结核分枝杆菌/利福平耐药基因联合结核感染T细胞斑点检测在耐药结核性胸膜炎中的应用价值

目的 探讨结核分枝杆菌/利福平耐药基因检测(Xpert MTB/RIF)联合结核感染T细胞斑点检测(T-SPOT.TB)对耐药性结核性胸膜炎诊断及治疗的价值.方法 选取2014年1月至2019年12月河北省胸科医院收治的62例结核性胸膜炎患者为结核性胸膜炎组,选择同期来河北省胸科医院院救治的非结核性胸膜炎患者60例为对...     

HIV合并结核杆菌感染患者病原菌分布情况及其耐药性分析

目的 调查HIV合并结核感染患者体内的病原菌分布情况,并对患者的耐药情况进行分析。 方法 收集2014年1月—2016年1月河南省传染病医院收治的HIV/MTB双重感染及单纯结核患者136例,根据患者的感染情况将患者分为3组,56例HIV/MTB双重感染患者为HIV/MTB组,40例结核患者为MTB组,40例AIDS患者为HIV组。对3组患者进行标本采集,在MGIT管内开展相应的前处理后接种,采用绝对浓度法对培养阳性的菌株实施耐药性检测。统计患者体内的病原菌分布情况,并对其耐药性进行评价比较,记录实验结果,进行统计学分析。 结果 3组患者的一般临床资料均无结核病史。3组患者的性别、年龄等资料比较差异无统计学意义(P>0.05)。HIV/MTB组患者成功分离出菌株38例,其检出阳性率为67.86%,共分离出菌株83株,部分病原菌分布与MTB组和HIV组比较,差异存在统计学意义(P<0.05)。MTB组与HIV组患者成功分离出菌株22例、24例,其检出阳性率分别为56.41%、58.54%,共分离出菌株分别为39株、41株,2组患者均易感染革兰阴性菌,与HIV/MTB组不同,且革兰阳性菌对3组患者的感染能力较低。HIV/MTB组中有2例(3.57%)对RFP、INH、OFL、KAN均耐药,而MTB组和HIV组不存在。HIV/MTB组总初始耐药(包括耐INH、耐SM)与MTB组和HIV组比较,差异有统计学意义(P<0.05)。 结论 在HIV合并结核感染患者治疗时,应选择联合用药治疗,以针对革兰阴性致病菌为主,还应同时考虑真菌、病毒、耶氏肺孢子菌等病原体。      

GeneXpert Mtb/RIF检测技术在临床耐药结核病诊断中的应用价值

目的 评估GeneXpert Mtb/RIF检测技术在临床耐药结核病诊断中的应用效果。方法 收取240例结核病住院患者的晨痰样本分别进行痰涂片镜检、MGIT960液体培养及GeneXpert Mtb/RIF快速检测,对于MGIT960液体培养与GeneXpert同为阳性的样本进一步进行MGIT960药敏检测。以MGIT960液体法作为金标准,评估GeneXpert Mtb/RIF检测技术的敏感性和特异性以及Kappa值。结果 224例有效样本中涂片镜检阳性检测率为26.8%,MGIT960液体培养阳性检出率为45.1%,GeneXpert检测阳性检出率为46.9%;以MGIT960液体培养作为金标准,涂片镜检法的敏感度为59.4%,特异度为75.0%,GeneXpert检测法敏感度为91.1%,特异度为92.4%;以MGIT960药敏检测为金标准,GeneXpert检测法与之相比两种方法的一致性为96.7%,敏感度为92.3%,特异度为98.5%。结论 GeneXpert Mtb/RIF检测技术是一个敏感、特异和快速有效方法,有利于结核病的早期诊断。     

Consensus statement. Global burden of tuberculosis: estimated incidence, prevalence, and mortality by country. WHO Global Surveillance and Monitoring Project.

