Effect of Individualized Nursing Intervention on Patients with Tuberculosis Latent Infection and Active Tuberculosis

Objective:This paper aims to explore the effect of individualized nursing intervention on patients with active tuberculosis(ATB)and latent tuberculosis infection(LTBI).Methods:The nursing study started in January 2020 and ended in January 2023.A total of 60 patients with ATB and LTBI were included,and they were divided into two groups according to the intervention schemes selected for control testing,each with 30 cases.The intervention program selected for group A was routine care,and for group B was individualized nursing.The proportion of adverse reactions,changes in the level of lung items,self-management outcomes and satisfaction were evaluated and compared.Results:After evaluating the proportion of adverse reactions,the total proportion of ATB and LTBI in group B was lower than that in group A(P<0.05).Based on the evaluation and testing of the expiratory flow(EF),expiratory volume(EV),and vital capacity(VC)after the intervention,these levels in group B showed higher outcomes than those in group A(P<0.05).The scores in terms of living habits,sleep,diet,and compliance in group B were higher than those in group A(P<0.05).The total proportion of the satisfaction of ATB and LTBI patients in group B was higher than that in group A(P<0.05).Conclusion:After the intervention of individualized nursing measures in patients with ATB and LTBI,it was found that it can not only play a positive role in the prevention and control of adverse reactions,but also improve their lung function,and promote their self-management,with good satisfaction level,thus it has high research and clinical application values.

Development and Evaluation of a Promising Biomarker for Diagnosis of Latent and Active Tuberculosis Infection

Background:Diagnosing latent tuberculosis(TB)infection(LTBI)and active TB(ATB)is crucial for preventing disease progression and transmission.However,current diagnostic tests have limitations in terms of accuracy and sensitivity,making it challenging to diagnose these different infection states.Therefore,this study intends to develop a promising biomarker for LTBI and ATB diagnosis to overcome the limitations of the current diagnostic tests.Methods:We developed a novelmultiepitope-based diagnostic biomarker(MEBDB)fromLTBI region of differentiation antigens using bioinformatics and immunoinformatics.Immune responses induced byMEBDM were detected using enzyme-linked immunosorbent spot and cytometric bead assays.This study was conducted from April 2022 to December 2022 in the SeniorDepartment of Tuberculosis at the 8thMedical Center of PLA General Hospital,China.Blood samples were collected from participants with ATB,individuals with LTBI,and healthy controls(HCs).The diagnostic efficacy of MEBDB was evaluated using receiver operating characteristic curves.Results:A novel MEBDB,designated as CP19128P,was generated.CP19128P comprises 19 helper T lymphocyte epitopes,12 cytotoxic T lymphocyte epitopes,and 8 B-cell epitopes.In silico simulations demonstrated that CP19128P possesses strong affinity for Toll-like receptors and elicits robust innate and adaptive immune responses.CP19128P generated significantly higher levels of tumor necrosis factor(TNF-α),interleukin 4(IL-4),and IL-10 in ATB patients(n=7)and LTBI(n=8)individuals compared with HCs(n=62)(P<0.001).Moreover,CP19128P-induced specific cytokines could be used to discriminate LTBI and ATB from healthy subjects with high sensitivity and specificity.Combining IL-2 with IL-4 or TNF-α could differentiate LTBI from HCs(the area under the receiver operating characteristic curve[AUC],0.976[95% confidence interval[CI],0.934-1.000]or 0.986[0.956-1.000]),whereas combining IL-4 with IL-17A or TNF-α could differentiate ATB from HCs(AUC,0.887[0.782-0.993]or 0.984[0.958-1.000]).Conclusions:Our study revealed that CP19128P is a potential MEBDBfor the diagnosis of LTBI andATB.Our findings suggest a promising strategy for developing novel,accurate,and sensitive diagnostic biomarkers and identifying new targets for TB diagnosis and management.

Interferon-Gamma Release Assay is Not Appropriate for the Diagnosis of Active Tuberculosis in High-Burden Tuberculosis Settings： A Retrospective Multicenter Investigation

