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Recent transmission of Mycobacterium tuberculosis in China: the implication of molecular epidemiologyfor tuberculosis control

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《医学前沿（英文）》 2018年第12卷第1期页码 76-83 doi: 10.1007/s11684-017-0609-5

摘要：

Tuberculosis (TB) has remained an ongoing concern in China. The national scale-up of the Directly Observed Treatment, Short Course (DOTS) program has accelerated the fight against TB in China. Nevertheless, many challenges still remain, including the spread of drug-resistant strains, high disease burden in rural areas, and enormous rural-to-urban migrations. Whether incident active TB represents recent transmission or endogenous reactivation has helped to prioritize the strategies for TB control. Evidence from molecular epidemiology studies has delineated the recent transmission of ( ) strains in many settings. However, the transmission patterns of TB in most areas of China are still not clear. Studies carried out to date could not capture the real burden of recent transmission of the disease in China because of the retrospective study design, incomplete sampling, and use of low-resolution genotyping methods. We reviewed the implementations of molecular epidemiology of TB in China, the estimated disease burden due to recent transmission of strains, the primary transmission of drug-resistant TB, and the evaluation of a feasible genotyping method of strains in circulation.

关键词： tuberculosis recent transmission molecular epidemiology China

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Invasive mucinous adenocarcinoma with lepidic-predominant pattern coexisted with tuberculosis: a case

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《医学前沿（英文）》 2018年第12卷第3期页码 330-333 doi: 10.1007/s11684-017-0545-4

摘要：

We observed a rare case of invasive mucinous adenocarcinoma (IMA) with a lepidic-predominant pattern accompanied by pulmonary tuberculosis. An 85-year-old man with repeated cough and sputum was admitted to Xinhua Hospital. T-SPOT test result was 212 pg/ml (reference value of negative is<14 pg/ml), culture was positive, and tuberculin skin test (PPD) was negative (skin induration<5 mm). The patient was treated with several courses of antibiotics and anti-tuberculosis treatments. Repeated chest CT scans showed disease progression. Bronchoscopy yielded negative results. PET-CT scans showed negative results. A percutaneous lung biopsy revealed mucin-secreting cells lining the alveolar walls. IMA with a lepidic-predominant pattern was diagnosed after invasiveness was found after experimental treatments. Simultaneous occurrence of pulmonary tuberculosis and lung cancer are common; however, the present case of IMA having a lepidic-predominant pattern and coexisting with active tuberculosis has not been reported yet.

关键词： invasive mucinous adenocarcinoma lepidic-predominant tuberculosis

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Treatment outcomes of pulmonary tuberculosis in the past decade in the mainland of China: a meta-analysis

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《医学前沿（英文）》 2013年第7卷第3期页码 354-366 doi: 10.1007/s11684-013-0257-3

摘要：

Due to the implementation of directly observed treatment strategy (DOTS), China has made a significant achievement in tackling the tuberculosis (TB) epidemic in the 1990s. However, only half of regions in China met or exceeded the 85% rate of treatment success target. The aim of the present study is to summarize the treatment outcomes of smear-positive pulmonary TB in the mainland of China in the past decade using meta-analysis based on systematic review of published observational studies. A total of 50 eligible articles (58 studies) were identified and included in this study. The summarized treatment success rates were 93.9% (95% CI, 92.8%–94.7%) for new cases and 85.4% (95% CI, 83.0%–87.6%) for previously treated cases, and the summarized cured rate were 92.2% (95% CI, 90.9%–93.3%) and 81.2% (95% CI, 79.1%–83.1%), respectively. A remarkable increase of rates for treatment success and cure was observed in the 1990s. After 2000, the summarized treatment outcomes were tending towards stability. In addition, geographic areas, type of the data and administrative level of the hospital were also found to influence the estimates of the treatment outcomes. Results of the present study clearly show, in general, that the pulmonary TB treatment achieved significant success in the past decade in the mainland of China. However, it needs to be further strengthened in the central and west areas.

