Clinical picture of tuberculosis with concomitant hemoblastoses

AIM: To study clinical symptoms, course and diagnosis of tuberculosis in patients with hemoblastosis (HB). MATERIAL AND METHODS: 79 patients with tuberculosis and HB were examined. HB was represented by lymphoproliferative diseases (n = 61), acute leukemia (n = 4), chronic myeloproliferative diseases (n = 14). RESULTS: Pulmonary tuberculosis was in 61 (77.2%) patients: in 46 with lymphoproliferative disease (LPD), 4 with acute leukemia (AL) and 11 with myeloproliferative disease(MPD). Generalized tuberculosis was detected in 8 (10.1%) patients (7 with LPD and 1 with MPD) and extrapulmonary tuberculosis was in 10 (12.7%) patients (8 with LPD and 2 with MPD). Infiltrative, disseminated and military tuberculosis of the lungs developed in 55.7, 6.6 and 1.6% HB patients. CONCLUSION: Persistent fever in HB patients may point to developing tuberculosis infection. Fever syndrome and intoxication in patients with HB remission may serve a diagnostic marker of tuberculosis.     

系统性红斑狼疮并结核病临床观察

目的分析总结系统性红斑狼疮(SLE)患者中结核病的发生率、临床特征以及其发病的危险因素和预后。方法研究分析了1995至2004年期间在我院随诊的915例SLE者中的42例并发结核病的患者,结核病的诊断包括临床表现、影像学检查、生化检查、微生物学及组织学检查,并记录其受累器官、治疗药物以及疗效。结果42例患者中33例女性,9例男性,年龄16~52岁(平均28岁),病程2月至6年(平均26月),临床表现主要为发热(42例)、咳嗽(25例)、骨关节痛(15例)、淋巴结肿大(8例)和头痛(4例)。受累器官包括肺32例(76.2%),肺外结核者18例(42.9%),其中结核性脑膜炎6例、骨关节结核4例、结核性腹膜炎2例和淋巴结结核6例。单器官受累者34例,其中一例经经验性治疗后好转,多器官受累者8例。仅4例患者结核菌素试验阳性,其阳性率9.5%。全部患者在诊断结核病前均经过大剂量糖皮质激素的治疗。41例患者经联合抗痨治疗(INH+Rif+Eth或+Pyra),仅1例经INH+Rif+Eth治疗1月后改左氧氟沙星治疗2年,39例抗痨治疗后痊愈。结论SLE患者结核病以及肺外结核的发生率均明显增高。强的松使用可能与结核病的发生相关。早期诊断较困难,抗痨治疗有效。     

Fetal thymus size as a predictor of chorioamnionitis in women with preterm premature rupture of membranes.

OBJECTIVE: Emerging evidence indicates that chorioamnionitis is associated with a significant decrease in thymic size at birth in very low birth weight (VLBW) preterm infants. The aim of this study was to determine whether decreased fetal thymus size is associated with histological or clinical chorioamnionitis in patients with preterm premature rupture of membranes (PROM). METHODS: Twenty-one patients between 24 and 35 weeks of gestation with preterm PROM were included. Serial ultrasound examinations were performed during the latency period, and measurements of the fetal thymus size were obtained. Small thymus was defined as a thymus perimeter < or = 5th percentile according to a fetal thymus nomogram, which was based on measurements of 403 fetuses. Diagnosis of chorioamnionitis was made using neonatal clinical parameters and histological examinations of the placentas. RESULTS: In our study 13 patients presented with thymus size below the 5th percentile. Among the 13 patients with small thymus, nine (69%) had clinical or histological findings consistent with the diagnosis of chorioamnionitis. All eight women with a normal-sized thymus had no evidence of clinical or histological chorioamnionitis. Fetal thymus perimeter < or = 5th percentile yielded a sensitivity of 100%, specificity of 66.7%, a positive predictive value of 69% and a negative predictive value of 100% for identifying chorioamnionitis in patients with preterm PROM. CONCLUSIONS: Fetal thymus size is decreased in women with preterm PROM and chorioamnionitis. Measurement of the fetal thymus might allow an early diagnosis of chorioamnionitis in cases of preterm PROM. Normal thymus size might be used to rule out latent intrauterine infection.     

