High incidence of tuberculosis in prison officers in Zomba,Malawi

We conducted a study in four prisons in Zomba district, Malawi, to determine the tuberculosis case notification rate in prison officers during the year 2000. Of 201 prison staff, 9 (4.5%) were diagnosed with TB: 2 with smear-positive pulmonary tuberculosis (PTB), 4 with smear-negative PTB and 3 with extrapulmonary TB (EPTB). This incidence in prison officers (9/201) was significantly greater than the incidence in primary school teachers in a separate (unpublished) study in Malawi the previous year (78/4,289) (OR 2.58,[95% CI, 2.44 – 2.73], p <0.015). Expressed as annual TB case notification rates, the data for prison officers in these 4 prisons was 4,478 per 100,000, compared to 1,786 per 100,000 in teachers. There may be a high incidence of TB in prison officers. Further research needs to be carried out in this group to confirm these findings and to develop an occupational health service to reduce the risk of TB for these workers.     

Epidemiology of extra pulmonary tuberculosis in Eastern Sudan

Objective: To investigate the epidemiological factors associated with extra pulmonary tuberculosis(EPTB) in Kassala, Eastern Sudan.Methods: Patients infected with TB(pulmonary and extra-pulmonary) documented at the hospital were interviewed with a structured questionnaire used to gather socio-demographic information. The diagnosis of EPTB cases was based on presence of tuberculous granulomas in the histological samples, positive PCR to DNA of mycobacterium tuberculosis, radiological i ndings and l uid analysis suggestive of EPTB and clinical diagnosis with adequate response to anti-tuberculous therapy.Results: A total of 985 patients with TB were enrolled in the study, including 761(77.3%) with PTB and 224(22.7%) with EPTB. The mean age(SD) of patients with PTB and EPTB was 33.2(15.4) and 34.7(14.6) years respectively. The prevalence of EPTB was at(22.7%), with TB lymphadenitis 79(35.3%), marking the frequent form of EPTB followed by peritoneal TB 27(12.05%). While residence and occupation were not associated with EPTB, those with lower level of education(OR = 0.3; coni dence intervals(CI) = 0.2-0.5; P 0.001), female(OR = 8.7, CI = 4.9-15.1, P 0.001), non vaccination(OR=70.3, CI = 34.2-144.3, P 0.001), and non smoker(OR = 0.1; CI = 0.06-0.20; P 0.001), were associated with high prevalence of EPTB. Conclusions: Around one quarter of patients with TB in this study were more likely to have EPTB. Therefore, ef ective strategic plans regarding diagnostic procedures and control measures are needed to reduce the burden of the disease in Sudan.     

3- to 24-month Follow-up on COVID-19 with Pulmonary Tuberculosis Survivors after Discharge: Results from a Prospective,Multicenter Study

ObjectiveCoronavirus disease 2019 (COVID-19) and tuberculosis (TB) are major public health and social issues worldwide. The long-term follow-up of COVID-19 with pulmonary TB (PTB) survivors after discharge is unclear. This study aimed to comprehensively describe clinical outcomes, including sequela and recurrence at 3, 12, and 24 months after discharge, among COVID-19 with PTB survivors.MethodsFrom January 22, 2020 to May 6, 2022, with a follow-up by August 26, 2022, a prospective, multicenter follow-up study was conducted on COVID-19 with PTB survivors after discharge in 13 hospitals from four provinces in China. Clinical outcomes, including sequela, recurrence of COVID-19, and PTB survivors, were collected via telephone and face-to-face interviews at 3, 12, and 24 months after discharge.ResultsThirty-two COVID-19 with PTB survivors were included. The median age was 52 (45, 59) years, and 23 (71.9%) were men. Among them, nearly two-thirds (62.5%) of the survivors were moderate, three (9.4%) were severe, and more than half (59.4%) had at least one comorbidity (PTB excluded). The proportion of COVID-19 survivors with at least one sequela symptom decreased from 40.6% at 3 months to 15.8% at 24 months, with anxiety having a higher proportion over a follow-up. Cough and amnesia recovered at the 12-month follow-up, while anxiety, fatigue, and trouble sleeping remained after 24 months. Additionally, one (3.1%) case presented two recurrences of PTB and no re-positive COVID-19 during the follow-up period.ConclusionThe proportion of long symptoms in COVID-19 with PTB survivors decreased over time, while nearly one in six still experience persistent symptoms with a higher proportion of anxiety. The recurrence of PTB and the psychological support of COVID-19 with PTB after discharge require more attention.     

