Table of Content

10 July 2025, Volume 47 Issue 7

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Guideline·Standard·Consensus

Expert consensus on the application of Mycobacterium tuberculosis infection detection technologies

Tuberculosis Control Branch of Chinese Antituberculosis Association, Standardization Professional Branch of Chinese Antituberculosis Association, Elderly Tuberculosis Control Branch of Chinese Antituberculosis Association

Chinese Journal of Antituberculosis. 2025, 47(7):  813-829.  doi:10.19982/j.issn.1000-6621.20250231

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Mycobacterium tuberculosis infection test is an essential method for identifying latent tuberculosis infection and clinically diagnosing tuberculosis. To better guide clinical practice, this consensus was jointly organized by the Tuberculosis Control Branch, Standardization Professional Branch and Elderly Tuberculosis Control Branch of Chinese Antituberculosis Association. Based on domestic and international research progress and clinical practice experiences, and taking into account the specific situations in different scenarios, recommendations on the application of Mycobacterium tuberculosis infection detection technologies are proposed. The consensus provides a detailed introduction to the characteristics and applications of various Mycobacterium tuberculosis infection tests and offers specific suggestions for the selection and application of detection technologies in different application scenarios, such as high-risk populations, key venue populations, and clinical tuberculosis diagnosis. In addition, the application of infection test results in tuberculosis treatment efficacy evaluation is discussed. This consensus aims to provide references for professionals related to tuberculosis prevention and control, diagnosis and treatment in medical and health institutions at all levels and types, in order to help achieve the goal of “ending the TB epidemic”.

Expert consensus on all-oral short-course therapy for drug-resistant tuberculosis

Chinese Antituberculosis Association, Editorial Board of Chinese Journal of Antituberculosis, Beijing Chest Hospital Capital Medlical University/Beijing Tuberculosis and Thoracic Tumor Research Institute

Chinese Journal of Antituberculosis. 2025, 47(7):  830-839.  doi:10.19982/j.issn.1000-6621.20250087

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The World Health Organization (WHO) Treatment Guidelines for Drug-Resistant Tuberculosis (2016 Update) recommend an entirely oral treatment regimen for drug-resistant tuberculosis (DR-TB). Previous studies have shown that compared to injection-containing or longer-course treatment regimens, short-course oral treatment regimens can achieve better medication safety, tolerability, and treatment adherence, while maintaining treatment success rates. In the WHO Consolidated Guidelines on Tuberculosis, Module 4: Treatment of Drug-Resistant Tuberculosis (2022 Update), a 6-month short-course treatment regimen for DR-TB (6BPaLM; where B: bedaquiline, Pa: pretomanid, L: linezolid, M: moxifloxacin) was proposed, marking the dawn of an era of entirely oral short-course treatment for DR-TB. In June 2024, the WHO issued a rapid communication on new treatment regimens for DR-TB, which are more aligned with the actual situation in China compared to previously recommended short-course oral regimens. To develop a fully oral DR-TB treatment regimen tailored to China’s context, the Chinese Antituberculosis Association took the lead in collaborating with Beijing Chest Hospital/Beijing Tuberculosis and Thoracic Tumor Research Institute affiliated to Capital Medical University and the Editorial Board of the Chinese Journal of Antituberculosis to organize experts in the field to draft the Expert consensus on all-oral short-course therapy for drug-resistant tuberculosis. Based on recent domestic and international research progress on entirely oral regimens for DR-TB, this consensus recommends a short-course, entirely oral treatment regimen suitable for China’s national conditions and identifies the appropriate patient populations. It also provides consensus opinions on precautions for using entirely oral treatment regimens and the management of adverse reactions. It is hoped that the publication of this consensus will provide technical guidance for the comprehensive application of short-course treatment regimens for DR-TB in China, thereby further improving the treatment success rates for DR-TB patients in the country.

Study Protocol

Dosage of recombinant Mycobacterium tuberculosis fusion protein for skin testing in the 18-65 year-old population and its safety in the 3-17 and 66-75 year-old populations: a randomized, blinded, positive-controlled phase Ⅱ clinical trial

Wang Jing, Wang Qingfeng, Jing Wei, Wang Yujin, Wang Xueyu, Huang Hairong, Chu Naihui, Nie Wenjuan

Chinese Journal of Antituberculosis. 2025, 47(7):  840-845.  doi:10.19982/j.issn.1000-6621.20250067

