Chinese Journal of Antituberculosis

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Chinese Journal of Antituberculosis. 2024, 46(11): 0-0.

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Difficulties and challenges faced by short-term treatment regimen for drug-resistant pulmonary tuberculosis

Li Qi, Nie Wenjuan, Chu Naihui

Chinese Journal of Antituberculosis. 2024, 46(11): 1297-1302. doi:10.19982/j.issn.1000-6621.20240370

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Interpretation of World Health Organization’s Key updates to the treatment of drug-resistant tuberculosis: rapid communication

Wang Yutong, Liu Yuhong

Chinese Journal of Antituberculosis. 2024, 46(11): 1303-1305. doi:10.19982/j.issn.1000-6621.20240422

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In June 2024, the World Health Organization issued Key updates to the treatment of drug-resistant tuberculosis: rapid communication, recommending a new 6-month BPaL-based regimen with levofloxacin or clofazimine or both, based on new clinical trial evidence. And a nine-month protocol for the treatment of multidrug-/rifampicin-resistant tuberculosis that is fluoroquinolone-sensitive, with the aim of notifying major updates ahead of the official release of the new guidelines for the treatment of drug-resistant tuberculosis. This article interprets the main updates in the notice for the reference of professionals in related fields.

Efficacy and safety of Baidiziyin Pill and Shenqiyifei Pill in adjuvant treatment of susceptible pulmonary tuberculosis patients: a national randomized controlled multicenter clinical study

Wang Xueyu, Shi Wenhui, Li Qi, Jing Wei, Chu Naihui, Nie Wenjuan

Chinese Journal of Antituberculosis. 2024, 46(11): 1306-1312. doi:10.19982/j.issn.1000-6621.20240277

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Background: Tuberculosis frequently manifests with symptoms including cough, sputum production, fatigue, anorexia, and weight loss. The first-line treatment regimens are often associated with adverse effects, notably hepatotoxicity and nephrotoxicity. Baidiziyin Pill and Shenqiyifei Pill exhibit properties that alleviate tuberculosis symptoms, possess anti-inflammatory effects, enhance cellular immune function, and offer hepatoprotective benefits. To date, no studies have investigated the application of Baidiziyin Pill and Shenqiyifei Pill as adjunctive therapies in conjunction with first-line anti-tuberculosis treatment. Methods: This study utilizes a multicenter randomized controlled trial design, focusing on patients newly diagnosed as susceptible pulmonary tuberculosis. Participants were randomly assigned to either an experimental group or a control group. Both groups received the standard first-line anti-tuberculosis treatment regimen, while the experimental group additionally received Baidiziyin Pill and Shenqiyifei Pill as adjunctive therapies. The primary objective is to compare symptom relief between the two groups, thereby evaluating the efficacy of Baidiziyin Pill and Shenqiyifei Pill in alleviating symptoms and mitigating adverse effects in patients undergoing first-line anti-tuberculosis treatment. Discussion: While this study does not evaluate the independent effects of the two drugs or their long-term therapeutic outcomes, it aims to optimize the treatment protocol for newly diagnosed pulmonary tuberculosis. The goal is to alleviate both respiratory and systemic symptoms associated with tuberculosis, as well as the adverse reactions resulting from anti-tuberculosis chemotherapy, ultimately improving the quality of life for affected patients. This research aspires to offer clinicians enhanced insights and strategies for the adjunctive use of traditional Chinese medicine in the treatment of tuberculosis.

Multi center randomized controlled clinical trial of shorter oral regimen containing new drugs in the treatment of rifampicin-resistant pulmonary tuberculosis

Nie Wenjuan, Sun Feng, Wang Xueyu, Ren Yanfei, Liu Renyu, Li Minhan, Li Qi, Zhang Wenhong, Chu Naihui

Chinese Journal of Antituberculosis. 2024, 46(11): 1313-1319. doi:10.19982/j.issn.1000-6621.20240281

