Serological analysis of human tuberculosis by an ELISA with mycobacterial antigen 60

An ELISA method for detecting serum antibodies against A60, an antigen prepared from the cytoplasm of Mycobacterium bovis BCG, has been applied to 385 subjects, namely 197 controls (neonates, healthy adults, and tuberculin negative, nontuberculous patients), and 188 subjects at various stages of tuberculous infection and disease. Most IgM determinations gave negative results. While the neonates and normal adults had titers of IgG anti-A60 antibodies below the cut off value, wide variations in antibody titers were observed among the various types of subjects infected by M. tuberculosis. The results obtained with nontuberculous subjects were: 100% negative IgG in neonates and healthy adult individuals and 6.4% "false positive" cases among 124 non-tuberculous patients. The percentage of serologically positive cases of tuberculosis was: 5.9% in latent active primary forms, 42.8% in patent active primary forms, and 82.8% in active postprimary forms. Tuberculous infections had a positively rate of 14.7%, while inactive postprimary tuberculosis had a positivity rate of 50%. The results obtained with A60 can favourably be compared with other serum ELISA tests for tuberculous antibodies against purified or semipurified mycobacterial antigens. Anti-A60 ELISA IgG antibody test can be useful to monitor the kinetics of humoral immunological response during tuberculous infection, disease and chemotherapy. A positive IgG ELISA test may support the diagnosis of active tuberculous disease.     

Detection of free and immune-complexed serine protease and its antibody in TB patients with and without HIV co-infection.

OBJECTIVE: To understand the usefulness of detecting tuberculous IgG antibodies against mycobacterial excretory-secretory 31 kDa serine protease antigen (SEVA TB ES-31) and circulating free and circulating immune-complexed (CIC) serine protease in TB patients with and without HIV infection. DESIGN: Serum was collected from 144 individuals: patients with TB, with TB-HIV co-infection and HIV infection only, and ill and healthy controls. SEVA TB ES-31 antigen, a serine protease isolated from Mycobacterium tuberculosis H37Ra culture fluid, was used in indirect penicillinase ELISA to detect tuberculous antibodies. Similarly, affinity purified anti-ES-31 antibody was used in sandwich ELISA to detect circulating free and CIC serine protease. RESULTS: There was less sensitivity for tuberculous antibody in HIV-infected TB patients (46%) than in those with TB alone (87%) using mycobacterial serine protease. However, the sensitivity of detection of TB in the presence of HIV increased to 87% by concomitant detection of circulating free and CIC serine protease antigen. CONCLUSION: Detection of free and CIC tuberculous serine protease antigen along with antibody is more useful for detecting TB in the presence of HIV co-infection.     

HIV/AIDS合并非结核分枝杆菌肺病97例临床分析

目的 探讨HIV/AIDS合并非结核分枝杆菌(nontuberculosis mycobacteria, NTM)肺病的临床特点,以提高诊疗水平. 方法 对我院2009—2012年97例HIV/AIDS合并NTM肺病患者进行回顾性分析. 结果 97 例中咳嗽 93 例(95.88%),咳痰88例(90.72%),气喘71例(73.20%),发热70例(72.16%),消瘦69例(71.13%),乏力58例(59.79%),胸痛 47 例(48 . 45%),腹泻36例(37.11%). HIV感染途径为性乱史64例(65.98%),静脉吸毒史26例(26.80%),输血史2例(2.06%),不详5例(5.15%). 胸部影像学表现以双肺中下叶多见,多为左下肺受累,形态多种多样,并容易形成空洞及支气管扩张样改变,可见胸膜病变. 结论 HIV/AIDS合并NTM肺病的临床症状、胸部影像学表现、痰涂片、PPD试验和结核抗体检查酷似肺结核,在痰培养结果未回报前,临床上二者鉴别诊断非常困难.患者通常合并多处浅表淋巴结肿大,反复痰涂片抗酸杆菌阳性. 痰培养药物敏感性试验提示对一线抗结核药物耐药率高,应引起临床足够重视.     

The detection of antibodies to Mycobacterium tuberculosis and its reactivity to three different purified protein derivative by ELISA]

The specific PPD IgG antibodies in serum of patients with pulmonary tuberculosis and its reactivity to PPD of Mycobacterium tuberculosis M. bovis and M. avium were detected by ELISA. The results showed that the antibody level and positive rate of patients with pulmonary tuberculosis significantly increased than those of normal subjects. Specific antibody level and its positive rate were higher in hospitalized patients than those treated in clinic and both were higher in sputum positive cases than in sputum negative one. There was cross-reactivity among three different PPD. Absorption black test indicated that M. tuberculosis PPD had good specificity. PPD should be further purified in order to make ELISA as a useful serodiagnostic tool.     

