应用微列阵技术快速鉴定常见致病性分枝杆菌

目的利用微列阵技术建立一种简便、快速、灵敏、特异的分枝杆菌菌种鉴定方法,为临床医师正确诊断提供依据。方法以DNA测序法为对照,通过微列阵技术分析20种分枝杆菌标准株及473株分枝杆菌临床分离株。结果微列阵技术分析20种分枝杆菌标准株,特异性为100％,在473株分枝杆菌临床分离株中,358株与分枝杆菌属探针和结核分枝杆菌（Mycobacterium tuberculosis,MTB）复合群探针杂交阳性,鉴定为MTB复合群。115株为非结核分枝杆菌（nontuberculosis myvobacterial,NTM）,其中47株为龟分枝杆菌龟亚种和脓肿亚种,32株为胞内分枝杆菌,15株为鸟分枝杆菌,11株为堪萨斯分枝杆菌,4株为偶然分枝杆菌,2株为戈登分枝杆菌,2株为土分枝杆菌,2株只与分枝杆菌属探针杂交,经测序显示1株为副瘰疬分枝杆菌,1株为莫娜分枝杆菌,芯片上无鉴定这2个菌种的探针。结论做列阵技术是一种能准确、高效鉴定分枝杆菌菌种的分子诊断技术,对临床快速、特异诊断结核病具有重要意义。     

54例非结核分枝杆菌感染者对二线抗结核药的耐药分析

目的：观察分析非结核分枝杆菌（NTM）的耐药情况。方法收集本院分枝杆菌培养阳性并鉴定为非结核分枝杆菌的病例,并对其药效结果进行分析。结果320例分枝杆菌培养阳性病例中,54例为非结核分枝杆菌,占16.9%,对二线抗结核药物阿米卡星（AK）,卷曲霉素（CPM）,对氨基水杨酸钠（PAS）,莫西沙星（MFX）,左氧氟沙星（LFX）和丙硫异烟胺（TH1321）均有不同程度的耐药,耐药率高达87.0%,且大多数呈现多耐药。结论非结核分枝杆菌对抗结核药呈现耐药现象,故临床用药困难,对临床抗结核治疗效果不佳或疑似NTM肺病的患者应及早做痰培养、菌型鉴定及药物敏感试验并寻求其他有效的治疗方法。     

An unusual case of genito-urinary tuberculosis. Case report

We represent and discuss etiology, diagnosis as well as differential diagnoses of tuberculous orchtitis referring to an actual case of this rare disease. In the least of all cases one can conclude from the clinical symptoms on the tuberculous origin of the disease. Other differential diagnoses will set more frequently due to rarity of this disease. Quite a lot of cases a bacterial superinfection veils the sterile leucocyturia as main characteristic of genitourinary tuberculosis. Imaging diagnostics frequently fails to give indications of tuberculous origin of the lesion. As before the evidence of Mycobacteria tuberculosis is the most important parameter to proof a tuberculosis. Despite required microbiological cultivation to make a resistogram the polymerase chain reaction is a high sensitive and comparable fast method for detection of Mycobacteria even from tissue. In such dubious cases we recommend to perform an operative denudation due to frequently difficult delimitation from malignant testicular tumours.     

Liver transplantation without isoniazid prophylaxis for recipients with a history of tuberculosis

Abstract:  Tuberculosis remains one of the most serious infections after organ transplantation. Isoniazid prophylaxis for liver transplant recipients with a history of tuberculosis is generally recommended. However, its benefit is controversial because of potential hepatotoxicity of isoniazid. It is crucial to determine appropriate post-transplant managements for the recipients with a history of tuberculosis. The purpose of this study was to investigate the necessity of isoniazid prophylaxis for liver transplant recipients who had a history of tuberculosis. The medical records of 1116 liver transplant recipients were studied, of whom seven had a history of tuberculosis (0.63%). One who underwent living-donor liver transplantation for fulminant hepatic failure was excluded from evaluation because of early death, caused by bacterial sepsis two months after transplantation, although reactivation of tuberculosis was not observed. The median observation period after transplantation was 25.5 months (range 12–82). Reactivation of tuberculosis did not occur in any of these six patients. In conclusion, we could not find rationale for isoniazid prophylaxis in liver transplant recipients with past diagnosis of tuberculosis, when the disease is considered to be inactive. Tuberculosis should be considered as cause of post-transplant infections, and careful post-transplant observations are essential for an early diagnosis.     

