This study aimed to learn the recurrence rate in the retreatment TB patients with sputum smear and/or culture positive （ss＋ and/or c＋） two years after they were declared cured, and to explore causes of recurrence ...This study aimed to learn the recurrence rate in the retreatment TB patients with sputum smear and/or culture positive （ss＋ and/or c＋） two years after they were declared cured, and to explore causes of recurrence in order to improve long-time treatment outcome. 5 cities were selected as research locations. Recurrence of TB was judged by chest X-ray examination together with sputum smear and culture examination.展开更多
Background:Quick diagnosis of smear-negative pulmonary tuberculosis(TB)and extra-pulmonary TB are urgently needed in clinical diagnosis.Our research aims to investigate the usefulness of the interferon-γrelease assay...Background:Quick diagnosis of smear-negative pulmonary tuberculosis(TB)and extra-pulmonary TB are urgently needed in clinical diagnosis.Our research aims to investigate the usefulness of the interferon-γrelease assay(IGRA)for the diagnosis of smear-negative pulmonary and extra-pulmonary TB.Methods:We performed TB antibody and TB-IGRA tests on 389 pulmonary TB patients(including 120 smear-positive pulmonary TB patients and 269 smear-negative pulmonary TB patients),113 extra-pulmonary TB patients,81 patients with other pulmonary diseases and 100 healthy controls.Blood samples for the TB-Ab test and the TB-IGRA were collected,processed,and interpreted according to the manufacturer’s protocol.Results:The detection ratio of smear-positive pulmonary TB patients and smear-negative pulmonary TB patients were 90.8%(109 of 120)and 89.6%(241 of 269),respectively.There was no statistically significant difference of its performance between these two sample sets(P>0.05).The detection ratio of positive TB patients and extra-pulmonary TB patients were 90.0%(350 of 389)and 87.6%(99 of 113),respectively,which was not significantly different(P>0.05).Conclusions:In this work,the total detection ratio using TB-IGRA was 89.4%,therefore TB-IGRA has diagnostic values in smear-negative pulmonary TB and extra-pulmonary TB diagnosis.展开更多
The SSM （sputum smear microscopy） and five immunochromatographic tuberculosis antibody detection tests （DiaSpot TB, Spodex TB, SD Rapid TB, Clinotech TB Screen and Precious One-step TB） were compared for diagnosis...The SSM （sputum smear microscopy） and five immunochromatographic tuberculosis antibody detection tests （DiaSpot TB, Spodex TB, SD Rapid TB, Clinotech TB Screen and Precious One-step TB） were compared for diagnosis of active TB at the Leprosy and Tuberculosis Referral Hospital, Uzuakoli, Abia State, Nigeria. Sputum specimens from 150 study participants （male/female ratio, 0.81） were cultured on Lowenstein-Jensen slopes and direct smears were stained by Ziehl-Neelsen technique and examined by light microscopy. Sera were tested for anti-TB antibodies using the rapid TB tests. A total of 91 participants were culture positive, 79 （86.8%） for M. tuberculosis and 12 （13.2%） for nontuberculous mycobacteria. The sensitivity of SSM was 50% （95% CI： 39.0-61.0） and specificity was 92.3% （95% CI： 86.4-98.2） in those culture positive for M. tuberculosis. The sensitivity and specificity of the Rapid TB tests ranged from 24.1-39.2% and 78.4-87.8%, respectively. None of the five rapid TB tests had acceptable level of accuracy for diagnosis of active TB. The sensitivity of SSM though moderate is inadequate for long term TB control in this setting.展开更多
The prevalence of TB in sub-Sahara Africa has been reported as 511 per 100,000 populations and a mortality of 74 per 100,000 in year 2009. In the same period, incidence was estimated at 350 cases per 100,000. In this ...The prevalence of TB in sub-Sahara Africa has been reported as 511 per 100,000 populations and a mortality of 74 per 100,000 in year 2009. In the same period, incidence was estimated at 350 cases per 100,000. In this regard, the health system requires strengthening to respond to the rising cases of infection, drug resistance and quality of life lost while continuing to seek interventions that improve adherence to medication and case detection among those infected. Methods: This study sought to determine factors that are associated with sputum positivity after intensive phase of chemotherapy in people with tuberculosis. It was a retrospective case-control study conducted in Rhodes chest clinic, a City Council health unit in Nairobi that specializes in treatment of chest infections. The participants were sampled from clinic attendants who had completed two months of intensive phase TB chemotherapy and met inclusion criteria. Results: Seventy participants of whom 25 (36%) were sputum positive at the end of two (2) months intensive phase were included in the study. Skipping medication doses was significantly associated with sputum positivity (p = 0.01). Patients who were sputum positive at the end of the two-month period were more likely to have taken longer time before seeking treatment compared to those who were sputum negative by median (IQR) 8 (3 - 12) and 4 (3 - 8) weeks respectively although this difference was not significant (p = 0.09). Patients who had not disclosed their infection status had a two-fold possibility of remaining sputum positive at the end of intensive phase. Conclusion: Early diagnosis and treatment of TB, and adherence to medication were important factors that affect sputum conversion during intensive phase of TB treatment. Therefore, public health practitioners should advise patients to seek prompt diagnosis and treatment of signs and symptoms of tuberculosis.展开更多
