BACKGROUND Pulmonary tuberculosis(PTB)is prevalent in immunocompromised populations,including patients with hematologic malignancies,human immunodeficiency virus infections,and chronic diseases.Effective treatment for...BACKGROUND Pulmonary tuberculosis(PTB)is prevalent in immunocompromised populations,including patients with hematologic malignancies,human immunodeficiency virus infections,and chronic diseases.Effective treatment for acute promyelocytic leukemia(APL)combined with PTB is lacking.These patients show an extremely poor prognosis.Therefore,studies should establish efficient treatment options to improve patient survival and prognosis.CASE SUMMARY A 60-year-old male with pain in the right side of his chest and a fever for 4 d visited the outpatient department of our hospital.Peripheral blood smear revealed 54%blasts.Following bone marrow examinations,variant APL with TNRC18-RARA fusion gene was diagnosed.Chest computed tomography scan showed bilateral pneumonitis with bilateral pleural effusions,partial atelectasis in the lower lobes of both lungs,and the bronchoalveolar lavage fluid gene X-Pert test was positive,indicative of PTB.Carrimycin,ethambutol(EMB),and isoniazid(INH)were administered since he could not receive chemotherapy as the WBC count decreased continuously.After one week of treatment with carrimycin,the patient recovered from fever and received chemotherapy.Chemotherapy was very effective and his white blood cells counts got back to normal.After being given five months with rifampin,EMB and INH and chemotherapy,the patient showed complete remission from pneumonia and APL.CONCLUSION We report a case of PTB treated successfully with carrimycin with APL that requires chemotherapy.展开更多
BACKGROUND In China,the prevalence of type 2 diabetes mellitus(T2DM)among diabetic patients is estimated to be between 90%-95%.Additionally,China is among the 22 countries burdened by a high number of tuberculosis cas...BACKGROUND In China,the prevalence of type 2 diabetes mellitus(T2DM)among diabetic patients is estimated to be between 90%-95%.Additionally,China is among the 22 countries burdened by a high number of tuberculosis cases,with approximately 4.5 million individuals affected by active tuberculosis.Notably,T2DM poses a significant risk factor for the development of tuberculosis,as evidenced by the increased incidence of T2DM coexisting with pulmonary tuberculosis(T2DMPTB),which has risen from 19.3%to 24.1%.It is evident that these two diseases are intricately interconnected and mutually reinforcing in nature.AIM To elucidate the clinical features of individuals diagnosed with both T2DM and tuberculosis(T2DM-PTB),as well as to investigate the potential risk factors associated with active tuberculosis in patients with T2DM.METHODS T2DM-PTB patients who visited our hospital between January 2020 and January 2023 were selected as the observation group,Simple DM patients presenting to our hospital in the same period were the control group,Controls and case groups were matched 1:2 according to the principle of the same sex,age difference(±3)years and disease duration difference(±5)years,patients were investigated for general demographic characteristics,diabetes-related characteristics,body immune status,lifestyle and behavioral habits,univariate and multivariate analysis of the data using conditional logistic regression,calculate the odds ratio(OR)values and 95%CI of OR values.RESULTS A total of 315 study subjects were included in this study,including 105 subjects in the observation group and 210 subjects in the control group.Comparison of the results of both anthropometric and biochemical measures showed that the constitution index,systolic blood pressure,diastolic blood pressure and lymphocyte count were significantly lower in the case group,while fasting blood glucose and high-density lipoprotein cholesterol levels were significantly higher than those in the control group.The results of univariate analysis showed that poor glucose control,hypoproteinemia,lymphopenia,TB contact history,high infection,smoking and alcohol consumption were positively associated with PTB in T2DM patients;married,history of hypertension,treatment of oral hypoglycemic drugs plus insulin,overweight,obesity and regular exercise were negatively associated with PTB in T2DM patients.Results of multivariate stepwise regression analysis found lymphopenia(OR=17.75,95%CI:3.40-92.74),smoking(OR=12.25,95%CI:2.53-59.37),history of TB contact(OR=6.56,95%CI:1.23-35.03)and poor glycemic control(OR=3.37,95%CI:1.11-10.25)was associated with an increased risk of developing PTB in patients with T2DM,While being overweight(OR=0.23,95%CI:0.08-0.72)and obesity(OR=0.11,95%CI:0.02-0.72)was associated with a reduced risk of developing PTB in patients with T2DM.CONCLUSION T2DM-PTB patients are prone to worse glycemic control,higher infection frequency,and a higher proportion of people smoking,drinking alcohol,and lack of exercise.Lymphopenia,smoking,history of TB exposure,poor glycemic control were independent risk factors for T2DM-PTB,and overweight and obesity were associated with reduced risk of concurrent PTB in patients with T2DM.展开更多
[Objectives]This study was conducted to explore the X-ray manifestations of pneumoconiosis patients and differentiation from pulmonary tuberculosis.[Methods]Retrospective analysis was conducted on 103 patients who und...[Objectives]This study was conducted to explore the X-ray manifestations of pneumoconiosis patients and differentiation from pulmonary tuberculosis.[Methods]Retrospective analysis was conducted on 103 patients who underwent lung examinations,including 47 cases of pneumoconiosis and 56 cases of pulmonary tuberculosis.The differences in nodule characteristics and accompanying cavity sign between pneumoconiosis and pulmonary tuberculosis were compared.[Results]The X-ray manifestations of pneumoconiosis patients mainly included various forms of lung images,which were uneven in density,and had blurry edges,and sometimes thickening of lung markings and reduction of lung volume could be observed.The acinar nodules observed in X-ray films of patients with hematogenous disseminated pulmonary tuberculosis appeared petal like.The uniformity of nodule appearance such as nodule distribution,nodule density,and nodule size was significantly lower in pneumoconiosis than in hematogenous disseminated pulmonary tuberculosis,showing a statistical significance(P<0.05).The diameter of cavities in patients with pneumoconiosis accompanied by cavity sign[(0.64±0.13 vs 3.37±0.95)cm]was lower than that in patients with secondary pulmonary tuberculosis accompanied by cavity sign.There was a significant difference in the thickness of the cavity wall between the two diseases,and patients with pneumoconiosis accompanied by cavity sign had a higher rate of thick wall cavities(>3 mm).The X-ray manifestations of pneumoconiosis and tuberculosis were relatively similar,but the distribution,density and size of nodules in pneumoconiosis were relatively uneven,and the patients accompanied by cavity sign had smaller cavity diameter and higher rate of thick-walled cavities.[Conclusions]This study provides a reference for the clinical differential diagnosis of pneumoconiosis and pulmonary tuberculosis.展开更多
Background: In Gabon, the epidemiology of tuberculosis has been considerably reshaped by the AIDS virus. It is in this context that the present study was conducted to assess the prevalence of pulmonary tuberculosis an...Background: In Gabon, the epidemiology of tuberculosis has been considerably reshaped by the AIDS virus. It is in this context that the present study was conducted to assess the prevalence of pulmonary tuberculosis and associated factors among patients at the Amissa Bongo Regional Hospital in Franceville, Gabon. Patients and Methods: This prospective, cross-sectional study was conducted in the biomedical analysis laboratory of the Amissa Bongo Regional University Hospital in Franceville from 19 June 2021 to 22 January 2022. After agreeing to take part in the study, participants were asked to fill in a questionnaire to collect their socio-demographic data and habits. Clinical signs were also observed. Sputum and gastric fluid samples were collected and examined using the Xpert MTB/RIF test and BAAR smear microscopy. Data were analysed using R software version 3.6.1. The results of the univariate and multivariate analyses were considered significant for p ≤ 0.05. Results: A total of 309 patients were included in this study, 50.81% (n = 157) men and 49.19% (n = 152) women. Of these, 98 had a positive diagnosis of pulmonary tuberculosis, giving an overall prevalence rate of 31.72%. There were 40 women or 40.82% (95% CI: [0.30 - 0.51]) and 58 men or 59.18% (95% CI: [0.48 - 0.69]). A univariate analysis of the prevalence of tuberculosis according to risk factors and clinical signs indicated a certain association between certain variables. However, an in-depth multivariate logistic regression analysis of this prevalence, according to the risk factors and clinical signs observed in the patients in the study, indicated that the age group 15 and 49 years (Adjusted OR = 47.77;95% CI: [4.4;519.7] p = 0.001*), fever (Adjusted OR = 4.83;95% CI: [1.16, 20.12] p = 0.031*), alcohol consumption (Adjusted OR = 12.2;95% CI: 12.2 [2.5;5.9] p = 0. 002*), smoking (Adjusted OR = 9.83;95% CI: [1.78;54.24] p = 0.037), HIV infection (Adjusted OR = 4.63;95% CI: [1.25;17.1] p = 0.022), cough (Adjusted OR = 4.31;95% CI: [1.21, 15.4] p = 0. 025*), chest pain (Adjusted OR = 103.6;95% CI: [19.4;55.2] p = 0.000), night sweating cough (Adjusted OR = 10.84;95% CI: [3.18;36.98] p = 0.000*) were significant risk factors for pulmonary tuberculosis. Conclusion: The results of the present study showed that the prevalence of pulmonary tuberculosis was greatest among males in Franceville and the surrounding area. The 15 - 49 age group, fever, alcohol consumption, smoking, HIV infection, chest pain, night sweats and cough were significant risk factors for pulmonary tuberculosis. Consequently, screening for tuberculosis in HIV-positive patients, public awareness and community mobilisation should be encouraged.展开更多
