Table of Content

10 December 2023, Volume 45 Issue 12

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Interpretation of Standards

Interpretation of the Political Declaration of the Second High-level Meeting of the General Assembly of United Nations on the Fight Against Tuberculosis

Zhang Lijie, Liu Yuhong

Chinese Journal of Antituberculosis. 2023, 45(12):  1117-1119.  doi:10.19982/j.issn.1000-6621.20230380

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Tuberculosis is a major infectious disease that seriously endangers human health, and is also one of the major public health issues of global concern. The 78th General Assembly of United Nations held the second high-level meeting on the fight against tuberculosis in New York on September 23, 2023. Representatives of countries and international organizations expressed their support for the initiatives of United Nations initiative on the strategic goal of ending tuberculosis epidemic by 2030. Political Declaration of the High-level Meeting of General Assembly on the Fight Against Tuberculosis produced by the General Assembly was agreed by heads of state and government and senior representatives, which proposed the policy and measures to accelerate the achievement of the goal of ending tuberculosis epidemic by 2030.

Interpretation of WHO operational handbook on tuberculosis: module 1: prevention-infection prevention and control

Sun Yuxian, Liu Yuhong

Chinese Journal of Antituberculosis. 2023, 45(12):  1120-1124.  doi:10.19982/j.issn.1000-6621.20230365

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In August 2023, World Health Organization (WHO) published WHO operational handbook on tuberculosis: module 1: prevention-infection prevention and control, as a supporting material for WHO consolidated guidelines on tuberculosis: module 1: prevention-infection prevention and control released in December 2022, to provide feasible suggestions for the implementation of the recommendations on tuberculosis infection prevention and control in clinical as well as prevention and control programme. The author interprets the key content of this manual for reference.

Special Topic

Discipline construction of tuberculosis: from clinical resources to medical research-based translational medicine

Wang Jin, Lu Shuihua

Chinese Journal of Antituberculosis. 2023, 45(12):  1125-1130.  doi:10.19982/j.issn.1000-6621.20230353

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Currently, great progress has been made in tuberculosis (TB) diagnosis, treatment and prevention; however, there is still a long way to go. In recent years, large-scale cohort studies and biological sample library resources have led to continuous breakthroughs in disease research and TB-related translational medicine. Diagnostic technology and drug development ideas and approval standards have also begun to change, and related products have gradually been applied in clinic, improving the level of precise prevention, diagnosis, and treatment. In this review, we present the current dilemma based on the current situation of TB diagnosis and treatment, elaborate the concept TB prevention and treatment based on the concept of precision medicine, emphasize the role of medical research-based transformation in the accurate diagnosis and treatment of TB, as well as the dual-path transformation of clinical medicine and public health. Finally, on the road to TB translational medicine, it is proposed that, attention should be paid to the cultivation of comprehensive, innovative and high-level medical talents, and establish a policy-oriented guarantee system to guide the orderly development of precision medicine and medical research transformation.

Focusing on the diagnosis of pulmonary tuberculosis in sputum-free patients and exploring the potential of tongue swab substitution

Dong Yu, Pang Yu

Chinese Journal of Antituberculosis. 2023, 45(12):  1131-1133.  doi:10.19982/j.issn.1000-6621.20230379

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Tuberculosis is a global health threat. Pulmonary tuberculosis is the main form of tuberculosis, and sputum is the preferred diagnostic specimen. The bacteriological or molecular biological tests for sputum have become the gold standard, however, the difficulty of diagnosis in sputum-free patients is increasing. Although bronchial lavage fluid and gastric fluid can be used in the diagnosis of pulmonary tuberculosis, there are difficulties and inconveniences in the collection process. Tongue swab, as a simple and rapid specimen with low biosafety risk, may be an ideal replacement type of sputum specimen or a new means to assist in the diagnosis of tuberculosis. In this paper, the author emphasizes the importance of the diagnosis of patients with sputum-free pulmonary tuberculosis, and looks forward to the application of tongue swab in the diagnosis of pulmonary tuberculosis.

