Extrapulmonary tuberculosis in immunocompetent adults

Tuberculosis continues to be a significant cause of morbidity and mortality. Although tuberculosis usually attacks the lungs, other organs can also be affected, leading to extrapulmonary tuberculosis (EPT) or disseminated tuberculosis. This study retrospectively analysed the incidence, clinical sites and risk factors for EPT in 252 patients with EPT between 1 January 1991 and 30 June 2003. EPT was defined as clinical, laboratory, imaging, and/or histopathological evidence of mycobacterial infection in a site other than hilar lymph nodes or lung parenchyma. In our study group, tuberculous lymphadenitis (36.5%) was found to be the most common clinical presentation of EPT. 119 (47.2%) patients developed the severe form of EPT, according to the WHO report, and 133 (52.8%) patients developed the less severe form. A case history of pulmonary tuberculosis was found to be a risk factor for the development of EPT (p <0.05). The study showed that EPT is still a public health problem. These findings suggested that pulmonary tuberculosis may play a critical role in the development of EPT. 12-month therapy may be chosen in patients with EPT considering acceptable adverse effects without relapses.     

Clinical manifestations of tuberculosis in HIV-infected patients

OBJECTIVE: The purpose of the present study was to evaluate the impact of HIV infection on the clinical presentation of tuberculosis. METHODOLOGY: We retrospectively studied the impact of HIV infection on the clinical presentation of tuberculosis. A total of 60 consecutive patients co-infected with HIV and tuberculosis were identified. RESULTS: Majority were male (88.3%) and the most common transmission category was heterosexual contact (80%). Most were in the advanced stage of HIV infection; 93% had CD4 cell count less than 200/mm3. Concerning the site of tuberculosis involvement, 37% had pulmonary involvement alone, 13% had extrapulmonary disease involving one single site, 50% had both pulmonary and extrapulmonary involvement. Fifteen (25%) patients also met the criteria of disseminated tuberculosis, who had a significantly lower mean CD4 cell count than those with pulmonary involvement alone (mean 40 vs 102; P = 0.048). Chest radiographs comprised a wide spectrum of manifestations. A considerable proportion had primary pulmonary tuberculosis pattern (38%) and normal radiographs (8.5%). CONCLUSIONS: Our patients generally had advanced HIV infection; 93% of those had CD4 lymphocyte count < 200/mm3. Extrapulmonary involvement and disseminated disease were common. Radiographic manifestations of pulmonary tuberculosis were often 'atypical' due to the greater proportion of primary tuberculosis among our patients.     