Clinical manifestations, diagnosis and course of Pneumocystis carinii pneumonia in patients with hematologic diseases]

AIM: To characterize clinical, diagnostic and course features of pneumonia caused by Pneumocystis carinii (PC) in hematologic inpatients. MATERIALS AND METHODS: 27 patients with blood diseases were studied. 22 of them had acute respiratory insufficiency and 5 had unclear lung affection. The data from bronchoalveolar lavage (BAL), lung biopsy, serum tests for IgG, IgM anti-PC-antibodies were used for diagnosis of PC-pneumonia. RESULTS: PC-pneumonia was diagnosed in 8 of 27 patients. Clinical manifestations characteristic for PC-pneumonia were not found. In 5 patients the diagnosis was made on the evidence provided by BAL. Lymphocyte count in BAL was elevated to 27.7 +/- 8.7%. Open biopsy of the lung and transbronchial biopsy diagnosed PC-pneumonia in 2 and 1 patients, respectively. Previous BAL examinations failed to detect PC-pneumonia in 2 of them. In all the patients PC-pneumonia was associated with another infection (bacterial, cytomegaloviral). Histologically, the picture of the disease was determined by the severity of the lung affection or its complications. 5 of 8 patients failed treatment with trimethoprim-sulphamethoxazole and died. Marked respiratory insufficiency was registered at PC-pneumonia diagnosis in all the lethal cases. CONCLUSION: Clinical and x-ray pictures of PC-pneumonia in hemoblastosis patients are not specific. All such patients with symptoms of lung infection resistant to antibacterial and antifungal therapy should be examined for PC-pneumonia.     

慢性肾脏病合并结核感染诊治进展

慢性肾脏病（Chronic kidney disease ,CKD）和结核病是危及人类健康的慢性疾病,慢性肾脏病患者感染结核的风险增加,与CKD的进展有关,且肺外结核发生率高,临床症状不典型,结核相关筛查实验阳性率低,CKD患者抗结核药物副作用较普通人群高且严重,预后更差,早期诊断及及时治疗对改善预后有重要意义。     

LCx Mycobacterium tuberculosis assay is valuable with respiratory specimens, but provides little help in the diagnosis of extrapulmonary tuberculosis

BACKGROUND: Commercial nucleic acid amplification tests, designed for the detection of Mycobacterium tuberculosis DNA/RNA in respiratory samples, are often applied also in nonrespiratory specimens in order to verify the diagnosis of extrapulmonary tuberculosis. AIM. To evaluate the value of the Abbott LCx Mycobacterium tuberculosis assay for the diagnosis of pulmonary and extrapulmonary tuberculosis based on routine clinical laboratory results. METHODS: The assay was used to analyse 350 respiratory and 826 nonrespiratory specimens from 961 patients, of whom 3.6% had culture-proven tuberculosis. The results obtained by the LCx assay were compared with the records on mycobacterial isolates of the national reference laboratory and, in the case of positive findings, with clinical data. RESULTS: In comparison with culture, the sensitivity, specificity and positive/negative predictive value of the assay on respiratory specimens were 87.5%, 99.7%, 93.3% and 99.4%, respectively. With nonrespiratory specimens, the overall sensitivity, specificity and positive/negative predictive value of the LCx assay were 73.3%, 98.0%, 40.7% and 99.5%, respectively. When clinical and histological data were also included, the positive predictive value of LCx with nonrespiratory specimens was 45.8%. CONCLUSION: Critical interpretation of the nucleic acid amplification results obtained from nonrespiratory specimens is necessary in both laboratory and clinical settings.     