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Background: The tuberculin skin test, which uses purified protein derivative (PPD), is widely employed for tuberculosis screening. However, the tuberculin skin test cannot reliably distinguish between latent tuberculosis infection, BCG vaccination effects, and active tuberculosis disease. Therefore, more accurate diagnostic methods for tuberculosis are needed. The recombinant Mycobacterium tuberculosis fusion protein, composed of early secreted antigenic target 6 (ESAT-6) and culture filtrate protein 10 (CFP-10) derived from the reference strain H37Rv, demonstrates diagnostic potential for latent tuberculosis infection, active tuberculosis disease, and the immune status following BCG vaccination. Methods: The study was conducted in two phases. In the first phase, a randomized, blinded, self-controlled dual-arm skin test design with a comparator product was used to compare the sensitivity of different dose groups of recombinant Mycobacterium tuberculosis fusion protein and control reagents in pulmonary tuberculosis patients aged 18-65 years, as well as to their specificity in healthy subjects and non-tuberculous pulmonary diseases patients. Receiver operating characteristic (ROC) curves and the area under the curve (AUC) were calculated to determine the optimal diagnostic cut-off value for the recombinant Mycobacterium tuberculosis fusion protein. The concordance rates of the Mycobacterium tuberculosis fusion protein, the control reagent, and the interferon-gamma release assay (IGRA) were evaluated, along with safety assessment of the fusion protein. In the second phase, an open-label, single-arm design was adopted. Subjects aged 3-17 and 66-75 year-old received single-arm intradermal test to evaluate the safety of the recombinant Mycobacterium tuberculosis fusion protein. Discussion: This study aimed to assess the disagnostic efficacy of the recombinant Mycobacterium tuberculosis fusion protein for detecting latent tuberculosis infection and active tuberculosis, as well as to evaluate its safety profile. The clinical research findings are expected to facilitate the broader application of recombinant Mycobacterium tuberculosis fusion protein based diagnostic technology across diverse population and clinical settings.

Original Articles

Community-based active case-finding for pulmonary tuberculosis in the elderly: analysis of strategies and effectiveness based on a multicenter cohort study

Zhang Canyou, Xia Yinyin, Chen Hui, Zhao Fei, Wang Lixia, Zhang Hui, Cheng Jun

Chinese Journal of Antituberculosis. 2025, 47(7):  846-854.  doi:10.19982/j.issn.1000-6621.20250032

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Objective: To evaluate the screening workload and yield for different community-based active case-finding (ACF) strategies for pulmonary tuberculosis (TB) in the elderly. Methods: A retrospective study was conducted. Data from three consecutive years (2013—2015) of active TB screening among individuals aged ≥65 years were re-analyzed. The screening, implemented by the China CDC across 27 townships/communities in 10 counties/districts spanning eastern, central, and western China, collected data on risk factors, presumptive TB symptoms, and chest radiography (CXR). Eight ACF strategies for the elderly were simulated: symptom screening (Strategies 1-3), high-risk group screening (Strategies 4-7), and universal screening (Strategy 8). Analyses focused on screening participation, TB screening outcomes, detection of individuals with presumptive TB symptoms, screening workload, and case detection yield for each strategy. Results: From 2013 to 2015, the eligible elderly populations (≥65 years) were 38888, 40909, and 43006 individuals, respectively. The numbers undergoing symptom screening were 37989 (97.69%), 37219 (90.98%), and 37771 (87.83%), and those receiving CXR were 33717 (86.70%), 33686 (82.34%), and 33268 (77.36%), showing a significant declining trend year-on-year (Z=-51.651 and -34.802, respectively; P<0.001 for both). During the 2013 initial symptom screening, Strategy 3 (using the WHO-recommended 4-symptom screen) identified significantly more individuals with presumptive TB symptoms (3.75%, 1424/37989) compared to Strategy 1 (national guideline symptoms: 1.92%, 731/37989) and Strategy 2 (study-defined symptoms: 2.10%, 798/37989), and detected 5 more active TB cases than Strategy 1. Strategies 1, 2, and 3 required CXR for 1.79% (696/38888), 1.96% (762/38888), and 3.39% (1317/38888) of the elderly, respectively. These strategies detected 25.00% (14/56), 26.79% (15/56), and 28.57% (16/56) of bacteriologically confirmed pulmonary TB cases, and 18.39% (32/174), 18.97% (33/174), and 21.26% (37/174) of active TB cases. The number needed to screen (NNS) to detect one bacteriologically confirmed TB case was 50, 51, and 83, respectively, and to detect one active TB case was 22, 24, and 36, respectively. Compared to symptom screening, high-risk group strategies (4-7) required CXR for a larger proportion of participants, ranging from 9.07% (Strategy 4, 3527/38888) to 36.81% (Strategy 7, 14314/38888). The detection proportions for bacteriologically confirmed TB and active TB increased from Strategy 4 (37.50% (21/56); 30.46% (53/174)) to Strategy 7 (64.29% (36/56); 66.09% (115/174)). Correspondingly, the NNS increased from 168 and 67 (Strategy 4) to 398 and 125 (Strategy 7). Universal screening (Strategy 8) detected all cases (100.00%; 56/56 bacteriologically confirmed, 174/174 active TB). Screening efficiency in the second year for high-risk strategies was comparable to the first year, but declined significantly in the third year. Conclusion: Community-based ACF for pulmonary TB in the elderly should employ a more sensitive symptom definition to improve case detection. Incorporating high-risk factors enhances screening efficiency. Continuous ACF implementation should not exceed two consecutive rounds; strategies require timely evaluation and adjustment.

