Effect of an immunomodulator containing Mycobacterium w on sputum conversion in pulmonary tuberculosis

Sputum conversion is an important milestone in the management of pulmonary tuberculosis. Early sputum conversion is desirable. A controlled study was done to improve sputum conversion rate of current short course chemotherapy using immunomodulator containing mycobacterium w. The immunomodulator is very potent and freely available. It shares antigens with Mycobacterium tuberculosis. In a randomised pattern 69 of 134 patients suffering from pulmonary tuberculosis received the immunomodulator intradermally every 15 days along with chemotherapy. The use of the immunomodulator results in preponement of sputum conversion. The sputum conversion rate obtained by chemotherapy at 60 days was achieved latest by 30 days when mycobacterium w containing immunomodulator was used as an adjuvant therapy. This was found irrespective of bacterial load (1 +, minimal or 3+, maximal) in sputum or category (fresh or retreatment) of disease. The therapy was well tolerated.     

High risk of active tuberculosis in HIV-infected drug users with cutaneous anergy.

OBJECTIVES--To determine the incidence of active tuberculosis in human immunodeficiency virus (HIV)-seropositive and HIV-seronegative drug injectors with cutaneous anergy and to examine the effectiveness of isoniazid chemoprophylaxis in preventing tuberculosis among drug injectors with positive tuberculin test results. DESIGN AND SETTING--Prospective observational study linked to an ongoing study of HIV infection within a New York City (NY) methadone program; subjects also underwent routine intradermal tuberculin testing and multiple-antigen delayed-type hypersensitivity skin testing. The 31-month study period ended December 31, 1990. METHODS--Anergic subjects and tuberculin reactors who were HIV seropositive were compared by HIV disease status and CD4+ T-lymphocyte levels. Tuberculosis incidence was calculated for anergics (none treated with isoniazid) and for treated and untreated tuberculin reactors, by HIV serological status. RESULTS--Among those seropositive for HIV, anergic subjects had more advanced HIV disease and fewer CD4+ cells (median 0.33 vs 0.56 x 10(9)/L, P less than .01) compared with tuberculin reactors, although neither clinical status nor CD4+ cell counts consistently predicted anergy. Five (7.6%) of 68 anergic subjects who were HIV seropositive and none of 52 anergic subjects who were HIV seronegative (n = 18) or of unknown (n = 34) HIV serological status developed active tuberculosis during the study period (P less than .05). The tuberculosis incidence rate among anergic subjects who were HIV seropositive was 6.6 cases per 100 person-years (95% confidence interval [Cl], 2.1 to 15.3). Of 25 HIV-seropositive tuberculin reactors who did not receive or complete 12 months of isoniazid prophylaxis, tuberculosis incidence was 9.7 cases per 100 person-years (95% Cl, 2.6 to 24.7; P = 0.56, compared with the rate among anergic HIV seropositives); there were no cases of tuberculosis in 53.4 person-years of follow-up for 27 HIV-seropositive tuberculin reactors who received 12 months of prophylaxis (rate difference between treated and untreated groups, 9.7 cases per 100 person-years, 95% Cl, 1.3 to 18.0). CONCLUSION--Drug injectors with cutaneous anergy who are seropositive for HIV are at high risk of active tuberculosis, similar to that among untreated HIV-seropositive tuberculin reactors. A decreased incidence of active tuberculosis was seen in HIV-seropositive tuberculin reactors receiving 12 months of isoniazid chemoprophylaxis, compared with untreated or partially treated subjects. These results support the routine use of delayed-type hypersensitivity testing to accompany tuberculin testing for drug injectors with known or suspected HIV infection, and consideration of isoniazid prophylaxis for anergic as well as tuberculin-reactive subjects who are HIV seropositive, in populations with a high prevalence of coexisting HIV and Mycobacterium tuberculosis infection.     

