Molecular Characteristics and Drug Susceptibility of Mycobacterium tuberculosis Isolates from Patients Co-infected with Human Immunodeficiency Virus in Beijing,China

70 clinical Mycobacterium tuberculosis strains isolated from AIDS patients in two HIV/AIDS referral hospitals in Beijing were used in this study.M.tuberculosis and non-tuberculosis mycobacterium（NTM）were identified by using multi-locus PCR.M.tuberculosis was genotyped by using 15-locus MIRU-VNTR technique and spoligotyping afterwards.Meanwhile,the drug susceptibilities of the strains to the four first-line anti TB drugs（rifampin,isoniazid,streptomycin, and ethambutol） and the four second-line anti-TB drugs （capreomycin, kanamycin, ofloxacin, and ethionanide） were tested with proportional method. In this study, M. tuberculosis and NTM strains isolated from AIDS patients with TB-like symptoms were identified and genotyping analysis indicated that Beijing genotype was the predominant genotype. In addition, the prevalence of drug-resistant TB, especially the prevalence of XDR-TB, was higher than that in TB patients without HIV infection.

CUTANEOUS MYCOBACTERIUM MARINUM INFECTION DIAGNOSED BY PCR-RFLP ANALYSIS

Objective To identify Mycobacterium marinum （M. marinum ） inducing misdiagnosis and treatment failure. Methods The lesional specimen of patient with cutaneous M. marinum were cultivated on L6wenstein-Jensen medium. The isolate was identified by biochemical tests and polymerase chain reaction （PCR）-restriction fragment length polymorphism （RFLP） analysis of the hsp65 gene. Results Smooth and non- pigmented colonies were noted after incubation at 32 ℃ for 2 weeks. The isolate was acid-fast bacilli and confirmed as M. marinum by biochemical tests and PCR-RFLP. Conclusion For a correct diagnosis of cutaneous M. marinum infection, it is crucial for clinicians to have a high index of suspicion, obtain the history of exposure and trauma and understand growth characteristics of the organism. Compared with conventional biochemical techniques, PCR-RFLP analysis is a more rapid, accurate and reliable method for mycobacterial identification to species level.

Prevalence and risk factors associated with tuberculosis mortality in Brunei Darussalam

Objective:To determine the prevalence and risk factors associated with tuberculosis mortality in Brunei Darussalam and to explore its underlying causes.Methods:A retrospective cohort study was conducted where data on socio-demographics,clinical characteristics and treatment outcomes of all tuberculosis patients registered at the National tuberculosis Coordinating Centre between 2013 and 2017 were collected.Overall tuberculosis mortality and the proportion of tuberculosis-related deaths were calculated.Logistic regression analysis was used to determine the risk factors of tuberculosis mortality when compared to those who are cured and/or completed tuberculosis treatment.Results:Of 1107 tuberculosis cases,99 died,giving an overall tuberculosis mortality rate of 8.9%(95%CI 7.4%-10.8%).Significant risk factors associated with tuberculosis mortality were age≥40 years(adjusted OR for 40-59 years was 3.89;95%CI 1.13-1.69;adjusted OR for≥60 years was 22.3;95%CI 7.27-91.9,using 20-39 years as reference),female sex(adjusted OR 1.74;95%CI 1.09-2.79),having renal disease(adjusted OR 25.7;95%CI 2.82-191.50)and having any cancers(adjusted OR 3.61;95%CI 1.26-10.00).The majority(75.8%)of the recorded deaths were not related to tuberculosis.Conclusions:Tuberculosis patients who were older than 40 years,female,and having renal disease and any cancer will need close monitoring in their management program to prevent tuberculosis mortality.Clinicians should also focus on other non-tuberculosis aspects of the patient’s medical history.

Baseline HBV Load Increases the Risk of Anti-tuberculous Drug-induced Hepatitis Flares in Patients with Tuberculosis

Hepatitis associated anti-tuberculous treatment（HATT） has been a main obstacle in managing patients co-infected with Mycobacterium tuberculosis and hepatitis B virus（HBV）. Therefore, we evaluated the factors related to the severity of adverse effects during HATT, especially those associated with liver failure. A retrospective study was carried out at Tongji Hospital from 2007 to 2012. Increases in serum transaminase levels of 〉3, 5, and 10 times the upper limit of normal（ULN） were used to define liver damage as mild, moderate, and severe, respectively. Patients with elevated total bilirubin（TBil） levels that were more than 10 times the ULN（〉171 μmol/L） with or without decreased（〈40%） prothrombin activity（PTA） were diagnosed with liver failure. A cohort of 87 patients was analyzed. The incidence of liver damage and liver failure was 59.8%（n=52） and 25.3%（n=22）, respectively. The following variables were correlated with the severity of hepatotoxicity： albumin（ALB） levels, PTA, platelet counts（PLT）, and the use of antiretroviral therapies（P〈0.05）. Hypo-proteinemia and antiretroviral therapy were significantly associated with liver failure, and high viral loads were a significant risk factor with an odds ratio（OR） of 2.066. Judicious follow-up of clinical conditions, liver function tests, and coagulation function, especially in patients with high HBV loads and hypoalbuminemia is recommended. It may be advisable to reconsider the use of antiviral drugs failure during the course of anti-tuberculous treatment of HBV infection patients to avoid the occurrence of furious liver failure.