Original Articles

Estimation on direct medical costs of pulmonary tuberculosis in China

Liu Yuhong, Gao Mengqiu, Zhang Lijie, Ma Liping, Nie Lihui, Jiang Guanglu, Ding Hongwan, Li Liang

Chinese Journal of Antituberculosis. 2023, 45(12):  1134-1140.  doi:10.19982/j.issn.1000-6621.20230317

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Objective: To formulate clinical service packages required by different types of pulmonary tuberculosis and make estimation on direct medical costs accordingly. Results of estimation will be used to inform policy recommendations on optimized allocation of funds dedicated for tuberculosis prevention, promotion of multi-channel financing as well as further alleviation of financial burden of tuberculosis patients. Methods: According to China’s current tuberculosis prevention and control strategy, technical recommendations and clinical pathways, also in consideration of current capacity and clinical practices in tuberculosis designated hospitals at all levels, adoption and potential upgrade of new control strategy as well as application of new technologies and interventions in the future, this study had formulated different clinical service packages for different types of pulmonary tuberculosis patients and calculated the direct cost incurred by individual patient during diagnosis and treatment as well as total cost of these packages by multiplying the numbers of these different pulmonary tuberculosis patient groups in China. Results: Direct cost for a rifampicin-susceptible pulmonary tuberculosis patient was about 15370 Yuan, that of a rifampicin-resistant pulmonary tuberculosis patient was about 196585 Yuan. The annual budget required to cover the total direct medical cost of all pulmonary tuberculosis patients in China was about 14.69 billion Yuan with an average annual investment of 10 Yuan per capita, of which total medical cost for rifampicin-susceptible pulmonary tuberculosis patients accounts for 10.76 billion Yuan (73.2%, 10.76/14.69), that of rifampicin-resistant pulmonary tuberculosis patients was 3.93 billion Yuan (26.8%, 3.93/14.69). Of total medical cost, 8.31 billion Yuan (56.6%, 8.31/14.69) was incurred by outpatient cost; 6.38 billion Yuan (43.4%, 6.38/14.69) was inpatient cost. Conclusion: The estimates come out of this study have provided promotion of multi-channel financing, overall budgeting and allocation of funds dedicated for tuberculosis prevention and control, development of feasible medical cost alleviation and concession policy for tuberculosis patients with valuable references.

Development of national reference panel for Mycobacterium tuberculosis antigen detection kits

Shi Dawei, Chen Xianglin, Dong Wenzhu, Wen Shuan, Zhang Tingting, Wang Yufeng, Huang Hairong, Xu Sihong

Chinese Journal of Antituberculosis. 2023, 45(12):  1141-1146.  doi:10.19982/j.issn.1000-6621.20230260

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Objective: To establish a national reference panel for tuberculosis antigen detection reagent. Methods: The raw materials were confirmed by microbiologic and molecular tests, then homogenized, diluted, dispensed, and assembled to the panel. The copy numbers of the panel samples were identified using the Mycobacterium tuberculosis nucleic acid detection kit. Two colloidal gold reagents were used for the collaborative calibration study, and accordingly the quality requirement was finally determined. Then the uniformity and stability of the reference material were investigated. Results: The reagents of the two companies both could correctly detect all positive candidate reference samples (5/5) and negative candidate reference samples (5/5); for the reference substance (Rv) after 2-fold serially dilution, both reagents of the two companies could detect positive with 32-fold diluted samples and negative for 64-fold diluted samples. The reference panel consisted of 5 negative and 5 positive samples and one limit of detection (LoD)/precision sample. The acceptable quality requirement of the reference was determined as follows: the agreement rate of the negative samples should be 5/5; the agreement rate of positive samples should be 5/5; The P0 was 2-fold serially diluted to 64-fold, and the test result of 16-fold dilution should be positive. The precision sample P0 was diluted to 8-fold and tested 10 times in parallel, and the test results should all be positive and the color intensity of the strip should be uniform. Conclusion: The national reference panel could be used for performance evaluation and quality control of colloidal gold detection kit for Mycobacterium Tuberculosis antigen.

