Chinese Journal of Antituberculosis

Interpretation of Guideline on tuberculosis infection prevention and control in primary health care institute

Cheng Jun, Lu Wei

Chinese Journal of Antituberculosis. 2022, 44(8): 762-767. doi:10.19982/j.issn.1000-6621.20220207

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Guideline on tuberculosis infection prevention and control in primary health care institute (T/CHATA-018-2022), one of association standards launched by Chinese Antituberculosis Association, was put into force from Feb, 24th, 2022. In order to make the potential users to understand this standard well, the author described its background, main content and basis of measurements, and application.

Analysis on the epidemic situation of pulmonary tuberculosis in schools in China from 2004 to 2021

Chen Hui, Zhang Canyou, Zhang Hui, Cheng Jun, Li Tao

Chinese Journal of Antituberculosis. 2022, 44(8): 768-776. doi:10.19982/j.issn.1000-6621.20220200

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Objective: To investigate the epidemic trend of pulmonary tuberculosis (PTB) of students and staff in China from 2004 to 2021. Methods: The reported data of PTB in students and staff (excluding Taiwan, Hongkong and Macao) from 2004 to 2021 were collected from Infectious diseases surveillance system and China statistical yearbook, and the trend of epidemic situation in schools was analyzed. Results: From 2004 to 2021, a total of 908171 student patients with PTB were reported, with the reported incidence of 19.26/100000, while 112336 staff patients with PTB were reported with the reported incidence of 34.12/100000. From 2008 to 2019, the reported incidence rates of PTB among students and staff both showed the downward trend (average annual percent change=―3.41% and ―8.22%, Z=―2.005 and ―6.626, P=0.045 and <0.001). Eighteen provinces showed significantly decreasing trends in incidence among students, and eleven provinces showed stable trends. However, two provinces (Tibet and Qinghai) showed significantly increasing trends. Conclusion: The PTB reported incidence in schools in China was decreasing, but incidences of Tibet and Qinghai were on the rise. PTB prevention and control in schools has achieved positive effects. It is still necessary to continue to strengthen the prevention and control of PTB in schools, and more attention should be paid to key areas and schools.

Analysis of epidemic characteristics of pulmonary tuberculosis among students in Sichuan from 2016 to 2020

Xiao Yue, Xia Lan, Xia Yong, Rao Zhengyuan, Li Yunkui, Chen Chuang

Chinese Journal of Antituberculosis. 2022, 44(8): 777-783. doi:10.19982/j.issn.1000-6621.20220198

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Objective: To analyze the epidemic characteristics of pulmonary tuberculosis (PTB) among students in Sichuan during 13th Five-Year period, in order to provide reference for optimizing TB prevention and control in schools. Methods: Data about TB epidemic situation and population of students, including age, gender, region, detection, medical information, diagnosis results, etc., were collected from the Infectious Diseases Reporting System, Tuberculosis Information Management System and Sichuan Yearbook were collected from 2016 to 2020. A retrospective description was used to analyze the spatial, temporal and population distribution of PTB in students, the detection and the delay of treatment. Results: From 2016 to 2020, a total of 253582 PTB cases were reported in Sichuan, including 19540 student cases (7.71%), incidence rate of students increased year by year, from 5.39% (2905/53865) in 2016 to 10.47% (4839/46218) in 2020 ( $χ t r e n d 2$ =1030.301, P<0.01). For students, the reported peaks PTB were in March and April (16.97% (493/2905) and 10.29% (299/2905)) in 2016, March (14.20% (493/3471)) and December (11.67% (405/3471)) in 2017, March (15.56% (630/4049), 14.43% (617/4276)) and September (11.43% (463/4049), 10.69% (457/4276)) in 2018 and 2019, May (14.51% (702/4839)), August (10.99% (532/4839)) and September (11.43% (553/4839)) in 2020. In 2020, 2021 cases (120.29/100000, 2021/1680000) of PTB were reported in Ganzi Tibetan Autonomous Prefecture, Liangshan Yi Autonomous Prefecture and Aba Tibetan and Qiang Autonomous Prefecture, increased by 118.71% in comparison with that in 2016 (55.00/100000, 801/1434000). In the other regions in Sichuan, 2818 cases (21.15/100000, 2818/13326000) of PTB were reported in 2020, increased by 29.60% in comparison with that in 2016 (16.33/100000, 2104/12888000). The proportion of students aged 15 and younger increased year by year, from 17.93% (441/2459) in 2016 to 28.77% (1272/4422) in 2020, the difference was statistically significant (χ²=200.120, P<0.01). The proportion of Yi and Tibetan increased year by year, from 20.01% (492/2459) in 2016 to 41.09% (1817/4422) in 2020. The proportion found in physical examination increased year by year, from 5.77% (142/2459) in 2016 to 8.25% (365/4422) in 2020, with a statistically significant difference (χ²=53.234, P<0.01). The proportion of positive etiology increased year by year, from 14.76% (363/2459) in 2016 to 34.31% (1517/4422) in 2020, with a statistically significant difference (χ²=748.482, P<0.01). The delay rate of student patients was 53.50% (9060/16936), and the median delay was 16 days. Conclusion: From 2016 to 2020, the PTB incidence in students was on the rise; in Ganzi Tibetan Autonomous Prefecture, Liangshan Yi Autonomous Prefecture and Aba Tibetan, the epidemic situation was more serious.