结核病症状筛查在四川省布拖县HIV感染/AIDS患者中发现结核病患者的价值

目的 探讨结核病症状筛查在HIV感染/AIDS患者中诊断活动性结核病的作用,为基层医生在HIV感染/AIDS患者中诊断结核病提供参考。方法 选取四川省凉山彝族自治州布拖县“两乡一镇”现场,对688例HIV感染/AIDS患者采用多项筛查的方法进行结核病筛查,其中“结核病症状筛查”共计发出了688份结核病可疑症状筛查问卷,回收628份,有效问卷623份。问卷调查表的主要内容包括:(1)咳嗽、咳痰持续2周;(2)反复咳出带血的痰;(3)反复发热持续2周以上;(4)夜间经常出汗;(5)无法解释的体质量明显下降;(6)经常容易疲劳或呼吸短促;(7)淋巴结肿大。出现(1)~(7)中1个或多个症状为结核病症状筛查阳性。专家组根据623例受检者的可疑症状问卷筛查、痰涂片显微镜检查、胸部X线摄影、痰培养、结核菌素试验和结核感染T淋巴细胞斑点试验(T-SPOT.TB)等检查结果综合判断,以确诊其中的活动性结核病。并以专家组诊断结果作为参考标准,计算结核病症状筛查在诊断活动性结核病的敏感度、特异度、阳性预测值、阴性预测值、约登指数、Kappa值,评价结核病症状筛查在HIV感染/AIDS患者中筛查结核病的应用价值。结果 现场结核病症状筛查中,结核病症状阳性率为66.29%(413/623),专家组共计确诊113例活动性结核病患者,以此作为参考标准,计算结核病症状筛查活动性结核病的敏感度、特异度、阳性预测值、阴性预测值、约登指数和Kappa 值分别为69.03%(78/113)、34.31%(175/510)、18.89%(78/413)、83.33%(175/210)、0.03和-0.76。结论 结核病症状筛查在HIV感染/AIDS患者中确诊活动性结核病阳性结果与专家组确诊患者比较的约登指数、Kappa值均较低,但症状筛查投入低、操作简单且有效,特别是在医疗资源特别匮乏的边远地区及少数民族地区,可作为排查结核病的预警指标。     

Value of tuberculin test in screening tuberculosis infection in HIV infected/AIDS patients in Butuo County,Sichuan Province

目的 探讨结核病症状筛查在HIV感染/AIDS患者中诊断活动性结核病的作用,为基层医生在HIV感染/AIDS患者中诊断结核病提供参考。方法 选取四川省凉山彝族自治州布拖县“两乡一镇”现场,对688例HIV感染/AIDS患者采用多项筛查的方法进行结核病筛查,其中“结核病症状筛查”共计发出了688份结核病可疑症状筛查问卷,回收628份,有效问卷623份。问卷调查表的主要内容包括:(1)咳嗽、咳痰持续2周;(2)反复咳出带血的痰;(3)反复发热持续2周以上;(4)夜间经常出汗;(5)无法解释的体质量明显下降;(6)经常容易疲劳或呼吸短促;(7)淋巴结肿大。出现(1)~(7)中1个或多个症状为结核病症状筛查阳性。专家组根据623例受检者的可疑症状问卷筛查、痰涂片显微镜检查、胸部X线摄影、痰培养、结核菌素试验和结核感染T淋巴细胞斑点试验(T-SPOT.TB)等检查结果综合判断,以确诊其中的活动性结核病。并以专家组诊断结果作为参考标准,计算结核病症状筛查在诊断活动性结核病的敏感度、特异度、阳性预测值、阴性预测值、约登指数、Kappa值,评价结核病症状筛查在HIV感染/AIDS患者中筛查结核病的应用价值。结果 现场结核病症状筛查中,结核病症状阳性率为66.29%(413/623),专家组共计确诊113例活动性结核病患者,以此作为参考标准,计算结核病症状筛查活动性结核病的敏感度、特异度、阳性预测值、阴性预测值、约登指数和Kappa 值分别为69.03%(78/113)、34.31%(175/510)、18.89%(78/413)、83.33%(175/210)、0.03和-0.76。结论 结核病症状筛查在HIV感染/AIDS患者中确诊活动性结核病阳性结果与专家组确诊患者比较的约登指数、Kappa值均较低,但症状筛查投入低、操作简单且有效,特别是在医疗资源特别匮乏的边远地区及少数民族地区,可作为排查结核病的预警指标。     