Antibacterial activity of a new compound, Shudapyridine (WX-081), against Mycobacterium abscesses

Su Lei, Liu Lina, Wang Qingfeng, Chu Naihui, Nie Wenjuan

Chinese Journal of Antituberculosis. 2023, 45(12):  1147-1151.  doi:10.19982/j.issn.1000-6621.20230364

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Objective: To analyze the in vitro and in vivo activity of Sudapyridine (WX-081) against Mycobacterium abscess. Methods: The standard strain ATCC19977 and 7 clinical isolates of Mycobacterium abscess were selected, and the minimum inhibitory concentration (MIC) of WX-081 against Mycobacterium abscess were measured. In order to further evaluate the in vivo activity of WX-081 against Mycobacterium abscesses, AB type wild zebrafish was selected to construct an infection model of Mycobacterium abscesses. The maximum tolerated concentration (MTC) of WX-081, betaquiline, and azithromycin were tested to evaluate the antibacterial effect of WX-081 against Mycobacterium abscesses. Results: The in vitro MIC range of WX-081 for 1 standard strain of Mycobacterium abscess and 7 clinical isolates was 0.7813-1.5625 μg/ml. The MTCs of zebrafish against azithromycin, betaquiline, and WX-081 were 62.50 μg/ml, 15.60 μg/ml, and 62.50 μg/ml, respectively. When the concentrations of WX-081 were 11.95 μg/ml, 3.91 μg/ml, 7.81 μg/ml, 15.60 μg/ml, 31.20 μg/ml, and 62.50 μg/ml, the whole body fluorescence intensities of zebrafish were 535952±23902, 520519±18208, 492988±17182, 462296±14360, 419947±13302, and 375347±11359, respectively; the fluorescence intensities of zebrafish head were 101579±6065, 101495±10160, 93190±5468, 89877±10333, 76778±4906, and 70976±5726, respectively; with the increase of WX-081 concentration, the values gradually decreased and were lower than those of the untreated infected animal model group (zebrafish whole body fluorescence intensity was 671089±22305; zebrafish head fluorescence intensity was 671089±22305, the differences were statistically significant (comparison of whole body fluorescence intensity of zebrafish: t values were 4.134, 5.229, 6.326, 7.871, 9.670, and 11.815, respectively, all P<0.001; comparison of head fluorescence intensity of zebrafish: t values were 2.639, 2.170, 3.444, 2.872, 4.999, and 5.336, respectively, all P<0.001). On the 4th to 9th day after fertilization, when the WX-081 concentrations of 1.95 μg/ml, 3.91 μg/ml and 7.81 μg/ml, the mortality rates of zebrafish were 90.0% (54/60), 85.0% (51/60), and 81.7% (49/60), respectively. When the concentration of WX-081 gradually increased, the mortality rate gradually decreased (P<0.05). Conclusion: WX-081 effectively inhibits the growth of Mycobacterium abscesses in vitro and in vivo, prolongs the survival time of zebrafish infected with Mycobacterium abscesses, and it has good activity against Mycobacterium abscesses.

Association of ESRRB rs12437118 polymorphisms with tuberculosis susceptibility of Han population in northern China

Duan Shujuan, Zhao Lingjuan, Li Chuanyou, Li Ling, Wang Wei

Chinese Journal of Antituberculosis. 2023, 45(12):  1152-1157.  doi:10.19982/j.issn.1000-6621.20230293