结核病人外周血T辅助细胞含量分析

目的分析结核病患者Th细胞含量变化与结核分枝杆菌感染的关系。方法抽取肺结核患者、肺外结核患者、肺癌患者和健康人2ml肝素钠抗凝静脉血,按说明书进行胞内和膜表面分子染色,染色的细胞经流式细胞仪分析分泌IL-17、IFN-γ、IL-4阳性的T细胞和CTLA-4、PD-1阳性的T细胞。结果肺结核、肺外结核和肺癌组Th17细胞含量高于健康组、Th2细胞含量低于健康组、Th1细胞含量呈下降趋势,但与健康组比较差异无统计学意义。因此,肺结核、肺外结核组Th1细胞含量与Th17细胞含量比值及Th2细胞含量与Th17细胞含量比值低于健康组。肺外结核组CTLA-4阳性的CD3+T细胞(CTLA-4+CD3+T含量)含量高于肺结核组、肺癌组和健康组,肺结核和肺癌组PD-1阳性的CD4+T细胞(PD-1+CD4+T细胞)含量高于健康组。肺结核组,CTLA-4+CD3+T含量与Th1细胞含量呈负相关(r=-0.48,P=0.014);肺外结核组,PD-1+CD4+T细胞含量与Th17细胞含量呈正相关(r=0.68,P=0.015)。结论活动性结核病患者Th17细胞含量升高。     

The prevalence of pulmonary tuberculosis among miners from the Karonga,Rumphi, Kasungu and Lilongwe Districts of Malawi in 2019

IntroductionMiners in sub-Saharan Africa have a greater risk of tuberculosis (TB) than any other working population in the world. In spite of the presence of large and vulnerable population of miners in Malawi, no previous study has aimed to assess the burden of TB among these miners. This study aimed to determine the prevalence of pulmonary tuberculosis (PTB) and health-seeking behaviour (HSB) in a population of miners in Malawi, and a range of associated factors. Our goal was to develop a method to identify missing cases of TB.MethodsWe conducted a cross-sectional study in the Karonga, Rumphi, Kasungu and Lilongwe districts of Malawi in 2019. We calculated frequencies, proportions, odds ratios (ORs) and their 95% confidence intervals (95% CIs), and used the chi-square test in STATA version15.1 to investigate the burden and magnitude of PTB in the mining sector. Bivariate and multivariate logistic regression models were also fitted for PTB and HSB.ResultsOf the 2400 miners approached, we were able to interview 2013 (84%). Of these, 1435 (71%) were males, 1438 (71%) had known HIV status and 272 (14%) had PTB. Multivariate analysis showed that the miners performing informal mining were 50% more likely to develop PTB compared with those in formal mining (adjusted odds ratio [AOR]=1.50, 95% CI: 1.10–2.05, P=0.01). A total of 459 (23% of 2013) miners had presumptive TB. Of these, 120 (26%) sought health care; 80% sought health care at health facilities. Multivariate analysis also showed that miners who experienced night sweats were less likely to seek health care compared with those without night sweats (AOR=0.52, 95% CI: 0.30–0.90, P=0.02).ConclusionThe prevalence of PTB was higher among miners than in the general population. Consequently, targeted TB screening programmes for miners may represent a suitable strategy to adopt if we are to end TB by 2030. Poor health-seeking behaviours among miners is worrisome and further qualitative research is necessary to understand the barriers to accessing health care in these settings.     