Epidemiological characteristics of pulmonary tuberculosis among students in Chongqing from 2016 to 2020

Zhang Wen, Yu Ya, Fan Jun, Wu Chengguo, Wang Qingya, Pang Yan, Fan Jun, Zhang Liyi, Liu Ying

Chinese Journal of Antituberculosis. 2022, 44(8): 784-791. doi:10.19982/j.issn.1000-6621.20220196

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Objective: To analyze the epidemic characteristics of pulmonary tuberculosis (PTB) in students during the 13th Five-Year Plan period, and to provide evidence for the effective control and prevention of TB during 14th Five-year Plan period. Methods: Using current address and onset date as conditions, the data of PTB epidemic among students in Chongqing from 2016 to 2020 were extracted from the National Health Security Information Project Disease Prevention and Control Information System-Infectious Disease Surveillance Subsystem, the distribution of reported incidence among students was analyzed. Results: A total of 9453 cases of PTB students cases were registered from 2016 to 2020, and an annual reported incidence of PTB among students was 33.78/100000 (9453/27.9844 million), rising from 32.22/100000 (1741/5.4043 million) in 2016 to 37.78/100000 (2101/5.5611 million) in 2018, then slowly decreased to 29.64/100000 (1729/5.8342 million) in 2020 ( $χ t r e n d 2$ =17.53, P<0.001). The annual average registration rate of smear positive cases were 9.09/100000 (2543/27.9844 million), which increased from 5.51/100000 (298/5.4043 million) to 13.18/100000 (769/5.8342 million) with statistical differences between different years ( $χ t r e n d 2$ =241.89, P<0.001). The annual incidence peak occurred in March and December of college entrance examination and September of college entrance examination, and the incidence ranged from 11.47% (241/2101) to 15.85% (276/1741). The majority of PTB cases was around 16-18 years old, accounted for 47.73% (4512/9453). The proportion of student patients aged 13-15 years was increased from 12.94% (263/2032) to 21.11% (365/1729)( $χ t r e n d 2$ =63.18, P<0.001), but the proportion of student patients aged 16-18 years decreased from 52.31% (1063/2032) to 43.78% (757/1729) and 19-22 years decreased from 32.34% (563/1741) to 26.32% (455/1729)( $χ t r e n d 2$ =35.73, P<0.001; $χ t r e n d 2$ =20.34, P<0.001). From the point of disease distribution by place, the number of PTB among students in Chongqing from 2016 to 2020 were concentrated in the city cluster of three gorges reservoir area in northeast Chongqing (33.37% (3154/9453)), and second in the new area of Chongqing city proper (23.79% (2249/9453)), the city cluster of Wuling mountain area in southeast Chongqing (23.76% (2246/9453)) and the central urban area of Chongqing (19.08% (1804/9453)). The incidence of the disease in different regions had statistical significance (χ²=48.23,P<0.001). Conclusion: The epidemic situation of PTB among students in Chongqing was still serious. The focus of attention is students aged 16-18 and the students from northeast Chongqing. Implementing active screening will be of great significance to reduce the incidence of PTB among students.

Investigation and analysis of a school pulmonary tuberculosis aggregated epidemic in Chongqing

Fan Jun, Su Qian, Chen Jian, Yu Ya, Wang Qingya, Zhang Ting, Cheng Jun, Feng Xinyu

Chinese Journal of Antituberculosis. 2022, 44(8): 792-796. doi:10.19982/j.issn.1000-6621.20220099