Background： Direct ZN （Ziehl-Neelsen） sputum smear microscopy for diagnosis of TB （tuberculosis） has low sensitivity, especially in TB/HIV co-infected patients. Sputum concentration by bleach （NaOCI） with sedim...Background： Direct ZN （Ziehl-Neelsen） sputum smear microscopy for diagnosis of TB （tuberculosis） has low sensitivity, especially in TB/HIV co-infected patients. Sputum concentration by bleach （NaOCI） with sedimentation has been used to increase the sensitivity of sputum smear microscopy in many settings but with varying results. Objective： To determine whether bleach plus centrifugation significantly improves the detection of AFB （acid-fast bacilli） in ZN smear-negative sputum specimens. Methods： Three hundred and seventy sputum specimens were collected from new TB suspects attending a Nairobi referral district hospital and processed for direct microscopy using ZN technique and culture on Lowenstein Jensen Media. All smear-negative specimens were treated with 3.5% bleach and left to stand for 30 min before centrifugation. The bleach treated smears were processed and examined using ZN technique. Results： Of the 370 specimens, 200 （54%） were positive culture. The number of sputum samples that were smear-positive by direct ZN was 138 （37.2%）, with a sensitivity of 66%. After treatment of direct ZN smear-negative specimens with 3.5% bleach and centrifugation, the total number of AFB smear-positive samples increased to 171 with an increase in sensitivity of 66% to 81.1% （15.1%）. Conclusion： In this study, bleach with centrifugation significantly increased the yield of sputum smear microscopy. Further evaluation of these techniques in routine programmes is required especially in settings where the burden of TB/HIV is high.展开更多
Background Early detection of pulmonary tuberculosis （PTB） is a big challenge in smear negative and sputum scarce patients in China.Simultaneous amplification and testing methods for detection of the Mycobactedum tu...Background Early detection of pulmonary tuberculosis （PTB） is a big challenge in smear negative and sputum scarce patients in China.Simultaneous amplification and testing methods for detection of the Mycobactedum tuberculosis （MTB） complex （SAT-TB assay） is a novel molecular technique established in our hospital.This method has a high sensitivity and specificity in the lab.In this study,the clinical diagnostic performance of this method in smear-negative or sputum-scarce PTB suspects was investigated and evaluated.Methods Two hundred smear negative and 80 sputum-scarce patients were recruited in this study.Samples that included sputum or bronchial washing fluid were collected and sent for both bacteria culture and SAT-TB assay.Diagnosis for these patients was based on the comprehensive evaluation of chestX-ray/CT study,histology examination,lab results,and treatment response.Sensitivity,specificity,positive predictive value （PPV） and negative predictive value （NPV） for each diagnostic test were investigated and calculated using confirmed tuberculosis （TB） and non-TB cases.The time required for detection of MTB was also measured for each method.Results Ninety-two patients （33％） were diagnosed as definitive TB,112 patients （40％） were probable PTB,and 76 （27％） were non-TB.The sensitivity,specificity,PPV,and NPV of SAT-TB in smear-negative PTB suspects were 93％ （95％ CI,84％-98％）,98％ （95％ CI,90％-100％）,98％ （95％ Cl,91％-100％）,and 93％ （95％ CI,83％-98％）.In sputum scarce PTB suspects,the sensitivity,specificity,PPV,and NPV of the SAT-TB assay on bronchial washing fiuids were 90％ （95％Cl,74％-98％）,100％ （95％ Cl,85％-100％）,100％ （95％ Cl,88％-100％）,and 88％ （95％ CI,69％-97％）.The accuracy of the SAT-TB assay is consistent with the bacteria culture assay.The median time required for detecting MTB in the SAT-TB assay was 0.5 day,which was much faster than bacteria culture （28 days）.Conclusions The SAT-TB assay is a fast and accurate method for the detection of MTB.It can be widely applied in the clinic and be an asset in early detection and management of PTB suspects,especially in those patients who are smear negative or sputum scarce.展开更多
基金supported by ‘Follow-up Study of Retreatment TB Patients with Sputum Smear Positive Two Years after Declared Cured’(TB10-002)
文摘This study aimed to learn the recurrence rate in the retreatment TB patients with sputum smear and/or culture positive （ss＋ and/or c＋） two years after they were declared cured, and to explore causes of recurrence in order to improve long-time treatment outcome. 5 cities were selected as research locations. Recurrence of TB was judged by chest X-ray examination together with sputum smear and culture examination.
基金This work was supported by Grants from the National Natural Sciences Foundation of China(81271893)the Natural Science Foundation of Zhejiang Province(LY12H19002)+2 种基金Zhejiang Provincial Program for the Cultivation of High-level Innovative Health Talents,the Scientific Research Foundation of the Education Department of Zhejiang Province(Y201534356)the Natural Science Foundation of Zhejiang Medical College(2014B01)Visiting Engineer Program of the Education Department of Zhejiang Province(FG2014011).