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Objective: To investigate the relationship between rs12437118 polymorphisms in ESRRB-coding gene ESRRB and tuberculosis susceptibility in Han population in northern China. Methods: A total of 607 Han tuberculosis patients in northern China visited Beijing Chest Hospital affiliated to Capital Medical University from March 2018 to October 2019(the case group) and 660 Han staff of tuberculosis specialist hospitals in northern China (the health control group) were collected. Competitive allele-specific PCR (KASP) was used to determine the polymorphism of the ESRRB gene rs12437118 single nucleotide polymorphism (SNP). Serum levels of ESRRB protein were measured by enzyme-linked immunosorbent assay (ELISA). By comparing the differences between genotype and ESRRB protein, the relationship between ESRRB gene rs12437118 locus polymorphisms and tuberculosis susceptibility was analyzed. The association of ESRRB rs12437118 polymorphisms with tuberculosis was evaluated using different genetic models, including dominant and recessive models. Results: The frequencies of GG, GA and AA rs12437118 genotypes were 50.2% (305/607), 38.1% (231/607) and 11.7% (71/607) in the case group and 44.9% (296/660), 45.6% (301/660) and 9.5% (63/660) in the healthy control group, respectively, and the difference between the two groups was statistically significant (χ²=7.619, P=0.022). GA rs12437118 SNP genotype was significantly associated with a low risk of tuberculosis in the Han population in northern China (OR (95%CI)=1.34 (1.06-1.70), χ²=6.079, P=0.014). The serum ESRRB level in the case group (243.1 (174.3, 367.3) pg/μl) was significantly lower than that in the healthy control group (360.3 (240.0, 604.1) pg/μl)(Z=5.623, P<0.001). However, there were no significant difference in ESRRB levels with different rs12437118 genotypes between the case group and the control group. ESRRB levels of AA, GA and GG genotypes in the case group were 328.9 (226.3, 553.0) pg/μl, 232.6 (164.7, 379.7) pg/μl and 196.8 (150.1, 328.4) pg/μl, respectively (F=1.790, P=0.171); and in the control group were 427.5 (253.9, 619.4) pg/μl, 353.7 (247.8, 666.4) pg/μl and 303.3 (219.8, 519.1) pg/μl, respectively (F=1.751, P=0.177). Conclusion: There was a significant association between ESRRB rs12437118 GA genotype and tuberculosis susceptibility in Han population in northern China, and low expression of ESRRB in serum of tuberculosis patients was not associated with rs12437118 gene polymorphism.

Efficacy analysis of GeneXpert MTB/RIF and TB-DNA fluorescent PCR methods for detecting pus samples in the diagnosis of extrapulmonary tuberculosis

Shao Yanqin, Zhu Mingzhi, Dai Lingshan, Peng Lijun, Mei Bin, Fang Tingting, Cai Long

Chinese Journal of Antituberculosis. 2023, 45(12):  1158-1163.  doi:10.19982/j.issn.1000-6621.20230304

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Objective: To compare the diagnostic value of Mycobacterium tuberculosis (MTB)/Rifampicin resistance real-time fluorescent quantitative nucleic acid amplification assay (GeneXpert MTB/RIF, Xpert) and tuberculosis/non-tuberculosis mycobacterium PCR fluorescent probe (TB-DNA) in detecting extra-pulmonary pus samples for tuberculosis. Methods: A retrospective analysis was performed on 388 cases of suspected extrapulmonary tuberculosis treated in Hangzhou Red Cross Hospital from January 2021 to February 2023, and pus samples were obtained from the lesion site. The pus samples were detected by Xpert, TB-DNA and BACTEC MGIT 960 liquid culture (MGIT 960 culture), respectively. To compare the efficacy of two fluorescence PCR methods in the diagnosis of extrapulmonary tuberculosis in pus samples, using clinical diagnosis as a reference standard. Results: Using a clinical diagnosis as the standard, the sensitivity, specificity, and AUC of Xpert and TB-DNA were 84.15% (276/328), 100.00% (60/60), 0.92 and 84.45% (277/328),100.00% (60/60), 0.92, respectively. Using culture as the gold standard, the sensitivity, specificity, and AUC of Xpert and TB-DNA were 89.90% (89/99), 35.29% (102/289), 0.63 and 92.93% (92/99), 35.99% (104/289), 0.65, respectively. Consistency analysis showed that TB-DNA and Xpert were highly consistent with clinical diagnosis (Kappa values were 0.62, 0.63), MGIT 960 culture showed very low consistency with clinical diagnosis (Kappa value was 0.12). Among the 388 samples, TB-DNA and Xpert simultaneously detected 262 cases of MTB positivity, but neither method detected 97 cases. There were 15 cases of TB-DNA positivity and Xpert negativity, and 14 cases of TB-DNA negativity and Xpert positivity. Xpert detected 276 cases of MTB positivity, 12 cases of rifampicin resistance, and the rifampicin resistance rate was 4.35% (12/276). Conclusion: After receiving pus samples from newly treated patients with extrapulmonary tuberculosis, TB-DNA could be used for preliminary screening, and positive samples could be obtained by other detection methods for drug resistance information.

