Table of Content

10 June 2024, Volume 46 Issue 6

Previous Issue    Next Issue

CONTENTS

Chinese Journal of Antituberculosis. 2024, 46(6):  0-0. 

Abstract ( 118 )   PDF (911KB) ( 129 )   Save

Related Articles | Metrics

Special Topic

Screening strategy in zero tuberculosis community project

Cheng Jun, Zhao Yanlin

Chinese Journal of Antituberculosis. 2024, 46(6):  605-612.  doi:10.19982/j.issn.1000-6621.20230435

Abstract ( 345 )   HTML ( 47 )   PDF (1193KB) ( 501 )   Save

References | Related Articles | Metrics

Active case finding and tuberculosis (TB) preventive treatment are core elements of zero tuberculosis community project, and a feasible screening strategy based on local TB epidemic and practice will be benefit to find out TB patients/subclinical TB patients and high risk populations. Based on reviewing both the World Health Organization guidelines on active case finding and management of latent TB infection and evidence-based guidelines for screening suggested by domestic scholars, authors suggest that high risk populations in community, peoples living or working in key places, and patients visiting hospitals should be screened for TB in zero tuberculosis community project sites. The specific screening strategy for every kind of target population and the following categorical intervention have been provided by the authors.

Interpretation of Standards

Dedicating to innovation, practicing to achieve targets: interpretation of research & innovation part of the WHO Global Tuberculosis Report 2023

Shu Wei, Liu Yuhong

Chinese Journal of Antituberculosis. 2024, 46(6):  613-617.  doi:10.19982/j.issn.1000-6621.20240159

Abstract ( 414 )   HTML ( 54 )   PDF (1009KB) ( 499 )   Save

References | Related Articles | Metrics

“Intensified research and innovation” is the third pillar of the End TB Strategy, new research and technology are important tools to accelerate the process of eliminating tuberculosis (TB). On November 7, 2023, World Health Organization released the Global Tuberculosis Report 2023, updating the global prevalence of TB and the progress in the prevention, diagnosis and treatment. This paper reviews the key achievements in the areas of TB research and innovation for new diagnostics, drugs and regimens as well as vaccines introduced in the report, and discusses some of China’s indigenous progresses in related areas. This paper aims to make China’s TB professionals better informed about the latest research development in TB prevention and control around the globe, fostering indigenous TB innovation efforts with greater originality.

Interpretation of Evidence and research gaps identified during development of policy guidelines for tuberculosis (Second edition): tuberculosis related comorbidity

Liu Guizhen, Deng Guofang

Chinese Journal of Antituberculosis. 2024, 46(6):  618-624.  doi:10.19982/j.issn.1000-6621.20240076

Abstract ( 342 )   HTML ( 20 )   PDF (1030KB) ( 648 )   Save

References | Related Articles | Metrics

Addressing comorbidities and associated risk factors in patients with tuberculosis is crucial for eradicating the disease. In 2023, the World Health Organization released the second edition of Evidence and research gaps identified during development of policy guidelines for tuberculosis, which highlights the principal research gaps in tuberculosis-related comorbidities, notably in Mycobacterium tuberculosis/HIV co-infection, nutritional support and care, and among populations of injecting drug users. In this article, the author interprets these identified research gaps and summarizes China’s current research advancements in these areas, providing insights for professionals engaged in related fields.

Original Articles

Comparison of microbiota diversity in the sputum of pulmonary tuberculosis patients with rifampicin resistance or sensitivity

Zhang Hongtai, Ren Yixuan, Hu peilei, Wang Nenhan, Li Jie, Tian Lili, Zhao Yanfeng, Chen Shuangshuang, Li Chuanyou

Chinese Journal of Antituberculosis. 2024, 46(6):  625-633.  doi:10.19982/j.issn.1000-6621.20240047

