结核T淋巴细胞斑点试验辅助诊断鱼刺伤肉芽肿一例

患者,男,65岁。右手拇指肿胀1个月余,脓肿切开引流术后10天。就诊时因切口未愈合,未进行组织病理及组织细菌培养等检查。查血结核T淋巴细胞斑点试验(T-SPOT.TB)阳性。经PPD实验及胸片排除结核杆菌感染后,反复询问病史,疑似带鱼刺伤史,结合病史及T-SPOT.TB高度怀疑鱼刺伤肉芽肿。3周后切口愈合后行病理示炎性肉芽肿改变,组织qPCR海分枝杆菌阳性。最终确诊为海分枝杆菌感染。给予口服克拉霉素治疗,3.5个月后病情痊愈。     

皮肤分枝杆菌感染的研究进展

皮肤分枝杆菌感染是一类复杂的皮肤疾病,临床和病理无特异表现,易漏诊误诊。临床上大致分为3类,皮肤结核、麻风、非结核分枝杆菌感染性皮肤病。本文就各类分枝杆菌感染相关的皮肤疾病进行流行病学特征、临床表现、诊断及治疗进展进行综述。     

非结核分枝杆菌感染与艾滋病

近年来,欧美报告高达25%~50%的艾滋病患者中并发非结核分枝杆菌感染,非结核分枝杆菌感染发病率的明显上升引起了人们的关注。综述了非结核分枝杆菌感染与艾滋病的相互关系及其内在联系、非结核分枝杆菌感染的诊断及其防治的研究进展,以期引起人们对非结核分枝杆菌感染的重视和进一步研究。     

附睾结节穿刺标本结核分枝杆菌DNA联合血清miR-29a-3p、ADA检测对附睾结核的诊断价值

目的 探究附睾结节穿刺标本结核分枝杆菌脱氧核糖核酸(TB-DNA)联合血清微小RNA-29a-3p(miR-29a-3p)、腺苷脱氨酶(ADA)检测在附睾结核中的诊断价值。方法 选取2015年1月至2021年10月河北省胸科医院收治的120例附睾结节患者为研究对象,经病理学诊断,将其分为附睾结核组(60例)和非附睾结核组(60例)。检测受试者附睾结节穿刺标本TB-DNA、血清miR-29a-3p和ADA水平;以病理学诊断附睾结核结果为金标准,评估TB-DNA、miR-29a-3p、ADA及三项联合诊断附睾结核的价值。结果 TB-DNA检测诊断附睾结核的灵敏度为78.33%,特异度为93.33%,准确度为85.83%;与非附睾结核组相比,附睾结核组患者血清miR-29a-3p表达水平降低,ADA水平升高(P<0.05);血清miR-29a-3p、ADA诊断附睾结核的曲线下面积(AUC)分别为0.908、0.885,截断值分别为0.81、19.39U/L,灵敏度分别为81.67%、76.67%,特异度分别为88.33%、91.67%,准确度分别为85.00%、84.17%;TB-DN...     

扁平寻常狼疮一例

患者女,70岁,因胸背部红色斑片伴瘙痒2年就诊.皮损为胸背部大片红褐色浸润性斑片、丘疹、斑块,部分表面有血痂.皮损组织病理检查显示,真皮浅中部多数上皮样细胞团块,部分周边有淋巴细胞为主的炎细胞浸润;真菌镜枪及培养阴性;组织液行分枝杆菌培养8周显示阳性菌落生长,抗酸染色阳性.采用聚合酶链反应-限制性片段长度多态性(PCR-RFLP)分析,证实为结核分枝杆菌感染.根据患者的临床表现和实验室检查,诊断为扁平寻常狼疮.     

Tspot.TB在艾滋病合并潜伏结核感染的诊断中的应用

目的评价结核感染T细胞斑点试验(T-spot.TB)在艾滋病(AIDS)人群中诊断潜伏结核感染的应用价值,了解AIDS患者中潜伏结核感染情况。方法应用T-spot.TB试剂盒对120例AIDS患者的外周血液标本进行检测,并同时进行结核菌素纯蛋白衍生物(PPD)试验。结果在总体AIDS患者、CD4^+T淋巴细胞计数水平(简称CD4细胞)<200个/μL和≥200个/μL组中,T-spot.TB阳性率为30.8%、32.7%和27.3%,PPD检测阳性率分别为13.3%、9.2%和20.5%。同时,进一步分析发现T-spot.TB检测率与患者免疫状态无关。结论T-spot.TB检测AIDS合并潜伏结核感染阳性率高于PPD试验,T-spot.TB检测对AIDS患者中潜伏结核感染的诊断有较大的应用价值。     

海分枝杆菌感染一例

患者,女,57岁.右上肢结节3个月.组织病理检查为感染性肉芽肿性改变.PAS未见菌丝和孢子结构,抗酸染色阴性.海分枝杆菌qPCR阳性.诊断:海分枝杆菌感染.给予多西环素、克拉霉素、利福平等治疗,皮损逐渐消退.     