Objective: To systematically review the rate of patient delay of pulmonary tuberculosis (PTB) patients among students in China. Methods: Databases including Web of Science Core Collection, PubMed, The Cochrane Library...Objective: To systematically review the rate of patient delay of pulmonary tuberculosis (PTB) patients among students in China. Methods: Databases including Web of Science Core Collection, PubMed, The Cochrane Library, CBM, CNKI, VIP, and WANFANG DATA were electronically searched to collect cross-sectional studies on the incidence of delayed consultation in students with PTB in China from January 1, 2000, to November 15, 2022. Two researchers independently screened studies, extracted data, and assessed the risk of bias of the included studies. Meta-analysis was then performed by Stata 16.0 software. Results: In total, 60 cross-sectional studies with 260,707 cases involving 136,701 delayed consultation PTB patients were included. The results of meta-analysis showed that the rate of patient delay was 46.4% (95% CI 44.3% to 48.4%) among students with PTB in China. Results of subgroup analyses showed that: 1) The rates were 46.8% and 50.4% for male and female students, respectively. 2) The rates for the East, Central and West parts of China were 42.3%, 45.6% and 50.5%, respectively. 3) The rates were increased first and then decreased during 2007 to 2020. 4) The rates of students from primary school, junior high school, senior high school and university were 50.3%, 49.8%, 40.7% and 44.9%, respectively. 5) The rates for the Han and the other nationalities were 50.3% and 53.9%, respectively. 6) The rates for local and non-local students were 47.2% and 50.5%, respectively. 7) The rates of patients detected by consultation due to symptoms, recommendation due to symptoms, referral, tracking and healthy physical examination were 50.5%, 51.6%, 46.6%, 55.6% and 16.2%, respectively. 8) The rates of patients with initial PTB and retreatment PTB were 53.1% and 59.6%, respectively. 9) The rates of patients with positive etiology, negative etiology and without etiological results were 55.9%, 47.0% and 51.6%, respectively. 10) The rates of severe and non-severe patients were 59.4% and 52.9%, respectively. Conclusion: The patient delay rate for Chinese students with PTB is generally at a high level. There are substantial differences in the patient delay rate for students with PTB among different genders, regions, study stages, nationalities, household registration types, detection methods, and treatment classifications.展开更多
Background: Tuberculosis (TB) is one of the world’s deadliest infectious diseases. Tumor necrosis factor-Alpha (TNF-α) and Interleukin 8 (IL-8) are involved in the pathogenesis of pulmonary TB (PTB). However, the co...Background: Tuberculosis (TB) is one of the world’s deadliest infectious diseases. Tumor necrosis factor-Alpha (TNF-α) and Interleukin 8 (IL-8) are involved in the pathogenesis of pulmonary TB (PTB). However, the contribution of polymorphisms of these cytokines to PTB susceptibility needed more investigation across geographic regions and ethnic groups. Purpose: The aim of this study was to investigate the association of the TNF-α-308 G/A and IL-8-251T/A polymorphisms with PTB risk in the Congolese population. Methods: This case-control study included 150 PTB patients and 160 control subjects. Blood samples were collected from all participants and were used for the TNF-α-308 G/A and IL-8-251T/A genotyping by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) technique. Odds ratios (OR) were calculated to estimate the potential polymorphism associations. A P level of Results: A significant difference was found between PTB patients and controls regarding the TNF-α-308AA genotype (P = 0.035) distribution. Moreover, this genotype was associated with risk to TB (OR = 7.19, 95% CI = 0.85 - 60.65, P = 0.035). The A allele was significantly more frequent in PTB patients than in controls, and was associated with risk to PTB (OR = 1.68, 95% CI = 1.05 - 2.68, P = 0.014). Regarding the IL-8-251T/A gene, TA and AA genotypes were significantly more frequent in PTB patients compared to controls, and were associated with increased risk to PTB (OR = 2.64, 95% CI = 0.97 - 7.18, P = 0.031 and OR = 3.0, 95% CI = 1.13 - 7.98, P = 0.014, respectively). However, the IL-8-251 A allele was not associated to PTB susceptibility (OR = 0.27, 95% CI = 0.15 - 0.44). Conclusion: TNF-α-308G/A and IL-8-251T/A polymorphisms may be associated to PTB susceptibility in the Congolese population, and the AA genotype of both cytokines could be a risk factor.展开更多
Background: Hematopoietic system is seriously affected by tuberculosis. It exerts a dazzling variety of hematological effects involving both cell lines and plasma components [1]. Anemia and leukopenia are not unusual ...Background: Hematopoietic system is seriously affected by tuberculosis. It exerts a dazzling variety of hematological effects involving both cell lines and plasma components [1]. Anemia and leukopenia are not unusual with tuberculosis (TB), but pancytopenia is rare [2]. Findings: In this report, we described a case of a 42 years man presenting bleeding and pancytopenia;bacteriological pulmonary TB was established by genotypic rapid test and treatment following the WHO guidelines on drug-sensitive TB treatment. Patient recovered entirely with the WHO recommended regimen associated with general and local treatment of the bleeding. Conclusion: This case report emphasizes the importance of always suspecting tuberculosis in a tuberculosis-endemic area, even when the clinical manifestations are atypical, like pancytopenia and also of properly investigating the differential diagnosis. Even though prognosis seems to be less good, actual treatment regimen is still effective.展开更多
Objective: To assess the missed opportunities from the diagnosis of bacilliferous pulmonary tuberculosis by optical microscopy compared to GeneXpert MTB/RIF between 2015 and 2019. Methods: This is a retrospective anal...Objective: To assess the missed opportunities from the diagnosis of bacilliferous pulmonary tuberculosis by optical microscopy compared to GeneXpert MTB/RIF between 2015 and 2019. Methods: This is a retrospective analysis of the diagnostic results of bacilliferous pulmonary tuberculosis in patients suspected of pulmonary tuberculosis at their first episode during the period. GeneXpert MTB/RIF (GeneXpert) and optical microscopy (OM) after Ziehl-Neelsen stained smear were performed on each patient’s sputum or gastric tubing fluid sample. Results: Among 341 patients suspected of pulmonary tuberculosis, 229 patients were declared bacilliferous tuberculosis by the two tests (67%), 220 patients by GeneXpert and 95 patients by OM, i.e. 64.5% versus 28% (p i.e. 58.5% of the positive cases detected by the two tests (134/229 patients) and 39.3% of the patients suspected of tuberculosis (134/341 patients). On the other hand, among 95 patients declared positive by OM, the GeneXpert ignored 9 (9.5%), i.e. 4% of all the positive cases detected by the two diagnostic tests (9/229 patients) and 3% of the patients suspected of tuberculosis (9/341 patients). The differences observed between the results of the two tests were statistically significant at the 5% threshold (p Conclusion: This study reveals missed diagnostic opportunities for bacilliferous pulmonary mycobacteriosis, statistically significant with optical microscopy than GeneXpert. The GeneXpert/optical microscopy couple could be a good contribution to the strategies for the elimination of pulmonary tuberculosis in sub-Saharan Africa.展开更多
Objective:To explore the effect of integrated medical and nursing care in patients with pulmonary tuberculosis combined with lung cancer.Methods:From August 2021 to August 2022,60 patients with pulmonary tuberculosis ...Objective:To explore the effect of integrated medical and nursing care in patients with pulmonary tuberculosis combined with lung cancer.Methods:From August 2021 to August 2022,60 patients with pulmonary tuberculosis combined with lung cancer were admitted.All patients were diagnosed with pulmonary tuberculosis according to the Guidelines for the Diagnosis and Treatment of Pulmonary Tuberculosis and with lung cancer by pathology.The patients were randomly divided into two groups,with 30 cases in each group.The control group received daily nursing care,whereas the study group received integrated medical and nursing care.The sputum conversion rate,tumor remission rate,and quality of life of patients were observed and analyzed.Results:The item function score and symptom function score of the observation group were higher than those of the control group(P<0.05);the total effective rate of the observation group was significantly higher than that of the control group(P<0.05);the sputum conversion rate of the observation group was significantly higher than that of the control group(P<0.05).Conclusion:For patients with pulmonary tuberculosis combined with lung cancer,the application of integrated medical and nursing care can help consolidate the treatment effect and improve the quality of life of patients;thus,it is worthy of promotion and application.展开更多