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Background: The treatment course of drug-resistant tuberculosis is long, the cure rate is low, and the incidence of adverse reactions is high. Most of the full oral short-range drug resistance programs promoted by the World Health Organization cannot be fully promoted in China due to the problem of drug varieties and drug tolerance. It is urgent to explore safer and more effective treatment programs and drugs suitable for China. Methods: The prospective multi-center randomized controlled clinical trial was used in the trial. The patients with rifampicin-resistant pulmonary tuberculosis confirmed by molecular drug sensitivity test or phenotypic drug sensitivity test were randomly divided into the 18-month long-term treatment scheme recommended by the World Health Organization as the control group, and the 6-month oral short-term drug resistance scheme containing bedaquiline, contezolid, delamanid, moxifloxacin or levofloxacin (the patients resistant to fluoroquinolones were changed to clofazimine) to evaluate the efficacy and safety of the new 6-month oral drug resistance scheme containing contezolid in the treatment of rifampicin-resistant pulmonary tuberculosis. Discussion: This study aims to shorten the treatment time of rifampicin-resistant pulmonary tuberculosis, improve the cure rate, optimize the safety of the plan, provide the basis for the development of new drugs and new short-term treatment plans for rifampicin-resistant pulmonary tuberculosis, and provide Chinese data for the World Health Organization to develop treatment guidelines for drug-resistant tuberculosis. Meanwhile, this study includes Class 1 innovative drugs in China, representing the latest achievements in the field of pharmaceutical innovation in China. However, this study is not a head to head clinical trial, but rather a comparison of two different treatment regimens to obtain the overall treatment outcome. In the future, it is necessary to verify factors such as the appropriate dosage of new drugs in the regimen to obtain more specific research conclusions.

Six cases of pseudomembranous colitis caused by anti-tuberculosis drugs and literature review

Ge Jing, Wang Jun, He Yuqi, Nie Wenjuan

Chinese Journal of Antituberculosis. 2024, 46(11): 1320-1326. doi:10.19982/j.issn.1000-6621.20240243

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Objective: To report the clinical diagnosis and treatment process of 6 patients with pseudomembranous colitis (PMC) caused by anti-tuberculosis drugs, and to analyze the pathogenic mechanism, clinical characteristics, treatment, and prognosis in combination with literature. Methods: Six cases of diarrhea after anti-tuberculosis treatment confirmed as PMC by colonoscopy examination were reported from May 2022 to March 2024 at Beijing Chest Hospital Affiliated to Capital Medical University. Clinical information (including clinical onset, stool shape, and related accompanying symptoms), laboratory examination results (including stool routine examination, stool culture), endoscopic examination, pathological examination results, final diagnosis, treatment process, and prognosis were analyzed. Six articles and 99 patients with PMC after using anti-tuberculosis drugs were retrieved through searching studies published from January 1990 to May 2020 in the PubMed database using “tuberculosis+Clostridium difficile” and “tuberculosis+pseudomembranous colitis” as search terms, and the Wanfang database using “tuberculosis+pseudomembranous colitis” and “tuberculosis+pseudomembranous colitis” as search terms. The characteristics of patients in this group were summarized and literature review was conducted for selected patients. Results: Among the 6 patients, 5 had pulmonary tuberculosis and 1 had Mycobacterial avium disease. All cases occurred diarrhea, abdominal pain and bloating after anti-tuberculosis treatment containing rifampicin and ethambutol for about 2-30 days. Clostridium difficile examination in stool was negative. Colonoscopy examination showed a yellow white pseudomembrane covered with the colon mucosa. Pathological biopsy showed acute and chronic inflammation of mucosal tissue. After discontinuing rifampicin, using vancomycin (0.25 g/time, 4 times/day, orally) for anti infection, regulating gut microbiota, and fluid replacement to treat shock for 3-5 days, the symptoms significantly improved. When the symptoms disappeared and anti tuberculosis drugs were taken again, 2 cases experienced diarrhea symptoms again. Among the 99 patients involved in the literature, there were 97 cases of pulmonary tuberculosis, 1 case of bone tuberculosis, and 1 case of tuberculous meningitis. All cases experienced varying degrees of diarrhea and abdominal pain within 9-120 days of using anti-tuberculosis drugs such as isoniazid, rifampicin, and pyrazinamide. Mucosal congestion and edema with white pseudomembranous features were observed under colonoscopy, and all cases were confirmed after colonoscopy and fecal examination. 29 patients were positive for Clostridium difficile toxin examination and were given vancomycin for anti-infection treatment (including 10 patients who used metronidazole) and probiotics to regulate intestinal microbiota. Symptoms improved for all cases,including 3 recurrent patients. Conclusion: It is necessary to be alert to the occurrence of PMC in patients who use rifamycin for a long time, especially for elderly tuberculosis patients who use glucocorticoids and have abnormal immune function. When a false membrane in the intestine is observed under colonoscopy, and the intervention measures such as discontinuing rifampicin, using vancomycin and/or metronidazole for anti infection, or supplementing with intestinal microbiota regulating agents have good effects, PMC can be clinically diagnosed.

