ObjectiveTo investigate the clinical characteristics of non-tuberculous mycobacterium (NTM) pulmonary disease and pulmonary tuberculosis, as well as the bacterial distribution of NTM pulmonary disease. Methods The bacterial distribution and clinical characteristics of 104 patients with NTM lung disease hospitalized in Jiangxi Provincial People’s Hospital from May 2017 to May 2020 were retrospectively analyzed, as well as the clinicplal characteristics of 155 patients with tuberculosis hospitalized during the same period. Results The age of NTM lung disease group [(60±15) years] was higher than that of tuberculosis group [(55±19) years]. There were statistically significant differences in basic diseases (such as malignant tumor, type 2 diabetes, old tuberculosis, bronchiectasis), laboratory examination (such as blood routine examination, albumin) and chest imaging characteristics between the two groups (P<0.05). There was no significant difference in clinical symptoms (such as cough, sputum or fever) (P>0.05). The common underlying diseases of NTM lung disease were malignant tumor (29%), bronchiectasis (21%), chronic obstructive pulmonary disease (19%), etc. The common clinical symptoms of NTM lung disease included cough, sputum, fever, hemoptysis, chest tightness and shortness of breath, and other non-specific respiratory symptoms. The common manifestations of NTM lung disease on chest high-resolution CT (HRCT) included patchy images (82%), mediastinal lymph node enalargement (35%), pleural thickening (31%), pleural effusion (26%) and other signs. The isolates of NTM included Mycobacterium avium (50%), Mycobacterium intracellulare (21%), Mycobacterium chelonae/abscessus (14%), Mycobacterium fortuitum (5%), Mycobacterium gordonae (4%), Mycobacterium gilvum (3%), and Mycobacterium smegmatis (3%). Multivariate Logistic regression analysis showed that advanced age (OR=1.027) was a risk factor for NTM lung disease. Conclusions The clinical manifestations of NTM lung disease and tuberculosis are similar and difficult to distinguish. For male patients over 60 years old with malignant tumor, old tuberculosis, bronchiectasis and other basic diseases, and the chest HRCT findings are mainly bronchiectasis, NTM lung disease should be actively excluded. There is little difference in clinical manifestations between different strains of NTM lung disease, and the treatment cycle of NTM lung disease is long and easy to be interrupted, requiring enhanced follow-up.
ObjectiveTo observe the impact of perioperative nursing intervention on pulmonary tuberculosis patients undergoing lung resection. MethodThirty-six pulmonary tuberculosis patients going to undergo lung resection hospitalized between January and December 2013 were randomly divided into intervention group and control group with 18 in each. Patients in the intervention group received routine perioperative care plus nursing intervention including preoperative, environmental, dieting and pain intervention. Then, complications, hospitalization time and costs, as well as patients' satisfaction with the nursing work were compared between the two groups. ResultsAfter nursing intervention, complications, hospitalization time, hospital costs of patients in the intervention group were significantly less than the control group (P<0.05), and patients' satisfaction was significantly higher (P<0.05). ConclusionsPerioperative nursing intervention on lung resection treatment and rehabilitation of patients play an active and effective role, which can reduce complications, shorten hospitalization time, reduce hospital costs and improve patients' satisfaction.
Objective To systematically review the safety of rifapentine vs. rifampicin for pulmonary tuberculosis. Methods PubMed, EMbase, The Cochrane Library, CBM, VIP, WanFang Data and CNKI databases were electronically searched to collect randomized controlled trials (RCTs) of rifapentine vs. rifampicin for pulmonary tuberculosis up to September 2017. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then, meta-analysis was performed by using RevMan 5.3 software. Results A total of 26 RCTs involving 3 624 cases were included. The results of meta-analysis showed that the rifapentine group was superior to the rifampicin group on the incidence of abnormal liver function (RR=0.31, 95%CI 0.32 to 0.47, P<0.000 01), skin rash occurrence rate (RR=0.24, 95%CI 0.16 to 0.37,P<0.000 01), the incidence of leukopenia (RR=0.41, 95%CI 0.31 to 0.54,P<0.000 01), and the incidence of gastrointestinal reaction (RR=0.46, 95%CI 0.37 to 0.57,P<0.000 01) with statistical significance. Conclusions Current evidence shows that compared with rifampicin, rifapentine can effectively reduce the adverse reactions of patients. Due to limited quality and quantity of the included studies, more high quality studies are needed to verify the above conclusion.
