Fast and Accurate Identification of <i>M. tuberculosis</i>Complex Using an Immunochromatographic MPT64 Antigen Detection Test

Background: A new rapid Immunochromatographic test (ICT) kit (MPT64 TB Ag Kit) for detection of MPT64 Antigen in M. tuberculosis (MTB) isolates used for rapid identification of MTB isolates developed by SD (Standard Diagnostics) Bio line, South Korea was evaluated. The ICT is a rapid, reliable and cheaper method that can be used instead of conventional biochemical tests for confirming MTB in culture isolates in resource limited laboratories. The study also evaluated the ability of ICT to detect MPT64-Antigen before the micro MGIT could signal positive. Material/Methods: A total of 450 sputum samples of individual patients were used for the study. 152 isolates of Mycobacteria were recovered from solid and liquid media. These strains were tested for the detection of MPT64-antigen. H37Rv strain was served as the positive reference control and also used for early detection of Antigen experiment. Findings: The development of bands on both test and sample region when H37Rv strain was tested were seen (MPT64 antigen positive). When 138 MTB isolates were tested, it showed a similar banding pattern indicating 100% sensitivity. MPT64 band formation was not detected in any of the 14 isolates indicating 100% specificity. Both PPV & NPV were 100%. All the isolates negative for MPT64 Ag were confirmed as MOTT by conventional bio-chemical PNBA. The H37Rv strain showed a faint band from the 2nd day onwards from inoculation till 3rd day in the earlier Antigen detection experiment. Conclusion: Rapid identification of MTB culture isolate is a pressing need for diagnosis and proceeding to perform drug susceptibility testing. MPT64 TB Ag detection ICT kit is a rapid, reliable method, good substitute for molecular identification methods, and conventional biochemical test which is time-consuming and technically demanding. The early detection of Antigen can be used as an effective tool in diagnosis.

Comparison of Susceptibilities of M. tuberculosis H37Ra and M. chelonei subsp. Abscessus to Disinfectants

Objective To determine the susceptibilities of M. tuberculosis H37Ra and M. chelonei subsp. absecessus to several frequently-used disinfectants and to evaluate the practicability of surrogating M. tuberculosis by the latter. Methods A suspension quantitative bactericidal test was set up in accordance with Chinese Technique Standard for Disinfection to evaluate the susceptibility of each mycobacteria strain to each selected disinfectant. Killing log value was used as criterion in comparing the susceptibility to disinfectants between the two strains. Results M. chelonei subsp. abscessus was more resistant to chlorine disinfectant than M. tuberculosis while the two strains were similarly resistant to iodophor disinfectant, peracetic acid, alcohol and glutaraldehyde disinfectant. Conclusion M. chelonei subsp. abscessus has the potential to surrogate M. tuberculosis in evaluating mycobactericidal efficacies of disinfectants.

Application of PCR-SSCP in detecting rpoB drug resistant gene polymorphism of M. tuberculosis L-form from pneumoconiosis patients with tuberculosis

Objective: To study the relationship between the polymorphism of drug resistant gene rpoB and drug resistance against rifampicin(RFP) of M. tuberculosis L-forms, and to evaluate its clinical application. Methods: A total of 52 clinical isolated strains of M. tuberculosis L-forms were collected. rpoB gene polymorphism was analyzed by polymerase chain reaction and single-strand conformation polymorphism (PCR-SSCP) and conventional antimicrobial susceptibility test (AST). Their results were compared. Results: AST results showed that 38 of 52 clinical isolated strains were drug resistance (73.08％),while PCR-SSCP indicated 65.38％ (32/52) rpoB gene polymorphism. There was no statistic significance(χ2= 2.4914) between the 2 methods. Conclusion:Combined the application of PCR-SSCP with AST in detecting rpoB drug resistant gene polymorphism of M. tuberculosis L-form from pneumoconiosis patients with tuberculosis may have advantages at earlier diagnosis and guidance of clinical medications.

