Investigation of the cell composition and gene expression in the delayed-type hypersensitivity tuberculin skin test

Dear Editor,The tuberculin skin test(TST)reagents have continuously improved,with the ESAT6-CFP10(EC)test having recently been introduced,but are seldom based on the direction of the delayed-type hypersensitivity(DTH)mechanism.Previous studies only partially showed the infiltration and activation of immune cells and the production of cytokines of the skin induration[1,2],and lack the detailed measurements of cell proportions and gene expression in the DTH response.Therefore,in this study,we revealed the comprehensive characteristics of DTH by single-cell RNA sequencing(scRNA-seq)in the guinea pig tuberculosis(TB)model[Experimental Animal Welfare Ethics Committee,Beijing Tuberculosis and Thoracic Tumor Research Institute(2021-064)].

Evaluation of Interferon-Gamma Release Assay Testing and Tuberculin Skin Test for Early Diagnosis of Tuberculosis in Children and Adolescents

Background: This study aimed to evaluate the diagnostic value of interferon-γ release assay (IGRA), a sensitive microbiological diagnostic method, in children and adolescents with suspected tuberculosis in a country with a high burden of tuberculosis. Method: This study included 581 children and adolescents aged 4 - 19 years who were suspected of having tuberculosis, were latently infected with Mycobacterium tuberculosis, and had received at least one dose of BCG vaccine between April 17, 2019, and February 24, 2021. The study evaluated the TST results of 106 patients who had a positive Quantiferon test and were suspected of having tuberculosis. Results: The study included 581 patients aged between 4 and 19 years. Of these, 106 patients tested positive for the Quantiferon test, while 19 were indeterminate and 456 were negative. The Quantiferon test positivity rate was 18.24%. Among the 106 QFT-Plus-positive cases, 23 patients also tested positive for TST. The difference in distribution was found to be statistically significant. Conclusion: The QFT-Plus test is considered an alternative to TST and other microbiological diagnostic methods for early tuberculosis diagnosis, particularly in children and adolescents.

Performance and correlation of QuantiFERON-TB Gold, T-SPOT.TB and tuberculin skin test in young children with or exposed to tuberculosis

Objective:To evaluate the performance of interferon gamma release assays and tuberculin skin test in Bacillus Calmette-Guerin vaccinated young children.Methods:A cross-sectional study was conducted in healthy children younger than 5 years who were recently diagnosed with tuberculosis or had recent exposure to active tuberculosis.QuantiFERON-TB Gold,T-SPOT.TB and tuberculin skin test were performed in each patient.Results:Of the 60 children,median age 3.3 years,17 had tuberculosis and 43 had recent tuberculosis exposure.Overall,15(25.0%)children had tuberculin skin test reaction≥10 mm;8(13.3%)were positive by QuantiFERON-TB Gold In-Tube test,and 12(20.0%)by T-SPOT.TB.Nineteen(31.7%)children had at least one positive test.There was a moderate agreement between interferon gamma release assays and tuberculin skin test.Conclusions:The positive rates of interferon gamma release assays and tuberculin skin test were low in young children who were infected with tuberculosis,supporting the management strategy of not testing children younger than 5 years.

Performance and correlation of interferon gamma release assays and tuberculin skin test in HIV-infected children and adolescents with immune reconstitution

Objective:To evaluate the performance of interferon gamma release assays and tuberculin skin test in HIV-infected children and adolescents with immune reconstitution.Methods:A cross-sectional study was conducted in HIV-infected patients aged 5-18 years receiving antiretroviral treatment with CD4 T-lymphocytes>25%or>500 cells/mm3 for at least 6 months.QuantiF ERON-TB Gold,T-SPOT.TB,and tuberculin skin test were performed in each patient.Results:A total of 50 patients were enrolled with median age of 13.7 years,CD4 counts of 753(IQR:587-989)cells/mm3.Among 27 patients with tuberculosis(16)or tuberculosis exposure(11),8(29.6%)were positive to at least one test,2(7.4%)were positive QuantiFERON-TB Gold,3(11.1%)positive T-SPOT.TB,and 7(25.9%)had tuberculin skin test≥5 mm.Among 23 patients without history of tuberculosis or exposure,all had negative interferon gamma release assays,while 2(8.7%)had positive tuberculin skin test.Conclusions:All tests had low sensitivity despite immune reconstitution.

