BACKGROUND Soft tissue tuberculosis is rare and insidious,with most patients presenting with a localized enlarged mass or swelling,which may be factors associated with delayed diagnosis and treatment.In recent years,n...BACKGROUND Soft tissue tuberculosis is rare and insidious,with most patients presenting with a localized enlarged mass or swelling,which may be factors associated with delayed diagnosis and treatment.In recent years,next-generation sequencing has rapidly evolved and has been successfully applied to numerous areas of basic and clinical research.A literature search revealed that the use of next-generation sequencing in the diagnosis of soft tissue tuberculosis has been rarely reported.CASE SUMMARY A 44-year-old man presented with recurrent swelling and ulcers on the left thigh.Magnetic resonance imaging suggested a soft tissue abscess.The lesion was surgically removed and tissue biopsy and culture were performed;however,no organism growth was detected.Finally,Mycobacterium tuberculosis was confirmed as the pathogen responsible for infection through next-generation sequencing analysis of the surgical specimen.The patient received a standardized anti-tuberculosis treatment and showed clinical improvement.We also performed a literature review on soft tissue tuberculosis using studies published in the past 10 years.CONCLUSION This case highlights the importance of next-generation sequencing for the early diagnosis of soft tissue tuberculosis,which can provide guidance for clinical treatment and improve prognosis.展开更多
AIM:To define the parameters that positively predict diagnosis of Crohn's disease (CD) and differentiate it from gastrointestinal tuberculosis (GITB). METHODS:This prospective study over 3 years was carried out in...AIM:To define the parameters that positively predict diagnosis of Crohn's disease (CD) and differentiate it from gastrointestinal tuberculosis (GITB). METHODS:This prospective study over 3 years was carried out in the consecutive Indian patients with definite diagnosis of CD and equal numbers of patients with definite diagnosis of GITB. Demographic, clinical, laboratory, morphological and histological features were noted in all the patients. Serological tests such as p-ANCA, c-ANCA, IgA ASCA and IgG ASCA, were performed. Endoscopic biopsy and/or surgical tissue specimens were subjected to smear and culture for acid-fast bacilli (AFB) and tissue polymerase chain reaction for tuberculosis (TB PCR). Diagnosis of CD and GITB was based on the standard criteria. Data were analyzed using univariate Chi-square test and multiple logistic regression (MLR). RESULTS:The study is comprised of 26 patients with CD (age 36.6 ± 8.6 year, male:female, 16:10) and 26 patients with GITB (age 37.2 ± 9.6 year, male:female, 15:11). The following clinical variables between the two groups (CD vs