Aim:To explore the diagnostic value of spiral CT chest enhanced scan for adults with active pulmonary tuberculosis.Methods:The clinical data of 60 adult patients with active pulmonary tuberculosis who were treated in ...Aim:To explore the diagnostic value of spiral CT chest enhanced scan for adults with active pulmonary tuberculosis.Methods:The clinical data of 60 adult patients with active pulmonary tuberculosis who were treated in our hospital from January 2018 to November 2019 were retrospectively analyzed.All patients underwent conventional chest radiography and spiral CT chest enhanced scan.The number of tuberculosis diagnosis,the detection rate of special site lesions,and the detection rate of active pulmonary tuberculosis signs by the two methods were compared.Results:In 60 patients,the pathological results confirmed the existence of 75 tuberculosis lesions.The detection rate of spiral CT was 98.67%,which was not statistically significant compared with the detection rate of 92.00%(P>0.05)in the conventional chest X-ray.The detection rate of spiral CT enhanced scans for tuberculosis lesions in special sites was 100.00%,which was significantly higher than that of conventional chest X-ray of 7.69%,and the accuracy rate of active pulmonary tuberculosis signs was 98.85%higher than that of conventional chest X-ray of 79.31%.P<0.05).The difference was statistically significant(P<0.05).Conclusion:Spiral CT chest enhanced scan can not only find special tuberculosis lesions that cannot be detected by conventional chest radiography,but also accurately determine active pulmonary tuberculosis in adults,which is of high diagnostic value.展开更多
Objective:To investigate the application value of loop-mediated isothermal amplification(LAMP),GeneXpert,mycobacterial culture,smear microscopy,TSPOT.TB(TSPOT),ratio of TB-specific antigen to phytohemagglutinin(TBAg/P...Objective:To investigate the application value of loop-mediated isothermal amplification(LAMP),GeneXpert,mycobacterial culture,smear microscopy,TSPOT.TB(TSPOT),ratio of TB-specific antigen to phytohemagglutinin(TBAg/PHA ratio)in the detection of mycobacterium tuberculosis in the bronchoalveolar lavage fluid.Methods:A retrospective analysis was performed on the patients who underwent bronchoscopy from December 2018 to November 2019 in Tongji Hospital.The patients with positive tuberculosis culture or positive GeneXpert in bronchoalveolar lavage fluid were selected as the case group,and those without tuberculosis served as the control group.The receiver operating characteristic(ROC)curve was used to evaluate the diagnostic value of LAMP,GeneXpert,culture,smear microscopy,TSPOT,and TBAg/PHA ratio.Results:For the patients with positive cultures as case,the sensitivity of LAMP,GeneXpert,smear microscopy,TSPOT and TBAg/PHA ratio was 73.49%,89.16%,25.30%,80.00%,33.85%,respectively,the specificity was 99.00%,100.00%,99.00%,86.00%,100.00%,respectively,the area under the ROC curve(AUC)was 0.849,0.938,0.633,0.830,0.669,respectively.For the patients with positive GeneXpert as case,the sensitivity of LAMP,mycobacterial culture,smear microscopy,TSPOT and TBAg/PHA ratio was 73.20%,74.23%,22.68%,68.92%,29.73%,respectively,the specificity was 99.00%,100.00%,99.00%,86.00%,100.00%,respectively,the AUC was 0.853,0.878,0.623,0.775,0.649,respectively.Conclusion:The sensitivity of GeneXpert was best.The sensitivity and diagnostic value of LAMP were slightly lower than those of GeneXpert,and were similar to tuberculosis culture.The sensitivity of smear microscopy was low.The specificity of TSPOT was low.When TBAg/PHA ratio>0.2 was used as a diagnostic index,the specificity was improved,but the sensitivity was low.展开更多
BACKGROUND Depression has been reported to be prevalent in patients with pulmonary tuberculosis(PTB).Moreover,several clinical symptoms of PTB and depression overlap,such as loss of appetite and malnutrition.However,t...BACKGROUND Depression has been reported to be prevalent in patients with pulmonary tuberculosis(PTB).Moreover,several clinical symptoms of PTB and depression overlap,such as loss of appetite and malnutrition.However,the association between depression and malnutrition in TB patients has not been fully elucidated.AIM To explore the association between depression and malnutrition in patients with PTB.METHODS This hospital-based cross-sectional study included patients with PTB in Shanghai Pulmonary Hospital Affiliated to Tongji University from April 2019 to July 2019.The Patient Health Questionnaire-9(PHQ-9)scale was used to evaluate depression.The cut-off value was set at 10,and the nutritional state was determined by the body mass index(BMI).In addition,the Quality of Life Instruments for Chronic Diseases was employed to establish the quality of life(QOL).Univariable analysis and multivariable analysis(forward mode)were implemented to identify the independent factors associated with depression.RESULTS A total of 328 PTB patients were screened for analysis.Eight were excluded for missing demographic data,four excluded for missing nutrition status,and sixteen for missing QOL data.Finally,300 PTB patients were subjected to analysis.We found that depressive state was present in 225 PTB patients(75%).The ratio of malnutrition in the depressive PTB patients was 45.33%.Our results revealed significantly lower BMI,hemoglobin,and prealbumin in the depression group than in the control group(P<0.05).Moreover,the social status differed significantly(P<0.05)between the groups.In addition,glutamic pyruvic transaminase and glutamic oxaloacetic transaminase in the depression group were significantly higher than those in the control group(P<0.05).Multivariable logistic regression analysis showed that BMI[odds ratio(OR)=1.21,95%confidence interval(CI):1.163-1.257,P<0.001]and poor social function(OR=0.95,95%CI:0.926-0.974,P=0.038)were independently associated with depression.CONCLUSION Malnutrition and poor social function are significantly associated with depressive symptoms in PTB patients.A prospective large-scale study is needed to confirm these findings.展开更多
Objective:To summarize the precise association between pulmonary tuberculosis(PTB) and P2x7 A1513 C gene polymorphism.Methods:PubMed and Google Scholar web-databases were searched for the studies reporting the associa...Objective:To summarize the precise association between pulmonary tuberculosis(PTB) and P2x7 A1513 C gene polymorphism.Methods:PubMed and Google Scholar web-databases were searched for the studies reporting the association of P2x7 A1513 C polymorphism and PTB risk.A meta-analysis was performed for the selected case-control studies and pooled odds ratios(ORs) and 95%confidence intervals(95%CIs) were calculated for all the genetic models.Results:Eleven studies comprising 2 678 controls and 2 113 PTB cases were included in this meta-analysis.We observed overall no significant risk in all the five genetic models.When stratified population by the ethnicity,Caucasian population failed to show any risk of PTB in all the genetics models.In Asian ethnicity,variant allele(C vs.A:P=0.001;QR=1.375,95%CI=1.159-1.632) and heterozygous genotype(AC vs.AA:P=0.001;OR=1.570,95%CI=1.269-1.944) demonstrated significant increased risk of PTB.Likewise,recessive genetic model(CC+AC vs.AA:P=0.001;OR=1.540,95%CI= 1.255-1.890) also demonstrated increased risk of PTB in Asians.Conclusions:Our meta-analysis did not suggest the association of P2x7 A1513 C polymorphism with PTB risk in overall or separately in Caucasian population.However,it plays a significant risk factor for predisposing PTB in Asians.Future larger sample and expression studies are needed to validate this association.展开更多
BACKGROUND Several studies have demonstrated that airborne transmission of Mycobacterium tuberculosis bacteria from patients with active pulmonary tuberculosis(TB) to other passengers or crew members can occur during ...BACKGROUND Several studies have demonstrated that airborne transmission of Mycobacterium tuberculosis bacteria from patients with active pulmonary tuberculosis(TB) to other passengers or crew members can occur during long flights. As such, non-infectious TB patients are usually allowed to undertake air travel after taking the appropriate anti-TB drugs. However, the global guidelines for air travel for patients with TB are inconsistent and insufficiently detailed with respect to cavitary pulmonary TB(CPTB).CASE SUMMARY Here, we report a case in which a patient with multiple CPTB was permitted air travel, following negative sputum acid-fast bacilli smear tests after administration of proper anti-TB medication. The patient’s culture results were pending.CONCLUSION This case revealed that more specific guidelines regulating air travel for patients with CPTB are necessary.展开更多