Analysis of public knowledge, attitude and practice on tuberculosis prevention and control based on Structural Equation Modeling

Zhong Yi, Yu Shengnan, Zhang Yuqi, Jing Rui, Li Xiujun

Chinese Journal of Antituberculosis. 2025, 47(7):  855-862.  doi:10.19982/j.issn.1000-6621.20250040

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Objective: To understand the knowledge-attitude-practice of tuberculosis prevention and control among public, analyze their correlations based on Structural Equation Modeling, to provide a basis for exploring suitable tuberculosis prevention and control measures and health education for the public. Methods: From October 2022 to April 2023, a stratified cluster random sampling method was used to select public personnel from a university in Shandong Province, a municipal hospital, and a municipal railway bureau for a questionnaire survey. A total of 854 pieces of questionnaire were collected, with 833 valid questionnaire, resulting in a valid response rate of 97.54%.The survey content included basic information, knowledge of tuberculosis prevention and control core knowledge, tuberculosis prevention and control attitude and practice. AMOS 24.0 software was used to construct a structural equation model and analyze the relationship and correlation strength among knowledge, attitude and practice. Results: The average score of tuberculosis control knowledge, attitude and practice were 2.82±1.90 (Full scale was 6), 9.78±1.61 (Full scale was 12), and 8.04±1.47 (Full scale was 10), respectively. There were significant differences in the awareness rates of tuberculosis prevention and control core knowledge among different age (P=0.003), occupation (P<0.001), and income (P=0.003) groups. There were no significant differences in tuberculosis prevention and control beliefs among different groups of the study population. Age (P=0.022), occupation (P<0.001), educational background (P=0.004), and income (P<0.001) all exerted a significant influence on tuberculosis prevention practice. Structural equation fitting result showed that tuberculosis prevention and control knowledge had a positive effect on practice, its total effect was 0.488, of which the direct effect was 0.460, the indirect effect was 0.028. Conclusion: The public had a relatively low awareness of tuberculosis prevention and control core knowledge. Good cognition of tuberculosis and correct attitude towards tuberculosis prevention and control will have a positive effect on practice.

Assessment of the public awareness of core information on tuberculosis prevention and control in Guangdong Province based on a two-level model

Zhou Fangjing, Liang Hongdi, Li Jianwei, Chen Yuhui, Wen Wenpei, Wu Huizhong

Chinese Journal of Antituberculosis. 2025, 47(7):  863-869.  doi:10.19982/j.issn.1000-6621.20250060

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Objective: This study aims to analyze the awareness of core information on tuberculosis (TB) prevention and control among the public in Guangdong Province and to identify its influencing factors, to enhance the scientific basis and effectiveness of health promotion and health education for TB prevention and control. Methods: A multistage stratified random sampling method was employed to select 1403 permanent residents of Guangdong Province as the survey subjects. Nationally standardized questionnaire was used to conduct face-to-face interviews. A two-level logistic regression model was constructed, with individual characteristics as Level 1 units and permanent residential area as Level 2 unit, to analyze the factors associated with the awareness of core information on TB prevention and control. Results: Among 1403 permanent residents, the overall awareness rate of core information on TB prevention and control was 85.10% (5970/7015). The awareness rates for the five individual core messages and the rate for full awareness of all five messages were 76.76% (1077/1403), 90.38% (1268/1403), 92.16% (1293/1403), 87.53% (1228/1403), 78.69% (1104/1403), and 57.80% (811/1403), respectively. 75.41% (1058/1403) of all the residents had received TB health education, who had significantly higher overall awareness rate, individual message awareness rates, and full awareness rate compared with those who had not received such education (92.02% vs. 63.88% (χ²=810.22, P<0.001), 91.02% vs. 33.04% (χ²=487.04, P<0.001),95.09% vs. 75.94% (χ²=107.44,P<0.001), 96.03% vs. 80.29% (χ²=87.04, P<0.001), 92.06% vs. 73.62% (χ²=79.33, P<0.001), 85.92% vs. 56.52% (χ²=132.30, P<0.001), 71.27% vs. 16.52% (χ²=317.43, P<0.001)). Two-level multivariable logistic regression analysis revealed that females had a higher rate of full awareness of TB prevention and control core information than males (OR=1.344, 95%CI: 1.045-1.732). Individuals with middle school education and those with college or higher education had higher full awareness rates than those with primary school education or below (OR=2.106, 95%CI: 1.402-2.902; OR=1.434, 95%CI: 1.334-2.322). Residents with non-local household registration, those engaged in agricultural labor, and those who had not received TB health education had lower full awareness rates compared to their respective counterparts (OR=0.403, 95%CI: 0.237-0.683; OR=0.530, 95%CI: 0.334-0.839; OR=0.075, 95%CI: 0.054-0.103). Conclusion: The two-level model is applicable for evaluating the awareness of TB prevention and control core information among the general public in Guangdong Province. The public in Guangdong Province has a relatively high level of the awareness of core information TB prevention and control. However, further efforts are needed to enhance the public’s understanding of the TB contagiousness and curability. Targeted health education with enhanced precision should be provided to permanent residents who are male, with primary school education or below, with non-local household registration, engaged in agricultural labor, and have not received TB health education. Additionally, the coverage of health education and health promotion activities should be further expanded, with particular attention to ensuring equitable implementation in both urban and rural areas.