1979～2000年四次全国儿童结核病流行病学抽样调查分析

目的分析中国儿童结核病流行情况。方法总结从1979～2000年全国4次结核病流行病学抽样调查(流调)资料,并对儿童(0～14岁)结核病疫情进行分析。结果4次结核病流调0～14岁儿童结核感染率分别为8．8％、9．6％、7．5％和9．0％;1979、1990、2000年儿童活动性肺结核患病率分别为241．7／10万、172．1／10万、91．8／10万,儿童结核杆菌培养阳性(菌阳)肺结核患病率1990年、2000年为12．7／10万、12．3／10万,儿童痰涂片抗酸杆菌阳性(涂阳)肺结核患病率1979年、1990年、2000年分别为7．5／10万、7．5／10万、6．7／10万。结合人口资料,估算2000年约有2608万0～14岁儿童感染结核,活动性肺结核患儿约26．6万,菌阳肺结核患儿约3．6万,涂阳肺结核患儿约1．9万,分别占同期所有病例的4．5％、5．9％、1．8％、1．3％;4次流调城市及农村儿童结核感染率之比分别为1．8、1．8、1．7、1．2。结论1979～2000年,儿童结核感染率并没有很大的下降;儿童结核中菌阴肺结核患儿占有相当比例;儿童结核病疫情城乡差别正在缩小;用常规监测数据来代替大规模流调是趋势;在新的、更为有效的疫苗发明以前,卡介苗接种仍将是我国结核病控制工作的重要内容之一。     

Effect of COVID-19 lockdown on the pathway of care and treatment outcome among patients with tuberculosis in a rural part of northern India: a community-based study

Objectives: The coronavirus disease 2019 (COVID-19) pandemic affected routine healthcare services across all spectra, and tuberculosis (TB) care under the National Tuberculosis Elimination Program have been affected the most. However, evidence available at the community level is minimal. The clinical features, care cascade pathway, and treatment outcomes of TB patients pre- and during/post-COVID-19 pandemic lockdown in a rural community health block in northern India were assessed and compared.Materials and Methods: This was a retrospective cohort study that included all patients diagnosed with TB and initiated treatment under programmatic settings between January 1 and June 30, 2020, in a rural TB unit in northern India. The periods from January 1 to March 23 and March 24 to June 30 were marked as pre-lockdown and during/post-lockdown, respectively.Results: A total of 103 patients were diagnosed and treated for TB during the study period. A significantly higher proportion of pulmonary TB cases were reported during/post-lockdown (43, 82.7%) compared to that pre-lockdown (32, 62.7%), and a higher diagnostic delay was noted during/post-lockdown (35, 81.4%). Through adjusted analysis, patients diagnosed during/post-lockdown period (adjusted risk ratio [aRR], 0.85; 95% confidence interval [CI], 0.73–0.98) and previously treated (aRR, 0.77; 95% CI, 0.60–0.995) had significantly lower favorable treatment outcomes.Conclusions: The symptom and disease (pulmonary/extrapulmonary) pattern have changed during/post-lockdown. The care cascade delays are still high among TB patients, irrespective of the lockdown status. Lockdown had a significant adverse impact on the outcomes of TB treatment.     

综合医院结核病诊断及转诊现状分析

目的了解综合医院结核病诊治现状。方法通过北京大学人民医院网上工作统计报表、结核病网上报卡、化验室痰结核菌检查登记本、放射科摄片统计报表、结核病患者转诊单、住院病例等，查询2005年8月至2006年7月间呼吸科门诊量、X线摄片量、痰结核菌检查结果、结核报卡、转诊情况，并对转诊和住院患者的状况进行分析。结果呼吸科X线摄片占门诊量的11．0％（4960／45055）；痰结核菌检查1512例，阳性24例；肺结核病转诊189例，占门诊量的0．4％（189／45055），其中结核病报卡183例，登记率96．8％；住院后确诊为肺结核30例，从人院到确诊〈14d共27例（占90．0％）；转诊26例，转诊率86．7％。结论北京大学人民医院结核病的发现、诊断及转诊工作具有较高水平；有一些环节需要重视，包括进一步提高痰检率及痰检质量，提高放射科医生及呼吸科医生的读片水平；重视气管镜检查及病理诊断在疑难结核病诊断中的价值；痰菌阴性肺结核在肺结核的发病中比例较高，对其诊断应予以重视。     

Mycobacterial species causing pulmonary tuberculosis at the korle bu teaching hospital, accra, ghana

