Table of Content

10 December 2024, Volume 46 Issue 12

Previous Issue    Next Issue

Special Topic

Prioritizing prevention and enhancing comprehensive interventions to accelerate the end of tuberculosis epidemic—Insights from the implementation of the research projects in Zhongmu County

Xin Henan, Wang Dakuan, Zhang Bin, Liu Zisen, Duan Weitao, Gao Lei

Chinese Journal of Antituberculosis. 2024, 46(12):  1429-1433.  doi:10.19982/j.issn.1000-6621.20240381

Abstract ( 155 )   HTML ( 16 )   PDF (1235KB) ( 219 )   Save

Figures and Tables | References | Related Articles | Metrics

Although significant achievements had been achieved in tuberculosis (TB) control in China, the global targets of the “End TB” by 2035 is still far from reach. The focus of TB control strategies shifting from “integration of prevention and treatment” to “prevention-oriented control” will be necessity in China. With the release and implementation of the Action Plan for Tuberculosis-Free Communities, active case finding (ACF) among key populations has become an important part of TB control work. It is worth exploring whether tuberculosis preventive treatment (TPT) could be integrated with ACF among these key populations. Our team conducted latent tuberculosis infection (LTBI) epidemiological surveys and intervention studies among key populations in rural communities in Zhongmu County, Zhengzhou City, Henan Province. After ten years of work, the notified TB incidence rate in Zhongmu County dropped from 85/100000 in 2013 to 19/100000 in 2023, the declining is faster than the average level in Zhengzhou City. The gradually formed “Zhongmu Model” during the implementation of research projects, featuring “ACT+TPT” in key populations, provides reference for establishing a new community-based intervention strategy. In the future, through more systematic and in-depth research, practice and optimization, the formation of integrated intervention strategy targeting key populations will accelerate the achievements of the “End TB” goals.

Ethical framework for evaluating isolation treatment of patients with infectious pulmonary tuberculosis

Zhang Di, Du Ying, Gao Lei

Chinese Journal of Antituberculosis. 2024, 46(12):  1434-1441.  doi:10.19982/j.issn.1000-6621.20240389

Abstract ( 127 )   HTML ( 10 )   PDF (1040KB) ( 141 )   Save

References | Related Articles | Metrics

Tuberculosis is the infectious disease that causes the largest number of deaths in the world. As a public health policy, the isolation treatment of patients with infectious pulmonary tuberculosis could effectively prevent the spread of tuberculosis and is very important for achieving the global goals of the “END TB” strategy. However, isolation treatment has raised a series of important public health ethical issues, the core of which is to restrict individual freedom in order to protect people’s health. At present, China has started the legislative work of isolation treatment for patients with infectious pulmonary tuberculosis. Properly solving such problems would promote the formulation and implementation of effective isolation treatment regulations and policies. The purpose of this paper is to construct an ethical framework for evaluating isolation, so as to assist legislators, policy makers and public health practitioners to deal with the ethical problems of isolation and make isolation treatment ethical.

Original Articles

In vitro inhibitory and intracellular bactericidal activity of omadacycline against Mycobacterium abscessus

Ma Shiran, Chen Suting, Huang Hairong, Duan Hongfei

Chinese Journal of Antituberculosis. 2024, 46(12):  1442-1447.  doi:10.19982/j.issn.1000-6621.20240274

Abstract ( 144 )   HTML ( 15 )   PDF (789KB) ( 208 )   Save

Figures and Tables | References | Related Articles | Metrics

Objective: To evaluate the antimicrobial and bactericidal activities of omadacycline against Mycobacterium abscessus (MAB) and provide insights into optimizing drug combinations for the treatment of MAB infections. Methods: A total of 58 clinical isolates of MAB, obtained from patients at the Beijing Chest Hospital between 2015 and 2016, as well as a reference strain (ATCC 19977), were included in this study. The minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) of omadacycline against the reference strain were measured using microdilution, alongside determining the MIC₉₀ for the clinical isolates. The checkerboard assay was employed to evaluate the effects of drug combinations on the reference strain, while intracellular bactericidal activity was assessed to measure the drugs’ efficacy against intracellular bacteria. Results: Omadacycline demonstrated MIC of 0.5 μg/ml and MBC of 4 μg/ml against the reference strain, with MIC₉₀ of 0.5 μg/ml for the clinical isolates. Synergistic effects were observed when omadacycline was combined with clarithromycin, linezolid, and bedaquiline, with fractional inhibitory concentration indices (FICIs) of 0.250, 0.375, and 0.375, respectively. Additive effects were noted when combined with clofazimine, azithromycin, and rifabutin, with FICIs of 0.750, 0.625 and 0.560. The combination of omadacycline and bedaquiline produced the most substantial reduction in MBC, decreasing from 4 μg/ml to 0.05 μg/ml, representing a 98.75% reduction compared to omadacycline monotherapy. For intracellular bacteria, the combination of omadacycline and azithromycin demonstrated the most pronounced bactericidal effect at 24 hours, reducing the bacterial count from (7.02±0.06) log₁₀ CFU to (5.36±0.10) log₁₀ CFU (t=3.241, P<0.001). At 48 hours, the combination of omadacycline and clofazimine reduced the intracellular bacterial load from (7.36±0.10) log₁₀ CFU to (5.33±0.35) log₁₀ CFU (t=8.265, P=0.004). Similarly, the combination of omadacycline and imipenem resulted in a reduction of intracellular bacteria from (6.87±0.15) log₁₀ CFU to (5.10±0.17) log₁₀ CFU (t=13.190, P<0.001). The combination of omadacycline and linezolid reduced the intracellular bacterial count from (6.95±0.05) log₁₀ CFU to (5.26±0.24) log₁₀ CFU (t=11.920, P=0.005). Similarly, the combination of omadacycline and rifabutin lowered the intracellular bacterial load from (6.98±0.07) log₁₀ CFU to (5.65±0.16) log₁₀ CFU (t=13.440, P=0.001). Conclusion: Omadacycline combined with other drugs demonstrates significant inhibitory and bactericidal activity against MAB. These findings suggest that omadacycline holds promise as a therapeutic option for treating MAB infections.