Background：Interferon-gamma release assay （IGRA） has been used in latent tuberculosis （TB） infection and TB diagnosis,but the results from different high TB-endemic countries are different.The aim of this study was to investigate the value of IGRA in the diagnosis of active pulmonary TB （PTB） in China.Methods：We conducted a large-scale retrospective multicenter investigation to further evaluate the role of IGRA in the diagnosis of active PTB in high TB-epidemic populations and the factors affecting the performance of the assay.All patients who underwent valid T-SPOT.TB assays from December 2012 to November 2015 in six large-scale specialized TB hospitals in China and met the study criteria were retrospectively evaluated.Patients were divided into three groups：Group 1,sputum culture-positive PTB patients,confirmed by positive Mycobacterium tuberculosis sputum culture;Group 2,sputum culture-negative PTB patients;and Group 3,non-TB respiratory diseases.The medical records of all patients were collected.Chi-square tests and Fisher＇s exact test were used to compare categorical data.Multivariable logistic analyses were performed to evaluate the relationship between the results of T-SPOT in TB patients and other factors.Results：A total of 3082 patients for whom complete information was available were included in the investigation,including 905 sputum culture-positive PTB cases,914 sputum cultmre-negative PTB cases,and 1263 non-TB respiratory disease cases.The positive rate of T-SPOT.TB was 93.3% in the culture-positive PTB group and 86.1% in the culture-negative PTB group.In the non-PTB group,the positive rate of T-SPOT.TB was 43.6%.The positive rate of T-SPOT.TB in the culture-positive PTB group was significantly higher than that in the culture-negative PTB group （x2 =25.118,P 〈 0.01）,which in turn was significantly higher than that in the non-TB group （x2 =566.l 16,P 〈 0.01）.The overall results were as follows：sensitivity,89.7%;specificity,56.37%;positive predictive value,74.75%;negative predictive value,79.11%;and accuracy,76.02%.Conclusions：High false-positive rates of T-SPOT.TB assays in the non-TB group limit the usefulness as a single test to diagnose active TB in China.We highly recommend that IGRAs not be used for the diagnosis of active TB in high-burden TB settings.

Diagnostic Significance of Mycobacterium tuberculosis T-cell Assays for Active Tuberculosis

Background：Active tuberculosis （TB） with negative results of sputum smear is difficult to be identified.Till now,there is no effective and noninvasive diagnostic method.This study evaluated the diagnostic power of Mycobacterium tuberculosis T-cell （T.SPOT（R）.TB） assays for active TB.Methods：We retrospectively screened 450 suspected TB patients that were hospitalized in the Respiratory Department of Henan Province People＇s Hospital from June 2015 to June 2016.The patients were divided into the active,previous,and non-TB groups according to their final diagnosis.We evaluated the diagnostic value of the T-SPOT（R）.TB assay by constructing receiver operating characteristic （ROC） curves and calculating the optimal diagnostic cutoff value.In addition,we compared the levels of A antigen （ESAT-6） and B antigen （CFP-10） in active TB.Results：The sensitivity,specificity,positive predictive value,negative predictive value,positive likelihood ratio,and negative likelihood ratio of T-SPOT（R）.TB for active TB were 89.78%,63.16%,0.56,0.92,2.47,and 0.16,respectively.For active TB,the area under the ROC curve （AUC） of the A antigen （0.89） was higher than that of the B antigen （0.86）.The AUC of the A antigen for active TB was largest at a cutoff value of 13.5 spot-forming cells （SFCs） per 2.5 × 105 peripheral blood mononuclear cells （PBMCs）.The AUC of the A and B antigens was 0.60 and 0.58 for previous TB.The levels of A and B antigen in the active TB group were significantly different from those in the previous-and non-TB groups （A antigen：x2 =105.41,P 〈 0.01 and B antigen：x2 =91.03,P 〈 0.01;A antigen：x2 =12.99,P 〈 0.01 and B antigen：x2 =8.56,P 〈 0.01,respectively）.There were no significant differences in the levels of A and B antigens between the non-TB group and previous TB group （A antigen：x2 =1.07,P 〉 0.05 and B antigen：x2 =0.77,P 〉 0.05）.Conclusions：T-SPOT（R）.TB has high sensitivity and specificity for the diagnosis of active TB at a cutoff value of 13.5 SFCs per 2.5 × 10^5 PBMCs and is not influenced by previous TB.

Mycobacterium tuberculosis latency-associated antigen Rv1733c SLP improves the accuracy of differential diagnosis of active tuberculosis and latent tuberculosis infection