Analysis of occupational satisfaction and associated factors among tuberculosis health management staff in primary healthcare institutions in Hunan Province

Fan Jiangjing, Zhou Meng, Xu Zuhui, Zhang Chuanfang

Chinese Journal of Antituberculosis. 2025, 47(7):  870-877.  doi:10.19982/j.issn.1000-6621.20250020

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Objective: To analyze the occupational satisfaction and its influencing factors among tuberculosis health management personnel in primary healthcare institutions in Hunan Province, and to provide evidence for strengthening human resources development for tuberculosis prevention and control in primary healthcare institutions. Methods: A stratified cluster sampling method was employed. From March to April 2023, 14 prefecture-level cities in Hunan Province were first categorized according to the provincial basic public health evaluation classification system. Subsequently, 6 counties/districts were randomly selected from three cities/prefectures (Changde City, Yongzhou City, and Xiangxi Autonomous Prefecture). The study finally included 1289 tuberculosis health management staff from 1256 primary healthcare institutions as study subjects. After obtaining informed consent, sociodemographic data, work-related factors, and anxiety or depression were collected through Tencent questionnaire survey. The Minnesota Satisfaction Questionnaire (MSQ) was used to evaluate staffs’ occupational satisfaction. Results: A total of 1161 valid questionnaires were collected, with a response rate of 90.07% (1161/1289). The overall satisfaction score was (79.60±12.03) points. The highest score item among tuberculosis health management staff was “The way colleagues get along” ((4.16±0.61) points), while the lowest score item was “Remuneration compared to the workload” ((3.61±1.02) points). Multivariable analysis revealed that tuberculosis health management staffs who were being female, holding licensed nurse or village doctors, and working in a full-time tuberculosis management demonstrated significantly higher occupational satisfaction (t=2.430, P=0.015; t=2.005, P=0.045; t=2.968, P=0.003; t=2.337, P=0.020). Conversely, tuberculosis health management staffs with self-rated health status as “good” or “fair/poor”, higher anxiety and depression scores, and personnel residing in Yongzhou City exhibited significantly lower occupational satisfaction (t=-2.607, P=0.009; t=-4.652, P<0.001; t=-3.182, P=0.002; t=-2.942, P=0.003; t=-2.607, P=0.009). Conclusion: The overall satisfaction of tuberculosis health management staffs in primary healthcare institutions in Hunan Province approached the “relatively satisfied” level. Targeted strategies should prioritize improving occupational satisfaction among male staffs, licensed physicians, individuals with self-rated “good” or “fair/poor” health status, personnel exhibiting higher anxiety and depression scores, residents in Yongzhou City, as well as staffs concurrently engaged in other public health service programs.

The diagnostic value of targeted next generation sequencing in sputum-free pulmonary tuberculosis patients

Yang Zeliang, Ma Zichun, Shang Yuanyuan, Shi Jin, Jing Wei, Pang Yu, Qin Lin

Chinese Journal of Antituberculosis. 2025, 47(7):  878-883.  doi:10.19982/j.issn.1000-6621.20250127

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Objective: To evaluate the diagnostic value of targeted next generation sequencing (tNGS) for sputum-free pulmonary tuberculosis (TB) patients. Methods: We enrolled 149 sputum-free pulmonary TB patients derived from Beijing Chest Hospital, Capital Medical University from December, 2023 to March, 2024 for the collection of bronchoalveolar lavage fluids (BALFs), followed by culture, Xpert test, and tNGS. Based on microbiological reference standard (MRS) and clinical reference standard (CRS), the diagnostic capacity of these detection methods was compared. Results: The positive detection rates of culture, Xpert, and tNGS were 47.0% (70/149), 53.0% (79/149), and 89.3% (133/149), accordingly. Compared with MRS, the sensitivity of tNGS was 100.0% (81/81), which was similar to Xpert with 97.5% (79/81, χ²=2.025, P=0.155) and higher than culture with 86.4% (70/81, χ²=11.801, P=0.001). Based on CRS, tNGS exhibited the sensitivity of 96.3% (131/136) and the specificity of 84.6% (11/13). The sensitivity of tNGS was significantly higher than Xpert with 59.6% (81/136; χ²=53.459, P<0.001) and culture with 51.5% (70/136; χ²=70.921, P<0.001). Conclusion: tNGS showed an excellent diagnostic potential for sputum-free pulmonary TB patients, thus providing an alternative method for early TB diagnosis.