Clinical Performances of Pure TB-Lamp Kit for <i>M. tuberculosis</i>Complex Detection in Sputum Samples

Tuberculosis represents a main concern for public health worldwide. In poor countries, the most prevalent method for bacteriological confirmation re- mains Smear Sputum Microscopy (SSM). This study objective was to assess clinical performances of Loop Mediated Isothermal Amplification for TB detection (Lamp-TB). Sputum of patients presenting symptoms consistent with tuberculosis were collected according to the National Tuberculosis Control Programme guidelines in Centre Antituberculeux de Yopougon. SSM after Ziehl-Neelsen staining and TB-Lamp were blindly performed with spot sputum specimen. Samples, transported at Institut Pasteur de Cote d’Ivoire were decontaminated according to N-acetyl-L-cystein (NALC) method. In Mycobacteria Growth Indicator Tube (MGIT), 500 μl of pellet were inoculated and incubated in MGIT 960 instrument. MPT64 antigen was detected on positive culture. Of 500 patients enrolled, 469 were included. Clinical isolates of M. tuberculosis Complex were detected for 157 (33.5%). Comparatively to culture, Sensitivity and Specificity of SSM were 86% (95% Confidence interval (CI): 81% - 91%) 96% (95%IC: 94% - 98%) respectively. TB-Lamp Sensitivity was 92% (95%CI: 88% - 96%), and Specificity 94% (95%CI: 91% - 97%). Positive Predictive Value of SSM and TB-Lamp was 91.8% and 88.8% respectively. Negative Predictive Value of TB-Lamp assay was 95.7% whereas this of SSM was 93.3%. Positive Likelihood Ratio was 15.3 for TB-Lamp and 21.5 for SSM 21.5 whereas negative Likelihood of TB-Lamp was lower than SSM. Active tuberculosis was detected in162/469 (34.5%) with TB-Lamp and 147 (31.3%) with SSM. TB-Lamp assay performances estimated from sputum samples may improve detection of active TB cases in routine.

Specific Antigens to Distinguish <i>M. tuberculosis</i>from <i>M. avium</i>

To distinguish Mycobacterium tuberculosis from Mycobacterium avium, specific M. tuberculosis antigens had been studied for improving the early differential diagnosis effect of tuberculosis caused by different Mycobacterium. The rabbit anti-M. avium sera and anti-M. tuberculosis sera were analyzed for antibody-based reactivity by matrix-assisted laser desorption-ionization mass spectrometry (MALDI-TOF Mass) against M. tuberculosis proteins. The immunoreactive spots, which were attributed to the proteins HspX, GroES and CFP-10, were mostly located at 10 - 60 kDa and PI 4 - 6, subsequently Western blotting result proved that HspX and CFP-10 were specific to M. tuberculosis and ELISA testing result of 30 M. avium positive sera showed that GroES were cross-reactive to M. avium. Lastly, positive and negative tuberculosis reference sera and based on the mechanism of indirect ELISA, the specificity and the sensitivity of the methods targeting the antibodies HspX, GroES or CFP-10 were evaluated at 37% and 26%, 12% and 97%, 81% and 98%, respectively. The combination of these three antibody detection methods allowed to reached a specificity of 42%, and of 39% without taken into account of the method targeting the GroES antibody. Using proteomics approach, we found three M. tuberculosis specific antigens showed good potential in tuberculosis diagnosis, providing basic study for serodiagnosis of tuberculosis.

Comparative study of a rabbit model of spinal tuberculosis using different concentrations of Mycobacterium tuberculosis

BACKGROUND Tuberculosis is among the most devastating infectious diseases worldwide.Spinal tuberculosis is not easy to detect at an early stage,which without effective treatment often leads to spinal deformity and spinal cord damage which in turn cause complications such as paraplegia and quadriplegia.In this study,we established a model using three concentrations of bacteria and carried out a comprehensive evaluation of the model by imaging,general observations,and histopathological and bacteriological studies.AIM To establish a rabbit model of spinal tuberculosis and examine the effect on the model’s efficacy using different concentrations of Mycobacterium tuberculosis(M.tuberculosis)inoculum.METHODS New Zealand rabbits were randomly divided into experimental,control and blank groups.The experimental and control animals were sensitized with complete Freund′s adjuvant,a hole was drilled beneath the upper endplate of the L6 vertebral body and filled with gelfoam sponge.The experimental group was divided into three subgroups(experimental 1,experimental 2,experimental 3)and infused with M.tuberculosis suspension at various concentrations.The control group was inoculated with saline and the blank group received no treatment.The 12-week post-operative survival rates were 100%,80%and 30%in the experimental groups inoculated with concentrations of 106,107 and 108 CFU/mL bacteria,respectively.RESULTS The survival rate of the control and blank groups was 100%.Vertebral body destruction at 8 weeks in the three experimental groups as determined by X-ray analysis was 33.3%,62.5%and 66.7%,and by computed tomography(CT)and 3-dimensional CT 44.4%,75%and 100%,respectively.At 12 weeks,the figures were 44.4%,75%and 100%by X-ray analysis and 44.4%,100%and 100%by CT and 3-dimensional CT,respectively.All surviving rabbits of the experimental groups had vertebral destruction.The positive bacterial culture rates were 22.2%,75%and 66.7%,respectively,in the experimental groups.After being sensitized with complete Freund's adjuvant,large differences were observed in the extent of spinal tuberculosis after inoculation of the rabbits with different concentrations of H37RV standard M.tuberculosis.CONCLUSION The experimental 1 had a low success rate at establishing an infection.The experimental 3 resulted in high mortality and complication rates.The experimental 2 was optimum for establishing a spinal tuberculosis model based on the high level of symptoms observed and the low rabbit mortality.