Background: Differential diagnosis of active tuberculosis (ATB) and latent tuberculosis infection (LTBI) has been a challenge for clinicians in high TB burden countries. The purpose of this study was to improve the accuracy of differential diagnosis of ATB and LTBI by using fluorescent immunospot (FluoroSpot) assay to detect specific Th1 cell immune responses. The novelmycobacterium tuberculosis (MTB) latency-associated antigens Rv1733c and synthetic long peptides derived from Rv1733c (Rv1733c SLP) were used based on virulence factors early secreting antigen target-6 (ESAT-6) and culture filtrate protein-10 (CFP-10).Methods: Fifty-seven ATB cases, including 20 pathogen-confirmed ATB and 37 clinically diagnosed ATB, and 36 LTBI cases, were enrolled between January and December 2017. FluoroSpot assay was used to detect the interferon γ (IFN-γ) and interleukin 2 (IL-2) secreted by the specific T cells after being stimulated with MTB virulence factors ESAT-6 and CFP-10, MTB latency-associated antigens Rv1733c and Rv1733c SLP. The receiver operating characteristic (ROC) curve was used to define the best cutoff value of latency-associated antigens in the use of differentiating ATB and LTBI. The sensitivity, specificity, predictive value, and likelihood ratio of ESAT-6 and CFP-10-FluoroSpot combined with latency-associated antigen in the differential diagnosis of ATB and LTBI were also calculated.Results: Following the stimulation with Rv1733c and Rv1733c SLP, the frequency of single IL-2-secreting T cells stimulated by Rv1733c SLP had the largest area under the ROC curve, which was 0.766. With a cutoff value of 1 (spot-forming cells [SFCs]/2.5 × 105 peripheral blood mononuclear cells) for frequency, the sensitivity and specificity of distinguishing ATB from LTBI were 72.2% and 73.7%, respectively. ESAT-6 and CFP-10-FluoroSpot detected the frequency and proportion of single IFN-γ-secreting T cells;the sensitivity and specificity of distinguishing ATB from LTBI were 82.5% and 66.7%, respectively. Combined with the frequency of single IL-2-secreting T cells stimulated by Rv1733c SLP on the basis of ESAT-6 and CFP-10-FluoroSpot, the sensitivity and specificity increased to 84.2% and 83.3%, respectively.Conclusion: Rv1733c SLP, combined with ESAT-6 and CFP-10, might be used as a candidate antigen for T cell-based tuberculosis diagnostic tests to differentiate ATB from LTBI.

Diagnostic Value of Spiral CT Chest Enhanced Scan in Adult with Active Pulmonary Tuberculosis

Aim:To explore the diagnostic value of spiral CT chest enhanced scan for adults with active pulmonary tuberculosis.Methods:The clinical data of 60 adult patients with active pulmonary tuberculosis who were treated in our hospital from January 2018 to November 2019 were retrospectively analyzed.All patients underwent conventional chest radiography and spiral CT chest enhanced scan.The number of tuberculosis diagnosis,the detection rate of special site lesions,and the detection rate of active pulmonary tuberculosis signs by the two methods were compared.Results:In 60 patients,the pathological results confirmed the existence of 75 tuberculosis lesions.The detection rate of spiral CT was 98.67%,which was not statistically significant compared with the detection rate of 92.00%(P>0.05)in the conventional chest X-ray.The detection rate of spiral CT enhanced scans for tuberculosis lesions in special sites was 100.00%,which was significantly higher than that of conventional chest X-ray of 7.69%,and the accuracy rate of active pulmonary tuberculosis signs was 98.85%higher than that of conventional chest X-ray of 79.31%.P<0.05).The difference was statistically significant(P<0.05).Conclusion:Spiral CT chest enhanced scan can not only find special tuberculosis lesions that cannot be detected by conventional chest radiography,but also accurately determine active pulmonary tuberculosis in adults,which is of high diagnostic value.

Hip Tuberculosis at Stage IV: Outcomes and Some Conditions for Total Hip Replacement

Background: Treatment of hip disorders during active hip tuberculosis has long been a controversial issue. Some authors have reported performing hip replacement with different strategies with very good outcomes. This study aimed to describe the surgical outcomes and necessary conditions for total hip replacement in active hip tuberculosis. Methods: We conducted a quasi-experimental study. The study enrolled 40 patients with 42 active tuberculosis hips at stage IV treated by total hip replacement from October 2016 to December 2019 at the National Lung Hospital. We followed up with the patients for at least 12 months, evaluated surgical outcomes, and investigated the factors associated with these outcomes by logistic regression analysis. Results: Surgical outcomes showed that 37 patients (88.1%) had excellent hip function, no abscesses, and no sinus tract formation. Four cases (9.5%) had sinus tract formations. One case (2.4%) had good hip function. Binary logistic regression models revealed that sinus tract formation was associated with preoperative tuberculosis infection syndrome. The average time to obtain antituberculosis drug treatment preoperatively was 4.6 weeks. Conclusion: Total hip replacement for active hip tuberculosis is a practical and promising treatment method. Surgeons should consider improving patients’ conditions before performing total hip replacement, administering antitubercular drugs, and arthrotomy to eliminate all abscesses, and decrease the risk of tuberculosis infection syndrome and the inflammatory response.

