无家可归者多地点结核病传播

地点:2002-2003年,在华盛顿King县,结核病(TB)在多个收容所的人群中大规模爆发。目的:控制结核病在多个地点的传播。设计:2002年,对收容所病人的接触者进行筛查,作结核菌素皮试(TSTs)和症状回顾。根据这些筛查的结果,确定和优选传播的地点。2003年,对暴露于这些点的队列作彻底的筛查(例如,症状回顾, TST,胸部X线检查[CXR],痰检和痰培养)。利用PCR为基础的方法对从病人那里分离出来的结核分枝杆菌作基因分型,以快速确认爆发相关病人。结果:2002-2003年,King县313例确诊的病人中有48例(15％)与爆发相关;通过基因分型,47例培阳病人分离出和爆发相匹配的菌株。3个收容所由于在2002年接纳的病人超过12人,所以人群中TST阳性率(约30％)高于收容所中的一般水平(7％)。用一个痰培养筛查接触者和CXR发现结核病人的敏感度相似(分别为77％和62％)。结论:一个广泛的资源密集的途径可能有助于控制疾病的传播。这次爆发突显出无家可归者的脆弱性和在城市维持强有力的结核病规划的必要性。     

无家可归者多地点结核病传播

地点:2002-2003年,在华盛顿King县,结核病(TB)在多个收容所的人群中大规模爆发.目的:控制结核病在多个地点的传播.设计:2002年,对收容所病人的接触者进行筛查,作结核菌素皮试(TSTs)和症状回顾.根据这些筛查的结果,确定和优选传播的地点.2003年,对暴露于这些点的队列作彻底的筛查(例如,症状回顾,TST,胸部X线检查[CXR],痰检和痰培养).利用PCR为基础的方法对从病人那里分离出来的结核分枝杆菌作基因分型,以快速确认爆发相关病人.结果:2002-2003年,King县313例确诊的病人中有48例(15%)与爆发相关;通过基因分型,47例培阳病人分离出和爆发相匹配的菌株.3个收容所由于在2002年接纳的病人超过12人,所以人群中TST阳性率(约30%)高于收容所中的一般水平(7%).用一个痰培养筛查接触者和CXR发现结核病人的敏感度相似(分别为77%和62%).结论:一个广泛的资源密集的途径可能有助于控制疾病的传播.这次爆发突显出无家可归者的脆弱性和在城市维持强有力的结核病规划的必要性.     

伦敦无家可归者中的结核病：一个关于筛检和治疗结核病的有效模式

背景伦敦南区无家可归者收容所。目的发展一种适宜于在无家可归者中筛检肺结核病人的有效方法。设计用观察性研究评价筛检方法的可接受性、病例检出率和治疗完成情况。筛检方法包括肺结核病症状问卷、结核菌素试验和在现场冲洗、判读的X线胸片检查。结果1O名受检者(0.5％)被确定为活动性肺结核;其中7人为50岁以上的男性白人。结核病症状问卷调查作用甚小。9名病例是通过X线胸片检查发现,而只有3名病例进行了结核菌素试验。在检出的10名活动性肺结核病例中8人完成了治疗。另外5名结核菌素试验强阳性,但胸片检查正常的受检者开始了预防性药物治疗。结论X线胸片检查是最有用的筛检方法,如果将之针对于高危人群将是有效的。采取激励方法似乎能提高筛检的接受率。结核菌素试验对于鉴别需要药物预防或BCG免疫接种的受检者有意义。只要对受检者进行正确的管理,病人会有很好的依从性。     

中国结核病诊疗现状及展望

中国是全球结核病高负担国家,结核病疫情较重。中国用于潜伏性结核感染诊断工具是结核菌素纯蛋白衍生 物(PPD) 试验以及γ- 干扰素释放试验(IGRA),其中IGRA 较PPD 试验具有一定优势。中国结核病诊断技术包括 细菌学、分子生物学、病理学、影像学以及血清学等,其中分子生物学技术是近年来出现的新的诊断技术。中国初复 治肺结核患者多采用标准化治疗方案,耐药结核病治疗方案应遵循国际原则。未来结核病诊断治疗应不断采用新技 术,并加强国际合作。     

河南省WHO结核病耐药监测报告

目的 １９９６年４月－１２月河南省作为ＷＨＯ全球耐药监测网第一个中国成员，在全省３０个点进行了结核病耐药监测，以提供结核病控制参考资料。方法 按ＷＨＯ＝ＩＵＡＴＬＤ耐药监测指南实施。随机整群抽样３０个监测点，用抗结核药史〈１月及≥１月的涂阴肺结核顺序入选前对经史复核，Ｌ－Ｊ培养基培养，比例法作药敏ＳＨＲＥ４药接受南韩ＳＲＬ空及资料分析用ＷＨＯＳＤＲＴＢ软件分析。Ｘ＾２检验等统计学处理。结果 入选１     