Tuberculosis in the patients undergoing haemodialysis in Japan, 1996

We conducted a questionnaire survey on patients undergoing haemodialysis about the present situation of tuberculous incidence. They are immunocompromised hosts and are said to be at high risk of developing tuberculosis in many reports. (1) DESIGN Of the 167,192 patients on haemodialysis registered on December 31, 1996 in Japan, 71,411 patients were available for the questionnaire survey. Of the 2,893 hospitals used as the study subjects, 1,108 hospitals gave satisfactory replies. Of them, 141 hospitals reported that they had patients with tuberculosis in 1996, and 79 cases were collected by the detailed survey on tuberculosis patients conducted later. They included 45 male cases, 34 female cases for tuberculosis of all forms, 28 male cases, 15 female cases for pulmonary tuberculosis (PTB), 13 male cases, 4 female cases for tuberculosis bacilli positive pulmonary tuberculosis (TB positive PTB), and 17 male cases, 19 female cases for extrapulmonary tuberculosis. (2) RESULTS: In tuberculosis of all forms, the number of observed patients (O) against the number of patients expected (E) was calculated, and the standardized patients ratio (O/E ratio) was computed. It was 1.55 for male, 2.79 for female and 1.99 for total. The incidence of tuberculosis haemodialysis patients was significantly higher compared with the general population (p < 0.01). As to PTB, the O/E ratio was 1.01 for male, 1.40 for female and 1.16 for total; the incidence of PTB was not significantly higher compared with the general population. With TB positive PTB, the O/E ratio was 0.96 for male, 0.80 for female and 0.97 for total, and no significant difference was found. As for extrapulmonary tuberculosis, the O/E ratio was 13.45 for male, 13.07 for female and 12.97 for total; the incidence of extrapulmonary tuberculosis in haemodialysis patients was significantly higher (p < 0.01), but it was lower than these reported in the past literature. The seventy nine cases consisted of 52 primary treatment cases, 23 retreatment cases, and 4 unknown cases. Out of 79 cases, 36 cases developed tuberculosis almost at the same time or within 1 year after undergoing haemodialysis, and thereafter it decreased gradually. Underlying diseases for haemodialysis were mainly glomerulonephritis and diabetic nephropathy. There were many patients who failed to notify to the public health centers after the diagnosis of tuberculosis was made, and it is needed to improve such a situation in the future. The prognosis of tuberculosis undergoing haemodialysis was poor. Three out of 43 patients with PTB and 2 out of 13 tuberculosis pleurisy cases died. (3) CONCLUSION: The risk of developing PTB in patients undergoing haemodialysis was not high compared with the general population, however, the risk was much higher for extrapulmonary tuberculosis. Moreover, the treatment outcome was not satisfactory in patients with PTB and pleurisy. As patients undergoing haemodialysis have the factors which suppress the cell-mediated immunity, it is required to restudy the measures to prevent development of tuberculosis, management and treatment in the future.     

Evaluation of a unified treatment regimen for all new cases of tuberculosis using guardian-based supervision.

SETTING: Ntcheu District, Malawi, using an oral antituberculosis treatment regimen. OBJECTIVE: To determine whether directly observed treatment (DOT) during the initial phase of treatment supervised either in hospital, at health centres or by guardians in the community, was associated with 1) satisfactory 2-month and 8-month treatment outcomes, and 2) with a reduction of in-patient hospital-bed days. DESIGN: Prospective data collection of all tuberculosis (TB) patients registered between 1 April 1996 and 30 June 1997, with 2-month and 8-month treatment outcomes, sputum smear conversion in smear-positive pulmonary TB patients (PTB) and in-patient hospital-bed days. RESULTS: Among the 600 new patients, 302 had smear-positive PTB, 150 smear-negative PTB and 148 extrapulmonary TB (EPTB). Eight-month treatment completion was 65% for smear-positive PTB patients, which was significantly higher than in patients with smear-negative PTB (45%) and EPTB (54%), due mainly to high 8-month mortality rates. The site of the intensive phase was determined in 596 patients: 178 (30%) received DOT from guardians, 115 (19%) from a health centre and 303 (51%) in hospital. At 2 months, mortality rates were significantly higher in hospitalised patients. Two-month treatment outcomes (including sputum smear conversion rates in smear-positive PTB patients) were similar between patients receiving DOT at health centres or from guardians. Decentralised DOT resulted in a 25% reduction in hospital-bed days in patients alive at 2 months compared with that predicted using the old regimens. CONCLUSION: Decentralising DOT to health centres and to guardians during the intensive phase is associated with satisfactory treatment outcomes.     

Should pulmonary tuberculosis be an AIDS-defining diagnosis in patients infected with HIV?

Between 1983 and 1989, we cared for 56 patients with tuberculosis and human immunodeficiency virus (HIV) infection. In 37 patients (66%), tuberculosis occurred before any other AIDS-defining disease (group 1); in 10 (18%) it occurred during the same month as another AIDS-defining disease (group 2); and in 9 (16%), after the diagnosis of AIDS (group 3). Tuberculosis was entirely pulmonary in 14 patients (25%), entirely extrapulmonary in 9 (16%), and both pulmonary and extrapulmonary in 33 (59%). The frequency of extrapulmonary involvement was similar in patients from group 1 and from groups 2 and 3 (combined): 76% versus 74%. Needle biopsy of the liver revealed hepatic involvement in 18 patients (32%). The mean CD4 lymphocyte count was 232/mm3 when tuberculosis was entirely pulmonary, and 243/mm3 when extrapulmonary disease was present (difference not significant). In group 1, the onset of both pulmonary and extrapulmonary tuberculosis occurred at the same stage of HIV infection, 12 and 10 months, respectively, before any other AIDS-defining disease. Treatment, planned to last 1 year, was highly effective, despite frequent side-effects. Among the 32 patients who completed treatment, relapse of tuberculosis occurred in 2 (6%) with a mean follow-up of 16 months (0-53 months) after completion. Our results suggest that pulmonary tuberculosis should be included in the criteria for diagnosis of AIDS.     