Male genital tuberculosis in Siberians

To study the epidemiology and the clinical picture of male genital tuberculosis in Siberia, Russia. Five hundred and fourteen patients with genitourinary tuberculosis were enrolled in the study: 414 had kidney tuberculosis only, 100 had genital involvement. The clinical picture and structure of genital tuberculosis were investigated: 42 had tuberculosis of scrotal organs and 58 had tuberculosis of the prostate. Urinary cultures, urinalysis, three-glass test, and investigation of the prostate secretion, Mycobacteria culture, and susceptibility testing were performed in all 514 patients. 33.6% of all patients earlier suffered from pulmonary or extrapulmonary tuberculosis and were successfully cured. In 61.9% nephrotuberculosis was diagnosed alongside with an orchiepididymitis. In 30.9% of patients bilateral epididymorchitis was diagnosed. Mycobacteriuria was present in 38.1%. Scrotal fistula was found in 11.9%. In 66.7% the symptoms appeared acutely. Half of the patients with prostate tuberculosis complained of dysuria, 23 (39.6%) had perineal pain, 34 (58.6%) had flank pain. Leucocytes in urine were present in 49 (84.5%) patients, and in prostatic secretion in 45 (77.6%) patients. Erythrocytes in urine were present in 31 (53.4%) patients, and in prostatic secretions in 17 (29.3%) patients. Male genital tuberculosis has no specific pathognomonic signs. Using a special algorithm for the management of patients with prostatitis or epididymitis is recommended.     

Laryngeal tuberculosis in renal transplant recipients.

BACKGROUND: Tuberculosis is the most common non-pyogenic infection encountered among renal transplant recipients in India. Although the lung is the most common site of involvement, a number of extrapulmonary organs can be involved. There is often a delay in diagnosis and institution of effective chemotherapy when there is an unusual site of involvement. METHODS AND RESULTS: We report two renal transplant recipients with laryngeal tuberculosis who presented with prolonged hoarseness of voice and painful dysphagia. Acid-fast bacilli were demonstrated on laryngeal biopsy and smear. Fever and pulmonary involvement were seen in only one patient. This is the first report of laryngeal tuberculosis in renal transplant recipients. CONCLUSIONS: Laryngeal tuberculosis should be suspected in renal transplant recipients who develop hoarseness of voice and odynophagia. Demonstration of acid-fast bacilli on biopsy or smear obtained by direct laryngoscopy helps in determining the diagnosis.     

骨科感染偶发分枝杆菌的临床案例分析一例

［摘要］ 目的 偶发分枝杆菌属于快速生长的分枝杆菌,在自然界分布广泛,但其导致的骨科感染病例少见报道,现分析我院骨科感染偶发分枝杆菌病例一例,为临床治疗提供参考。方法 回顾分析其实验室检查过程、临床特点及治疗过程,并随访其治疗效果。结果 非结核分枝杆菌容易漏诊、误诊,常规细菌培养不易检出,其导致的感染难以控制,且治疗过程较长。结论 非结核分枝杆菌导致的感染报道越来越多,但是治疗过程较复杂,治疗时间较长,其分离、培养及鉴定对临床有着极其重要的意义。     

Prevalence and manifestations of tuberculosis in renal transplant recipients: a single-center experience in Thailand

This retrospective review presented the prevalence and manifestations of tuberculosis among renal transplant recipients in our center between 1987 and mid 2007. The prevalence of tuberculosis was 5/151 (3.3%) recipients with a median age of 49 years (range = 38-55). The median time of diagnosis after transplantation was 23 months (range = 1-47). All five patients had pulmonary tuberculosis. None developed extrapulmonary infection. Presenting symptoms were fever (60%), productive cough (80%), weight loss (40%), and hemoptysis (20%). One patient had non-parathyroid-related hypercalcemia. Cyclosporine dosage needed to be increased in all patients. Two subjects who experienced side effects of hepatitis and/or jaundice from rifampicin were switched to second-line drugs. Infection with Mycobacterial tuberculosis is a not uncommon problem in renal transplant recipients especially in endemic areas. Tuberculosis must be excluded for immunosuppressed patients with clinical or radiological suspicion.     