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Objective: To investigate and analyze a school aggregated pulmonary tuberculosis epidemic in Chongqing and to provide thoughts and suggestions for the prevention and control of tuberculosis in schools. Methods: Descriptive epidemiological methods were used to investigate and analyze a school pulmonary tuberculosis epidemic in Chongqing from December 2020 to May 2021. Pulmonary tuberculosis screening was conducted with symptom screening, tuberculin skin test (TST) and chest X-ray, and epidemiological investigation of close contacts was also carried out. Results: After confirming 1 case of pulmonary tuberculosis with positive etiology (the index case), 8 active pulmonary tuberculosis patients and 42 latent tuberculosis infection patients were detected after 4 close contacts screening and 1 follow-up screening. All the 8 pulmonary tuberculosis students were concentrated in the class of the indicator case, with the incidence rate of 12.7% (8/63) and the etiological positive rate of 2/8. There were 34 latent tuberculosis infection patients, the latent infection rate of pulmonary tuberculosis was 61.8% (34/55), and all of them had completed preventive treatment. The incidence risk and infection risk of students in the class of the indicator case (RR=27.6, 95%CI: 13.5-56.4) were higher than those in other classes. Among the 8 cases of pulmonary tuberculosis in school, 6 were male, and 2 were female. The age distribution of cases was most in the 15-year old group (6 cases). Due to the poor quality of the chest X-ray of the first contact screening, the student patients were not found in time, resulting in the subsequent diagnosis of 3 patients. Two latent infected students were transformed into pulmonary tuberculosis patients during preventive treatment due to non-standard medication. Conclusion: The clustering of the epidemic was obvious. The low quality of screening and the failure to complete preventive treatment were important reasons for the spread of the epidemic. Therefore, when dealing with the school pulmonary tuberculosis epidemic, the quality of screening should be improved, the window period should be fully considered according to the epidemiological survey, and the standardization and completion rate of preventive treatment should be ensured.

Determination of the critical value of prophylactic medication in school population for the diagnosis of latent tuberculosis infection by tuberculin skin test

Lu Peng, Wang Rong, Liu Jiasong, Liu Qiao, Ding Xiaoyan, Lu Wei, Zhu Limei

Chinese Journal of Antituberculosis. 2022, 44(8): 797-801. doi:10.19982/j.issn.1000-6621.20220197

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Objective: To explore the critical value of mean diameter of induration tuberculin by skin test (TST) for the diagnosis of late tuberculosis infection (LTBI) that needs preventive medication in the treatment of tuberculosis epidemic in school. Methods: From October 2020 to October 2021, 163 students and teachers from two schools with three or more student tuberculosis patients in Jiangsu Province were selected. All the subjects were tested by TST and QuantiFERON-TB gold in-tube (QFT). Using the QFT results as the reference standard, the receiver operating characteristic curve (ROC) was used to determine the critical value of mean diameter of induration tuberculin, to diagnosis LTBI students and teachers who needed to have preventive treatment. Results: Of the 163 individuals, 79 (48.5%) were positive and 84 (51.5%) were negative in QFT. Among 132 individuals with moderate positive in TST, 62 were QFT positive (47.0% (95%CI: 38.3%-55.6%)). Of the 163 individuals, using the QFT results as the reference standard, TST had the highest diagnostic value when the induration diameter of TST was 12.5 mm, with a sensitivity of 38.0% (95%CI: 27.3%-49.6%) and a specificity of 82.1% (95%CI: 72.3%-89.6%). The area under the curve (AUC) was 0.621 (95%CI: 0.542-0.696). Among 132 individuals with moderate positive TST, using the QFT results as the reference standard, TST had the highest diagnostic value when the induration diameter of TST was 12.5 mm, with a sensitivity of 25.8% (95%CI: 15.5%-38.5%) and a specificity of 87.1% (95%CI: 77.0%-93.9%), and the AUC was 0.572 (95%CI: 0.483-0.657). Conclusion: In the treatment of tuberculosis epidemic in school if there are three or more tuberculosis cases in a class or the moderate or strong positive rate of TST is much higher than the normal range in the region, attention should be paid to the population with moderate positive TST results.

Application value of two-step detection of Mycobacterium tuberculosis infection screening in schools

Dong Xiaowei, Guo Huixin, Zhang Chenchen, Wang Jiawen, He Junlei, Li Guanhai, Li Jianwei, Wen Wenpei

Chinese Journal of Antituberculosis. 2022, 44(8): 802-807. doi:10.19982/j.issn.1000-6621.20220096

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Objective: To evaluate the application value of tuberculin skin test (TST) combined with interferon-gamma release assays (IGRA)(shorter form“two-step”) screening Mycobacterium tuberculosis (MTB) infection and active tuberculosis in students’ physical examination. Methods: A cross-sectional study was conducted in 74358 students in Guangdong during 2017—2021, 50701 (68.18%) were treated with chest X-ray and 74148 (99.72%) were tested with TST. And then, 9702 (13.08%) students positive in TST test received IGRA test (two-step approach). Finally, the students with abnormal chest X-ray and those who were positive in TST and IGRA tests (double positive) should be further examined to clarify the diagnosis of pulmonary tuberculosis. Results: Using the IGRA test results as the reference standard,taking the mean diameter of induration detected by TST of 5, 10 and 15 mm as the positive threshold, the consistency rates of MTB infection detected by TST and IGRA were 15.97% (1549/9702), 26.63% (2584/9702) and 81.11% (7869/9702), respectively, with the Kappa values of 0.014, 0.014 and 0.112, respectively. The rate of MTB infection detected by TST was significantly higher than that of the two-step method (11.67% (8652/74148) vs. 1.02% (759/74148), χ²=7068.423,P<0.001). The detection rate of pulmonary tuberculosis among students with moderate and strongly positive TST was significantly lower than that among students with double positive (0.29% (15/5219) vs. 1.84% (14/759), χ²=30.133,P<0.001). Conclusion: The consistency of detecting MTB infection by TST and IGRA is poor. The “two-step method” can significantly improve the detection rate of MTB infection and the screening efficiency of pulmonary tuberculosis in schools.