Clinical features and outcome of tuberculosis in solid organ transplant recipients

BACKGROUND:: Taiwan is an area with moderate to high incidence of Mycobacterium tuberculosis infection. The risk of M tuberculosis infection in transplantation recipients is considered to be significant. Our aim in this study was to investigate the clinical spectrums of M tuberculosis-infected transplantation recipients in a southeast Asian country, Taiwan. METHODS:: We retrospectively analyzed the demographic data, clinical features, treatment, and outcome of M tuberculosis infection in kidney, heart, and liver transplant recipients from May 1996 to April 2005 at the National Taiwan University Hospital. RESULTS:: Fifteen patients who had received solid organ transplantation developed tuberculosis (kidney = 6, heart = 7, liver = 2). The median duration from transplantation to diagnosis of tuberculosis was 31 months. The cumulative incidence of post-transplantation tuberculosis was 2.0% (15/760), ie, approximately 3 times that of the general population. Ten patients (66.7%) had pulmonary tuberculosis, 1 (6.7%) had extrapulmonary tuberculosis, and 4 (26.7%) had disseminated tuberculosis. Nine patients completed the anti-tuberculosis treatment; the median treatment duration was 12 months (pulmonary: 9 months; extrapulmonary: 13.5 months). No treatment failure was noted in patients receiving the complete treatment course. The graft failure and mortality rates of post-transplantation tuberculosis were 13.3% each (2/15). The tuberculosis-associated mortality rate was 6.7% (1/15). CONCLUSIONS:: Cumulative incidence of tuberculosis was slightly higher in transplant recipients than in the general population in Taiwan. Conventional 4-combined anti-tuberculosis regimen for 12 months can treat the potentially fatal infection successfully in post-transplantation tuberculosis patients without recurrence.     

Clinical analysis of foreign-born patients with tuberculosis found in Malaysia

In this retrospective study, we investigated 263 foreign patients who were diagnosed as having tuberculosis at the National Tuberculosis Center (NTBC) from January 2001 to December 2002. The age range was 14-72 years, with a mean of 33.3 +/- 9.95 years. The study subjects were predominantly males (60%) and females comprised 40%, where the greater impact of tuberculosis was observed in the young and active ones (up to 34 years of age), than middle-age (up to 54). A significantly higher percentage of these patients were from the Southeast Asian countries (87%) and particularly occurred in single male (47.5%) and married female (71.4%) patients (p<0.05). We also found that tuberculosis was significantly higher in female (50.5%) and male (64%) with smoking laborers (p<0.05). Fever (70%), cough (90.5%) and BCG vaccination status showed a significantly higher percentage in male patients (p<0.05), whereas lymphadenopathy (22%) was found in a significantly higher percentage in females (p<0.05). Overall, pulmonary disease (94.3%) occurred more commonly in males and the pleura (3.2%) was the most common site of disseminated tuberculosis. By contrast, the lymph node (11.4%) and miliary (4.8%) forms were the more common extrapulmonary tuberculosis in females. More males had higher percentage of treatment completed at > or = 6 (38%) and > or = 9 (13.3%) months in pulmonary tuberculosis, whilst, more females showed higher percentage of treatment completed (8.7%) in extrapulmonary tuberculosis. Surprisingly, more women showed non-compliance to the anti-tubercular therapy than their counterpart in this study.     