皮肤非结核分枝杆菌感染2例报告

背景：非结核分枝杆菌的培养比较困难，国内关于确诊非结核分枝杆菌感染的报告很少，目的：探讨非结核分枝杆菌感染的实验室诊断方法及非结核分枝杆菌感染的治疗措施。方法：应用聚合酶链反应和ELISA技术进行实验室诊断，并以联合疗法分别治疗之。结果：2例非结核分枝杆菌感染患者经联合疗法治疗有显著疗效。结论：所用的聚合酶链反应和ELISA有助于诊断非结核分枝杆菌感染，氟嗪酸、利福平、氨苯砜联合疗法治疗有显著疗效。     

嗜血分枝杆菌感染的研究进展

嗜血分枝杆菌(mycobacterium haemophilum)是一种抗酸杆菌,属于非结核分枝杆菌(nontuberculous mycobacteria,NTM)中的一种。近年来国外关于嗜血分枝杆菌感染的病例报道越来越多,但国内尚无相关报道。本文对其临床表现、诊断及治疗等方面的研究进展进行综述,以提高对该病的认识。     

皮肤非结核分枝杆菌感染三例

目的评价T-SPOT.TB在皮肤非结核分枝杆菌感染中的诊断价值。方法对3例拟诊为游泳池肉芽肿的患者在治疗前后进行T-SPOT.TB检测。结果例1显示相对分子质量6 000早期分泌靶向抗原(ESAT-6)阴性,相对分子质量10 000培养滤过蛋白肽段库(CEP-10)阳性;例2显示ESAT-6及CEP-10均阳性;例3显示ESAT-6阳性,CEP-10阴性。3例患者经过口服利福喷丁、乙胺丁醇和克拉霉素治疗4个月,皮损均获得痊愈。治疗后检测T-SPOT.TB,例1和例3阳性结果全部转阴。结论初步研究显示,在拟诊皮肤非结核分枝杆菌感染中检测T-SPOT.TB在快速和准确诊断方面有重要的参考意义。     

Evaluation of an IFN-gamma assay in the diagnosis of latent tuberculosis in patients with psoriasis in a highly endemic setting

Screening for latent tuberculosis infection is mandatory before starting anti-tumour necrosis factor treatments, but its diagnosis still poses a challenge. While studies performed in developed countries have demonstrated superior performance of T-cell based interferon-γ release assay (IGRA) compared with the tuberculin skin test, there is a debate about whether this holds true in tuberculosis endemic areas. The performance of an IGRA kit T-SPOT.TB was evaluated in 33 moderate-to-severe untreated psoriasis patients and, as controls, 30 patients with common dermatological diseases at a tuberculosis highly endemic setting. The frequency of positive tuberculin skin test responses and induration size in controls were higher than in psoriasis patients (53% vs. 18% and 9.3 ± 1.4 vs. 2.6 ± 0.7 mm, respectively, p < 0.001). In contrast, the frequency of positive response and mean number of spots elicited with the T-SPOT.TB test were not significantly different between patients and controls (47% vs. 43% and 14.7 ± 3.2 vs. 20.5 ± 3.1 spots/well, respectively). The two tests presented good agreement in the control, but not the psoriasis group (κ values of 0.625 and 0.375, respectively). Thus, in a highly tuberculosis-endemic setting the T-SPOT.TB test was superior to the tuberculin skin test in diagnosing latent tuberculosis infection in psoriasis, probably because the immune dysregulation of psoriasis shows a lower interference in the in vitro test.     

Tuberculosis screening in patients with psoriasis before antitumour necrosis factor therapy: comparison of an interferon-γ release assay vs. tuberculin skin test