OBJECTIVE: To estimate the risk and prevalence of Mycobacterium tuberculosis (MTB) infection and tuberculosis (TB) incidence, prevalence, and mortality, including disease attributable to human immunodeficiency virus (HIV), for 212 countries in 1997. PARTICIPANTS: A panel of 86 TB experts and epidemiologists from more than 40 countries was chosen by the World Health Organization (WHO), with final agreement being reached between country experts and WHO staff. EVIDENCE: Incidence of TB and mortality in each country was determined by (1) case notification to the WHO, (2) annual risk of infection data from tuberculin surveys, and (3) data on prevalence of smear-positive pulmonary disease from prevalence surveys. Estimates derived from relatively poor data were strongly influenced by panel member opinion. Objective estimates were derived from high-quality data collected recently by approved procedures. CONSENSUS PROCESS: Agreement was reached by (1) participants reviewing methods and data and making provisional estimates in closed workshops held at WHO's 6 regional offices, (2) principal authors refining estimates using standard methods and all available data, and (3) country experts reviewing and adjusting these estimates and reaching final agreement with WHO staff. CONCLUSIONS: In 1997, new cases of TB totaled an estimated 7.96 million (range, 6.3 million-11.1 million), including 3.52 million (2.8 million-4.9 million) cases (44%) of infectious pulmonary disease (smear-positive), and there were 16.2 million (12.1 million-22.5 million) existing cases of disease. An estimated 1.87 million (1.4 million-2.8 million) people died of TB and the global case fatality rate was 23% but exceeded 50% in some African countries with high HIV rates. Global prevalence of MTB infection was 32% (1.86 billion people). Eighty percent of all incident TB cases were found in 22 countries, with more than half the cases occurring in 5 Southeast Asian countries. Nine of 10 countries with the highest incidence rates per capita were in Africa. Prevalence of MTB/HIV coinfection worldwide was 0.18% and 640000 incident TB cases (8%) had HIV infection. The global burden of tuberculosis remains enormous, mainly because of poor control in Southeast Asia, sub-Saharan Africa, and eastern Europe, and because of high rates of M tuberculosis and HIV coinfection in some African countries.     

HIV/TB in India: a public health challenge

The impact of HIV/AIDS epidemic on the epidemiology of TB worldwide is being noted with growing concern. Patients with HIV are more susceptible to opportunistic diseases including TB. The risk of development of TB in HIV-infected patients in India is 6.9/100 person-years compared to a 10% lifetime risk of developing TB in an HIV negative individual with Mycobacterium tuberculosis. Treatment with DOTS significantly prolongs the life of HIV-infected persons with TB. The Government of India emphasised the need for strengthening collaboration between TB and AIDS control programmes for better management of HIV-infected patients with TB. Areas with higher prevalence of HIV infection have been prioritised the RNTCP coverage and most are already implementing the RNTCP. The basic purpose of HIV-TB programme co-ordination is to ensure optimal synergy between the two programmes for prevention and control of both the diseases.     

免疫层析法检测MPT64蛋白在结核与非结核分枝杆菌鉴定中的临床应用价值

目的评价免疫层析法检测MPT64蛋白鉴别结核与非结核分枝杆菌的临床应用价值。方法采用免疫层析法检测201株分枝杆菌,其中包括4株结核分枝杆菌复合群(mycobacterium tuberculosis complex,MTC)标准株、135株结核分枝杆菌(mycobacterium tuberculosis,MTB)临床分离株、17株非结核分枝杆菌(nontuberculosis mycobacterium,NTM)标准株和45株NTM临床分离株的MPT64蛋白。结果 4株MTC标准菌株和135株MTB临床分离株中,138株MPT64蛋白检测阳性,1株检测为阴性,敏感性为99.3%(138/139),17株NTM标准株和45株NTM临床分离株MPT64蛋白检测均为阴性,特异性为100%(62/62),201株结核和非结核分枝杆菌MPT64蛋白检测的准确度为99.5%(200/201)。结论应用免疫层析法检测MPT64蛋白鉴别结核与非结核分枝杆菌敏感性高,特异性强,方法简便、快速、准确,具有良好的临床应用前景。     

Non-Tuberculous Mycobacterial Pulmonary Disease identified during community-based screening for Mycobacterium Tuberculosis: a case report