Diagnostic utility of microRNA profiles in cavitatory and noncavitatory pulmonary tuberculosis:Research protocol

BACKGROUND Tuberculosis(TB)is a common infection causing huge morbidity and mortality to mankind.The analytical methods used in diagnosing TB are not sensitive in paucibacillary infections and also require trained technical personnel.MicroRNAs are stable in serum and other body fluids,and hold great potential in the diagnosis of TB.AIM To analyze the dysregulated microRNA profiles among patients with cavitatory and non-cavitatory pulmonary TB.METHODS The prospective study will be conducted in a tertiary care center in India.Adult patients with newly diagnosed pulmonary TB will be included.There will be two groups:Patients with sputum positive pulmonary TB with cavity and without cavity(group1),and apparently healthy individuals(group 2).The participants will undergo sputum examination,Xpert Mycobacterium TB complex/resistance to rifampin(Mtb/RIF)assay,chest X-ray,and blood investigations and serum microRNA detection.Ethics approval has been obtained.Written informed consent will be obtained.Appropriate statistical analyses will be used.RESULTS MicroRNAs will be correlated with sputum positivity,Xpert Mtb/RIF assay,radiological involvement,inflammatory markers,and course of the disease among cases and controls.CONCLUSION MicroRNAs could serve as potential diagnostic biomarkers in diagnostically challenging TB patients.

2023-08-23辽宁普兰店M 4.6地震震源参数测定及发震构造初判

2023-08-2318:19辽宁省大连市普兰店区发生M 4.6地震,为准确描述本次地震的震源特征,探讨其孕育和发震机理,本文通过测定地震的震源深度,反演震源机制、矩张量及质心深度,给出震源机制中心解;同时分析震源机制与构造应力场的关系,根据小震重定位结果对发震断层面进行拟合,初步确定了本次地震的发震断层。结果表明,普兰店M 4.6地震初始破裂深度为12.0 km,震源机制解参数为节面Ⅰ走向50°,倾伏角75°,滑动角-169°;节面Ⅱ走向317°,倾伏角80°,滑动角-15°,矩震级M W4.8,最优质心深度12 km;地震矩M_(0)为1.796×10^(16)Nm,矩张量解M_(rr)、M_(tt)、M_(pp)、M_(rt)、M_(rp)、M_(tp)分别为-0.004、0.946、-0.942、0.017、-0.305、-0.125;中心解参数为节面Ⅰ走向47.03°,倾伏角79.04°,滑动角-168.15°;节面Ⅱ走向314.75°,倾伏角78.37°,滑动角-11.19°。构造应力场作用在中心解节面Ⅰ上的相对剪应力为0.877,相对正应力为-0.544;投影于节面Ⅱ上的相对剪应力为0.911,相对正应力为0.161。拟合的断层面走向148.91°,倾伏角89.85°,其在构造应力体系下的滑动角为26.47°。综合分析认为,普兰店M 4.6地震发生在NW向普兰店-长海构造带,是沿应力场最优节面以左旋走滑为错动方式的天然地震。