Abstract ( 213 )   HTML ( 8 )   PDF (5758KB) ( 313 )   Save

Figures and Tables | References | Related Articles | Metrics

Objective: To explore the structural differences in the respiratory tract flora community in pulmonary tuberculosis patients with rifampicin (RFP) resistance or sensitivity using 16S high-throughput sequencing technology. Methods: Sputum samples (80 patients) from Beijing Center for Disease Control and Prevention (70 patients) and Hunan Chest Hospital (10 patients) were included in this prospective study. Using Xpert assay, high-throughput targeted rpoB sequencing and RFP susceptibility assay on these sputum samples, the 80 patients were divided into RFP-resistant group (RFP-R, with RFP resistance based on the RFP-resistance determining region (RRDR) mutation; 41 patients) and RFP-sensitive group (RFP-S, no RRDR mutation; 39 patients). High-throughput sequencing of the 16S V4 region, bioinformatics analysis, and statistical analysis of the sequencing results were performed. Results: In total, 41950224 original 16S rRNA reads were obtained from the RFP-R and RFP-S groups, with 344 and 342 average operational classification units (OTUs) for the RFP-R group and RFP-S group, respectively. Firmicutes (47.72%), Bacteroidota (22.36%), Proteobacteria (14.67%), Actinobacteriota (7.57%), and Fusobacteriota (6.46%) were the main bacterial phyla detected, accounting for 98.78% of the microbial community. Compared with the RFP-S group, the relative abundances of the Fusobacteriota (7.531% vs. 5.167%; t=2.218, P=0.030) and Spirochaeta (0.596% vs. 0.246%; t=2.128, P=0.038) in the RFP-R group were significantly higher, the same as for Oribacterium (0.690% vs. 0.326%; t=3.112, P=0.003), Filifactor (0.135% vs. 0.030%; t=2.171, P=0.035), Allisonella (0.046% vs. 0.006%; t=3.237, P=0.002), Pseudomonas (0.205% vs. 0.054%; t=2.040, P=0.046), and Treponema (0.601% vs. 0.242%; t=2.155, P=0.036), whereas Capnocytophaga (0.351% vs. 0.772%; t=―2.044, P=0.046) and Pauljensenia (2.314% vs. 3.706%; t=―2.660, P=0.010) in the RFP-R group showed decreased relative abundances compared with those in the RFP-S group. Conclusion: RFP resistant and sensitive Mycobacterium tuberculosis infection did not affect the overall structure of the respiratory tract flora in pulmonary tuberculosis patients. However, significant differences were observed in the relative abundance of two Phyla (Fusobacteriota, Spirochaeta) and seven Genera (Oribacterium, Filifactor, Allisonella, Pseudomonas, Treponemas, Capnocytophaga, Pauljensenia) between the RFP-resistant and sensitive groups. Specifically, Capnocytophaga and Pauljensenia exhibited higher abundance in the RFP-sensitive group while the remaining taxa showed higher abundance in the RFP-resistant group.

Analysis of the distribution characteristics of microbial communities in the lower respiratory tract of pulmonary tuberculosis patients based on metagenomic sequencing

Xu Yu, He Yukun, Zhou Dexun, Zhang Pingji

Chinese Journal of Antituberculosis. 2024, 46(6):  634-640.  doi:10.19982/j.issn.1000-6621.20240078

Abstract ( 267 )   HTML ( 21 )   PDF (3474KB) ( 246 )   Save

Figures and Tables | References | Related Articles | Metrics

Objective: To explore the differences in the distribution of microbial communities in the lower respiratory tract among patients with pulmonary tuberculosis, other pathogenic infections, and non-infectious pulmonary diseases. Methods: In this retrospective study, 83 patients suspected of having pulmonary tuberculosis, admitted to Beijing Jishuitan Hospital affiliated with Capital Medical University and Peking University People’s Hospital between March 1, 2021, and February 28, 2023, were selected for analysis. All study subjects were negative for sputum smears and T-SPOT.TB tests, and received bronchoscopy with bronchoalveolar lavage as per standard diagnostic procedures. Pathogen testing on bronchoalveolar lavage fluid (BALF) included metagenomic next-generation sequencing, GeneXpert MTB/RIF assays, and conventional bacterial and fungal cultures. Basic patient information and laboratory test results were collected via the electronic medical record system, enabling the analysis of lower respiratory tract microbiota characteristics across diverse patient groups. Results: Following pathogenetic analysis, the cohort was categorized into tuberculosis (28 patients), pneumonia (38 patients), and non-infection groups (17 patients). Examination of microbial abundance and diversity within the lower respiratory tract revealed median Shannon indices of 1.2864 (IQR: 0.3021, 1.9459), 1.1032 (IQR: 0.3725, 1.7711), and 1.2049 (IQR: 0.6873, 1.9974) for the tuberculosis, pneumonia, and non-infection groups respectively. Similarly, median Simpson indices were 0.5693 (IQR: 0.1346, 0.8259), 0.5503 (IQR: 0.1900, 0.7533), and 0.5141 (IQR: 0.3065, 0.7507), and Chao1 indices were 8.50 (IQR: 3.00, 20.75), 7.50 (IQR: 3.25, 18.75), and 7.00 (IQR: 2.00, 22.00) respectively, with no significant statistical differences noted (H-values of 0.130, 0.208, 0.235; P-values of 0.973, 0.901, and 0.889). β-Diversity analysis showed a dispersed distribution within the tuberculosis group indicating notable within-group heterogeneity, whereas the pneumonia and non-infection groups exhibited extensive overlap. Pathogenic microbial community analysis indicated heightened prevalence of Firmicutes, Staphylococcus, and Streptococcus in tuberculosis group samples; Bacteroidetes, Proteobacteria, Corynebacterium, Enterococcus, and Pseudomonas were notably prevalent in pneumonia group samples; whereas Actinobacteria, Fusobacteria, and respiratory colonizers such as Rothia and Neisseria showed increased abundance in non-infection group samples. LEfSe analysis revealed significant enrichment of Mycobacterium tuberculosis, Streptococcus mucosus, and atypical Veillonella in the tuberculosis group; Corynebacterium striatum, Klebsiella pneumoniae, and Pseudomonas maltophilia were prominently enriched in the pneumonia group; in contrast, the non-infection group exhibited a diversification of 12 microbial species, marking a notable deviation from the pathogenic profiles observed in the tuberculosis and pneumonia groups and bearing closer resemblance to the microbiota of the upper respiratory tract. Conclusion: Infection with Mycobacterium tuberculosis influences the distribution of microbial communities in the lower respiratory tract, exerting minimal effects on α diversity. Notably, its impact on β diversity significantly surpasses that observed in pneumonia caused by other pathogens and in non-infectious pulmonary conditions.