关键词： tuberculosis treatment outcome China meta-analysis

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Testing of tuberculosis infection among Chinese adolescents born after terminating the Bacillus Calmette

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《医学前沿（英文）》 2017年第11卷第4期页码 528-535 doi: 10.1007/s11684-017-0573-0

摘要：

The prevalence of tuberculosis infection among adolescents born after terminating the Bacillus Calmette–Guérin (BCG) booster vaccination in China was estimated using tuberculin skin testing (TST) and QuantiFERON-TB Gold assay (QFT) to investigate the influence of neonatal BCG vaccination on the performance of TST. Data analysis was conducted for 2831 eligible participants aged 5–15 years from the baseline survey of a population-based multi-center prospective study. The prevalence rates of TST (induration≥10 mm) and QFT positivity were 9.3% (264/2827) and 2.5% (71/2831), respectively. The rate of QFT indeterminate result was 2.2% (62/2831). The overall agreement between TST and QFT was low (concordance= 88.0%; κ coefficient= 0.125). Only TST was positively associated with BCG vaccination with an adjusted odds ratio of 1.71 [95% confidence interval, 1.26–2.31]. A history of close contact with patients of active TB was significantly associated with positivity for TST and QFT. Our results suggested that BCG neonatal vaccination still affects TST performance, and a two-step approach might be considered for TB infection testing among adolescents in China.

关键词： tuberculin skin test interferon-γ release assays adolescent agreement

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Associations between

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《医学前沿（英文）》 2018年第12卷第1期页码 92-97 doi: 10.1007/s11684-017-0610-z

摘要：

Investigations on the genetic diversity of Mycobacterium tuberculosis in China have shown that Beijing genotype strains play a dominant role. To study the association between the M.?tuberculosis Beijing genotype and the drug-resistance phenotype, 1286 M. tuberculosis clinical isolates together with epidemiological and clinical information of patients were collected from the center for tuberculosis (TB) prevention and control or TB hospitals in Beijing municipality and nine provinces or autonomous regions in China. Drug resistance testing was conducted on all the isolates to the four first-line anti-TB drugs (isoniazid, rifampicin, streptomycin, and ethambutol). A total of 585 strains were found to be resistant to at least one of the four anti-TB drugs. The Beijing family strains consisted of 499 (53.20%) drug-sensitive strains and 439 (46.80%) drug-resistant strains, whereas the non-Beijing family strains comprised 202 (58.05%) drug-sensitive strains and 146 (41.95%) drug-resistant strains. No significant difference was observed in prevalence (c²=2.41, P>0.05) between the drug-resistant and drug-sensitive strains among the Beijing family strains. Analysis of monoresistance, multidrug-resistant TB, and geographic distribution of drug resistance did not find any relationships between the M.?tuberculosis Beijing genotype and drug-resistance phenotype in China. Results confirmed that the Beijing genotype, the predominant M. tuberculosis genotype in China, was not associated with drug resistance.

关键词： tuberculosis drug resistance genotype molecular biology

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Ventricular tachycardia in a disseminated MDR-TB patient: a case report and brief review of literature

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《医学前沿（英文）》 2014年第8卷第2期页码 259-263 doi: 10.1007/s11684-014-0321-7

摘要：

Although significant breakthroughs have been achieved in tuberculosis management, we still encounter numerous difficulties in diagnosis and treatment of the disease. Additionally, a new challenge, multidrug-resistant tuberculosis (MDR-TB) with unspecific clinical presentation, often results in delayed diagnosis. In this paper, we reported a case of disseminated tuberculosis with rare presentation of ventricular fibrillation, which proved resistant to both isoniazid and rifampicin. A review of literature showed that ventricular fibrillation or tachycardia in tuberculosis patients with pericarditis or myocarditis has been sporadically reported in the past, but none has been conducted involving patients with MDR-TB infections.

关键词： tuberculosis MDR-TB ventricular tachycardia

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Characteristics of compensatory mutations in the

Shengfen Wang, Yang Zhou, Bing Zhao, Xichao Ou, Hui Xia, Yang Zheng, Yuanyuan Song, Qian Cheng, Xinyang Wang, Yanlin Zhao

《医学前沿（英文）》 2020年第14卷第1期页码 51-59 doi: 10.1007/s11684-019-0720-x

摘要： The aim of this study was to characterize gene mutations in (MTB) and investigate the factors associated with mutations and the relation between mutations and tuberculosis (TB) transmission. A total of 245 MTB clinical isolates from patients with TB in six provinces and two municipalities in China were characterized based on gene mutations through DNA sequencing of and genes, phenotyping via standard drug susceptibility testing, and genotypic profiling by mycobacterial interspersed repetitive unit-variable number tandem repeat (MIRU-VNTR) typing. Approximately 36.4% of the rifampin-resistant isolates harbored nonsynonymous mutations in the gene. Twenty-nine nonsynonymous single mutations and three double mutations were identified. The mutations at locus 483 (11.3%) were predominant, and the mutations at V483G, W484G, I491V, L516P, L566R, N698K, and A788E accounted for 54.5% of the total detected mutations. Fifteen new mutations in the gene were identified. Rifampin resistance and mutations at locus 531 were significantly associated with mutations. MIRU-VNTR genotype results indicated that 18.4% of the studied isolates were clustered, and the mutations were not significantly associated with MIRU-VNTR clusters. A large proportion of mutation was observed in the rifampicin-resistant MTB isolates. However, the findings of this study do not support the association of mutation with compensated transmissibility.

