预防结核病的三项有效措施

要控制结核病的传染和流行,就要从结核病的预防着手。目前,最有效的预防措施有三项。一、控制传染源排菌的肺结核病人是结核病的主要传染源,一名涂片检查排菌的病人,每毫升痰液中至少有5,000～10,000条结核菌,它能传染10～20个健康人。在受传染的人中,又可有10%的发病,这些发病者中的半数又将成为新的传染源。所以,传染源不控制,结核病的流行就将持续。控制传染源最有效的办法是给予合理的治疗(详见本刊1982年4期“肺结核治愈的关键是什么?”)。一个经治疗的传染源,其传染性迅速消失。这是因为:①一个治疗前每毫升痰中有数百     

电话督导访视在肺结核治疗管理中的应用分析

目的:探讨电话督导访视在肺结核治疗管理中的应用效果。方法:采用回顾性方法分析,选取预防控制中心结防科自2017年1月至2017年12月随访的255例肺结核患者,均给予全程督导管理模式,及时领取药物给予电话督导方式,分析治疗依从性及有效性。结果:255例肺结核患者依从率为97.3%,治疗有效率为91.4%。结论:肺结核治疗管理中实施全程督导管理与电话督导访视可提高治疗依从性及治疗有效性。     

门诊治疗59例耐多药肺结核近期效果分析

目的：探讨门诊督导治疗耐多药肺结核的方法、治疗效果和药物不良反应。方法：利用世行贷款中国结核病控制项目督导点对耐多药肺结核病人实行全程督导治疗并观察结果。结果：59例耐多药肺结核患者按规定全程规则治疗满18个月疗程，3月末痰菌阴转率为40．7％，6月末为51％，完成18个月疗程后其痰菌阴转率为76．3％。放射学完成疗程后病灶明显吸收率为83．1孵。不良反应中表现为胃肠道反应者39．4％，肝功能损害15．7％，神经精神系统反应者15．7％。结论：门诊全程督导治疗耐多药结核病规则治疗率和治愈率高，副反应轻微，相对治疗费用低，可被大多数患者接受，值得临床研究推广。     

760例流动暂住人口肺结核实施全程督导化疗管理分析

如何对流动人口肺结核病人进行有效的管理，一直是结核病控制工作中探索的重要课题，宝安区是深圳经济发达特区，随着经济发展，从外地涌入的暂住人口（指领取暂住证一年以上者）达77万，为常住人口的3倍。暂住人口中的肺结核病人流动性相对较大，为确保这部分病人有效的治疗管理，纳入世银贷款中国结核项目，与常住人口的涂阳肺结核病人同步采用全程督导化疗（DOTS）管理。现将1993年5月～1997年12月对流动暂住人口初治涂阳肺结核病人治疗管理效果分析如下。1资料与方法1．1病例发现：采用因症就诊发现方法，凡有咳嗽、咳痰2周以上或伴有…     

全程督导管理痰培养阳性肺结核179例分析

克拉玛依市结防所在结核杆菌痰涂片检查的基础上，为充分发现传染源。于2001年开展了痰结核分枝杆菌快速培养项目，对培养阳性的肺结核患者也采用涂阳患者的短程全程督导（DOTS）方式治疗管理，现将179例痰培养阳性患者治疗效果分析如下。     

田东县实施DOTS策略和DOT治疗前后肺结核病人的痰涂片分析

目的分析实施DOTS策略和DOT治疗前后肺结核病人的痰涂片情况。方法对2004年田东县肺结核登记病例和1999～2003年结核病疫情报告的痰涂片情况进行统计分析。结果实施DOTS策略前的痰检人数、痰检率和涂阳率均比实施DOTS策略后低;实施DOT治疗前初诊病人的涂阳率比转诊病人高;涂阳率农民高于干部工人、男性高于女性;实施DOT治疗后满2个月及满6～8个月初诊肺结核病人的痰涂阴转率较转诊肺结核高。结论加大力度实行肺结核病归口管理,以农村为重点加强卫生宣教,使肺结核病人能在第一时间内接受统一检查和督导化疗与管理,是发现、治愈涂阳肺结核病人和进一步控制肺结核病流行的最有效措施。     