Analysis on the trend of age change of pulmonary tuberculosis in Sichuan from 2011 to 2020

Li Ting, Liu Shuang, Lu Jia, Wang Danxia, Xia Lan

Chinese Journal of Antituberculosis. 2022, 44(8): 808-814. doi:10.19982/j.issn.1000-6621.20220085

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Objective: To analyze the epidemic characteristics and trends of pulmonary tuberculosis (PTB) in different age groups in Sichuan from 2011 to 2020. Methods: The reported incidence data and population data of PTB patients in Sichuan Province from 2011 to 2020 were collected through the Infectious Disease Reporting Information Management System and Basic Information System, the subsystem of China Disease Prevention and Control Information System, and the trend analysis was carried out using the JoinPoint regression model. Results: From 2011 to 2020, 567300 PTB cases were reported in Sichuan. The reported incidence rate decreased from 81.14/100000 (65250 cases) in 2011 to 55.19/100000 (46218 cases) in 2020 with the annual decreasing rate of 4.19%, the standardized incidence rate showed a downward trend (annual percent change, APC), the APC and average annual percent change (AAPC) both were -4.0% (95%CI: -4.7%--3.3%). The average onset age increased from 44.19 years in 2011 to 45.45 years in 2020 with increasement of 0.104 years every year (β=0.104, P=0.008). During the 10 years, the incidence rate of PTB was the highest in people aged 65 or above (96.94/100000, 99961 cases). The peak age of incidence rate moved from 65 years (113.08/100000, 9694 cases) in 2011 to 15-24 years (89.77/100000, 8688 cases) in 2020. The incidence rate of people aged 25 and above showed a downward trend. The incidence rates of 25-34, 35-44, 45-54, 55-64, and 65 years and above decreased from 87.83/100000 (8855 cases), 77.89/100000 (12596 cases), 97.37/100000 (9778 cases), 121.07/100000 (11308 cases) and 113.08/100000 (9694 cases), respectively in 2011 to 62.85/100000 (6663 cases), 40.57/100000 (4754 cases), 58.23/100000 (8376 cases), 62.67/100000 (6543 cases) and 73.43/100000 (9686 cases), respectively in 2020. The AAPCs were -4.5% (95%CI: -7.8%--1.1%), -7.7% (95%CI: -8.9%--6.6%), -4.9% (95%CI: -8.9%--0.8%), -6.8% (95%CI: -8.0%--5.6%) and -4.6% (95%CI: -5.8%--3.4%), respectively. The incidence rate of children aged 0-14 years increased from 6.96/100000 (923 cases) in 2015 to 10.98/100000 (1508 cases) in 2020 with the APC of 9.2% (95%CI: 4.1%-14.4%). Conclusion: Although the incidence of PTB in Sichuan Province has been decreasing, the incidence rate of children and adolescents under 25 years old has been increasing in recent years, comprehensive prevention and control measures should be taken. At the same time, we should also pay attention to the elderly people.

Epidemiological characteristics of inactive pulmonary tuberculosis among the elderly in high-endemic rural areas in Quzhou City, Zhejiang Province

Zhu Ping, Hao Xiaogang, Wang Wei, Chen Bin

Chinese Journal of Antituberculosis. 2022, 44(8): 815-820. doi:10.19982/j.issn.1000-6621.20220128

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Objective: To analyze the epidemiological characteristics of inactive pulmonary tuberculosis among the elderly in high tuberculosis endemic rural areas in Quzhou, Zhejiang Province. Methods: The elderly population aged 65 and above who lived for at least 6 months in 6 administrative villages in 2 townships in Quzhou City, Zhejiang Province with high incidence of tuberculosis, were recruited. Free digital radiography (DR) screening and gamma-interferon release assays (IGRA) were performed to detect latent infection of Mycobacterium tuberculosis and screen inactive pulmonary tuberculosis, thus to obtain the prevalence of inactive pulmonary tuberculosis in the elderly people and analyze characteristics of patients and detection positive rate. Results: A total of 2050 subjects met the enroll criteria, and 1658 completed all screening tests, with a screening rate of 80.88% (1658/2050). The detection positive rate of inactive pulmonary tuberculosis was 8.62% (143/1658), the detection rate of active pulmonary tuberculosis was 0.24% (4/1658). The proportion of detected with inactive pulmonary tuberculosis in the elderly male (63.64%, 91/143) significantly higher than females (36.36%, 52/143), and the difference was statistically significant (χ²=12.161, P=0.000). The detection positive rate increased from 5.60% (34/607) among 65-69 years age group to 12.20% (10/82) among 85 years old and above age group, and the difference was statistically significant ( $χ t r e n d 2$ =12.329, P=0.000). The incidence rate of pulmonary fibrous lesions among inactive pulmonary tuberculosis patients (62.94%, 90/143) was significantly higher than that of the general population (13.04%, 197/1511,χ²=226.817, P=0.000). Conclusion: The detection positive rate of inactive pulmonary tuberculosis in rural elderly people in high tuberculosis incidence areas in Quzhou City, Zhejiang Province is rather high. Scientific researches should be continued to monitor the risk characteristics of the disease, so as to provide basic data for formulating local intervention measures to lower the epidemic.