An all-oral shortened regimen containing new drugs to treat MDR/rifampicin-resistant tuberculosis: three case reports and literature review

Li Xuelian, Jing Wei, Wang Qingfeng, Chu Naihui, Nie Wenjuan

Chinese Journal of Antituberculosis. 2024, 46(11): 1327-1334. doi:10.19982/j.issn.1000-6621.20240301

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Objective: To evaluate the efficacy and safety of a novel all-oral short-course regimen for the treatment of multidrug-resistant (MDR) and rifampicin-resistant (RR) tuberculosis (TB). Methods: A retrospective analysis was conducted on the clinical data of three MDR/RR-TB patients who received a short-course oral regimen containing new drugs (bedaquiline, contezolid and delamanid) at Beijing Chest Hospital in December 2023. Using the keywords “multidrug-resistant tuberculosis, contezolid” and “multidrug-resistant tuberculosis, bedaquiline, delamanid” relevant studies were retrieved from CNKI, Wanfang, and PubMed databases. A total of 11 studies were identified, 8 of which included new drugs such as contezolid, delamanid and bedaquiline. The efficacy and safety of these regimens were analyzed in combination with the clinical data of the three reported cases. Results: Efficacy analysis revealed that 84% of patients receiving contezolid-based regimens achieved negative sputum cultures and (or) smears for Mycobacterium tuberculosis. Chest CT scans indicated lesion improvement, with stability maintained after treatment cessation. Among patients treated with bedaquiline and delamanid-based regimens, 91% showed favorable outcomes. The sputum culture conversion rate for Mycobacterium tuberculosis was 95% at week 8 and remained at 95% at week 24 of treatment. Additionally, the median time to sputum culture conversion in the bedaquiline and delamanid group was shorter compared to that of the bedaquiline-only group. Safety analysis revealed that no cases of myelosuppression, peripheral neuropathy, or optic neuropathy were observed in patients receiving contezolid-based regimens. In the bedaquiline and delamanid group, the QTcF interval increased by an average of 20.7 ms from baseline (mean range: 16.1 ms to 25.3 ms), with 2 patients experiencing a QT prolongation of >500 ms. Additionally, 4 patients experienced 6 instances of QTcF prolongation exceeding baseline by 60 ms. No grade 3 or 4 QTc prolongation events, arrhythmias, permanent treatment discontinuations, or deaths were reported. The extent of QTc prolongation was lower in the bedaquiline and delamanid group compared to the bedaquiline-only group. During treatment, 52% of patients developed myelosuppression, and 42% experienced peripheral neuropathy. By 48 weeks of follow-up, most adverse events had resolved. Conclusion: The all-oral short-course regimen containing new drugs (bedaquiline, delamanid, and contezolid) demonstrated promising efficacy in patients with multidrug-resistant or rifampicin-resistant tuberculosis. No serious drug-related adverse events were observed throughout the treatment course.

A case of multiple infections such as multidrug-resistant tuberculosis caused by positive anti-interferon-γ autoantibodies and literature review

Tian Yuan, Jing Wei, Wang Qingfeng, Chu Naihui, Nie Wenjuan

Chinese Journal of Antituberculosis. 2024, 46(11): 1335-1342. doi:10.19982/j.issn.1000-6621.20240212

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Objective: To report the diagnosis and treatment of a case of multi-drug resistant tuberculosis complicated with multiple infections such as marneffei caused by positive anti interferon gamma auto-antibody, and analyzes the clinical characteristics, laboratory examination, treatment and prognosis of the disease combined with literature. Methods: The study retrospectively analyzed the clinical data of a case of multi-drug resistant tuberculosis complicated with multiple infections such as marneffei caused by positive anti interferon gamma auto-antibodies admitted to Beijing Chest Hospital affiliated to Capital Medical University on August 2, 2023. The search deadline is May 31, 2024. The relevant literature was not retrieved from PubMed database with “Anti interferon-γ auto-antibodies, Multi-drug resistant tuberculosis” as the search term, Wanfang database and CNKI database with “Anti-interferon-γ auto-antibodies, multi drug resistant tuberculosis” as the search term. However, “anti interferon gamma auto-antibodies and anti interferon gamma auto-antibodies” were detected in Wanfang database, CNKI and PubMed database respectively, and two anti interferon gamma auto-antibodies were detected with drug sensitive tuberculosis, 61 anti interferon gamma auto-antibodies were detected with opportunistic infection, and 17 anti-interferon-γ auto-antibodies were detected with related treatment. Summarize the patient’s characteristics and conduct relevant literature review. Results: After immune evaluation, the patient was found to have abnormal cellular immunity and gene mutations. Due to adverse drug reactions and poor general physical condition, the best treatment opportunity was missed and the desired effect was not achieved. According to literature research, 65 cases were complicated with two or more opportunistic infections, 50 cases had skin damage, and there was no previous literature report on anti-interferon-γ auto-antibodies complicated with multi-drug resistant tuberculosis. In the acquired immunodeficiency syndrome patients with positive anti-interferon-γ auto-antibodies reported in the literature, 71 cases of Marneffei’s basket shaped mycosis, 31 cases of non-tuberculous mycobacterial disease, and 2 cases of tuberculosis were opportunistic infection pathogens. Among them, 65 patients developed two or more opportunistic infections, and 50 patients had skin damage. Conclusion: Patients with positive anti-interferon-γ auto-antibodies may have multiple infections and poor treatment outcomes. Early use of new immune preparations combined with targeted treatment for related pathogens may achieve better prognosis.