Regulating effect of reactive oxygen species/protein kinase RNA-like endoplasmic reticulum kinase signaling axis on BCG-induced ferroptosis in mouse macrophages

Chen Feifei, Zheng Yongzhi, Wu Sufang, Kang Qian, Jin Chunyang

Chinese Journal of Antituberculosis. 2024, 46(12):  1448-1458.  doi:10.19982/j.issn.1000-6621.20240275

Abstract ( 115 )   HTML ( 12 )   PDF (6406KB) ( 141 )   Save

Figures and Tables | References | Related Articles | Metrics

Objective: To investigate the role of reactive oxygen species (ROS)/protein kinase RNA-like endoplasmic reticulum kinase (PERK) signaling pathway in the regulation of ferroptosis in RAW264.7 macrophages induced by BCG infection. Methods: The ferroptosis inhibitor deferoxamine (DFO) was used to investigate the role of ferroptosis in BCG infection-induced apoptosis by dividing RAW264.7 cells into control, BCG, DFO, and BCG+DFO groups; the PERK inhibitor GSK2606414 was used to investigate the role of PERK signaling pathway in BCG infection-induced cell ferroptosis by dividing RAW264.7 cells into control, BCG, GSK2606414, and BCG+GSK2606414 groups. The ROS scavenger N-acetylcysteine (NAC) was used to investigate the role of ROS in the regulation of PERK by dividing RAW264.7 cells into control, BCG, NAC and BCG+NAC groups. Colorimetric assay was used to detect cellular lactate dehydrogenase (LDH) release rate, Fe²⁺, glutathione (GSH) and lipid peroxidation concentration. Immunoblotting was used to detect expression of glutathione peroxidase 4 (GPX4), phosphorylated PERK (p-PERK), activating transcription factor 4 (ATF4), and C/EBP-homologous protein (CHOP); flow cytometry was used to detect ROS concentration. Immunofluorescence was used to detect p-PERK protein concentration. Colony-forming unit (CFU) assay was used to calculate the survival of BCG in cells. Results: Compared with the BCG group, the BCG+DFO group had elevated cell survival rate ((84.72±3.62)% vs. (58.41±2.73)%, t=-4.263, P=0.004), GSH level ((8.85±0.54) μmol/mg vs. (4.81±0.36) μmol/mg, t=-10.116, P<0.001), and relative GPX4 protein expression level (0.82±0.06 vs. 0.33±0.03, t=-10.519, P<0.001); LDH release rate ((15.70±3.18)% vs. (56.24±4.98)%), Fe²⁺ ((8.15±0.64) μmol/mg vs. (18.68±1.27) μmol/mg) and lipid peroxidation level ((22.18±2.24)% vs. (58.13±4.47)%) were significantly reduced (t=35.982, P<0.001; t=20.203, P<0.001; t=32.528, P<0.001). Compared with the BCG group, the BCG+ GSK2606414 group had p-PERK (0.23±0.02 vs. 0.69±0.04), ATF4 (0.39±0.02 vs. 0.91±0.06), CHOP protein (0.24±0.03 vs. 0.61±0.04), Fe²⁺ ((11.70±0.91) μmol/mg vs. (17.92±1.22) μmol/mg) and lipid peroxidation ((19.17±1.75)% vs. (53.28±3.01)%) all significantly reduced (t=17.177, P<0.001; t=21.024, P<0.001; t=19.358, P<0.001; t=11.999, P<0.001; t=30.292, P<0.001, respectively), while GPX4 protein relative expression (0.57±0.04 vs. 0.20±0.02) and GSH level ((8.15±0.47) μmol/mg vs. (4.69±0.22) μmol/mg) were significantly elevated in cells (t=-15.044, P<0.001; t=-9.316, P<0.001). In addition, BCG-infected GSK2606414-treated macrophages had significantly lower bacterial loads at 24 h and 48 h ((1.72±0.15)×10⁵CFU and (1.48±0.12)×10⁵CFU) compared with those in the BCG group ((3.51±0.28)×10⁵CFU and (2.94±0.21)×10⁵CFU; t=17.576, P<0.001; t=15.225, P<0.001). The relative level of ROS in the cells of the BCG+NAC group (1.59±0.11) was significantly lower compared to the BCG group (3.24±0.14, t=20.215, P<0.001). The bacterial loads of BCG-infected NAC-treated macrophages were significantly lower at 24 and 48 h ((0.91±0.12)×10⁵CFU and (0.80±0.13)×10⁵CFU) compared to those of the BCG group ((2.18±0.18)×10⁵CFU and (2.37±0.21)×10⁵CFU; t=16.672, P<0.001; t=20.630, P<0.001). Conclusion: BCG infection-induced macrophage ferroptosis is associated with activation of ROS/PERK signaling.