There is a rising prevalence of Non-Tuberculous Mycobacterial (NTM) disease in sub-Saharan Africa identified on culture specimens. However, distinguishing mycobacterial colonisations from infection from identified NTMs on culture in the sub-Saharan Africa setting remains to be established. A 49-year-old man presented with the cardinal symptoms of tuberculosis (TB) in a community TB prevalence survey in Blantyre, Malawi. Mycobacteriology was atypical, prompting a line probe assay which revealed Mycobacterium avium complex (MAC) species.The epidemiology of Mycobacterium tuberculosis complex (MTBC) is better known than that of NTM. Up-scaling culture and speciation may be a solution to this gap in knowledge of the burden of disease of NTM. Like most resource-poor settings, TB culture is not routinely done in the diagnosis and management of TB in Malawi. Furthermore, the treatment of NTM is not analogous to that of MTBC. The multi-drug regimens used for NTM disease treatment includes a newer macrolide (azithromycin, clarithromycin), ethambutol, and rifamycin, and require prolonged durations of therapy aimed at facilitating clearance of the mycobacteria and minimizing the emergence of drug resistance. Clinicians must thus be aware of this rising burden of NTM disease and consider other diagnostic options to better investigate this disease in patients.     

61例HIV感染者与580例结核病人双重感染调查

目的 调查广西HIV感染者中结核病（TB）患病率以及结核病患者中HIV感染检出率.方法 对61例HIV感染者及580例结核病患者进行双重感染检出率及其影响因素的问卷调查,并查看病例.结果 61例HIV感染者中结核病患病率为11.5%（肺结核为8.2%,肺外结核为3.5%）,580例结核病患者HIV感染检出率为2.8%.结论 HIV感染者发生结核病的机率高;结核病患者中HIV感染检出率高于一般人群,应在两类人群中加强艾滋病和结核病相关知识的宣传教育.     

赣榆县结核杆菌与非结核杆菌感染情况及菌株耐药分布研究

目的了解本地区典型肺结核病人结核分枝杆菌与非结核分枝杆菌感染及菌株耐药分布情况。方法收集2008年6月-2009年底我县典型肺结核病人痰标本,进行直接痰涂片检查、痰菌培养、耐药检测及结核分枝杆菌及非结核杆菌鉴定。结果 345例痰标本检出306例菌株。结核分枝杆菌288株,占94.12%,对H、R、E、S4种一线抗痨药耐药率分别为18.06%、18.40%、8.33%、21.53%;非结核分枝杆菌18株,对H、R、E、S4种一线抗痨药耐药率分别为100%、33.3.3%、33.33%、100%。结论本地区结核病人对一线抗痨药物耐药情况较为严重,非结核分枝杆菌感染比例较高,在今后工作中值得重视。     

3种常规结核分枝杆菌及耐药突变检测方法的对比研究

目的 评价3种实验室常规检测方法用于诊断肺结核患者结核分枝杆菌（Mycobacterium tuberculosis,MTB）及耐药突变情况的应用价值。 方法 回顾性分析经临床确诊的肺结核患者246例,应用Gene Xpert MTB/RIF技术（Xpert法）、BD960液体快速培养法（BD960法）联合快速药物敏感试验（药敏试验）、MTB核酸检测联合MTB耐药基因（DNA芯片法）检测诊断 MTB及耐药突变检出情况。 结果 BD960法对MTB的阳性检出率低于MTB核酸检测和Xpert法,差异有统计学意义（P＜0.05）。药敏试验、MTB耐药基因检测和Xpert法利福平耐药检出率差异无统计学意义（P＞0.05）。与药敏试验利福平耐药结果相比,MTB耐药基因检测和Xpert法的敏感度、特异度、阳性预测值、阴性预测值、准确度和约登指数分别为91.30%、95.32%、84.00%、97.60%、94.47%、86.63%和95.65%、93.57%、80.00%、98.77%、94.01%、89.22%,X-pert 法和MTB耐药基因检测利福平耐药结果高度一致（Kappa值=0.833,0.840）。药物敏感试验和MTB耐药基因检测异烟肼耐药检出率差异无统计学意义（P＞0.05）。 结论 BD960法、Xpert法和MTB核酸检测均能准确检测样本中的MTB,药敏试验、MTB耐药基因检测和Xpert法能分析MTB利福平（异烟肼）耐药情况,MTB耐药基因检测和Xpert法且具有较高的敏感度和特异度,可结合实际需求在耐多药结核病防治中应用。     