Objective To analyze the report status of the pulmonary tuberculosis in the elderly people aged ≥ 65 years old. Methods The reported data of senile pulmonary tuberculosis and the whole population pulmonary tuberculosis at West China Hospital of Sichuan University between January 1, 2012 and December 31, 2022 were retrospective selection. Descriptive methods were used to analyze the different characteristics and etiology of senile pulmonary tuberculosis. Results A total of 2 182 senile pulmonary tuberculosis were reported. The report was mainly positive reports of etiology [1091 cases (50.00%)], and the component ratio increased year by year (χ2=49.986, P<0.001). The proportion of senile pulmonary tuberculosis in the whole population pulmonary tuberculosis increased from 17.62% in 2012 to 29.04% in 2022, and the difference between different years was statistically significant (χ2=40.261, P<0.001). In the reported patients, the male to female ratio was 2.30∶1. There were 7 cases of rifampicin resistant, 1 091 cases of etiology positivity, 674 cases of etiology negativity, and 410 cases of no etiology results. The number of reported cases in the age group of 65-74 was higher than that in the age group of 75 and above. The seasonal distribution was not obvious (concentration<0.3). The patients were mainly from other cities of the province [919 cases (42.12%)], and the Department of Pulmonary and Critical Care Medicine (including the Tuberculosis Ward) was reported the most [1439 cases (65.95%)]. The majority of occupations were retired individuals [952 cases (43.63%)]. Conclusions From 2012 to 2022, the prevention and treatment of senile pulmonary tuberculosis has achieved some results, but the overall burden is still very heavy. The detection of senile pulmonary tuberculosis should be strengthened.
ObjectiveTo summarize the overall diagnostic accuracy of serum proteomic assay for pulmonary tuberculosis through a Meta-analysis.MethodsStudies regarding the diagnostic utility of serum proteomic assay for pulmonary tuberculosis were searched in Scopus, PubMed, Wanfang, China National Knowledge Infrastructure, and CQVIP. The methodical quality was evaluated by Quality Assessment for Studies of Diagnostic Accuracy Studies-2 tool. The pooled sensitivity, specificity, positive/negative likelihood ratios, and diagnostic odds ratio were calculated. Summary receiver operating characteristic curve was generated and the area under the curve was calculated.ResultsThere were 10 articles with 2 433 patients included in this study, containing 1 191 cases and 1 242 controls. The pooled sensitivity, specificity, positive/negative likehood ratios, and diagnostic odds ratio were 0.86, 0.88, 6.72, 0.17, and 46.84, respectively. The area under the curve was 0.93.ConclusionSerum proteomic assay plays a role in diagnosing pulmonary tuberculosis, and proteomic assay represents a novel and useful method for diagnosing pulmonary tuberculosis.
ObjectiveTo investigate the diagnostic value of products triggered by endotoxin including cytokines and procalcitonin for differentiating bacterial pneumonia from pulmonary tuberculosis. MethodsFifty patients diagnosed to have hospital-acquired pneumonia and another 50 patients diagnosed with tuberculosis admitted into West China Hospital between January and August 2015 were recruited in this study. The frequencies of CD4+ interferon (IFN)-γ+, CD4+ tumor necrosis factor (TNF)-α+, CD4+ interleukin (IL)-2+, CD4+ IL-10+ as well as CD8+IFN-γ+, CD8+TNF-α+, CD8+IL-2+, CD8+IL-10+ populations in peripheral blood were detected by flow cytometry after endotoxin stimulation. Meanwhile, the levels of procalcitonin, IL-6 and C reactive protein were measured by immunofluorescence staining. ResultsThe frequencies of CD4+ IFN-γ+, CD4+ TNF-α+, CD4+ IL-2+, CD4+ IL-10+ as well as CD8+ IFN-γ+, CD8+ TNF-α+, CD8+ IL-2+, CD8+ IL-10+ populations in the pneumonia group increased significantly compared with those in the tuberculosis group (P < 0.05). The levels of procalcitonin, IL-6 and C-reactive protein in the pneumonia group increased statistically compared with the counterparts in the tuberculosis group (P < 0.05). The positive rates of procalcitonin, IL-6 and C-reactive protein in the pneumonia group were significantly higher than those in the tuberculosis group (P < 0.05). ConclusionMeasurement of products triggered by endotoxin is beneficial for differential diagnosis of pneumonia from tuberculosis.
Objective To describe the underlying conditions of chronic pulmonary aspergillosis (CPA). Methods A retrospective study was performed. Details of the clinical, imaging features, and the underlying conditions of CPA patients admitted to a tertiary university teaching hospital from January 2009 to December 2016 were extracted from clinical records. The classification distribution of CPA, and underlying conditions were analyzed. Results Among the 108 CPA patients, 87 cases had underlying conditions, 21 cases had no underlying conditions. Seventy two (66.7%) patients were engaged in agriculture, the proportion of which was significantly higher in the cases without underlying conditions (85.7% vs. 62.1%). Chronic necrotizing pulmonary aspergillosis (CNPA) was the most common type of these CPA cases. The cases without underlying conditions had significantly more proportion of CNPA than the cases with underlying conditions (85.7% vs. 62.1%). The cases with systemic underlying conditions had significantly more proportion of CNPA than the cases only with pulmonary underlying conditions (82.8% vs. 51.7%). Chronic cavity pulmonary aspergillosis (24/108, 22.2%) only existed in the cases with pulmonary underlying conditions. Underlying conditions were identified in 87 cases of CPA, with 85.1% (74/87) pulmonary and 33.3% (29/87) systemic underlying diseases. Previous tuberculosis mycobacterial infection, bronchiectasis and chronic obstructive pulmonary disease were the most common pulmonary underlying conditions (40.2%, 39.1% and 35.6%, respectively). Diabetes (16.1%) and glucocorticoid using (13.8%) were the most two common systemic underlying conditions. Conclusions CPA can occur in patients with and without underlying diseases. CNPA is the most common type of these CPA, the proportion of which is higher in cases without underlying conditions and cases with systemic underlying conditions. Farming maybe the risk factors of CPA. Chronic pulmonary primary diseases are the most common underlying conditions. The most common systemic factors are diabetes and glucocorticoid using.