Summary OBJECTIVE: Characterize mycobacterial species causing pulmonary tuberculosis (PTB) at the Korle-Bu Teaching Hospital in Ghana. DESIGN: Sputum smear positive samples, two (2) from 70 patients diagnosed as having tuberculosis, after they had consented, were collected from the Korle-Bu Teaching Hospital Chest Clinic between January and July 2003. SETTING: Korle-Bu Teaching Hospital Chest Clinic, Accra. RESULTS: Sixty-four mycobacterial isolates were obtained and confirmed as members of Mycobacterium tuberculosis complex by colonial morphology and conventional biochemical assays. Forty-seven (73%) were M. tuberculosis, the human strain, 2 (3%) M. bovis, the bovine strain, 13 (20%) M. africanum I (West Africa type), and 2 (3%) M. africanum II (East Africa type). CONCLUSION: The results indicate that, there are various strains causing PTB at the Korle-Bu Teaching Hospital and of great concern is M. bovis, which mostly causes extra-PTB in humans but found to cause PTB in this study. This calls for the need to conduct a nationwide survey using both conventional and molecular techniques to characterize various mycobacterial species causing TB in Ghana. This will result in better understanding of the various strains circulating in the country and inform individual TB treatment regimen especially the inclusion or exclusion of pyrazinamide.     

Extrapulmonary tuberculosis: clinical and epidemiologic spectrum of 636 cases

BACKGROUND: The aim of this study was to evaluate the percentage and characteristics of extrapulmonary tuberculosis (EPTB) cases in a Turkish industrial city, Kocaeli (population: 1,203,335) and to illustrate its extent as a serious health problem for this city and country. METHODS: We investigated the results of microbiologic, radiologic, and histopathologic findings of patients with extrapulmonary tuberculosis, retrospectively, who were admitted to four Tuberculous Dispensaries between 1996 and 2000. RESULTS: Six hundred thirty six cases were diagnosed with EPTB. Three hundred forty five were males (54.2%) and 291, females (45.8%). Mean age of patient cases was 22.5+/-17.1 years (range, 1-86 years); 41.4% of cases were <15 years of age and 30.9%, between 20 and 39 years of age. Contact history with tuberculosis cases was determined in 242 cases (38%); of these, 194 were <15 years of age (80.2%). The most common form of EPTB was observed to be lymph node tuberculosis (56.3%); of these cases, 256 (71.5%) had involvement in intrathoracic, 92 (25.7%) in cervical, and 10 (2.8%) in axillary lymph nodes. The second most frequent extrapulmonary form was pleural tuberculosis (31.1%). EPTB was diagnosed by histopathologic methods in 229 patients (36.0%) and by microbiologic methods in 27 (4.2%); tuberculin skin test was significantly positive (>10 mm) in 95.5% of patients. When cases were classified according to severity, 87 cases (13.7%) were found severe and 549 (86.3%) as less severe EPTB. Five hundred sixty one cases (88.2%) lived in urban areas and 75 (11.8%), in rural areas. CONCLUSIONS: EPTB is very common in early adulthood in the Kocaeli region, with lymph nodes the most common localization.     

Pulmonary disease empirically treated as tuberculosis-a retrospective study of 107 cases

Pulmonary disease is sometimes treated empirically as tuberculosis (TB) in the absence of microbial confirmation if the clinical suspicion of active TB is high. In a country of relatively high TB and low HIV burden, we retrospectively studied 107 patients (69.2% male; mean age (SD): 45 (17) years) who received empirical anti-TB treatment for intrapulmonary opacities or pleural effusions suspected of active TB in our hospitals between 1998 and 2002. The diagnosis of definite or probable 'smear-negative' pulmonary TB was made based on treatment outcome at two months with rifampicin, isoniazid, pyrazinamide and ethambutol (or streptomycin). At this end-point, 81 patients (84.4%) had both clinical and radiological improvement (definite cases), 12 (12.5%) had clinical improvement alone and 3 (3.1%) had radiological improvement alone (probable cases). Confirmation of acid-fast bacilli was subsequently obtained in 12 patients (all definite cases) from culture of initial pulmonary specimens. Eleven patients (10.5%) were diagnosed as 'non-TB' based on absence of both clinical and radiological improvement or discovery of another cause for the pulmonary condition at or before this two-month study end-point. In the 'non-TB' group, 2 had carcinoma, 2 had HIV-related pulmonary diseases, 1 had bronchiectasis, while in 6 causes were indeterminate. Six (6.3%) and 3 (27.3%) patients reported adverse effects from anti-TB drugs from the 'TB' and 'non-TB' groups respectively. Our findings suggest that empirical anti-TB treatment is an acceptable practice if clinical suspicion is high in patients coming in our region.     

