Effects of the Cytotoxic T-Cells on the Dynamics of Co-Infection of HIV-1 and Mycobacterium tuberculosis

Enhancement of the Human Immunodeficiency Virus (HIV) specific cytotoxic T-cells mechanisms in an HIV-1 and Mycobacterium tuberculosis (Mtb) co-infected individual seems to improve the clinical picture of an individual by reducing Acquired Immuno Deficiency Syndrome (AIDS) state progression rate. In this paper, we develop a system of deterministic differential equations representing the immune cells involved in an HIV-1 and Mtb co-infected individual. Results show that although the non-lytic arm of the HIV-1 cytotoxic T-cells affects the co-infection dynamics more than the lytic factors, a combination of both factors results in a more positive reduced progression to the AIDS state. This is due to the increased protection of the CD4+ T-cells by the CTL mechanisms by further reducing infections and replications by the HIV. Thus, HIV-1 specific CTLs mechanisms’ involvement is here recommended to be part of a solution to the HIV and Mtb co-infection problems.

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.

Fluoroquinolones for the treatment of latent Mycobacterium tuberculosis infection in liver transplantation

Solid organ transplantation(SOT)is the best treatment option for end-stage organ disease.Newer immunosuppressive agents have reduced the incidence of graft rejection but have increased the risk of infection,particularly due to the reactivation of latent infections due to opportunistic agents such as Mycobacterium tuberculosis.Active tuberculosis(TB)after SOT is a significant cause of morbidity and mortality.Most cases of posttransplant TB are secondary to reactivation of latent tuberculosis infection(LTBI)due to the effects of long-term immunosuppressive therapy.Risk minimization strategies have been developed to diagnose LTBI and initiate treatment prior to transplantation.Isoniazid with vitamin B6 supplementation is the treatment of choice.However,liver transplantation(LT)candidates and recipients have an increased risk of isoniazid-induced liver toxicity,leading to lower treatment completion rates than in other SOT populations.Fluoroquinolones(FQs)exhibit good in vitro antimycobacterial activity and a lower risk of drug-induced liver injury than isoniazid.In the present review,we highlight the disease burden posed by posttransplant TB and summarize the emerging clinical evidence supporting the use of FQs for the treatment of LTBI in LT recipients and candidates.

Soft tissue tuberculosis detected by next-generation sequencing:A case report and review of literature

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.

Distribution Characteristics of Drug Susceptibility Test Results of Tuberculosis and Non-Tuberculous Bacilli in Patients with Opportunistic Infections of AIDS

Objective: To understand the distribution of drug susceptibility test results of opportunistic infections of tuberculosis and non-tuberculous bacilli in AIDS patients. Methods: The AIDS patients who were hospitalized in our hospital from January 2016 to June 2019 were collected as the research objects, and patients with opportunistic tuberculosis and non-tuberculous bacilli from AIDS patients were screened for drug susceptibility tests, and the distribution characteristics of drug susceptibility were analyzed. Results: 179 strains of tuberculosis and non-tuberculous mycobacteria were isolated from the specimens of AIDS patients, including 135 cases of tuberculosis mycobacteria and 44 cases of non-tuberculous mycobacteria. In the results of the drug susceptibility test, most strains of Mycobacterium tuberculosis showed sensitivity to commonly used drugs, and a few strains showed resistance;most strains of non-tuberculous mycobacteria showed resistance, and a few strains showed sensitivity. Conclusion: AIDS opportunistic infection of Mycobacterium tuberculosis and non-tuberculous mycobacteria have significant differences in drug sensitivity test results. Timely detection and analysis are of great significance to the diagnosis and treatment of the disease.

The Strengths, Weaknesses, Opportunities and Threats (SWOT) Analysis of <i>Mycobacterium tuberculosis</i>: A Systematic Review