Baseline mycobacterial immune responses in HIV-infected adults primed with bacille Calmette-Guérin during childhood and entering a tuberculosis booster vaccine trial

BACKGROUND: Most new tuberculosis vaccines will be administered as a booster to subjects primed with bacille Calmette-Guérin (BCG) during childhood. METHODS: We investigated in vivo and in vitro immune responses to mycobacteria in human immunodeficiency virus (HIV)-positive subjects in Tanzania primed with BCG during childhood and entering a tuberculosis booster vaccine trial. Tests included intradermal skin testing for Mycobacterium tuberculosis purified protein derivative (PPD) and Mycobacterium avium sensitin (MAS); lymphocyte proliferation assays and interferon (IFN)-gamma levels after stimulation with Mycobacterium vaccae sonicate (MVS), M. tuberculosis early secreted antigen (ESAT)-6, M. tuberculosis antigen 85 (Ag85), or M. tuberculosis whole-cell lysate (WCL); and determination of serum antibody to lipoarabinomannin (LAM). RESULTS: A total of 888 subjects with CD4 cell counts > or = 200 cells/mm3 were enrolled. PPD and MAS test results were positive in 34% and 30% of the subjects, respectively. Proliferative responses were detected as follows: MVS, 6%; Ag85, 24%; ESAT-6, 21%; and WCL, 59%. IFN-gamma responses were 2%, 6%, 12%, and 38%, respectively. LAM antibody was detected in 28% of the subjects. Subjects were more likely to have detectable proliferative and IFN-gamma responses if they had positive PPD test results or CD4 cell counts > or = 500 cells/mm3. Overall, 94% of the subjects had evidence of primed mycobacterial immune responses. CONCLUSION: Of HIV-positive BCG-immunized adults with CD4 cell counts > or = 200 cells/mm3 in Tanzania, 94% are primed for booster mycobacterial immunization.     

艾滋病合并肺结核的免疫功能变化

目的 探讨艾滋病合并肺结核的免疫功能变化。方法 回顾分析1997年12月～2002年12月住院的艾滋病并发肺结核病末稍血CD4与PPD皮试反应并以无并发肺结核病的HIV感染／艾滋病相比较。结果 5例艾滋病并发肺结核病的PPD皮试反应均为阴性。仅1例痰涂片找到抗酸杆菌，痰结核菌培养均阴性。末稍血CD4细胞计数除1例264个／uL外，余4例均极度减低。结论 HIV感染／艾滋病的末稍血的CD4细胞数下降。合并肺结核病时更为严重，表明两病并存时机体的免疫功能进一步下降。     

结核病患者人类免疫缺陷病毒感染的检测

目的人类免疫缺陷病毒（ＨＩＶ）和结核分支杆菌（ＭＴＢ）双重感染已引起广泛关注。通过对住院肺结核患者ＨＩＶ检测,了解住院肺结核患者中ＨＩＶ感染及艾滋病（ＡＩＤＳ）发病状况。方法对２９７３例住院肺结核患者常规采用明胶颗粒凝集试验法或ＨＩＶ１＋２抗体金标快速测试法进行初筛,阳性者抽血复测,并由北京市检测中心确定。结果２９７３例中ＨＩＶ（＋）３例,阳性率１．０１‰。男２例,女１例。年龄分别为２３、４０、２７岁,平均年龄３０岁,占２１～４０岁年龄组的２．８６‰。通过静脉吸毒血源性感染１例,异性间性乱２例。３例均已发展为ＡＩＤＳ。结论结核病防治工作者对ＨＩＶ／ＭＴＢ双重感染的危险性要有充分认识与高度重视。对具有ＨＩＶ感染危险因素的肺结核患者,特别是其中的中青年患者应常规进行ＨＩＶ抗体检测,有助于ＡＩＤＳ的早期发现、治疗,防止ＡＩＤＳ的传播流行     

The serodiagnosis of tuberculosis by enzyme-linked immunosorbent assay with tuberculin purified protein derivative