Analysis of characteristics and factors influencing treatment outcome of registered tuberculosis patients in Linping District, Hangzhou City from 2013 to 2022

Chen Liyan, Zhang Xiaoqiang, Yu Jianping, Zheng Xiao, Zhang Yu

Chinese Journal of Antituberculosis. 2024, 46(12):  1459-1468.  doi:10.19982/j.issn.1000-6621.20240326

Abstract ( 138 )   HTML ( 21 )   PDF (817KB) ( 97 )   Save

Figures and Tables | References | Related Articles | Metrics

Objective: This study aims to analyze the characteristics of pulmonary tuberculosis patients diagnosed and treated in county-level (district-level) designated tuberculosis hospitals in Hangzhou, and to identify factors influencing treatment outcomes. Methods: Data for pulmonary tuberculosis patients diagnosed and treated in Linping District, Hangzhou City from 2013 to 2022 were extracted from the “Tuberculosis Management Information System” subsystem within the “China Disease Prevention and Control Information System,” based on the area of initial diagnosis. A total of 1999 patients were included in this analysis. Patient data on sociodemographic characteristics, diagnostic and treatment information, and treatment outcomes were collected and analyzed. Univariate and multivariate logistic regression models were applied to identify factors influencing adverse treatment outcomes, with further subgroup analyses conducted. Results: Of the 1999 patients, 52.58% (1051/1999) tested positive for pathogens, 41.47% (829/1999) were pathogen-negative, and 5.95% (119/1999) had no pathogen results. Initial treatment was administered to 91.80% (1835/1999) of patients, while 8.20% (164/1999) underwent retreatment. A standard treatment protocol was used for 43.62% (872/1999) of patients, and 31.37% (627/1999) received fixed-dose combination therapy. Additionally, 8.75% (175/1999) of patients had comorbidities other than tuberculosis, and 12.16% (243/1999) had concurrent tuberculosis infections. Treatment success was achieved in 93.00% (1859/1999) of patients, while 7.00% (140/1999) experienced adverse outcomes. Multivariate analysis revealed that tuberculosis patients aged 65 and older, those undergoing retreatment, patients with positive pathogen test results, and those with additional comorbidities had an elevated risk of adverse treatment outcomes (OR(95%CI): 2.320 (1.402-3.838), 4.527 (2.803-7.310), 3.419 (2.073-5.638), and 2.132 (1.275-3.567), respectively). Conversely, female patients and those with non-pathogenic tuberculosis exhibited a reduced risk of adverse outcomes (OR (95%CI): 0.486 (0.293-0.808) and 0.323 (0.116-0.904), respectively). The impact of the treatment regimen on outcomes was found to correlate with age (interaction P=0.002) and to interact with sputum smear results at the end of the second month of treatment (interaction P=0.046). For younger patients (<35 years), the standard treatment regimen was more effective (OR (95%CI): 0.170 (0.059-0.493)), whereas individualized treatment plans yielded poorer outcomes for patients with low treatment adherence (those lacking a sputum smear test at the two-month mark)(OR (95%CI): 0.253 (0.132-0.485)). Conclusion: Treatment outcomes in pulmonary tuberculosis patients are influenced by factors such as age, treatment history, bacteriological findings, and comorbid conditions. Tailored treatment strategies should be implemented based on individual patient characteristics to enhance treatment success rates.

Analysis of the health education status of tuberculosis in rural residents and the influencing factors of the core information of tuberculosis prevention and control during the “13th Five-Year Plan” period

Ni Shuaihu, Chen Gang, Wang Jia, Li Yuhong, Li Xue, Chen Wei, Zhang Hui, Qu Yan, Luo Xiaofeng, Zhao Yanlin

Chinese Journal of Antituberculosis. 2024, 46(12):  1469-1477.  doi:10.19982/j.issn.1000-6621.20240363

Abstract ( 125 )   HTML ( 25 )   PDF (869KB) ( 119 )   Save

Figures and Tables | References | Related Articles | Metrics

Objective: To assess the status of tuberculosis health education and the factors influencing the comprehension of core tuberculosis prevention and control information among rural residents in China during the ‘13th Five-Year Plan’. The analysis aims to enhance tuberculosis health education based on scientific evidence. Methods: Using the prevalence survey method and referring to multi-stage cluster random sampling method, a total of 26593 permanent rural residents aged 15 and above living in village-level administrative units of 31 provinces (municipalities and autonomous regions) and Xinjiang Production and Construction Corps were selected from the special survey database for the final assessment of the National Tuberculosis Prevention and Control Plan in the ‘13th Five-Year Plan’. We collected 26250 valid responses to questionnaires on tuberculosis health education, yielding an effective response rate of 98.71%. The questionnaire covered general demographic information (gender, age, education level), the core information of tuberculosis prevention and control (Q₁: Tuberculosis is a chronic infectious disease that seriously endangers health for a long time; Q₂: Tuberculosis is mainly transmitted through the respiratory tract, and everyone can be infected; Q₃: Cough and sputum for more than 2 weeks should be suspected of tuberculosis, and seek medical treatment in time; Q₄: Not spitting, covering mouth and nose when coughing or sneezing, and wearing a mask can reduce the spread of tuberculosis; Q₅: Standardized full treatment can cure the vast majority of patients and avoid infecting others), and the current status of health education (methods of receiving health education, preferred methods learning about tuberculosis prevention and control information, methods of accessing online science popularization, preferred types of tuberculosis dissemination and online science popularization materials). Both univariate and multivariate logistic regression analyses were employed to assess the relationship between various demographic characteristics and the level of awareness and understanding of core tuberculosis prevention and control information. Results: The total awareness rate of 26250 rural residents on the core information of tuberculosis prevention and control was 81.77% (107323/131250). The awareness rates of Q₁ to Q₅ core information were 76.97% (20205/26250), 88.14% (23138/26250), 88.70% (23285/26250), 84.00% (22049/26250) and 71.03% (18646/26250), respectively. Among them, the total awareness rate (85.20% (89062/104535)) and the awareness rate of Q₁-Q₅ core information (80.28% (16785/20907), 92.11% (19258/20907), 92.68% (19377/20907), 86.66% (18117/20907), 74.26% (15525/20907)) of tuberculosis prevention and control core information of rural residents who had received tuberculosis health education were significantly higher than those of rural residents who had not received tuberculosis health education (68.35% (18259/26715), 64.01% (3420/5343), 72.62% (3880/5343), 73.14% (3908/5343), 73.55% (3930/5343), 58.41% (3121/5343)), the differences were statistically significant (χ²=4051.600, 635.000, 1545.700, 1619.600, 542.160, 518.430, Ps<0.001). Compared with rural residents aged 15-29, with education levels of primary school or below, employed in government or public institutions and who had not received tuberculosis health education, those aged 45-59, with educational achievements ranging from junior high school to bachelor’s degrees or above, employed in business or services, and who had received tuberculosis health education demonstrated superior awareness of the core information related to tuberculosis prevention and control (OR=1.156, 95%CI: 1.050-1.273; OR=1.667, 95%CI: 1.568-1.773; OR=1.882, 95%CI: 1.716-2.065; OR=1.974, 95%CI: 1.736-2.245; OR=1.693, 95%CI: 1.431-2.005; OR=1.242, 95%CI: 1.035-1.489; OR=2.655, 95%CI: 2.485-2.839). The top three methods for rural residents to receive tuberculosis health education were TV/radio (52.02% (13656/26250)), leaflets/folded pages/posters (31.49% (8265/26250)), and direct doctor communication (26.53% (6963/26250)). The main methods of accessing online health science popularization information were WeChat and Weibo (36.58% (9602/26250)) and search engines (25.28% (6636/26250)). Preferred methods learning about tuberculosis prevention and control information included TV/radio (62.80% (16484/26250)), doctor dissemination (45.95% (12062/26250)), and internet dissemination (36.57% (9599/26250)). Audio-visual (40.98% (10757/26250)) and graphic (36.90% (9685/26250)) materials were the preferred types of tuberculosis dissemination, with video (60.28% (15824/26250)) and graphic (46.82% (12290/26250)) being the most popular types of science popularization. Conclusion: During the assessment of the ‘13th Five-Year Plan’, there was a notable enhancement in the health education status related to tuberculosis prevention and control among rural residents in China. However, the awareness of core tuberculosis information had considerable scope for improvement. On the basis of increasing the publicity of network media and developing the dissemination of publicity materials suitable for network media, targeted publicity and education of tuberculosis prevention and control can be carried out for rural residents with low education level and who have not received tuberculosis health education.