血浆m1A及其编码器基因对结肠腺癌诊断的综合分析

目的探讨m1A RNA甲基化相关基因和血浆m1A甲基化水平对结肠腺癌(colorectal adenocarcinoma,COAD)的诊断效能,为COAD早期诊断提供新的方案。方法通过UALCAN、The Human Protein Atlas和TCGA-GTEx数据库,分析COAD组织和正常结肠组织中m1A相关基因mRNA和蛋白水平的差异表达。利用ELISA法检测收集于我院初诊的COAD患者和正常人血浆中m1A甲基化水平。结合COAD临床病理特征分析m1A甲基化对COAD的诊断效能。结果m1A编码器和读码器基因的蛋白水平和mRNA水平在COAD组织中的表达显著上调,其中以TRMT6和TRMT10C两个编码器表达升高最为显著。两个编码器基因均可作为COAD诊断,尤其是早期诊断标志物,且其AUC均达到0.9以上。m1A总体甲基化水平在COAD血浆中明显升高,并可作为早期COAD的诊断标志物。结论m1A编码器基因和血浆m1A在COAD中明显升高,有望成为一种新的早期COAD诊断标志物。

高糖环境通过抑制免疫反应基因1的表达诱导巨噬细胞促炎性 M1型极化

目的研究高糖环境对巨噬细胞极化的影响及其潜在分子机制。方法将离体培养的RAW264.7细胞随机分为过表达对照组(NC-OE组)、免疫反应基因1过表达组(IRG1 OE组)、沉默对照组(NC-siRNA组)和IRG1沉默组(IRG1 siRNA组),电穿孔进行质粒转染后再组内随机分为对照组(Con组)和高糖组(HG组),60 mmol/L葡萄糖干预72 h后收集细胞进行检测。CCK-8检测细胞活性,相差显微镜观察细胞形态,Western blotting检测细胞中IRG1、iNOS、Arg-1、IL-1β和IL-10蛋白表达,免疫荧光染色检测细胞中iNOS和Arg-1蛋白荧光水平,ELISA法检测细胞培养基中IL-1β和IL-10蛋白水平。结果与对应Con组相比,HG组IRG1表达均下降(P<0.01),同时出现较多梭形和多突形细胞且两极可见伸展的伪足,iNOS表达升高(P<0.01)、Arg-1表达下降(P<0.05),IL-1β表达和分泌升高(P<0.05)、IL-10分泌下降(P<0.01)。转染IRG1过表达质粒后,与对应NC-OE组相比,IRG1 OE组IRG1水平均升高(P<0.01);高糖环境下,HG-IRG1 OE组梭形和多突形细胞明显减少、iNOS表达下降(P<0.01)、Arg-1表达升高(P<0.01)、IL-1β表达和分泌下降(P<0.01)、IL-10表达和分泌升高(P<0.05)。IRG1沉默后,与对应NC-siRNA组相比,IRG1 siRNA组IRG1水平降低(P<0.01);高糖环境下,HG-IRG1 siRNA组多突形细胞和伪足进一步增加、Arg-1表达降低(P<0.01)、IL-10表达和分泌减少(P<0.05)。结论高糖环境诱导巨噬细胞促炎性M1型极化进而诱发慢性炎症反应,其作用机制可能与抑制巨噬细胞中IRG1蛋白表达有关。

Primary gastroduodenal tuberculosis presenting as gastric outlet obstruction:A case report and review of literature

BACKGROUND Mycobacterium tuberculosis(TB)is the causative agent of TB,a chronic granulo-matous illness.This disease is prevalent in low-income countries,posing a significant global health challenge.Gastrointestinal TB is one of the three forms.The disease can mimic other intra-abdominal conditions,leading to delayed diagnosis owing to the absence of specific symptoms.While gastric outlet obs-truction(GOO)remains a frequent complication,its incidence has declined with the advent of proton pump inhibitors and Helicobacter pylori eradication therapy.Gastroduodenal TB can cause upper gastrointestinal hemorrhage,obstruction,and malignancy-like tumors.CASE SUMMARY A 23-year-old male presented with recurrent epigastric pain,distension,nausea,vomiting,and weight loss,prompting a referral to a gastroenterologist clinic.Endoscopic examination revealed distorted gastric mucosa and signs of chronic inflammation.However,treatment was interrupted,possibly owing to vomiting or comorbidities such as human immunodeficiency virus infection or diabetes.Subsequent surgical intervention revealed a dilated stomach and diffuse thickening of the duodenal wall.Resection revealed gastric wall effacement with TB.CONCLUSION Primary gastric TB is rare,frequently leading to GOO.Given its rarity,suspicions should be promptly raised when encountering relevant symptoms,often requiring surgical intervention for diagnosis and treatment.

