耐多药结核病诊断方法研究进展

耐多药结核病的防治对于结核病的防控具有重要意义,已成为结核病防治的难点和热点问题。早期对结核病患者进行耐多药检测能够提高耐多药结核病患者的治疗成功率。耐多药结核病的诊断方法包括传统的培养方法及新型分子生物学诊断方法。作者对耐多药结核病的诊断方法进行综述,以期为耐多药结核病防治提供科学依据。     

血清γ-干扰素诱导蛋白10对活动性肺结核的诊断价值

目的探讨血清γ-干扰素诱导蛋白10(IP-10)在儿童青少年活动性肺结核诊断中的应用价值。方法选取住院确诊肺结核儿童青少年92例为肺结核组,同期体检无结核感染者107例为对照组,两组均检测γ-干扰素诱导蛋白-10(IP-10);其中肺结核43例和无结核感染者50例行结核感染T细胞斑点试验(T-SPOT)检测,其敏感性和特异性与IP-10比较。结果肺结核组IP-10浓度高于对照组,绘制ROC曲线下面积为0.921,取血IP-10诊断活动性肺结核临界浓度值为155.82 pg/mL,其敏感性(75.5%)低于血T-SPOT(90.7%),但特异性(95.9%)明显高于血T-SPOT(84%),差异均具有统计学意义(P<0.05)。结论IP-10在儿童青少年肺结核患者中明显升高,特异性强,可作为辅助临床早期、快速诊断活动性肺结核的检测指标。     

Disseminated cutaneous tuberculosis from BCG vaccination site in an immunocompetent child

A healthy 4‐month‐old girl presented with widespread scaly papules and a nodule over the site of BCG immunization. A diagnosis of disseminated cutaneous tuberculosis in an immunocompetent child was confirmed with biopsy. The child was treated with antituberculosis therapy without recurrence.     

结核分枝杆菌检测技术研究进展

结核是由结核分枝杆菌引起的一种世界性疾病,为最受关注的公共卫生问题之一。虽然近年来结核病的发病率呈下降趋势,但其对人类健康造成的危害仍十分严峻。患者的及时上报是结核病防控的重要环节之一,报告率的上升有助于提高结核的治愈率以及卫生机构对结核患者的管理强度。快速、准确的诊断方法直接影响结核病的报告率,影响疾病传播和患者管理,是控制结核发病的基础。近年来,分子诊断技术发展迅速,为结核病的快速诊断提供了新的思路。分子诊断技术检测速度快,灵敏度、特异度、准确率高,绝大多数技术成本低廉,可同时对多个样本进行检测,实用性较强,具有较好的发展前景。本文对现阶段临床上实际应用的结核诊断技术与近年来出现的新型分子诊断技术进行简要概述。     

The technological imperative in tuberculosis care and prevention in Vietnam

ABSTRACT

A monocausal bacteriological understanding of infectious disease orients tuberculosis control efforts towards antimicrobial interventions. A bias towards technological solutions can leave multistranded public health and social interventions largely neglected. In the context of globalising biomedical approaches to infectious disease control, this ethnography-inspired review article reflects upon the implementation of rapid diagnostic technology in low- and middle-income countries. Fieldwork observations in Vietnam provided a stimulus for a critical review of the global rollout of tuberculosis diagnostic technology. To address local needs in tuberculosis control, health managers in resource-poor settings are readily cooperating with international donors to deploy novel diagnostic technologies throughout national tuberculosis programme facilities. Increasing investment in new diagnostic technologies is predicated on the supposition that these interventions will ameliorate disease outcomes. However, suboptimal treatment control persists even when accurate diagnostic technologies are available, suggesting that promotion of singular technological solutions can distract from addressing systemic change, without which disease susceptibility, propagation of infection, detection gaps, diagnostic delays, and treatment shortfalls persist.     

心理干预联合认知干预在惠州市学校 肺结核病密切接触者中的应用观察

目的研究心理干预联合认知干预在惠州市学校肺结核病密切接触者中的应用效果。方法随机数表法将学校2018年1月—2019年1月肺结核患者密切接触者200名分为观察组和对照组,各100例,对照组给予认知干预,观察组给予心理干预联合认知干预。观察并比较两组研究对象干预前后的焦虑自评量表(SAS)评分、调查主动检查人数、发病情况、对肺结核的了解情况以及两组研究对象的满意度。结果与干预前比较,两组干预后SAS评分下降,肺结核知识评分上升,且观察组干预后下降或上升幅度大于对照组(P<0.05);观察组主动筛查率高于对照,感染发病率明显低于对照组(P<0.05);观察组满意率为95.00%,高于对照组的86.00%(P<0.05)。结论心理干预联合认知干预在学校肺结核密切接触者中应用可有效缓解不良情绪,提高主动筛查率和疾病的认知了解。     

Is interleukin-2 an optimal marker for diagnosing tuberculosis infection? A systematic review and meta-analysis

Abstract

Background

Latent tuberculosis infection (LTBI) is a huge reservoir for the deadlier TB disease. Accurate identification of LTBI is a key strategy to eliminate TB. Therefore, a systematic review and meta-analysis approach was used to assess diagnostic potential of IL-2 for LTBI.     

Enfermedad tuberculosa en población pediátrica en Madrid en los últimos 26 años

IntroductionTuberculosis (TB) continues to be a serious public health problem and establishing a definitive diagnosis among children is extremely challenging. Pulmonary tuberculosis is the most prevalent form, with children under the age of 2 years being at greatest risk of severe and disseminated forms. The aim of this study was to describe TB among children in Spain in recent years.Patients and methodsA retrospective study of paediatric patients diagnosed with TB in two hospitals of the Community of Madrid over a 26-year period (1991-2017). Epidemiological and clinical variables, additional tests and treatments received were analysed.Results170 children were included. The two most-affected age groups were infancy and adolescence. 42.9% of patients were immigrant children (South-America or Morocco). The main reasons for consultation were TB contact (20.6%) and fever (15.3%). At diagnosis, 61.8% of cases referred an epidemic environment, and 30.6% were asymptomatic. The Mantoux tuberculin skin test was positive in 92.2% of patients and IGRA was positive in 70.6%. Pulmonary TB was identified in 91.8% of children vs. 8.2% with extrapulmonary forms. Gastric juice culture was positive in 36.9% of cases and three strains resistant to isoniazid were isolated. All patients were cured without complications except one who died.ConclusionsPulmonary TB continues to be the most prevalent form among children and presumptive diagnosis (symptoms consistent with positive Mantoux test or suggestive X-ray) is the most common form of diagnosis. It is important to conduct a contact investigation in order to control the spread of TB.