Application of blood management in the perioperative period of lumbar tuberculosis under the concept of enhanced recovery after surgery

Liu Shuren, Fu Lin, Wang Lianbo, Zhao Guisong, Li Zhuo, Dong Zhaoliang

Chinese Journal of Antituberculosis. 2024, 46(11): 1343-1349. doi:10.19982/j.issn.1000-6621.20240155

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Objective: To explore the blood management in the perioperative period of lumbar tuberculosis under the concept of enhanced recovery after surgery (ERAS). Methods: A retrospective study was conducted to collect the data of 61 patients with lumbar tuberculosis who underwent simple lumbar posterior surgery after standardized anti-tuberculosis treatment in Hebei Chest Hospital from May 2020 to May 2023. According to different blood management methods during the perioperative period, the patients were divided into ERAS blood management group (observation group; 32 cases) and conventional blood management group (control group; 29 cases). The operation time, intraoperative blood transfusion volume, postoperative 3-day drainage volume, postoperative bedridden time and total volume of perioperative blood loss were compared between two groups of patients. Lower back pain and functional recovery were assessed using the visual analogue scale (VAS) and Oswestry disability index (ODI). Results: All patients successfully completed the surgery and were followed up. The observation group showed lower operation time ((127.65±25.37) min), intraoperative blood transfusion volume (200 (100, 400) ml), postoperative bedridden time ((5.09±1.15) d), total perioperative blood loss volume (833.30 (678.76, 897.22) ml) compared to that of control group ((159.10±21.02) min, 450 (400, 800) ml, (5.86±1.03) d, 1086.37 (793.60, 1264.00) ml), and the differences were statistically significant (t=5.240, P=0.000; Z=3.469, P=0.001; t=2.748, P=0.008; Z=3.134, P=0.002). There were a total of 5 cases of rash complications, 3 cases of lower limbs thrombosis, and 8 cases of grade C healing due to tuberculosis infection in the two groups, with incidence rates of 9.38% (3/32) and 6.89% (2/29), 6.25% (2/32) and 3.45% (1/29), 15.63% (5/32) and 10.34% (3/29), respectively. The ODI scores at 6 months were (7.38±1.07) % and (7.41±1.02) %, and the VAS scores were (2.81±0.74) points and (2.97±0.68) points after 6 months of follow-up, respectively, with no significant differences (χ²=0.124, P=1.000; χ²=0.255, P=1.000; χ²=-0.593, P=0.553; t=0.145, P=0.885; t=0.843, P=0.403). Conclusion: Perioperative blood management directed by the concept of ERAS can significantly reduce surgery time, postoperative bedridden time and total perioperative blood loss, it is conducive to the smooth implementation of surgery, reduce the risk of surgical blood loss, and make the patient recover as soon as possible, which has a certain positive clinical significance. But is not better than common blood management for postoperative complications, thrombosis, surgical incision healing, lower back pain and functional recovery, indicates that the postoperative complications and long-term efficacy of the two methods are consistent and the safety is the same.