Successful management of two heart transplant recipients with mycobacterial pulmonary infections

We report two cases of pulmonary tuberculosis in heart transplant recipients: a 46-year-old man with pulmonary tuberculosis due to Mycobacterium tuberculosis and a 64-year-old man with nontuberculous mycobacterial infection with pulmonary infiltrates due to Mycobacterium xenopi. The time intervals from transplantation to diagnosis were 3 and 4 years, respectively. The patient with tuberculosis underwent standard treatment with isoniazid, rifampin, ethambutol, and pyrazinamide. The patient with the nontuberculous mycobacterial infection received treatment with clarithromycin and ciprofloxacin for 18 months in addition to rifampin for the first 3 months. Both patients responded well to treatment. No recurrences were observed during follow-up. The interactions between antibiotic treatment and cyclosporine therapy should be observed closely in organ transplant recipients, requiring frequent level determinations and dosing changes.     

Screening for tuberculosis in the study of the living renal donor in a developing country

Given the high prevalence of tuberculosis (Tb) in the Mexican population, a strict program to detect Tb in the potential donor is required. Chest x-ray, excretory urogram, urinalysis with microscopic exam of the sediment, urine cultures for M. tuberculosis, and tuberculin skin test (TST) with PPD-RT23 performed for evaluation of 222 living donors were reviewed. Isoniazid prophylaxis before kidney donation was gathered. Donors and recipients were followed up for a minimum of 2 years. According to the TST result, 36.8% of the donors had latent tuberculosis; however, all other studies were normal or negative in all of them. Use of isoniazid prophylaxis in TST-positive donors made no difference in risk of transmission of tuberculosis to the recipient or development of tuberculosis among the donors. Normal chest x-ray and excretory urogram, along with a negative microscopic examination of the urine, safely exclude tuberculosis transmission to recipients.     

Mycobacterial infection after liver transplantation

Tuberculosis occurred in 5 (1.2%) of 462 liver transplant recipients. De novo infection was assumed in 4 patients and a recurrent infection in 1. The clinical courses varied, from asymptomatic open lung tuberculosis to disseminated disease with cerebral tuberculoma and convulsions. Four patients survived with anti-tuberculous triple-drug therapy. Very few cases of tuberculosis after liver transplantation have been reported (4 patients in the medical literature and 5 patients in this paper). However, the incidence, course of infection, and outcome seem to be similar to those of tuberculosis in renal transplant recipients, approximately 150 cases of which are known.     

Pott's disease after heart transplantation: a case report

The incidence of tuberculosis among patients undergoing antirejection therapy is considerably higher than in the general population. Heart transplant recipients have been found to carry the highest risk of tuberculosis. There are no reported data about Pott's disease in heart transplant recipients. The authors present a case of Pott's disease seen after heart transplantation (HTx).     

Nocardiosis in tropical renal transplant recipients

BACKGROUND: The epidemiology of nocardiosis in the tropics among renal transplant recipients has not been reported. METHODS: An evaluation of nocardiosis for 30 yr in one of the large transplant centres in South Asian region. RESULTS: Of the 1968 patients who received primary renal allografts at Christian Medical College & Hospital, 27 patients developed nocardiosis over 30 yr. Early nocardiosis (2 yr). Seventeen patients (63%) had two or more associated post-transplant infections, of whom 10 had tuberculosis. Mortality in these patients was associated with chronic liver disease. CONCLUSIONS: Nocardiosis manifests earlier (<2 yr) in CsA treated patients who have chronic liver disease. Among renal transplant recipients of the tropics nocardiosis is a marker of a high susceptibility to tuberculosis and other infections, the association with tuberculosis is stronger in those developing early nocardiosis (<2 yr). Chronic liver disease is a risk factor for death in patients with nocardiosis especially when associated with tuberculosis. This report constitutes the largest single centre experience among renal transplant recipients.     