应用结核病DNA疫苗治疗小鼠耐多药结核病的研究

目的 研究结核分枝杆菌Ag85A质粒DNA疫苗单独或联合药物治疗小鼠耐多药结核病的效果,为建立耐多药结核病的免疫治疗新策略和新方案奠定基础.方法 用结核分枝杆菌高耐利福平、低耐异烟肼临床分离株HB361尾静脉注射17～19 g的6～8周龄雌性BALB/C小鼠后,将小鼠随机分为6组,每组10只.感染后第2天开始,分别用pVAX1载体(A组)、利福平(B组)、吡嗪酰胺(C组)、Ag85A质粒DNA疫苗(D组)、Ag85A质粒DNA疫苗联合利福平(E组)、Ag85A质粒DNA疫苗联合吡嗪酰胺(F组)治疗60 d.治疗结束后4周,分别取肺、肝和脾观察病理改变,称取重量,做菌落计数.结果 小鼠感染4周后,肺内菌量达到1.5×107 CFU,脾内菌量达到1.1×106 CFU.A、B组小鼠死亡率均为10%,其余各组小鼠均存活.治疗结束后4周,肺组织病理显示,各治疗组肺组织病变均有不同程度减轻,病变局限,可见正常的肺泡结构,肺泡轮廓相对清晰.与A组比较,C、D、E、F组肺组织菌落数分别减少了1.18、1.35、1.38、1.08 logs,脾脏菌落数分别减少了0.91、1.00、1.26、1.03 logs(P＜0.01).结论 结核分枝杆菌Ag85A质粒DNA疫苗单独或联合药物治疗小鼠耐多药结核病均有显著疗效.Ag85A质粒DNA疫苗与抗结核药物联合治疗是治疗耐多药结核病的最有前途的免疫策略.     

西安市结核病的病原学调查

目的调查西安市结核病的分枝杆菌菌种类型及其分布。方法采用抽样调查方法收集结核病患者的痰标本及其背景资料,用痰涂片、痰培养以及PCR方法检测,用鉴别培养基对分离菌株进行菌种鉴定。结果共收集574例拟诊结核病病例,实验室检测1602份痰标本。采用痰涂片、痰培养和PCR3种方法联合应用,阳性者260例,分枝杆菌检测阳性率45.30。137例分枝杆菌培养阳性者中,结核分枝杆菌复合体占73.72,其中结核分枝杆菌和牛分枝杆菌分别为67.88和5.84;11.68为非结核分枝杆菌,14.60为混合感染,其中11.68为结核分枝杆菌与牛分枝杆菌,2.92为结核分枝杆菌与非结核分枝杆菌混合感染。结论西安市结核病的致病菌复杂,包括结核分枝杆菌、牛分枝杆菌和非结核分枝杆菌,尤其是非结核分枝杆菌混合感染应予以高度重视。     

试论耐多药结核病的传播

结核病目前仍然是危害人类健康的重大传染病之一,耐多药(multidrug resistant,MDR)和广泛耐药结核病(extensively drug-resistant,XDR)的出现,使全球结核病控制形势变得更加严峻。耐药结核病最初是在结核病人的治疗过程中由于各种人为的因素,如单一用药、药物的质量、病人的依...     

应用结核病DNA疫苗治疗小鼠耐多药结核病的研究

Objective To establish foundation for new strategy and program on immune therapy of multi-drug resistant tuberculosis (MDR-TB) by studying the therapeutic effects of Mycobacterium tuberculosis Ag85A plasmid DNA vaccine alone or combined with drugs on MDR-TB mice. Methods Sixty 6-8 weeks old female BALB/C mice were injected via tail vein with clinical isolate Mycobacterium tuberculosis HB361 which was highly resistant to rifampin (RFP) and lowly resistant to isoniazid. The mice were randomly divided into six groups, ten mice in each group. From the second day after infection,the mice respectively received pVAX1 vector (group A), RFP (group B), pyrazinamide (PZA) (group C),Ag85A plasmid DNA vaccine (group D), Ag85A plasmid DNA vaccine combined with RFP (group E),Ag85A plasmid DNA vaccine combined with PZA (group F) for sixty days. Four weeks after the end of treatment,the lung, liver and spleen of the mice were taken and their pathological changes, weight and colony count were examined. Results Four weeks after infection, the numbers of bacteria in lung and spleen of the mice reached up to 1.5×107 CFU and 1.1 × 106 CFU,respectively. The death rates of mice in group A and group B were both 10% ,and the mice in other groups were alive. Four weeks after the end of treatment,lung pathology in the treated groups showed that the lung lesions were slight and limited,normal alveolar structure were seen, and the profile of the alveoli was relatively clear. Compared with group A, group C, D, E, F reduced by 1.18,1.35,1.38,1.08 logs on the colony count of lung, and reduced by 0.91,1.00,1.26 and 1.03 logs on the colony count of spleen (P＜0.01), respectively. Conclusions Mycobacterium tuberculosis Ag85A plasmid DNA vaccine alone or combined with drugs has significant therapeutic effects on MDR-TB mice. Ag85A plasmid DNA vaccine combined with anti-tuberculosis drugs is the most promising immunization strategy for treatment of MDR-TB.     