TB) were significant in univariate analysis:duration of symptoms (58.1 ± 9.8 vs 7.2 ± 3.4 mo), diarrhoea (69.2% vs 34.6%), bleeding per rectum (30.7% vs 3.8%), fever (23.1% vs 69.2%), ascites (7.7% vs 34.6%) and extra-intestinal manifestations of inflammatory bowel disease (61.5% vs 23.1%). Of these, all except ascites and extra-colonic manifestations were found statistically significant by MLR. Accuracy of predicting CD was 84.62% based on the fever, bleeding P/R, diarrhoea and duration of symptoms while it was 63.4% when histology was reported as inflammatory bowel disease and 42.3% when there was recurrence of disease after surgery. Accuracy of predicting GITB was 73.1% when there was co-existing pulmonary lesions and/or abdominal lymphadenopathy;75% when tuberculosis was reported in histology;63.4% when granuloma was found in histology;82.6% when TB PCR was positive;and 61.5% when smear and/ or culture was positive for AFB. Serological test was not useful in differentiation of CD from GITB. Positivity rates for CD and GITB were:p-ANCA-3.8% and 3.8%, c-ANCA-3.8% and 0%, IgA ASCA-38.4% and 23.1%, and IgG ASCA-38.4% and 42.3%, respectively. CONCLUSION:Simple clinical parameters like fever, bleeding P/R, diarrhoea and duration of symptoms have the highest accuracy in differentiating CD from GITB.展开更多
目的探讨实时荧光定量PCR(qPCR)在结核病理诊断中的应用价值。方法回顾性分析1323例疑似结核病的石蜡包埋组织qPCR结果,并与临床诊断结果、抗酸染色结果进行对比分析。结果1323例病例中1073例有明确的诊断结果,其中结核阳性率为68.22%(7...目的探讨实时荧光定量PCR(qPCR)在结核病理诊断中的应用价值。方法回顾性分析1323例疑似结核病的石蜡包埋组织qPCR结果,并与临床诊断结果、抗酸染色结果进行对比分析。结果1323例病例中1073例有明确的诊断结果,其中结核阳性率为68.22%(732/1073)。1073例病例中,qPCR阳性率为45.39%、敏感性为0.663、特异性为0.994,肺、胸膜、骨、淋巴结、肠中qPCR敏感性分别为0.706、0.676、0.437、0.678、0.625,特异性分别为0.993、1.000、1.000、1.000、1.000,手术组织阳性率和敏感性分别为48.42%、0.692,均高于活检组织,且差异有统计学意义(P<0.05)。755例同时具有qPCR结果和抗酸染色结果的病例中,qPCR与抗酸染色法符合率75.36%(95%CI 72.17~78.30),qPCR阳性率(43.44%,328/755)高于抗酸染色的阳性率(21.5%,162/755)(P<0.05),qPCR的AUC(95%CI)=0.837(0.817~0.859)高于抗酸染色AUC(95%CI)=0.656(0.634~0.678)(P<0.05),敏感性高于抗酸染色(0.677 vs 0.327)(P<0.05)。结论qPCR在结核病的病理诊断中具有良好的应用价值,联合抗酸染色可以更准确地进行鉴别诊断。展开更多
目的:分析神经元特异性烯醇化酶(neuron specific enolase,NSE)、S100B、胶质纤维酸性蛋白(glial fibrillary acidic protein,GFAP)在结核性脑膜炎(tuberculous meningitis,TBM)患儿血清及脑脊液中表达的动态变化特征及其对患儿预后预...目的:分析神经元特异性烯醇化酶(neuron specific enolase,NSE)、S100B、胶质纤维酸性蛋白(glial fibrillary acidic protein,GFAP)在结核性脑膜炎(tuberculous meningitis,TBM)患儿血清及脑脊液中表达的动态变化特征及其对患儿预后预测价值。方法:采用前瞻性研究方法,连续纳入2018年1月1日至2021年12月31日于南华大学附属长沙中心医院儿童结核科收治的72例TBM患儿作为TBM组。搜集同期住院,诊断为肺结核同时排除TBM的患儿20例作为肺结核组。TBM组患儿治疗6个月后根据预后情况,分为完全康复组(47例)和预后不良组(25例)。采用酶联免疫吸附试验法测定TBM组入院48 h内及治疗后(1、2、3周)和肺结核组入院48 h内的血清和脑脊液NSE、S100B、GFAP水平,并进行比较。采用受试者工作特征(receiver operating characteristic,ROC)曲线及曲线下面积(area under the curve,AUC)分析TBM患儿入院时脑脊液NSE、S100B、GFAP水平,预测其不良预后的阈值、敏感度及特异度。