Analysis of infection patterns and drug resistance of 22 recurrent pulmonary tuberculosis patients in Sichuan based on whole-genome sequencing

Lei Hui, Zhang Shu, Li Ting, Gao Yuan, Liu Shuang, Chen Chuang, Xia Lan, Wang Weina, Gao Wenfeng, He Jinge

Chinese Journal of Antituberculosis. 2024, 46(6):  641-647.  doi:10.19982/j.issn.1000-6621.20240036

Abstract ( 179 )   HTML ( 14 )   PDF (1428KB) ( 253 )   Save

Figures and Tables | References | Related Articles | Metrics

Objective: To analyze the infection patterns and drug resistance information of recurrent pulmonary tuberculosis patients, and to provide evidence for the treatment and prevention of tuberculosis. Methods: A prospective study was conducted. According to the inclusion criteria, 2207 strains of culture positive from pulmonary tuberculosis patients between 2012 and 2021 were collected from three drug-resistant surveillance sites in Sichuan Province (Emeishan, Fucheng and Jiangyou). After removing 286 duplicate strains, they were compared with the “Tuberculosis Information Management System” of the Chinese Center for Disease Control and Prevention to exclude 18 patients with an onset interval of less than 12 months, and the remaining 34 patients with two or more visits were selected for strain resuscitation, DNA extraction and whole genome sequencing to analyze the tuberculosis infection patterns and drug resistance of recurrent patients. Results: A total of 22 patients with recurrent tuberculosis were included in the analysis, except for 11 patients with failure of subculture of a paired strain and 1 patient with non-tuberculous by whole genome sequencing. Among them, 14 cases (63.6%) were due to relapse, 13 (92.9%) cases were local patients, onset interval was 18.00 (13.50, 24.50) months, initial infection Lineage 2, cases of drug resistance, MDR and INH resistance were 10 (71.4%), 6 (42.9%), 2 (14.3%) and 5 (35.7%), respectively. Acquired resistance occurred in 2 patients with relapse, and resistance to Eto disappeared in 1 patient. The remaining 8 (36.4%) cases were reinfection, of which 4 (4/8) were local patients, onset interval was 14.50 (13.25, 16.75) months, cases with initial infection Lineage 2, drug resistance, MDR and INH resistance were 4 (4/8), 5 (5/8), 3 (3/8), and 5 (5/8),respectively, and the drug resistance types of the two infections were different. Conclusion: As a high burden area of tuberculosis, the recurrence tuberculosis was still dominated by relapse in Sichuan Province. However, we should also focus on the serious reinfection of drug resistance, actively pay attention to the treatment of such patients, and develop individualized medication regimens to reduce the recurrence of tuberculosis.

Comparison of QuantiFERON-TB Gold Plus with QuantiFERON-TB Gold In-Tube assay in auxiliary diagnosis of osteoarticular tuberculosis

Jia Hongyan, Fan Jun, Sun Qi, Song Ruixue, Du Boping, Dong Jing, Wang Yingchao, Xing Aiying, Zhu Chuanzhi, Li Zihui, Pan Liping

Chinese Journal of Antituberculosis. 2024, 46(6):  648-653.  doi:10.19982/j.issn.1000-6621.20240084