Analysis of spatial-temporal feature of notified pulmonary tuberculosis cases aged 60 years and above in Gansu Province from 2018 to 2022

Wang Bo, He Aiwei, Yang Shumin, Zhao Jianxi, Bai Yu’e, Guo Qiang, Ma Yubao, Liu Fang

Chinese Journal of Antituberculosis. 2023, 45(12):  1164-1169.  doi:10.19982/j.issn.1000-6621.20230236

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Objective: To provide more targeted pulmonary tuberculosis (PTB) prevention and control policy suggestions by analyzing the spatial-temporal distribution characteristics of PTB notification rate among people aged 60 years and above at county level in Gansu Province from 2018 to 2022. Methods: The number of PTB notification cases and data of resident population disaggregated by county level,gender and age group in Gansu Province from 2018 to 2022 were derived from the Chinese Disease Prevention and Control Information System. Global spatial autocorrelation (Moran’s I) and local spatial autocorrelation were analyzed, so did the spatial-temporal scanning. Results: The average PTB notification rate among males ≥60 years in county level of Gansu Province from 2018 to 2022 was 74.53/100000 (7740/10385100), and for females it was 61.79/100000 (6661/10780200). The notification rate among all elderly people at county level of Gansu Province from 2018 to 2022 showed spatial autocorrelation (Moran’s Is>0,Ps<0.05).High-high incidence areas concentrated in Jiuquan City (Suzhou District,Dunhuang County,Guazhou County,Yumen County,Jinta County),Jiayuguan City,Zhangye City (Ganzhou District,Gaotai County,Minle County,Shandan County,Sunan County),Wuwei City (Liangzhou District,Tianzhu County,Gulang County),Jinchang City (Yongchang County,Jinchuan District).The spatial-temporal scanning showed that the primary gathering areas of PTB notification rate were mainly Jiuquan City (Suzhou District,Jinta County,Aksai County,Dunhuang City),Jiayuguan City,Zhangye City (Ganzhou District,Linze County,Minle County,Shandan County,Sunan County, Gaotai County),Wuwei City (Liangzhou District,Gulang County,Minqin County). The gathering time was from January 1st 2018 to December 31st 2019. Conclusion: The epidemic situation of PTB in people aged 60 years and above at county level of Gansu Province was still severe from 2018 to 2022, and the notification rate of PTB showed an obvious spatial aggregation, the hot spots concentrated in Hexi Corridor (northwest) of Gansu Province.

Temporal-spatial distribution of pulmonary tuberculosis in Tianjin during 2011—2022

Zhang Wenqian, Huang Fei, Zhang Guoqin, Pang Xuewen, Zhang Fan

Chinese Journal of Antituberculosis. 2023, 45(12):  1170-1176.  doi:10.19982/j.issn.1000-6621.20230287