Background: The emergence of multidrug resistant tuberculosis (MDR-TB) and extensively drug- resistant tuberculosis (XDR-TB) has highlighted the need for early accurate detection and drug susceptibility. Objective: Th...Background: The emergence of multidrug resistant tuberculosis (MDR-TB) and extensively drug- resistant tuberculosis (XDR-TB) has highlighted the need for early accurate detection and drug susceptibility. Objective: The purpose of the present study was to evaluate the accuracy of GeneX-pert MTB/RIF assay for the detection of Mycobacterium tuberculosis and rifampicin resistance. Methodology: This cross sectional study was done in the Department of Microbiology at Sir Salimullah Medical College, Dhaka and National Institute of Chest Disease & Hospital (NIDCH), Dhaka during the period of January 2014 to December 2014 for a period of 1 (one) year. Sputum samples from suspected MDR-TB patients were collected by purposive sampling technique from OPD of Sir Salimullah Medical College (SSMC) and NIDCH. Microscopy, liquid culture in liquid MGIT 960 media and GeneXpert MTB/RIF were done for MTB diagnosis and detection of rifampicin resistance. MGIT 960 media were also used for determination of drug resistance. Result: Liquid culture yielded higher growth (68%) from 100 samples while GeneXpert MTB assay showed similar result (67% positive and 33% negative). Drug susceptibility test in MGIT 960 media showed that out of 68 positive cases Rifampicin resistant cases were 15 (22.05%) whereas GeneXpert MTB assay detected 14 (20.89%) were Rifampicin resistant out of 67 MTB positive samples. When compared to liquid culture the calculated sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV) and accuracy of GeneXpert MTB were 98.52%, 100%, 96.96%, 100% and 99%. Conclusion: GeneXpert MTB/RIF assay is high detection rate of pulmonary tuberculosis and multidrug resistant tuberculosis.展开更多
Objective:To explore the effect of case management nursing service on compliance behavior and quality of life of patients with pulmonary tuberculosis.Methods:69 cases of pulmonary tuberculosis patients in our hospital...Objective:To explore the effect of case management nursing service on compliance behavior and quality of life of patients with pulmonary tuberculosis.Methods:69 cases of pulmonary tuberculosis patients in our hospital from September 2019 to August 2020 were selected as the research objects.The 69 patients were divided into study group(35 cases)and control group(34 cases).The compliance behavior,quality of life and nursing satisfaction of pulmonary tuberculosis patients were studied and analyzed.Results:The compliance rate of the control group was 82.35%,and that of the study group was 97.14%;The quality of life in the control group was[61.32±7.66],which was significantly lower than that in the study group[71.12±7.23];The satisfaction rate of the study group was 97.14%,which was significantly higher than 73.53%of the control group.Conclusion:In the treatment of tuberculosis patients,the use of case management nursing service can effectively improve the quality of life of patients,improve the compliance behavior of patients,and improve the treatment effect of patients,which is worthy of promotion.展开更多
Objective Coronavirus disease 2019(COVID-19)and tuberculosis(TB)are major public health and social issues worldwide.The long-term follow-up of COVID-19 with pulmonary TB(PTB)survivors after discharge is unclear.This s...Objective Coronavirus disease 2019(COVID-19)and tuberculosis(TB)are major public health and social issues worldwide.The long-term follow-up of COVID-19 with pulmonary TB(PTB)survivors after discharge is unclear.This study aimed to comprehensively describe clinical outcomes,including sequela and recurrence at 3,12,and 24 months after discharge,among COVID-19 with PTB survivors.Methods From January 22,2020 to May 6,2022,with a follow-up by August 26,2022,a prospective,multicenter follow-up study was conducted on COVID-19 with PTB survivors after discharge in 13 hospitals from four provinces in China.Clinical outcomes,including sequela,recurrence of COVID-19,and PTB survivors,were collected via telephone and face-to-face interviews at 3,12,and 24 months after discharge.Results Thirty-two COVID-19 with PTB survivors were included.The median age was 52(45,59)years,and 23(71.9%)were men.Among them,nearly two-thirds(62.5%)of the survivors were moderate,three(9.4%)were severe,and more than half(59.4%)had at least one comorbidity(PTB excluded).The proportion of COVID-19 survivors with at least one sequela symptom decreased from 40.6%at 3 months to 15.8%at 24 months,with anxiety having a higher proportion over a follow-up.Cough and amnesia recovered at the 12-month follow-up,while anxiety,fatigue,and trouble sleeping remained after 24months.Additionally,one(3.1%)case presented two recurrences of PTB and no re-positive COVID-19during the follow-up period.Conclusion The proportion of long symptoms in COVID-19 with PTB survivors decreased over time,while nearly one in six still experience persistent symptoms with a higher proportion of anxiety.The recurrence of PTB and the psychological support of COVID-19 with PTB after discharge require more attention.展开更多
<strong>Background: </strong>Tuberculosis (TB) is an infectious disease and it is a public health concern due to the endemic nature of the disease. Nigeria’s health systems still rely heavily on out-dated...<strong>Background: </strong>Tuberculosis (TB) is an infectious disease and it is a public health concern due to the endemic nature of the disease. Nigeria’s health systems still rely heavily on out-dated tuberculosis diagnostic tests;including sputum smear microscopy and chest radiography. This necessitated the urgent need to explore a more reliable, effective method that can rapidly enhance simultaneous detection of <em>Mycobacterium tuberculosis</em> (MTB) and rifampicin (RIF) resistance. <strong>Aims: </strong>We evaluated the prevalence of MTB and rifampicin resistance and the influence of socio-demographic factors. <strong>Methods:</strong> A longitudinal, descriptive study that employs the Xpert MTB/RIF automated molecular method for rapid detection of rifampicin resistance. Secondary data were collected from the medical record from March 2017 to December 2018. Primary data were collected by direct clinical observations and analysis with gene expert machine from January 2019-March 2019. <strong>Results:</strong> Study populations were 1893 subjects pooled as secondary data at the Gene Expert laboratory, with a mean age of 44.92 years and were categorized based on sex, 1125 (59.4%) males and 768 (40.6%) females respectively. The MTB detected were 117 (15.7%) for males while 76 (9.9%) were positive for females. 948 (84.3%) were negative for males and 692 (90.1%) negative for females. Also, the categories for age were grouped into three but the older age groups (29 - 54) and (55 - 80) were more vulnerable to MTB having a p = 0.506 which is statistically non-significant;only 14 (5.5%) have RIF while 239 (94.5%) do not have RIF resistance strains. Logistic regression analysis of MTB detected showed a significant association (p < 0.05) for sex and a non-significant association (p > 0.05) for age. The prevalence rate for RIF Resistance is 5.53%, there is a statistical difference p = 0.001 between RIF Resistance and MTB in Ilorin. <strong>Conclusion: </strong>The utilization of validated molecular technique for MTB strain identification has shown stronger epidemiological impetus for an improved care management outcome specifically in resources limited areas.展开更多
Background: The current screening tools for tuberculosis (TB) are inadequate resulting in insufficient TB case detection and continued community transmission of TB. As the world is geared into finding missing TB cases...Background: The current screening tools for tuberculosis (TB) are inadequate resulting in insufficient TB case detection and continued community transmission of TB. As the world is geared into finding missing TB cases, new strategies are called for to aid in rapid identification of TB cases. This study aimed to evaluate the role C-reactive protein (CRP) in triaging patients to get a definitive test for active pulmonary TB diagnosis in urban Tanzania. Methods: A case-control study was conducted among pulmonary TB (PTB) patients and contacts without active PTB. The diagnosis of PTB was performed using GeneXpert MTB/RIF assay and culture. Blood was collected from cases and controls for measuring CRP levels during recruitment. We compared socio-demographic characteristics, clinical and laboratory parameters obtained during recruitment and performed diagnostic accuracy analyses for CRP. Results: Out of all 193 study participants who were involved in final analysis, 147 (76.2%) were males. Pulmonary TB cases had significantly lower median BMI than controls (median 17.4 kg/m<sup>2</sup> [IQR: 15.8 - 19.2 kg/m<sup>2</sup>] vs., 24.9 kg/m<sup>2</sup> [IQR: 22.1 - 28.5 kg/m<sup>2</sup>), p < 0.001). There was no statistical difference in prevalence of HIV between PTB cases and controls i.e., 13.33% vs., 11.7%, p = 0.48. CRP was significantly higher in PTB cases vs., controls (median 67.8 mg/L, [IQR: 36.5 - 116.9 mg/L] vs., 1.55 mg/L, [IQR: 0.59 - 6.0 mg/L], p = 0.003). Furthermore, CRP at cut-off ≥10 mg/L was associated with best combination of sensitivity, specificity and area under the curve of 89.9%, 95% CI: 82.2 - 95.0, 80.9%, CI: 71.4 - 88.2 and 0.85, 95% CI: 0.80 - 0.90 respectively. A multivariate logistic regression model adjusted for fever, night sweats and body mass index showed that CRP above 10 mg/L was significantly associated with PTB, aOR 5.2, 95% CI 1.2 - 22.8. Conclusions: CRP at cut-off ≥10 mg/L can be used to screen pulmonary TB. These findings can be used to improve TB screening algorithm by incorporating CRP in combination with TB symptoms to identify patients who need further confirmatory TB tests. However, additional prospective studies are required to support our findings and contribute into policy recommendations on use of CRP in a screening algorithm for pulmonary TB.展开更多