Abstract ( 192 )   HTML ( 19 )   PDF (771KB) ( 147 )   Save

Figures and Tables | References | Related Articles | Metrics

Objective: To assess the utility and concordance of QuantiFERON-TB Gold Plus (QFT-Plus) and QuantiFERON-TB Gold In-Tube (QFT-GIT) assays in the adjunctive diagnosis of osteoarticular tuberculosis. Methods: Between April and September 2023, 88 patients diagnosed with osteoarticular tuberculosis at the Beijing Chest Hospital, affiliated with Capital Medical University, were enrolled as the observation group, while 123 individuals presenting with non-tuberculous osteoarticular conditions comprised the control group. Each participant underwent concurrent peripheral blood assays using both the QFT-Plus and QFT-GIT. This study evaluated the diagnostic utility and result concordance of the two tests in aiding the diagnosis of osteoarticular tuberculosis. Results: Of the 211 initial participants, 4 were excluded due to indeterminate results, leaving 207 subjects for analysis (86 in the observation group and 121 in the control). The QFT-Plus assay demonstrated a sensitivity of 95.3% (95%CI: 87.9%-98.5%), specificity of 70.2% (95%CI: 61.2%-78.0%), positive predictive value of 65.5% (95%CI: 60.2%-77.5%), and negative predictive value of 95.5% (95%CI: 88.3%-98.6%). The QFT-GIT assay recorded a sensitivity of 91.9% (95%CI: 83.4%-96.4%), specificity of 66.9% (95%CI: 57.7%-75.1%), positive predictive value of 66.4% (95%CI: 57.1%-74.6%), and negative predictive value of 92.0% (95%CI: 83.8%-96.5%). The overall concordance between QFT-Plus and QFT-GIT results was 91.8% (95%CI: 88.1%-95.5%), with a positive agreement of 92.4% (95%CI: 87.7%-97.2%) and a negative agreement of 90.9% (95%CI: 84.9%-96.9%). The Kappa coefficient for agreement was 0.832 (95%CI: 0.756-0.908, P<0.001). Conclusion: The QFT-Plus and QFT-GIT assays demonstrated substantial concordance and comparable diagnostic efficacy in the auxiliary evaluation of osteoarticular tuberculosis.

Impact of gaseous air pollutants on the risk of incident active pulmonary tuberculosis among rural people with latent tuberculosis infection

Tian Sifan, Guo Tonglei, Chen Chen, Zhang Bin, Xin Henan, Du Jiang, Cao Xuefang, Feng Boxuan, He Yijun, He Yongpeng, Wang Dakuan, Liu Zisen, Yan Jiaoxia, Shen Lingyu, Di Yuanzhi, Chen Yanxiao, Jin Qi, Duan Weitao, Gao Lei, Gao Xu

Chinese Journal of Antituberculosis. 2024, 46(6):  654-663.  doi:10.19982/j.issn.1000-6621.20240061

Abstract ( 253 )   HTML ( 21 )   PDF (2234KB) ( 255 )   Save

Figures and Tables | References | Related Articles | Metrics

Objective: To investigate the influence of primary atmospheric gaseous pollutants on the incidence of active pulmonary tuberculosis among adults in rural areas with latent tuberculosis infection (LTBI). Methods: This study utilized a multicenter, longitudinal cohort of rural residents with LTBI (LATENTTB-NSTM), spanning from 2013 to 2018, comprising 3866 participants who were monitored quarterly over five years to document new cases of active pulmonary tuberculosis. Concentrations of atmospheric gaseous pollutants such as sulfur dioxide (SO₂), nitrogen dioxide (NO₂), ozone (O₃), and carbon monoxide (CO) were precisely matched to the residential locations and periods under review. The association between exposure levels and the emergence of active tuberculosis was analyzed using time-dependent Cox proportional hazards models, stratified by age, sex, educational attainment, family income, and lifestyle factors. Results: Among 3866 individuals diagnosed with latent tuberculosis infection, surveillance identified 58 new cases of active pulmonary tuberculosis. Incremental exposures to SO₂ and CO by 10 μg/m³ and 100 μg/m³, respectively, over a six-month period were associated with a respective 81.0% (HR=1.810, 95%CI: 1.153-2.843) and 19.6% (HR=1.196, 95%CI: 1.031-1.388) increase in the risk of developing active tuberculosis. Notably, these associations appeared more pronounced among older adults and smokers, though the differences did not reach statistical significance (interaction P-values >0.05). Conclusion: Exposure to atmospheric gaseous pollutants, particularly SO₂ and CO, is associated with a heightened risk of developing active pulmonary tuberculosis among individuals with LTBI in rural settings. The management of air quality, therefore, plays a crucial role in the strategic control of tuberculosis.