Tuberculous infection in southern Chinese renal transplant recipients

A retrospective study of the prevalence and pattern of tuberculosis among renal transplant patients in a single centre in southern China was performed. Twenty-three cases of tuberculosis were diagnosed among 440 patients between January 1991 and December 2002. There were 18 men and five women. The mean age of the patients was 39.3 +/- 13.4 yr. There were 13 living-related and 10 cadaveric renal transplants. The interval between renal transplantation and the development of tuberculosis ranged from 3 to 127 months with a median of 46 months. There were 18 cases of pulmonary tuberculosis, two cases of pulmonary plus laryngeal tuberculosis, two cases of disseminated tuberculosis, and one case of tuberculosis involving the urinary tract. Diagnosis was established by positive culture for Mycobacterium tuberculosis in 21 patients and response to empirical anti-tuberculosis treatment in two patients. The duration of symptoms before the diagnosis of tuberculosis was 27 +/- 12 d. The patients were treated with standard anti-tuberculosis drugs for 11 +/- 3 months. The anti-tuberculosis treatment was in general well-tolerated. Five patients developed transient hepatitis, three patients developed thrombocytopenia and five patients developed gouty arthritis. One patient died 2 months after initiation of anti-tuberculosis therapy. All other patients completed anti-tuberculosis treatment. No recurrence of tuberculosis was observed after a median follow-up of 90 months. We concluded that (i) tuberculosis is prevalent among southern Chinese renal transplant recipients; (ii) high index of suspicion for tuberculosis among renal transplant recipients is warranted to ensure early diagnosis and prompt initiation of treatment; and (iii) treatment with standard anti-tuberculosis drugs for an extended period of time is well-tolerated and is associated with favourable outcome.     

Tuberculous meningitis in a renal transplant recipient

Tuberculous meningitis is a very rare, but serious extrapulmonary complication of mycobacterial infections in immunocompromised patients, such as organ transplant recipients. We describe here a 66-year-old Turkish woman without any history of tuberculosis, who received a renal allograft transplant in 1994. After a pilgrimage to an endemic area for tuberculosis, she presented with fever and headache in August 1998. Clinical examination revealed positive meningism and hyperreflexia. Lymphocytosis was noted in her cerebrospinal fluid (CSF) and Mycobacterium tuberculosis infection was detected by PCR within the CSF. Despite immediate triple antituberculosis therapy, the patient's clinical condition deteriorated rapidly, with the development of septic shock syndrome, and she died three weeks after admission due to cardiovascular and respiratory failure. Mycobacterial infections, including extrapulmonary manifestations, should thus be considered in all renal transplant recipients presenting with unexplained fever. Preventive therapy, i.e. isoniazid prophylaxis, may also be recommended for patients risking exposure in areas endemic for tuberculosis.     

Simultaneous cytomegalovirus and Mycobacterium tuberculosis infection presenting as hemorrhagic colitis 3 years after a kidney transplant

Cytomegalovirus is an important cause of colonic disease in solid organ transplant recipients. Although several reports have shown that simultaneous infection with other pathogens may aggravate the course of cytomegalovirus colitis, to our knowledge, no case of colitis caused by simultaneous cytomegalovirus and Mycobacterium tuberculosis has been previously reported. We describe a case of hemorrhagic colitis associated with simultaneous cytomegalovirus/ Mycobacterium tuberculosis infection in a 26-year-old woman, 38 months after a kidney transplant. Initial results of histopathologic analyses of gastrointestinal biopsies showed that tuberculosis was the only cause of colitis, as no morphologic alteration suggestive of cytomegalovirus infection was observed on hematoxylin-eosin staining. However, further analysis with immunoperoxidase staining confirmed the clinical suspicion of cytomegalovirus infection. This report shows that cytomegalovirus/tuberculosis coinfection may be a cause of late-onset colitis among solid organ transplant recipients. It also illustrates that coinfection with other pathogens may pose an additional challenge for diagnosing gastrointestinal cytomegalovirus disease.     