Analysis of clinical characteristics of bloodstream infection of mycobacteria in AIDS patients

Ding Xiurong, Liu Jiachen, Chen Shuhua, Kang Yanfang, Wang Chen, Lou Jinli

Chinese Journal of Antituberculosis. 2022, 44(8): 821-826. doi:10.19982/j.issn.1000-6621.20220112

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Objective: To explore the clinical characteristics of mycobacterium bloodstream infection in AIDS patients and to improve the differential diagnosis of Mycobacterium tuberculosis (MTB) and nontuberculous mycobacteria (NTM) infection. Methods: A retrospective survey was conducted in 135 AIDS patients with mycobacterium bloodstream infection admitted to Beijing Youan Hospital from June 2016 to June 2021. The clinical data, including medical history, symptoms, signs, laboratory results, etiological characteristics, imaging characteristics and treatment were collected and the data of MTB patients and NTM patients were analyzed and compared. Results: (1) Etiological examination: among the 135 patients, 64 (47.4%) were infected with MTB and 71 (52.6%) were infected with NTM. Mycobacterium avium was dominant in NTM isolates (40 strains, 56.3%). (2) Clinical manifestations: the main clinical manifestations of those patients were fever (83.7%, 113/135), followed with cough (44.4%, 60/135), fatigue (30.4%, 41/135), diarrhea (25.2%, 34/135), etc. The incidence rate of fever, cough, expectoration and the peak body temperature in MTB infection group were significantly higher than those of NTM group (92.2% (59/64) vs. 76.1% (54/71), χ²=6.421, P=0.011; 56.3% (36/64) vs. 33.8% (24/71), χ²=6.869, P=0.009; 32.8% (21/64) vs. 11.3% (8/71), χ²=9.263, P=0.002; and (39.0±1.0) ℃ vs. (38.6±1.2) ℃, t=2.025, P=0.045, respectively). (3) Laboratory examination: procalcitonin, white blood cell count, hemoglobin and positive rate of smear acid-fast in MTB group were significantly higher than those in NTM group (1.57 (0.42, 6.71) ng/ml vs. 0.31 (0.11, 1.80) ng/ml, Z=-3.433, P=0.001; 6.62 (3.39, 8.78)×10⁹/L vs. 4.03 (2.81, 6.20)×10⁹/L, Z=2.798, P=0.005; (95.5±21.5) g/L vs. (78.7±14.6) g/L, t=5.344, P<0.001; 45.3% (29/64) vs. 11.2% (8/71), χ²=19.609, P<0.001, respectively), and the differences were statistically significant. There was significant difference on the CD4⁺ T lymphocyte count between the MTB group and the NTM group (14 (8, 55)×10⁶/L vs. 7 (2, 20)×10⁶/L, Z=-3.434, P=0.001). (4) Imaging findings: the incidence of miliary shadow and thoracic lymph node enlargement in MTB group was higher than that in NTM group (17.2% (11/64) vs. 1.4% (1/71) and 85.9% (55/64) vs. 71.8% (51/71)), and the differences were statistically significant (χ² values were 8.491 and 3.971, P values were 0.004 and 0.046, respectively). (5) Treatment outcome: the length of hospital stay in the MTB group was 18 (8,25) d, significantly shorter than that in the NTM group (26 (15,38) d), and the difference was statistically significant (Z=-3.344, P=0.001). The mortality rate of MTB group was 17.2% (11/64), which was significantly higher than that of NTM group (2.8% (2/71), χ²=5.328, P=0.021). Conclusion: Mycobacterium bloodstream infection should be constantly paid attention among AIDS patients with significantly reduced CD4⁺ T lymphocytes, if they concurrent fever, cough and expectoration, significantly increased inflammatory indicators, anemia, hypoproteinemia and typical imaging changes in the lungs. There are some differences of the clinical manifestations and laboratory indices between MTB and NTM infection, but lack of specificity.