关键词： tuberculosis drug resistance compensatory mutations transmission

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Effect of antitubercular treatment on the pregnancy outcomes and prognoses of patients with genital tuberculosis

Jing Yue, Bo Zhang, Mingyue Wang, Junning Yao, Yifan Zhou, Ding Ma, Lei Jin

《医学前沿（英文）》 2019年第13卷第1期页码 121-125 doi: 10.1007/s11684-018-0615-2

摘要： This retrospective study aims to demonstrate the effect of antitubercular treatment (ATT) on the pregnancy outcomes and prognoses of patients with genital tuberculosis (GTB) who had received laparoscopy and/or hysteroscopy. This study included 78 patients with infertility and who were diagnosed with GTB through laparoscopy and/or hysteroscopy over the period of November 2005 to October 2015. The recruited patients were divided into ATT and nonATT groups on the basis of ATT duration. The GTB recurrence rates, menstrual patterns, and pregnancy outcomes of the patients were determined at follow-up. Among the 78 patients, 46 received ATT and 32 did not receive ATT. The menstrual volumes of patients in the ATT group significantly decreased relative to those of patients in the nonATT group. GTB did not recur among all patients regardless of treatment. A total of 11 pregnancies (36.7%) in the ATT group and 19 pregnancies (63.3%) in the nonATT group were observed. Pregnancy rates significantly differed ( = 0.002) between the two groups. ATT may decrease the menstrual volume and pregnancy rates of patients who were diagnosed with GTB through laparoscopy and/or hysteroscopy. In addition, ATT did not improve the prognosis of patients with chronic GTB.

关键词： antitubercular treatment pregnancy prognosis genital tuberculosis

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Study on factors affecting TB/HIV co-infection in four counties of China

Shi-Ming CHENG MD, Yu-Ji LAI MS, Er-Yong LIU MS, Lin ZHOU MD, Xue-Jing WANG MS, Qiu-Lan CHEN MS, Dong-Ming LI MS, Ning WANG MD,

《医学前沿（英文）》 2010年第4卷第2期页码 185-191 doi: 10.1007/s11684-010-0040-7

摘要： The factors affecting case detection of tuberculosis (TB)/human immunodeficiency virus (HIV) co-infection cases were explored in order to provide evidence-based formulation of a TB/HIV co-infection control strategy in China. Four counties with different modes of HIV transmission and varying cooperation mechanisms between TB and HIV institutions were selected. HIV test among TB patients and TB examination among people living with HIV/acquired immunodeficiency syndrome (AIDS) were conducted. Patients also completed questionnaires on potential factors affecting TB/HIV co-infection. The results showed that 19 (1.7%) were HIV-positive among 1089 cases of people living with active TB who received HIV testing. Conversely, there were 126 (10%) cases of active TB among 1255 cases of people living with HIV/AIDS. Among the newly discovered 145 cases of TB/HIV co-infection, AIDS institutions found 86.9% of these co-infections and 14.1% came from TB institutes. In different registration categories, there were 31 (21.4%) cases of smear positive TB, 104 (71.7%) cases of smear negative TB, and extrapulmonary cases accounted for 10 (6.9%). Gender, occupation, marital status, ethnic group, education, HIV transmission route, CD4 level, and type of TB susceptible symptoms had significant effects on whether HIV/AIDS patients were co-infected with TB disease (<0.01). Sex, age, ethnic group, occupation, and type of tuberculosis had no significant influence on whether TB patients had HIV infection. AIDS institutions could find more TB/HIV co-infection patients in comparison with TB institutions, particularly in patients with smear negative pulmonary tuberculosis and extrapulmonary tuberculosis. Therefore, a cooperation mechanism should be built up between TB and HIV control systems, and routine TB checks should be conducted for HIV/AIDS patients. In areas where sex or drug use is the major transmission mode of HIV infection, antiretroviral therapy should be expanded, treatment adherence should be improved and patients’ immunity level should be increased in order to decrease TB incidence. Cough and expectoration of more than two weeks, bloody sputum, and recurrent fevers could be revealing symptoms in TB screening of HIV/AIDS patients.

关键词： tuberculosis/acquired immunodeficiency syndrome dual infection prevention and control case detection impact factors