Tuberculin purified protein derivative (PPD) is a relatively crude antigen prepared from Mycobacterium tuberculosis and has species nonspecificity in immunological reaction. It is, however, more readily available than more highly purified materials. Therefore, the detection of IgG antibody to PPD was done by enzymed-linked immunosorbent assay (ELISA) and its diagnostic useful was evaluated in this study. The patients with active tuberculosis had significantly high titer of IgG antibody to PPD compared with healthy persons and the patients without tuberculosis (P less than 0.001). An upper limit of normal set (=cut-off titer) at 2 standard deviations above mean of logarithmic titers in 220 healthy adult subjects would result in positive test reactions on the sera from 78 of 100 patients with active tuberculosis. Although 8 of 39 with atypical mycobacteriosis would be positive, 6 of 7 were distinguished almost with tuberculosis by detecting antibodies to PPD from M. intracellulare and M. kansasii concurrently. The antibody titer increased after chemotherapy would be gradually reduced under the cut-off titer when culture of mycobacteria turned to negative and markers of inflammation became negative. In false-negative cases, 4 were patients with hypo-gammaglobulinemia, 6 were with fresh tuberculosis before chemotherapy, 2 were with negative CRP in all clinical course and 4 were with bacilli needed over 7 weeks culture. From these results, this assay is helpful in the diagnosis of tuberculosis and a useful marker for judgment of clinical improvement, although detection of antibody has its limitations.     

Isolation of human immune deficiency virus from African AIDS patients and from persons without AIDS or IgG antibody to human immune deficiency virus

We previously reported a high incidence of acquired immune deficiency syndrome (AIDS) in Kinshasa, Zaire, as well as a high frequency of antibody to human immunodeficiency virus (HIV), which includes HTLV-III and LAV viruses, in persons without AIDS. In this report we assessed the frequency of HIV virus infection in persons with and without clinical AIDS and the association of virus isolation to presence of antibody. We isolated HIV from 27 (77%) of 35 patients with AIDS, and 5 of 9 patients with AIDS-related complex (ARC). Virus was also isolated from plasma and cerebrospinal fluid of patients in the study. The presence of antibody was a reliable marker for virus infection in African patients with AIDS. HIV was isolated from 5 of 27 control patients without AIDS, 3 of whom had normal T helper to T suppressor ratios and normal numbers of T helper cells. Two of these patients had no detectable antibody to HIV by ELISA or Western blot methods. In a population, such as the general heterosexual population of Kinshasa, with frequent infection by HIV and with few clearly definable risk groups, screening for antibodies to HIV may not be sufficient to identify some virus infected persons.     

艾滋病与结核病相关性研究

目的调查结核病人群的艾滋病病毒(HIV)感染情况,了解HIV与结核分枝杆菌(MTB)的相关性.方法对2272例诊断为结核病的住院病人进行HIV抗体检测,初筛阳性者进一步做免疫印迹试验(WB).结果检出HIV抗体阳性者7例,检出率为0.308%.7例HIV抗体阳性者中,男性5例,女性2例.其中6例为活动性肺结核,1例结核性胸膜炎,发病年龄以20～40岁为主,占86%.结论结核病人群中的HIV抗体阳性者比一般人群高10倍.建议对有HIV高危行为的结核病患者尤其是中青年患者做常规HIV抗体检测,以便早期发现、治疗HIV/MTB双重感染者,预防与控制艾滋病和结核病的流行.     

Tuberculosis in HIV-infected subjects in Italy: a multicentre study. The Gruppo Italiano di Studio Tubercolosi e AIDS.

OBJECTIVES: To evaluate the strength of the association between tuberculosis and HIV infection in Italy, to assess the pattern of this association in relation to HIV transmission categories, and to describe clinical presentation of tuberculosis in a large group of Italian HIV-infected subjects. DESIGN: Multicentre review of clinical records. SETTING: Twenty-one infectious disease hospital units in nine of the 20 administrative regions of Italy. PATIENTS, PARTICIPANTS: All HIV-infected adults observed by each participating unit (in- and outpatients) between 1985 and 1989. MAIN OUTCOME MEASURE: Culture-proven tuberculosis. RESULTS: A total of 306 cases of tuberculosis were observed. Of these, 85 were pulmonary, 167 extrapulmonary, and 54 both pulmonary and extrapulmonary. The proportion of HIV-infected subjects diagnosed with tuberculosis increased during the study period from three out of 1380 (0.2%) in 1985 to 152 out of 6504 subjects (2.3%) in 1989 (P less than 0.0001). Two hundred and twenty-six of the 2760 (8.19%) patients with AIDS had tuberculosis within 12 months of AIDS diagnosis; the proportion of AIDS patients with tuberculosis remained stable after 1985. Compared with AIDS patients who were intravenous drug users, only homosexual AIDS patients had a significantly lower proportion of tuberculosis (178 out of 1958 versus 30 out of 522; P less than 0.02). CONCLUSIONS: Our data show that tuberculosis is quite common among HIV-infected subjects in Italy, and suggest that the risk of tuberculosis in these subjects has not changed. There are some differences between the pattern of the association between tuberculosis and HIV infection in Italy, compared with other industrialized countries.     