综合医院肺外结核101例临床分析

目的　通过对 101例肺外结核 (EPT)的临床分析提高对EPT的诊疗水平。方法 对上海市第五人民医院自 1994年 1月—2001年 1月收治的EPT患者的诊治情况,进行回顾性分析。结果共收治EPT 101例,老年人中发病较高 (33.7%),最低 8.3%,最高 20.2%,平均 12.8%± 4.6%,发病部位以颈淋巴结结核最为常见 (42.6%),其次是腹腔结核 (13.9%)和肾结核 (12.9%)。其中病理确诊 70例 (69.3%),病原菌确诊 16例 (15.8%),诊断性抗结核治疗及门诊随访 15例 (14.9%)。共延误诊断 45例 (44.6%)。采用规范化疗方案治疗的 62例 (61.4%):不规范化疗方案治疗的 39例(38.6%)。规范化疗治愈率 100%,不规范化疗复治率为 25.6%。结论 综合医院应重视EPT的诊治工作,采取综合诊断措施,做到早期诊断、规范化疗。     

肺结核化疗中发热原因分析

目的　分析肺结核患者在使用抗结核化学药物治疗过程中出现发热的原因。方法 对2003—2006年在抗结核治疗中出现发热的112例住院病人进行回顾性分析。结果 112例病人共出现发热140例次,总结发热原因可分为6大类,按照所占比例依次为:非结核性感染、结核性发热、药物反应、支气管镜检查术后、合并肺外结核和其他合并症。院内获得性感染占非结核性感染例数的98%。结核性发热与低蛋白血症有一定相关性。结论 以院内获得性感染为主的非结核性感染是所有发热原因中最多见者,其次要警惕药物热和合并肺外结核。     

Extrapulmonary tuberculosis in Peninsular Malaysia: retrospective study of 195 cases

During a 2-year retrospective study, 195 non-HIV-infected patients with extrapulmonary tuberculosis (EPT) were diagnosed at the National Tuberculosis Center, Kuala Lumpur, representing 10% of all patients with tuberculosis. Their mean age was 39 (+/- SD) 14 years old (range 14-81). The largest age group was 25-34 years, while 78.5% were less than 50 years of age. The subjects were mainly female (50.3%), Malay (49.2%), married (61.5%), resided in Kuala Lumpur (51.0%), and were unemployed (50.3%). Regarding risk factors, they were smokers and/or alcohol users (21.0%), and injecting drug users (IDUs) (5.1%); they also had history of tuberculosis (3.6%) and contact with TB patients (9.2%). Lymphadenopathy was the most common sign (45.6%) shown in the medical records. 42% of x-ray findings (chest, spine, and hip) showed signs consistent with tuberculosis, while histopathology was the most useful diagnostic tool (52.3%) and lymph node was the most frequent specimen used (35.0%) in this study. The three main sites of involvement were lymph nodes (42.6%), miliary and disseminated (19.5%), and pleura (12.8%). The outcome of this study showed 72.8% of these patients had completed treatment for at least 6 months, whilst, only 4.6% of patients were still undergoing treatment, and unfortunately, 22.6% of them showed non-adherence to anti-tubercular therapy at a duration of less than 6 months. However, no MDR-TB or death cases were reported or registered in this study.     

AIDS-defining illnesses: a comparison between before and after commencement of highly active antiretroviral therapy (HAART)

