2011~2020年西安市新城区结肺核病流行病学分析

[目的]了解西安市城区肺结核病的流行病学分布特征,为以后肺结核病防控提供科学依据。[方法]采用描述性流行病学分析方法对西安市城区 2011~2020 肺结核病发病情况进行分析。[结果]西安市城区 2011~2020年合计报告肺结核病3208例,年平均发病率为52.4/10 万。男性报告发病率高于女性,男女性别比为2.05:1。年龄分布以 15 岁及以上为主,占 98.6%。报告发病人数最多三种职业依次为家务及待业、离退人员、农民。全年各月均发病,无明显季节性。[结论] 新城区肺结核发病率仍处于一个高水平,并且出现新的防控难点,总体防控形势不容乐观。需要政府加大对结核病的投入和相关保障政策,加强重点人群防控,减少结核病发病。

Diagnostic dilemma of abdominal tuberculosis in non-HIV patients:An ongoing challenge for physicians

AIM： To assess the clinical features, yield of the diagnostic tests and outcome of abdominal tuberculosis in non-HIV patients.METHODS： Adult patients with discharge diagnosis of abdominal tuberculosis （based upon; positive microbiology, histo-pathology, imaging or response to trial of anti TB drugs） during the period 1999 to 2004 were analyzed. Patient＇s characteristics, laboratory investigations, radiological, endoscopic and surgical findings were evaluated. Abdominal site involved （intestinal, peritoneal, visceral, and nodal） and response to treatment was also noted.RESULTS： There were 209 patients enrolled. One hundred and twenty-three （59%） were females. Symptoms were abdominal pain 294 （93%）, fever 234 （64%）, night sweats 99 （48%）, weight loss 98 （47%）, vomiting 75 （36%）, ascites 74 （35%）, constipation 64 （31%）, and diarrhea 25 （12%）. Sub-acute and acute intestinal obstruction was seen in 28 （13%） and 12 （11%） respectively. Radiological evidence of pulmonary tuberculosis was found in 134 （64%） patients. Basis of diagnosis of abdominal tuberculosis were radiology （Chest and barium X-Rays, Ultrasound and CT scan abdomen） in 111 （53%） and histo-pathology （tissue obtained during surgery, colonoscopy, CT or ultrasound guided biopsy, laparoscopy and upper gastro intestinal endoscopy） in 87 （42%） patients. Mycobacterium culture was positive in 6/87 （7%） patients and response to therapeutic trial of anti tubercular drugs was the basis of diagnosis in 5 （2.3%） patients. Predominant site of involvement by abdominal TB was intestinal in 103 （49%） patients, peritoneal in 87 （42%） patients, solid viscera in 10 （5%） and nodal in 9 （4%） patients. Response to medical treatment was found in 158 （76%） patients and additionally 35 （17%） patients also underwent surgery. In a 425 ± 120 d follow-up period 12 patients died （eight post operative） and no case of relapse was noted.CONCLUSION： Abdominal TB has diverse and nonspecific symptomatology. No single test is adequate for diagnosis of abdominal tuberculosis in all patients. Abdominal TB in non-HIV patients remains an ongoing diagnostic dilemma requiring a high index of clinical suspicion.

Mycobacterium avium subspecies paratuberculosis and its relationship with Crohn's disease

The hypothesis postulating that Mycobacterium avium paratuberculosis(MAP) is the cause of Crohn's disease(CD) has been circulating for many years.Advances in molecular techniques,such as polymerase chain reaction and culture methods,have enabled researchers to demonstrate that there is an association between MAP and CD.Recently,genome-wide association studies have identified novel susceptibility genes for CD,which are critical for generation of an adaptive immune response that is protective against intracellular pathogens,including M.tuberculosis infection.However,the role of MAP as a cause of CD suffered a setback with the report that administration of antimycobacterial therapy failed to lead to a sustained response in CD patients.Accordingly,this review sought neither to confirm nor refute this,but instead to survey recent literature on the role of MAP in CD.