Introduction: The increase in cases of drug-resistant pulmonary tuberculosis, especially in endemic areas, is mainly associated with re-treatment, although resistant tubercle bacilli can be easily transmitted between ...Introduction: The increase in cases of drug-resistant pulmonary tuberculosis, especially in endemic areas, is mainly associated with re-treatment, although resistant tubercle bacilli can be easily transmitted between all susceptible persons. Objective: The study aimed to describe pulmonary tuberculosis, risk factors and MDR in new and re-treated suspected patients attending Wad Madani Tuberculosis Center that provides service in central Sudan. Methods: Cross-sectional laboratory based study among 300 presumptive pulmonary tuberculosis patients during 2018 and 2019 was conducted. Cases were divided into new and re-treated. Mycobacterium tuberculosis DNA and rpoB gene of multi-drug resistance (MDR) were detected in sputum samples by GeneXpert assay as manufacturer instructions. Results: Out of 300 suspected participants, 34% (103/300) were diagnosed as pulmonary tuberculosis using GeneXpert method. The frequency of males, the age group from 21 to 40 and rural housing were the most with percentage reach 68% (70/103), 51% (53/103) and 58.3% (60/103) respectively. All observed symptoms were significantly associated with pulmonary tuberculosis. New cases represented 59.2% (61/103) while re-treated was 40.8% (39/103). The overall frequency of MDR patients was 9.7% (10/103) of which 50% (5/103) had relapse situation. Conclusion: It appeared that the cases of MDR pulmonary tuberculosis are on the increase compared to previous findings, recommended measures must be taken to control the spread of tuberculosis and the causes of re-treatment and relapse must be studied.展开更多
文摘BACKGROUND Pulmonary tuberculosis(PTB)is prevalent in immunocompromised populations,including patients with hematologic malignancies,human immunodeficiency virus infections,and chronic diseases.Effective treatment for acute promyelocytic leukemia(APL)combined with PTB is lacking.These patients show an extremely poor prognosis.Therefore,studies should establish efficient treatment options to improve patient survival and prognosis.CASE SUMMARY A 60-year-old male with pain in the right side of his chest and a fever for 4 d visited the outpatient department of our hospital.Peripheral blood smear revealed 54%blasts.Following bone marrow examinations,variant APL with TNRC18-RARA fusion gene was diagnosed.Chest computed tomography scan showed bilateral pneumonitis with bilateral pleural effusions,partial atelectasis in the lower lobes of both lungs,and the bronchoalveolar lavage fluid gene X-Pert test was positive,indicative of PTB.Carrimycin,ethambutol(EMB),and isoniazid(INH)were administered since he could not receive chemotherapy as the WBC count decreased continuously.After one week of treatment with carrimycin,the patient recovered from fever and received chemotherapy.Chemotherapy was very effective and his white blood cells counts got back to normal.After being given five months with rifampin,EMB and INH and chemotherapy,the patient showed complete remission from pneumonia and APL.CONCLUSION We report a case of PTB treated successfully with carrimycin with APL that requires chemotherapy.
文摘BACKGROUND In China,the prevalence of type 2 diabetes mellitus(T2DM)among diabetic patients is estimated to be between 90%-95%.Additionally,China is among the 22 countries burdened by a high number of tuberculosis cases,with approximately 4.5 million individuals affected by active tuberculosis.Notably,T2DM poses a significant risk factor for the development of tuberculosis,as evidenced by the increased incidence of T2DM coexisting with pulmonary tuberculosis(T2DMPTB),which has risen from 19.3%to 24.1%.It is evident that these two diseases are intricately interconnected and mutually reinforcing in nature.AIM To elucidate the clinical features of individuals diagnosed with both T2DM and tuberculosis(T2DM-PTB),as well as to investigate the potential risk factors associated with active tuberculosis in patients with T2DM.METHODS T2DM-PTB patients who visited our hospital between January 2020 and January 2023 were selected as the observation group,Simple DM patients presenting to our hospital in the same period were the control group,Controls and case groups were matched 1:2 according to the principle of the same sex,age difference(±3)years and disease duration difference(±5)years,patients were investigated for general demographic characteristics,diabetes-related characteristics,body immune status,lifestyle and behavioral habits,univariate and multivariate analysis of the data using conditional logistic regression,calculate the odds ratio(OR)values and 95%CI of OR values.RESULTS A total of 315 study subjects were included in this study,including 105 subjects in the observation group and 210 subjects in the control group.Comparison of the results of both anthropometric and biochemical measures showed that the constitution index,systolic blood pressure,diastolic blood pressure and lymphocyte count were significantly lower in the case group,while fasting blood glucose and high-density lipoprotein cholesterol levels were significantly higher than those in the control group.The results of univariate analysis showed that poor glucose control,hypoproteinemia,lymphopenia,TB contact history,high infection,smoking and alcohol consumption were positively associated with PTB in T2DM patients;married,history of hypertension,treatment of oral hypoglycemic drugs plus insulin,overweight,obesity and regular exercise were negatively associated with PTB in T2DM patients.Results of multivariate stepwise regression analysis found lymphopenia(OR=17.75,95%CI:3.40-92.74),smoking(OR=12.25,95%CI:2.53-59.37),history of TB contact(OR=6.56,95%CI:1.23-35.03)and poor glycemic control(OR=3.37,95%CI:1.11-10.25)was associated with an increased risk of developing PTB in patients with T2DM,While being overweight(OR=0.23,95%CI:0.08-0.72)and obesity(OR=0.11,95%CI:0.02-0.72)was associated with a reduced risk of developing PTB in patients with T2DM.CONCLUSION T2DM-PTB patients are prone to worse glycemic control,higher infection frequency,and a higher proportion of people smoking,drinking alcohol,and lack of exercise.Lymphopenia,smoking,history of TB exposure,poor glycemic control were independent risk factors for T2DM-PTB,and overweight and obesity were associated with reduced risk of concurrent PTB in patients with T2DM.
基金Supported by Science and Technology Fund of Guizhou Health and Health Committee(gzwjkj2020-1-184)。
文摘[Objectives]This study was conducted to explore the X-ray manifestations of pneumoconiosis patients and differentiation from pulmonary tuberculosis.[Methods]Retrospective analysis was conducted on 103 patients who underwent lung examinations,including 47 cases of pneumoconiosis and 56 cases of pulmonary tuberculosis.The differences in nodule characteristics and accompanying cavity sign between pneumoconiosis and pulmonary tuberculosis were compared.[Results]The X-ray manifestations of pneumoconiosis patients mainly included various forms of lung images,which were uneven in density,and had blurry edges,and sometimes thickening of lung markings and reduction of lung volume could be observed.The acinar nodules observed in X-ray films of patients with hematogenous disseminated pulmonary tuberculosis appeared petal like.The uniformity of nodule appearance such as nodule distribution,nodule density,and nodule size was significantly lower in pneumoconiosis than in hematogenous disseminated pulmonary tuberculosis,showing a statistical significance(P<0.05).The diameter of cavities in patients with pneumoconiosis accompanied by cavity sign[(0.64±0.13 vs 3.37±0.95)cm]was lower than that in patients with secondary pulmonary tuberculosis accompanied by cavity sign.There was a significant difference in the thickness of the cavity wall between the two diseases,and patients with pneumoconiosis accompanied by cavity sign had a higher rate of thick wall cavities(>3 mm).The X-ray manifestations of pneumoconiosis and tuberculosis were relatively similar,but the distribution,density and size of nodules in pneumoconiosis were relatively uneven,and the patients accompanied by cavity sign had smaller cavity diameter and higher rate of thick-walled cavities.[Conclusions]This study provides a reference for the clinical differential diagnosis of pneumoconiosis and pulmonary tuberculosis.