Background: Mycobacterium tuberculosis, the etiology of pulmonary and extra pulmonary tuberculosis is taunted to have predated the existence of mankind, and science has elucidated its presence in old Egyptian’ mummies, as it continues to evade current antibiotic treatments, wreck the havoc and decimate human populations. Presented here, are the Strengths, Weaknesses, Opportunities and Threats (SWOT) analysis of Mycobacterium tuberculosis, and the first proposal for the application of this innovative concept in the field of Tuberculosis research, to proffer holistic platform, focused knowledge, and strategies at undermining the prowess of the tubercle bacilli and overcoming its scourge. Materials and Methods: A systematic review was carried out to mine data on the strengths, the weaknesses, the opportunities and threats to M. tb, by review of several publications using meaningful theme and specific search phrases on the subject. Results: Strengths of Mycobacterium tuberculosis include: possession of abundant cell wall mycothiol;M. tb is highly contagious and requires low infectious dose (ID50) to establish infection;ability to specifically target and replicate in the host’ macrophages;ability to establish extrapulmonary multiorgan involvement;dual polymorphism i.e. existence in both an actively replicating form as well as or latent state;assumption of variable metabolic states;delayed seeding from the lungs of the replicating bacteria cells to the mediastinal lymph nodes;delayed macrophage apoptosis prior to bacterial growth and ultimate cellular necrosis;ability to shift to glyoxylate pathway during lipid metabolism in lieu of glucose during persistence phase in the host. Weaknesses of M. tuberculosis include: the requirement for growth of a membrane protein called Rv3671c during in vivo replication for survival in the acidic milieu of the macrophages and phagosome;M. tb is a fastidious slow growing bacterium with long generation time;establishment of productive infection in less than 10% of infected subjects;the bacterium is strictly an intracellular aerobic pathogen;and variable bacteria level of adenosine triphosphate. Opportunities harnessed by M. tb include: development and spread of resistant strains owing to inadequate and inappropriate drug treatment;limited efficacy and use of BCG Vaccine;MDR-TB is under-diagnosed in children;pathogenic synergy of coinfection of the Human Immunodeficiency Virus (HIV) and Mycobacterium tuberculosis (MTB);difficulty of TB screening in HIV-infected persons;immune status of the host;immigration;slow response of the cellular immune response to M. tbwhich enables constant endogenous reinfection of the host;anatomical vulnerability of the lungs;aerosols by inspired air is crucial for latent tuberculosis infection. Threats to M. tuberculosis include: the development and use of sensitive combination of microbiological tests as the gold-standard in HIV infected patients;annual TB test;selective isolation of TB patients by reintroduction of sanatoria;prioritizing genomic drug targets;sustenance of the global TB funds;development of potent vaccine;live imaging using computer tomography and positron electron tomography to characterize active TB in lesions;development and application of Infecton for imaging deep seated infections.

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.

Symptomatic bradycardia in tuberculosis-related giant bullae(vanishing lung syndrome):A case report

Rationale:Vanishing lung syndrome is rare and can be associated with a history of smoking and marijuana use.The occurrence of giant bullae can also be linked to infections,particularly tuberculosis in tropical countries.Patient concerns:A 26-year-old male complained of weakness,severe vomiting,and reduced breathlessness when lying on the left side.He had a history of pulmonary tuberculosis two years ago.Diagnosis:Symptomatic bradycardia in tuberculosis-related giant bullae.Interventions:The patient was recommended to undergo an elective bullectomy,but he decided not to proceed with the procedure.Atropine sulfate was administered to alleviate symptoms of bradycardia,while a standardized anti-tuberculosis regimen were started for the next six months.Outcomes:Following 7 days of intensive care treatment involving antituberculosis medications and atropine sulfate,the patient achieved hemodynamic stability,opting against bullectomy despite residual symptoms of dyspnea.Subsequent six months of antituberculosis therapy notably alleviated symptoms without requiring bullectomy.Lessons:Increasing intrathoracic pressure can also be caused mechanically by giant bullae.Cardiac symptoms in vanishing lung syndrome are reversible and can be alleviated once the underlying cause is addressed.In this case,symptomatic bradycardia was reduced only with tuberculosis treatment without bullectomy intervention。

Regulatory roles of extracellular vesicles in immune responses against Mycobacterium tuberculosis infection

Extracellular vesicles(EVs)are cystic vesicles naturally released by most mammalian cells and bacteria.EV contents include proteins,lipids,and nucleic acids.EVs can act as messengers to transmit a variety of molecules to recipient cells and thus play important regulatory roles in intercellular signal transduction.EVs,released by either a host cell or a pathogen,can carry pathogen-associated antigens and thus act as modulators of immune responses.EVs derived from Mycobacterium tuberculosis(Mtb)-infected cells can regulate the innate immune response through various pathways,such as regulating the release of inflammatory cytokines.In addition,EVs can mediate antigen presentation and regulate the adaptive immune response by transmitting immunoregulatory molecules to T helper cells.In this review,we summarize the regulatory roles of EVs in the immune response against Mtb.