Biliary tuberculosis causing cicatricial stenosis after oral anti-tuberculosis therapy

A 36-year-old Philippine woman presented with dark urine and yellow sclera. Endoscopic retrograde cholangiopancreatography （ERCP） confirmed dilatation of the intrahepatic bile ducts and also showed an irregular stricture of the common hepatic duct at the liver hilum. Histological examination of biopsies from the bile duct revealed epithelioid cell granulomas and caseous necrosis. Tubercle bacilli were then detected on polymerase chain reaction （PCR） testing of the bile, giving the diagnosis of biliary tuberculosis. Although microbiological cure was confirmed, the patient developed cicatricial stenosis of the hepatic duct. She underwent repeated treatments with endoscopic biliary drainage （EBD） tubes and percutaneous transhepatic biliary drainage （PTBD） tubes, and the stenosis was corrected after 6 years. We present a case of tuberculous biliary stricture, a condition that requires careful differentiation from the more common malignancies and needs long-term follow-up due to the risk of posttreatment cicatricial stenosis, although it is rare.

Sirolimus-related pulmonary toxicity mimicking 'asthma like' symptoms

Sirolimus is an immunosuppressant with expanding use in pediatric organ transplantation, dermatology and rheumatology. We report two cases of children who developed asthma like symptoms and were diagnosed with interstitial lung disease, which responded to discontinuation of sirolimus. Pediatricians should be aware about the pulmonary side effects of sirolimus.

Usefulness of DWI in the evaluation of pulmonary isolated lesions

Objective： The aim of our study was to investigate the value of Diffusion-weighted MR imaging （DWl） for evaluating differential diagnosis of pulmonary isolated lesions. Methods： Twenty-seven consecutive patients enrolled in this study, all of whom underwent single direction DWl examinations and received a histologic and clinical diagnosis. Diffusion factor B value was 300, 500, 800 s/mm2, respectively. DWl images of twenty cases could be satisfied to measurement and diagnosis and success rate was percent 74. Among these, lung tuberculoma 5 cases, harmatoma 3 cases, peripheral lung cancer 12 cases. The apparent diffusion coefficient （ADC） values of the lesions were measured. Statistical analyses were performed with the independent samples t test for comparing difference of ADC values between malignant nodules and benign nodules at different 8 value. Results： DWI images of twenty cases could be satisfied and its success rate was percent 74. When B value was 300 s/mm2, ADC values of malignant nodules and benign nodules were 0.002192±0.0006091 mm2/s, 0.002454 ± 0.0007892 mm2/s, respectively, and P = 0.442. When B value was 500 s/mm2, ADC value of malignant nodules and benign nodules were 0.002065 ± 0.0006769 mm2/s, 0.002871± 0.0007746 mm2/s, respectively, and P = 0.033. When B value was 800 s/mm2, ADC value of malignant nodules and benign nodules were 0.001646 ± 0.0004292 mm2/s, 0.002651 ＋ 0.0008041 mm2/s, respectively, and P = 0.009. There were the most different between malignant nodules and benign nodules at B value 800 and statistical significance. Conclusion： Lung DWl imaging is helpful to diagnosis and differential diagnosis between malignant and benign isolated nodules. The ADC value of benign lesions was statistically higher than that of malignant tumors.

Efficacy of thalidomide therapy in pediatric Crohn's disease with evidence of tuberculosis

AIM To evaluate the efficacy of thalidomide for treating troublesome cases of pediatric Crohn's disease(CD) with tuberculosis infection.METHODS A retrospective study of clinical outcome among children treated with thalidomide was conducted. All patients had evidence of tuberculosis infection with a failure of anti-tuberculosis treatment for more than one year,and were subsequently diagnosed with CD. All the patients received thalidomide treatment with a starting dose of 1.2-2.5 mg/kg per day. Remission was defined as pediatric CD activity index less than or equal to 10.RESULTS Ten patients with CD were treated with thalidomide at an average age of 7.2 years and followed up for a median of 22.2 mo. Clinical remission rate was 60% after 9-12 mo of thalidomide treatment. One patient with no response had an interleukin-10 receptor alpha gene mutation. Erythrocyte sedimentation rate,C-reactive protein and platelet count showed a dramatic decrease; hemoglobin level and weight improved significantly after thalidomide treatment when compared with the baseline values.CONCLUSION Thalidomide is an effective and safe drug for remission of CD in pediatric patients who have been treated for tuberculosis.

