Clinical value of polymerase chain reaction in the diagnosis of joint tuberculosis by detecting the DNA of Mycobacterium tuberculosis

Objective: To assess the clinical value of polymerase chain reaction (PCR) in the diagnosis and differential diagnosis of joint tuberculosis (TB). Methods: PCR was used blindly to detect the DNA of Mycobacterium tuberculosis (M.TB) in five specimens of M.TB, 5 of BCG, and 10 of other bacteria. Then, M. TB in 98 samples from patients with joint TB and 100 samples from patients with non‐tubercular joint disorders were detected by PCR, acid‐fast staining and culture,. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of PCR were calculated. The χ2 test was used for statistical analysis of the frequency of various factors. At the same time, some problems with PCR were also systematically analyzed. Results: (1) In the “standard samples”, both M. TB and BCG showed positive while other bacteria were negative. (2) In 98 cases from patients with joint TB, 81 were positive by PCR, 6 by acid‐fast staining, and 17 by culture. In 100 cases from patients with non‐tuberculous joint disorders, 9 were positive by PCR, and none by either acid‐fast staining or culture. Sensitivity, specificity, accuracy, positive and negative predictive value of PCR were 82.65% (81/98), 91.00% (91/100), 86.87% (172/198), 90.00% (81/90) and 84.26% (91/108), respectively. (3) The positive rates for PCR, acid‐fast staining and culture in detection of M. TB were 82.65% (81/98), 6.12% (6/98), and 17.34% (17/98), respectively. There were statistically significant differences between the three methods (P < 0.001). (4) The process of PCR is automatic, and can be completed within 3 to 6 hours, whereas 4 to 8 weeks are required for the conventional culture of M. TB. Conclusion: PCR is a sensitive, specific, rapid, simple and minimally invasive method for detection of M. TB in samples from joint TB, and can play an important role in early and rapid diagnosis and differential diagnosis of joint TB. But it also has some limitations, such as false positivity and false negativity.     

Clinical review of pulmonary disease caused by Mycobacterium xenopi.

Mycobacterium xenopi comprised 56% of all non-tuberculous mycobacteria isolated in the Brompton Hospital laboratory during six years. M xenopi alone was cultured from the sputum of 23 patients, whose clinical and bacteriological features are reviewed. Pulmonary disease was considered to be due to the organism present in 15 of these patients on the basis of strict criteria for a causal relationship. Radiographs of all these patients were consistent with mycobacterial disease, showing pulmonary cavitation in 11, apical shadowing in three, and upper lobe fibrosis in one. In nine patients the disease was chronic, progressing very slowly with longstanding respiratory symptoms and extensive radiographic abnormalities developing over many years (mean 19 years). In six patients the disease was subacute, being of recent onset with radiographic shadowing of limited extent. M xenopi was isolated as a saprophyte from four patients who had lung disease of known cause and single isolates were obtained from four patients who had no lung disease attributable to this organism. In vitro drug sensitivity tests showed the sputum cultures of 17 of 22 patients to be sensitive to two or more of the drugs rifampicin, isoniazid, and ethambutol. Response to chemotherapy was unpredictable and did not always correlate with the results of sensitivity tests. Of 11 patients treated with at least two drugs to which their organisms were sensitive, two remained sputum positive, one relapsed after 18 months of chemotherapy, and eight have remained sputum negative during a minimum of three years' follow-up.     

Pulmonary Mycobacterium kansasii infection: comparison of radiological appearances with pulmonary tuberculosis.