The value of ultrasound examination in the diagnosis and treatment evaluation of chest tuberculosis in children

Hu Qiang, Jin Linyuan, Zhou Xiaohui, Zhang Qianrong, Deng Yuhang, Tang Xianpeng, Zhou Haiyi, Zhang Min

Chinese Journal of Antituberculosis. 2024, 46(11): 1350-1355. doi:10.19982/j.issn.1000-6621.20240248

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Objective: This study aims to evaluate the diagnostic value and therapeutic efficacy of ultrasound in pediatric chest tuberculosis. Methods: A retrospective analysis was performed on 131 confirmed pediatric chest tuberculosis cases admitted to the Student and Pediatric Tuberculosis Ward at the Changsha Central Hospital from May 2023 to May 2024. Demographic data (e.g., gender and age), clinical diagnoses, and chest imaging findings were collected. The diagnostic accuracy of ultrasound was compared with that of chest computed tomography (CT) for detecting chest tuberculosis. For lesions identifiable via ultrasound, the utility of ultrasound in therapeutic response evaluation was further assessed during follow-up. Results: Of the 131 pediatric patients, the detection rates for chest CT and ultrasound were 100.0% (131/131) and 75.6% (99/131), respectively, showing a statistically significant difference (χ²=36.450, P<0.001). Among the cases with lung parenchymal lesions, 85 (64.9%) involved the pleura and were detected by ultrasound, appearing as irregular hypoechoic areas adjacent to the pleura without evidence of bronchial air sign. The remaining 46 cases (35.1%) presented on CT as fibrous, cord-like, spotted, or nodular lesions, without pleural involvement, and were undetectable by ultrasound. The detection rates of pulmonary cavities and mediastinal lymph node enlargement by ultrasound were 33.3% (5/15) and 21.7% (5/23), respectively. A total of 43 pulmonary parenchymal lesions and 19 pleural tuberculosis lesions were monitored by ultrasound during follow-up. Of these, 5 pulmonary parenchymal lesions and 1 pleural tuberculosis lesion showed enlargement, and 5 new pleural lesions were detected in other children during the follow-up period. At the one-month follow-up, the reduction rate of pleural tuberculosis lesions ((14±4) %) was significantly lower than that of pulmonary parenchymal lesions ((43±11) %), with statistical significance (t=2.512, P=0.020). After three months of follow-up, 15 (34.9%) pulmonary parenchymal lesions fully resolved, whereas none (0/19) of the pleural tuberculosis lesions showed complete resolution, demonstrating a statistically significant difference (χ²=6.940, P=0.008). Conclusion: Ultrasound demonstrates comparable diagnostic value to CT in detecting lung parenchymal and pleural lesions involving the pleura in pediatric chest tuberculosis. Moreover, ultrasound offers an irreplaceable advantage in treatment monitoring, making it a preferred modality for follow-up evaluation in most pediatric chest tuberculosis cases.

Diffusion weighted imaging with different b-values for the classification diagnosis of pulmonary tuberculosis and prediction of multidrug-resistance risk

Liu Xin, Yu Qianhui

Chinese Journal of Antituberculosis. 2024, 46(11): 1356-1364. doi:10.19982/j.issn.1000-6621.20240201

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Objective: To investigate the diagnostic efficacy of diffusion weighted imaging (DWI) with different b-values in classifying tuberculosis (TB) and predicting multidrug-resistance (MDR) risk. Methods: This study enrolled 110 TB patients admitted to Heilongjiang Provincial Infectious Disease Prevention and Control Hospital between October 2020 and May 2023. All patients underwent DWI with various b-values (0, 500, 800, 1000 s/mm²) to compare the diagnostic accuracy for TB classification at different b-values. Based on drug resistance test results, the 110 patients were divided into an MDR-TB group (47 cases) and a drug-sensitive TB group (63 cases). Clinical data and imaging features of the two groups were compared, and logistic regression was used to explore the relationship between apparent diffusion coefficient (ADC) and MDR-TB. Results: At a b-value of 800 s/mm², the rates of missed diagnosis (1.82%, 2/110) and misdiagnosis (3.64%, 4/110) in diagnosing various classifications of TB were significantly lower than those at b-values of 0, 500, and 1000 s/mm² (the missed diagnosis rate and misdiagnosis rate were 11.82% (13/110) and 17.27% (19/110), 9.09% (10/110) and 13.64% (15/110), 8.18% (9/110) and 10.91% (12/110), respectively), the differences were statistically significant (missed diagnosis: χ²=8.657, P=0.003; χ²=5.641, P=0.018; χ²=4.689, P=0.030; misdiagnosis: χ²=10.925, P=0.000; χ²=6.970, P=0.008; χ²=4.314, P=0.038). The area under the curve, accuracy, and Youden index of the receiver operating characteristic curve with a b-value of 800 s/mm² were the highest (0.874, 96.35%, and 0.788, respectively), all higher than those with b-values of 0, 500, and 1000 s/mm² (0.718, 82.73%, 0.612, and 0.735, 86.36%, 0.695, and 0.862, 89.09%, 0.724, respectively). After adjusting confounding factors, ADC was independently correlated with MDR risk, showing a negative correlation (r=-0.719, P<0.05). Conclusion: DWI with a b-value of 800 s/mm² demonstrates superior efficacy in diagnosing different TB classifications, with higher sensitivity and accuracy. ADC was negatively correlated with MDR risk.

