accounted for 41.5% (17/41). Among extrapulmonary tuberculosis, lymph node tuberculosis accounted for 41.2% (7/17), tuberculous meningitis accounted for 29.4% (5/17). The percentage of children who were defaulters, relapsed, and treatment failure were 58.5% (24/41), 31.7% (13/41), and 9.8% (4/41), respectively. Besides, 18 (75.0%) of the defaulters were caused by adverse drug reactions. Among all the 24 pulmonary tuberculosis patients who had chest CT, 12 (50.0%) patients showed unilateral lung lesions without cavities, 9 (37.5%) showed bilateral lung lesions, 2 (8.3%) showed unilateral plural effusion with pleural thickening,and 1 (4.2%) showed cavities. The retreatment regimen of 23 (56.1%) relapsed children was 3H-R-Z-E/9-15H-R-E or 3H-R-Z/9-15H-R-E (H: isoniazid, R: rifampicin, Z: pyrazinamide, E: ethambutol). While the remaining 18 (43.9%) cases were treated with non-standardized regimes. After follow-up, 35 cases (85.4%) completed the treatment and cured, 2 (4.8%) were still taking medicines with stable condition, and 4 (9.8%) were lost to follow-up. In summary, among children with retreatment drug-sensitive tuberculosis, pulmonary tuberculosis and defaulters are more common, unilateral lung non-cavitary lesions are more common in chest CT, and the overall prognosis is good. However, attention should be paid to the follow-up of children, especially those with adverse drug reactions during initial treatment.

Study on the implementation of using electronic medicine box to assist drug taking management of pulmonary tuberculosis patients

HAO Xiao-gang, WANG Wei, ZHANG Xing, ZHU Ping, XU Chun-feng

Chinese Journal of Antituberculosis. 2022, 44(1): 110-112. doi:10.19982/j.issn.1000-6621.20210339

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From July 2018 to June 2019, 1488 tuberculosis patients were diagnosed in Quzhou City, and a kind of electronic medicine box was recommended to them for voluntarily adoption. 915 patients (61.49%) chose to use the electronic medicine box. 79.34% (726/915) of them persisted to use it at the end of 2 months’ treatment, 66.01% (604/915) persisted at the end of 4 months’ treatment, and 52.35% (479/915) persisted at the end of 6 months’ treatment. There were statistical differences ( $χ trend 2$ =586.924, P=0.001). The adoption rate of electronic medicine box for pulmonary tuberculosis patients needs to be improved, and the persistance of using it will decline as the use time increases.

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