Tuberculin as Intralesional Therapy for Viral Warts—Single-Blind, Split, Placebo, Controlled Study

Background: BCG vaccine as an antigen has proved its effectiveness as an immunotherapy for viral warts. Tuberculin is an antigenic extract of M. tuberculosis capable of eliciting an immunological skin reaction. Objective: To assess the efficacy of tuberculin intralesional injection in the treatment of viral warts. Patients and Methods: This single ,blind, placebo controlled study was conducted at the Department of Dermatology, Baghdad Teaching Hospital, Baghdad, Iraq from March 2010 to July 2011.Forty-one patients with different types of viral warts were enrolled in this study;tuberculin test was done to patients prior to instillation of intralesional treatment. Then the patients treated by intralesional tuberculin in each lesion located on the right side of the body, and intralesional distilled water in each lesion located on the left side of to a maximum of 3 injections, at 2 weeks interval or until full resolution of these lesions. Patients were evaluated every 2 weeks to assess the regression of their lesions and to record any local and systemic adverse effects. The response to treatment was evaluated by decrease in size and reduction in number of warts. Scoring of response to treatment was as follow: 1) Responders: including patients who showed complete cure or those with good response (>50% reduction). 2) Non responders: including patients who showed minimal response (<50% reduction), or those with no improvement (stable disease and disease progression). The follow up period lasted up to 2 months after the last dose. Results: Thirty out of 41 patients had completed the study, of them 14 (46.66%) patients showed response of their lesions on the right side of the body that were treated with tuberculin;15 patients showed no response, 1 patient showed minimal response, 7 patients showed good response and 7 patients showed complete cure (23.33%). Regarding the lesions treated with intralesional distilled water, 25 patients showed no response, 3 patients showed minimal response, 2(6.66) patients showed good response and no patient showed complete cure of their warts. Of the 14 responder patients to intralesional tuberculin, 10 patients were tuberculin tested positive, and 4 patients were tested negative, and of the 16 non responder patients to intralesional tuberculin, 3 patients were tuberculin tested positive, and 13 patients were tuberculin tested negative which was statistically significant difference. No side effects reported from tuberculin therapy apart from mild pain at site of injection. Conclusion: Intralesional injection of tuberculin is an effective therapy for viral warts when compared with control, possibly through its local immunological action and had no systemic immunological response. Patients with previous BCG vaccine showed better response to tuberculin injection.

Comparison between Quanti-FERON-TB Gold In-Tube test and tuberculin skin test for diagnosis of latent tuberculosis in children: A cross-section study

Objective: To compare Quanti-FERON-TB Gold In-Tube (QFT-GIT) test and tuberculin skin test (TST) for the diagnosis of latent tuberculosis infection in children. Methods: In this cross-sectional study, 64 participants who were between 3 months and 14 years old and had close contact with smear-positive pulmonary tuberculosis were included. Both QFT-GIT test and TST were done and the results were analyzed by SPSS software and Kappa test. Results: The distribution of gender and age according to QFT-GIT and TST results were matched (P>0.05). Overall agreement between QFT-GIT and TST for diagnosis of latent tuberculosis infection in children was 75%. In addition, the contingency coefficient was 0.257, and the Kappa measure of agreement was 0.246 (P=0.034). Conclusions: Compared to TST, QFT-GIT shows no apparent advantage for diagnosis of latent tuberculosis infection in children.

Indications, Interpretation and Clinical Consequences of Tuberculin Skin Tests in Resource Limited Settings

Objective: to evaluate the policy of TST testing in Suriname. As there is no gold standard to diagnose latent tuberculosis infection (LTBI), the tuberculin skin test (TST) is used to diagnose LTBI. However, internationally, the cut-off values of the TST are not uniform and depend on local tuberculosis (TB) epidemiology and guidelines for test initiation. In Suriname, where currently several indications exist for TSTs, cut-off values are set at 5 mm or 10 mm, depending on the age and/or medical history of the patient. LTBI classification is performed by pulmonologists primarily based on the American Thoracic Society targeted TB testing guidelines. Method: retrospective analysis of outpatient TST data between 2011 and 2019 from Suriname’s sole pulmonary medicine clinic. Result: 1373 patients were evaluated. 590 patients were from the screening group of whom 253 had a positive TST result, 46 of whom were classified as LTBI. In the contact tracing group of 649 patients, 616 had a positive TST, 352 of whom were classified as LTBI. In the medical condition group of 134 patients, 96 had a positive TST, 38 of whom were classified as LTBI. Eventually, positive TST results were found for 965 tested patients: 436 patients were classified as LTBI and 529 non-LTBI patients were not prescribed chemoprophylaxis. None of the non-LTBI TST-positive patients were diagnosed with active TB, including 174 patients with a TST result of 15 mm or greater and in need of IPT, but not prescribed by judgement of the pulmonologist or because of loss to follow-up. Conclusion: the overrepresentation of positive TST results in Suriname is attributable to stringent cut-off values, especially among patients who do not disclose TB risk factors. In our opinion the TST cut-off value for such patients in Suriname and other similar settings could be set at 15 mm. We also promote that for all patients with a TST result of 15 mm or greater, offering IPT should be considered (after excluding active TB).