Guidance for National Tuberculosis Programmes on the management of tuberculosis in children - an update

About one million children develop tuberculosis (TB) annually worldwide. Childhood TB is common in Malawi accounting for about 12% of all TB cases. Childhood TB differs from TB in adults in ways that have important implications for the prevention, diagnosis and treatment of TB in children. Young children living in close contact with a case of smear-positive pulmonary TB are at particular risk of infection and TB disease. Screening of the household contacts of an infectious source case is therefore recommended to identify children with TB and enable their prompt treatment, and to provide children who do not have TB with isoniazid preventive treatment. It is recognised that there is a need to improve the diagnosis and management of children with TB, the prevention of TB in children and to ensure their inclusion under the implementation of the Stop TB strategy by National TB Programmes. A subgroup of the WHO DOTS Expansion Working Group called the Stop TB Partnership Childhood TB Subgroup published guidelines for the management of child TB in 2006. The guidelines are designed to complement current national and international guidelines on the implementation of the Stop TB Strategy and existing guidelines, but also to fill existing gaps to ensure that children with M. tuberculosis infection and TB disease are identified early and managed effectively. This paper summarises some of the most important information and recommendations put forward in those guidelines.     

几种常用肺结核病诊断方法临床价值的探讨

为了探讨肺结核病的诊断方法，观察了直接痰涂片查抗酸杆菌、痰结核杆菌聚合酶链反应（ＰＣＲ）检测法、结核菌素试验（ＰＰＤ试验）和血中抗分枝杆菌抗体测定对肺结核病的诊断价值。结果表明：痰涂片法诊断肺结核病的特异性达１００％，但敏感性只有２２．２％。而其他３种方法虽然敏感性稍有提高，但特异性很差。提示：目前诊断肺结核病最可靠的方法仍是痰涂片法     

Untreated Prior Pulmonary Tuberculosis Adversely Affects Pregnancy Outcomes in Infertile Women Undergoing in vitro Fertilization and Embryo Transfer: A Large Retrospective Cohort Study

Objective Prior pulmonary tuberculosis(PTB) on chest X-ray(CXR) was commonly found in infertile patients receiving examinations before in vitro fertilization and embryo transfer(IVF-ET). It was unclear whether untreated PTB would affect pregnancy outcomes after IVF-ET.Method We conducted a retrospective cohort study of 14,254 infertile patients who had received IVFET at Peking University Third Hospital in 2017. Prior PTB was defined as the presence of signs suggestive of old or inactive PTB on CXR, with or without a clinical TB history. Patients who had prior PTB on CXR but had not received a clinical diagnosis and anti-TB therapy were included for analysis. Live birth,clinical pregnancy, and miscarriage rates were compared between the untreated PTB and non-PTB groups.Results The untreated PTB group had significantly lower clinical pregnancy(31.7% vs. 38.1%) and live birth(23.8% vs. 30.6%) rates than the non-PTB group(both P < 0.001). Multivariate analysis revealed that untreated PTB was a risk factor for decreased live birth rate [odds ratio(OR), 0.80;95% confidence interval(CI), 0.66–0.98;P = 0.028] in all patients and for increased miscarriage(OR, 4.19;95% CI,1.69–10.39;P = 0.002) and decreased live birth(OR, 0.45;95% CI, 0.24–0.83;P = 0.011) rates in patients with unexplained infertility.Conclusions Untreated PTB was associated with adverse pregnancy outcomes after IVF-ET, especially in patients with unexplained infertility, highlighting the clinical significance of PTB in this specific patient population.     