BACKGROUND: A study was undertaken to determine if there are differences in the radiological appearances at presentation between pulmonary infections caused by Mycobacterium kansasii and Mycobacterium tuberculosis. Correct recognition of the organism has important implications with regard to initial therapy and contact tracing. METHODS: The initial chest radiographs of 28 patients with pulmonary M kansasii infection were compared with those of 56 age, sex, and race matched patients with M tuberculosis infection. All patients in both groups were culture positive and none was known to be HIV positive. The radiographs were analysed independently by two radiologists who were unaware of the causative organism. RESULTS: Radiographic abnormalities in patients with M kansasii infection were more frequently unilateral and right side predominant, while those with tuberculosis more frequently involved a lower lobe. Air space shadowing involving more than one bronchopulmonary segment and pleural effusions were seen less frequently in M kansasii infection (four of 28 (14%) versus 30 of 56 (54%) and none of 28 versus 15 of 56 (27%)). Cavitation (21 of 28 (75%) versus 34 of 56 (61%) was seen to a similar extent in patients with M kansasii infection and in those with tuberculosis. Cavities tended to be smaller in patients with M kansasii infection (p < 0.01). CONCLUSIONS: Differences are seen in the radiographic appearances of pulmonary infection caused by M kansasii and M tuberculosis. These differences are not sufficient to allow a positive diagnosis on the basis of radiographic findings alone, but the presence of a pleural effusion or lower lobe involvement makes M kansasii infection very unlikely.     

The value of thoracoplasty before extensive unilateral resection for pulmonary tuberculosis.

Among 24 patients who required extensive unilateral resection for tuberculosis, 17 underwent adequate thoracoplasty before resection and seven others received either no thoracoplasty before resection or an inadequate one. These two groups were comparable as to severity of disease and operative risk. The incidence of serious complications was 83 per cent in the latter group compared to 12 per cent in the former. While the number of patients in each group is too small for a statistically valid comparison, the results suggest that an adequate thoracoplasty before resection is of definite value in preventing pleural complications after extensive unilateral resection for tuberculosis.     

Bacteriologically confirmed pulmonary tuberculosis in childhood. Clinical and radiological features

Over a 4-year period 185 cases of pulmonary tuberculosis in children were confirmed by culture of Mycobacterium tuberculosis, usually from gastric aspirate. The majority of cases occurred in boys (62%) and the younger age groups were more commonly affected--26% of patients were less than 1 year old and 65% less than 3 years of age. At the time of presentation 40% of the 151 children tested had a negative tuberculin test. A chest radiograph was available in 136 cases. The commonest changes seen were lymphadenopathy (63%) and segmental lesions (56%). The latter affected mainly the right lung and in particular the right middle lobe. Cavitating tuberculous disease was present in 19 children, including 5 aged less than 1 year.     

t细胞斑点试验对菌阴肺结核的诊断价值

结核病是全球严重的公共卫生问题之一,据who估计,全球约有20亿人感染结核分枝杆菌,每年约有200万人死于结核病[1-2].传统的结核分枝杆菌检测方法因检测的敏感性、特异性等缺陷限制了其推广应用.酶联免疫斑点试验( enzyme-linkedimmunospot,elispot)是一种体外检测单细胞水平特异性抗体分泌细胞功能的免疫学技术,由lalvani等[3 ]首先将其应用于结核病的快速诊断,为结核病的实验室检测提供了一条新途径.本文就t细胞斑点试验在菌阴肺结核中的诊断价值进行初步探讨.     

Chylothorax due to Mycobacterium tuberculosis.

Chylothorax in an adult is a rare cause of pleural effusion. Mycobacterium tuberculosis may cause chylous effusion, but usually in association with extensive intrapulmonary involvement. A case of chylothorax is presented in which M tuberculosis was isolated from the pleural fluid and was the only intrathoracic manifestation of tuberculosis.     