陕西省TB与HIV/AIDS双向筛查及TB/HIV患者抗结核治疗转归队列分析

目的 了解陕西省TB/HIV (结核分枝杆菌 /艾滋病病毒)双重感染防治工作。提高TB/HIV发现、治疗和管理力度,控制结核病和艾滋病的进一步传播,保护公众健康。方法 收集整理和分析2010—2017年陕西省各地上报的《TB/HIV 双重感染防治管理工作年度报表》。结果 2010—2017年,累计接受HIV抗体检测的结核病患者43 304例,检测率25.10%,HIV检测阳性数16例,阳性检出率0.04%;同期,HIV /AIDS患者中,新检出的HIV/AIDS中接受X线胸片或查痰9 666人,结核病检查率76.81%;诊断TB/HIV双重感染患者224人,结核病患者检出率2.32%;既往的HIV/AIDS中接受X线胸片或查痰24 277人次,结核病检查率80.43%;诊断TB/HIV双重感染患者105人,结核病患者检出率0.43%;结核中筛HIV/AIDS,新检出HIV/AIDS中筛结核,既往HIV/AIDS中筛结核,三组检出率两两进行对比,差别均有统计学意义（P<0.001）;共进行抗结核治疗263例,抗结核治疗率76.23%;进行抗病毒治疗256例,抗病毒治疗率74.20%;抗结核治疗的TB/HIV患者中治愈35例（17.59%）,完成疗程率141例（70.85%）,结核死亡1例（0.50%）,非结核死亡15例（7.54%）,丢失2例（1.00%）,其他5例（2.51%）。结论 双向筛查是切实有效的早期发现TB/HIV的方法,有利于提高TB/HIV的早期发现,并能提高TB/HIV双重感染患者结核病的治疗成功率、降低结核病死亡率,有效的控制TB/HIV双重感染疫情。     

重庆市流行非结核分枝杆菌菌种鉴定及感染人群特征

目的 了解重庆地区非结核分枝杆菌（NTM）流行的优势菌种和NTM感染人群的特征。方法 回顾分析2016年7月—2017年12月在重庆市公共卫生医疗救治中心就诊,并经分枝杆菌菌种PCR-反向点杂交法鉴定为NTM和NTM混合感染的患者资料。结果 95例NTM感染病例,单一NTM感染共 80例,其中快生长分枝杆菌（RGM）2种,脓肿分枝杆菌31例（38.75%）,偶发/猪分枝杆菌14例（17.50%）;慢生长分枝杆菌（SGM）5种,胞内分枝杆菌25例（31.25%）,鸟分枝杆菌5例（6.25%）,戈登分枝杆菌3例（3.75%）,堪萨斯分枝杆菌2例（2.50%）;分枝杆菌混合感染共15例,其中TB和NTM 混合感染11例, NTM混合感染4例。单一NTM感染病例中,男性多于女性,胞内分枝杆菌感染者男性比例最高。而NTM混合感染者中,性别比例均接近1∶1。单一NTM感染者主要集中于20~<30岁和40~<60岁之间,而TB和NTM混合感染者在30~<50岁之间最多。脓肿分枝杆菌感染者主要在20~59岁之间,胞内分枝杆菌感染者主要分布于40~<79岁之间,偶发/猪分枝杆菌的患者集中于60岁以下。结论 重庆市NTM的主要流行优势种类以脓肿分枝杆菌和胞内分枝杆菌为主,感染者男性多于女性,以20~<30岁和40~<60岁之间最多,对于不同种类的NTM,感染者的年龄分布和性别比例有所不同。     

HIV-TB: the 'cursed duet'

Tuberculosis is the most common infection among HIV-infected patients in India. More deaths were reported due to tuberculosis in AIDS patients in pre-antiretroviral therapy era. HIV is the strongest of all known, risk factors for the development of TB. Tuberculosis can develop at any stage of the HIV disease. Extrapulmonary tuberculosis is more common and constitues half of the cases in HIV-infected individual with TB. Hilar lymphadenopathy is frequently observed. TB in HIV frequently poses a diagnostic challenge. Acid-fast bacillus demonstration on sputum smear microscopy is the main-stay laboratory investigation for TB. In addition to antituberculous therapy, antiretroviral therapy must be initiated in HIV-infected individual with TB. Early referrals to the RNTCP and ART programmes are the best option for management.     