Study on the efficacy and safety of CO₂ cryotherapy combined with forceps in the treatment of lymph node fistula tracheobronchial tuberculosis in infants

Zhao Yidi, Zhang Tongqiang, Liu Fujun, Xu Yongshen, Guo Wei

Chinese Journal of Antituberculosis. 2022, 44(8): 827-834. doi:10.19982/j.issn.1000-6621.20220114

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Objective: To evaluate the efficacy and safety of CO₂ cryotherapy combined with forceps in the treatment of infants with lymph node fistula tracheobronchial tuberculosis (TBTB). Methods: The clinical data, including age, gender, clinical symptoms, diagnosis, imaging features, and characteristics of lesions under bronchoscope, of seven children with lymph node fistula TBTB were retrospectively analyzed. All the patients underwent fiberoptic bronchoscope interventional therapy in the Respiratory Department of Tianjin Children’s Hospital from July 2012 to July 2020. The cough grade, CT and bronchoscopic lesion changes before and after the intervention were analyzed by descriptive summary. Results: Among the 7 patients, 6 were male and 1 was female, aged from 8 months to 3 years, and the duration of the disease ranged from 5 to 70 d. All the children were treated mainly with bronchoscopic CO₂ cryotherapy combined with forceps, and the number of interventions was 1 to 3 times. Three months after intervention, the cough scores of decreased from 2 to 0 in 5 patients, which was dramatic effective, and decreased from 3 to 1 in 2 patients, which was mild effective. It was showed by the CT reexamination that the manifestations of enlarged and calcified lymph nodes in the hilum and mediastinum, bronchial obstruction, emphysema, and pulmonary atelectasis of the five patients were significantly improved compared with those before the intervention. Among the five patients,≥1/2 of the lung lesions absorbed was found in four, the treatment was dramatic effective; and the other one had <1/2 of the lung lesions absorbed, the treatment was mild effective. Reexamination of fiberoptic bronchoscopy in 7 children showed that the the fistula was basically closed, the bronchial lesions were significantly absorbed and improved, the lumen stenosis or obstruction was reduced, and the bronchial mucosa was relatively smooth. Among the 7 patients, 5 of them had bronchial lesion absorption of ≥2/3, which was dramatic effective, and 2 of them had improved bronchial lesion absorption but <2/3, which was mild effective. No patients had intraoperative respiratory distress or decrease in oxygen saturation. None of the patients had any serious postoperative complications such as pneumothorax, mediastinal emphysema, airway spasm, luminal edema, or hemorrhage. They were followed up for 3-6 months with the application of fiberoptic bronchoscope intervention, except for one, and no recurrence of lesions was observed in any of the 6 patients. Conclusion: CO₂ cryotherapy combined with forceps intervention for infant with lymph node fistula TBTB achieved good therapeutic results, and no complications such as tracheobronchial stenosis, softening, obstructive pneumonia, or pulmonary atelectasis were observed, therefore, this treatment is safe and effective.

The diagnostic value of cell-free Mycobacterium tuberculosis DNA test on pleural effusion in early diagnosis of tuberculous pleurisy

Zhang Yun, Li Kun, Liang Qingtao, Liu Zichen, Duan Hongfei, Li Xuelian, Guo Ru, Che Nanying, Yang Xinting

Chinese Journal of Antituberculosis. 2022, 44(8): 835-843. doi:10.19982/j.issn.1000-6621.20220064

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Objective: To evaluate the diagnostic value of cell-free Mycobacterium tuberculosis DNA test (CF.TB) on pleural effusion in detecting tuberculous pleurisy. Methods: A total of 216 patients with unexplained pleural effusion in Beijing Chest Hospital Affiliated with Capital Medical University from July 2016 to December 2018 were enrolled. All patients were given thoracentesis or thoracic catheterization to collect pleural effusion. The CF.TB, SAT-PCR, GeneXpert MTB/RIF and adenosine deaminase (ADA) assay were performed on pleural effusion samples and T-SPOT.TB test was used on blood sample. With a composite reference standard (CRS) as the reference standard, the sensitivity, specificity, positive prediction value and negative prediction value of CF.TB, SAT-PCR, GeneXpert MTB/RIF assay, ADA and T-SPOT.TB were evaluated. Moreover, the diagnostic value of CF.TB alone and CF.TB plus ADA test were assessed. Results: Among those 216 patients, 165 cases were confirmed as tuberculous pleurisy clinically,51 cases were non-tuberculosis pleural effusion. With CRS as the reference standard, the sensitivity of CF.TB, SAT-PCR and GeneXpert MTB/RIF assay, ADA and T-SPOT.TB were 70.30% (116/165), 7.88% (13/165), 12.12% (20/165), 67.27% (111/165) and 87.27% (144/165) respectively. The specificity of five tests were 100.00% (51/51), 100.00% (51/51), 100.00% (51/51), 92.16% (47/51), and 62.75% (32/51) respectively. The positive prediction value were 100.00% (116/116), 100.00% (13/13), 100.00% (20/20), 96.52% (111/115) and 88.34% (144/163) respectively. The negative prediction value were 51.00% (51/100), 25.12% (51/203), 26.02% (51/196), 46.53% (47/101) and 60.38% (32/53) respectively. The sensitivity of CF.TB test was significantly higher than that of SAT-PCR (70.30% vs. 7.88%), GeneXpert MTB/RIF (12.12%) and ADA test (67.27%), the differences were statistically significant (χ² values were 1.350, 1.153 and 1.025, respectively, all P values=0.000). Furthermore, comparing with CF.TB test alone, performing CF.TB plus ADA could significantly improve the sensitivity of detecting tuberculous pleurisy (88.48%, 146/165 vs 70.30%, 116/165), the difference was statistically significant (χ² value was 16.670, P value=0.000). Conclusion: CF.TB test has higher sensitivity than SAT-PCR and GeneXpert MTB/RIF, and higher specificity than ADA and T-SPOT.TB in diagnosing tuberculous pleurisy. Moreover, jointly using CF.TB and ADA can significantly improve its sensitivity. We suggest it should be adopted as an important assisting diagnostic method for detecting tuberculous pleurisy.