Background Antitumour necrosis factor (anti‐TNF) treatments may reactivate latent tuberculosis infection (LTBI). For detecting LTBI, the tuberculin skin test (TST) has low sensitivity and specificity. Interferon‐γ release assays (IGRA) have been shown to be more sensitive and specific than TST. Objective To compare the TST and the T‐SPOT.TB IGRA for identifying LTBI in patients with psoriasis before anti‐TNF treatment. Methods A retrospective study was carried out over a 4‐year period on patients with psoriasis requiring anti‐TNF treatment. All were subjected to the TST, T‐SPOT.TB and chest X‐ray. Risk factors for LTBI and history of bacillus Calmette–Guérin (BCG) vaccination were recorded. The association of T‐SPOT.TB and TST results with risk factors for LTBI was tested through univariate logistic regression models. Agreement between tests was quantified using kappa statistics. Treatment for LTBI was started 1 month before anti‐TNF therapy when indicated. Results Fifty patients were included; 90% had prior BCG vaccination. A positive T‐SPOT.TB was strongly associated with a presumptive diagnosis of LTBI (odds ratio 7·43; 95% confidence interval 1·38–39·9), which was not the case for the TST. Agreement between the T‐SPOT.TB and TST was poor, κ = 0·33 (SD 0·13). LTBI was detected and treated in 20% of the patients. In 20% of the cases, LTBI was not retained in spite of a positive TST but a negative T‐SPOT.TB. All patients received an anti‐TNF agent for a median of 56 weeks (range 20–188); among patients with a positive TST/negative T‐SPOT.TB, no tuberculosis was detected with a median follow‐up of 64 weeks (44–188). One case of disseminated tuberculosis occurred after 28 weeks of adalimumab treatment in a patient with LTBI in spite of treatment with rifampicin. Conclusion This study is the first to underline the frequency of LTBI in patients with psoriasis (20%), and to support the use of IGRA instead of the TST for its detection. Nevertheless, there is still a risk of tuberculosis under anti‐TNF therapy, even if LTBI is correctly diagnosed and treated.     

Changing the way we diagnose tuberculids with interferon gamma release assays

Diagnosing tuberculids traditionally requires clinicopathological correlation together with positive tuberculin skin tests (TST) or demonstration of Mycobacterium tuberculosis (MTB) DNA by polymerase chain reaction (PCR). Interferon gamma release assays (IGRA) are new laboratory tests approved for the diagnosis of MTB infection. We describe three patients with tuberculids who had no other clinical feature of tuberculosis (TB) infection and negative PCR of skin biopsies. Their diagnoses were aided by positive IGRA.     

用PCR-限制性片段长度多态性分析法检测游泳池肉芽肿中海分枝杆菌

目的：探讨用PCR-限制性片段长度多态性（RFLP）分析法快速检测游泳池肉芽肿组织中海分枝杆菌。方法：对疑诊为游泳池肉芽肿患者5份皮损组织DNA进行PCR扩增,扩增产物分别用BstEⅡ和HaeⅢ两种限制性内切酶进行酶切,再用琼脂糖凝胶电泳进行RFLP分析,并与培养结果进行比较。结果：5份标本中均检测出海分枝杆菌,与培养结果一致。经过3～7个月治疗,4例患者治愈,1例患者好转。结论：用PCR—RFLP可以快速鉴定海分枝杆菌,有利于该类疾病的早期诊断和及时治疗。     

TP-ELISA、TP-PA、RPR、TRUST四种方法对进展期梅毒诊疗效果的对比分析

目的:考察TP-ELISA、TP-PA、RPR、TRUST四种方法对进展期梅毒诊疗效果差异。方法:采集150例进展期梅毒阳性患者和150例健康对照的血样并使用TP-ELISA、TP-PA、RPR、TRUST四种方法进行检测,测定其灵敏度、特异性、阳性预测值和阴性预测值。结果:四种检测方法中TP-PA法梅毒患者组阳性率最高(99.3%),RPR法健康对照组阳性率最低(0.0%),四组间比较差异具有统计学意义(χ~2=38.646,χ~2=8.542,P0.05)。TP-ELISA、TP-PA、RPR、TRUST四种方法的灵敏度、特异性、阳性预测值和阴性预测值差异均具有统计学意义(χ~2=38.646,χ~2=8.542,χ~2=9.737,χ~2=32.986,P0.05)。四种检测方法对治疗有效和治愈患者的梅毒检出效果差异存在统计学意义(χ~2=38.646,χ~2=98.124,χ~2=11.715,P0.01)。结论:TP-LISA和TP-PA灵敏度和准确度高,可用于进展期梅毒的诊断,RPR法和TRUST法对疗效判断准确,四种方法具不同临床应用价值。     

The reliability of tuberculin skin test in the diagnosis of latent tuberculosis infection in psoriasis patients: A case‐control study