Study on the interaction between Mycobacterium tuberculosis membrane protein MmpS5/MmpL5 and bedaquiline

Zheng Zhuangbin, Bi Lijun, Zhang Liqun

Chinese Journal of Antituberculosis. 2025, 47(7):  884-892.  doi:10.19982/j.issn.1000-6621.20240584

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Objective: To express and purify the Mycobacterium tuberculosis membrane proteins MmpS5 and MmpL5, investigate their interaction with bedaquiline (Bdq), and elucidate the specific transport mechanism of the MmpS5/MmpL5 efflux pump system in conferring Bdq resistance. Methods: Expression plasmids for MmpS5 and MmpL5 were constructed. MmpS5 and MmpL5 proteins were expressed and purified in HEK293F mammalian cells and Mycobacterium smegmatis, respectively. The interactions between Bdq and MmpS5/MmpL5 were assessed using differential scanning fluorimetry (DSF) and competitive enzyme-linked immunosorbent assay (ELISA). Results: The expression plasmids for MmpS5 and MmpL5 were successfully constructed. MmpS5 was purified in HEK293F cells, and MmpL5 was purified in Mycobacterium smegmatis. DSF results showed that as the concentration of Bdq increased, the melting temperature (Tm) of MmpS5 slightly decreased. Whereas the Tm of MmpL5 significantly increased, by up to 5.98 ℃, suggesting a binding interaction between MmpL5 and Bdq. Competitive ELISA further demonstrated that the absorbance of MmpL5 decreased significantly with increasing concentrations of unlabeled Bdq, indicating that MmpL5 interacts with biotin-labeled Bdq, and this interaction can be competitively inhibited by unlabeled Bdq. Conclusion: In the MmpS5/MmpL5 efflux pump system, MmpL5 directly interacts with Bdq, while MmpS5 shows no significant interaction. These findings suggest that MmpL5 may directly mediate the efflux of Bdq, whereas MmpS5 likely plays an auxiliary role without direct involvement in Bdq transport. This study provides a critical foundation for understanding the mechanistic role of the MmpS5/MmpL5 efflux pump in Bdq resistance.

Application value of MeltPro two-step method in tuberculosis diagnosis and drug resistance screening

Chen Shuangshuang, Wang Nenhan, Zhao Yanfeng, Fan Ruifang, Tian Lili, Chen Hao, Luo Ping, Li Jie, Li Chuanyou, Dai Xiaowei

Chinese Journal of Antituberculosis. 2025, 47(7):  893-900.  doi:10.19982/j.issn.1000-6621.20250107

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Objective: To evaluate the diagnostic value of MeltPro^? MTBC combined with MeltPro^? MDR fluorescent PCR melting curve technique (referred to as the “MeltPro two-step method”) for tuberculosis (TB) diagnosis and drug resistance detection in suspected pulmonary tuberculosis (PTB) patients. Methods: Adopting prospective research methods, sputum samples from suspected PTB patients who met the enrollment criteria and were initially diagnosed at Tuberculosis Outpatient Department in Beijing Center for Disease Prevention and Control from April to December 2024 were collected. Several detection methods including smear microscopy, mycobacterial culture, GeneXpert MTB/RIF (Xpert), MeltPro^? MTBC, and MeltPro^? MDR assays were performed separately, and the positive detection rates of Mycobacterium tuberculosis (MTB) by smear microscopy, Xpert, and MeltPro^? MTBC were calculated. The diagnostic performance of smear microscopy, Xpert and MeltPro^? MTBC was evaluated based on clinical diagnosis. Drug resistance by Xpert and the MeltPro two-step method were compared. Consistency between Xpert semi-quantitative MTB levels and MeltPro^? MTBC results, as well as the success rate of MeltPro^? MDR detection, were analyzed. Results: A total of 219 sputum specimens from suspected patients were collected, and 143 cases (65.3%) were diagnosed with PTB (87 confirmed, 56 clinically diagnosed), 6 cases (2.7%) had non-tuberculous mycobacterial (NTM) infections, and 70 cases (32.0%) were patients with other pulmonary diseases. The MTB positive detection rates by smear microscopy, Xpert, and MeltPro^? MTBC were 24.7% (54/219), 35.6% (78/219), and 37.4% (82/219), respectively (χ²=9.536, P=0.008), with no significant difference between MeltPro^? MTBC and Xpert (χ²=0.158, P=0.691). Using clinical diagnosis as the reference, the sensitivities of smear microscopy, Xpert, and MeltPro^? MTBC were 35.0% (50/143), 54.5% (78/143), and 57.3% (82/143), with specificities of 94.7% (72/76), 100.0% (76/76), and 100.0% (76/76), and Kappa values of 0.233, 0.454, and 0.483, respectively. Rifampicin (RFP) resistance rates were 5.1% (4/78) by Xpert and 6.8% (5/74) by MeltPro^? MDR, while isoniazid (INH) resistance was 14.9% (11/74) by MeltPro^? MDR. The detection success rate of MeltPro^? MDR correlated with Xpert semi-quantitative MTB levels: 8/8 for high, 100.0% (24/24) for medium, 100.0% (24/24) for low, 54.5% (12/22) for very low, and 9.2% (6/65) for negative samples. Conclusion: The MeltPro two-step method demonstrates high consistency with Xpert in TB diagnosis and RFP resistance screening while enabling simultaneous detection of RFP and INH resistance. It is a reliable and convenient method for rapid diagnosis of TB and screening of drug resistance.