Analysis of latent tuberculosis infection and active pulmonary tuberculosis diprevalence among newly admitted students of Sichuan Province for the year 2022

Xia Lan, Xiao Yue, Chen Chuang, Xia Yong, Zhu Sui, Zhang Linglin

Chinese Journal of Antituberculosis. 2024, 46(6):  664-671.  doi:10.19982/j.issn.1000-6621.20240007

Abstract ( 230 )   HTML ( 18 )   PDF (776KB) ( 265 )   Save

Figures and Tables | References | Related Articles | Metrics

Objective: To understand the prevalence of latent tuberculosis infection (LTBI) and active pulmonary tuberculosis among newly admitted students in Sichuan Province in 2022, students’ tuberculosis screening results were summarized and analyzed to provide theoretical basis for implementation of newly admitted student tuberculosis screening in schools. Methods: Basic information on newly admitted students in all types of schools in Sichuan Province for the year 2022 was obtained from the provincial educational enrollment system, and a database was established using “2022 Autumn Student Enrollment Tuberculosis Screening Information Form”. Descriptive statistical analysis method was used to analyze the detection of tuberculosis and LTBI among newly admitted students, including their epidemiological characteristics and tracking result of LTBI cases taking and completing preventive treatment. Results: In 2022, a total of 2787900 newly admitted students in schools across Sichuan Province underwent standardized tuberculosis screening, accounting for 97.69% (2787900/2853817) of all newly admitted students. Active pulmonary tuberculosis was detected in 247 students, with a detection rate of 8.86/100000 (247/2787900). The prevalence among female was 10.11/100000 (145/1434131), higher than that among males which stood at 7.18/100000 (102/1419686),the difference was statistically significant(χ²=7.058,P<0.01). Among 1790830 new students tested for LTBI, the infection rate was 3.09% (55313/1790830). Among the 8104 students eligible for preventive treatment, 13.73% (1113/8104) took such treatment, and 925 completed the whole course, resulting in an 83.11% completion rate, two of the new students who did not complete the treatment became active tuberculosis patients during the treatment period. Conclusion: In Sichuan Province in 2022, the screening rate for LTBI was high among newly admitted students, however, the detection rate of LTBI was relatively low, and the proportion of LTBI students receiving preventive treatment was not high.

Analysis of surveillance and tracking results of pulmonary tuberculosis clusters in schools in Beijing from 2013 to 2023

Zhao Xin, Li Yamin, Tao Liying, Zhang Ya’nan, Li Yanyuan, Xu Yan, Yan Yinsuo, Gao Zhidong, He Xiaoxin

Chinese Journal of Antituberculosis. 2024, 46(6):  672-677.  doi:10.19982/j.issn.1000-6621.20240027

Abstract ( 222 )   HTML ( 19 )   PDF (745KB) ( 221 )   Save

Figures and Tables | References | Related Articles | Metrics

Objective: To analyze the results of surveillance, tracking and management of tuberculosis clusters in schools in Beijing from 2013 to 2023, and describe the characteristics of tuberculosis clusters in schools in Beijing, so as to provide reference for the management and prevention of tuberculosis epidemics. Methods: The incidence of tuberculosis reported in schools in the “Periodic Report of Infectious Disease Reporting Information Management System” was collected, and the “Monthly Report of Monitoring, investigation and Disposal of Tuberculosis Cluster Outbreaks in Schools of Beijing” reported by tuberculosis prevention and control institutions in each district was summarized, and the monitoring effect of tuberculosis cluster outbreaks in the whole city, as well as the characteristics of cluster outbreaks, cluster outbreaks and public health emergencies was analyzed. Results: From 2013 to 2023, a total of 4428 school tuberculosis cases were reported in Beijing, and a total of 743 suspected school tuberculosis clusters were detected through surveillance. The number of reported school tuberculosis cases (4428) was highly positively correlated with the number of suspected tuberculosis clusters in school (743)(Pearson correlation coefficient=0.699, P=0.017). Among the 743 suspected school tuberculosis clusters, 139 events were confirmed as tuberculosis clusters, accounting for 18.71% (139/743) of the total. Among them, 6 were classified as school tuberculosis public health emergencies. In each school tuberculosis clusters, the number of diagnosed patients was mainly 2 cases, accounting for 51.80% (72/139). The low peak periods for the school tuberculosis clusters were February (2 events) and August (5 events), and the top three districts with the number of clusters were Haidian District (69 events), Changping District (17 events) and Tongzhou District (11 events). Universities (94 events) were the main places of school tuberculosis clusters. Conclusion: The monitoring of tuberculosis clusters in schools conducting in Beijing can timely detect and handle such tuberculosis clusters early. Special attention should be paid to the prevention and control of tuberculosis clusters in colleges and universities to prevent the occurrence and spread of tuberculosis clusters.