Use of low-dose computed tomography to assess pulmonary tuberculosis among healthcare workers in a tuberculosis hospital

Background:According to the World Health Organization,China is one of 22 countries with serious tuberculosis(TB)infections and one of the 27 countries with serious multidrug-resistant TB strains.Despite the decline of tuberculosis in the overall population,healthcare workers(HCWs)are still at a high risk of infection.Compared with high-income countries,the TB prevalence among HCWs is higher in low-and middle-income countries.Low-dose computed tomography(LDCT)is becoming more popular due to its superior sensitivity and lower radiation dose.However,there have been no reports about active pulmonary tuberculosis(PTB)among HCWs as assessed with LDCT.The purposes of this study were to examine PTB statuses in HCWs in hospitals specializing in TB treatment and explore the significance of the application of LDCT to these workers.Methods:This study retrospectively analysed the physical examination data of healthcare workers in the Beijing Chest Hospital from September 2012 to December 2015.Low-dose lung CT examinations were performed in all cases.The comparisons between active and inactive PTB according to the CT findings were made using the Pearson chi-square test or the Fisher’s exact test.Comparisons between the incidences of active PTB in high-risk areas and non-high-risk areas were performed using the Pearson chi-square test.Analyses of active PTB were performed according to different ages,numbers of years on the job,and the risks of the working areas.Active PTB as diagnosed by the LDCT examinations alone was compared with the final comprehensive diagnoses,and the sensitivity and positive predictive value were calculated.Results:A total of 1012 participants were included in this study.During the 4-year period of medical examinations,active PTB was found in 19 cases,and inactive PTB was found in 109 cases.The prevalence of active PTB in the participants was 1.24%,0.67%,0.81%,and 0.53%for years 2012 to 2015.The corresponding incidences of active PTB among the tuberculosis hospital participants were 0.86%,0.41%,0.54%,and 0.26%.Most HCWs with active TB(78.9%,15/19)worked in the high-risk areas of the hospital.There was a significant difference in the incidences of active PTB between the HCWs who worked in the high-risk and non-high-risk areas(odds ratio[OR],14.415;95%confidence interval(CI):4.733-43.896).Comparisons of the CT signs between the active and inactive groups via chi-square tests revealed that the tree-in-bud,cavity,fibrous shadow,and calcification signs exhibited significant differences(P=0.000,0.021,0.001,and 0.024,respectively).Tree-in-bud and cavity opacities suggest active pulmonary tuberculosis,whereas fibrous shadow and calcification opacities are the main features of inactive pulmonary tuberculosis.Comparison with the final comprehensive diagnoses revealed that the sensitivity and positive predictive value of the diagnoses of active PTB based on LDCT alone were 100%and 86.4%,respectively.Conclusions:Healthcare workers in tuberculosis hospitals are a high-risk group for active PTB.Yearly LDCT examinations of such high-risk groups are feasible and necessary.

Analysis and predication of tuberculosis registration rates in Henan Province, China: an exponential smoothing model study

Background The World Health Organization End TB Strategy meant that compared with 2015 baseline,the reduction in pulmonary tuberculosis(PTB)incidence should be 20 and 50%in 2020 and 2025,respectively.The case number of PTB in China accounted for 9%of the global total in 2018,which ranked the second high in the world.From 2007 to 2019,854672 active PTB cases were registered and treated in Henan Province,China.This study was to assess whether the WHO milestones could be achieved in Henan Province.Methods The active PTB numbers in Henan Province from 2007 to 2019,registered in Chinese Tuberculosis Information Management System were analyzed to predict the active PTB registration rates in 2020 and 2025,which is conductive to early response measures to ensure the achievement of the WHO milestones.The time series model was created by monthly active PTB registration rates from 2007 to 2016,and the optimal model was verified by data from 2017 to 2019.The Ljung-Box Q statistic was used to evaluate the model.The statistically significant level isα=0.05.Monthly active PTB registration rates and 95%confidence interval(CI)from 2020 to 2025 were predicted.Results High active PTB registration rates in March,April,May and June showed the seasonal variations.The exponential smoothing winter’s multiplication model was selected as the best-fitting model.The predicted values were approximately consistent with the observed ones from 2017 to 2019.The annual active PTB registration rates were predicted as 49.1(95%CI:36.2–62.0)per 100000 population and 34.4(95%CI:18.6–50.2)per 100000 population in 2020 and 2025,respectively.Compared with the active PTB registration rate in 2015,the reduction will reach 23.7%(95%CI,3.2–44.1%)and 46.8%(95%CI,21.4–72.1%)in 2020 and 2025,respectively.Conclusions The high active PTB registration rates in spring and early summer indicate that high risk of tuberculosis infection in late autumn and winter in Henan Province.Without regard to the CI,the first milestone of WHO End TB Strategy in 2020 will be achieved.However,the second milestone in 2025 will not be easily achieved unless there are early response measures in Henan Province,China.

ANTIMICROBIAL ACTIVITY OF CYMBOPOGON CITRATUS ESSENTIAL OIL AND CITRAL THIOSEMICARBAZONE AGAINST MYCOBACTERIUM TUBERCULOSIS

Introduction:Tuberculosis,caused by Mycobacterium tuberculosis became more prevalent due to drug resistance.Cymbopogon citratus,a crop from the African flora contains an essential oil rich in carbonyl compounds.Condensation of carbonyl compounds with thiosemicarbazides gave thiosemicarbazones which exhibit rather