Performance of Comparative Cervical Tuberculin Test and Serological Methods with Culturing of Nasal Swab in Diagnosis of Bovine Tuberculosis in Cross Breed Cattle Baghdad Iraq: A Comparative Evaluation

This study was designed to assess the diagnostic value of Rapid Antigen bovine TB antibody test kit (RAT) and any association with cervical comparative tuberculin test (CCTT), (iELISA) and nasal swabs culturing, among based detection of M. bovis infection. A herd of 21 animals aged 1 - 8 years cross bread cattle of college of veterinary medicine. 19 (90.47%) animals had good body condition scores, two bulls included, and 2 (9.52%) cows were fair. Serum samples were collected, analyzed for anti-bovine TB antibody using RAT and iELISA. Also the herd was screened by CCTT. The tests were carried out twice, more than ten month interval, and twelve nasal swabs were taken within second survey. The first survey results revealed prevalence rate: 4 (19.04%) animals considered positive results (one positive and 3 suspected results) for CCTT, while the prevalence rate according to RAT was 10 (47.61%). The difference between the two prevalence rate was significant (McNemar chi-statistic = 4.50, p-value = 0.03) Kappa = 0.215 95% confidence interval: from -0.128 to 0.558;the strength of agreement is considered to be “fair”. The study interprets: sensitivity 30%;specificity 99%. The second survey results revealed prevalence rate according to CCTT was 4 (36.36%), while prevalence rate according to RAT was 5 (45.45%). The difference between the two prevalence was not significant (McNemar chi-statistic = 0.33, p-value = 0.56). Kappa = 0.441 95% confidence interval: from -0.087 to 0.968;the strength of agreement is considered to be “moderate”;sensitivity: 60%;specificity: 83%. All serum samples and nasal swabs gave negative results for iELISA and culturing respectively. The study concluded that RAT was highly specific, easy, labor and time saving, suggesting its use as screening test in bovine tuberculosis, and CCTT could be used to confirm positive animals screened by RAT, while there was no association between RAT, CCTT with body condition scores, iELISA and nasal swabs culture results.

Analysis of the chemoprophylactic effect on close contacts of patients with active tuberculosis and positive tuberculin skin tests