一起甲型肝炎暴发的调查报告

峄城区世界银行贷款结核病控制项目 (简称项目 ) ,于 1 995年 5月份启动。本文对峄城区 1 995年5月至 2 0 0 2年 6月间所发生的肺结核病人 ,严格按照“项目”要求实施现代结核病控制策略 ,对传染性肺结核病人实行全程督导免费治疗的工作措施 ,现将化疗效果以及病人调查进行综合分析。资料来源于县 区级项目管理季报表、年报表、肺结核病例登记簿。人口资料来源于区统计局。全区 1 995 - 2 0 0 2年登记初诊结核 1 762例 ,涂阳病人 5 72例 ,其中新发涂阳 492例 ,复发涂阳 78例。平均病例登记率为 64 0 4 1 0万 ,新发菌阳病例登记率为 1 6 82 …     

341例肺结核病人的疗效观察

本文对３４１例肺结核病人进行了临床治疗效果观察，经用世界银行贷款结核病控制项目手册所规定的化疗方案，实行了全程督导管理的方法，治疗管理的３４１例肺结核病人，治愈３３４例，治愈率９８％。失败７例，失败率２％，比全国短程化疗协作组６ＲＨＥ方案阴转率９０．７％的效果显著。     

传染病医院消毒与隔离

传染病医院是收容国家法定传染病的专科医院,传染源集中,传播途径广泛,在医疗实践中,有效预防与控制医院感染,成为现代医院管理的重点和难点。为预防各种传染病在医院的传播扩散,在消毒隔离方面传染病医院较综合医院有着更为严格的标准和要求。我院是一所传染病专科医院,多年来,医院一直坚持科学建筑布局,严格区域管理,不断完善各种消毒隔离制度,严格日常的培训和督导,使消毒隔离措施得到很好落实,有效防止了传染病在医院的传播扩散。     

石家庄市2002-2004年涂阳肺结核病人短程化疗近期效果分析

为评价我市结核病控制项目开展后的成效，进一步落实DOTS（directly observe treatment short-course）策略，现将我市2002-2004年的涂阳肺结核病人的近期疗效进行分析，以期改进措施提高控制效果。结果证实实施DOTS管理下的全程督导的化学疗法是行之有效的控制措施，现将结果报告如下：     

Tuberculosis in HIV-infected and AIDS patients

The course of the combined infection (tuberculosis plus HIV-infection) has been analysed in 41 patients. Of them, 24 patients developed tuberculosis in the presence of HIV-infection (group 1) and 17 were infected with HIV when they already had tuberculosis running up to 5 years. HIV-infection in group 1 ran a more severe course, the patients developed generalized, disseminated and complicated forms of tuberculosis with more frequent lethal outcome. 39 patients of both groups received specific antituberculous therapy including 1-5 drugs. A response to treatment was achieved in 23 (60%) patients (52 and 47.8% at early and late HIV-infection stages, respectively). Treatment failure was explained by development of severe opportunistic infections and secondary diseases (generalized cytomegalovirus infection, advanced candidiasis, toxoplasmosis), poor compliance, asocial life style, advanced tuberculosis process, late diagnosis, inadequate treatment. It is shown that in late HIV-infection positive results of treatment can be expected only in early detection of tuberculosis and active long-term treatment.     

Tuberculosis and infection control

Against a background of rising tuberculosis (TB) rates, increasing incidence of TB and human immunodeficiency virus (HIV) co-infection, coupled with the emergence of multidrug-resistant TB (MDR-TB) and extensively drug-resistant TB (XDR-TB), the need for effective TB infection control has never been more vital (World Health Organization (WHO), 2009). TB infection control has been defined as 'a combination of measures aimed at minimizing the risk of TB transmission within populations' (WHO, 2009: p.ix). Health professionals are frequently confused about appropriate infection control measures when caring for patients affected by infectious respiratory tuberculosis (Mohandas and Cunniffe, 2009). This article aims to address the key infection control measures required to optimize patient care and reduce the risk of TB transmission within hospital and community settings.     