Analysis of the detection and treatment of rifampicin-resistant pulmonary tuberculosis patients in Guangzhou during the “12th Five-Year Plan” and “13th Five-Year Plan” periods

Du Yuhua, Feng Yajuan, Lei Yu, Lai Keng, He Weiyun

Chinese Journal of Antituberculosis. 2024, 46(6):  678-686.  doi:10.19982/j.issn.1000-6621.20240024

Abstract ( 165 )   HTML ( 10 )   PDF (898KB) ( 190 )   Save

Figures and Tables | References | Related Articles | Metrics

Objective: To compare and analyze the detection and treatment of rifampicin-resistant pulmonary tuberculosis (RR-PTB) patients in Guangzhou during the “12th Five-Year Plan” and “13th Five-Year Plan” periods, and provide scientific basis for further development of RR-PTB prevention and control programme in Guangzhou. Methods: Data on RR-PTB patients registered in Guangzhou from January 1, 2011, to December 31, 2020 (“12th Five-Year Plan” (2011—2015) and “13th Five-Year Plan” (2016—2020)) were extracted from the “Tuberculosis Information Management System” subsystem of the “Chinese Center for Disease Control and Prevention Information System”. The data includes gender, age, ethnicity, occupation, residence registration, drug-resistant type, treatment category and other relevant information. RR-PTB cases were enrolled. Patient registration, population characteristics, drug-resistance screening and treatment outcomes for RR-PTB cases were analyzed. Results: From 2011 to 2020, the average annual registration rate of RR-PTB patients was 0.71/100000 (1152/162.8608 million), increasing from 0.31/100000 (42/13.4632 million) in 2011 to 0.38/100000 (60/15.9495 million) in 2015 and 0.97/100000 (182/18.7403 million) in 2020, and showing a gradual upward trend ($\chi_{\text {trend }}^{2}$=256.395, P<0.001). During the “12th Five-Year Plan” period, the average annual registration rate was 0.34/100000 (250/73.5806 million), with no statistically significant differences in registration rates between different years ($\chi_{\text {trend }}^{2}$=4.674, P=0.322). During the “13th Five-Year Plan” period, the average annual registration rate was 1.01/100000 (902/89.2802 million), with statistically significant differences in registration rates between different years ($\chi_{\text {trend }}^{2}$=38.439, P<0.001). Among the 1152 patients, the majority were males (851 cases, 73.87%), aged 25-34 years (257 cases, 22.31%), and housekeeping work or unemployment individuals (364 cases, 31.60%). The proportion of migrants, newly diagnosed cases, RR-PTB cases (excluding isoniazid-resistant cases), and extensively drug-resistant pulmonary tuberculosis increased from 8.80% (22/250), 11.20% (28/250), 0.00% (0/250), and 0.00% (0/250) during the “12th Five-Year Plan” period to 54.43% (491/902), 37.14% (335/902), 19.84% (179/902), and 0.78% (7/902) during the “13th Five-Year Plan” period, respectively, all showing statistically significant differences (χ²=91.370, 298.740, 97.915, 34.096, Ps<0.001). The screening rate of drug-resistant pulmonary tuberculosis in high-risk groups increased from 60.91% (148/243) in 2017 to 98.95% (568/574) in 2020, the screening rate of newly diagnosed/initially treated bacteriologically confirmed pulmonary tuberculosis increased from 83.93% (1410/1680) in 2018 to 94.99% (3222/3392) in 2020, and the differences were statistically significant ($\chi_{\text {trend }}^{2}$=425.043, 269.670, Ps<0.001). The proportion of patients who were enrolled for RR-PTB treatment, completed of treatment, and successfully treated increased from 81.20% (203/250), 2.46% (5/203), and 45.81% (93/203) during the “12th Five-Year Plan” period to 91.02% (821/902), 33.62% (276/821), and 67.48% (554/821) during the “13th Five-Year Plan” period, respectively. The proportion of treatment failure patients decreased from 17.73% (36/203) to 2.68% (22/821), with statistically significant differences (χ²=19.112, 86.809, 46.636, 58.572, Ps<0.001). Conclusion: Significant achievements have been made in the prevention and control of RR-PTB in Guangzhou during the “12th Five-Year Plan” and “13th Five-Year Plan” periods. In the next step, we need to continue to adhere to the principles of government leadership, multi-sector cooperation, and broad social participation, effectively implementing the requirements of the tuberculosis prevention and control programme, and strengthen the construction of the tuberculosis prevention and control service system.

Clinical characteristics and prognosis of patients with novel coronavirus infection complicated with pulmonary tuberculosis

Li Yao, Fang Zhe, Luo Danlin, Hu Yanmei, Tang Mi, Tang Zhigang, Wen Xinmin, Zhang Yong, Yao Bibo, Wang Qi, Yi Hengzhong

Chinese Journal of Antituberculosis. 2024, 46(6):  687-698.  doi:10.19982/j.issn.1000-6621.20240127