结果:入院时血清及脑脊液NSE、S100B、GFAP水平[中位数(四分位数)],TBM组分别为15.12(3.22,26.90)μg/L、1.11(0.40,3.20)μg/L、15.34(3.44,45.82)μg/L和37.90(6.50,142.70)μg/L、2.31(1.02,10.20)μg/L、65.31(10.87,252.60)μg/L,均明显高于肺结核组[分别为7.03(2.48,13.23)μg/L、0.25(0.12,0.36)μg/L、10.38(2.41,19.00)μg/L和7.56(2.12,12.79)μg/L、0.35(0.05,0.51)μg/L、7.86(2.41,13.80)μg/L],差异均有统计学意义(血清水平:Z值分别为-5.064、-6.817、-2.693,P值分别为0.000、0.000、0.007;脑脊液水平:Z值分别为-6.465、-6.816、-6.778,P值均为0.000);预后不良组脑脊液NSE、S100B、GFAP水平分别为60.16(24.90,142.70)μg/L、2.59(1.32,10.20)μg/L、118.74(58.83,252.60)μg/L,明显高于完全康复组[分别为29.37(6.50,68.82)μg/L、1.97(1.02,6.10)μg/L、45.39(10.87,84.93)μg/L],差异均有统计学意义(Z值分别为-4.855、-3.212、-6.334,P值分别为0.000、0.001、0.000)。治疗后1、2、3周,预后不良组脑脊液NSE分别为49.58(15.38,87.56)μg/L、41.53(9.60,82.00)μg/L、25.97(5.56,58.49)μg/L,S100B分别为10.15(3.63,15.72)μg/L、1.60(0.41,3.28)μg/L、0.75(0.41,1.60)μg/L,GFAP分别为99.75(65.79,180.84)μg/L、63.94(13.65,120.59)μg/L、38.03(10.87,85.40)μg/L,均明显高于完全康复组[NSE分别为18.49(4.87,36.12)μg/L、14.51(4.87,35.70)μg/L、8.53(2.12,21.70)μg/L;S100B分别为5.34(2.19,10.08)μg/L、0.66(0.19,1.56)μg/L、0.40(0.11,0.74)μg/L;GFAP分别为45.39(10.87,84.93)μg/L、17.77(5.66,38.15)μg/L、12.82(5.04,26.90)μg/L,差异均有统计学意义(NSE:Z值分别为-2.496、-3.815、-4.041,P值分别为0.013、0.000、0.000;S100B:Z值分别为-3.331、-4.745、-1.207,P值分别为0.047、0.000、0.036;GFAP:Z值分别为-4.940、-2.337、-3.745,P值分别为0.000、0.016、0.012)。ROC曲线分析,获得最大约登指数下入院时TBM患儿脑脊液NSE、S100B、GFAP水平对预后不良的预测阈值分别为51.92μg/L、2.75μg/L、77.54μg/L。结论:TBM患儿血清及脑脊液NSE、S100B、GFAP水平明显增高,经治疗后血清NSE、S100B、GFAP水平快速降至正常,而脑脊液NSE、S100B、GFAP水平下降缓慢。TBM患儿入院时脑脊液NSE≥51.92μg/L、S100B≥2.75μg/L或GFAP≥77.54μg/L,且经治疗后脑脊液NSE、S100B、GFAP下降缓慢,提示预后不良的可能。展开更多
基金Supported by the National Natural Science Foundation of China,No.82272544。
文摘BACKGROUND Soft tissue tuberculosis is rare and insidious,with most patients presenting with a localized enlarged mass or swelling,which may be factors associated with delayed diagnosis and treatment.In recent years,next-generation sequencing has rapidly evolved and has been successfully applied to numerous areas of basic and clinical research.A literature search revealed that the use of next-generation sequencing in the diagnosis of soft tissue tuberculosis has been rarely reported.CASE SUMMARY A 44-year-old man presented with recurrent swelling and ulcers on the left thigh.Magnetic resonance imaging suggested a soft tissue abscess.The lesion was surgically removed and tissue biopsy and culture were performed;however,no organism growth was detected.Finally,Mycobacterium tuberculosis was confirmed as the pathogen responsible for infection through next-generation sequencing analysis of the surgical specimen.The patient received a standardized anti-tuberculosis treatment and showed clinical improvement.We also performed a literature review on soft tissue tuberculosis using studies published in the past 10 years.CONCLUSION This case highlights the importance of next-generation sequencing for the early diagnosis of soft tissue tuberculosis,which can provide guidance for clinical treatment and improve prognosis.