Tuberculosis in urogenital organs

Because of the progress in chemotherapy for Mycobacterium tuberculosis, it has become quite rare to diagnose patients with genitourinary tuberculosis. In Japan, however, the incidence of tuberculosis remains comparatively high, particularly in elderly patients, among advanced countries. Furthermore, infectious adverse events associated with intravesical instillation therapy with bacille Calmette-Guérin (BCG), which is one of the most useful agents against non-muscle invasive bladder cancer, are frequently developed. Considering these findings, it is still necessary to be well informed of the diagnosis as well as treatment for genitourinary tuberculosis. In this review, therefore, we would like to summarize the important topics concerning genitourinary tuberculosis, including BCG infection following intravesical instillation therapy for bladder cancer.     

Aspirin and ibuprofen enhance pyrazinamide treatment of murine tuberculosis

OBJECTIVES: Aspirin (acetylsalicylic acid) or ibuprofen [2-(4-isobutyl-phenyl)-propionic acid] was administered to mice undergoing treatment of tuberculosis infection with pyrazinamide to determine if these non-steroidal anti-inflammatory drugs (NSAIDs) enhance pyrazinamide activity in vivo. METHODS: BALB/c mice were infected with Mycobacterium tuberculosis H37Rv through aerosol exposure. Mice were treated orally with aspirin, ibuprofen or pyrazinamide, alone and in combination. The impact of daily administration of these drugs for 1 month was determined by enumerating viable bacteria in the lung and spleen. RESULTS: Aspirin or ibuprofen alone at 20 mg/kg per day had little effect on tuberculosis infection after 1 month of treatment, while pyrazinamide at 150 mg/kg per day led to a reduction of about 1.5 log(10) cfu in the lung and 2 log(10) cfu in the spleen compared with the control. Simultaneous administration of either aspirin or ibuprofen with pyrazinamide resulted in a further decrease of about 0.4 log(10) cfu in the lung and more than 1 log(10) cfu in the spleen compared with mice receiving pyrazinamide alone. All spleens in the pyrazinamide-only treatment group were positive for infection. Of mice treated with both aspirin and pyrazinamide, two of five spleens were negative for colony formation, with a lower limit of detection of 0.90 log(10) cfu per organ. Three of five mice given ibuprofen and pyrazinamide had culture-negative spleens. CONCLUSIONS: Aspirin and ibuprofen enhance the effect of pyrazinamide during the initial phase of tuberculosis treatment in the mouse model. Further investigation is necessary to determine the impact of NSAIDs on long-term treatment with pyrazinamide and other antituberculosis drugs in the mouse model of tuberculosis infection and the clinical implications of these findings on tuberculosis treatment in humans.     

ICU继发性肺结核患者 下呼吸道感染病原菌分布及耐药性分析

目的 了解深圳、龙岗、光明和龙华新区四家三级区属医院ICU继发性肺结核患者并发下呼吸道感染的病原菌分布特征及其耐药性现状,为临床诊断和合理选用抗生素治疗提供参考依据。方法 对随机选取2013年2月～2015年10月在三家区属医院ICU确诊为继发性肺结核并发下呼吸感染患者593例的痰标本病原菌培养和药敏结果进行回顾性分析。结果 593例ICU继发性肺结核并发下呼吸道感染患者中共分离出617株病原菌,其中真菌占49.6%(306/617),革兰阴性杆菌占40.4%(249/617),革兰阳性球菌占10.0%(62/617); 真菌感染主要病原体为白色假丝酵母菌和光滑假丝酵母菌,分别占44.2%(273/617)和4.5%(28/617),革兰阴性杆菌主要为肺炎克雷伯菌、铜绿假单胞菌及流感嗜血杆菌,分别占16.7%(103/617),12.0%(74/617)及7.3%(45/617),革兰阳性球菌主要为金黄色葡萄球菌、表皮葡萄球菌及溶血葡萄球菌,分别占4.5%(28/617),3.2%(20/617)及0.9%(5/617); 分离出的病原菌为多药耐药菌,对常用抗菌药物呈现不同程度的耐药性。结论 ICU继发性肺结核患者并发下呼吸道感染的病原菌以真菌和革兰阴性杆菌多见,最常见为白色假丝酵母菌、肺炎克雷伯菌及铜绿假单胞菌,且对常用抗菌药物产生不同程度的耐药性。     

