福建省结核分枝杆菌多位点可变数目串联重复序列基因分型研究

目的 了解福建省结核分枝杆菌的多位点可变数目串联重复序列基因分型(MLVA)的特征.方法 选择15个可变数目串联重复位点(VNTR),检测福建省30个耐药监测点临床分离的结核菌株,结果使用BioNumerics (Version 4.5)软件进行聚类分析.结果 313株结核菌被分为9个基因群(Ⅰ～Ⅸ),分别包含220、9、48、2、1、3、10、10、10株菌,以Ⅰ群为主(70.3％,220/313);Ⅰ群菌株异烟肼、链霉素、乙胺丁醇和耐多药的耐药率与其他基因群的差异无统计学意义(P＞0.05),但利福平(RFP)耐药率为33.2％(73/220),明显高于其他群菌株RFP的耐药率20.4％(19/93),差异有统计学意义(P＜0.05).结论 福建省结核分枝杆菌菌株存在明显的基因多态性,以Ⅰ群菌株为主,并与RFP耐药性具有相关性,应加强此类菌株流行的监测.     

湖北省某男子监狱在押人员肺结核患病情况调查分析

目的：了解湖北省某男子监狱中在押人员的肺结核患病情况,为制定在押人群结核病的有效防控措施提供参考依据。方法随机整群抽取湖北省某监狱中的1146名在押人员进行胸部 X 线摄片检查,对有异常阴影者进一步开展痰涂片和痰培养。所有数据经双人采用 Excel 2003软件录入,通过 SPSS 20.0软件进行统计分析。结果该男子监狱的活动性肺结核患病率为1588.70/10万,显著高于同年全国结核病流行病学调查中的男性水平(P <0.01),略高于湖北省男性的平均水平;其中,新发现患者占55.56%,复治患者占33.33%。此外,涂阳肺结核患病率为88.26/10万,培阳肺结核患病率为441.31/10万。结论男子监狱内的肺结核疫情亟待重视,应整合社会医疗资源,对在押人员进行定期肺结核筛查,并保障系统规范地给予治疗。     

内固定与非内固定治疗胸腰段脊柱结核的比较研究

目的 对比研究单纯植骨和内固定治疗胸腰段脊柱结核的疗效，探讨胸腰段结桉外科治疗中一期前路病灶清除植骨内固定的可行性及其治疗效果。方法 采用一期前路病灶清除，单纯植骨融合治疗胸腰段脊柱结核患者25例，植骨内固定治疗21例，对比观察术后植骨融合、畸形矫正及结核病灶愈合情况。结果 平均随访2年2个月，43倒患者获访，两组患者脊柱结核均治愈，植骨全部骨性融合。内固定组融合时间短，畸形矫正效果好，无明显矫正角丢失，优良率95％，非内固定组73．9％。结论 一期前路病灶清除植骨内固定．既可彻底清除痛灶、矫形．并能重建脊柱的即刻稳定性．其疗效的优良率明显高干非内固定组。     

消水散辅助治疗结核性胸水有效性及安全性观察

目的探讨自制消水散辅助化疗药物治疗结核性胸水的有效性、安全性。方法将60例结核性胸水患者随机分为实验组和对照组各30例,实验组采用抗结核化疗方案2HRZE(S)／4HR 消水散,对照组化疗方案2HRZE(S)／4HR 呋噻米注射液,疗程均为24周。结果实验组临床症状、血沉变化、胸水消退时间、免疫功能等指标改善情况均明显优于对照组,两组间不良反应发生情况无统计学差异。结论消水散辅助治疗结核性胸水疗效较好,不良反应低,并能提高患者的免疫功能。     

Chronic Pulmonary Disease Caused by Tsukamurella toyonakaense

Unidentified Mycobacterium species are sometimes detected in respiratory specimens. We identified a novel Tsukamurella species (Tsukamurella sp. TY48, RIMD 2001001, CIP 111916^T), Tsukamurella toyonakaense, from a patient given a misdiagnosis of nontuberculous mycobacterial pulmonary disease caused by unidentified mycobacteria. Genomic identification of this Tsukamurella species helped clarify its clinical characteristics and epidemiology.     