Recent Progress in Diagnosis Methods for Latent Tuberculosis Infection and Its Clinical Applications

Most people with latent Mycobacterium tuberculosis infection can partly develop active tuberculosis (TB). Therefore, diagnosis of this condition bears significance in early TB prevention. To date, the main methods for diagnosis of latent TB infection (LTBI) include tuberculin skin test and interferon γ release test. These two methods feature their own advantages and disadvantages. Although new diagnostic markers continually emerge, no uniform diagnostic criteria are available for TB detection. This study summarizes several methods for diagnosis of LTBI and new related markers and their application value in clinical practice.

Helicobacter pylori infection and respiratory diseases:a review

In the past few years,a variety of extradigestive disorders, including cardiovascular,skin,rheumatic and liver diseases, have been associated with Helicobacter pylori(H.pylori) infection.The activation of inflammatory mediators by H.pylori seems to be the pathogenetic mechanism underlying the observed associations.The present review summarizes the current literature,including our own studies,concerning the association between H.pyloriinfection and respiratory diseases. A small number of epidemiological and serologic,case- control studies suggest that H.pylori infection may be associated with the development of chronic bronchitis.A frequent coexistence of pulmonary tuberculosis and H.pylori infection has also been found.Moreover,recent studies have shown an increased H.pyloriseroprevalence in patients with bronchiectasis and in those with lung cancer.On the other hand,bronchial asthma seems not to be related with H.pylori infection. All associations between H.pylori infection and respiratory diseases are primarily based on case-control studies, concerning relatively small numbers of patients.Moreover, there is a lack of studies focused on the pathogenetic link between respiratory diseases and H.pylori infection. Therefore,we believe that larger studies should be undertaken to confirm the observed results and to clarify the underlying pathogenetic mechanisms.

Lumbar infection caused by Mycobacterium paragordonae:A case report

Mycobacterium paragordonae(M.paragordonae),a slow-growing,acid-resistant mycobacterial species,was first isolated from the sputum of a lung infection patient in South Korea in 2014.Infections caused by M.paragordonae are rare.CASE SUMMARY Herein,we report the case of a 53-year-old patient who presented with fever and low back pain.Lumbar nuclear magnetic resonance imaging revealed the destruction of the lumbar vertebra with peripheral abscess formation.After antiinfective and diagnostic anti-tuberculosis treatment,the patient had no further fever,but the back pain was not relieved.Postoperatively,the necrotic material was sent for pathological examination,and all tests related to tuberculosis were negative,but pus culture suggested nontuberculous mycobacteria.The necrotic tissue specimens were subjected to metagenomic next-generation sequencing,which indicated the presence of M.paragordonae.Finally,the infecting pathogen was identified,and the treatment plan was adjusted.The patient was in good condition during the follow-up period.CONCLUSION M.paragordonae,a rare nontuberculous mycobacterium,can also cause spinal infections.In the clinic,it is necessary to identify nontuberculous mycobacteria for spinal infections similar to Mycobacterium tuberculosis.

The Medium for Acceleration of <i>Mycobacterium tuberculosis</i>Growth

This article has described the results of studies conducted on pre-culture samples in a modified environment Shkolnikova Dorozhkova at 37&deg;C during 24 - 48 hours. It was stated that this method helps grow Mycobacterium tuberculosis, which, when sown on the medium give rise visible colonies on the 5th - 7th day. These data confirm the possibility to accelerate the growth of mycobacteria and shorten the terms of diagnosing tuberculosis by 3 or 4 times thanks to pre-culturing of the diagnostic material in the experimental medium. The original conception of the Mycobacterium tuberculosis development step-by-step was elaborated which was based on changeability of mycobacteria and prominent character of their development from division of the bacterial cells to the development of the maturated cells and further biological transformation under conditions of the surrounding factors. This conception gave the explanation of the integrated picture of the biological changeability of Mycobacterium tuberculosis. It was stated that the cocci-like, flask-like, grain-like, virus-like, filtrating forms, L-forms and other agent forms are the stages of the biological development of tuberculosis mycobateria which are not always identified by the routine methods of microbiological diagnostics implemented in the veterinary practice. Thus, the use of the developed method of diagnostics of tuberculosis in animals together with agglutination test, ELISA and PCR allow shortening the terms of primary diagnosis of tuberculosis in animals by bacteriological method by 5 - 7 days.