Tuberculosis Infection in Children

Globally, tuberculosis (TB) is the leading cause of infectious disease mortality; however, clinicians in the United States are increasingly unfamiliar with TB and the recommended tests and treatment for latent TB infection. Compared with adults, children who develop TB more often develop severe disease, and children < 2 years are particularly susceptible to developing TB disease after initial infection. Nurse practitioners who work in primary care are on the front lines of identifying children at high risk and obtaining testing and treatment. This article reviews the clinical course for identifying children at risk for TB and provides updated guidelines for testing and treatment.     

脊柱结核围手术期处理策略

目的：探讨脊柱结核一期内固定手术的围手术期处理方法。方法：一期手术治疗脊柱结核患者68例。围手术期处理主要包括正规化疗、围手术期营养支持、选择正确的手术时机、术后支具保护下逐步功能锻炼、定期随访、监测药物副作用等。结果：68例患者切口均一期愈合,无窦道形成。平均2.2年随访,结核治愈、后凸畸形纠正,10例患者出现化疗相关的并发症对症或调整药物后症状控制。结论：正确的围手术期处理是脊柱结核手术成功的重要保证。     

Tuberculosis during lung cancer treatment-A case series

This study aimed to clarify the characteristics of patients with lung cancer undergoing treatment until the onset of tuberculosis. Between 2005 and 2019, patients who were admitted to Tokyo National Hospital due to tuberculosis during lung cancer treatment were examined retrospectively. There were 42 patients, and detailed medical information was obtained in 39 patients. The median age of the 39 patients were 75 years (range: 47–92 years), of which 33 were males and 36 were Japanese Baby Boomers or older. Regarding risk factors for developing tuberculosis, smoking was noted in 34 cases, oral corticosteroid use in 13, and previous tuberculosis in six. Thirty-seven patients had one risk factor and 19 had two or more risk factors, but diagnosis of latent tuberculosis infection (LTBI) was obtained in only one patients, and none had received LTBI treatment. The first-line treatment for lung cancer was resection in 13 cases, chemoradiotherapy in 6, chemotherapy in 10, radiation therapy in 3, laser therapy in 1, and best supportive care (BSC) alone in 6. At tuberculosis onset, BSC accounted for 17 cases, but other situations were considerably existed such as anticancer medication (12 cases), and observation after lung cancer treatment (10 cases). Tuberculosis occurred in various situations in elderly patients with lung cancer. It is critical to actively evaluate the risk of tuberculosis and consider LTBI screening and treatment.     

Tuberculosis: infection control in hospital and at home

This article examines infection control issues relating to tuberculosis (TB) in acute and community settings. Background information on TB is discussed briefly along with key challenges to global and national control. A programme to prevent infection composed of specific hierarchical levels is outlined, using national and international guidance, and suggestions are made for infection control in the community. The article will be useful for nurses involved in the care of patients with confirmed or suspected TB.     

Tuberculosis Health Education Needs in Homeless Shelters

Abstract Tuberculosis has reemerged as an important public health concern, particularly with the rise in multi-drug-resistant strains. The homeless are at increased risk for infection, for active disease, and for incomplete treatment. Public health authorities have recommended that tuberculosis health education materials be developed specifically for residents and staff of homeless shelters. In this study, a diverse sample of 20 adult homelessshelter residents responded to open-ended questions regarding 1) their knowledge of tuberculosis and tuberculosis screening and treatment, 2) their perceptions of access to health care services related to tuberculosis, and 3) their views of health education regarding tuberculosis. The majority of the subjects had limited knowledge of tuberculosis and of screening and treatment for the disease. Many had misconceptions about the disease, particularly regarding its transmission. An analysis of the subjects' responses within the framework of the Health Belief Model indicated that basic tuberculosis health education programs for residents of homeless shelters are needed. The study findings indicated that a small-group educational format utilizing written materials and video aids might be most effective.