文摘AIM:To define the parameters that positively predict diagnosis of Crohn's disease (CD) and differentiate it from gastrointestinal tuberculosis (GITB). METHODS:This prospective study over 3 years was carried out in the consecutive Indian patients with definite diagnosis of CD and equal numbers of patients with definite diagnosis of GITB. Demographic, clinical, laboratory, morphological and histological features were noted in all the patients. Serological tests such as p-ANCA, c-ANCA, IgA ASCA and IgG ASCA, were performed. Endoscopic biopsy and/or surgical tissue specimens were subjected to smear and culture for acid-fast bacilli (AFB) and tissue polymerase chain reaction for tuberculosis (TB PCR). Diagnosis of CD and GITB was based on the standard criteria. Data were analyzed using univariate Chi-square test and multiple logistic regression (MLR). RESULTS:The study is comprised of 26 patients with CD (age 36.6 ± 8.6 year, male:female, 16:10) and 26 patients with GITB (age 37.2 ± 9.6 year, male:female, 15:11). The following clinical variables between the two groups (CD vs TB) were significant in univariate analysis:duration of symptoms (58.1 ± 9.8 vs 7.2 ± 3.4 mo), diarrhoea (69.2% vs 34.6%), bleeding per rectum (30.7% vs 3.8%), fever (23.1% vs 69.2%), ascites (7.7% vs 34.6%) and extra-intestinal manifestations of inflammatory bowel disease (61.5% vs 23.1%). Of these, all except ascites and extra-colonic manifestations were found statistically significant by MLR. Accuracy of predicting CD was 84.62% based on the fever, bleeding P/R, diarrhoea and duration of symptoms while it was 63.4% when histology was reported as inflammatory bowel disease and 42.3% when there was recurrence of disease after surgery. Accuracy of predicting GITB was 73.1% when there was co-existing pulmonary lesions and/or abdominal lymphadenopathy;75% when tuberculosis was reported in histology;63.4% when granuloma was found in histology;82.6% when TB PCR was positive;and 61.5% when smear and/ or culture was positive for AFB. Serological test was not useful in differentiation of CD from GITB. Positivity rates for CD and GITB were:p-ANCA-3.8% and 3.8%, c-ANCA-3.8% and 0%, IgA ASCA-38.4% and 23.1%, and IgG ASCA-38.4% and 42.3%, respectively. CONCLUSION:Simple clinical parameters like fever, bleeding P/R, diarrhoea and duration of symptoms have the highest accuracy in differentiating CD from GITB.