Analysis of the use of anti-tuberculosis fixed-dose combination and influencing factors in county-level tuberculosis designated hospital in Fujian Province

Chen Daiquan, Lin Shufang, Dai Zhisong, Zhou Yinfa, Chen Kun, Lin Yongming

Chinese Journal of Antituberculosis. 2024, 46(11): 1365-1372. doi:10.19982/j.issn.1000-6621.20240209

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Objective: To analyze the use of anti-tuberculosis fixed-dose combinations (FDC) in Fujian Province and its influencing factors, so as to provide evidence for expanding FDC adoption and promoting standardized tuberculosis treatment. Methods: A total of 18 tuberculosis designated hospitals were selected from 9 cities and Pingtan comprehensive experimental area in Fujian Province based on typical sampling method. A total of 980 patients with rifampicin-susceptible pulmonary tuberculosis who met the enrollment criteria and were registered and treated from January 1, 2020 to December 31, 2021 were enrolled. The use or replacement of FDC were analyzed. A two-level logistic model was used to analyze the factors affecting the use of FDC. Results: Among 980 tuberculosis patients, 80.41% (788/980) used FDC as initial treatment drugs. The two-level logistic model analysis showed that patients aged 60-90 years and with complications/comorbidities were risk factors for not using FDC (OR=1.499, 95%CI: 1.000-2.247, P=0.049; OR=1.844, 95%CI: 1.231-2.761, P=0.003), while patients with body mass 38-54 kg, 55-70 kg and 71-90 kg were more likely using FDC (OR=0.297, 95%CI: 0.123-0.721, P=0.007; OR=0.334, 95%CI: 0.136-0.823, P=0.017; OR=0.217, 95%CI: 0.065-0.722, P=0.013). 16.50% (130/788) of patients who initially treated with FDC switched to single-drug formulations in subsequent treatment. The replacement rate of FDC was significantly different between variable regions (2.96% (4/135) -32.00% (24/75),χ²=50.752, P<0.001). The replacement rate was also significantly different between 60-90 years group (20.45% (54/264)) and 13-59 years group (14.50% (76/524))(χ²=4.513, P=0.034). Conclusion: The usage rate of anti-tuberculosis FDC in Fujian Province is about 80%, and there are significant differences between different regions. Age, body weight, and complications/comorbidities are factors associated with the use of FDC.

Epidemiological characteristics of non-tuberculous mycobacterial disease in Guangzhou

Liang Feng, Liu Deqing, Chen Hua, Chen Pinru, Tan Yaoju, Hu Jinxing, Zhang Danni, Xu Liuqing

Chinese Journal of Antituberculosis. 2024, 46(11): 1373-1379. doi:10.19982/j.issn.1000-6621.20240185