Clinical value of pulmonary needle biopsy in diagnosis of pulmonary carcinoma

In 92 consecutive pulmonary needle biopsies, preliminary diagnoses on the basis of radiological and clinical data were compared with cytological reports. Three groups emerged. In the first, of 43 cases with radiological changes typical for primary lung carcinoma and no clinical data making other diagnosis a plausible alternative, the cytologist found carcinoma cells in 37 and malignant lymphoma cells in one. A further 3 cases proved to be carcinomas at the histological examination. Two cases were not carcinomas. In the second group, where 30 patients displayed radiological changes less typical for primary diagnoses, or clinical/anamnestical data also supported alternative diagnoses, the cytologist found malignancies in 8 cases, carcinoid in one and no signs of malignancy in 21 cases. In 19 cases the patients were considered radiologically to have no malignancies. Malignant cells were found in none. It is concluded that in a certain group of patients, the diagnosis of pulmonary carcinoma can be made with reasonable accuracy from radiological and clinical data alone. Needle aspiration biopsy and similar techniques are of questionable value as routine procedures when the probability of this diagnosis is already very high on other grounds. Their use should be reserved for cases where plausible diagnostic alternatives are present.     

MRI在脊柱肿瘤结核鉴别诊断中的价值

[目的]评价磁共振成像（MRI）在脊柱肿瘤、结核鉴别诊断中的价值。[方法]回顾分析经病理证实的63例脊柱病变（31例结核，32例肿瘤）MRI资料。[结果]32例肿瘤椎间盘均未受累，其中10例仅累及椎体，20例椎体、附件均受累，2例仅累及附件。31例结核软组织均受累，附件均未见受累，其中29例椎间隙狭窄或消失。无论结核，还是肿瘤，T1WI以低信号为主，T2WI以高信号为主。[结论]MRI有助于脊柱肿瘤、结核鉴别诊断，椎间盘未受累为肿瘤特点，椎间盘、软组织受累及附件完整为脊柱结核的特点。     

核素全身骨显像在脊柱结核诊治中的临床价值

[目的]评价核素全身骨显像在脊柱结核诊治中的价值。[方法]对175例脊柱结核采用99Tcm—MDP（亚锡亚甲基二膦酸盐）核素全身骨显像，了解脊柱病灶的显影情况和全身其他骨关节是否并存病灶的情况。[结果]175例患者全部显像为阳性，其中伴有多节段椎体结核者146例，其中2个椎体者78例，3个椎体者26例，4个椎体以上者42例。伴有四肢骨关节结核者22例，伴骶髂关节结核者29例。[结论]核素全身骨显像在脊柱结核诊治中有重要价值，可以发现全身骨与关节多个结核病灶，对制定脊柱结核的治疗方案有指导作用。     

Pulmonary Mycobacterium kansasii infection: comparison of the clinical features,treatment and outcome with pulmonary tuberculosis.

BACKGROUND: In the United Kingdom Mycobacterium kansasii is the most common pulmonary non-tuberculous mycobacteria to cause disease in the non-HIV positive population. METHODS: The clinical features, treatment, and outcome of 47 patients (13 women) of mean (SD) age 58 (17) years with culture positive pulmonary M kansasii infection were compared with those of 87 patients (23 women) of mean (SD) age 57 (16) years with culture positive pulmonary M tuberculosis infection by review of their clinical and laboratory records. Each patient with M kansasii infection was matched for age, sex, race and, where possible, year of diagnosis with two patients with M tuberculosis infection. RESULTS: All those with M kansasii infection were of white race. Haemoptysis was more common in patients infected with M kansasii but they were less likely to present as a result of an incidental chest radiograph or symptoms other than those due to mycobacterial infection. Patients with M kansasii were also less likely to have a history of diabetes, but the frequency of previous chest disease and tuberculosis was similar. An alcohol intake of > 14 units/week was less frequent in those with M kansasii, but there were no significant differences in drug history, past and present smoking habit, occupational exposures, social class, or marital status. Patients with M kansasii received a longer total course of antimycobacterial therapy and, in particular, extended treatment with ethambutol and rifampicin was given. There was no significant difference in outcome between pulmonary M kansasii or M tuberculosis infection. CONCLUSIONS: There are group differences between the clinical features of the two infections but, with the possible exception of diabetes and alcohol intake, these features are unlikely to be diagnostically helpful. Treatment of M kansasii infection with ethambutol, isoniazid, and rifampicin in these patients was as effective as standard regimens given to patients infected with M tuberculosis.     