Outbreak of tuberculosis in a homeless population involving multiple sites of transmission.

SETTING: During 2002-2003, a large outbreak of tuberculosis (TB) occurred among persons using multiple homeless facilities in King County, Washington. OBJECTIVE: To control the transmission of TB in multiple settings. DESIGN: In 2002, contacts exposed to patients in homeless facilities were screened using tuberculin skin tests (TSTs) and symptom review. Based on these screening results, sites of transmission were identified and prioritised, and exposed cohorts at these sites were offered intensive screening tests in 2003 (e.g., symptom review, TST, chest radiograph [CXR], sputum examination and culture). Mycobacterium tuberculosis isolates from patients were genotyped using PCR-based methods to identify outbreak-associated patients quickly. RESULTS: During 2002-2003, 48 (15%) of 313 patients diagnosed in King County were outbreak-associated; 47 culture-positive patients had isolates that matched the outbreak strain by genotyping. Three facilities visited by >12 patients in 2002 had a higher prevalence of TST positive results (approximately 30%) among clients compared with the background rate (7%) in the homeless community. Screening contacts with one sputum culture was as sensitive as CXR in detecting TB disease (77% vs. 62%, respectively). CONCLUSIONS: A comprehensive, resource-intensive approach likely helped to control transmission. This outbreak highlights the vulnerability of homeless populations and the need to maintain robust TB programs in urban settings.     

Outbreak of tuberculosis in a 2000-year-old Chinese population.

The molecular identification of Mycobacterium tuberculosis DNA in ancient human remains has been achieved mainly in mummies with macroscopic changes but not in the skeletons without bone tuberculosis. Using polymerase chain reaction studies, we identified mycobacterial DNA in 2000-year-old human skeletons without pathological changes. Our findings suggest that these people suffered from an outbreak of tuberculosis. Molecular examinations for mycobacterial DNA in the bone marrow of skeletons may contribute to the clarification of ancient diseases in old human populations.     

Analysis of Mycobacterium tuberculosis transmission patterns in a homeless shelter outbreak.

SETTING: From July 1997 through May 1998, ten tuberculosis (TB) cases were reported among men in a Syracuse New York homeless shelter for men. OBJECTIVE AND DESIGN: Investigation to determine extent of, and prevent further, transmission of Mycobacterium tuberculosis. RESULTS: Epidemiologic and laboratory evidence suggests that eight of the ten cases were related. Seven cases had isolates with matching six-band IS6110 DNA fingerprints; the isolate from another case had a closely related fingerprint pattern and this case was considered to be caused by a variant of the same strain. Isolates from eight cases had identical spoligotypes. The source case had extensive cavitary disease and stayed at the shelter nightly, while symptomatic, for almost 8 months before diagnosis. A contact investigation was conducted among 257 shelter users and staff, 70% of whom had a positive tuberculin skin test, including 21 with documented skin test conversions. CONCLUSIONS: An outbreak of related TB cases in a high-risk setting was confirmed through the use of IS6110 DNA fingerprinting in conjunction with spoligotyping and epidemiologic evidence. Because of the high rate of infection in the homeless population, routine screening for TB and preventive therapy for eligible persons should be considered in shelters.     

Recent transmission of tuberculosis involving retired patients

The reported incidence of tuberculosis (TB) in three different regions of Rio Grande do Sul State in Brazil varies considerably. We used IS6110-RFLP and spoligotyping methods to genotype Mycobacterium tuberculosis isolates obtained from 268 patients between 1998 and 2000 in order to assess the levels of recent transmission of TB in the three regions. The degree of clustering of the strain types did not differ among the three regions; neither did other characteristics such as demographic features, underlying medical conditions, or the proportion of resistant TB. As reported previously, male patients were at greater risk of developing TB and our data suggest that part of this may be related to the higher rates of recent transmission among them (P < 0.05). In addition, we found that retired patients were almost 3 times more likely to be infected with cluster-pattern strains than patients reporting any other occupation (P < 0.05), and more than 3 times more likely than non-retired patients in the same age group (P < 0.05) to be infected with cluster-pattern strains. We conclude that recent transmission is not a major factor contributing to the differences in TB incidence in the three regions of Rio Grande do Sul. The reason for the suggested high proportion of recent transmission TB cases among the retired people needs further studies.