脊柱附件结核的MRI影像特征分析

目的:总结脊柱附件结核的MRI影像特征,以提高对该病的早期诊断能力。方法:回顾性分析2019年1月至2023年10月在某院确诊为脊柱附件结核的21例患者的临床资料及MRI图像,总结其临床基本特征和MRI影像特征。结果:21例患者中,8例出现锥体征阳性、突发下肢无力,13例没有明确的神经功能缺损症状。病灶累及范围从C4至L5椎体,其中腰椎节段受累的脊柱附件结核有13例,胸椎节段受累的有6例,颈椎节段受累的有2例。15例仅累及单个脊柱附件及周边软组织,4例累及2个椎体,2例累及3个椎体。9例为椎弓根受累,8例为椎板受累,部分病例累及棘突、横突和小关节。脊柱附件结核的MRI主要表现为结核累及的骨质T_(1)WI呈稍低信号、T_(2)WI呈稍高信号,增强扫描以边缘强化为主,T_(2)WI抑脂序列及扩散加权成像序列可清晰显示邻近椎旁软组织水肿、脓肿及硬膜内外结核脓肿等特征性表现。结论:MRI能有效发现脊柱附件结核的骨质及软组织等结构的异常,其影像特点具有一定特征性,可作为早期发现脊柱附件结核的首选影像学检查方法及鉴别诊断手段。

“一用即弃社会”的可持续性议题:对M市二手物品分享和再利用的实地研究

作为可持续生产与可持续消费的重要环节,二手物品的分享和循环再利用是一个十分重要的议题。该议题因中国的垃圾分类和生态文明建设备受关注。对西方某城市(M市)的实地研究表明:慈善团体和民间机构在二手物品的分享和循环再利用中均比较活跃;在政府垃圾管理体制中,幸运的需求者在垃圾投放日可拣拾可用的二手物品;居民和租户通过车库大甩卖或庭院甩卖,低价出售或免费赠送不再需要的服装鞋帽、家具、日用品、修理工具、影像制品、书籍等等;互助与公益导向的各类用品回收再利用的互联网平台不仅惠及M市居民,而且覆盖全球主要城市。总之,不同的机构、活动与制度安排结合在一起,构成了一个稳定、持久、可靠的二手物品分享、循环、再利用的网络,在可持续消费中发挥重要作用。

Barriers to the Acceptance of Tuberculosis Preventive Treatment:A Multicenter Cross-sectional Study in China

Objective We aimed to understand the willingness and barriers to the acceptance of tuberculosis(TB)preventive treatment(TPT)among people with latent TB infection(LTBI)in China.Methods A multicenter cross-sectional study was conducted from May 18,2023 to December 31,2023 across 10 counties in China.According to a national technical guide,we included healthcare workers,students,teachers,and others occupations aged 15-65 years as our research participants.Results Overall,17.0%(183/1,077)of participants accepted TPT.There were statistically significant differences in the acceptance rate of TPT among different sexes,ages,educational levels,and occupations(P<0.05).The main barriers to TPT acceptance were misconceptions that it had uncertain effects on prevention(57.8%,517/894),and concerns about side effects(32.7%,292/894).Conclusion An enhanced and comprehensive understanding of LTBI and TPT among people with LTBI is vital to further expand TPT in China.Moreover,targeted policies need to be developed to address barriers faced by different groups of people.

Push forward LC-MS-based therapeutic drug monitoring and pharmacometabolomics for anti-tuberculosis precision dosing and comprehensive clinical management

The spread of tuberculosis(TB),especially multidrug-resistant TB and extensively drug-resistant TB,has strongly motivated the research and development of new anti-TB drugs.New strategies to facilitate drug combinations,including pharmacokinetics-guided dose optimization and toxicology studies of first-and second-line anti-TB drugs have also been introduced and recommended.Liquid chromatography-mass spectrometry(LC-MS)has arguably become the gold standard in the analysis of both endo-and exo-genous compounds.This technique has been applied successfully not only for therapeutic drug monitoring(TDM)but also for pharmacometabolomics analysis.TDM improves the effectiveness of treatment,reduces adverse drug reactions,and the likelihood of drug resistance development in TB patients by determining dosage regimens that produce concentrations within the therapeutic target window.Based on TDM,the dose would be optimized individually to achieve favorable outcomes.Pharmacometabolomics is essential in generating and validating hypotheses regarding the metabolism of anti-TB drugs,aiding in the discovery of potential biomarkers for TB diagnostics,treatment monitoring,and outcome evaluation.This article highlighted the current progresses in TDM of anti-TB drugs based on LC-MS bioassay in the last two decades.Besides,we discussed the advantages and disadvantages of this technique in practical use.The pressing need for non-invasive sampling approaches and stability studies of anti-TB drugs was highlighted.Lastly,we provided perspectives on the prospects of combining LC-MS-based TDM and pharmacometabolomics with other advanced strategies(pharmacometrics,drug and vaccine developments,machine learning/artificial intelligence,among others)to encapsulate in an all-inclusive approach to improve treatment outcomes of TB patients.