Evaluation of the potential of cross-priming amplification for the diagnosis of Mycobacterium tuberculosis infection

Jiang Shuping, Liu Changwei, Li Bin, Xu Xiaoqin, Luo Wenji, Yu Bolin, Zhang Yue

Chinese Journal of Antituberculosis. 2022, 44(8): 844-848. doi:10.19982/j.issn.1000-6621.20220065

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Objective: To evaluate the potential of cross-priming amplification (CPA) in the diagnosis of patients newly diagnosed with suspected pulmonary tuberculosis. Methods: Of 2408 new cases of suspected pulmonary tuberculosis presenting at Longhua District Chronic Disease Control Center in Shenzhen City from January, 2020 to May, 2021 were enrolled in the study. Sputum samples were collected and sputum smears (Ziehl-Neelsen acid-fast stain (AFS) method), BACTEC MGIT 960 (MGIT 960) liquid culture and CPA analysis were performed to detect Mycobacterium tuberculosis (MTB), MGIT 960 liquid culture being used as the gold standard to evaluate the diagnostic efficacy of CPA. Results: The MTB detection rate by AFS, MGIT 960 liquid culture and CPA was 8.89% (214/2408), 27.99% (674/2408) and 15.49% (373/2408), respectively. The difference in the detection rates of the three methods was statistically significant (χ²=314.619, P=0.000), with that of MGIT 960 liquid culture being significantly higher than both CPA and AFS, and that of CPA being higher than that of AFS (χ²=110.572, 292.158, 49.046, P=0.000). Using MGIT 960 liquid culture as the gold standard, the sensitivity, specificity, positive predictive value, negative predictive value and coincidence rate of CPA in detecting MTB were 52.37% (353/674), 98.85% (1714/1734), 94.64% (353/373), 84.23% (1714/2035) and 85.84% (2067/2408), respectively, while that of the AFS method was 31.45% (212/674), 99.88% (1732/1734), 99.07% (212/214), 78.94% (1732/2194) and 80.73% (1944/2408), respectively. The sensitivity of CPA (52.37%; 95%CI: 47.21%-59.64%) was significantly higher than that of AFS (31.45%; 95%CI: 26.87%-35.72%;χ²=108.290, P=0.000). Results of CPA were in good agreement with MGIT 960 liquid culture (Kappa=0.592), but AFS results showed poor agreement (Kappa=0.395). The smear-positive/culture-negative rate was 0.08% (2/2408), and the culture contamination rate was 5.40% (130/2408). All CPA detection results were valid. Conclusion: The positive detection rate and sensitivity of CPA for diagnosing cases of suspected MTB infection was significantly higher than that of AFS, and showed better consistency. The CPA technique is simple, rapid, economical and free of contamination, making it of promising value in the early diagnosis of MTB infection.

Study on the mechanism of Oridonin against pathological damage of tuberculosis

Li Yinhong, Liu Fanglin, Lu Zhenhui, Jiang Xin

Chinese Journal of Antituberculosis. 2022, 44(8): 849-854. doi:10.19982/j.issn.1000-6621.20220060