Feasibility analysis of identification of Mycobacterium bovis by thiophen-2-carboxylic acid hydrazine biochemical test

Yang Xinyu, Chen Hao, Dai Xiaowei, Li Qiao, Pang Mengdi, Li Bo, Miao Honghao, Li Jie, Li Chuanyou

Chinese Journal of Antituberculosis. 2025, 47(7):  901-906.  doi:10.19982/j.issn.1000-6621.20240543

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Objective: To evaluate the reliability of using thiophene-2-carboxylic acid hydrazide medium for identifying Mycobacterium bovis. Methods: One thousand two hundred and sixty-seven clinically isolated mycobacterium strains collected from 14 tuberculosis prevention and control institutions and 6 designated hospitals in Beijing from January 1 to December 31, 2019 were identified by medium containing P-nitrobenzoic acid and thiophen-2-carboxylic acid hydrazide. The strains of Mycobacterium tuberculosis complex (MTBC) with fewer than 20 colonies growing on culture medium containing 5 μg/ml thiophene-2-carboxylic acid hydrazine were re-inoculated into roche culture medium containing 5 μg/ml, 2.5 μg/ml, 1.25 μg/ml and 0.63 μg/ml thiophene-2-carboxylic acid hydrazine from another reagent company for sensitivity testing. At the same time, these strains were amplified by PCR and the products were subjected to agarose gel electrophoresis to determine whether they were Mycobacterium bovis by the presence of 168 bp bands. Results: Of the 1267 clinical mycobacterium isolates, 1177 strains belonged to MTBC, and 148 of these strains formed fewer than 20 colonies after culture on the medium containing 5 μg/ml of thiophene-2-carboxylic acid hydrazine. After changing into using medium from another reagent company, there were 27 sensitive strains in the 5 μg/ml medium and 10 sensitive strains in a lower concentration (2.5 μg/ml) of the same medium. In addition, molecular biological PCR experiments showed that only 1 of the 148 isolates was identified as Mycobacterium bovis. Conclusion: The error rate of thiophene-2-carboxylic acid hydrazine medium for identifying Mycobacterium bovis was high, so this method could not be used as a reliable identification evidence.

Functional outcomes and predictors of tuberculous meningitis in children and young adolescents: a hospital-based retrospective study

Wang Meiji, Liu Meijun, Chen Rui, Xia Lu, Liu Xuhui, Yang Yang, Liu Huarui, Ye Dan, Fei Zhentao, Xie Shiqi, Yang Shuqi, Pan Lei, Zhang Xiaolin, Xu Biao, Li Feng

Chinese Journal of Antituberculosis. 2025, 47(7):  907-913.  doi:10.19982/j.issn.1000-6621.20250057

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Objective: To analyze the clinical features and risk factors associated with the prognosis of tuberculous meningitis (TBM) in children, and to provide evidence for early detection and intervention on high-risk TBM in pediatric patients. Methods: Clinical records of TBM children diagnosed in Shanghai Public Health Clinical Center (Fudan University) between 01/01/2013 and 12/31/2023 were reviewed retrospectively. The neurological outcomes of anti-TB treatment at month-12 were evaluated by the modified Rankin Scale (mRS) through outpatient visit and telephone interview. The clinical characteristics of children with good prognosis and poor prognosis were compared, univariate and multivariate analyses were used to determine factors associated with poor prognosis. Results: A total of 91 patients were eligible for the study. Among them, 62 had a good prognosis while the left 29 had a poor prognosis. The median (quartile) age was 3.00 (1.00, 8.00) years old, and 51 were boys. On admission, the poor prognosis group had higher proportion of abnormal muscle strength (12/29, 41.38%), confusion (16/29, 55.17%), and hydrocephalus (17/29, 58.62%) compared to the good prognosis group ((9/62, 14.52%), (13/62, 20.97%), and (22/62, 35.48%), respectively)(χ²=8.032, P=0.005; χ²=10.647, P<0.001; χ²=4.319, P=0.038). In contrast, the frequency of cough ≥2 weeks (4/29, 13.79%) and expectoration (1/29, 3.45%) were lower in the poor prognosis group than in the good prognosis group ((21/62, 33.87%) and (13/62, 20.97%), respectively)(χ²=3.997, P=0.046; χ²=4.659, P=0.031). The Glasgow Coma Scale scores of the poor prognosis group were 13, lower than the 15 in the good prognosis group (Z=-4.190, P<0.001), and the difference in Medical Research Council (MRC) disease stage was statistically significant (χ²=22.327, P<0.001). In addition, the median (quartile) cerebrospinal fluid (CSF) lactate dehydrogenase level of 60.00 (29.50, 128.00) IU/L, the use of external ventricular drainage (7/29, 24.14%), and the frequency of mechanical ventilation (19/29, 65.52%) were higher in the poor prognosis group than in the good prognosis group (39.50 (20.75, 64.00) IU/L, (2/62, 3.23%), and (25/62, 40.32%), respectively)(Z=-2.100, P=0.036; χ²=9.696, P=0.002; χ²=5.022, P=0.025). Multivariate logistic regression analysis showed that confusion on admission (OR=3.690; 95%CI: 1.045-13.034; P=0.043) and external ventricular drainage (OR=8.041; 95%CI: 1.064-60.760; P=0.043) were independent risk factors for poor prognosis in children with TBM. Conclusion: Children with poor prognosis of TBM were more likely to have severe neurologic symptoms (e.g., muscle strength abnormalities, low GCS scores), hydrocephalus, and elevated CSF lactate dehydrogenase, and require higher mechanical ventilation. In contrast, respiratory symptoms (e.g., cough, sputum) were more prominent in the good prognosis group, which may suggest early consultation or milder disease. Admission confusion and external ventricular drainage were independent risk factors for poor prognosis.