Objective:The current study analyzed the chemoprophylactic effect of isoniazide on close contacts of patients with active tuberculosis and positive tuberculin skin tests(TSTs).Methods:A total of 1206 close contacts of patients with active tuberculosis and strongly-pos-itive TSTs were enrolled.The patients had chest X-ray examinations.Patients without tuberculosis and other diseases were divided into the following groups:90 patients in the prophylaxis group,who were given 300 mg of isoniazid qd(3-5 mg/kg for children)over a 10-month treatment course;and 89 patients in the control group without drug therapy.Both groups were followed for 10 years.Results:(1)There were 568 patients with negative results and 638 with positive results,includ-ing 445 with ordinarily-and moderately-positive results,and 193 with strongly-positive results(a positive rate of 52.9%[638/1206]and a strongly-positive rate of 16.0%[193/1206]).Fourteen tuber-culosis patients were identified(tuberculosis detection rate of 1.1%).(2)During the 3-year period of follow-up,there were 4 patients in the prophylaxis group and 12 patients in the control group who acquired tuberculosis(a morbidity rate of 4.7%[4/84]and 13.4%[12/89],respectively),and the dif-ference was statistically significant(χ^(2)=3.916,P=0.048).Six patients in the prophylaxis group,all of whom were children,discontinued medication use during the course of treatment due to adverse drug reactions,for an adverse drug reaction occurrence rate of 6.6%(6/90),a medication completion rate of 93.3%(84/90),and a 3-year protection ratio of 64.6%.(3)During the 4-6 year period,there were two patients in the prophylaxis group and three patients in the control group who acquired tubercu-losis(a morbidity rate of 2.5%[2/78]and 4.1%[3/73],respectively),two in the prophylaxis group and four in the control group who were lost to follow-up(a loss to follow-up rate of 2.5%[2/80]and 5.1%[4/77],respectively),and the difference was not statistically significant(χ^(2)=0.006,P=0.940;χ^(2)=0.215,P=0.643).(4)During the 7-10 year study,there was one patient in the prophylaxis group and two patients in the control group who acquired tuberculosis(a morbidity rate of 1.3%[1/72]and 3.1%[2/64],respectively),and four in the prophylaxis group and six in the control group who were lost to follow-up(a loss to follow-up rate of 5.2%[4/76]and 8.5%[6/70],respectively),and the dif-ference was not statistically different(χ^(2)=0.011,P=0.918;χ^(2)=0.176,P=0.675).(5)Within 10 years,there were 7 patients in the prophylaxis group and 17 patients in the control group who acquired tu-berculosis(a morbidity rate of 8.3%[7/84]and 21.5%[17/79],respectively;χ^(2)=4.770,P=0.029),and 6 in the prophylaxis group and 10 in the control group were lost to follow-up(the loss to follow-up rate was 7.1%[6/84]and 11.2%[10/89],respectively;χ^(2)=0.863,P=0.353).Conclusion:Close contacts of patients with active tuberculosis are at high-risk for acquir-ing tuberculosis.It is safe and effective for patients with strongly-positive TST results to undergo isoniazid chemoprophylaxis for 10 months.

原发性颈淋巴结结核诊治分析

目的探讨原发性颈淋巴结结核的临床特征、确诊方式及诊疗方案。方法回顾性分析宁波市医疗中心李惠利医院确诊的39例原发性颈淋巴结结核患者临床资料,总结其临床特点、治疗方法及随访情况。结果所有患者均以颈部无痛性质韧肿块为首发症状,肿块多位于颈部Ⅲ、Ⅳ、Ⅴ区,部分位于Ⅰ、Ⅱ区,均完善CT、MRI或B超等检查。根据影像学检查和临床经验,21例患者行结核菌素试验(PPD)或结核感染T细胞斑点试验(T-SPOT),其中2例PPD阳性,13例T-SPOT阳性,15例均经穿刺病理结果确诊,6例经手术病理确诊;1例经细针穿刺细菌培养发现结核杆菌确诊;17例影像学考虑肿瘤性病变,经颈淋巴结清扫或肿块部分切除术后病理确诊结核。39例患者均予标准抗结核治疗半年,随访1年未见复发。结论原发性颈淋巴结结核缺乏特异性症状,初步诊断可借助T-SPOT检查,确诊仍需结核杆菌培养阳性、穿刺细胞学或组织病理结果,治疗应采用世界卫生组织(WHO)推荐的6个月治疗方案,当伴有脓肿、窦道或溃疡型结核时,应结合手术治疗,可有效缩短术后抗结核治疗时间、减少药物用量及不良反应。

监狱羁押人群中两种结核分枝杆菌潜伏感染检测结果不一致原因及预防性治疗效果分析

目的:分析羁押人群中γ-干扰素释放试验(IGRA)和结核菌素皮肤试验(TST)结果差异的相关因素,以及预防性治疗对肺结核发病的效果。方法:采用社区随机对照试验,选取某市5所监狱,每所监狱以监区为单位分为对照组和干预组。结核分枝杆菌检测于2016年7—8月进行,对照组981例,采用常规结核病防治措施;干预组981例,在常规措施基础上采用IGRA和TST检测结核分枝杆菌潜伏感染,并对IGRA阳性者实施自愿的预防性治疗。收集所有研究对象的流行病学资料,每年定期开展X线胸片检查。分析IGRA和TST结果的一致性及相关因素;对比干预组和对照组3年内肺结核发病情况。结果:IGRA和TST两种方法判读结果一致率为77.93%(745/956)。BCG卡痕(OR=1.477,95%CI:1.068~2.043)是两种检测方法结果差异的相关因素。共计157例IGRA阳性者接受并均完成了预防性治疗,随访3年中发病率为0.00%(0/157),其他未预防性服药者发病率为2.05%(7/342),差异无统计学意义(χ^(2)=3.259,P=0.071);IGRA阴性者中,发病率为0.00%(0/460),低于IGRA阳性未服药者的发病率[2.05%(7/342)],差异有统计学意义(χ^(2)=9.498,P=0.002);最终干预组肺结核发病率为0.71%(7/981),对照组发病率为1.22%(12/981),差异无统计学意义(χ^(2)=1.329,P=0.249)。结论:在羁押人群中,BCG接种史是IGRA和TST差异的主要影响因素;应用IGRA进行结核分枝杆菌潜伏感染检测并对阳性者开展预防性治疗可有效减少狱内肺结核的发病。