Human Immunodeficiency Virus Infection-Associated Mortality during Pulmonary Tuberculosis Treatment in Six Provinces of China

Objective To investigate the risk factors attributable to tuberculosis-related deaths in areas with human immunodeficiency virus (HIV) infection epidemics.
Methods A prospective cohort study of newly registered patients in tuberculosis (TB) dispensaries in six representative Chinese provinces was conducted from September 1, 2009 to August 31, 2011. Risk factors for TB-associated death were identified through logistic regression analysis.
Results Of 19,103 newly registered pulmonary TB patients, 925 (4.8%) were found to be HIV-positive. Miliary TB and acid-fast bacillus smear-negative TB were more common among these patients. Out of a total of 322 (1.7%) deaths that occurred during TB treatment, 85 (26%) of the patients were co-infected with HIV. Multivariate analysis revealed that HIV infection was the strongest predictor of death [adjusted odds ratio (aOR) 7.86]. Other significant mortality risk factors included presentation with miliary TB (aOR 4.10; 95% confidence interval: 2.14-7.88), ≥35 years of age (aOR 3.04), non-Han ethnicity (aOR 1.67), and farming as an occupation (aOR 1.59). For patients with TB/HIV co-infection, miliary TB was the strongest risk factor for death (aOR 5.48). A low CD4 count (≤200 cells/μL) (aOR 3.27) at the time of TB treatment initiation and a lack of antiretroviral therapy (ART) administration (aOR 3.78) were also correlated with an increased risk of death.
Conclusion Infection with HIV was independently associated with increased mortality during TB treatment. Offering HIV testing at the time of diagnosis with TB, early TB diagnosis among HIV/acquired immunodeficiency syndrome patients, and the timely provision of ART were identified as the key approaches that could reduce the number of HIV-associated TB deaths.     

艾滋病与非结核分枝杆菌的双重感染研究进展

非结核分枝杆菌（non-tuberculous mycobacterium,NTM）感染是指除了结核分枝杆菌复合群和麻风分枝杆菌以外的分枝杆菌引起的感染。属于条件致病菌,常见于有基础疾病和存在免疫缺陷的患者,最好发于HIV感染者,被认为是引起艾滋病患者发生常见机会性感染的病原菌之一,尤其常见于CD4⁺T细胞小于50个/μL的艾滋病患者。近年来,由非结核分枝杆菌引起的感染在全球各地的报道呈现明显上升趋势,严重威胁着人类尤其是艾滋病患者的健康。由于NTM感染的相关临床症状、体征以及影像学表现等缺乏典型,容易被误诊为结核感染,且病死率高。故了解NTM的病原学分类、感染途径、HIV患者感染NTM后两者之间的相互作用机制,以及该病相关临床表现、实验室诊断方法和目前关于该病的治疗方法等显得至关重要,因此本综述就上述内容的研究进展做一概述。     

大连市住院结核病人HIV抗体检测结果调查

目的:了解大连结核病人群中HIV感染情况,为TB∕HIV双重感染防治工作提供依据。方法:采用连续抽样的方法,对大连市2009年1月1日～2011年12月31日住院的结核病人,用酶联免疫吸附试验(ELISA)进行HIV初筛,初筛阳性者于市疾控做免疫印迹(western-blot)确认试验。结果:调查住院肺结核病人7 726例,HIV阳性者14例,感染率0.18%;HIV感染病人年龄在20～58岁,男性组HIV感染率0.2%,女性组感染率0.1%;不同年龄活动性结核病人中HIV感染者主要集中在青壮年,占78.6%;TB∕HIV双重感染逐年呈上升趋势。结论:结核病专科医院应重视HIV抗体检测,对控制TB/HIV双重感染有重要意义。     