Immune recovery in HIV with Mycobacterium W

The human immunodeficiency virus (HIV) is associated with decreased immunity. There is depletion of CD4 cells. The objective of this study was to evaluate the effect of mycobacterium w on CD4 cell count in HIV + ve patients. A total of fifty patients were randomly assigned to one of the three treatment groups: (A) Mycobacterium w alone (n=17) (B) mycobacterium w plus two antiretroviral agents (n=16) (C) Mycobacterium w plus HAART (highly active antiretroviral therapy; (n=17). Mycobacterium w was administered intradermally at the dose of 0.1 ml in both deltoid region (first dose). The subsequent four doses of mycobacterium w were 0.1 intradermal in the deltoid region of one arm at monthly intervals. CD4 cell count in all the HIV + ve patients was measured at baseline and after five months period. CD4 counts was increased by 108.96%, compared to baseline, in the patients receiving both mycobacterium w and HAART, suggesting a synergistic action. However, significant increase (80.22% compared to baseline)was also seen in patients receiving mycobacterium w along, suggesting that myobacterium w was an effective immune response enhancer. Mycobacterium w was well tolerated by all patients.     

HIV/AIDS患者合并分枝杆菌感染及耐药性分析

目的了解HIV/AIDS患者合并分枝杆菌感染及其耐药状况。方法对601例HIV/AIDS患者标本用中性改良罗氏（Lowenstein-Jensen）培养基和BacT/ALERT 3D 240全自动培养仪同时进行分枝杆菌培养;培养阳性者用硝基苯甲酸（PNB）培养基、噻吩-2-羧酸肼（TCH）培养基进行菌种初步鉴定和用绝对浓度间接法进行8种抗结核药物敏感性试验。结果分枝杆菌培养阳性116例,检出率为19.30%;其中结核分枝杆菌93株,检出率为15.41%,非结核分枝杆菌23株,检出率为3.89%;93株结核分枝杆菌总耐药率为26.88%,耐多药率（MDR-TB）为7.53%,广泛耐药率（XDR-TB）为1.08%;23株非结核分枝杆菌总耐药率为100%。并且多数呈多重耐药。结论HIV/AIDS患者并发分枝杆菌感染率及其耐药率较高,尤其是非结核分枝杆菌耐药率更高,对HIV/AIDS患者疑为分枝杆菌合并感染时,应对相关标本进行分枝杆菌培养、鉴定和药敏试验,以便指导临床合理用药。     

应用PCR方法扩增IS6110保守片段快速鉴定结核分支杆菌

目的：了解PCR方法快速鉴定结核分支杆菌的可靠性，探索快速诊断结核病的实验方法。方法：应用PCR方法扩增149株结核分支杆菌临床分离株的IS6110保守片段，并与结核分支杆菌H37Rv标准株进行比较。结果：149株临床分离株中，140株可以扩增出与结核分支杆菌H37Rv标准株相同的123bp DNA片段(敏感性达93．9％)，而阴性对照均不能扩增出该片段。结论：应用PCR方法扩增IS6110保守片段来鉴定结核分支杆菌，结果准确可靠，且具有方便和快速等优点，有较大的临床应用价值。     

Research on preparation of mycobacterium tuberculosis DNA microarray]

OBJECTIVE: To optimize and develop the technique for mycobacterium tuberculosis DNA microarray. METHODS: The process included preparation of DNA samples, spotting and past-spotting treatment of arrays. DNA microarrays were prepared by spotting fluorescence labeled PCR products of target genes onto specially treated glass slides with robotics. The fluorescent signals before and after treatment were scanned with a scanner, and the DNA attachment rate was calculated from the obtained data by software. RESULTS: A foundation for optimizing the conditions of Mycobacterium tuberculosis DNA microarrays has been laid. The support aldehyde-modified glass slide is useful for anchoring DNA at Some distance. DMSO as spotting solution is of benefit to preparation of Mycobacterium tuberculosis DNA microarray. Drying the chip at 37 degrees C temperature after spotting can enhance the DNA combination rate. CONCLUSION: Several key steps of this technique have been optimized. This study has provided a foundation for optimizing the DNA attachment conditions in creating mycobacterium tuberculosis DNA microarray.     

Tuberculosis transmission in a large urban jail

Following diagnosis of moderately advanced tuberculosis in an inmate of Cook County Jail, tuberculin testing was performed to assess the degree of transmission of tuberculosis within the jail. Twenty-three percent of inmates exposed to the index patient were initially found to be tuberculin positive. Subsequent tuberculin testing three months later demonstrated a 71% rate of skin-test conversion in previously tuberculin-negative inmates exposed to the index patient. The rate of infectivity of tuberculosis within a jail is analogous to a household situation. Despite major obstacles, modern programs of tuberculosis screening and treatment are essential in correctional institutions.     