HIV seropositivity in patients with herpes zoster

Relationship between zoster and seropositivity for HIV is studied. Serum samples from 66 patients presenting acute zoster infection were tested for HIV antibodies, using ELISA. There was no previous selection of patients, what rendered the population studied unbiased. Seven patients (10.6%) were positive for HIV antibodies. Among them six belonged to AIDS risk groups, all were males and six had ages between 19 and 39 years (mean age value 31.7). Results suggest that the finding of zoster in younger age groups is not necessarily linked to HIV infection. When zoster is diagnosed in patients who belong to AIDS risk groups, independently from their age, the association with HIV infection is statistically significative. In these cases zoster can even be considered as a marker for HIV infection and it is mandatory to test these patients for HIV antibodies.     

γ-干扰素释放试验对HIV感染者合并菌阴肺结核辅助诊断价值的探讨

目的探讨γ-干扰素释放试验(IGRAs)对人类免疫缺陷病毒(HIV)感染者合并菌阴肺结核(HIV/菌阴肺结核)的辅助诊断价值。方法对128例于2014年5月至2016年4月在河南省鹤壁市传染病医院感染科住院期间行IGRAs检测的HIV/菌阴肺结核、人类免疫缺陷病毒感染/获得性免疫缺陷综合征(HIV/AIDS)、菌阴肺结核患者的IGRAs测定结果和相关临床资料进行回顾性分析。组内及组间构成比或率的比较采用χ~2检验,计量资料采用t检验,以P0.05的因素作为自变量,以IGRAs结果为阳性或阴性作为因变量,行Logistic回归(基于条件参数估计的后退法)分析。结果 (1)HIV/菌阴肺结核患者血γ-干扰素水平和阳性检出率高于HIV/AIDS患者(U=7.813,P=0.005;χ~2=8.486,P=0.004),但与菌阴肺结核患者相接近(U=1.109,P=0.292;χ~2=2.459,P=0.117)。(2)与IGRAs阴性的HIV/菌阴肺结核患者相比较,IGRAs阳性的HIV/菌阴肺结核患者的CD_4~+计数(t=5.349,P=0.002)、CD_4~+/CD_8~+(t=2.834,P=0.009)、淋巴细胞计数(t=5.576,P0.001)增高,血沉(t=-2.317,P=0.029)降低。(3)logistic回归分析显示,仅CD_4~+计数是影响HIV/菌阴肺结核患者IGRAs结果的独立因素(Wald X2=4.434,P=0.035,OR=13.5,95%CI=1.197-152.211)。(4)不同检测方法比较,HIV/菌阴肺结核患者IGRAs检测的敏感度(35.7%)和诊断正确率(72.7%)高于结核抗体(21.4%,63.6%)和PPD(14.2%,67.0%)检测,其特异度(90.0%)与PPD相接近(91.7%),略高于结核抗体(83.3%)。IGRAs联合PPD和结核抗体检测可提高敏感度至60.7%。结论IGRAS检测有助于从HIV患者中早期筛出或发现HIV/结核病患者。HIV/菌阴肺结核患者CD_4~+200/μL影响IGRAs的检测结果。IGRAs检测对HIV/菌阴肺结核的辅助诊断价值优于PPD和结核抗体,而三项联合检测也有助于HIV/菌阴肺结核的早期发现。     

Cytokine responses induced by Mycobacterium tuberculosis in patients with HIV-1 infection and tuberculosis.

OBJECTIVE: Tuberculosis (TB) is an important opportunistic infection in HIV patients. Immune responses to Mycobacterium tuberculosis in HIV/TB patients were evaluated. METHODS: Fifteen patients with HIV/TB, ten with HIV, four with TB, and five controls were enrolled. Peripheral blood mononuclear cells were isolated and stimulated with mycobacterial antigen (PPD). Interferon (IFN)-gamma and TNF-alpha in culture supernatants were measured by ELISA. RESULTS: IFN-gamma and TNF-alpha production after PPD stimulation was markedly decreased in HIV patients, but not in HIV/TB patients. In HIV patients with a CD4 cell count of less than 200/mm3, IFN-gamma and TNF-alpha production after PPD stimulation was higher in HIV/TB patients than in HIV patients. Cytokine responses to M. tuberculosis reconstituted after highly active antiretroviral therapy (HAART) and were prominent in HIV/TB patients. CONCLUSIONS: Cytokine responses to M. tuberculosis were retained in HIV-infected patients with tuberculosis, even in patients with a CD4 cell count of less than 200/mm3, and reconstituted after HAART.     