Sub-acute disseminated pulmonary tuberculosis in a girl diagnosed by CT guided transthoracic needle biopsy: case report and literature review

Primary tuberculosis often occurs in children with the main types of hilar lymphonode tuberculosis or Ghon complex. When pulmonary tuberculosis aggravates and tubercule bacillus invades pulmonary veins, a disseminated disease may occur clinically. One 8-year-old girl presented with hypodynamia and emaciation. CT indicated the disseminated disease and extensive mediastinal and hilar lymphadenopathy. But she had negative sputum smears and negative PPD test. The bronchi showed inflammatory change in fiberoptic bronchoscopy. Percutaneous transthoracic needle biopsy (PTNB) guided by CT was used as a means for the diagnosis of pulmonary tuberculosis. The case was rapidly diagnosed as sub-acute disseminated pulmonary tuberculosis with the help of combined CT imagine and histology.

Epithelioid haemangioendothelioma of the lung:one case report with positive pulmonary hilar lymph nodes

Pulmonary epithelioid hemangioendothelioma (PEH) is a rare tumor that occurs among young women and typically presents as bilateral multiple nodules. In this report, we described an unusual case of PEH presented as a single mass in a 46-year-old man, with 6 positive pulmonary hilar lymph nodes. Histologic findings were compared with conventional PEH, except those features such as round to oval-shaped nodules, hypocellular/cellular peripheral zone, hyaline, myxomatous intercellular stroma and intracellular vacuoles, and we found the patient's pulmonary hilar lymph nodes were metastasis and cholesterol crystal were discovered in the focal infarction areas. Immunohistochemically, the tumor cells were strong positive for CD34, CD31, factor VIII related endothelial antigen and vimentin. The patient died 3 and half months after the surgery without receiving any radiotherapy or chemotherapy. This report may contribute to the data on clinical and histological finding of this rare tumour.

Genes and regulatory networks involved in persistence of Mycobacterium tuberculosis

The causative agent of tuberculosis,Mycobacterium tuberculosis,is one of the most successful of human pathogens.It can evade the host immune response and establish a persistent infection or enter a dormant state within the host which can be reactivated if the host becomes immuno-compromised.Both of these features are major obstacles to tuberculosis eradication.Dormancy and reactivation of M.tuberculosis are tightly coordinated dynamic processes involving numerous genes and their products.Molecular mechanisms underlying M.tuberculosis persistence may provide an opportunity for the discovery of effective drug targets for tuberculosis control.Here,we review the genes required for M.tuberculosis persistence and propose a regulatory network for the action of these genes using text mining.This should provide fresh insights into the persistence mechanisms of M.tuberculosis and suggest candidates for new drug targets and immune intervention.

Optimal control of intervention strategies in malaria-tuberculosis co-infection with relapse

A model which incorporates some of the basic epidemiological features of the co- dynamics of malaria and tuberculosis （TB） is formulated and the effectiveness of current intervention strategies of these two diseases is analyzed. The malaria-only and TB-only models are considered first. Global stability disease-free steady states of the two sub- models does not hold due to the co-existence of stable disease-free with stable endemic equilibria, a phenomenon known as backward bifurcation. The dynamics of the dual malari^TB model with intervention strategies are also analyzed. Numerical simulations of the malaria-TB model are carried out to determine whether the two diseases can co- exist. Lastly, sensitivity analysis on key parameters that drive the disease dynamics is performed in order to identify their relative importance to disease transmission.