依赖利福平结核分枝杆菌Rv0341抗体阳性初治肺结核患者的临床特点分析

目的 探讨依赖利福平结核分枝杆菌(简称依R菌)Rv0341抗体阳性初治肺结核患者的临床特点.方法 纳入42例依R菌Rv0341抗体阳性的初治肺结核患者作为研究组,45例依R菌Rv0341抗体阴性的初治肺结核患者作为对照组,对两组的临床症状、X线影像学表现、痰结核分枝杆菌和依R菌培养阳性率、治疗效果等方面进行对比分析.结果 研究组咳痰、咯血、气促的发生率明显高于对照组(P＜0.05);X线影像学表现研究组病变更多累及双肺及多个肺野(P＜o.05),对照组病变更多局限于单肺和一个肺野(P＜o.05),且研究组出现空洞的比率高于对照组(P＜o.05);在痰结核分枝杆菌培养阳性率上两组差异无统计学意义(P＞0.05),但研究组痰依R菌培养阳性率组明显高于对照组(P＜0.05);对照组的治愈、好转率高于研究组(P＜0.05),对照组治疗无效的比例也低于研究组.结论 依R菌Rv0341抗体阳性初治肺结核患者具有临床症状重,病变范围广,易出现空洞,依R菌培养阳性率较高,治疗效果欠佳的特点、.     

H37Rv结核标准菌株构建豚鼠膝关节滑膜结核模型的研究

目的探索利用H37Rv结核标准菌株构建豚鼠膝关节滑膜结核病理模型的方法。方法对经过福氏佐剂免疫和致敏的豚鼠,行膝关节腔H37Rv菌株两种菌量(1×107/mL,50μL及100μL)的注射感染,观察豚鼠感染结核菌后膝关节滑膜组织及关节软骨与骨的病理变化,并行膝关节滑膜集菌培养。结果豚鼠膝关节在行两种菌量的H37Rv菌株感染后,局部肿胀均较明显,但动物的全身反应都较轻微。两组动物的膝关节滑膜病理切片均显示有典型的结核结节及其内的干酪样坏死灶形成;切片抗酸染色均检出有抗酸染色阳性的分枝杆菌;两组动物的关节滑膜匀浆培养均有结核分枝杆菌生长。结论通过在经预先免疫与致敏豚鼠的膝关节局部进行适当剂量的H37Rv结核菌株的注射感染,可以构建出与人类滑膜结核病理变化相似的豚鼠膝关节滑膜结核。     

Hospital outbreak of multidrug-resistant Mycobacterium tuberculosis infections. Factors in transmission to staff and HIV-infected patients.