Investigation and analysis of diagnostic quality of pathogenic negative pulmonary tuberculosis in county level tuberculosis designated hospitals in Gansu Province

Li Jianghong, Liu Fang, Yang Shumin, He Yujue, Ma Ling, Guo Qiang, Man Shijun

Chinese Journal of Antituberculosis. 2024, 46(12):  1478-1484.  doi:10.19982/j.issn.1000-6621.20240183

Abstract ( 106 )   HTML ( 7 )   PDF (790KB) ( 107 )   Save

Figures and Tables | References | Related Articles | Metrics

Objective: To analyze the diagnostic quality of pathogenic negative pulmonary tuberculosis in county level tuberculosis designated hospitals in Gansu Province, so as to further improve the diagnostic quality of pathogen negative pulmonary tuberculosis. Methods: The cross-sectional method was used to collect the data of active tuberculosis patients registered in Tuberculosis Information Management System in Gansu Province in 2021. The stratified cluster sampling method was used to select the clusters. Three cities were selected from the central, western and eastern parts of Gansu Province. Each city and prefecture selected three county level designated hospitals with the top three registered patients as the survey sites. The investigators collected the complete data of pathogenic negative pulmonary tuberculosis patients (except for tracheobronchial tuberculosis and tuberculous pleurisy) registered at each survey site through the “Field questionnaire of pathogenic negative pulmonary tuberculosis patients in Gansu Province”, and evaluated the diagnostic quality of pathogenic negative pulmonary tuberculosis from five aspects, including diagnostic process, diagnostic evidence, laboratory examination, imaging examination and diagnostic anti-infection treatment. Results: A total of 1187 pathogenic negative pulmonary tuberculosis patients who met the enrollment criteria from 26 designated hospitals were collected. Nine hundred and forty-one cases (79.28%) received standardized diagnostic procedures, and 699 cases (58.89%) diagnostic evidence met the requirements, 1176 cases (99.07%) received bacteriological examination, of which 1169 cases (98.48%), 368 cases (31.00%), 900 cases (75.82%) and 103 cases (8.68%) were examined for sputum smear, mycobacterium culture, molecular biology, and tuberculosis pathology, respectively, 1084 (91.32%) had qualified sputum specimens. Nine hundred and fifty-eight cases (80.71%) received at least one tuberculosis immunological examination. Among them, 724 cases (60.99%), 574 cases (48.36%) and 382 cases (32.18%) were provided tuberculin test, anti-tuberculosis antibody test and interferon-γ release test, respectively. The positive cases were 572 cases (79.01%), 187 cases (32.58%) and 329 cases (86.13%), respectively. Bronchoscopy and pleural effusion examination were performed in 198 cases (16.68%) and 29 cases (2.44%), the positive cases were all 0 cases, respectively. In the 1187 cases (100.00%) underwent imaging examinations, the chest X-ray examination rate (73.21% (869/1187)) and the qualification rate (85.04% (739/869)) were significantly lower than CT examination (99.16% (1177/1187)) and 92.78% (1092/1177), respectively), and the differences were statistically significant (χ²=335.585, P=0.000; χ²=31.829, P=0.000). The diagnostic team discussed 1166 patients (98.23%) and recommended diagnostic anti tuberculosis treatment for 626 patients, while 563 patients (89.94%) were actually treated. Conclusion: The sputum smear and the molecular biological examination of laboratory tests on pathogenic negative pulmonary tuberculosis were mainly used in the designated county (district) level tuberculosis hospitals in Gansu Province. The examination rate and pass rate of CT were relatively high, but molecular biology examination rate, diagnostic process rate and diagnostic rate still have larger space. It is suggested to strengthen the testing procedures and training of technical personnel at county level designated hospitals, and strictly implement the tuberculosis-related examination procedures, and further improve the quality of pathogenic negative pulmonary tuberculosis diagnosis.