文摘Background: In Gabon, the epidemiology of tuberculosis has been considerably reshaped by the AIDS virus. It is in this context that the present study was conducted to assess the prevalence of pulmonary tuberculosis and associated factors among patients at the Amissa Bongo Regional Hospital in Franceville, Gabon. Patients and Methods: This prospective, cross-sectional study was conducted in the biomedical analysis laboratory of the Amissa Bongo Regional University Hospital in Franceville from 19 June 2021 to 22 January 2022. After agreeing to take part in the study, participants were asked to fill in a questionnaire to collect their socio-demographic data and habits. Clinical signs were also observed. Sputum and gastric fluid samples were collected and examined using the Xpert MTB/RIF test and BAAR smear microscopy. Data were analysed using R software version 3.6.1. The results of the univariate and multivariate analyses were considered significant for p ≤ 0.05. Results: A total of 309 patients were included in this study, 50.81% (n = 157) men and 49.19% (n = 152) women. Of these, 98 had a positive diagnosis of pulmonary tuberculosis, giving an overall prevalence rate of 31.72%. There were 40 women or 40.82% (95% CI: [0.30 - 0.51]) and 58 men or 59.18% (95% CI: [0.48 - 0.69]). A univariate analysis of the prevalence of tuberculosis according to risk factors and clinical signs indicated a certain association between certain variables. However, an in-depth multivariate logistic regression analysis of this prevalence, according to the risk factors and clinical signs observed in the patients in the study, indicated that the age group 15 and 49 years (Adjusted OR = 47.77;95% CI: [4.4;519.7] p = 0.001*), fever (Adjusted OR = 4.83;95% CI: [1.16, 20.12] p = 0.031*), alcohol consumption (Adjusted OR = 12.2;95% CI: 12.2 [2.5;5.9] p = 0. 002*), smoking (Adjusted OR = 9.83;95% CI: [1.78;54.24] p = 0.037), HIV infection (Adjusted OR = 4.63;95% CI: [1.25;17.1] p = 0.022), cough (Adjusted OR = 4.31;95% CI: [1.21, 15.4] p = 0. 025*), chest pain (Adjusted OR = 103.6;95% CI: [19.4;55.2] p = 0.000), night sweating cough (Adjusted OR = 10.84;95% CI: [3.18;36.98] p = 0.000*) were significant risk factors for pulmonary tuberculosis. Conclusion: The results of the present study showed that the prevalence of pulmonary tuberculosis was greatest among males in Franceville and the surrounding area. The 15 - 49 age group, fever, alcohol consumption, smoking, HIV infection, chest pain, night sweats and cough were significant risk factors for pulmonary tuberculosis. Consequently, screening for tuberculosis in HIV-positive patients, public awareness and community mobilisation should be encouraged.
文摘Objective: To systematically review the rate of patient delay of pulmonary tuberculosis (PTB) patients among students in China. Methods: Databases including Web of Science Core Collection, PubMed, The Cochrane Library, CBM, CNKI, VIP, and WANFANG DATA were electronically searched to collect cross-sectional studies on the incidence of delayed consultation in students with PTB in China from January 1, 2000, to November 15, 2022. Two researchers independently screened studies, extracted data, and assessed the risk of bias of the included studies. Meta-analysis was then performed by Stata 16.0 software. Results: In total, 60 cross-sectional studies with 260,707 cases involving 136,701 delayed consultation PTB patients were included. The results of meta-analysis showed that the rate of patient delay was 46.4% (95% CI 44.3% to 48.4%) among students with PTB in China. Results of subgroup analyses showed that: 1) The rates were 46.8% and 50.4% for male and female students, respectively. 2) The rates for the East, Central and West parts of China were 42.3%, 45.6% and 50.5%, respectively. 3) The rates were increased first and then decreased during 2007 to 2020. 4) The rates of students from primary school, junior high school, senior high school and university were 50.3%, 49.8%, 40.7% and 44.9%, respectively. 5) The rates for the Han and the other nationalities were 50.3% and 53.9%, respectively. 6) The rates for local and non-local students were 47.2% and 50.5%, respectively. 7) The rates of patients detected by consultation due to symptoms, recommendation due to symptoms, referral, tracking and healthy physical examination were 50.5%, 51.6%, 46.6%, 55.6% and 16.2%, respectively. 8) The rates of patients with initial PTB and retreatment PTB were 53.1% and 59.6%, respectively. 9) The rates of patients with positive etiology, negative etiology and without etiological results were 55.9%, 47.0% and 51.6%, respectively. 10) The rates of severe and non-severe patients were 59.4% and 52.9%, respectively. Conclusion: The patient delay rate for Chinese students with PTB is generally at a high level. There are substantial differences in the patient delay rate for students with PTB among different genders, regions, study stages, nationalities, household registration types, detection methods, and treatment classifications.
文摘Background: Tuberculosis (TB) is one of the world’s deadliest infectious diseases. Tumor necrosis factor-Alpha (TNF-α) and Interleukin 8 (IL-8) are involved in the pathogenesis of pulmonary TB (PTB). However, the contribution of polymorphisms of these cytokines to PTB susceptibility needed more investigation across geographic regions and ethnic groups. Purpose: The aim of this study was to investigate the association of the TNF-α-308 G/A and IL-8-251T/A polymorphisms with PTB risk in the Congolese population. Methods: This case-control study included 150 PTB patients and 160 control subjects. Blood samples were collected from all participants and were used for the TNF-α-308 G/A and IL-8-251T/A genotyping by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) technique. Odds ratios (OR) were calculated to estimate the potential polymorphism associations. A P level of Results: A significant difference was found between PTB patients and controls regarding the TNF-α-308AA genotype (P = 0.035) distribution. Moreover, this genotype was associated with risk to TB (OR = 7.19, 95% CI = 0.85 - 60.65, P = 0.035). The A allele was significantly more frequent in PTB patients than in controls, and was associated with risk to PTB (OR = 1.68, 95% CI = 1.05 - 2.68, P = 0.014). Regarding the IL-8-251T/A gene, TA and AA genotypes were significantly more frequent in PTB patients compared to controls, and were associated with increased risk to PTB (OR = 2.64, 95% CI = 0.97 - 7.18, P = 0.031 and OR = 3.0, 95% CI = 1.13 - 7.98, P = 0.014, respectively). However, the IL-8-251 A allele was not associated to PTB susceptibility (OR = 0.27, 95% CI = 0.15 - 0.44). Conclusion: TNF-α-308G/A and IL-8-251T/A polymorphisms may be associated to PTB susceptibility in the Congolese population, and the AA genotype of both cytokines could be a risk factor.
文摘Background: Hematopoietic system is seriously affected by tuberculosis. It exerts a dazzling variety of hematological effects involving both cell lines and plasma components [1]. Anemia and leukopenia are not unusual with tuberculosis (TB), but pancytopenia is rare [2]. Findings: In this report, we described a case of a 42 years man presenting bleeding and pancytopenia;bacteriological pulmonary TB was established by genotypic rapid test and treatment following the WHO guidelines on drug-sensitive TB treatment. Patient recovered entirely with the WHO recommended regimen associated with general and local treatment of the bleeding. Conclusion: This case report emphasizes the importance of always suspecting tuberculosis in a tuberculosis-endemic area, even when the clinical manifestations are atypical, like pancytopenia and also of properly investigating the differential diagnosis. Even though prognosis seems to be less good, actual treatment regimen is still effective.
文摘Objective: To assess the missed opportunities from the diagnosis of bacilliferous pulmonary tuberculosis by optical microscopy compared to GeneXpert MTB/RIF between 2015 and 2019. Methods: This is a retrospective analysis of the diagnostic results of bacilliferous pulmonary tuberculosis in patients suspected of pulmonary tuberculosis at their first episode during the period. GeneXpert MTB/RIF (GeneXpert) and optical microscopy (OM) after Ziehl-Neelsen stained smear were performed on each patient’s sputum or gastric tubing fluid sample. Results: Among 341 patients suspected of pulmonary tuberculosis, 229 patients were declared bacilliferous tuberculosis by the two tests (67%), 220 patients by GeneXpert and 95 patients by OM, i.e. 64.5% versus 28% (p i.e. 58.5% of the positive cases detected by the two tests (134/229 patients) and 39.3% of the patients suspected of tuberculosis (134/341 patients). On the other hand, among 95 patients declared positive by OM, the GeneXpert ignored 9 (9.5%), i.e. 4% of all the positive cases detected by the two diagnostic tests (9/229 patients) and 3% of the patients suspected of tuberculosis (9/341 patients). The differences observed between the results of the two tests were statistically significant at the 5% threshold (p Conclusion: This study reveals missed diagnostic opportunities for bacilliferous pulmonary mycobacteriosis, statistically significant with optical microscopy than GeneXpert. The GeneXpert/optical microscopy couple could be a good contribution to the strategies for the elimination of pulmonary tuberculosis in sub-Saharan Africa.
基金Baoding Science and Technology Plan Project“The Effect of Medical-Nurse Integrated Nursing Model Combined with Psychological Intervention on the Clinical Curative Effect of Tuberculosis and Lung Cancer Patients”(Project number:2141ZF318).
文摘Objective:To explore the effect of integrated medical and nursing care in patients with pulmonary tuberculosis combined with lung cancer.Methods:From August 2021 to August 2022,60 patients with pulmonary tuberculosis combined with lung cancer were admitted.All patients were diagnosed with pulmonary tuberculosis according to the Guidelines for the Diagnosis and Treatment of Pulmonary Tuberculosis and with lung cancer by pathology.The patients were randomly divided into two groups,with 30 cases in each group.The control group received daily nursing care,whereas the study group received integrated medical and nursing care.The sputum conversion rate,tumor remission rate,and quality of life of patients were observed and analyzed.Results:The item function score and symptom function score of the observation group were higher than those of the control group(P<0.05);the total effective rate of the observation group was significantly higher than that of the control group(P<0.05);the sputum conversion rate of the observation group was significantly higher than that of the control group(P<0.05).Conclusion:For patients with pulmonary tuberculosis combined with lung cancer,the application of integrated medical and nursing care can help consolidate the treatment effect and improve the quality of life of patients;thus,it is worthy of promotion and application.