肺结核患者合并其他病原菌肺部感染的临床特点及危险因素分析

目的分析肺结核合并其他病原菌肺部感染患者的临床特点,为早期预防和临床诊疗提供理论依据。方法回顾性分析西南医科大学附属医院2016年7月-2019年7月收治的357例肺结核抗酸杆菌阳性患者的相关资料,对患者肺部影像学表现、临床特点、病原菌分布、潜在的感染相关因素进行分析。结果肺结核患者合并其他病原菌肺部感染191例,临床表现常有中高程度发热、咯脓痰等症状,影像学表现不典型;以白念珠菌为主的定植菌检出率高,肺炎克雷伯菌是常见的病原菌;咯血、重症肺结核、合并慢性肺疾病、血清白蛋白<40 g/L、BMI<18.5 kg/m^2、抗菌药物使用时间>2周是肺结核合并其他病原菌肺部感染的独立危险因素。结论肺结核患者合并其他病原菌肺部感染时,应针对病原菌及早进行经验治疗,以利于短期内控制感染;防控结核病及肺部基础疾病的进展、加强营养支持及维持理想体重可能有助于减少肺结核患者合并其他病原菌肺部感染。     

结核杆菌L-型感染与肺癌组织类型的关系

目的调查肺癌组织中结核分枝杆菌L-型的感染状况,以分析结核分枝杆菌L-型感染相关肺癌的临床病理学特征。方法采用原位分子杂交技术检测结核分枝杆菌L-型MPB64基因片段的存在及定位。同时,用IK抗酸染色法检测标本中的结核分枝杆菌L-型。结果原位分子杂交检测石蜡包埋73例肺癌组织中MPB64基因片段在肺鳞癌、肺腺癌、细支气管肺泡癌、小细胞未分化癌中的阳性率分别为85.0%、73.5%、81.8%和87.5%,差异无统计学意义(P>0.05)。IK抗酸染色检测结核分枝杆菌L-型在肺鳞癌、肺腺癌、细支气管肺泡癌、小细胞未分化癌中的阳性率分别为70.0%、64.7%、63.6%和75.0%,差异无统计学意义(P>0.05)。结论结核分枝杆菌L-型感染在肺癌的形成过程中可能起到一定的作用,但是与癌组织的病理学类型无关。     

泌尿系结核的诊断体会(附30例报告)

目的 提高泌尿系结核的诊断水平。方法 回顾分析30例泌尿系结核的临床资料，总结其诊断经验。结果最常见的主诉为尿路刺激征和血尿，分别为66．7％和33．3％。尿沉渣涂片抗酸杆菌阳性率为％．7％。静脉尿路造影(IVU)、逆行肾盂造影、CT的确诊率分别为23．3％、66．7％和70．0％。30例接受手术治疗，术后病理检查均证实为泌尿系结核。结论 泌尿系结核的临床诊断应综合病史、尿液分析、影像学分析、病原学诊断等多种方法，X线检查应首选IVU和逆行肾盂造影，对两未能明确诊断，可选择CR检查，对于中、晚期肾结核，CT的诊断价值较逆行肾盂造影更大。     

肺结核继发真菌感染28例临床分析

目的：通过对28例肺结核合并真菌感染的临床资料的分析，提高对两病并存的临床表现的认识和合理处理。方法：回顾分析1994年1月～2004年6月我科收治的28例肺结核合并真菌感染的资料。结果：合并真菌感染的肺结核主要特点：肺结核合并真菌感染以白色念珠菌为多，且发病部位以肺部最多。临床表现不典型或受伴发病的影响；结核病史长，年龄偏大，肺部病变广泛。空洞多，病情较重；多有继发真菌感染的诱因可寻；确诊有赖于病原学检查。结论：临床医师应加强对结核病的警惕性，特别是有结核病史、免疫缺陷(包括长期使用激素或化疗、应用广谱或多种抗生素，引起菌群失调)病史或合并营养不良的患者。原发病经正规治疗无缓解时，应警惕合并真菌感染的可能。合理正确应用抗结核药物，以免诱发结核药物引起的真菌感染。肺结核合并真菌感染的早期、对症治疗疗效较满意。     