重庆市复治涂阳肺结核患者耐药分析

目的 通过了解重庆市复治涂阳肺结核患者对抗结核药物的耐药情况,为改进重庆市肺结核病的防治措施提供参考和建议。方法 收集重庆市39个区县2016年5月至2017年10月期间复治涂阳患者培养阳性的菌株,并采用对硝基苯甲酸培养法鉴定结核分枝杆菌复合群。共收集428例复治涂阳肺结核患者菌株,采用传统的比例法进行8种抗结核药物的药敏试验,并对复治涂阳肺结核患者菌株耐（多）药情况进行分析。8种抗结核药物包括：异烟肼（INH）、利福平（RFP）、链霉素（Sm）、乙胺丁醇（EMB）、氧氟沙星（Ofx）、卡那霉素（Km）,阿米卡星（Am）和卷曲霉素（Cm）。结果 纳入的428例复治肺结核患者总耐药率为45.09%,以青年组耐药率最高,达57.14%,显著高于老年组（36.59%,P=0.002<0.017),但与中年组比较差异无统计学意义（43.52% P=0.022(>)0.017）;复治肺结核患者耐多药率为27.10%,其中青年组耐多药率（41.96%）显著高于中年组（24.35%）和老年组（17.89%, P<0.05);复治肺结核患者广泛耐药率达3.74%,耐Ofx及耐任一种二线注射类抗结核药物（包括Km、Am和Cm）的比例分别为16.12%和6.31%;复治肺结核患者对4种一线抗结核药物的耐药率顺位为：利福平（33.18%）、异烟肼（32.94%）、链霉素（28.74%）、乙胺丁醇（9.11%）。复治涂阳肺结核患者耐一种抗结核药物的耐药率为10.28%,对8种抗结核药物全部耐药的比例为1.17%。复治涂阳肺结核患者耐药状况不同性别之间差异无统计学意义。结论 重庆市复治涂阳肺结核患者的耐药形势严峻,其中青年是耐多药结核病发生的危险人群,应根据本市情况制定科学合理的结核病防治方案,减少耐药结核病的产生和传播。     

T细胞酶联免疫斑点试验在2 348例儿童结核病中的诊断价值

  目的  评价T细胞酶联免疫斑点（T-cells enzyme linked immunospot, TSPOT.TB）试验在儿童结核病中的诊断价值。  方法  收集2017年1~12月在重庆医科大学附属儿童医院住院并完善TSPOT.TB试验的2 348例患儿,结合患儿的病例资料,分析TSPOT.TB试验在儿童结核病中的诊断价值。  结果  本研究中TSPOT.TB试验诊断儿童结核病的敏感度为84.0%,特异度为99.1%,阳性预测值为93.1%,阴性预测值为97.8%。TSPOT.TB试验受试者工作特征（ROC）曲线下面积（area under the curve,AUC）为:A抗原的AUC值为0.893（P<0.05）,B抗原AUC值为0.883（P<0.05）。当A抗原或B抗原的斑孔数≤50时,随着TSPOT.TB试验斑孔数的增加,TSPOT.TB试验诊断儿童结核病的敏感度亦增加,但无明确线性关系;当A抗原或B抗原的斑孔数>50时,TSPOT.TB试验诊断儿童结核病具有高度的敏感度。TSPOT.TB真阳性病例组中,肺结核组的敏感度高于肺外结核组（P<0.05）。不同年龄结核病患儿中,随着患儿年龄的增长,TSPOT.TB试验的敏感度亦随之升高。  结论  TSPOT.TB试验在儿童结核病中有较高的诊断价值,可以快速辅助诊断儿童结核病。     

超声引导下穿刺活检对肺外结核的诊断价值

目的 探讨如何提高超声引导下穿刺活检对肺外结核(extrapulmonary tuberculosis,EPTB)的诊断价值.方法 对152例临床疑诊结核或诊断不明病灶的患者进行超声引导下穿刺活检,综合分析组织切片加特殊染色(病理组)、基因X-Pert MTB/RIF检测(基因组)、结核菌培养(菌培组)及涂片这4种方法...     