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Objective: To analyze the spatial-temporal distribution and clustering characteristic of pulmonary tuberculosis (PTB) in Tianjin from 2011 to 2022, and provide a theoretical basis for improving the level of tuberculosis control and development of tuberculosis control strategies. Methods: Through the “China Disease Prevention and Control Information System” subsystem “Tuberculosis Management Information System” and Tianjin Statistical Yearbook and China Infectious Disease Surveillance Information Report Management System, collected the notification rate of PTB from 2011 to 2022, patient datas (patient registration time and current address), administrative areas, and the relevant demographic information in Tianjin. To analyze the spatial-temporal distribution and clustering characteristic of PTB using SPSS 26.0, ArcGIS 10.7 and SaTScan 10.1 software. Results: Form 2011 to 2022, the notification rate of PTB in Tianjin ranged from 20.40/100000 (2801/13730000) to 26.42/100000 (3543/13410000), with no statistically significant difference ($x^{2}_{trend}=1.144$, P=0.233). The annual average notification rate of PTB were 23.82/100000 (39907/167506000) and the average annual decline rate was 2.32% $\left[\left(\sqrt[11]{\frac{20.40}{26.42}}-1\right) \times 100 \%\right]$. Form 2012 to 2016, the notification rate of PTB in Tianjin ranged from 23.15/100000 (3190/13780000) to 25.16/100000 (3548/14100000), with spatial aggregation (Moran’s I=0.138, 0.228, 0.130, 0.238, 0.288; Z=2.474, 3.625, 2.417, 3.732, 4.368; P=0.013, <0.001, 0.016, <0.001, <0.001). The local spatial autocorrelation analysis showed that there were two kinds of aggregation models (high-high and low-high models) in Tianjin except for 2021, in which clustering area were not formed. High-high clusters are mainly concentrated in the central urban area (Heping District, Hexi District, Hedong District, Nankai District, Hebei District, Hongqiao District) and the ring urban area (Beichen District, Dongli District, Xiqing District, and Jinnan District). The spatio-temporal scanning results showed that two spatio-temporal clustering areas existed. The first-level clustering area was mainly in six districts of Tianjin City from 2011-2016 (LLR=383.11, RR=1.42, P<0.001), and the second-level clustering area was in Binhai New Area from 2014-2019 (LLR=27.12, RR=1.32, P<0.001). Conclusion: The notification rate of PTB in Tianjin tends to be stable from 2011 to 2022 with spatial clustering from 2012 to 2016. The high-high clustering was mostly found in the central urban area and the ring urban area. And there were spatio-temporal clustering in the central urban areas and the Binhai New Area. As a consequence, we should pay attention to the changes of PTB epidemic in areas with large population mobility, dense population and economic development, to adjusted tuberculosis control strategy according to local conditions by improving the level of differential diagnosis and explored the strategy of active cases finding in the areas.

Application of ARIMA, ARIMAX, and NGO-LSTM models in forecasting the incidence of tuberculosis cases in Liaocheng City, Shandong Province

Sun Minghao, Duan Yuqi, Zheng Liang, Yu Shengnan, Cheng Chuanlong, Zuo Hui, Chen Ming, Li Xiujun

Chinese Journal of Antituberculosis. 2023, 45(12):  1177-1185.  doi:10.19982/j.issn.1000-6621.20230253

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Objective: The purpose of this study was to determine the optimal model for predicting tuberculosis incidence in Liaocheng City, Shandong Province by comparing the Autoregressive Integrated Moving Average (ARIMA) model, the Autoregressive Integrated Moving Average with Exogenous Regressors (ARIMAX) model, and the Long Short-Term Memory (LSTM) model combined with the Northern Goshawk Optimization (NGO) algorithm. Methods: Monthly tuberculosis case data from January 2011 to December 2018 were collected. We constructed ARIMA model, ARIMAX model, and NGO-LSTM model based on data from January 2011 to December 2017, respectively, and evaluate the performance of the three models in predicting the number of tuberculosis cases in 2018. Results: The mean absolute percentage errors (MAPE) for the ARIMA model, the multivariate ARIMAX model considering the monthly average relative humidity (lagged by 1 month) and the minimum temperature (lagged by 2 months), and the NGO-LSTM model for predicting tuberculosis incidence in 2018 were 9.293%, 8.419%, and 5.820%, respectively. The mean absolute errors (MAE) were 19.282, 16.997, and 13.119, respectively, and the root mean square errors (RMSE) were 23.773, 22.191, and 16.297, respectively. Conclusion: Among the three models, the NGO-LSTM model had the best predictive performance for monthly tuberculosis incidence in Liaocheng City, providing a new idea for the establishment of a tuberculosis alerting system and scientific basis for relevant departments to make decisions on tuberculosis prevention and control policy.