艾滋病合并肺结核21例临床分析

目的　探讨艾滋病合并肺结核患者临床特点。方法 回顾分析 21例艾滋病合并肺结核患者感染途径、临床表现、辅助检查及诊治情况。结果 21例患者中青壮年占 95.2%，其HIV感染途径主要是血液接触传播 15例占 71.4%和性接触传播 9例占 42.9%，两种感染途径兼有 4例占 19.0%。临床表现有持续发热(100%)、咳嗽 (61.9%)、腹泻 (33.3%) 1个月以上的特点。PPD试验阴性率 81.9%。全身淋巴结肿大 61.9%。X线表现播散型肺结核 76.2%，同时罹患肺外淋巴结核 52.4%，半年内病死率 61.9%。结论 艾滋病合并肺结核患者PPD试验阴性率高，X线表现不典型，病情复杂，疗效差，病死率高。     

抗分枝杆菌药物研究最新进展

随着人类免疫缺陷病毒（HIV）感染和艾滋病（AIDS）的流行，全球结核病和非结核分枝杆菌（NTM）病呈增多趋势，严重威胁着人类的生命和健康。由于耐药或耐多药结核分枝杆菌和NTM对大多常用的抗分枝杆菌药物均不敏感，因此，给临床治疗带来了极大的困难。本文就抗分枝杆菌药物的最新研究进展做一介绍。     

Factors associated with tuberculin skin test reactivity among HIV-infected people in Bangkok

INH preventive therapy (IPT) has been shown in several randomized controlled trials to reduce the risk of developing active TB in tuberculin skin test (TST) or purified protein derivative (PPD) positive HIV infected individuals. Detection of latent tuberculosis by TST and determination of factors associated with the PPD positivity in HIV-infected persons are important for the targeting of chemoprophylaxis. Six hundred asymptomatic and early symptomatic HIV-infected subjects attending the AIDS Clinic of the Chulalongkorn University Hospital, Bangkok, Thailand were enrolled in two randomized clinical trials of chemoprophylaxis against TB from December 1994 to December 1996. The availability of baseline characteristics, including TST reactivity, among these participants enabled a cross-sectional analysis of factors associated with PPD positivity. The results showed that 117 (19.5%) were PPD positive and 483 (80.5%) were PPD negative with ages 18-65 years (median 29 years). HIV exposure category was 46.2%, 34.5%, and 6.7% for heterosexual contact, commercial sex work, and homosexual and bisexual male contact respectively. The median CD4 cell count was 315/mm3 (range, 5-1,074/mm3). HIV exposure category and CD4 cell count were significantly associated with PPD status. Homosexual/bisexual contact had 3 times higher risk of PPD positivity than heterosexual contact (adjusted OR=2.9; 95% CI, 1.4-6.1) and risk of PPD positivity was higher among patients with CD4 cell counts of 200-500/ mm3 (adjusted OR=1.8; 95% CI, 1.0-3.1) and above 500/mm3 (adjusted OR=3.4; 95% CI, 1.7-6.7) when compared to patients with CD4 cell counts of less than 200/mm3. The HIV-infected persons in Bangkok with homosexual/bisexual contact are at higher risk for latent TB. Population-based tuberculin screening without accompanying HIV testing cannot be used to estimate the prevalence of actual latent TB in a population where HIV infection is widespread, such as in Thailand.     

非结核分枝杆菌感染占肺结核治疗效果不佳病例比例的研究

目的通过研究非结核分枝杆菌感染占肺结核治疗效果不佳病例的比例,来引起临床对非结核分枝杆菌肺病的重视。方法选择我院2011年4～10月期间,门诊和住院确诊为肺结核病人中抗结核治疗效果不佳病例共45例,进行临床分析。结果 45例抗结核治疗效果不佳病例中感染非结核分枝杆菌共28例占62%,再次培养仍为肺结核的共17例占38%。结论抗结核治疗效果不佳病例中有很大部分是非结核分枝杆菌肺病,由于两者在临床症状、X线影像、痰涂片、PPD试验、病理学检查都疑似,很容易误诊误治。