Liver Transplantation in a Monolung Patient: A Strategy of Sequential Treatments of Multiple Lung Tuberculosis Ca-vitations and Hepatocellular Carcinoma on Hepatitis B Related Virus Cirrhosis

The presence of extrahepatic infection is a contraindication for liver transplantation, even more if supported by an advanced pulmonary tuberculosis with persistent cavitation not curable with medical treatment. We report a case of a young patient with hepatocellular carcinoma on hepatitis B virus related liver cirrhosis and multiple lung tuberculosis cavitations. The patient was referred to our centre for liver transplantation. We adopted a strategy with sequential treatments. First a left extra-pericardial pneumonectomy was performed without opening the infected cavern, followed by a therapy with rifampicin, isoniazid and ethambutol for a period of nine months. After the cure of tuberculosis, the monolung patient eventually was listed for liver transplantation. An accurate planning of a multistep therapeutical strategy, an appropriate anesthetic management and a meticulous surgical technique allowed to successfully transplant a young patient suffering from three life-threatening diseases: cavitary tuberculosis, hepatitis B virus cirrhosis and hepatocellular carcinoma. Thirty months after liver transplantation the patient is in good health, with normal liver function, forced expiratory volume in one second of 42% (1.53 liters) and without any tuberculosis disease reactivation.

Mammalian cell cultures as models for Mycobacterium tuberculosis-human immunodeficiency virus(HIV) interaction studies:A review

Mycobacterium tuberculosis(MTB) and human immunodeficiency virus(HIV) co-infections have remained a major public health concern worldwide,particularly in Southern Africa.Yet our understanding of the molecular interactions between the pathogens has remained poor,primarily due to lack of suitable preclinical models for such studies.We reviewed the use,this far,of mammalian cell culture models in HIV-MTB interaction studies.Studies have described the use of primary human cell cultures,including monocyte-derived macrophage(MDM) fractions of peripheral blood mononuclear cell(PBMC),alveolar macrophages(AM),cell lines such as the monocyte-derived macrophage cell line(U937),T lymphocyte cell lines(CEMx174,ESAT-6-specific CD4+ T-cells) and an alveolar epithelial cell line(A549) and special models such as stem cells,three dimensional(3D) or organoid cell models [including a blood-brain barrier(BBB) cell model] in HIV-MTB interaction studies.The use of cell cultures from other mammals,including:mouse cell lines [macrophage cell lines RAW 264.7 and J774.2,fibroblast cell lines(NIH 3T3,C3 H clones),embryonic fibroblast cell lines and T-lymphoma cell lines(S1A.TB,TIMI.4 and R1.1)]; rat(T cells:Rat2,RGE,XC and HH16,and alveolar cells:NR8383) and primary guinea pigs derived AMs,in HIV-MTB studies is also described.Given the spectrum of the models available,cell cultures offer great potential for host-HIV-MTB interactions studies.

Analytic Study of Spinal Infections: Clinical Picture, Treatment, and Outcomes in King Fahad Military Medical Complex in Dhahran, Saudi Arabia

Objective: To evaluate the prevalence of spinal infection in a hospital located in the eastern region of Saudi Arabia through a retrospective review and to identify the associated etiological agents in terms of clinical picture, treatment, and outcomes. Design: Retrospective cross-sectional study. Setting: Single hospital in Dhahran, Saudi Arabia. Patients: Patients with any type of spinal infection and/or who had undergone neurosurgical intervention for spinal infection between January 2006 and December 2018. Methods: We collected data on all patients with an established diagnosis of spinal infection from January 2006 to December 2018 in the King Fahad Military Medical Complex in Dhahran, Saudi Arabia. A validated and structured checklist was used for data collection. Spinal infection diagnosis was based on the clinical manifestation, microbiological evidence, radiological findings, and antimicrobial therapy response. Results: Seventeen patients were included in this study, and their mean age was 54.93 years. Twelve of the patients were male and four were female. The approximate time from symptom onset to diagnosis was 2 - 6 months. Most of the patients experienced back pain, with lumbosacral spondylitis being the most commonly cited type (61.11%), followed by thoracolumbar spondylodiscitis (25%) and cervical spondylodiscitis (6.25%). The most frequently isolated organism was Mycobacterium tuberculosis (8 patients, 50%), followed by extended-spectrum beta lactamase (ESBL)-producing Escherichia coli (4 patients, 25%), Brucella spp (3 patients, 18.75%), Staphylococcus aureus (1 patient, 6.25%), and Quambalaria cyanescens (1 patient, 6.25%). Totally, in 50% of the patients with thoracolumbar and lumbosacra site involvement, tuberculosis spondylodiscitis was observed, while another 50% of the cases showed complications associated with paravertebral abscess that required surgical drainage. Conclusion: M. tuberculosis was found to be the major cause of infectious spondylodiscitis. Additionally, Quambalaria cyanescens was isolated;this is the second reported case of the organism being isolated and the first associated with spinal infection.