Manifestations and classification of MRI imaging of spinal cord tuberculosis

Li Xiang, Wei Jialu, Fu Xuwen, Qi Min, Gan Wei, Cun Xinhua

Chinese Journal of Antituberculosis. 2023, 45(12):  1186-1192.  doi:10.19982/j.issn.1000-6621.20230240

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Objective: To analysis the MRI imaging manifestations and staging of spinal cord tuberculosis. Methods: A retrospective study method was used to include the MRI imaging data of 82 patients who were diagnosed with intracranial tuberculosis combined with spinal cord tuberculosis for the first time at the Third People’s Hospital of Kunming from May 2019 to December 2021 according to the enrollment criteria, to summarize the imaging manifestations and staging. Results: The MRI imaging manifestations of 82 cases of spinal cord tuberculosis were classified into spinal cord parenchymal type (42 cases, 51.2%), spinal meninges type (36 cases, 43.9%), and mixed type (4 cases, 4.9%) according to the involvement or not of spinal membrane and spinal cord parenchyma. Among them, the spinal cord parenchymal type showed the single or multiple nodular enhancing or ring enhancing lesions in the spinal cord parenchyma, with or without spinal cord oedema, and the proportion (64.3% (27/42)) combined with haematogenous disseminated tuberculosis was higher than in the spinal meninges type group (30.6%, 11/36), and was more likely to combine with active secondary tuberculosis (31.0%, 13/42) and tuberculous meningitis (81.0%, 34/42) than that of the spinal meninges type group (61.1%, 22/36 and 97.2%, 35/36, respectively), with statistically significant differences (χ²=8.828, P=0.003; χ²=7.127, P=0.008; χ²=5.027, P=0.025). The spinal meninges type presented linear thickening of the soft spinal cord membrane and/or subarachnoid tuberculoma without spinal cord parenchymal lesions, which might be accompanied with spinal cord oedema, syringomyelia, or subarachnoid adhesions; the mixed type presented both of the above manifestations. Conclusion: Spinal cord tuberculosis is predominantly manifested by MRI of the spinal cord parenchymal type, followed by the spinal meningeal type, while the mixed type is rare, and the diagnostic value of MRI can be enhanced by taking the MRI features of each type as reference.

Review Articles

Progress of diagnosis of extrapulmonary tuberculosis with GeneXpert MTB/RIF Ultra

Dong Yu, Zhang Fuzhen, Shang Yuanyuan, Pang Yu

Chinese Journal of Antituberculosis. 2023, 45(12):  1193-1197.  doi:10.19982/j.issn.1000-6621.20230357

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Extrapulmonary tuberculosis is a form of tuberculosis characterized by various infection routes and sites, complex clinical manifestations, and a lack of specific diagnosis. Currently, there are limitations in etiological and immunological diagnostic methods, and there is an urgent need for laboratory techniques that can quickly and accurately diagnose extrapulmonary tuberculosis to facilitate early detection and timely treatment. GeneXpert MTB/RIF Ultra (Xpert Ultra) is a novel molecular diagnostic tool that has revolutionized the rapid and precise diagnosis of extrapulmonary tuberculosis. The author examines the diagnostic effectiveness of Xpert Ultra in different types of extrapulmonary tuberculosis specimens, aiming to assess its clinical value and offer new insights into the diagnosis of extrapulmonary tuberculosis.

Research progress on macrophage polarization and Mycobacterium tuberculosis infection

Wu Xianjin, Huang Haiyong, Xiao Leyao, Xu Junfa

Chinese Journal of Antituberculosis. 2023, 45(12):  1198-1204.  doi:10.19982/j.issn.1000-6621.20230265

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Tuberculosis is a chronic infectious disease caused by Mycobacterium tuberculosis (MTB), which seriously endangers human health, and the emergence of drug-resistant MTB greatly exacerbates the difficulty of treatments. As an essential factor against MTB, macrophage polarizes into two subpopulations including M1 and M2 types once infected, which exhibit distinguish impacts during host infection. Macrophage polarization is tightly related to the occurrence, progression, and prognosis of tuberculosis diseases. In this review, the authors summarized the dynamic balance of polarization between M1 and M2 macrophages and polarization-related pathways during MTB infection, which might provide some perspectives for vaccine development, prevention, and treatment of tuberculosis diseases.