Analysis of screening results of close contacts of patients with etiologically negative pulmonary tuberculosis in Yuexiu District,Guangzhou City

Gong Fang, Tan Shouyong, Bao Wanling, Liu Guobiao

Chinese Journal of Antituberculosis. 2024, 46(12):  1485-1489.  doi:10.19982/j.issn.1000-6621.20240204

Abstract ( 122 )   HTML ( 6 )   PDF (819KB) ( 121 )   Save

Figures and Tables | References | Related Articles | Metrics

Objective: To analyze the screening result of close contacts of etiologically negative tuberculosis (TB) patients in Yuexiu District, Guangzhou City, and to provide a basis for the screening and management of those close contacts. Methods: The screening results of 1149 close contacts (hereafter referred to as etiologically negative contact group) of 645 cases of etiologically negative TB registered at the TB control facility in Yuexiu District, Guangzhou City diagnosed from January 1, 2019, to December 31, 2022, were collected. Another 1780 close contacts of 920 etiologically positive pulmonary TB patients registered during the same period (hereinafter referred to as the etiologically positive contact group) were used as controls to compare the screening result of close contacts in the two groups. Results: Among 1149 close contacts with etiologically negative TB patients(534 male and 615 female), 45 TB patients were detected (3.92%). Among 1780 close contacts with etiologically positive TB patients (804 male and 976 female), 52 TB patients were detected (2.92%). The difference of TB detection rate was not statistically significant (χ²=2.159, P=0.142). In the etiologically negative contact group, 27 cases (2.35%) got suspicious symptoms and 19 (70.37%) cases were detected with TB from them, while 1122 (97.65%) cases were without suspicious symptoms and 26 (2.32%) cases were detected with TB. In the etiologically positive group, there were 42 (2.36%) cases with suspicious symptoms and 25 (59.52%) cases were detected with TB, while there were 1738 (97.64%) cases without suspicious symptoms and 27 (1.55%) cases were detected with TB. The TB detection rate was higher among symptomatic contacts than asymptomatic contacts in both groups, with statistically significant differences (χ²=324.482,P=0.000, χ²=465.715, P=0.000). Conclusion: TB can be found in close contacts with etiologically negative TB patients. The possibility of detecting TB in close contacts with suspicious symptoms is higher than in close contacts without suspicious symptoms.

Analysis of drug resistance in clinical isolates from 610 elderly tuberculosis patients

Xu Henan, Lai Congjuan, Zhang Zunjing, Guo Jing, Xu Lixia, Zhang Ying, Liu Zhongda

Chinese Journal of Antituberculosis. 2024, 46(12):  1490-1495.  doi:10.19982/j.issn.1000-6621.20240181

Abstract ( 109 )   HTML ( 8 )   PDF (776KB) ( 78 )   Save

Figures and Tables | References | Related Articles | Metrics

Objective: To analyze the drug resistance characteristics of clinical isolates of Mycobacterium tuberculosis (MTB) in elderly tuberculosis patients (≥60 years old) in a tuberculosis designated hospital in Lishui City, Zhejiang Province, China, offering insights for the prevention and control of drug-resistant tuberculosis in the elderly population of the region. Methods: Information on clinical isolates and samples from elderly tuberculosis patients visiting the Lishui Regional Tuberculosis Sentinel Hospital from 2018 to 2023 was collected. Resistance to first-line antituberculosis drugs (streptomycin, isoniazid, rifampicin, ethambutol) was detected using BACTEC MGIT 960 liquid drug susceptibility test and resistance characteristics were analyzed. Results: A total of 610 strains of MTB were included in the drug resistance detection and analysis. The overall drug resistance rate was 18.85% (115/610), and the multidrug resistance rate was 6.07% (37/610). The drug resistance rate of male patients was 19.38% (93/480), and that of female patients was 16.92% (22/130), with no statistically significant difference (χ²=0.402, P>0.05). The drug resistance rate among initial treatment patients was 18.18% (98/539), and that of retreated patients was 23.94% (17/71). Among them, the ethambutol resistance rate among retreated patients (8.45% (6/71)) was significantly higher than that among initial treatment patients (2.78% (15/539), χ²=6.063, P<0.05). The resistance rates for different drugs ranked as: isoniazid (14.59%, 89/610), streptomycin (8.85%, 54/610), rifampicin (7.38%,45/610), and ethambutol (3.44%, 21/610). The drug resistance patterns showed a total of 13 different drug resistance combinations. Among multidrug resistance combinations, the highest drug resistance rate was for “isoniazid+rifampicin+streptomycin”(2.62%,16/610). The drug resistance rate was 20.00% (19/95) in 2018 and 17.83% (23/129) in 2023, with no statistically significant difference for changing trend ( {\chi }_{\mathrm{t}\mathrm{r}\mathrm{e}\mathrm{n}\mathrm{d}}^2=1.792, P>0.05). Conclusion: The drug resistance rate of MTB in elderly tuberculosis patients in Lishui Region has decreased in the past years, but the drug resistance situation is still severe.