四川省2022年入学新生结核分枝杆菌潜伏感染与肺结核患病情况分析

目的:对2022年四川省入学新生结核病体检情况进行汇总和分析,了解全省入学新生结核分枝杆菌潜伏感染(latent tuberculosis infection,LTBI)与结核病患病情况,为学校新生入学结核病检查工作开展提供理论依据。方法:从四川省学籍管理系统中获得2022年全省各级各类学校入学新生基本信息,制作《2022年秋季新生入学结核病体检信息表》,建立数据库,采用描述性统计分析方法,分析新生入学结核病检查中结核病患者及LTBI者检出情况及其流行病学特征,追踪LTBI者接受预防性治疗及完成情况。结果:2022年四川省各级各类学校入学新生2787900名规范开展结核病体检,占全部新生的97.69%(2787900/2853817),发现活动性肺结核患者247例,检出率为8.86/10万(247/2787900)。其中,女性患病率为10.11/10万(145/1434131),高于男性[7.18/10万(102/1419686)],差异有统计学意义(χ^(2)=7.058,P<0.01)。四川省1790830名入学新生开展了LTBI检测,感染率为3.09%(55313/1790830)。符合预防性治疗条件的单纯结核菌素皮肤试验强阳性/重组结核分枝杆菌融合蛋白(EC)或γ-干扰素释放试验阳性者8104例中,13.73%(1113/8104)接受了预防性治疗,925例完成了全疗程,完成治疗率为83.11%,未完成治疗的新生中有2例在治疗期间转为活动性结核病。结论:四川省2022年入学新生体检率高,但LTBI检出率较低,接受预防性治疗率不高。

风湿免疫病患者结核分枝杆菌潜伏感染率及相关影响因素的多中心横断面研究

目的:以结核感染T细胞斑点试验(T-SPOT.TB)检测作为筛查结核分枝杆菌潜伏感染(latent tuberculosis infection,LTBI)的工具,调查我国风湿免疫病患者结核分枝杆菌潜伏感染率,并分析影响T-SPOT.TB检测结果的相关因素。方法:纳入自2014年9月至2016年3月我国东、中、西部13家三级甲等综合医院接诊的风湿免疫病患者作为研究对象,共计3715例。应用T-SPOT.TB对研究对象进行LTBI筛查。收集研究对象的基本信息,包括性别、年龄、地区、体质量指数、病程、吸烟史、基础疾病、结核病患者密切接触史、结核病既往史,以及糖皮质激素、免疫抑制剂及生物制剂的使用情况,实验室化验结果,风湿免疫病诊断结果等。采用单因素及多因素logistic回归模型分析影响T-SPOT.TB检测结果的因素。结果:3715例研究对象T-SPOT.TB检测阳性者有672例(18.1%,95%CI:16.9%~19.3%)。不同风湿免疫病病种患者T-SPOT.TB检测阳性率差异有统计学意义(χ^(2)=79.003,P<0.001),白塞综合征患者检测阳性率最高(44.4%,32/72),混合性结缔组织病患者检测阳性率最低(8.9%,4/45)。男性风湿免疫病患者T-SPOT.TB检测阳性率为23.6%(168/711),明显高于女性(16.8%,504/3004),差异有统计学意义(χ^(2)=18.213,P<0.001)。不同年龄组风湿免疫病患者T-SPOT.TB检测阳性率差异有统计学意义(χ^(2)=67.189,P<0.001),51~60岁组检测阳性率最高(24.8%,143/577),16~20岁组检测阳性率最低(8.1%,13/160)。多因素logistic回归分析显示:年龄≥41岁(aOR=1.81,95%CI:1.48~2.23),吸烟≥21支/d(aOR=1.66,95%CI:1.15~2.40),有结核病既往史(aOR=3.88,95%CI:2.71~5.57),患白塞综合征(aOR=3.00,95%CI:1.70~5.28)是T-SPOT.TB检测阳性结果的独立相关因素;使用大剂量激素(aOR=0.67,95%CI:0.47~0.96)或生物制剂(aOR=0.55,95%CI:0.36~0.84),淋巴细胞计数偏低(aOR=0.39,95%CI:0.25~0.62),低蛋白血症(aOR=0.72,95%CI:0.52~0.99),以及患多发性肌炎/皮肌炎(aOR=0.54,95%CI:0.29~0.99)、系统性红斑狼疮(aOR=0.75,95%CI:0.57~0.99)是T-SPOT.TB检测阴性结果的独立相关因素。结论:风湿免疫病患者总体结核分枝杆菌潜伏感染率为18.1%,各病种T-SPOT.TB检测阳性率差异明显。当患者有大剂量糖皮质激素、生物制剂的使用,淋巴细胞计数偏低,低蛋白血症,以及罹患系统性红斑狼疮时警惕假阴性结果。