miR-155/瘦素受体/AMPK轴在结核菌素诱导破骨细胞形成中的作用及机制

背景:破骨细胞异常活化在脊柱结核骨质破坏中起重要作用。在骨质疏松发病过程中,敲低miR-155通过增加瘦素受体的表达来激活磷酸腺苷依赖的蛋白激酶(AMP-dependent protein kinase,AMPK),进而抑制破骨细胞分化及骨吸收。但miR-155/瘦素受体/AMPK轴在脊柱结核骨质破坏中的作用尚不清楚。目的:研究miR-155/瘦素受体/AMPK轴在结核菌素诱导破骨细胞形成中的作用及机制。方法:培养单核巨噬细胞RAW264.7细胞,用不同浓度(1.0,2.5,5.0,10.0 IU/mL)结核菌素处理,转染阴性对照序列或miR-155抑制物、阴性对照siRNA序列或瘦素受体siRNA序列。采用抗酒石酸酸性磷酸酶染色检测破骨细胞数量,荧光定量PCR检测miR-155 mRNA表达,Western blot检测瘦素受体、p-AMPK蛋白表达,双荧光素酶报告基因验证miR-155靶向瘦素受体。结果与结论:①与对照组比较,2.5,5.0,10.0 IU/mL结核菌素组破骨细胞数量、miR-155 mRNA表达水平明显增加,瘦素受体、p-AMPK蛋白表达水平明显降低(P<0.05);②与阴性对照+5.0 IU/mL结核菌素组比较,miR-155抑制物+5.0 IU/mL结核菌素组破骨细胞数量、miR-155 mRNA表达水平明显降低,瘦素受体、p-AMPK蛋白表达水平明显增加(P<0.05);③与阴性对照组比较,miR-155抑制物组瘦素受体野生型双荧光素酶报告基因的荧光活力增加,miR-155模拟物组瘦素受体野生型双荧光素酶报告基因的荧光活力降低(P<0.05);④与阴性对照siRNA+miR-155抑制物+5.0 IU/mL结核菌素组比较,瘦素受体siRNA+miR-155抑制物+5.0 IU/mL结核菌素组miR-155 mRNA表达水平无明显变化(P>0.05),破骨细胞数量明显增加,瘦素受体、p-AMPK蛋白表达水平明显降低(P<0.05);⑤结果表明,结核菌素通过增加miR-155表达抑制下游瘦素受体表达及AMPK激活,进而诱导破骨细胞形成。

腕手部腱鞘结核临床误诊分析

目的探讨腕手部腱鞘结核临床误诊原因及防范措施。方法回顾性分析2023年4月至2024年4月收治的曾误诊的腕手部腱鞘结核3例的临床资料。结果1例右腕肿痛,拇指肿痛,根据相关检查结果及术后病理检查“腕部考虑滑膜炎,拇指考虑骨髓炎,结核不排除”,因腕部肿胀、疼痛加重再次入院,考虑结核。行抗结核治疗病情得到控制,出院诊断为“右腕手部腱鞘结核”。误诊时间3个月。外院继续抗结核治疗病情控制后行皮瓣手术治疗,随访未见结核复发,腕关节和屈指功能受限。1例左拇指掌侧肿物压痛加重、活动受限,考虑“指尖脓肿”,行指尖脓肿切开引流术后脓肿反复发作。结合病史及入院查体考虑“慢性感染”行扩创引流术,术后病理确诊为“手部腱鞘结核”。误诊时间11个月。确诊后行病灶清除术,随访未见结核复发,左拇指伸屈功能满意。1例左中指近节掌侧肿物,外院考虑为“狭窄性腱鞘炎”,予复方倍他米松注射液局部注射治疗,效果不佳。结合入院查体及相关检查结果,考虑结核感染,行病灶清除术,术后病理确诊为“手部腱鞘滑膜增殖型结核”。误诊时间14个月。确诊后行病灶清除术,随访未见结核复发,左手中指屈指活动功能满意。结论腕手部腱鞘结核因临床特征不典型,早期缺乏特异性诊断指标,误诊率较高,对长期对症治疗无效的腕手部病变应警惕腱鞘结核,尽早行病灶清除术及病理检查,以减少误诊。