Hodgkin Lymphoma after Disseminated Mycobacterium genavense Infection,Germany

Mycobacterium genavense infection, a rare nontuberculous mycobacteria infection, occurs in heavily immunocompromised patients (i.e., those with advanced HIV disease, genetic disorders, or acquired immunologic disorders and those undergoing immunosuppressive therapy). We report a case of disseminated M. genavense infection preceding Hodgkin lymphoma in a patient without obvious risk factors for this infection.     

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。     

Drop‐offs in the isoniazid preventive therapy cascade among children living with HIV in western Kenya, 2015–2019

IntroductionIsoniazid preventive therapy (IPT) can reduce the risk of tuberculosis (TB) in children living with HIV (CLHIV), but data on the outcomes of the IPT cascade in CLHIV are limited.MethodsWe evaluated the IPT cascade among CLHIV aged <15 years and newly enrolled in HIV care in eight HIV clinics in western Kenya. Medical record data were abstracted from September 2015 through July 2019. We assessed the proportion of CLHIV completing TB symptom screening, IPT eligibility assessment, IPT initiation and completion. TB incidence rate was calculated stratified by IPT initiation and completion status. Risk factors for IPT non‐initiation and non‐completion were assessed using Poisson regression with generalized linear models.ResultsOverall, 856 CLHIV were newly enrolled in HIV care, of whom 98% ([95% CI 97–99]; n = 841) underwent screening for TB symptoms and IPT eligibility. Of these, 13 (2%; 95% CI 1–3) were ineligible due to active TB and 828 (98%; 95% CI 97–99) were eligible. Five hundred and fifty‐nine (68%; 95% CI 64–71) of eligible CLHIV initiated IPT; median time to IPT initiation was 3.6 months (interquartile range [IQR] 0.5–10.2). Overall, 434 (78%; 95% CI 74–81) IPT initiators completed. Attending high‐volume HIV clinics (aRR = 2.82; 95% CI 1.20–6.62) was independently associated with IPT non‐initiation. IPT non‐initiation had a trend of being higher among those enrolled in the period 2017–2019 versus 2015–2016 (aRR = 1.91; 0.98–3.73) and those who were HIV virally non‐suppressed (aRR = 1.90; 95% CI 0.98–3.71). Being enrolled in 2017–2019 versus 2015–2016 (aRR = 1.40; 1.01–1.96) was independently associated with IPT non‐completion. By 24 months after IPT screening, TB incidence was four‐fold higher among eligible CLHIV who never initiated (8.1 per 1000 person years [PY]) compared to CLHIV who completed IPT (2.1 per 1000 PY; rate ratio [RR] = 3.85; 95% CI 1.08–17.15), with a similar trend among CLHIV who initiated but did not complete IPT (8.2/1000 PY; RR = 4.39; 95% CI 0.82–23.56).ConclusionsDespite high screening for eligibility, timely IPT initiation and completion were suboptimal among eligible CLHIV in this programmatic cohort. Targeted programmatic interventions are needed to address these drop‐offs from the IPT cascade by ensuring timely IPT initiation after ruling out active TB and enhancing completion of the 6‐month course to reduce TB in CLHIV.     

NRAMP1基因和人类对结核分枝杆菌的易感性

NRAMP1基因,又称SLC11A1基因,位于2号染色体长臂35区(2q35),包括15个外显子及内含子4中交替出现的1个外显子,长13 604 bp.NRAMP1的常见多态性基因有D543N、3′UTR、INT4和5′(GT)n等,和结核易感性相关.NRAMP1蛋白由巨噬细胞表达,是一种H+/二价阳离子的反向转运体,对巨噬细胞的功能有多效性.此文对NRAMP1基因及其和MTB的易感相关性的研究结果进行综述.     

2010-2019年上海市某医院多重耐药鲍曼不动杆菌的临床分布及耐药性分析

目的 分析2010-2019年上海市青浦区中医医院多重耐药鲍曼不动杆菌的临床科室分布情况及耐药性.方法 对上海市青浦区中医医院2010-2019年检出的394株鲍曼不动杆菌进行回顾性分析,使用法国生物梅里埃VITEK-2 Compact60全自动细菌鉴定及药敏分析仪,药敏结果根据美国临床和实验室标准协会标准进行判读.结...