Attempts to address the significant impact of HAART on medical variables on the Malaysian HIV/AIDS population have yet to be evaluated. This study aims to analyze the proportions of AIDS-defining illnesses (ADIs) before and after HAART. A retrospective study was carried out on 128 new cases of HIV infected patients who first commenced HAART in 2004 at the national HIV reference center. Before commencement of HAART, 76 clinical episodes of ADIs were recorded in 52 patients. Most common being pulmonary Mycobacterium tuberculosis (28.9%), PCP (27.6%) and disseminated and extrapulmonary Mycobacterium tuberculosis (11.8%). During HAART, 8 clinical episodes of ADIs were documented in 7 patients with a median time of onset of 10 weeks after initiation of HAART (range, 4-36 weeks). The median CD4 count at the time of the commencement of HAART for these patients was 11 cells/mm(3). ADIs reported include PCP (2 episodes), disseminated and extrapulmonary Mycobacterium tuberculosis (2 episodes), extrapulmonary cryptococcosis (1 episode), esophageal candidiasis (1 episode), recurrent pneumonia (1 episode) and disseminated or extrapulmonary histoplasmosis (1 episode). Three (37.5%) of these occurred despite a reduction of viral load by at least 2 log(10) and an increased in the CD4 cell count. In conclusion, ADIs can still present after the initiation of successful HAART especially in those with CD4 counts below 100 cells/mm(3). In Malaysia, ADIs are the major causes of HIV/AIDS associated morbidity and mortality, thus increased awareness on the management of these illnesses is warranted especially in the months following HAART.     

Correlation analysis between clinical characteristics and flow cytometry cells subsets in peripheral blood of patients with pulmonary tuberculosis

目的 了解肺结核患者临床特征与外周血流式细胞亚群[T淋巴细胞亚群及自然杀伤 (NK)细胞]的相关性。方法 连续性收集2019年1月1日至5月25日期间同济大学附属上海市肺科医院肺结核住院患者1000例的临床资料进行回顾性分析。将患者各临床特征数据与外周血流式细胞亚群的检测值采用Eviews 8.0软件分别建立多元线性逐步回归模型,以明确各临床特征与外周血流式细胞亚群的检测值之间的相关性。结果 (1)肺结核患者的肺部病灶范围及呼吸道标本抗酸染色涂片结果与CD3⁺T细胞表达有关:肺部病灶范围越大、呼吸道标本抗酸染色涂片阳性程度越高,CD3⁺ T细胞数量越低(回归系数分别为-0.255、-0.499, P值分别为0.021、0.027)。(2)患者的年龄、性别、结核分子生物学检测结果与CD4⁺ T细胞表达有关: 0~<20岁年龄段患者CD4⁺ T细胞数量低于其他年龄段患者(回归系数-4.710,P=0.031);男性CD4⁺ T细胞数量低于女性患者(回归系数-2.150, P=0.001);分子生物学检测阳性的患者CD4⁺ T细胞数量高于检测阴性的患者(回归系数1.433, P=0.030)。(3)初治患者CD8⁺ T细胞数量高于复治患者(回归系数1.247, P=0.029);呼吸道标本抗酸染色涂片阳性程度越高CD8⁺ T细胞数量越高(回归系数0.442, P=0.033)。(4)并发肺外结核者的NK细胞低于未并发肺外结核者(回归系数0.375, P=0.030)。结论 肺结核患者的肺部病灶累及范围、呼吸道标本抗酸染色阳性与外周血流式细胞亚群CD3⁺ T细胞具有相关性;年龄、性别、结核分子生物学检测结果与CD4⁺ T细胞具有相关性;是否初治、呼吸道标本抗酸染色阳性与CD8⁺ T细胞具有相关性;是否并发肺外结核与NK细胞表达水平具有相关性。     