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Objective: The general situation and epidemiological characteristics of non-tuberculous mycobacteria (NTM) disease in Guangzhou were analyzed to provide reference for development and implementation of effective prevention and management policy of NTM disease. Methods: To conduct a retrospective analysis of 2714 newly diagnosed cases of NTM disease in Guangzhou from January 1, 2018, to December 31, 2023. The study examined the annual detection rate trends of NTM disease, as well as the distribution characteristics by gender, age, and bacterial species/groups. We analyzed the impact of age on NTM disease across nine consecutive age groups, with a focus on comparing the detection differences between the youth group (21-40 years) and the middle-aged/elderly group (51-70 years). Additionally, based on the site of infection, we classified the cases into three groups: pulmonary, extrapulmonary, and disseminated, for further analysis. Results: The detection rate of new NTM disease in Guangzhou in 6 years was fluctuating. Male proportion decreased from 41.10% (194 cases) in 2018 to 38.10% (205 cases) in 2023, while female proportion increased from 58.90% (278 cases) to 61.90% (333 cases). The proportion of male decreased year by year, and the proportion of female increased year by year. The main age group was 51-70 years, accounting for 51.62% (1401/2714). The youth group (21-40 years) decreased from 23.09% (109/472) in 2018 to 16.36% (88/538) in 2023, and the middle-aged/elderly group (51-70 years) rose from 48.31% (228/472) to 55.76% (300/538). Among all 2714 patients with new NTM disease in Guangzhou in 6 years, the top 4 strains of NTM isolation from pulmonary group (97.09%, 2635/2714) were: bird-intracellular mycobacterium complex group (M.avium complex, MAC, 43.42%, 1144/2635), Turtle-Mycobacterium abscessus complex (Turtle-M.abscessus complex, MABC, 36.39%, 959/2635), Mycobacterium kansas (8.50%, 224/2635), and M.sp.contingent (4.10%,108/2635); the top 4 strains of NTM isolation from extrapulmonary group (1.69%, 46/2714) were: MABC (34.78%, 16/46), M.contingent (21.74%, 10/46), MAC(19.57%, 9/46), and Mycobacterium salina (15.22%, 7/46); the top 4 strains of NTM isolation from dissemination group (1.22%, 33/2714) were: MAC (42.42%, 14/33), MABC (27.27%, 9/33), Mycobacterium kansas ((15.15%, 5/33), and M.contingent (6.06%, 2/33). MAC induced lung disease composition ratio slightly increased, from 39.19% (185/472) in 2018 to 48.48% (176/363) in 2022 and 44.61% (240/538) in 2023, while MABC induced lung disease composition ratio decreased from 38.98% (184/472) in 2018 to 30.30% (163/538) in 2023. Conclusion: Middle-aged and elderly patients in Guangzhou are more susceptible to NTM, with a higher prevalence in females compared to males. The proportion of cases in the youth group (21-40 years) shows a declining trend, whereas the proportion in the middle-aged/elderly group (51-70 years) shows an increasing trend. The predominant species causing NTM pulmonary disease are MAC and MABC, with the proportion of MABC cases showing a downward trend.

Patient delay and related factors among elderly pulmonary tuberculosis patients in Lishui City,2019—2023

Chen Xiaolei, Tao Tao, Fan Pengfei, Li Qiuhua, Zhang Haifang

Chinese Journal of Antituberculosis. 2024, 46(11): 1380-1387. doi:10.19982/j.issn.1000-6621.20240247

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Objective: To analyze the trend and related factors of patient delay among elderly pulmonary tuberculosis (PTB) patients in Lishui City, and to provide basis for the formulation and adjustment of tuberculosis control measures. Methods: Data of 2436 cases of elderly PTB patients in Lishui City from 2019 to 2023 was extracted from the Tuberculosis Management Information System, a Sub-system of China Information System for Disease Control and Prevention, including medical records, diagnosis and treatment information,etc.,to analyze the distribution and change trend of their patient delay time and delay rate. Multivariable logistic regression was conducted to identify influencing factors. Results: From 2019 to 2023, the median (Q₁, Q₃) patient delay time was 30 (12, 77) days. The overall patient delay rate was 70.11% (1708/2436). The delay rates from 2019 to 2023 were 65.02% (290/446), 62.75% (288/459), 67.39% (310/460), 74.00% (353/477) and 78.62% (467/594), respectively, showing an statistically significant upward trend ( $χ t r e n d 2$ =42.993,P<0.001). Multivariable logistic regression showed that registration year being 2022 (OR=1.538, 95%CI: 1.149-2.059) or 2023 (OR=2.108,95%CI:1.584-2.805), firstly diagnosed in Lishui City (OR=3.931, 95%CI:1.602-9.650), and current address being Songyang County (OR=1.569, 95%CI:1.045-2.357) were risk factors for patient delay. Current address being Yunhe County (OR=0.433,95%CI:0.269-0.700), Jingning County (OR=0.412,95%CI:0.254-0.667), and Longquan City (OR=0.402,95%CI:0.260-0.621) were protective factors for patient delay. Conclusion: The patient delay rate in Lishui City was high, and showed an increasing trend. It is necessary to focus on local patients and patients in Songyang County, and take effective measures to reduce the delay rate of elderly tuberculosis patients.