Analysis of treatment completeness and its influencing factors of preventive treatment among 387 latent tuberculosis infection cases

Jiayinati Jingesi, Wang Xinqi, Liu Nianqiang, Wang Senlu, Yipaer Aihaiti, Feng Jianyu, Huang Tao, Kedieryekezi Wufuer

Chinese Journal of Antituberculosis. 2024, 46(12):  1496-1503.  doi:10.19982/j.issn.1000-6621.20240230

Abstract ( 145 )   HTML ( 14 )   PDF (798KB) ( 139 )   Save

Figures and Tables | References | Related Articles | Metrics

Objective: To study the treatment completeness and its influencing factors of 3H-P preventive treatment among close contacts of tuberculosis patients with latent tuberculosis infection (LTBI) and to provide a reference for further promotion of preventive treatment. Methods: Between January 1, 2023 and December 31, 2023, 387 LTBI cases who had close contact with tuberculosis patients and received preventive treatment with informed consent from Wushi County, Aksu Prefecture, Xinjiang Uygur Autonomous Region (Xinjiang) were enrolled as research subjects. A questionnaire was used to collect information of the completion of preventive treatment and its influencing factors, mainly including basic demographic information, awareness of tuberculosis prevention and control core knowledge, completion of preventive treatment, etc. Univariable and multivariable logistic regression were used to analyze the influencing factors related to the completion of preventive treatment. Results: Among 387 LTBI cases, 355 completed preventive treatment, with a treatment completion rate of 91.73%. The incidence of adverse reactions was 14.21% (55/387), and 4.39% (17/387) of cases discontinued their treatment due to adverse reactions. Multivariable logistic regression analysis indicated that taking exercise regularly (OR=5.337, 95%CI: 2.309-12.337) and attending training on tuberculosis prevention and control (OR=4.406, 95%CI: 1.942-9.994) were protective factors for completion of preventive treatment, while a history of alcohol consumption (OR=0.279, 95%CI: 0.108-0.720) and aged 50-64 years (OR=0.254, 95%CI: 0.092-0.698) were risk factors for completion of treatment. Conclusion: Completion of preventive treatment among close contacts of tuberculosis patients with LTBI was generally good, with adverse reactions being one of the main reasons for interruption of treatment. The completion rate of their treatment was affected by not exercising regularly, history of alcohol consumption, not attending training on tuberculosis prevention and control, and aged 50-64 years.

Analysis of epidemiological characteristics and therapeutic prognosis among pulmonary tuberculosis patients complicated with diabetes mellitus in Guangzhou City from 2014 to 2023

Yang Jieying, Xiao Xincai, Du Yuhua, Lai Keng, He Liqian, Wang Ting, Lin Ying, He Weiyun

Chinese Journal of Antituberculosis. 2024, 46(12):  1504-1510.  doi:10.19982/j.issn.1000-6621.20240232

Abstract ( 118 )   HTML ( 7 )   PDF (784KB) ( 107 )   Save

Figures and Tables | References | Related Articles | Metrics

Objective: Epidemiological characteristics and therapeutic prognosis of patients suffering from pulmonary tuberculosis combined with diabetes mellitus (PTB-DM) registered in Guangzhou City from 2014 to 2023 were analyzed to provide evidence for formulating measures to prevent and treat PTB-DM. Methods: Basic information of PTB-DM patients registered in Guangzhou from 2014 to 2023 were collected from the “TB Information Management System” of the “China Disease Control and Prevention Information System”. Descriptive epidemiological method was used to analyze the epidemiological characteristics and treatment outcomes of PTB-DM patients and patients with PTB alone. Non-conditional logistic regression model was used to analyze the influencing factors of PTB-DM. Results: All of 2468 PTB-DM cases were registered in Guangzhou from 2014 to 2023 with an average annual registration rate of 1.44/100000, accounting for 2.79% (2468/88307) of all PTB patients, and the proportion showed an overall upward trend ( {\chi }_{\mathrm{t}\mathrm{r}\mathrm{e}\mathrm{n}\mathrm{d}}^2=131.002, P<0.01). Non-conditional logistic regression analysis showed that compared with PTB patients who were younger, female, teachers/medical personnel/cadres, taking primary treatment, detected from health examination, not delayed in care seeking, and etiologically negative, patients who were older, male, doing housework/unemployed/farmer/herdsmen/fishermen/workers, taking retreatment, detected from referral or tracking, delayed in care seeking, and etiologically positive were more likely to have diabetes mellitus, the odds ratios were 1.436, 1.508, 1.386, 1.781, 1.442, 1.178, 2.050, 3.796, 3.688, 1.670 and 3.064, respectively. Among 83490 tuberculosis patients who had treatment outcomes recorded, the overall treatment success rate was 93.56% (78114/83490), while the success treatment rate was 89.52% (1990/2223) in PTB-DM patients, lower than 93.67% (76124/81267) in PTB patients without DM (χ²=61.942, P<0.05). Conclusion: PTB-DM patients in Guangzhou were mainly middle-aged and elderly adults, male, doing housework or unemployed. They had the characteristics of high retreatment rate, high etiologically positive rate, high drug resistance rate, high patient delay rate, low active detection rate and low treatment success rate. Two-way screening for PTB-DM should be strengthened to achieve early detection and treatment.