肺结核患者临床特征与外周血流式细胞亚群的相关性分析

目的 了解肺结核患者临床特征与外周血流式细胞亚群[T淋巴细胞亚群及自然杀伤 (NK)细胞]的相关性。方法 连续性收集2019年1月1日至5月25日期间同济大学附属上海市肺科医院肺结核住院患者1000例的临床资料进行回顾性分析。将患者各临床特征数据与外周血流式细胞亚群的检测值采用Eviews 8.0软件分别建立多元线性逐步回归模型,以明确各临床特征与外周血流式细胞亚群的检测值之间的相关性。结果 (1)肺结核患者的肺部病灶范围及呼吸道标本抗酸染色涂片结果与CD3⁺T细胞表达有关:肺部病灶范围越大、呼吸道标本抗酸染色涂片阳性程度越高,CD3⁺ T细胞数量越低(回归系数分别为-0.255、-0.499, P值分别为0.021、0.027)。(2)患者的年龄、性别、结核分子生物学检测结果与CD4⁺ T细胞表达有关: 0~<20岁年龄段患者CD4⁺ T细胞数量低于其他年龄段患者(回归系数-4.710,P=0.031);男性CD4⁺ T细胞数量低于女性患者(回归系数-2.150, P=0.001);分子生物学检测阳性的患者CD4⁺ T细胞数量高于检测阴性的患者(回归系数1.433, P=0.030)。(3)初治患者CD8⁺ T细胞数量高于复治患者(回归系数1.247, P=0.029);呼吸道标本抗酸染色涂片阳性程度越高CD8⁺ T细胞数量越高(回归系数0.442, P=0.033)。(4)并发肺外结核者的NK细胞低于未并发肺外结核者(回归系数0.375, P=0.030)。结论 肺结核患者的肺部病灶累及范围、呼吸道标本抗酸染色阳性与外周血流式细胞亚群CD3⁺ T细胞具有相关性;年龄、性别、结核分子生物学检测结果与CD4⁺ T细胞具有相关性;是否初治、呼吸道标本抗酸染色阳性与CD8⁺ T细胞具有相关性;是否并发肺外结核与NK细胞表达水平具有相关性。     

Factors influencing the successful treatment of infectious pulmonary tuberculosis.

SETTING: Achieving successful treatment of infectious pulmonary tuberculosis (PTB) could reduce the spread of tuberculosis (TB) and the emergence of multidrug resistance. OBJECTIVE: To explore factors associated with successful treatment for sputum-positive PTB. DESIGN: This study used a population-based retrospective cohort design. All PTB patients residing in southern Taiwan recorded in the tuberculosis registry from 1 January to 30 June 2003 were identified. Each patient's medical record was requested from treating hospitals and retrospectively reviewed for 15 months after the date PTB was confirmed. RESULTS: There were 399 PTB patients included in the study. Factors significantly associated with successful treatment included treatment by pulmonologists (OR 1.93), receiving directly observed therapy (DOT) (OR 1.76) and receiving treatment at the chest hospital (OR 5.41). Patients of advanced age were less likely to achieve treatment success (OR 0.97). Among patients treated by pulmonologists, those treated at the chest hospital had a significantly higher treatment success rate than those treated at other institutions (94.1% vs. 69.9%). CONCLUSIONS: Patients treated with DOT and by pulmonologists, especially at the chest hospital, had a higher treatment success rate. DOT and training of care professionals and institutions are therefore important factors that affect the successful treatment of TB.     

Influence of diabetes on manifestations and treatment outcome of pulmonary TB patients.

OBJECTIVE: To understand the influence of diabetes on the clinical and bacteriological aspects and treatment outcome of pulmonary tuberculosis (PTB) patients. SETTING AND DESIGN: Records of 692 consecutive smear-positive PTB patients admitted to a referral hospital in Riyadh, Saudi Arabia, were reviewed retrospectively. The characteristics of 187 patients with diabetes mellitus (PTB-DM group) were compared to 505 patients without DM (PTB group). RESULTS: In the PTB-DM group, 65.2% of the patients had numerous acid-fast bacilli (AFB) on sputum smear examination compared to 54.1% in the control group (P = 0.008). Among new cases, PTB-DM patients had a lower prevalence of resistance to any anti-tuberculosis drug (6.4% vs. 16.0%, P = 0.007) and achieved higher sputum conversion rates at the end of 3 months of treatment (98.9% vs. 94.7%, P = 0.013). Favourable outcomes (cured/treatment completed), failure, death and default were comparable in both groups (P = 0.7005). CONCLUSIONS: PTB-DM patients have a higher pre-treatment bacillary load, a lower prevalence of anti-tuberculosis drug resistance and achieve slightly higher sputum conversion by the end of 3 months of treatment compared to non-diabetic patients. The association of diabetes does not alter the final treatment outcome among PTB patients.     