OBJECTIVE--To describe transmission of multidrug-resistant (MDR) Mycobacterium tuberculosis infection among patients and health care workers (HCWs) in a ward and clinic for human immunodeficiency virus (HIV)-infected patients in a hospital, four studies were conducted. METHODS--Case patients and control patients were persons who had been treated in the HIV ward or clinic, whose clinical course was consistent with tuberculosis and who had at least one positive culture for M tuberculosis between January 1, 1988, and January 31, 1990, resistant to at least isoniazid and rifampin (case patients), or whose isolates were susceptible to all drugs tested (control patients). In the first study, case patients and control patients were compared to identify risk factors for MDR tuberculosis. In the second study, inpatient and outpatient days of MDR tuberculosis case patients were compared to determine whether acid-fast bacillus (AFB) smear-positivity or aerosolized pentamidine use was associated with higher numbers of subsequent MDR tuberculosis cases among exposed patients. In the third study, restriction fragment length polymorphism analysis was performed on available MDR and sensitive M tuberculosis isolates. In the fourth study, skin test conversion rates among HCWs in the HIV ward and clinic were compared with those of HCWs in another ward, and the strength of the associations between skin test conversions among HCWs on the HIV ward and the number of person-days that AFB smear-positive case patients and control patients were on this ward was estimated. RESULTS--Case patients were more likely than control patients to have been exposed on the HIV ward or clinic to an AFB smear-positive case patient (P less than .001). Inpatient and outpatient days of MDR tuberculosis case patients were associated with more subsequent cases of MDR tuberculosis if exposing case patients were smear-positive or if they received aerosolized pentamidine (P less than or equal to .01). Of 13 MDR isolates, all had one of two restriction fragment length polymorphism patterns; 10 sensitive isolates had restriction fragment length polymorphism patterns that were different from each other. The HCW skin test conversion rate was higher on the HIV ward and clinic than on the comparison ward (P less than .01). The risk of occupational acquisition of infection increased in direct proportion to the number of person-days that AFB smear-positive case patients were on the HIV ward (r = .75; P = .005), but did not increase in proportion to the number of person-days that AFB smear-positive control patients were there (r = -.36; P = NS). After isolation measures for AFB smear-positive tuberculosis patients were improved, MDR tuberculosis cases decreased to seven of 214 tuberculosis patients. CONCLUSIONS--Nosocomial transmission of MDR M tuberculosis infection to patients and HCWs occurred on the HIV ward and clinic. Infectiousness of MDR tuberculosis case patients was associated with AFB sputum-smear positivity. Case patients with MDR tuberculosis created a greater risk of skin test conversion for HCWs on the HIV ward than drug-susceptible control patients.     

聚合酶链反应在诊断肺结核中的应用

应用聚合酶链反应（ＰＣＲ）技术对７８例患者的痰、支气管肺泡灌洗液（ＢＡＬＦ）和胸水标本进行结核菌检测；并同时进行涂片抗酸染色、皮肤结核菌素试验及血结核菌抗体检测。结果：ＰＣＲ阳性率为４６．１５％，与涂片镜检、结核菌素试验强阳性、血结核菌抗体阳性率（分别为３．８５％、１７．９５％、１１．５４％）相比均有显著性差异（Ｐ＜０．０５）。由此可见ＰＣＲ方法比传统方法具有更高的结核杆菌检出率。     

电子支气管镜下取分泌物结核菌培养对支气管、不典型肺结核的诊断价值

目的评价BF260电子支气管镜下取分泌物用培养法对不典型肺结核的诊断价值。方法选自门诊和住院病人无痰或痰抗酸杆菌涂片检查屡为阴性的疑似肺结核患者,电子支气管镜下取分泌物培养结核杆菌。结果82例检出结核菌19株,培养阳性率为23.17%。同时做痰液培养生长2株,培养阳性率为3.66%。两者比较,差异明显,χ2=34.11,P<0.05;用支气管分泌物直接涂片检出抗酸杆菌5例,涂阳率6.10%,与培养比较,χ2=9.512,P<0.05。结论用支气管分泌物对无痰或痰抗酸杆菌涂片检查屡为阴性的肺结核患者行结核菌培养的方法,能明显提高结核菌的检出率,对临床不典型肺结核的明确诊断有重要价值。     

痰涂阳性肺结核患者密切接触者结核菌感染情况调查

目的 应用早期建立的结核分枝杆菌特异性IFN-γ酶联免疫斑点(Elispot)检测技术,以及结核菌素皮肤试验评价痰涂阳性肺结核患者密切接触者中结核菌的感染情况.方法 采用Elispot技术检测1 242例痰涂阳性肺结核患者的密切接触者进行外周血结核菌特异性IFN-γ水平,同时平行进行PPD皮试.结果 Elispot在密切接触者以及接触者中家属,朋友的阳性率分别是30％,34.25％和22.1％,PPD相应的结果是13.2％,15.57％和8.9％;两者阳性率比较差异有统计学意义(P＜0.01).Elisopt阳性率在不同年龄组均高于PPD,结果差异均有统计学意义.在47例确诊肺结核患者(发病率达3.78％)中,其中Elispot阳性34例(72.34％),PPD强阳性12例(25.53％);两者阳性率有统计学意义(P＜0.01).结论 与PPD比较利用Elispot诊断结核潜伏感染有较高辅助诊断价值.利用Elispot监测结核密切接触者,有利于早期发现结核病人.     