PCR—ELISA测定结核分枝杆菌DNA临床应用评价

目的　评价聚合酶链反应 酶联免疫吸附试验 (PCR ELISA)测定结核分枝杆菌DNA临床应用价值。方法　用PCR ELISA测定 436例肺结核、172例非结核病人痰标本中的结核分枝杆菌DNA ,并结合临床诊断和痰菌检查对实验结果进行分析。结果　 436例活动性肺结核病人本法最终阳性 341例 ,阳性率 78.2 1% ,其中痰菌阳性病人本法阳性率为 97.0 7% ,痰菌阴性病人阳性率为 5 5 .33 % (10 9/ 197) ;而 172例对照患者只有 3例假阳性 ,假阳性率 1.74%。结论　本法测定痰液结核分枝杆菌DNA对肺结核的诊断具有很高的敏感性和特异性 ,尤其对痰菌阴性的活动性肺结核病人具有重要辅助诊断价值     

原发性肝脏实质结核的外科诊治

目的:探讨原发性肝脏实质结核的临床特征及外科治疗。方法:对我院普外科1994～2004年收治的9例原发性肝实质结核病人的临床表现、诊断、治疗进行回顾。结果:本组病人手术前均未确诊,全部经术中冰冻切片证实为结核。结论:对肝功无明显异常而CT或B超发现肝脏占位,又不能除外恶性病变或伴有并发症的患者应当手术治疗,并行营养治疗和抗痨治疗。     

对PPD强阳性者采用预防性化疗的回顾性调查

[目的]用结核菌素纯蛋白衍生物（PPD）试验对其强阳性者采用预防性化疗，降低结核高危人群发病率。[方法]对PPD试验强阳性者采用预防性化疗3个月。[结果]1．PPD试验有卡痕者结核菌感染率比无卡痕者比较差异有统计学意义（P〈0．01）。2．实验组PPD试验强阳性者采用预防性化疗后其活动性肺结核患病率与对照组比较差异有统计学意义（P〈0.01）。[结论]PPD试验强阳性人群是结核病的高危人群，对其施行预防性化疗是干预其发展为临床结核病的重要措施。     

Increased risk of type 2 diabetes in noncirrhotic patients with chronic hepatitis C virus infection

OBJECTIVES: To investigate whether patients with chronic hepatitis C virus (HCV) infection without evidence of cirrhosis have an increased risk of diabetes mellitus (DM) and to evaluate possible risk factors for diabetes in this group. PATIENTS AND METHODS: We conducted a case-control study of 45 consecutive eligible patients with HCV infection and no clinical, scintigraphic, or histological evidence of cirrhosis, and a control group of 90 subjects without liver disease matched by age, sex, and body mass index and similar in their origin distribution. Eighty-eight patients with chronic hepatitis B virus (HBV) infection with no evidence of cirrhosis were also evaluated. The diagnosis of diabetes was based on the 1997 American Diabetes Association criteria. RESULTS: Fifteen patients (33%) with HCV infection were found to have type 2 diabetes compared with 5.6% in the control group without liver disease (P < .001) and 12% in the group with HBV infection (P = .004). Comparison of the patients with and without diabetes revealed that positive family history of diabetes, HCV 1b genotype, and a more severe liver histology were significantly associated with DM. CONCLUSIONS: Patients with chronic HCV infection have an increased prevalence of type 2 diabetes, and this prevalence is independent of cirrhosis. The pathogenesis is intriguing, appears to be unique to HCV, and requires further study.     