重组结核杆菌融合蛋白在肺结核密切接触者中筛查结核分枝杆菌感染效果分析

目的:探讨重组结核杆菌融合蛋白(recombinant mycobacterium tuberculosis fusion protein,EC)皮肤试验在筛查肺结核患者密切接触者结核分枝杆菌感染中的实用性和有效性,为进一步优化结核感染检测提供技术建议,了解密切接触者结核分枝杆菌潜伏感染(LTBI)现状。方法:2023年10月23日至11月14日在上海市奉贤区和金山区共选取140名肺结核密切接触者作为研究对象,对每名研究对象同时采用γ-干扰素释放试验(IGRA)和EC皮肤试验进行结核感染检测,采用Kappa值检验两种方法结果一致性,采用χ^(2)检验比较两组检测方法之间的差异,以P<0.05为差异有统计学意义。结果:140名研究对象,包括男性55例,女性85例;IGRA阳性率为15.00%(21/140),EC皮肤试验阳性率为14.29%(20/140),两种试验方法一致性检验Kappa值为0.857,差异无统计学意义(χ^(2)=0.029,P=0.866),两种检测方法检测结果为高度一致性;以IGRA作为结核感染的参考标准,EC皮肤试验的敏感度为85.71%(18/21)、特异度为98.32%(117/119)、阳性预测值为90.00%(18/20)、阴性预测值为97.50%(117/120);男性EC阳性率(32.73%,18/55)明显高于女性(2.35%,2/85),差异有统计学意义(χ^(2)=17.983,P<0.001)。结论:EC皮肤试验具有较强的特异性,可用于肺结核密切接触者结核分枝杆菌感染筛查,但受限于使用年龄和接种禁忌证,可采用IGRA对无法进行EC皮肤试验者进行补充检测。

临床护理路径联合健康教育在NTM肺病合并支气管扩张患者中的效果评价

目的探讨临床护理路径联合健康教育在非结核分枝杆菌(NTM)肺病合并支气管扩张患者中的护理效果。方法选取2022年1月至12月入住广州市胸科医院的206例NTM肺病合并支气管扩张患者,按照组间基本特征均衡可比的原则分为试验组(105例)与对照组(101例)。试验组男32例,女73例,年龄(60.20±9.06)岁。对照组男38例,女63例,年龄(63.18±10.96)岁。对照组实施常规护理,试验组在常规护理基础上实施NTM肺病临床护理路径联合健康教育,持续至患者出院。以问卷形式调查试验组、对照组患者关于NTM肺病合并支气管扩张相关知识的知晓情况,包括疾病知识、用药知识、饮食、排痰。对比两组疾病知识、用药知识、饮食、排痰的知晓情况,住院时间,健康教育满意度。采用χ^(2)检验、独立样本t检验。结果试验组疾病知识、用药知识、饮食、排痰知晓率分别为(93.29±7.72)%、(86.27±5.26)%、(86.56±8.09)%、(83.82±6.23)%,高于对照组的(85.59±9.91)%、(81.34±5.19)%、(82.87±8.10)%、(80.59±7.12)%;试验组住院时间为(15.97±5.45)d,短于对照组(17.95±5.98)d,满意度评分为(4.39±0.83)分,高于对照组(4.10±0.17)分,两组差异均有统计学意义(均P<0.05)。结论对NTM肺病合并支气管扩张患者使用NTM肺病临床护理路径联合健康教育,可有效加强患者对健康知识的掌握,提高护理满意度,从而促进病情康复,缩短住院时间。