应用噬菌体生物扩增法对HIV/TB双重感染患者抗结核药耐药性分析研究

目的 利用噬菌体生物扩增法(PhaB)分析人类免疫缺陷病毒(HIV)合并结核病(TB)双重感染患者的结核分枝杆菌的耐药状况,优化防治对策.方法 运用PhaB法对重庆市第九人民医院收治的112例HIV/TB双重感染患者(HIV/TB组)做TB菌的药敏检测,并与208例单纯肺结核患者(单纯TB组)的药敏检测做对比分析.结果 HIV/TB组的抗TB药耐药率要比单纯TB组低,HIV/TB双重感染患者5种常见抗TB药物的耐药率分别为异烟肼(INH) 7.14％、吡嗪酰胺(PZA) 7.14％、利福平(RFP) 5.36％、链霉素(SM) 5.36％、乙胺丁醇(EMB)4.46％,与单纯TB组患者比较(RFP 17.31％、INH 13.46％、PZA11.54％、EMB 10.58％、SM 9.62％),HIV/TB组RFP的耐药率低于单纯TB组,差异有统计学意义(P＜0.05),其他4种抗TB药耐药率与单纯TB组比较差异无统计学意义(P＞0.05),与绝对浓度法结果符合率分别为INH 96.4％、RFP 98.2％、PZA 96.4％、EMB 93.8％和SM 96.4％.结论 本地区HIV/TB双重感染患者结核分枝杆菌对RFP耐药率较普通肺结核患者低,与该类患者良好的服药依从性相关.PhaB测定所需时间短,操作简便,不需特殊仪器设备,可作为结核分枝杆菌耐药性的快速筛选方法.     

微阵列芯片技术在耐多药结核病临床诊断中的应用研究

目的 探讨微阵列芯片技术在耐多药结核病（multidrug resistant tuberculosis,MDR-TB）临床诊断中的应用。方法 收集2020年6月至2021年5月经滨州市中心医院确诊的245例住院肺结核患者的标本（痰液标本125例和痰培养分离菌株120例）。痰液标本同时采用DNA微阵列芯片技术和传统培养法检测其结核杆菌阳性率。痰液标本和分离菌株均采用DNA微阵列芯片技术进行肺结核耐多药检测和分枝杆菌菌种鉴定。结果 125例痰液标本经DNA微阵列芯片技术和痰培养法检测,阳性率分别为58.4%（73/125）和24.8%（31/125）,两种方法比较差异有统计学意义（2=14.520,P<0.001）。采用DNA微阵列芯片技术检测125例痰液标本和120例分离菌株,共检出结核分枝杆菌复合群192例,非结核分枝杆菌7例。结核分枝杆菌复合群192例检出耐药者41例,其中耐异烟肼15例,耐利福平19例,同时耐两种药物7例。非结核分枝杆菌包括胞内分枝杆菌4例,堪萨斯分枝杆菌2例,鸟分枝杆菌1例。结论 DNA微阵列芯片技术检测周期短,能同时进行结核分枝杆菌耐多药检测和菌种鉴定,对MDR-TB的早期诊断和治疗有较大的临床应用价值。     

临床肺结核治疗中耐药性分析及对策

目的:了解从分离自肺结核患者的结核分枝杆菌耐药基因突变率及耐药情况,以利抗结核治疗中药物的合理选用。方法:对痰涂片阳性的新发初治和复治肺结核患者进行痰结核分枝杆菌培养,阳性菌株采用高、低两种药物浓度,四种抗结核药物耐药性测试,同时用实时PCR法对结核分枝杆菌的耐药基因和突变进行检测。结果:127例痰培养阳性菌株总耐药率为14.2%,其中初治耐药率8.1%,复治耐药率35.7%,对四种抗结核药物的耐药率依次为异烟肼8.7%,利福平2.4%,链霉素2.4%,乙胺丁醇0.8%。耐药基因检测结果,在初治组中rpoB和katG的突变率为12.1%(12/99)和10.1%(10/99);复治组中rpoB和katG的突变率为32.1%(9/28)和21.4%(6/28)。结论:分离自肺结核患者的结核分枝杆菌在初始治疗时已存在耐药性,而药物治疗有可能使其耐药性增加。结果表明抗结核治疗前及在治疗过程中对结核分枝杆菌进行耐药性及耐药基因检测对指导临床抗结核治疗很有实际意义。     