Analysis of the influencing factors and clinical related characteristics of pulmonary tuberculosis in patients with type 2 diabetes mellitus

BACKGROUND In China,the prevalence of type 2 diabetes mellitus(T2DM)among diabetic patients is estimated to be between 90%-95%.Additionally,China is among the 22 countries burdened by a high number of tuberculosis cases,with approximately 4.5 million individuals affected by active tuberculosis.Notably,T2DM poses a significant risk factor for the development of tuberculosis,as evidenced by the increased incidence of T2DM coexisting with pulmonary tuberculosis(T2DMPTB),which has risen from 19.3%to 24.1%.It is evident that these two diseases are intricately interconnected and mutually reinforcing in nature.AIM To elucidate the clinical features of individuals diagnosed with both T2DM and tuberculosis(T2DM-PTB),as well as to investigate the potential risk factors associated with active tuberculosis in patients with T2DM.METHODS T2DM-PTB patients who visited our hospital between January 2020 and January 2023 were selected as the observation group,Simple DM patients presenting to our hospital in the same period were the control group,Controls and case groups were matched 1:2 according to the principle of the same sex,age difference(±3)years and disease duration difference(±5)years,patients were investigated for general demographic characteristics,diabetes-related characteristics,body immune status,lifestyle and behavioral habits,univariate and multivariate analysis of the data using conditional logistic regression,calculate the odds ratio(OR)values and 95%CI of OR values.RESULTS A total of 315 study subjects were included in this study,including 105 subjects in the observation group and 210 subjects in the control group.Comparison of the results of both anthropometric and biochemical measures showed that the constitution index,systolic blood pressure,diastolic blood pressure and lymphocyte count were significantly lower in the case group,while fasting blood glucose and high-density lipoprotein cholesterol levels were significantly higher than those in the control group.The results of univariate analysis showed that poor glucose control,hypoproteinemia,lymphopenia,TB contact history,high infection,smoking and alcohol consumption were positively associated with PTB in T2DM patients;married,history of hypertension,treatment of oral hypoglycemic drugs plus insulin,overweight,obesity and regular exercise were negatively associated with PTB in T2DM patients.Results of multivariate stepwise regression analysis found lymphopenia(OR=17.75,95%CI:3.40-92.74),smoking(OR=12.25,95%CI:2.53-59.37),history of TB contact(OR=6.56,95%CI:1.23-35.03)and poor glycemic control(OR=3.37,95%CI:1.11-10.25)was associated with an increased risk of developing PTB in patients with T2DM,While being overweight(OR=0.23,95%CI:0.08-0.72)and obesity(OR=0.11,95%CI:0.02-0.72)was associated with a reduced risk of developing PTB in patients with T2DM.CONCLUSION T2DM-PTB patients are prone to worse glycemic control,higher infection frequency,and a higher proportion of people smoking,drinking alcohol,and lack of exercise.Lymphopenia,smoking,history of TB exposure,poor glycemic control were independent risk factors for T2DM-PTB,and overweight and obesity were associated with reduced risk of concurrent PTB in patients with T2DM.