文摘Aim:To explore the diagnostic value of spiral CT chest enhanced scan for adults with active pulmonary tuberculosis.Methods:The clinical data of 60 adult patients with active pulmonary tuberculosis who were treated in our hospital from January 2018 to November 2019 were retrospectively analyzed.All patients underwent conventional chest radiography and spiral CT chest enhanced scan.The number of tuberculosis diagnosis,the detection rate of special site lesions,and the detection rate of active pulmonary tuberculosis signs by the two methods were compared.Results:In 60 patients,the pathological results confirmed the existence of 75 tuberculosis lesions.The detection rate of spiral CT was 98.67%,which was not statistically significant compared with the detection rate of 92.00%(P>0.05)in the conventional chest X-ray.The detection rate of spiral CT enhanced scans for tuberculosis lesions in special sites was 100.00%,which was significantly higher than that of conventional chest X-ray of 7.69%,and the accuracy rate of active pulmonary tuberculosis signs was 98.85%higher than that of conventional chest X-ray of 79.31%.P<0.05).The difference was statistically significant(P<0.05).Conclusion:Spiral CT chest enhanced scan can not only find special tuberculosis lesions that cannot be detected by conventional chest radiography,but also accurately determine active pulmonary tuberculosis in adults,which is of high diagnostic value.
文摘Objective:To investigate the application value of loop-mediated isothermal amplification(LAMP),GeneXpert,mycobacterial culture,smear microscopy,TSPOT.TB(TSPOT),ratio of TB-specific antigen to phytohemagglutinin(TBAg/PHA ratio)in the detection of mycobacterium tuberculosis in the bronchoalveolar lavage fluid.Methods:A retrospective analysis was performed on the patients who underwent bronchoscopy from December 2018 to November 2019 in Tongji Hospital.The patients with positive tuberculosis culture or positive GeneXpert in bronchoalveolar lavage fluid were selected as the case group,and those without tuberculosis served as the control group.The receiver operating characteristic(ROC)curve was used to evaluate the diagnostic value of LAMP,GeneXpert,culture,smear microscopy,TSPOT,and TBAg/PHA ratio.Results:For the patients with positive cultures as case,the sensitivity of LAMP,GeneXpert,smear microscopy,TSPOT and TBAg/PHA ratio was 73.49%,89.16%,25.30%,80.00%,33.85%,respectively,the specificity was 99.00%,100.00%,99.00%,86.00%,100.00%,respectively,the area under the ROC curve(AUC)was 0.849,0.938,0.633,0.830,0.669,respectively.For the patients with positive GeneXpert as case,the sensitivity of LAMP,mycobacterial culture,smear microscopy,TSPOT and TBAg/PHA ratio was 73.20%,74.23%,22.68%,68.92%,29.73%,respectively,the specificity was 99.00%,100.00%,99.00%,86.00%,100.00%,respectively,the AUC was 0.853,0.878,0.623,0.775,0.649,respectively.Conclusion:The sensitivity of GeneXpert was best.The sensitivity and diagnostic value of LAMP were slightly lower than those of GeneXpert,and were similar to tuberculosis culture.The sensitivity of smear microscopy was low.The specificity of TSPOT was low.When TBAg/PHA ratio>0.2 was used as a diagnostic index,the specificity was improved,but the sensitivity was low.
文摘BACKGROUND Depression has been reported to be prevalent in patients with pulmonary tuberculosis(PTB).Moreover,several clinical symptoms of PTB and depression overlap,such as loss of appetite and malnutrition.However,the association between depression and malnutrition in TB patients has not been fully elucidated.AIM To explore the association between depression and malnutrition in patients with PTB.METHODS This hospital-based cross-sectional study included patients with PTB in Shanghai Pulmonary Hospital Affiliated to Tongji University from April 2019 to July 2019.The Patient Health Questionnaire-9(PHQ-9)scale was used to evaluate depression.The cut-off value was set at 10,and the nutritional state was determined by the body mass index(BMI).In addition,the Quality of Life Instruments for Chronic Diseases was employed to establish the quality of life(QOL).Univariable analysis and multivariable analysis(forward mode)were implemented to identify the independent factors associated with depression.RESULTS A total of 328 PTB patients were screened for analysis.Eight were excluded for missing demographic data,four excluded for missing nutrition status,and sixteen for missing QOL data.Finally,300 PTB patients were subjected to analysis.We found that depressive state was present in 225 PTB patients(75%).The ratio of malnutrition in the depressive PTB patients was 45.33%.Our results revealed significantly lower BMI,hemoglobin,and prealbumin in the depression group than in the control group(P<0.05).Moreover,the social status differed significantly(P<0.05)between the groups.In addition,glutamic pyruvic transaminase and glutamic oxaloacetic transaminase in the depression group were significantly higher than those in the control group(P<0.05).Multivariable logistic regression analysis showed that BMI[odds ratio(OR)=1.21,95%confidence interval(CI):1.163-1.257,P<0.001]and poor social function(OR=0.95,95%CI:0.926-0.974,P=0.038)were independently associated with depression.CONCLUSION Malnutrition and poor social function are significantly associated with depressive symptoms in PTB patients.A prospective large-scale study is needed to confirm these findings.
文摘Objective:To summarize the precise association between pulmonary tuberculosis(PTB) and P2x7 A1513 C gene polymorphism.Methods:PubMed and Google Scholar web-databases were searched for the studies reporting the association of P2x7 A1513 C polymorphism and PTB risk.A meta-analysis was performed for the selected case-control studies and pooled odds ratios(ORs) and 95%confidence intervals(95%CIs) were calculated for all the genetic models.Results:Eleven studies comprising 2 678 controls and 2 113 PTB cases were included in this meta-analysis.We observed overall no significant risk in all the five genetic models.When stratified population by the ethnicity,Caucasian population failed to show any risk of PTB in all the genetics models.In Asian ethnicity,variant allele(C vs.A:P=0.001;QR=1.375,95%CI=1.159-1.632) and heterozygous genotype(AC vs.AA:P=0.001;OR=1.570,95%CI=1.269-1.944) demonstrated significant increased risk of PTB.Likewise,recessive genetic model(CC+AC vs.AA:P=0.001;OR=1.540,95%CI= 1.255-1.890) also demonstrated increased risk of PTB in Asians.Conclusions:Our meta-analysis did not suggest the association of P2x7 A1513 C polymorphism with PTB risk in overall or separately in Caucasian population.However,it plays a significant risk factor for predisposing PTB in Asians.Future larger sample and expression studies are needed to validate this association.
文摘BACKGROUND Several studies have demonstrated that airborne transmission of Mycobacterium tuberculosis bacteria from patients with active pulmonary tuberculosis(TB) to other passengers or crew members can occur during long flights. As such, non-infectious TB patients are usually allowed to undertake air travel after taking the appropriate anti-TB drugs. However, the global guidelines for air travel for patients with TB are inconsistent and insufficiently detailed with respect to cavitary pulmonary TB(CPTB).CASE SUMMARY Here, we report a case in which a patient with multiple CPTB was permitted air travel, following negative sputum acid-fast bacilli smear tests after administration of proper anti-TB medication. The patient’s culture results were pending.CONCLUSION This case revealed that more specific guidelines regulating air travel for patients with CPTB are necessary.
文摘Background: The emergence of multidrug resistant tuberculosis (MDR-TB) and extensively drug- resistant tuberculosis (XDR-TB) has highlighted the need for early accurate detection and drug susceptibility. Objective: The purpose of the present study was to evaluate the accuracy of GeneX-pert MTB/RIF assay for the detection of Mycobacterium tuberculosis and rifampicin resistance. Methodology: This cross sectional study was done in the Department of Microbiology at Sir Salimullah Medical College, Dhaka and National Institute of Chest Disease & Hospital (NIDCH), Dhaka during the period of January 2014 to December 2014 for a period of 1 (one) year. Sputum samples from suspected MDR-TB patients were collected by purposive sampling technique from OPD of Sir Salimullah Medical College (SSMC) and NIDCH. Microscopy, liquid culture in liquid MGIT 960 media and GeneXpert MTB/RIF were done for MTB diagnosis and detection of rifampicin resistance. MGIT 960 media were also used for determination of drug resistance. Result: Liquid culture yielded higher growth (68%) from 100 samples while GeneXpert MTB assay showed similar result (67% positive and 33% negative). Drug susceptibility test in MGIT 960 media showed that out of 68 positive cases Rifampicin resistant cases were 15 (22.05%) whereas GeneXpert MTB assay detected 14 (20.89%) were Rifampicin resistant out of 67 MTB positive samples. When compared to liquid culture the calculated sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV) and accuracy of GeneXpert MTB were 98.52%, 100%, 96.96%, 100% and 99%. Conclusion: GeneXpert MTB/RIF assay is high detection rate of pulmonary tuberculosis and multidrug resistant tuberculosis.