Analysis of rate of change of IS6110 RFLP patterns of Mycobacterium tuberculosis based on serial patient isolates.

The rate of change of IS6110 restriction fragment length polymorphism (RFLP) patterns of Mycobacterium tuberculosis was determined in serial isolates from 544 patients. In 25 patients (4.6%), the RFLP patterns of the follow-up isolates differed from the initial isolates. Patients with different follow-up strains were less likely to cluster with patients whose strains had indistinguishable RFLP patterns. Changes in RFLP patterns were more common for persons with extrapulmonary disease and for those who had both pulmonary and extrapulmonary isolates. Based on serial isolates spanning for the most part <3 months, the half-life was extrapolated to be 3.2 years (95% confidence interval, 2.1-5.0). The main implication of this study is that the rate of change of IS6110-based RFLP of M. tuberculosis supports the use of IS6110 typing in epidemiologic studies of recent transmission of tuberculosis.     

Extra-pulmonary and pulmonary tuberculosis in Hong Kong.

OBJECTIVE: To compare the characteristics of patients with pulmonary and extra-pulmonary tuberculosis and to describe the organ involvement, diagnosis and treatment of extra-pulmonary tuberculosis. MATERIALS AND METHODS: All patients with a diagnosis of tuberculosis treated by the Hong Kong Government Tuberculosis and Chest Service (Chest Service) in 1996 were studied. RESULTS: Of the 5757 patients treated, 13.7% had extra-pulmonary tuberculosis alone and 8.6% had both extra-pulmonary tuberculosis and pulmonary tuberculosis. Extra-pulmonary tuberculosis was more common in women under 30 and over 75 years of age. Only six patients had human immunodeficiency virus (HIV) infection, of whom two had extra-pulmonary tuberculosis. The most common site of extra-pulmonary involvement was the pleura, followed by the lymph nodes. Miliary tuberculosis occurred in only 2.9%. Lymph node involvement occurred significantly higher in women, while pleural disease was significantly higher in men. The duration of treatment varied according to the site of disease, being shorter (6 months) for those with pleural disease only and >9 months for those with miliary, meningeal, gastrointestinal and genitourinary disease; 80.3% completed treatment at 12 months and 85.5% at 24 months. Of those who completed treatment, 1.4% had a relapse of disease at 24 months follow-up; there was no significant difference between those with pulmonary or extra-pulmonary disease. CONCLUSION: In Hong Kong, extra-pulmonary tuberculosis is common, affecting 22.3% of TB patients, and is unrelated to HIV infection. There are sex differences in the organs most commonly affected. The rate of relapse of disease is low for those who completed treatment, irrespective of the site of involvement.     

Clinical,laboratory and evolutionary features of abdominal tuberculosis in comparison with other forms of extrapulmonary tuberculosis

