Three months of rifapentine and isoniazid for latent tuberculosis infection in hemodialysis patients: High rates of adverse events

The consequences of once-weekly rifapentine plus isoniazid for 3 months (3HP) against latent tuberculosis infections in hemodialysis patients have not been studied before. This is the first study to evaluate the safety and tolerability of 3HP in this population and revealed a completion rate of 65.4%. The therapy was not associated with hepatotoxicity, but with high rates of adverse events (69.2%).     

Early ancient sublineages of Mycobacterium tuberculosis Beijing genotype: unexpected clues from phylogenomics of the pathogen and human history

ObjectiveThe Mycobacterium tuberculosis Beijing family is an epidemiologically important lineage subdivided into large-scale phylogenetic sublineages: ancient, endemic in East Asia, and global modern. Here, we analysed ancient sublineages of the Beijing genotype in the Omsk region of southwestern Siberia, an intriguing area at the intersection of European Russia, Siberia, and Central Asia.MethodsThe study included 423 M. tuberculosis strains isolated in 2013–2017 and subjected to drug susceptibility testing, genotyping, and whole genome sequencing.ResultsThe Beijing genotype constituted 280 out of 423 strains. Forty Beijing strains belonged to the early ancient sublineage (wild type mutT4-48). Of these, 11 belonged to the 14717-15 MIRU-VNTR cluster and had intact RD181, 29 belonged to the 1071-32 cluster and had the RD181 deletion. Thirty-nine ancient strains were multidrug-resistant (MDR) and 20 pre-extensively drug resistant (XDR)/XDR. Comparison with global data demonstrated that these clones circulate mainly in Asian Russia with certain phylogenetic affinity to strains from Japan, Korea, and northeastern China. The genome-wide analysis revealed 29–37 single nucleotide polymorphism distances between isolates from different Russian regions within these two clusters.ConclusionsBased on phylogenetic, phylogeographic, genomic, and historical data, we hypothesize that these two clones or their direct ancestors were probably brought to Russia ～70 years ago after the Second World War with Japanese prisoners of war and, until recently, were mainly circulating in Siberia and the Far East. Their elevated prevalence in Omsk along with the extremely strong association with not only MDR but also pre-XDR/XDR also observed in other locations highlight their epidemic potential and the need for monitoring and attention from health authorities.     

Design,Synthesis, and in vitro antitubercular activity of 1,2,3‐triazolyl‐dihydroquinoline derivatives

In the quest for new active molecules against Mycobacterium tuberculosis, a series of dihydroquinoline derivatives possessing triazolo substituents were efficiently synthesized using click chemistry. The structure of 6l was evidenced by X‐ray crystallographic study. The newly synthesized compounds were evaluated for their in vitro antitubercular activity against Mycobacterium tuberculosis H37Rv (ATCC27294). The compounds 6a , 6g, and 6j (MIC: 3.13 μg/ml) showed promising activity when compared to the first‐line drug such as ethambutol. In addition, the structure and antitubercular activity relationship were further supported by in silico molecular docking studies of the active compounds against 3IVX.PDB (crystal structure of pantothenate synthetase in complex with 2‐(2‐(benzofuran‐2‐ylsulfonylcarbamoyl)‐5‐methoxy‐1H‐indol‐1‐yl)acetic acid).     

某院结核分枝杆菌利福平和异烟肼耐药基因特征

目的了解某院结核分枝杆菌(MTB)利福平耐药相关基因rpo B及异烟肼耐药相关基因kat G、inh A的突变特征,为耐药结核病的预防和治疗提供科学依据。方法收集83例结核病患者痰标本,分离培养MTB,采用BD960液体法检测利福平、异烟肼耐药性,提取菌株DNA,采用聚合酶链反应扩增rpo B、kat G、inh A全基因,对扩增产物进行测序分析。结果 83株样本中,39株对利福平耐药,51株对异烟肼耐药。耐利福平菌株rpo B基因突变率为97.44%(38/39),531位点突变率60.53%(23/38),526位点突变率23.68%(9/38),32株出现多位点联合突变。耐异烟肼菌株kat G基因突变率为98.04%(50/51),共发现16种突变类型,其中以kat G 315位点突变为主,占70.00%(35/50),1株为kat G与inh A联合突变。结论该院耐多药MTB产生耐药性与rpo B和kat G基因突变相关,检测MTB耐多药相关基因突变可为早期快速诊断耐药结核病提供参考依据。     