Cost-effectiveness analysis of bedaquiline-containing regimens for the treatment of patients with multidrug/rifampicin-resistant pulmonary tuberculosis in Nanning: a retrospective cohort study

Wei Liuying, Jing Wei, Liu Zhifeng, Nie Wenjuan, Huang Xianzhen, Huang Lianpiao, Ban Fengting, Lin Yanrong, Yang Shixiong, Zhu Qingdong

Chinese Journal of Antituberculosis. 2025, 47(7):  914-920.  doi:10.19982/j.issn.1000-6621.20240553

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Objective: To evaluate the efficacy, safety, and cost-effectiveness of bedaquiline-containing regimens for the treatment of multidrug/rifampicin-resistant tuberculosis (TB) patients in Nanning, Guangxi Zhuang Autonomous Region. Methods: Adult multidrug/rifampicin-resistant TB patients admitted to the Fourth People’s Hospital of Nanning from January 2019 to January 2024 were included. Patients were divided into two groups based on their treatment regimens: the conventional long-course regimen group (conventional group) and the bedaquiline-containing regimen group (bedaquiline group). Data on patients’ demographic characteristics, treatment process, treatment outcomes, adverse reactions, and treatment costs were collected and analyzed statistically. Results: A total of 521 patients were included in the study, with 134 in the bedaquiline group and 387 in the conventional group. The proportion of patients with favorable treatment outcomes in the bedaquiline group was 82.1% (110/134), significantly higher than that in the conventional group (63.3%, 245/387), with a statistically significant difference (χ²=16.173, P=0.001). The incidence of adverse reactions in the bedaquiline group was 31.3% (42/134), which was not significantly different from that in the conventional group (35.4%, 137/387)(χ²=0.726, P=0.394). There were no deaths in the bedaquiline group, while 24 patients died in the conventional group. The loss-to-follow-up rate in the conventional group was 24.0% (93/387), significantly higher than that in the bedaquiline group (12.7%, 17/134), with a statistically significant difference (χ²=7.691, P=0.006). The median treatment cost in the bedaquiline group was 11.0 (10.2,11.8) ten thousand yuan, significantly higher than that in the conventional group 6.6 (6.1, 7.7) ten thousand yuan, with a statistically significant difference (Z=75078.000, P=0.001). Cost-effectiveness analysis showed that the medical cost per successfully treated patient was 106000 yuan in the conventional group and 134000 yuan in the bedaquiline group. Conclusion: Although the treatment cost of bedaquiline is relatively high, its success rate is also relatively high, and its safety is good. It can provide more treatment options for rifampicin-resistant TB patients.

A case of pulmonary Castleman disease prone to misdiagnosis: a literature review

Liu Yiping, Lin Youfei, Chen Xiaohong, Pan Jianguang

Chinese Journal of Antituberculosis. 2025, 47(7):  921-929.  doi:10.19982/j.issn.1000-6621.20240593