Background/objectivesTuberculosis is a multisystem disease that might affect any organ. Abdominal tuberculosis (ABT) represents 5–17% from all extrapulmonary tuberculosis (EPT) sites. We aimed to study the clinical, laboratory and evolutionary features of ABT cases and to identify predictive factors associated with ABT.MethodsWe conducted a retrospective study including all patients hospitalized in the infectious diseases department for EPT between 1991 and 2019. We studied the characteristics of ABT cases, and we compared them with other EPT cases.ResultsWe identified 519 patients with EPT, among whom 86 (16.6%) patients had ABT. There were 58 females (67.4%). Peritoneal tuberculosis was the most common clinical form of ABT (68.6%), followed by intestinal tuberculosis (18.6%). Patients aged 60 years and above were significantly less affected with ABT (odds ratio (OR) = 0.2; p = 0.001). The revealing systemic symptoms including fever (OR = 2.04; p = 0.006), weight loss (OR = 2.5; p < 0.001) and anorexia (OR = 1.7; p = 0.021) were significantly more frequent among ABT patients. Inflammatory markers including C-reactive protein levels (37 [10–89] mg/l vs 10 [4–57] mg/l; p < 0.001) and erythrocyte sedimentation rates (43 [15–95] mm/h vs 27 [15–60] mm/h; p = 0.044) were significantly higher among ABT cases. Multivariate logistic regression analysis showed that anorexia (adjusted OR (AOR) = 1.9; p = 0.015) and pulmonary involvement (AOR = 3.3; p = 0.002) were independent predictors of higher rate of ABT. Concomitant involvement of neuro-meningeal (AOR = 0.18; p = 0.001) and osteo-articular (AOR = 0.2; p = 0.01) sites, 40–59 (AOR = 0.2; p < 0.001) and ≥60 (AOR = 0.2; p < 0.001) age groups as well as hemoglobin rate (AOR = 0.7; p < 0.001) were independently associated with lower rate of ABT.ConclusionsAnorexia and pulmonary involvement were independent predictors of higher rate of ABT. Concomitant involvement of neuro-meningeal and osteo-articular sites, 40–59 and ≥60 age groups and hemoglobin rate were independently associated with lower rate of ABT.     

基于CT分型方法的儿童肺结核临床特征分析

目的 分析儿童肺结核CT特征的临床特点。方法 回顾性分析首都医科大学附属北京儿童医院2006年7月至2014年12月经临床诊断并确诊为肺结核的734例患儿的临床资料(包括年龄、性别、临床表现,疫苗接种史、接触史及实验室检查等),基于CT分型对其CT特征、临床特点进行分析。结果 734例患儿中159例(21.7%)为经病原学检测确诊;CT分型中原发性肺结核和气管、支气管结核最多见(365例,50.4%),并发2种及以上类型者次之(199例,27.3%);3岁以下婴幼儿以原发性肺结核和气管、支气管结核多见(189例,26.1%), 7~14岁青春期儿童以结核性胸膜炎多见(94例,13.0%);并发肺外结核患者以结核性脑膜炎(109例,34.5%)及肺外播散累及2个及以上器官或组织者(103例,32.6%)最多见。192例(26.2%)患儿并发其他疾病或患有基础疾病。结论 不同年龄阶段患儿的肺结核CT分型不同,且常并发肺外结核;儿童肺结核CT表现有其自身特点及年龄分布特点。     

母牛分支杆菌菌苗免疫治疗肺结核临床观察--2年随访结果

目的　评价母牛分支杆菌 (M.vaccae)菌苗免疫治疗缩短初治菌阳肺结核化疗疗程及对耐多药肺结核的疗效。方法 142例初治菌阳肺结核和46例耐多药肺结核，配对随机分为M.vaccae菌苗免疫治疗组和单纯化疗对照组。初治治疗组 (A组)采用M.vaccae菌苗深部肌肉注射6次及4个月化疗，初治对照组 (B组)采用6个月化疗而不行免疫治疗；耐多药肺结核 (C组、D组)均给予18个月化疗，但治疗组 (C组)给予M.vaccae菌苗免疫治疗6次，对照组 (D组)单用化疗。M.vaccae菌苗免疫治疗结束，A组痰菌阴转率为95.8% (68/71)，B组为97.2% (69/71)，P＞0.05；C组和D组痰菌阴转率分别为34.8% (823)和4.7% (123)，P＜0.05。本文对疗程结束痰菌阴转且未失访的141例病人进行了2年随访。结果 A组2年复发率为6.3% (464)，B组为4.5% (366)P＞0.05，C组、D组2年复发率分别为11.1% (1/9)和50.0% (1/2)，P＞0.05。结论 M.vaccae菌苗免疫治疗可将初治菌阳肺结核的化疗疗程缩短为4个月，痰菌阴转率、2年复发率与对照组无差异，耐多药肺结核痰菌阴转率明显提高，复发率与对照组无差异。因此，M.vaccae菌苗免疫治疗可缩短初治菌阳肺结核的疗程，提高耐多药肺结核的疗效，建议推广。