基于改进YOLOv5的人体结核菌素试验后皮下硬块检测算法研究

针对传统皮下硬块检测方法精度低、计算速度慢等问题,提出了一种基于改进YOLOv5的皮下硬块目标检测算法。首先,将YOLOv5模型的主干网络CSPDarknet53进行改进,引入Faster模块来替换其中的C3模块。其次,利用模型剪枝在保证整个模型性能的同时减轻其计算复杂度。最后,引入Wise-IoU来进一步提升网络的回归性能。实验结果表明,基于改进YOLOv5的皮下硬块目标检测算法相比于原始的YOLOv5,准确率提升了1.2%,参数量减少了77.7%,整个算法更加轻量化,有效提高了算法对于皮下硬块的检测精度,减少了计算参数量,提升了算法的运行速度。

Tuberculosis in kidney transplant candidates and recipients

Tuberculosis(TB)is the leading cause of infectious mortality and morbidity in the world,second only to coronavirus disease 2019.Patients with chronic kidney disease and kidney transplant recipients are at a higher risk of developing TB than the general population.Active TB is difficult to diagnose in this population due to close mimics.All transplant candidates should be screened for latent TB infection and given TB prophylaxis.Patients who develop active TB pre-or post-trans-plantation should receive multidrug combination therapy of antitubercular therapy for the recommended duration with optimal dose modification as per glomerular filtration rate.

肺结核患者家庭内学生密切接触者结核分枝杆菌感染状况调查

目的:分析肺结核患者家庭内学生密切接触者结核分枝杆菌感染状况及其影响因素。方法:以2021年1月1日至12月31日在江苏省宝应县和张家港市、湖北省宜都市、重庆市彭水苗族土家族自治县和云南省昭通市昭阳区5个县(区)登记的活动性肺结核患者家庭内学生密切接触者为研究对象,开展结核菌素皮肤试验(tuberculin skin test,TST),调查人口学特征,并通过全民健康保障信息化工程疾病预防控制信息系统收集其指示病例的基本信息和诊断信息,分析结核分枝杆菌感染的相关因素。结果:477例指示病例共有686名家庭内学生密切接触者,TST检测总体接受率为92.27%(633/686),各县(区)之间的接受率差异有统计学意义(χ^(2)=57.781,P<0.001),以宝应县为最高(100.00%,35/35)。家庭内学生密切接触者总体感染率为14.85%(94/633,95%CI:11.85%~17.85%),强阳性率为5.06%(32/633),各县(区)之间的差异均有统计学意义(χ^(2)=35.800,P<0.001;Fisher确切概率法,P=0.029)。单因素分析结果显示,≥15岁年龄组[23.47%(23/98);95%CI:13.88%~33.06%]、就读于高中及以上学校[26.09%(18/69);95%CI:14.04%~38.14%]、住在宜都市[33.33%(28/84);95%CI:20.99%~45.68%]、指示病例诊断延迟[18.37%(52/283);95%CI:13.38%~23.37%]的家庭内学生密切接触者感染率更高;多因素logistic回归分析显示,在调整混杂因素后,指示病例诊断延迟的家庭内学生密切接触者的感染风险是指示病例无诊断延迟者的1.586倍(95%CI:1.016~2.476)。结论:活动性肺结核患者家庭内学生密切接触者的结核分枝杆菌感染率较高,尤其是指示病例诊断延迟的家庭内学生密切接触者,应及时开展筛查并采取后续干预措施。