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Objective: To characterize the radiological features, diagnostic process, clinical manifestations, treatment strategies, and prognostic outcomes of pulmonary Castleman disease (PCD), with the aim of reducing misdiagnosis and missed diagnosis. Methods: We conducted a retrospective analysis of the diagnostic workup, therapeutic interventions, and follow-up of the first documented case of PCD at Fuzhou Pulmonary Hospital, Fujian Province. Additionally, we performed a systematic literature search using the terms “Castleman’s disease” and “pulmonary” across the Wanfang, China National Knowledge Infrastructure (CNKI), and PubMed databases, covering the period from January 1994 to January 2024. A total of 48 eligible articles were identified, encompassing 239 reported cases of PCD. Results: A 42-year-old male patient presented with a one-year history of chronic cough and sputum production and was admitted to Fuzhou Pulmonary Hospital, Fujian Province, on April 23, 2019. He had previously been misdiagnosed with pulmonary tuberculosis at an outside institution. Following a comprehensive diagnostic evaluation—including bronchoscopy, cervical lymph node biopsy, percutaneous lung puncture, and multiple pathological consultations—the patient was ultimately diagnosed with plasma cell type PCD. He received standardized targeted therapy, which led to symptomatic improvement and clinical stabilization. Through literature screening, 239 csases of PCD were identified. Including the present case, a total of 240 patients were analyzed. Based on imaging characteristics and the feasibility of surgical resection, these cases were categorized into two subtypes: isolated PCD (IPCD) and diffuse PCD (DPCD). Of the 240 cases, 108 were classified as IPCD and 132 as DPCD, with both subtypes predominantly affecting young and middle-aged adults. IPCD was largely asymptomatic, with 68 patients (62.96%) presenting no clinical symptoms. In contrast, DPCD was associated with a broader spectrum of clinical manifestations, including cough (63 cases, 47.73%), fever and night sweats (44 cases, 33.33%), dyspnea (56 cases, 42.42%), and fatigue (54 cases, 40.91%). Histopathological analysis revealed that the majority of IPCD cases exhibited the hyaline vascular variant (77 cases, 79.39%), whereas the plasma cell variant was predominant in DPCD (75 cases, 56.82%). Pulmonary function tests were performed in four patients with DPCD, all of whom demonstrated mixed ventilatory defects and impaired diffusion capacity. Surgical resection was the primary treatment modality for IPCD and was associated with favorable outcomes. In contrast, DPCD was primarily managed with chemotherapy and targeted therapies, and exhibited a poorer prognosis, with seven reported deaths. Conclusion: PCD is an uncommon and often underrecognized lymphoproliferative disorder that presents diagnostic and therapeutic challenges. Multidisciplinary collaboration is essential for accurate diagnosis and optimal management. Imaging-based classification distinguishes two clinical subtypes—IPCD and DPCD—with DPCD presenting more frequent and severe symptoms, distinct pathological features, and poorer outcomes. This classification framework enhances clinical recognition and may guide therapeutic decision-making; however, further validation through prospective clinical studies is warranted.

Review Articels

Research progress on immunization strategies for tuberculosis vaccines

Yu Huimin, Zheng Hui, Liu Eryong, Huang Fei, Wu Dan, Yin Zundong

Chinese Journal of Antituberculosis. 2025, 47(7):  930-939.  doi:10.19982/j.issn.1000-6621.20250008

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Tuberculosis (TB) remains a critical global public health threat. While Bacille Calmette-Guérin (BCG) vaccination provides substantial protection against severe TB in children, it offers limited efficacy in high-risk populations such as adolescents and adults, and fails to significantly reduce the overall global TB burden. This review highlights two primary domains in TB vaccine immunization strategies: optimization of BCG-based approaches—including vaccination route modifications and revaccination—and the development of next-generation vaccines, encompassing BCG replacement, BCG booster, and therapeutic candidates. It synthesizes recent global progress in TB vaccine research, critically evaluates the distinct features and limitations of each strategy, and offers evidence-based perspectives to support future TB prevention and control efforts.

Application efficacy and research progress of mass spectrometry detection technology in the diagnosis of osteotuberculosis

Mao Lirong, Nie Yanhui, An Hongjuan, Wang Ruilan, Dong Enjun, Su Yue, Zhao Wenjuan, Du Jingli, An Huiru

Chinese Journal of Antituberculosis. 2025, 47(7):  940-946.  doi:10.19982/j.issn.1000-6621.20250038

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With the rapid advancement of multi-omics technologies, mass spectrometry (MS)-based proteomic and metabolomic analyses have emerged as powerful tools to support the diagnosis of osteoarticular tuberculosis. The identification of disease-specific protein biomarkers and metabolites not only enhances diagnostic accuracy but also offers critical insights into the complex interplay between Mycobacterium tuberculosis and host immune responses. These insights hold promise for guiding the development of novel anti-tuberculosis drugs and vaccines. This review synthesizes current findings on the diagnostic utility of MS in osteoarticular tuberculosis and highlights recent progress in understanding how MS-derived biomarkers influence host immune function, thereby underscoring the potential of MS in translational and clinical applications.

Research progress on psychological and psychiatric adverse reactions induced by antituberculosis drugs

Wang Yutong, Liu Yuhong, Li Liang

Chinese Journal of Antituberculosis. 2025, 47(7):  947-953.  doi:10.19982/j.issn.1000-6621.20250063

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China is one of the countries with a high tuberculosis (TB) burden, with a large patient population. Currently, the primary treatment for TB is chemotherapy with anti-TB drugs. However, due to the prolonged treatment duration and the complexity of multidrug regimens, adverse reactions are inevitable. Among these, psychiatric and psychological adverse reactions are relatively common. However, they are often overlooked in clinical practice due to their insidious onset and the lack of specific diagnostic tools and evaluation criteria. This article reviews the latest research progress on the incidence, risk factors, related drugs and their mechanisms, as well as management strategies for psychiatric and psychological adverse reactions induced by anti-TB drugs, aiming to provide theoretical evidence and practical guidance for the early detection and intervention of such adverse reactions.