Objective To investigate and analyze the epidemic characteristics and factors of pulmonary tuberculosis (PTB) to provide foundation and make prevention and treatment policy. Methods Statistical analysis was conducted to analyze the current existing PTB prevention and control data in the Center for Disease Control and Prevention of Zhushan County and corresponding prevention and treatment policy was proposed. Results Since 1997 when PTB was included into B infectious diseases in Zhushan County, 4 431 cases of PTB had been reported by the end of 2009. Annual reported incidence rate was 74.73 per 100 000 and the disease was found in 17 towns. All seasons witnessed the incidence but winter and summer had more sufferer. The youngest patient was 4 months whereas the oldest was 86 years old. The majority of the patients were from 20 to 59 years old, peasants were the main patients, and the incidence of male was higher than that of female. The use of chemotherapy resulted in a significant decline of PTB death rate. Poor immunity of elder group, population flow caused by poverty, low detection rate of patients and AIDS were the major causes to PTB epidemic. A lack of prevention and treatment in the grassroots hospital and difficulty to fully implement the Directly Observed Treatment, Short-course (DOTS) strategy in remote areas were also bottlenecks to PTB control process. Conclusion The followings should be performed to improve the quality of DOTS strategy implementation: strengthen the government’s commitment, provide policy and funding safeguard, conduct health education and health promotion widely, reinforce management according to the law, fully implement the DOTS strategy, and fortify the prevention and control construction.
ObjectiveTo compare the performance of 36-item short form health survey (SF-36) and World Health Organization quality of life-bref (WHOQOL-Bref) in assessing quality of life (QOL) in patients with pulmonary tuberculosis (TB). MethodsThe WHOQOL-Bref questionnaire and the SF-36 questionnaire were administered to patients with tuberculosis undergoing treatment from July to September 2013. The statistical methods of reliability analysis, factor analysis and the Pearson correlation coefficient analysis were used. ResultsIt showed that the WHOQOL-Bref and the SF-36 both had good reliability (Cronbach α=0.863 and 0.920, respectively). Constructive validity of the two instruments were checked by factor analysis and the Pearson correlation coefficient analysis, which indicated that both the two instruments had good validity. Among scales measuring similar concepts, many subscales of the SF-36 and the four domains of the WHOQOL-Bref unexpectedly had a fair correlation with one another. For example, the physical QOL, psychological QOL, and social relation QOL domains of the WHOQOL-Bref and physical functioning, mental health, and social functioning of the SF-36 were 0.482, 0.745, and 0.572, respectively. ConclusionThe WHOQOL-Bref and the SF-36 have an approximately equivalent practicability in assessing the quality of life in patients with TB.
Objective To investigate diagnosis and treatment strategies of patients with pulmonary tuberculosis （TB） complicated by Aspergillus infection. Methods Clinical data of 38 patients with pulmonary TB complicated by Aspergillus infection who underwent surgical treatment from January 2008 to December 2010 in Chengdu Infectious Disease Hospital were retrospectively analyzed. There were 23 male patients and 15 female patients with their average age of 37.8 （23-59） years. Preoperatively，all the patients received regular anti-TB treatment for more than 2 weeks，and patients with definite Aspergillus infection received anti-Aspergillus therapy for more than 3 days with consultation of infectious disease physicians. After above treatment，26 patients underwent lobectomy，1 patient underwent right pneumonectomy，and 11 patients underwent left pneumonectomy. All the patients were followed up at the outpatient department after discharge. They were evaluated every 2 weeks in the first 3 months，every 1 month after 3 months，and every 6 months after 1 year. During follow-up，they received acid-fast bacillus smear and sputum culture to check Aspergillus，as well as CT chest scan. Results All the patients successfully received surgical resection of the pulmonary lesion without perioperative death or severe complication. Postoperative pathology examination confirmed pulmonary TB with Aspergillosis infection in all the 38 patients，whose basic diseases included TB cavity in 17 patients，TB-destroyed lung in 12 patients，and post-TB bronchiectasis in 9 patients. All the patients were followed up after discharge for 1.5-4.5 years. During follow-up，they received regular anti-TB therapy for adequate duration in addition to antifungal medications such as voriconazole. None of the 38 patients had recurrence of Aspergillus infection or pulmonary TB. One patient had hemoptysis which was controlled after proper treatment during follow-up. Conclusion Missed diagnosis rate of pulmonary TB complicated by Aspergillus infection is high. Surgical resection of the pulmonary lesion and postoperative medication treatment are the most effective treatment strategies for patients with pulmonary TB complicated by Aspergillus infection.