Evaluation of Henes-PCR assay for Mycobacterium detection in different clinical specimens from patients with or without tuberculosis-associated HIV infection

The need for early diagnosis of tuberculosis, particularly in HIV-infected patients, requires the development of diagnosis methods that have a high sensitivity and specificity, as does the nucleic acid-based technology. With the purpose of improving the detection of mycobacterium in different clinical samples, we proposed and evaluated an assay based on nucleic acid-amplification: heminested-PCR (Henes-PCR). The procedure was designed to identify Mycobacterium spp., M. tuberculosis complex (MTC), and M. avium complex (MAC), although it has the potential to include more primers for the identification of other species. Analytical and clinical evaluation of Henes-PCR was performed by analysis of reference strains and 356 clinical specimens from 246 patients with pulmonary and meningitis tuberculosis and unrelated infections, including 142 HIV-infected individuals. Ninety-three percent (199) positive and 100% (143) negative results were obtained in specimens from patients with tuberculosis and non-tuberculosis infection, respectively. The overall sensitivity of Henes-PCR was 93.4%, specificity was 100%, positive and negative predictive values were 100 and 91.1%, respectively. Sensitivity and negative predictive value of Henes-PCR were significantly higher than culture procedure for microscopy-negative specimens. Even though frequency of HIV infection was higher in patients with tuberculosis, diagnostic parameters of Henes-PCR were similar between HIV-positive and HIV-negative patients. MTB was identified in 194 (98%) specimens while MAC was detected in 5 (2%) specimens. These findings suggest that Henes-PCR is a useful test for rapid detection of mycobacterium in clinically suspected cases of tuberculosis with smear-negative results.     

High Prevalence of Sexually Transmitted Diseases in Women with Urinary Infections

Objective: To determine the prevalence and factors associated with unrecognized sexually transmitted diseases (STDs) in women who had pelvic examinations and were subsequently released from the ED with a sole diagnosis of urinary tract infection (UTI).
Methods: A 3-month retrospective chart review was performed in an urban teaching hospital ED (>70,000 visits/year). Women aged 12–45 years who had pelvic examinations and were released from the ED with a sole diagnosis of UTI were included. Patient complaints, physical findings, and laboratory results were reviewed. Laboratory evaluations included the complete blood count, urinalysis, urine pregnancy test, and cervical cultures for Neisseria gonorrhoeae, Chlamydia trachomatis and Trichomonas.
Results: Of the 94 women who met study criteria, 53% had proven STDs (19% N. gonorrhoeae 22% C. trachornaris 33% Trichomonas). There was no difference between the patients with positive and negative tests for STDs with regard to complaints, physical findings, and laboratory results (all p > 0.05).
Conclusions: Women undergoing pelvic examinations who are subsequently released, from this urban ED with the diagnosis of UTI have a high (>50%) prevalence of occult STDs. No complaint, physical finding, or laboratory result reviewed was associated with the risk of an STD. Consideration should be given to empirical antibiotic therapy in similar urban populations.     

菌阴肺结核126例临床分析

目的:探讨菌阴肺结核的临床诊断与治疗,为菌阴肺结核的控制工作提供临床依据。方法:回顾分析126例菌阴肺结核患者的临床资料,分析其临床表现、实验室相关检查及肺CT表现。结果:126例患者的症状和体征无特异性。126例患者中,结核分枝杆菌纯蛋白衍化物(purified protein derivative of tuberculin.PPD)试验(++)68例,(+++)30例,(-)26例,(+)2例;结核抗体试验(immunochroma-tographic test,ICT)阳性39例;腺苷脱氨酶升高45例,血沉升高47例,C-反应蛋白升高20例;肺CT检查显示,病灶累及1个或2个肺叶,部位以尖后段或背段为主,形态表现主要为斑片、斑点、结节影,空洞为厚壁。抗结核药物治疗1个月、2个月、6个月后病灶吸收显效率分别为11.4%、41.3%、65.9%;空洞闭合率分别为8.0%、12.0%、44.0%。结论:菌阴肺结核临床表现不典型或无症状,无特异性相关检查结果,诊断困难;病灶位于活动性结核好发部位,提示肺结核可能;抗结核药物治疗后动态观察病灶吸收及空洞闭合情况对诊断有较大的帮助。     