HIV/AIDS患者预防和治疗结核病的研究

目的 :调查艾滋病病毒 (HIV) /艾滋病 (AIDS)患者结核菌素 (PPD)试验反应状况及与免疫系统受损程度的联系 ,并探讨其预防和治疗结核病的意义。方法 :采用前瞻性病例对照研究方法 ,对 40例HIV /AIDS患者和 2 0 2例健康者做结核菌素试验 ,并对HIV/AIDS患者做CD4、CD8细胞计数测定 ,对HIV/AIDS患者分组服药 ,观察胸部病变及结核发生情况。结果 :HIV/AIDS患者与健康者PPD阳性率分别为 12 .5 %、2 8.2 % ,差异有显著性意义 ( χ2 =4.3 3P <0 .0 5 )。当CD4细胞计数下降时 ,PPD反应减弱。CD4<2 0 0个 /mm3 时PPD均无反应 ( 0× 0 )。病例服药组经化学药物预防治疗后其肺部病变异常率及结核的发病率小于病例对照组。结论 :HIV/AIDS患者PPD阳性率显著低于健康者。CD4细胞数下降可能是艾滋病并发结核的主要原因。对HIV/AIDS患者使用化学药物预防和治疗结核有效 ,同时为制定相关政策提供了依据。     

Tuberculous pleural effusion

Despite prevention programs, tuberculosis is still endemic in developing countries. Extrapulmonary tuberculosis is increasing globally in the face of recent emergence of Human Immunodeficiency Virus (HIV) infection. Pleural tuberculosis is a common problem in daily clinical practice. We assessed 26 cases of tuberculous pleural effusion admitted in Bangabandhu Sheikh Mujib Medical University from 2002 to 2007. The diagnosis was based upon clinical examination, tuberculin reaction, imaging, pleural fluid analysis and response to antitubercular chemotherapy a surrogate clinical determinant. Apparently promising newer biochemical pleural fluid measurements were not utilized due to a number of limitations. The presenting symptoms found in this prospective analysis are fever (100%), nonproductive cough (73%), pleuritic chest pain (38%), loss of weight (38%) and shortness of breath (38%). A high index of suspicion after confident exclusion of malignancy and pneumonia is a clue to diagnosis. Out of 80 cases of extrapulmonary tuberculosis admitted during the study period, tuberculous pleural effusion constitutes 32.50%.     

不同浓度纯结素试验对HIV感染者结核病诊断价值

目的探讨不同浓度纯结素试验对H IV感染者结核病诊断的敏感性和特异性。方法采用5 IU(0.1m l)、1 IU、0.1 IU三个不同浓度结核菌素分别对H IV感染者合并涂阳肺结核病、涂阴肺结核病、单纯H IV感染者进行皮试。结果5 IU涂阳肺结核病人的灵敏度为37.8%、1 IU涂阳肺结核病人的灵敏度为17.8%、0.1 IU涂阳肺结核病人的灵敏度为2.2%;5 IU涂阴肺结核病人的灵敏度为36.7%、1 IU涂阴肺结核病人的灵敏度为21.5%、0.1 IU涂阴肺结核病人的灵敏度为2.6%;5 IU PPD试验的特异度为92.6%、1 IU PPD试验的特异度为96.7%、0.1 IU PPD试验的特异度为98.3%。结论5 IU对H IV感染者结核病的诊断具有较高的敏感性和特异性,对H IV感染者结核病的诊断具有较大的价值;1 IU和0.1 IU对感染者结核病的诊断具有较高的特异性,但敏感性太低,对H IV感染者结核病的诊断不具有应用价值。     

Polyneuritis following BCG re-vaccination

A 12-year-old healthy, tuberculin negative boy was re-vaccinated with BCG. Nine days later symmetrical polyneuritis developed in all extremities. The tuberculin test was now strongly positive. It is suggested that the polyneuritis was due to a hypersensitivity reaction resulting from the BCG re-vaccination.