Analysis of characteristics of 5 pulmonary tuberculosis cluster epidemics in a university

Cui Lingchou, Shi Haiping

Chinese Journal of Antituberculosis. 2024, 46(11): 1388-1394. doi:10.19982/j.issn.1000-6621.20240276

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Objective: To analyze causes of pulmonary tuberculosis cluster epidemics in a university, to provide effective reference for tuberculosis prevention and control in universities. Methods: Retrospective descriptive analysis was used to analyze tuberculosis archives of a university from January 1, 2014 to December 31, 2023, by sorting out epidemiology, contact screening, clinical characteristics and treatment status of patients, prevention and control measures, and other data of 5 pulmonary tuberculosis cluster epidemics. Then based on laboratory examination results, the chains of transmission, sources of infection and causes of epidemic were analyzed. Results: All 5 cluster epidemics were found by screening contacts of patients who sought medical treatment due to illness, 4 occurred in 2014 to 2018, 1 occurred in 2022, concentrated in the second and third years of college and in the middle of a semester. Among the 23 patients associated with the 5 cluster epidemics, 91.30% (21/23) were campus students and 8.70% (2/23) were off-campus family members; 95.65% (22/23) were male students. Of the 21 campus patients, 38.10% (8/21) were etiologically positive, and 52.38% (11/21) had symptoms. Of the 11 patients with symptoms, 8 (72.72%) actively sought medical treatment, of which 6 were delayed in healthcare-seeking and 4 were delayed in diagnosis; among the 4 patients with delay in diagnosis, 3 cases were misdiagnosed and 1 case was not reported. Sixteen patients were detected by screening, all of them were close contact students, and the patient detection rate among close contacts was 3.50% (16/457). Conclusion: Universities are prone to pulmonary tuberculosis cluster epidemics, delay in healthcare-seeking, patients not seeking medical care, misdiagnosis and underreporting in non-tuberculosis-designated medical institutions are the main causes.

Research progress in the treatment of tuberculosis with contezolid

Wang Yujin, Chu Naihui, Nie Wenjuan

Chinese Journal of Antituberculosis. 2024, 46(11): 1395-1399. doi:10.19982/j.issn.1000-6621.20240362

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The global situation of tuberculosis prevention and control is not optimistic, with high incidence rate and mortality. China is still one of the countries with high burden of tuberculosis in the world. In recent years, as the representative of oxazolidinones, linezolid has been increasingly widely used in the treatment of drug-resistant and severe tuberculosis. Due to its outstanding antibacterial effect, its clinical status has been continuously improved. However, due to the frequent occurrence of bone marrow suppression, peripheral neuropathy and other adverse reactions, its application in the long-term treatment of tuberculosis has been greatly limited. Contezolid is obtained by modifying the structure and activity of linezolid, greatly reducing its adverse reactions. In recent years, more and more studies have focused on the role of contezolid in the treatment of tuberculosis. In this paper, the research progress of contezolid in the treatment of tuberculosis was reviewed, with a view to providing reference for clinical use of contezolid in the treatment of tuberculosis.

Aspirin-exacerbated respiratory diseases: pathogenesis and treatment strategies

Ming Wenhua, Ma Tingting, Wang Hongtian, Wang Xueyan

Chinese Journal of Antituberculosis. 2024, 46(11): 1400-1405. doi:10.19982/j.issn.1000-6621.20240216

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Aspirin-exacerbated respiratory disease (AERD) is a clinical syndrome characterized by chronic rhinosinusitis with nasal polyps, asthma, and hypersensitivity to cyclooxygenase-1 (COX-1) inhibitors. Although the precise pathogenesis of AERD remains unclear, it is widely acknowledged that aberrant metabolism of arachidonic acid plays a central role in the development of this condition. Owing to the incomplete understanding of AERD, many clinicians struggle to establish an accurate diagnosis, which significantly compromises treatment outcomes. Current therapeutic approaches primarily include symptomatic pharmacological management, surgical interventions, aspirin desensitization, and the use of biologic agents. The author aims to provide a comprehensive overview of the pathogenesis and therapeutic strategies for AERD.

Progress in Traditional Chinese Medicine diagnosis and treatment of elderly pulmonary tuberculosis

Guo Jing, Liu Zhongda, Zhang Zunjing, Luo Shuirong

Chinese Journal of Antituberculosis. 2024, 46(11): 1406-1409. doi:10.19982/j.issn.1000-6621.20240192

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The proportion of elderly tuberculosis patients has been increasing year by year. Elderly patients with pulmonary tuberculosis have weakened immune function, many underlying diseases, atypical symptoms, and high rate of unfavorable treatment outcome, which are the key points and difficulties in the prevention and treatment of tuberculosis in China. Traditional Chinese medicine has a long history in the treatment of pulmonary tuberculosis. In recent years, many experts and scholars have conducted exploratory research on the treatment of pulmonary tuberculosis in the elderly with traditional Chinese medicine, suggesting the importance of traditional Chinese medicine in the treatment of elderly patients with pulmonary tuberculosis. This article summarizes the relevant research literature, aiming to provide guidance for clinical practice and provide direction for future research.

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