Abstract ( 212 )   HTML ( 14 )   PDF (1530KB) ( 219 )   Save

Figures and Tables | References | Related Articles | Metrics

Objective: This study aims to delineate the clinical presentations, radiographic features, and laboratory findings of patients co-infected with the novel coronavirus (COVID-19) and pulmonary tuberculosis, with a particular focus on assessing the prognostic implications of tuberculosis in the context of COVID-19 infection. Methods: The cohort comprised 140 patients admitted to Hunan Provincial Chest Hospital between December 2022 and January 2023 with confirmed COVID-19 infection. This group included 57 patients with isolated COVID-19 infection and 83 patients with concurrent pulmonary tuberculosis, of which 32 were diagnosed with drug-resistant tuberculosis. Comprehensive data on demographic characteristics, clinical manifestations, laboratory diagnostics, and outcomes were systematically gathered for analysis. A case-control study design was utilized. Initially, subjects were stratified into either the isolated COVID-19 group or the COVID-19 with tuberculosis co-infection group, facilitating a comparative analysis of demographic data, clinical manifestations, laboratory outcomes, and prognostic data. Subsequently, patients within the tuberculosis co-infection group were further categorized based on drug-resistance status, sputum test results, and treatment classification to refine the analytical depth. Kaplan-Meier survival analysis was employed to delineate the survival disparities between the groups. This analysis was instrumental in further identifying and evaluating the risk factors that may influence the prognosis of patients afflicted with both COVID-19 and pulmonary tuberculosis. Results: Patients co-infected with COVID-19 and tuberculosis exhibited a notably poorer prognosis, as evidenced by prolonged chest imaging recovery times (median (interquartile range, IQR)) of 8.5 (7.0, 11.5) days, compared to 7.0 (5.0, 10.0) days in the COVID-19-only group, achieving statistical significance (U=785.000, P=0.049). Furthermore, initial symptoms in the co-infected cohort were less typical, with fever presenting in only 38.6% (32/83) of cases, significantly lower than the 56.1% (32/57) observed in the COVID-19-only group (χ²=4.311, P=0.040). Radiographic findings between the groups revealed marked differences. In the isolated COVID-19 group, ground glass opacities were predominant, appearing in 52.6% (30/57) of cases, significantly exceeding the 21.7% (18/83) observed in the tuberculosis co-infected group (χ²=14.362, P<0.001). Conversely, the imaging profiles in the co-infected group were notably more complex, with patchy opacities and linear streaks being the most prevalent, identified in 91.6% (76/83) of cases—substantially higher than the 56.1% (32/57) and 28.1% (16/57) seen in the COVID-19-only group, with statistically significant differences (χ²=24.052 and 60.471, P<0.001 respectively). In patients with concurrent COVID-19 and tuberculosis, lymphocyte counts were significantly reduced at 1.0×10⁹/L (IQR: 0.7×10⁹/L to 1.6×10⁹/L), compared to 1.3×10⁹/L (IQR: 0.9×10⁹/L to 2.0×10⁹/L) in those with COVID-19 alone (U=1736.000, P=0.015). Similarly, white blood cell counts were lower in the co-infected group, recorded at 5.0×10⁹/L (IQR: 3.8×10⁹/L to 7.1×10⁹/L), versus 6.0×10⁹/L (IQR: 4.8×10⁹/L to 7.9×10⁹/L) in the COVID-19 only group, a statistically significant difference (U=1800.000, P=0.024). Neutrophil counts further supported these findings, being lower at 3.3×10⁹/L (IQR: 2.2×10⁹/L to 4.7×10⁹/L) compared to 3.6×10⁹/L (IQR: 3.0×10⁹/L to 5.2×10⁹/L) in patients with only COVID-19 (U=1865.000, P=0.049). Moreover, cytotoxic T cells (CD3⁺CD8⁺) counts were markedly reduced in the co-infected group at 344.2/μl (IQR: 239.6 to 457.3/μl), significantly lower than 567.6/μl (IQR: 437.8 to 618.6/μl) observed in the COVID-19 group (U=74.000, P=0.009). Survival analysis identified sputum positivity as a significant prognostic risk factor in these patients. Conclusion: Patients co-infected with COVID-19 and pulmonary tuberculosis experienced prolonged hospitalization and delayed recovery in chest imaging. Notably, those with sputum-positive pulmonary tuberculosis had significantly poorer prognostic outcomes.

Establishment and validation of a risk prediction model for drug-induced liver injury in patients with tuberculosis

Geng Junling, Zhang Yinan, Pan Hongqiu

Chinese Journal of Antituberculosis. 2024, 46(6):  699-706.  doi:10.19982/j.issn.1000-6621.20240030