Tuberculosis-diabetes comorbidities: Mechanistic insights for clinical considerations and treatment challenges

Tuberculosis(TB)remains a leading cause of death among infectious diseases,particularly in poor countries.Viral infections,multidrug-resistant and ex-tensively drug-resistant TB strains,as well as the coexistence of chronic illnesses such as diabetes mellitus(DM)greatly aggravate TB morbidity and mortality.DM[particularly type 2 DM(T2DM)]and TB have converged making their control even more challenging.Two contemporary global epidemics,TB-DM behaves like a syndemic,a synergistic confluence of two highly prevalent diseases.T2DM is a risk factor for developing more severe forms of multi-drug resistant-TB and TB recurrence after preventive treatment.Since a bidirectional relationship exists between TB and DM,it is necessary to concurrently treat both,and promote recommendations for the joint management of both diseases.There are also some drug-drug interactions resulting in adverse treatment outcomes in TB-DM patients including treatment failure,and reinfection.In addition,autophagy may play a role in these comorbidities.Therefore,the TB-DM comorbidities present several health challenges,requiring a focus on multidisciplinary collaboration and integrated strategies,to effectively deal with this double burden.To effectively manage the comorbidity,further screening in affected countries,more suitable drugs,and better treatment strategies are required.

Organizing pneumonia secondary to pulmonary tuberculosis:A case report

BACKGROUND Organizing pneumonia secondary to pulmonary tuberculosis is rare.Moreover,the temporal boundary between pulmonary tuberculosis and secondary organizing pneumonia has not been defined.We report a case of secondary organizing pneumonia associated with pulmonary tuberculosis occurring after nine months of antituberculosis treatment.CASE SUMMARY A 54 years old man,previously diagnosed with pulmonary tuberculosis and tuberculous pleurisy,underwent nine months of antituberculosis treatment.Follow-up lung computed tomography revealed multiple new subpleural groundglass opacities in both lungs,and a lung biopsy confirmed organizing pneumonia.Treatment continued with anti-tuberculosis agents and hormone therapy,and subsequent dynamic pulmonary computed tomography exams demonstrated improvement in lesion absorption.No disease recurrence was observed after corticosteroid therapy discontinuation.CONCLUSION When treating patients with active pulmonary tuberculosis,if an increase in lesions is observed during anti-tuberculosis treatment,it is necessary to consider the possibility of tuberculosis-related secondary organizing pneumonia,timely lung biopsy is essential for early intervention.

Differential diagnosis of Crohn’s disease and intestinal tuberculosis based on ATR-FTIR spectroscopy combined with machine learning

BACKGROUND Crohn’s disease(CD)is often misdiagnosed as intestinal tuberculosis(ITB).However,the treatment and prognosis of these two diseases are dramatically different.Therefore,it is important to develop a method to identify CD and ITB with high accuracy,specificity,and speed.AIM To develop a method to identify CD and ITB with high accuracy,specificity,and speed.METHODS A total of 72 paraffin wax-embedded tissue sections were pathologically and clinically diagnosed as CD or ITB.Paraffin wax-embedded tissue sections were attached to a metal coating and measured using attenuated total reflectance fourier transform infrared spectroscopy at mid-infrared wavelengths combined with XGBoost for differential diagnosis.RESULTS The results showed that the paraffin wax-embedded specimens of CD and ITB were significantly different in their spectral signals at 1074 cm^(-1) and 1234 cm^(-1) bands,and the differential diagnosis model based on spectral characteristics combined with machine learning showed accuracy,specificity,and sensitivity of 91.84%,92.59%,and 90.90%,respectively,for the differential diagnosis of CD and ITB.CONCLUSION Information on the mid-infrared region can reveal the different histological components of CD and ITB at the molecular level,and spectral analysis combined with machine learning to establish a diagnostic model is expected to become a new method for the differential diagnosis of CD and ITB.

Treatment of primary nasal tuberculosis with anti-tumor necrosis factor immunotherapy:A case report

BACKGROUND Primary nasal tuberculosis(TB)is a rare form of extrapulmonary TB,particularly in patients receiving anti-tumor necrosis factor(TNF)immunotherapy.As a result,its diagnosis remains challenging.CASE SUMMARY A 58-year-old male patient presented to the ear,nose,and throat department with right-sided nasal obstruction and bloody discharge for 1 month.He was diagnosed with psoriatic arthritis and received anti-TNF immunotherapy for 3 years prior to presentation.Biopsy findings revealed chronic granulomatous inammation and a few acid-fast bacilli,suggestive of primary nasal TB.He was referred to our TB management department for treatment with oral anti-TB agents.After 9 months,the nasal lesions had disappeared.No recurrence was noted during follow-up.CONCLUSION The diagnosis of primary nasal TB should be considered in patients receiving TNF antagonists who exhibit thickening and crusting of the nasal septum mucosa or inferior turbinate,particularly when pathological findings suggest granulomatous inflammation.