基金Medical science research key project plan of Hebei health and Family Planning Commission in 2018.Subject name:Evaluation of application effect of case management model in newly treated smear positive pulmonary tuberculosis patients,Question number:20180720.
文摘Objective:To explore the effect of case management nursing service on compliance behavior and quality of life of patients with pulmonary tuberculosis.Methods:69 cases of pulmonary tuberculosis patients in our hospital from September 2019 to August 2020 were selected as the research objects.The 69 patients were divided into study group(35 cases)and control group(34 cases).The compliance behavior,quality of life and nursing satisfaction of pulmonary tuberculosis patients were studied and analyzed.Results:The compliance rate of the control group was 82.35%,and that of the study group was 97.14%;The quality of life in the control group was[61.32±7.66],which was significantly lower than that in the study group[71.12±7.23];The satisfaction rate of the study group was 97.14%,which was significantly higher than 73.53%of the control group.Conclusion:In the treatment of tuberculosis patients,the use of case management nursing service can effectively improve the quality of life of patients,improve the compliance behavior of patients,and improve the treatment effect of patients,which is worthy of promotion.
基金supported by the Fundamental Research Funds for the Central public welfare research institutes[Z0734]Scientific and technological innovation project of CACMS[CI2021B003,CI2021A01314,CI2021A00704]+1 种基金National Natural Science Foundation of China[82274350]COVID-19 project of the National Administration of Traditional Chinese Medicine[GZY-KJS2021-007,2020ZYLCYJ05-13,2020ZYLCYJ07-5]。
文摘Objective Coronavirus disease 2019(COVID-19)and tuberculosis(TB)are major public health and social issues worldwide.The long-term follow-up of COVID-19 with pulmonary TB(PTB)survivors after discharge is unclear.This study aimed to comprehensively describe clinical outcomes,including sequela and recurrence at 3,12,and 24 months after discharge,among COVID-19 with PTB survivors.Methods From January 22,2020 to May 6,2022,with a follow-up by August 26,2022,a prospective,multicenter follow-up study was conducted on COVID-19 with PTB survivors after discharge in 13 hospitals from four provinces in China.Clinical outcomes,including sequela,recurrence of COVID-19,and PTB survivors,were collected via telephone and face-to-face interviews at 3,12,and 24 months after discharge.Results Thirty-two COVID-19 with PTB survivors were included.The median age was 52(45,59)years,and 23(71.9%)were men.Among them,nearly two-thirds(62.5%)of the survivors were moderate,three(9.4%)were severe,and more than half(59.4%)had at least one comorbidity(PTB excluded).The proportion of COVID-19 survivors with at least one sequela symptom decreased from 40.6%at 3 months to 15.8%at 24 months,with anxiety having a higher proportion over a follow-up.Cough and amnesia recovered at the 12-month follow-up,while anxiety,fatigue,and trouble sleeping remained after 24months.Additionally,one(3.1%)case presented two recurrences of PTB and no re-positive COVID-19during the follow-up period.Conclusion The proportion of long symptoms in COVID-19 with PTB survivors decreased over time,while nearly one in six still experience persistent symptoms with a higher proportion of anxiety.The recurrence of PTB and the psychological support of COVID-19 with PTB after discharge require more attention.
文摘<strong>Background: </strong>Tuberculosis (TB) is an infectious disease and it is a public health concern due to the endemic nature of the disease. Nigeria’s health systems still rely heavily on out-dated tuberculosis diagnostic tests;including sputum smear microscopy and chest radiography. This necessitated the urgent need to explore a more reliable, effective method that can rapidly enhance simultaneous detection of <em>Mycobacterium tuberculosis</em> (MTB) and rifampicin (RIF) resistance. <strong>Aims: </strong>We evaluated the prevalence of MTB and rifampicin resistance and the influence of socio-demographic factors. <strong>Methods:</strong> A longitudinal, descriptive study that employs the Xpert MTB/RIF automated molecular method for rapid detection of rifampicin resistance. Secondary data were collected from the medical record from March 2017 to December 2018. Primary data were collected by direct clinical observations and analysis with gene expert machine from January 2019-March 2019. <strong>Results:</strong> Study populations were 1893 subjects pooled as secondary data at the Gene Expert laboratory, with a mean age of 44.92 years and were categorized based on sex, 1125 (59.4%) males and 768 (40.6%) females respectively. The MTB detected were 117 (15.7%) for males while 76 (9.9%) were positive for females. 948 (84.3%) were negative for males and 692 (90.1%) negative for females. Also, the categories for age were grouped into three but the older age groups (29 - 54) and (55 - 80) were more vulnerable to MTB having a p = 0.506 which is statistically non-significant;only 14 (5.5%) have RIF while 239 (94.5%) do not have RIF resistance strains. Logistic regression analysis of MTB detected showed a significant association (p < 0.05) for sex and a non-significant association (p > 0.05) for age. The prevalence rate for RIF Resistance is 5.53%, there is a statistical difference p = 0.001 between RIF Resistance and MTB in Ilorin. <strong>Conclusion: </strong>The utilization of validated molecular technique for MTB strain identification has shown stronger epidemiological impetus for an improved care management outcome specifically in resources limited areas.
文摘Background: The current screening tools for tuberculosis (TB) are inadequate resulting in insufficient TB case detection and continued community transmission of TB. As the world is geared into finding missing TB cases, new strategies are called for to aid in rapid identification of TB cases. This study aimed to evaluate the role C-reactive protein (CRP) in triaging patients to get a definitive test for active pulmonary TB diagnosis in urban Tanzania. Methods: A case-control study was conducted among pulmonary TB (PTB) patients and contacts without active PTB. The diagnosis of PTB was performed using GeneXpert MTB/RIF assay and culture. Blood was collected from cases and controls for measuring CRP levels during recruitment. We compared socio-demographic characteristics, clinical and laboratory parameters obtained during recruitment and performed diagnostic accuracy analyses for CRP. Results: Out of all 193 study participants who were involved in final analysis, 147 (76.2%) were males. Pulmonary TB cases had significantly lower median BMI than controls (median 17.4 kg/m<sup>2</sup> [IQR: 15.8 - 19.2 kg/m<sup>2</sup>] vs., 24.9 kg/m<sup>2</sup> [IQR: 22.1 - 28.5 kg/m<sup>2</sup>), p < 0.001). There was no statistical difference in prevalence of HIV between PTB cases and controls i.e., 13.33% vs., 11.7%, p = 0.48. CRP was significantly higher in PTB cases vs., controls (median 67.8 mg/L, [IQR: 36.5 - 116.9 mg/L] vs., 1.55 mg/L, [IQR: 0.59 - 6.0 mg/L], p = 0.003). Furthermore, CRP at cut-off ≥10 mg/L was associated with best combination of sensitivity, specificity and area under the curve of 89.9%, 95% CI: 82.2 - 95.0, 80.9%, CI: 71.4 - 88.2 and 0.85, 95% CI: 0.80 - 0.90 respectively. A multivariate logistic regression model adjusted for fever, night sweats and body mass index showed that CRP above 10 mg/L was significantly associated with PTB, aOR 5.2, 95% CI 1.2 - 22.8. Conclusions: CRP at cut-off ≥10 mg/L can be used to screen pulmonary TB. These findings can be used to improve TB screening algorithm by incorporating CRP in combination with TB symptoms to identify patients who need further confirmatory TB tests. However, additional prospective studies are required to support our findings and contribute into policy recommendations on use of CRP in a screening algorithm for pulmonary TB.
文摘Introduction: The increase in cases of drug-resistant pulmonary tuberculosis, especially in endemic areas, is mainly associated with re-treatment, although resistant tubercle bacilli can be easily transmitted between all susceptible persons. Objective: The study aimed to describe pulmonary tuberculosis, risk factors and MDR in new and re-treated suspected patients attending Wad Madani Tuberculosis Center that provides service in central Sudan. Methods: Cross-sectional laboratory based study among 300 presumptive pulmonary tuberculosis patients during 2018 and 2019 was conducted. Cases were divided into new and re-treated. Mycobacterium tuberculosis DNA and rpoB gene of multi-drug resistance (MDR) were detected in sputum samples by GeneXpert assay as manufacturer instructions. Results: Out of 300 suspected participants, 34% (103/300) were diagnosed as pulmonary tuberculosis using GeneXpert method. The frequency of males, the age group from 21 to 40 and rural housing were the most with percentage reach 68% (70/103), 51% (53/103) and 58.3% (60/103) respectively. All observed symptoms were significantly associated with pulmonary tuberculosis. New cases represented 59.2% (61/103) while re-treated was 40.8% (39/103). The overall frequency of MDR patients was 9.7% (10/103) of which 50% (5/103) had relapse situation. Conclusion: It appeared that the cases of MDR pulmonary tuberculosis are on the increase compared to previous findings, recommended measures must be taken to control the spread of tuberculosis and the causes of re-treatment and relapse must be studied.