Abstract ( 284 )   HTML ( 29 )   PDF (2331KB) ( 231 )   Save

Figures and Tables | References | Related Articles | Metrics

Objective: To explore the risk factors of drug-induced liver injury in patients with tuberculosis, and to establish and validate a nomogram prediction model. Methods: The clinical data of 498 patients with anti-tuberculosis drug-induced liver injury (ATB-DILI) in the Third People’s Hospital of Zhenjiang from January 2017 to June 2023 were retrospectively collected. The patients were divided into modeling group and validation group according to the ratio of 7:3. The independent risk factors were screened using LASSO regression and multivariate logistic regression analysis, a nomogram prediction model was established for internal and external verification. Results: After LASSO screening variables, multivariate logistic regression analysis showed that hyperglycemia (OR=1.183, 95%CI: 1.037-1.349), high hemoglobin (OR=1.028, 95%CI: 1.011-1.045), extrapulmonary tuberculosis (OR=2.159, 95%CI: 1.240-3.759), and high international normalized ratio (OR=5.767, 95%CI: 1.259-26.421) were independent risk factors for ATLI, while high uric acid (OR=0.998, 95%CI: 0.996-0.999) and low PLT (OR=0.990, 95%CI: 0.986-0.995) were protective factors. The nomogram model was constructed based on the above related factors. The area under the receiver operating characteristic (ROC) curve was 80.3% and 79.1% in the modeling groups and validation groups, calibration curve P-value were 0.318 and 0.605, the decision curve showed that the nomogram model had certain clinical practicability in the high risk threshold range 9%-85% and 1%-93%. Conclusion: The nomogram model for risk predicting ATB-DILI among inpatients with tuberculosis in this study has good predictability, consistency and clinical practicability, which can provide individualized basis for the prevention and control of anti-tuberculosis drug-induced liver injury.

Clinical effect of one-stage posterior debridement,autogenous morselized bone graft and internal fixation in the treatment of thoracolumbar tuberculosis

Lu Zenghui, Zhang Huijun, Yue Xiaotong, Yan Jinyu

Chinese Journal of Antituberculosis. 2024, 46(6):  707-712.  doi:10.19982/j.issn.1000-6621.20240034

Abstract ( 156 )   HTML ( 8 )   PDF (1896KB) ( 268 )   Save

Figures and Tables | References | Related Articles | Metrics

Objective: To assess the clinical outcomes of single-stage posterior debridement, intervertebral autogenous morselized bone grafting, and internal fixation for the treatment of thoracolumbar tuberculosis. Methods: This retrospective analysis encompassed 31 patients with thoracolumbar tuberculosis treated at the Orthopedic Department of Xi’an Chest Hospital from January 2020 to June 2022, all undergoing single-stage posterior lesion clearance, intervertebral autogenous morselized bone grafting, and internal fixation. Surgical metrics analyzed included duration, blood loss, complications, and postoperative improvements in Visual Analogue Scale (VAS) scores, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), spinal cord function (Frankel classification), spinal curvature (Cobb angle), and bone graft fusion. Results: The study followed up 31 patients for a period ranging from 18 to 36 months, averaging (24.0±8.5) months. There were no instances of nerve or spinal cord injuries during surgeries, nor were there cases of postoperative wound infections. Surgical metrics revealed an average duration of (190.6±64.4) minutes and blood loss of (442.5±114.6) ml. Notably, at 3 months postoperatively, significant improvements were observed with the VAS scores decreasing from 5.5±1.9 to 2.2±0.7, ESR from (49.3±18.1) mm/1 h to (11.9±6.6) mm/1 h, and CRP levels from (34.1±16.7) mg/L to (7.9±5.5) mg/L, all demonstrating statistically significant reductions (t-values of 10.554, 11.683, and 9.826, respectively; P<0.001). Fusion was achieved after interbody bone grafting surgery. At the last follow-up, the Cobb angle was (9.6±3.3)°, and compared with preoperative ((18.5±5.8)°), the difference was statistically significant (t=11.527, P<0.001). The last follow-up Frankel neurological function grading was D grade in 2 cases and E in 29 cases. Conclusion: Single-stage posterior lesion clearance combined with intervertebral autogenous morselized bone grafting and internal fixation proves to be a safe and efficacious strategy for thoracolumbar tuberculosis patients fitting surgical criteria. The procedure demonstrates definitive therapeutic outcomes.

Review Articles

Advances in biomarker research for tuberculosis diagnosis

Xu Wenhui, Zhang Yanqiu, Shi Jie, Sun Dingyong

Chinese Journal of Antituberculosis. 2024, 46(6):  713-721.  doi:10.19982/j.issn.1000-6621.20240046

Abstract ( 246 )   HTML ( 25 )   PDF (821KB) ( 249 )   Save

Figures and Tables | References | Related Articles | Metrics

Tuberculosis is a global public health problem. Biomarkers of Mycobacterium tuberculosis can be used for early diagnosis and treatment monitoring of tuberculosis. However, current tuberculosis diagnostic methods are insufficient, and there is an urgent need to identify new and easily accessible biomarkers for rapid diagnosis of tuberculosis to explore new methods for rapid diagnosis of tuberculosis. This review introduces the latest research progress of tuberculosis biomarkers in blood, urine, saliva and other sample sources, respectively, to provide clues for the development of novel tuberculosis diagnostic methods.