2013—2021年杭州某综合医院非结核分枝杆菌肺病流行状况分析

目的 分析杭州市结核病定点诊治医院2013—2021年非结核分枝杆菌（nontuberculosis mycobacteria,NTM）肺病的流行状况,为杭州市该病的临床防治诊疗及流行病学提供依据。方法 收集2013—2021年浙江大学医学院附属杭州市胸科医院结核科及呼吸与危重症医学科收治的疑似肺结核患者,经抗酸杆菌涂片及BACTEC MGIT960确诊为分枝杆菌感染,采用实时荧光聚合酶链反应（polymerase chain reaction,PCR）检测结核分枝杆菌复合群（Mycobacterium tuberculosis complex,MTB）与NTM的菌群鉴定,对鉴定为NTM的菌株采用HAIN基因分型鉴定法及DNA微阵列技术进行菌种鉴定,并对感染者的相关资料进行总结分析。结果 2013—2021年,从37 520例疑似肺结核患者标本中分离出NTM菌株1257株,检出率从2013年的0.8%上升到2021年的6.7%。患者中男性占50.76%,女性占49.24%。年龄分布上,60~79岁的中老年患者最多,占55.0%。2013年检出3种NTM菌种,分别是胞内分枝杆菌、脓肿分枝杆菌和龟/脓肿分枝杆菌;2021年菌种分布达13种,前三位分别是胞内分枝杆菌、龟/脓肿分枝杆菌和鸟分枝杆菌。结论 2013—2021年杭州地区NTM检出率持续升高,感染人群以男性、60~79岁的中老年为主,感染菌种以胞内分枝杆菌、龟/脓肿分枝杆菌和鸟分枝杆菌为主。     

Purified protein derivative skin testing on HIV/AIDS patients and logistic regression analysis of its risk factors

Objective： To understand the reactivity of purified protein derivative skin test（PPD test） in HIV-infected persons and to determine the influential factors associated with PPD. Methods： 174 HIV/AIDS patients registered in the local center for disease control and prevention（CDC） participated this study from April to June in 2006. Questionnaire,CD4 count and thoracic roentgenogram were performed for all participants. Results： In this study, response rate of questionnaires was 83.65%. The majority of these participants had a different degree of immunodeficiency that accounted for 93.64%. Female patients had a higher CD4 count than that of males. The total positive rate of PPD was 38.15%. Analysis of single factor in our study indicated that CD4 count, previous tubereulosis history, tuberculosis contact history and thoracic roentgenogram manifestation of patients were related to their PPD diameters. Further analysis of multiple factors also supports the previous conclusion that CD4 count and previous tuberculosis history of patients were risk factors in the PPD test. Conclusion： The PPD test of HIV/AIDS patients could be affected by several factors. For persons infected with HIV, the confirmation of latent tuberculosis infection （LTBI） should be considered the combination effect of previous MTB infection and body cellular immune function.     

Changes in Escherichia coli resistance to co-trimoxazole in tuberculosis patients and in relation to co-trimoxazole prophylaxis in Thyolo,Malawi

In Thyolo district, Malawi, an operational research study is being conducted on the efficacy and feasibility of co-trimoxazole prophylaxis in preventing deaths in HIV-positive patients with tuberculosis (TB). A series of cross-sectional studies were carried out to determine i) whether faecal Escherichia coli (E.coli) resistance to co-trimoxazole in TB patients changed with time and ii) whether the resistance pattern was different in HIV positive TB patients who were taking co-trimoxazole prophylaxis. Co-trimoxazole resistance among E.coli isolates in TB patients at the time of registration was 60% in 1999 and 77% in 2001 (p<0.01). Resistance was 89% among HIV-infected TB patients (receiving co-trimoxazole), while in HIV negative patients (receiving anti-TB therapy alone) it was 62% (p<0.001). The study shows a significant increase of E.coli resistance to co-trimoxazole in TB patients which is particularly prominent in HIV infected patients on co-trimoxazole prophylaxis. Since a high degree of plasmid-mediated transfer of resistance exists between E.coli and the Salmonella species, these findings could herald limitations on the short and long term benefits to be anticipated from the use of co-trimoxazole prophylaxis in preventing non-typhoidal salmonella bacteraemia and enteritis in HIV infected TB patients in Malawi.