Analysis of treatment outcomes and influencing factors of rifampicin-sensitive pulmonary tuberculosis patients in Chongqing City

Yu Ya, Chen Jian, Xu Biao, Zhao Qi, Wu Chengguo, Wang Qingya, Fan Jun, Zhong Jiyuan

Chinese Journal of Antituberculosis. 2024, 46(12):  1511-1518.  doi:10.19982/j.issn.1000-6621.20240273

Abstract ( 98 )   HTML ( 10 )   PDF (854KB) ( 98 )   Save

Figures and Tables | References | Related Articles | Metrics

Objective: To analyze the treatment outcomes and risk factors of rifampicin-sensitive pulmonary tuberculosis (PTB) patients in Chongqing City, and to provide evidence for improving treatment management measures of patients and accurately evaluating treatment outcomes. Methods: A retrospective study was conducted to include a total of 11545 rifampicin-sensitive PTB patients diagnosed and registered for treatment in Chongqing City in 2022 from the Chinese tuberculosis information management system (TBMIS). Basic demographic information and clinical data of the subjects were recorded and sorted out. Univariable and multivariable logistic regression models were used to analyze factors affecting treatment outcomes. Results: Treatment success rate of 11545 rifampicin-sensitive PTB patients was 90.26% (10421/11545).Treatment failure rate was 0.72% (83/11545), loss of follow-up rate was 1.49% (172/11545), and mortality rate was 5.52% (637/11545). Multivariable logistic regression analysis showed that ethnic minority (OR=1.573, 95%CI: 1.288-1.922), aged over 60 years old (60-74 years old:OR=3.322,95%CI:1.043-10.583;≥75 years old:OR=7.941,95%CI:2.490-25.323), etiologically positive (OR=1.419, 95%CI: 1.214-1.659), retreatment (OR=1.371, 95%CI: 1.121-1.677), severe pulmonary tuberculosis (OR=1.348, 95%CI: 1.108-1.639), adverse reactions (OR=4.183, 95%CI: 2.707-6.464), moderate and treated in secondary or lower institutions (OR=1.333, 95%CI: 1.161-1.532) were risk factors for treatment success. Being female (OR=0.659, 95%CI: 0.562-0.773) was a protective factor for treatment success. Conclusion: The treatment success rate of rifampicin-sensitive PTB patients in Chongqing City was about 90%, but special attention should be paid to patients who are ethnic minorities, over 60 years old, etiologically positive, retreatment, severe case, having adverse reactions, and treated in secondary and lower facilities.

The causal relationship between immune cells and pulmonary tuberculosis: a mendelian randomization study

Wen Weinong, An Zhenxiang, He Yuanli, He Song, Liu Chuang, Sun Kai

Chinese Journal of Antituberculosis. 2024, 46(12):  1519-1526.  doi:10.19982/j.issn.1000-6621.20240270

Abstract ( 91 )   HTML ( 9 )   PDF (2848KB) ( 117 )   Save

Figures and Tables | References | Related Articles | Metrics

Objective: This study aims to evaluate the causal relationship between immune cells and pulmonary tuberculosis (TB) using Mendelian Randomization (MR) analysis. This approach provides novel insights into vaccine development, TB prevention strategies, and prognosis evaluation. Methods: Summary data from genome-wide association studies (GWAS) were utilized, with genetic loci related to pulmonary TB selected as instrumental variables. Five methods were applied for two-sample MR analysis: MR-Egger regression, weighted median, inverse variance weighted, simple mode, and weighted mode. The causal relationship between immune cells and pulmonary TB was assessed using odds ratios (OR, 95%CI). Heterogeneity was evaluated using Cochran’s Q, and pleiotropy was examined through the MR-pleiotropy residual sum and outlier (MR-PRESSO) test and MR-Egger regression. The leave-one-out method was employed to verify the stability of the results. Results: The inverse variance weighted analysis revealed a strong association between pulmonary TB risk and Unsw mem %B cell (β=-0.257, OR=0.773, 95%CI: 0.607 to 0.985, P=0.037), CD19 on IgD⁺CD38^- (β=-0.493, OR=0.610, 95%CI: 0.379 to 0.982, P=0.042), CD39⁺ secreting Treg %CD4 Treg (β=0.425, OR=1.532, 95%CI: 1.099 to 2.135, P=0.012), CD25 on CD45RA^-CD4 not Treg (β=-0.719, OR=0.487, 95%CI: 0.262 to 0.904, P=0.023), CD45 on CD33br HLA-DR⁺ (β=-0.364, OR=0.695, 95%CI: 0.508 to 0.949, P=0.022), HLA-DR on CD33^-HLA-DR⁺ (β=0.153, OR=1.166, 95%CI: 1.024 to 1.323, P=0.020), HLA-DR on CD14^-CD16^- (β=0.134, OR=1.144, 95%CI: 1.006 to 1.300, P=0.040), and PDL-1 on monocyte (β=0.379, OR=1.462, 95%CI: 1.056 to 2.026, P=0.022). No significant heterogeneity or pleiotropy was found. Conclusion: Elevated levels of four immune cell phenotypes—unswitched memory B cells, CD19 on IgD⁺CD38^- cells, CD25 on CD45RA^-CD4 non-Treg cells, and CD45 on CD33bright HLA-DR⁺ cells—may be associated with a reduced risk of developing tuberculosis. In contrast, increased levels of four other immune cell phenotypes—CD39⁺ secreting regulatory T cells (%CD4 Treg), HLA-DR on CD33^-HLA-DR⁺ cells, PDL-1 on monocytes, and HLA-DR on CD14^-CD16^- cells—may be linked to an elevated risk of tuberculosis.

Review Articles

Advances in the application of animal models and 3D cell models in tuberculosis research

Li Chaofan, Chen Zhi

Chinese Journal of Antituberculosis. 2024, 46(12):  1527-1534.  doi:10.19982/j.issn.1000-6621.20240347

Abstract ( 96 )   HTML ( 7 )   PDF (817KB) ( 113 )   Save

References | Related Articles | Metrics

Tuberculosis, caused by Mycobacterium tuberculosis (MTB), remains one of the world’s most significant infectious diseases, yet the mechanisms underlying MTB-host interactions are not fully understood. Animal models and 3D cell models offer a comprehensive and intricate experimental platform that facilitates the simulation of various aspects of tuberculosis pathophysiology. This review examines the application of these models in tuberculosis research, aiming to pave the way for advances in prevention, diagnosis, and treatment.