2022年贵州省新生入学肺结核筛查情况分析

目的对入学新生进行肺结核筛查结果进行分析,为贵州省学校结核病防控工作提供一定的基础数据和参考依据。方法对2022年贵州省入学新生开展肺结核筛查。筛查内容有症状筛查(肺结核密切接触史、肺结核可疑症状)、结核菌素皮肤试验(PPD试验)/重组结核杆菌融合蛋白试验(EC试验)、胸部X线片3种,根据不同年级采取不同筛查方法。采用构成比、百分率、千分率等进行描述性分析。结果2022年贵州省共有7651所学校的1675408名新生参加了入学肺结核筛查。肺结核密切接触史率、可疑症状率分别为1.64‰、1.26‰;PDD强阳性率为2.02%、EC阳性率为4.26%;肺结核检出率为16.43/10万,不同办学单位(χ^(2)=9.069,P=0.003)、不同寄宿类型(χ^(2)=92.747,P<0.001)和不同学校类型(P=0.003)的活动性肺结核检出率差异均有统计学意义。结论新生入学肺结核筛查工作对于学校肺结核疫情防控和降低学生肺结核患病水平具有重要意义;要进一步加强对新生的肺结核的健康教育,提升自我防护意识。

中国肾移植受者结核病临床诊疗指南(2023版)

本指南旨在为肾移植受者结核病的临床管理提供全面而实用的指导。首先,概述了肾移植受者结核病的特殊性,强调了其高发生率及临床表现的多样性。为了更好地理解患者的病情,建议在移植前进行结核病相关的评估,并注意移植术后对结核病的监测。在诊断方面,详细介绍了目前常用的结核病诊断方法,并提供了在肾移植受者中的适用性评估。在确诊后,讨论了在免疫抑制药应用的背景下,如何平衡结核病治疗和排斥反应的策略,并关注了潜在的药物相互作用。预防方面,强调了在肾移植前对结核病的筛查。本指南旨在提高医务人员对肾移植受者结核病管理的认知,促进更有效的临床实践,提高受者的生活质量。

2021年泽普县15岁以下中学入学新生结核病感染情况分析

目的:了解泽普县15岁以下中学入学新生结核病感染现状,为学校结核病防控工作提供科学依据。方法:对2021年泽普县15岁以下中学入学新生进行结核菌素试验,对检测结果进行分析,并采用logistic回归模型进行影响因素分析。结果:结核菌素试验阳性率为5.47%(248/4531)。其中,一般阳性率为3.38%(153/4531),中度阳性率为1.50%(68/4531),强阳性率为0.60%(27/4531)。不同年级新生结核菌素试验阳性率和强阳性率比较,差异有统计学意义(χ^(2)值分别为31.74、20.26,P<0.05);不同民族新生结核菌素试验阳性率比较,差异有统计学意义(χ^(2)=37.83,P<0.05);农村新生和城镇新生结核菌素试验阳性率比较,差异有统计学意义(χ^(2)=17.42,P<0.05)。多因素logistic回归分析结果显示,高一年级(OR=3.43)、汉族(OR=2.46)和城镇(OR=1.69)是入学新生结核感染的主要因素。结论:开展结核菌素试验可以了解新生结核病感染现况,识别学生感染结核病的主要因素,从而有针对性地采取防控措施,防止结核病在校园内传播流行。

干扰素体外释放酶联免疫检验在结核病临床诊断中的应用

目的探讨干扰素体外释放酶联免疫检验(IGRA)在结核病临床诊断中的应用价值。方法选择2022年9月—2023年9月在菏泽市传染病医院经初步检查怀疑为结核病的530例患者作为研究对象,对所有患者实施IGRA和结核菌素皮肤试验,以结核杆菌DNA检测结果作为诊断的“金标准”,比较应用IGRA与结核菌素皮肤试验诊断结核病所得诊断结果,分析两种方法诊断结核病的结果与结核杆菌DNA检测结果的一致性。结果在530例疑似结核病患者中,经结核杆菌DNA检测共412例患者确诊结核病(包括肺结核329例,肺外结核83例),检出率为77.74%。IGRA诊断结核病的敏感度、特异度、阳性预测值、阴性预测值、准确度均显著高于结核菌素皮肤试验(敏感度:98.30%比95.15%;特异度:97.46%比88.98%;阳性预测值:99.26%比96.79%;阴性预测值:94.26%比84.00%;准确度:98.11%比93.77%;均P<0.05)。IGRA和结核菌素皮肤试验诊断结核病的结果与结核杆菌DNA检测结果的一致性分析表明,IGRA与结核杆菌DNA检测结果高度一致(κ值为0.894),结核菌素皮肤试验与结核杆菌DNA检测结果中度一致(κ值为0.657)。结论在对结核病进行诊断时,应用IGRA进行检测具有较高的诊断价值,可实现对结核病的灵敏和准确诊断。