文摘目的探讨实时荧光定量PCR(qPCR)在结核病理诊断中的应用价值。方法回顾性分析1323例疑似结核病的石蜡包埋组织qPCR结果,并与临床诊断结果、抗酸染色结果进行对比分析。结果1323例病例中1073例有明确的诊断结果,其中结核阳性率为68.22%(732/1073)。1073例病例中,qPCR阳性率为45.39%、敏感性为0.663、特异性为0.994,肺、胸膜、骨、淋巴结、肠中qPCR敏感性分别为0.706、0.676、0.437、0.678、0.625,特异性分别为0.993、1.000、1.000、1.000、1.000,手术组织阳性率和敏感性分别为48.42%、0.692,均高于活检组织,且差异有统计学意义(P<0.05)。755例同时具有qPCR结果和抗酸染色结果的病例中,qPCR与抗酸染色法符合率75.36%(95%CI 72.17~78.30),qPCR阳性率(43.44%,328/755)高于抗酸染色的阳性率(21.5%,162/755)(P<0.05),qPCR的AUC(95%CI)=0.837(0.817~0.859)高于抗酸染色AUC(95%CI)=0.656(0.634~0.678)(P<0.05),敏感性高于抗酸染色(0.677 vs 0.327)(P<0.05)。结论qPCR在结核病的病理诊断中具有良好的应用价值,联合抗酸染色可以更准确地进行鉴别诊断。
文摘目的:分析神经元特异性烯醇化酶(neuron specific enolase,NSE)、S100B、胶质纤维酸性蛋白(glial fibrillary acidic protein,GFAP)在结核性脑膜炎(tuberculous meningitis,TBM)患儿血清及脑脊液中表达的动态变化特征及其对患儿预后预测价值。方法:采用前瞻性研究方法,连续纳入2018年1月1日至2021年12月31日于南华大学附属长沙中心医院儿童结核科收治的72例TBM患儿作为TBM组。搜集同期住院,诊断为肺结核同时排除TBM的患儿20例作为肺结核组。TBM组患儿治疗6个月后根据预后情况,分为完全康复组(47例)和预后不良组(25例)。采用酶联免疫吸附试验法测定TBM组入院48 h内及治疗后(1、2、3周)和肺结核组入院48 h内的血清和脑脊液NSE、S100B、GFAP水平,并进行比较。采用受试者工作特征(receiver operating characteristic,ROC)曲线及曲线下面积(area under the curve,AUC)分析TBM患儿入院时脑脊液NSE、S100B、GFAP水平,预测其不良预后的阈值、敏感度及特异度。结果:入院时血清及脑脊液NSE、S100B、GFAP水平[中位数(四分位数)],TBM组分别为15.12(3.22,26.90)μg/L、1.11(0.40,3.20)μg/L、15.34(3.44,45.82)μg/L和37.90(6.50,142.70)μg/L、2.31(1.02,10.20)μg/L、65.31(10.87,252.60)μg/L,均明显高于肺结核组[分别为7.03(2.48,13.23)μg/L、0.25(0.12,0.36)μg/L、10.38(2.41,19.00)μg/L和7.56(2.12,12.79)μg/L、0.35(0.05,0.51)μg/L、7.86(2.41,13.80)μg/L],差异均有统计学意义(血清水平:Z值分别为-5.064、-6.817、-2.693,P值分别为0.000、0.000、0.007;脑脊液水平:Z值分别为-6.465、-6.816、-6.778,P值均为0.000);预后不良组脑脊液NSE、S100B、GFAP水平分别为60.16(24.90,142.70)μg/L、2.59(1.32,10.20)μg/L、118.74(58.83,252.60)μg/L,明显高于完全康复组[分别为29.37(6.50,68.82)μg/L、1.97(1.02,6.10)μg/L、45.39(10.87,84.93)μg/L],差异均有统计学意义(Z值分别为-4.855、-3.212、-6.334,P值分别为0.000、0.001、0.000)。治疗后1、2、3周,预后不良组脑脊液NSE分别为49.58(15.38,87.56)μg/L、41.53(9.60,82.00)μg/L、25.97(5.56,58.49)μg/L,S100B分别为10.15(3.63,15.72)μg/L、1.60(0.41,3.28)μg/L、0.75(0.41,1.60)μg/L,GFAP分别为99.75(65.79,180.84)μg/L、63.94(13.65,120.59)μg/L、38.03(10.87,85.40)μg/L,均明显高于完全康复组[NSE分别为18.49(4.87,36.12)μg/L、14.51(4.87,35.70)μg/L、8.53(2.12,21.70)μg/L;S100B分别为5.34(2.19,10.08)μg/L、0.66(0.19,1.56)μg/L、0.40(0.11,0.74)μg/L;GFAP分别为45.39(10.87,84.93)μg/L、17.77(5.66,38.15)μg/L、12.82(5.04,26.90)μg/L,差异均有统计学意义(NSE:Z值分别为-2.496、-3.815、-4.041,P值分别为0.013、0.000、0.000;S100B:Z值分别为-3.331、-4.745、-1.207,P值分别为0.047、0.000、0.036;GFAP:Z值分别为-4.940、-2.337、-3.745,P值分别为0.000、0.016、0.012)。ROC曲线分析,获得最大约登指数下入院时TBM患儿脑脊液NSE、S100B、GFAP水平对预后不良的预测阈值分别为51.92μg/L、2.75μg/L、77.54μg/L。结论:TBM患儿血清及脑脊液NSE、S100B、GFAP水平明显增高,经治疗后血清NSE、S100B、GFAP水平快速降至正常,而脑脊液NSE、S100B、GFAP水平下降缓慢。TBM患儿入院时脑脊液NSE≥51.92μg/L、S100B≥2.75μg/L或GFAP≥77.54μg/L,且经治疗后脑脊液NSE、S100B、GFAP下降缓慢,提示预后不良的可能。