121例二线抗结核药品不良反应分析

目的探讨二线抗结核药品药品不良反应(ADR)发生的特点。方法从某院2017年度ADR报告汇总表中选取二线抗结核药品所致ADR患者的病历,对不同性别、年龄的患者ADR发生情况,ADR类型以及患者各种ADR所涉及的器官系统及其主要临床表现、转归数据信息进行统计分析。结果报告的121例二线抗结核药品ADR患者中,男性占比较高(72例,59. 50%),年龄 60岁者居多(70例,57. 85%)。引发ADR的药品剂型主要是注射剂型(80例,66. 12%),主要药品是莫西沙星(38例,31. 40%)和左氧氟沙星(29例,23. 96%)。ADR累及的器官系统以全身性为主(69/128,53. 91%),其次是中枢及外周神经系统(22/128,17. 19%)。严重的ADR患者9例(7. 44%),痊愈和好转的ADR患者118例(97. 52%)。结论使用二线抗结核药品ADR多发生于老年患者,尤其以喹诺酮类药品的全身性损害和中枢及外周神经系统损害为主。在诊治过程中,应及时对高危人群和主要治疗药品进行ADR监测和主动干预,并作出应对处理。     

湖南省2012—2017年学生肺结核登记情况及流行特征

目的分析湖南省学生肺结核患者登记情况,了解流行特征,为完善全省学校结核防治策略提供依据。方法利用2012-2017年中国结核病信息管理系统中登记的资料,统计分析湖南省学生结核病患者登记率及其流行特征。结果2012-2017年湖南省发现学生肺结核患者7 940例,登记发病率为13.23/10万,涂阳肺结核患者2 203例,登记发病率为3.67/10万。2012-2017年学生活动性肺结核登记发病率比较,差异有统计学意义（χ2=80.079,P<0.001）;2012-2017年学生涂阳肺结核登记发病率比较,差异有统计学意义（χ2=112.213,P<0.001）。二季度学生肺结核登记人数最多（占32.2%）,以男性为主（占60.8%）,年龄以15～19岁为主（占61.8%）。2012-2017年各市州学生肺结核登记情况比较,差异有统计学意义（χ2=320.432,P<0.001）,累计登记总数居前三位的分别是长沙市、湘西州、衡阳市。2012-2017年登记学生肺结核患者来源以转诊为主（占38.8%）,99.8%患者接受抗结核治疗,诊断治疗以涂阴患者、非重症、非耐药、初治患者为主,分别占67.9%、95.2%、99.5%、99.3%。结论应加强学校结核病防治工作,加强对高中和大学入学新生的结核病筛查,定期开展学校结核病知识的宣传,提高学校结核病防治的意识。     

沈阳浑南区2012—2016年肺结核流行特征分析

目的了解辽宁省沈阳市浑南区2012—2016年肺结核病流行病学特征,发现浑南区肺结核病重点防治区域及防治人群,为制定结核病防治策略和确定防范重点提供依据。方法对沈阳市浑南区2012—2016年肺结核资料进行分析,利用χ2检验验证不同年份和不同性别间肺结核发病差异。结果 2012—2016年沈阳市浑南区共报告肺结核病例1 088例,年均发病率为48.65/10万,总体呈下降趋势;2012—2016年各年发病率分别为72.34/10万、53.81/10万、37.70/10万、40.12/10万、39.26/10万,各年发病率差异有统计学意义(χ2=80.049,P<0.001);男女性年均发病率分别为95.76/10万、39.30/10万,差异有统计学意义(χ2=193.865,P<0.001);发病年龄主要集中在20~29岁,占22.98%;职业因素中,病例集中在前3位的分别为家务及待业、农民和学生,分别占45.04%、30.51%、12.87%,共占总发病人数的88.42%;病例多集中在人口密集地区,首位的是五三街道(24.17%)。结论2012—2016年沈阳市浑南区结核病呈下降趋势。发病的重点人群集中在20~29岁、男性、家务及待业群体,且病例在五三街道分布较多,应针对以上三间分布特征采取针对措施。     

上腭黏膜长期不愈溃疡1例

1临床资料邹XX,男性,43岁,2004年9月发现左腭咽部溃疡伴疼痛,渐增大,疼痛加重,于外院就诊,取活检,病理示“黏膜肉芽肿性炎”。经一般抗炎治疗无效,症状进行性加重,2004年12月来我院就诊。患者平素体健,否认系统性疾病及传染病史。检查:患者面部对称,开口度一指半,口内25—28缺失,上腭见大面积溃疡,前起上颌硬区,后达软腭后缘,外侧越过左牙槽嵴达颊黏膜咬合线处,内侧越过中线约1 cm,右侧翼下颌皱襞处见散在溃疡,溃疡暗红色,无分泌物。右侧颌下区扪及数枚直径约0.5 cm淋巴结,质软,可活动,无压痛。实验室及特殊检查:白细胞4.1×109个/L,中性…     

口腔颌面部结核误诊原因临床分析

目的：分析口腔颌面部结核的误诊原因。方法：对13例口腔结核病误诊病例的误诊原因进行分析。结果：口腔颌面部结核病发病部位、临床表现多样化，容易导致误诊。结论：口腔颌面部结核病确诊主要靠病理检查，复杂病例需多种方法综合分析，必要时应进行抗结核诊断性治疗。