Tuberculin skin test (TST), which is used in the diagnosis of latent tuberculosis infection, may cause Koebner's phenomenon and false‐positive results in psoriasis patients. The purpose of this study is to compare TST with QuantiFERON‐TB Gold Plus (QFT‐plus) test in psoriasis patients and to determine the effects of psoriasis on TST results. Ninety‐two psoriasis patients and 30 control subjects were included in the study. QFT‐plus test, TST, and prick test to distinguish the increase of induration because of the skin trauma were performed on both groups. The demographics, risk factors for latent tuberculosis infection, BCG vaccination history, Koebner's history, psoriasis severity, and treatment history of the patients were recorded. The effects of these variables on test results were investigated by comparing those with control group. The criteria of National Tuberculosis Diagnosis and Treatment Guidelines were used in the evaluation of test results, and threshold value of positivity for TST was taken as 10 mm in BCG‐vaccinated patients who are planned to start biological treatment. Prick test results were negative in the control group. There was no significant relation between the results of prick test and TST induration diameters in the patient group. Although TST positivity was significantly higher in patients (62%) compared with control group (33%), QFT‐plus test results were not statistically different between two groups. Agreement between two tests was determined to be low in patient group with 48% (K = 0.1), and it was determined to be moderate with 77% in control group (K = 0.4). QFT‐plus test was found to be negative in 46 of 57 TST‐positive patients (80.7%) in patient group. It was determined in both groups that vaccination did not have any effect on test results. When threshold value was lowered to 5 mm in patient group without considering BCG reaction, the number of TST‐positive patients increased from 57 to 65. Mean TST induration diameter was 10 mm and 14 mm in cases with mild and moderate to severe clinical manifestation, respectively (P = .04). However, no effect of disease period and treatment was determined on both test results. TST positivity was higher in psoriasis patients compared with control group. It was considered due to the increased reaction of the skin to mycobacterial antigens rather than the Koebner's response. Although TST results were not affected by BCG, it was concluded that a 10‐mm threshold value of positivity was a suitable approach in order to reduce the number of patients receiving unnecessary preventive treatment in patients who are considered to initiate biologic agents. Furthermore, it was also concluded that QFT‐plus test may be preferred in psoriasis patients since it is applied in vitro and its specificity is higher and not affected by disease severity.     

Retrospective study of Mycobacterium marinum skin infections

BACKGROUND: Although infection by Mycobacterium marinum is well reported in the literature, there have been few epidemiologic studies. The purpose of this study was to review the epidemiology of patients with cutaneous M. marinum infection over a 3-year period at the National Skin Centre in Singapore. METHODS: Patients with a diagnosis of cutaneous M. marinum infection, confirmed histologically, were collated from computerized data from 1995 to 1997. Thirty-eight patients were diagnosed as having cutaneous M. marinum infection based on history, and clinical and histologic features. RESULTS: Out of the 38 cases of M. marinum infection, there were 30 men and eight women. The age range was 14-85 years (mean: 44.7 years). The duration of disease ranged from 1 to 132 months (mean: 19 months). Thirteen patients (34.2%) had fish rearing as a hobby and four patients (10.5%) had occupational exposure to fish. Twelve patients (31.5%) gave a history of trauma to the disease site. All patients had biopsies of the lesions. All showed infective granulomas/granulomatous inflammation on histology. Acid-fast bacilli were identified in five out of 38 patients (13.2%) and mycobacteria were isolated in one out of 35 patients (2.9%). Nineteen patients received treatment with cotrimoxazole-trimethoprim alone, three with minocycline alone, five with minocycline and cotrimoxazole-trimethoprim, seven with various combinations of drugs, one with excision, and three defaulted treatment. The duration of treatment ranged from 4 to 38 weeks (mean: 14.9 weeks). Twenty-six patients (68.4%) showed clinical improvement, two (5.3%) had no response, and 10 (26.3%) were lost to follow-up. None of the patients worsened with treatment. The follow-up period ranged from 1 to 20 months (mean: 6.8 months). CONCLUSIONS: The diagnosis of cutaneous M. marinum infection is mainly clinical, with supporting evidence from histologic features and the response to therapy. Risk factors include a history of trauma and water/fish-related hobbies or occupations. There is a poor yield of positive isolates in our experience; however, empirical treatment usually produces a good clinical response. In future, the polymerase chain reaction (PCR) technique may become more widely available as a rapid, sensitive, and specific means of diagnosis.     

Application of IFN‐γ releasing assay for the diagnosis of erythema induratum of Bazin

Background Erythema induratum of Bazin (EIB) is regarded to be a hypersensitive reaction to the concomitant tuberculosis. Recently, interferon‐γ releasing assay (IGRA) has been focused as a promising tool in the diagnosis of latent tuberculosis. However, there has been no large scale study to investigate the usefulness of IGRA in the diagnosis of EIB. Objectives To evaluate the diagnostic performance for the detection of EIB. Methods We retrospectively reviewed medical records of all patients with EIB, in the Department of Dermatology, at the Seoul National University Hospital, between April 2009 and September 2011. We analysed clinicopathological features, responses to IGRA and the treatment courses. In addition, we compared positive rate of IGRA in patients with other diseases during the same period. Results All of the 22 patients demonstrated a positive response to IGRA (100%) and showed a good response to anti‐tuberculosis treatment. In contrast, positive rate was 63.64% and 66.67% in patients with psoriasis and other vasculitis respectively. We observed complete resolution of skin lesions in 14 patients. Partial resolution was attained in one patient and the other seven patients are currently on the medication and are showing good responses. Conclusion We verified that IGRA has an excellent diagnostic performance in EIB, through this observational study. It is strongly suggested that if EIB is clinicopathologically suspected, IGRA should be performed.