耐多药肺结核的肺切除术

目的 分析肺切除术治疗耐多药肺结核(MDR-RTB)的效果与预后.方法 对1995年1月至2006年7月期间行肺切除术治疗的56例MDR-PFB病人进行回顾性分析.结果 病人术前痰菌均为阳性,术后阴转51例.术中无死亡,术后并发症14例.方差分析显示MDR-PTB者的肺功能与病变类型密切相关.单因素和多因素logistic回归分析均显示支气管内膜结核和吻合口包埋与术后支气管胸膜瘘(BPF)的发生率显著相关.结论 肺切除术是治疗MDR-PTB有效的辅助手段.把握MDR-PTB的手术时机可减少对肺功能的损害.支气管内膜结核是术后BPF的高危因素,而对残端吻合口包埋可有效降低术后BPF的发生率.     

尿钾浓度测定在氯胺酮相关性膀胱炎中的临床价值

目的 探讨24 h尿液钾离子浓度测定在治疗氯胺酮相关性膀胱炎过程中的应用方法和价值. 方法 氯胺酮相关性膀胱炎患者43例.男29例,女14例,年龄17 ～ 29岁,平均22岁.患者按入院治疗期间是否留置尿管分为A组(非留置组,32例)和B组(留置组,入院后即留置尿管,11例),两组均以抗炎、抗氧化、改善微循环、解痉镇痛及修复膀胱黏膜屏障为基础治疗方案.对照组为健康志愿者30名.各组均于治疗前后检测24 h尿钾、尿钠和尿肌酐浓度.24 h尿钾、尿钠浓度均以24 h尿肌酐浓度作为内参,标准化后进行比较.A、B组于治疗前后行盆腔疼痛与尿急/尿频(PUF)评分.分析治疗前后组间、组内尿钾浓度的变化并分析与PUF评分的关系. 结果 各组治疗前后24 h尿肌酐、尿钠浓度差异无统计学意义(P＞0.05).尿钾浓度:①治疗前:A、B组及对照组分别为(1.80±0.67)、(6.22 ±0.92)、(6.47±0.97)mmol K/mmol Cr,A组与B组、对照组比较差异均有统计学意义(P =0.0001).②治疗后:3组分别为(6.23±1.42)、(6.02±0.98)、(6.47 ±0.97)mmol K/mmol Cr,A组与B组、对照组比较差异均无统计学意义(P＞0.05).PUF评分:①治疗前A组23.19 ±3.64,B组21.95±3.86,差异无统计学意义(t=1.302,P=0.200);A组PUF评分与尿钾浓度呈负相关(r=-0.637,P=0.0001),B组与PUF评分无显著相关性(r=0.581,P=0.188);②治疗后A组18.31 ±2.19,B组17.18±2.68,差异无统计学意义(t=-0.331,P=0.742);A、B组PUF评分与尿钾浓度均呈负相关(A组:r=-0.427,P=0.015;B组:r=-0.779,P=0.005).43例患者治疗前PUF评分22.77±3.63,治疗后18.12±2.83,治疗前后比较差异有统计学意义(t=6.347,P=0.0001). 结论 尿钾浓度测定能较好评估氯胺酮相关性膀胱炎患者的病情及判断治疗效果.     

Pulmonary tuberculosis due to Mycobacterium bovis.

During 1969-84 Mycobacterium bovis was isolated from 20 patients with pulmonary tuberculosis. This represented less than 1% of the total cases of respiratory tuberculosis confirmed bacteriologically at the Liverpool Public Health Laboratory during this period. All 20 patients were considered to have reactivated disease and all presented with the typical features of respiratory tuberculosis. During the same period four cases of pulmonary infection by Mycobacterium africanum were recognised. This organism is difficult to differentiate from M bovis and failure to distinguish the two mycobacteria could lead to a misleading epidemiological picture of bovine tuberculosis in man.