Causes of delay in diagnosis of pulmonary tuberculosis in patients attending a referral hospital in Western Kenya

OBJECTIVE: To determine the length of delays from onset of symptoms to initiation of treatment of pulmonary tuberculosis (PTB). DESIGN: Cross-sectional study. SETTING: Chest/TB clinic, Moi Teaching and Referral Hospital (MTRH), Eldoret, Kenya. SUBJECTS: Newly diagnosed smear positive pulmonary tuberculosis (PTB) patients. RESULTS: Two hundred and thirty patients aged between 12 and 80 (median; 28.5) years were included in the study. They comprised 148 (64.3%, median 30 years) males and 82 (35.7%, median 28 years) females. One hundred and two (44%) came from urban and 128 (56%) came from rural setting covering a median distance of 10 (range 0-100) kilometres and paying Kshs 20 (range 0-200) to facility. Cough was the commonest symptom reported by 228 (99.1%) of the patients followed by chest pain in 214 (80%). The mean patient delay was 11 +/- 17 weeks (range: 1-78 weeks) with no significant difference between males and females, the mean system delay was 3 +/- 5 weeks (range: 0-39 weeks). The median patient, health systems and total delays were 42, 2, and 44 days respectively for all the patients. Marital status, being knowledgeable about TB, distance to clinic and where help is sought first had significant effect on patient delay. CONCLUSION: Patient delay is the major contributor to delay in diagnosis and initiation of treatment of PTB among our patients. Therefore TB control programmes in this region must emphasise patient education regarding symptoms of tuberculosis and timely health seeking behaviour.     

肺结核合并糖尿病患者的抗结核治疗效果及其影响因素

目的 应用生存分析方法分析本地区合并糖尿病的肺结核患者(PTB-DM组)和单纯肺结核患者(PTB组)的抗结核治疗效果是否存在差别,并分析影响PTB-DM预后的因素。 方法 采用前瞻性队列研究设计方案,以2013年6月—2014年12月江苏大学医学院附属镇江三院登记治疗的116例合并糖尿病的肺结核患者和120例单纯肺结核患者的8个月随访资料为例,采用Kaplan-Meier生存分析方法评估肺结核未好转率,分别采用log-rank检验和Cox比例风险回归模型对PTB-DM患者的预后进行单因素和多因素分析。 结果 生存曲线结果显示,合并糖尿病的肺结核患者的累积未好转率明显高于单纯糖尿病患者(Log-rank检验,P=0.001)。单因素分析表明年龄、合并空洞、复治结核、产生耐药、发生抗结核药物性肝损害这5个因素差异具有统计学意义(Log-rank检验,P＜0.05)。应用Cox比例风险回归模型做多因素分析发现,年龄、复治结核、产生耐药这3个因素差异具有统计学意义(P＜0.05)。 结论 糖尿病会降低结核病的治疗效果。对结核病患者尤其是合并有其他影响结核病预后的高危患者,规律地监测并有效控制患者的血糖水平,可提高结核病的好转率,并改善其预后。      

Challenges of Childhood TB/HIV Management in Malawi

The diagnosis and management of childhood tuberculosis (TB) are major challenges in countries such as Malawi with high incidence of TB and human immunodeficiency virus (HIV) infection. Diagnosis of TB in children often relies only on clinical features but clinical overlap with the presentation of HIV and other HIV-related lung disease is common. The tuberculin skin test (TST), the standard marker of M. tuberculosis infection in immune competent children, has poor sensitivity in HIV-infected children and is not usually available in Malawi. HIV test should be routine in children with suspected TB as it improves clinical management. HIV-infected children are at increased risk of developing active disease following TB exposure which justifies the use of isoniazid preventive therapy (IPT) once active disease has been excluded but this is difficult to implement and appropriate duration of IPT is unknown. HIV-infected children with active TB experience higher mortality and relapse rates on standard TB treatment compared to HIV-uninfected children, highlighting the need for further research to define optimal treatment regimens. HIV-infected children should also receive appropriate supportive care including cotrimoxazole prophylaxis and anti-retroviral treatment (ART) if indicated. There are concerns about concurrent use of some anti-TB drugs such as rifampicin with some ARTs.