Research progress on co-infection of non-tuberculous mycobacteria and other respiratory pathogens

Du Shanshan, Sha Wei, Wang Li

Chinese Journal of Antituberculosis. 2024, 46(12):  1535-1540.  doi:10.19982/j.issn.1000-6621.20240264

Abstract ( 106 )   HTML ( 7 )   PDF (800KB) ( 121 )   Save

References | Related Articles | Metrics

With the increasing aging of the population and the growing number of patients with structural lung diseases, the incidence of non-tuberculous mycobacteria pulmonary disease (NTM-PD) is on the rise. Most patients with NTM-PD have pre-existing underlying lung disease and are frequently co-infected with multiple pathogenic microorganisms, which further increases the difficulty of diagnosis and treatment of NTM disease as well as the evaluation of the efficacy of regimen. Co-infection is one of the major reasons for the low therapeutic success rate and high relapse rate. The authors reviewed the research progress of NTM co-infections by searching the relevant literature, in an attempt to enrich the understanding of pulmonary co-infections in patients with NTM-PD and to discuss their clinical intervention strategies.

Research progress on latent tuberculosis infection in medical staff

Chen Yujie, Wang Linghua, Cheng Xiaoyan, Li Huiyuan

Chinese Journal of Antituberculosis. 2024, 46(12):  1541-1547.  doi:10.19982/j.issn.1000-6621.20240291

Abstract ( 153 )   HTML ( 10 )   PDF (811KB) ( 162 )   Save

References | Related Articles | Metrics

Tuberculosis (TB) is an important public health problem in China. Early management of latent tuberculosis infection (LTBI) is one of the important contents of TB control strategy. Affected by the specific working environment, medical staff is one of the high-risk groups of LTBI, and the risk of progressing to active TB is also extremely high, which has a serious impact at the society, public health and the individuals. Therefore, it is urgent to improve attention to the LTBI management of medical staff. This article reviewed the current situation, screening strategy, influencing factors and management plans of LTBI in medical staff, in order to improve the awareness of LTBI-related issues among medical staff, clarify relevant personal and occupational risk factors, and provide reference for strengthening TB prevention and control in medical institutions and reducing occupational hazards.

The current application status of deep learning in Chest X-ray screening for lung diseases

Li Junliang, Liu Xin, Lin Zhiyuan, Long Xianrong, Jiang Zhihang, Huo Yingyu

Chinese Journal of Antituberculosis. 2024, 46(12):  1548-1559.  doi:10.19982/j.issn.1000-6621.20240245

Abstract ( 126 )   HTML ( 11 )   PDF (1379KB) ( 272 )   Save

Figures and Tables | References | Related Articles | Metrics

There are various types of lung diseases with serious harm, and early detection of those diseases is crucial to improve the survival rate of patients. In recent years, deep learning technology has made a breakthrough progress in analysis of medical images, which providing new possibilities for early screening of lung diseases. The authors reviewed relevant studies in the past five years, focusing on the applications of Convolutional Neural Networks, Transformer models, and their hybrid architectures in chest X-ray (CXR) image analysis. Additionally, the potential of multi-model ensemble learning strategies and attention mechanisms in improving the diagnostic accuracy of lung diseases was also analyzed. This comprehensive review aims to systematically review and analyze the current application, challenges, and future directions of using deep learning technologies in chest X-ray screening for lung disease detection.

Research progress on the effects of bedaquiline,delamanid and pretomanid on liver function in the treatment of multidrug-resistant tuberculosis

Shi Chunjing, Liu Xing, Li Longfen, Li Wenming, Zhang Huajie, Wang Ge, Zeng Haiyan, Liu Li, Shen Lingjun

Chinese Journal of Antituberculosis. 2024, 46(12):  1560-1565.  doi:10.19982/j.issn.1000-6621.20240257

Abstract ( 134 )   HTML ( 12 )   PDF (853KB) ( 125 )   Save

References | Related Articles | Metrics

The treatment of multidrug-resistant tuberculosis (MDR-TB) faces many challenges. The anti-TB drugs bedaquiline, delamanid and pretomanid, which are drugs having new therapeutic targets in recent 50 years, show good therapeutic potential for MDR-TB. However, relevant studies have shown that they can affect liver function and cause drug-induced liver injury. The authors reviewed liver function injury caused by single drug or multidrug combination of bedaquiline, delamanid and pretomanid, and its related mechanisms and precautions, in order to provide evidence and reference for the clinical use of them in the treatment of MDR-TB.

Research progress on mixed infection in pulmonary tuberculosis patients

He Jing, Zhang Zhongfa

Chinese Journal of Antituberculosis. 2024, 46(12):  1566-1572.  doi:10.19982/j.issn.1000-6621.20240312

Abstract ( 119 )   HTML ( 8 )   PDF (803KB) ( 314 )   Save

Figures and Tables | References | Related Articles | Metrics

Tuberculosis (TB) is one of the major public health concerns in China, with pulmonary TB being its most prevalent clinical presentation. In recent years, the detection rate of co-infections involving pulmonary TB and other pathogens has significantly increased, driven by a deeper understanding of TB and advancements in isolation and culture techniques. Co-infection with other pathogens is a critical complication of pulmonary TB, closely associated with the invasiveness and drug resistance of Mycobacterium tuberculosis. However, the complexity of pathogens involved in co-infections remains insufficiently understood, posing a considerable challenge in the clinical management of TB. The authors provide an overview of recent studies on co-infections with pulmonary TB, with a focus on common co-infecting pathogens, such as other respiratory bacteria, fungi, viruses, non-tuberculous mycobacteria, and the human immunodeficiency virus. The discussion aims to offer insights into the clinical diagnosis and treatment of TB co-infections, serving as a reference for improved patient management.