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Objective: To explore the mechanism of Oridonin against pathological damage of tuberculosis through its effect on the NOD-like receptor protein 3 (NLRP3) inflammasomes and endoplasmic reticulum stress in Mycobacterium tuberculosis (MTB)-infected macrophages. Methods: H37Ra strain was used to establish macrophage infection model, meanwhile, blank control group, MTB infection model group and Oridonin intervention groups with different concentrations (0.5, 1.0, 2.0, 4.0 μmol/L) and different time points (6, 12, 24 h) were also set up. Methyl thiazolyl tetrazolium (MTT) method was used to detect the safe dosage range of Oridonin. Western blot was used to detect the expression level of NLRP3 and thioredoxin-interacting protein (TXNIP) protein, immunoglobulin binding protein (Bip), CCAAT/enhancer binding protein homologous protein (CHOP), phosphorylated eukaryotic translation initiation factor 2α (peIF2α) and phosphorylated inositol Requires protein expression of enzyme 1α (pIRE1α) which related to endoplasmic reticulum stress. Western blot was also used to detect the changes of NF-κB/pJNK/pp38 pathway located on downstream of endoplasmic reticulum stress. Protein quantitative analysis was performed with Image J software. Results: The survival rate of infected macrophage treated with oridonin below 4.0 μmol/L was about 90%, indicating minor toxic to cells. Western blot showed that compared with the model group at different time points (12, 24 h), Oridonin could significantly reduce expression levels of NLRP3 protein (4.35±0.13 vs. 5.95±0.15; 1.90±0.05 vs. 3.93±0.09) and TXNIP protein (1.14±0.05 vs. 1.73±0.04; 0.78±0.05 vs. 1.33±0.02), the differences were statistically significant (F=508.308 and 166.278; all P=0.000). Compared with the model group at different time points (6 h, 12 h), Oridonin could significantly reduce expression levels of Bip protein (1.85±0.07 vs. 2.27±0.07; 0.97±0.03 vs. 2.28±0.17), peIF2α protein (1.75±0.42 vs. 1.75±0.03; 1.31±0.04 vs. 2.45±0.17), IRE1α protein (10.48±0.40 vs. 14.19±0.45; 6.15±0.15 vs. 15.76±1.27), pp65 protein (0.69±0.01 vs. 1.07±0.03; 0.28±0.01 vs. 0.39±0.02), the differences were statistically significant (F=149.510, 10.489, 10.294, and 288.194, respectively; all P<0.01). Conclusion: Oridonin could regulate endoplasmic reticulum stress to inhibit the activation of NLRP3 inflammasomes, thus exert the anti-pathological damage effect in MTB-infected macrophages.

Research progress of nutrition screening and assessment tools for patients with tuberculosis

Liu Xiaotong, Wang Ansu, Jiang Zhongyan, Lou Yijiao, Gao Fengqiong, Feng Jiayi, Xia Tongxia

Chinese Journal of Antituberculosis. 2022, 44(8): 855-859. doi:10.19982/j.issn.1000-6621.20220140

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National burden of tuberculosis in China is the second in the world, and malnutrition has significant impact on the prognosis of tuberculosis. At present, there are many kinds of tools for the screening and evaluation of nutrition. In order to help the clinical workers choose appropriate tools for the evaluation of nutrition according to different situations of patients, the author summarized the content, application, advantages and limits of different tools commonly used for tuberculosis.

Application value of rapid rehabilitation model based on 4R crisis management in elderly patients with cognitive impairment after spinal tuberculosis surgery

Ai Yajuan, Han Xu, Bi Na, Xue Haibin, Ren Yinping

Chinese Journal of Antituberculosis. 2022, 44(8): 860-864. doi:10.19982/j.issn.1000-6621.20220137

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A total of 128 patients undergoing spinal tuberculosis surgery admitted to the Department of Orthopedics, 8th Medical Center, PLA General Hospital, from February 2019 to December 2021 were selected. Routine nursing was performed in 68 cases of the above patients from February 2019 to May 2020, of the other 60 patients admitted from June 2020 to December 2021 were treated with rapid rehabilitation mode based on 4R crisis management after surgery. By random drawing, 40 patients were selected from the each of the two groups as control group and observation group. No emergencies or postoperative complications were found in observation group; while in the control group, 4 cases (10.0%) suffered adverse events and 6 cases (15.0%) had complications, the differences was statistically significant (χ²=4.211, P=0.040; χ²=6.486, P=0.001). The cognitive impairment scores on the third day, the first week and the second week after operation of the observation group were significantly lower than those of the control group (26.90±0.58 vs. 27.12±0.60, t=1.702, P=0.047; 26.72±0.55 vs. 27.02±0.57, t=2.441, P=0.008; 26.57±0.54 vs. 26.95±0.50, t=3.221, P<0.001, respectively). Twenty-nine patients (72.5%) had the independent walking physical activity of independent walking ability after surgery in the observation group, significantly more than that in the control group (19 patients, 47.5%)(Z=-2.467, P=0.014). In the observation group, the postoperative hospitalization time was (14.55±0.67) d, significantly shorter than that in the control group ((15.02±0.82) d, t=2.836, P=0.003). Therefore, for the elderly patients with cognitive impairment after spinal tuberculosis surgery, the implementation of 4R crisis management rapid rehabilitation mode could improve the safety of clinical nursing, reduce the occurrence of postoperative complications, and is helpful to the postoperative rehabilitation of patients.

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