Efficacy of isoniazid prophylaxis in renal allograft recipients

The efficacy of isoniazid (INH) prophylaxis in renal allograft recipients who are on long-term immunosuppression in a region highly prevalent for tuberculosis (TB) was studied. INH (300 mg/d in patients weighing more than 35 kg and 5 mg/kg/d in patients with <35 kg body weight) together with Pyridoxine 50 mg/d for 1 year was started in randomly assigned renal allograft recipients. Occurrence of clinical tuberculosis during the initial 2 years posttransplantation was observed in the risk group and patients at no risk. Risks were defined as acute rejection episodes and exposure to antirejection therapy, past history of TB completely or incompletely treated, radiological evidence of past tuberculosis, history of tuberculosis in close contacts. Among 480 patients registered in the study, INH prophylaxis was given to 219 randomly assigned renal allograft recipients. Results were compared among patients developing TB during the initial 2 years posttransplantation in both the groups. Risk factors were analyzed for comparison in both groups. No significant difference was observed in terms of past history of TB, TB in close contacts, episodes of acute rejection during the initial 3 months, and comorbidities such as cytomegalovirus infection, hepatitis C virus infection, and posttransplant diabetes. One patient from the INH group and 10 patients from the non-INH group developed TB during the initial 2 years posttransplantation (P < .0001). None of patients required discontinuation of INH. INH was observed to be safe and effective as a chemoprophylactic agent in renal allograft recipients.     

馆陶县2012至2014年初治涂阳肺结核患者分枝杆菌培养及耐药

目的调查本县初治涂阳肺结核患者分枝杆菌培养及耐药情况,为分析结核病的防治措施提供依据。 方法选择2012-2014年于本县医院诊治的初治涂阳肺结核患者,在对其进行分枝杆菌培养的基础上,将阳性菌株送至本市相关实验室进行菌种鉴定以及药物敏感性分析。 结果本研究中共收治562例初治涂阳肺结核患者,其中性别比男︰女= 2.23︰1,平均年龄（41.2±3.7）岁;菌群类别：结核分枝杆菌492株（87.54%）,非结核分枝杆菌70株（12.46%）。敏感株为448株（79.72%）,耐药菌株为114株（20.28%）,其中耐多药菌株为36株（6.41%）,单耐药患者以耐链霉素（S）为常见（5.34%）,其次为耐异烟肼（称H）（4.63%）。多耐药中以至少耐异烟肼、链霉素（HS）为常见（22/562,3.91%）,其次为耐异烟肼、利福平（耐HR）（3.73%）。多耐药中耐两药者16例（2.85%）,耐3药者17例（3.02%）,耐4药者3例（0.53%）。耐药顺序为S > H > R > E。 结论中青年男性为肺结核防治的高危人群,需要对其进行密切防控。本县结核分枝杆菌复合群菌株的耐药率虽不高,但初治涂阳患者存在耐多药,需要进一步改进结核病的防控工作。     

Study of local and systemic effects of intravesical BCG

Defects in cell-mediated immunity have been implicated as one of the underlying causes for the appearance and progression of neoplasms. One approach toward correcting these defects employs immune potentiators for the purpose of stimulating cell-mediated immunity. BCG is the immune potentiator which has been used most frequently in the experimental and clinical situation. A preliminary study directed toward ascertaining the local histologic changes and systemic serum response to BCG injection in the dog bladder was undertaken in anticipation of its possible application in the treatment of bladder neoplasm. Local response was predictable and was associated with low morbidity. The appearance of serum precipitin bands to culture filtrates of Mycobacteria tuberculosis strains strongly suggests systemic absorption and reaction to BCG administered intravesically.     

Bone graft tuberculosis outbreak in USA: Is it a concern in India?

Globally, 25% of the population is infected with tuberculosis, which poses a leading cause of death worldwide. The transmission of tuberculosis (TB) during organ transplant is reported in the literature whereas only one report has been published on the transmission of TB, during bone allograft transplantation. In the US, in May 2021, an outbreak of TB occurred in patients undergoing spine surgery with bone allograft. This bone graft was retrieved from 80 years deceased donor with latent TB, which was not diagnosed earlier. The recipients were started with a long course of anti-tuberculous drugs. This review narrates the pathway of TB spread among transplant recipients and the strategies to be followed while performing organ or tissue transplantation.