影像学联合三种分子诊断技术诊断结核病的价值

目的评估GeneXpert MTB/RIF、TaqMan探针荧光定量PCR、RNA恒温扩增法3种不同原理的分子生物学检验方法联合影像学表现对结核病诊断的价值。方法收集胸部X线检查表现怀疑结核分枝杆菌感染的患者标本38例,以临床诊断结核病为金标准,比较GeneXpert MTB/RIF、TaqMan探针荧光定量PCR法、RNA恒温扩增法3种分子生物学检验方法的敏感度、特异性、阳性预测值和阴性预测值。结果胸部X线检查怀疑结核分枝杆菌感染的患者中,23名临床诊断为结核病,15名临床排除结核病。GeneXpert MTB/RIF、TaqMan探针荧光定量PCR、RNA恒温扩增法检测的敏感度分别为87.0%、52.2%和13.0%,阴性预测值分别为83.3%、57.7%和43.2%,差异具有统计学意义（P < 0.05）。3种方法的阳性预测值均为100%。GeneXpert MTB/RIF方法的敏感度和阴性预测值最高,其次为TaqMan探针荧光定量PCR法,RNA恒温扩增法敏感度和阴性预测值最低。结论对于胸部X线检查怀疑结核分枝杆菌感染的患者,GeneXpert MTB/RIF检测结核分枝杆菌具有更高的敏感度,在结核病诊断中具有较好的辅助诊断价值,应推荐成为结核分枝杆菌感染检测的首选分子生物学方法。     

5种结核分枝杆菌检测方法的临床应用价值研究

目的评价5种结核分枝杆菌检测方法对肺结核的辅助诊断价值。方法统计2018年1-10月在广州医科大学附属第一医院住院的患者,分为临床诊断肺结核患者和临床诊断非结核普通住院患者共209例,用结核培养法、PCR-荧光探针法、结核感染T淋巴细胞酶联免疫斑点试验(T-SPOT.TB)法、抗酸染色法、利福平耐药实时荧光定量核酸扩增检测技术(Xpert MTB/RIF)法分别进行检测,比较这5种方法在临床诊断中的价值。结果结核培养法、抗酸染色法、PCR-荧光探针法、T-SPOT.TB法、Xpert MTB/RIF法阳性率分别为16.8%、23.4%、39.2%、53.0%、52.2%。结核培养法灵敏度为52.17%,特异度为100.00%;抗酸染色法灵敏度为42.45%,特异度为96.67%;PCR-荧光探针法灵敏度为76.00%,特异度为97.98%;T-SPOT.TB法灵敏度为91.67%,特异度为79.80%;Xpert MTB/RIF法灵敏度为99.09%,特异度为100.00%。结论Xpert MTB/RIF法是最值得推荐的方法,也是唯一可以作为诊断结核感染的分子生物学方法,如果能够联合这几种方法,可以快速、准确地对结核感染进行诊治。     

Informative value of a cytological method of examination in lung diseases

A total of 8055 cytological examinations of the sputum, bronchial secretion, pleural exudate, aspirate of the puncture of the lungs and peripheral lymph nodes were performed in 6525 patients with different pulmonary diseases. Neutrophilic, macrophagal and eosinophilic types of changes on cytograms were of clinical importance in patients with inflammatory bronchial and pulmonary diseases and bronchial asthma. In sarcoidosis epithelioid cells in the bronchial secretion were found in 11%, specific elements in tuberculosis in 5% of the patients. Comparison of the cytological and histological data in cancer patients showed coincidence in 94% of the patients. A possibility of a wide use of cytological studies in comprehensive diagnosis of pulmonary diseases was proved and their clinical importance shown.