文摘Background:Quick diagnosis of smear-negative pulmonary tuberculosis(TB)and extra-pulmonary TB are urgently needed in clinical diagnosis.Our research aims to investigate the usefulness of the interferon-γrelease assay(IGRA)for the diagnosis of smear-negative pulmonary and extra-pulmonary TB.Methods:We performed TB antibody and TB-IGRA tests on 389 pulmonary TB patients(including 120 smear-positive pulmonary TB patients and 269 smear-negative pulmonary TB patients),113 extra-pulmonary TB patients,81 patients with other pulmonary diseases and 100 healthy controls.Blood samples for the TB-Ab test and the TB-IGRA were collected,processed,and interpreted according to the manufacturer’s protocol.Results:The detection ratio of smear-positive pulmonary TB patients and smear-negative pulmonary TB patients were 90.8%(109 of 120)and 89.6%(241 of 269),respectively.There was no statistically significant difference of its performance between these two sample sets(P>0.05).The detection ratio of positive TB patients and extra-pulmonary TB patients were 90.0%(350 of 389)and 87.6%(99 of 113),respectively,which was not significantly different(P>0.05).Conclusions:In this work,the total detection ratio using TB-IGRA was 89.4%,therefore TB-IGRA has diagnostic values in smear-negative pulmonary TB and extra-pulmonary TB diagnosis.
文摘The SSM （sputum smear microscopy） and five immunochromatographic tuberculosis antibody detection tests （DiaSpot TB, Spodex TB, SD Rapid TB, Clinotech TB Screen and Precious One-step TB） were compared for diagnosis of active TB at the Leprosy and Tuberculosis Referral Hospital, Uzuakoli, Abia State, Nigeria. Sputum specimens from 150 study participants （male/female ratio, 0.81） were cultured on Lowenstein-Jensen slopes and direct smears were stained by Ziehl-Neelsen technique and examined by light microscopy. Sera were tested for anti-TB antibodies using the rapid TB tests. A total of 91 participants were culture positive, 79 （86.8%） for M. tuberculosis and 12 （13.2%） for nontuberculous mycobacteria. The sensitivity of SSM was 50% （95% CI： 39.0-61.0） and specificity was 92.3% （95% CI： 86.4-98.2） in those culture positive for M. tuberculosis. The sensitivity and specificity of the Rapid TB tests ranged from 24.1-39.2% and 78.4-87.8%, respectively. None of the five rapid TB tests had acceptable level of accuracy for diagnosis of active TB. The sensitivity of SSM though moderate is inadequate for long term TB control in this setting.
文摘The prevalence of TB in sub-Sahara Africa has been reported as 511 per 100,000 populations and a mortality of 74 per 100,000 in year 2009. In the same period, incidence was estimated at 350 cases per 100,000. In this regard, the health system requires strengthening to respond to the rising cases of infection, drug resistance and quality of life lost while continuing to seek interventions that improve adherence to medication and case detection among those infected. Methods: This study sought to determine factors that are associated with sputum positivity after intensive phase of chemotherapy in people with tuberculosis. It was a retrospective case-control study conducted in Rhodes chest clinic, a City Council health unit in Nairobi that specializes in treatment of chest infections. The participants were sampled from clinic attendants who had completed two months of intensive phase TB chemotherapy and met inclusion criteria. Results: Seventy participants of whom 25 (36%) were sputum positive at the end of two (2) months intensive phase were included in the study. Skipping medication doses was significantly associated with sputum positivity (p = 0.01). Patients who were sputum positive at the end of the two-month period were more likely to have taken longer time before seeking treatment compared to those who were sputum negative by median (IQR) 8 (3 - 12) and 4 (3 - 8) weeks respectively although this difference was not significant (p = 0.09). Patients who had not disclosed their infection status had a two-fold possibility of remaining sputum positive at the end of intensive phase. Conclusion: Early diagnosis and treatment of TB, and adherence to medication were important factors that affect sputum conversion during intensive phase of TB treatment. Therefore, public health practitioners should advise patients to seek prompt diagnosis and treatment of signs and symptoms of tuberculosis.
文摘Background： Direct ZN （Ziehl-Neelsen） sputum smear microscopy for diagnosis of TB （tuberculosis） has low sensitivity, especially in TB/HIV co-infected patients. Sputum concentration by bleach （NaOCI） with sedimentation has been used to increase the sensitivity of sputum smear microscopy in many settings but with varying results. Objective： To determine whether bleach plus centrifugation significantly improves the detection of AFB （acid-fast bacilli） in ZN smear-negative sputum specimens. Methods： Three hundred and seventy sputum specimens were collected from new TB suspects attending a Nairobi referral district hospital and processed for direct microscopy using ZN technique and culture on Lowenstein Jensen Media. All smear-negative specimens were treated with 3.5% bleach and left to stand for 30 min before centrifugation. The bleach treated smears were processed and examined using ZN technique. Results： Of the 370 specimens, 200 （54%） were positive culture. The number of sputum samples that were smear-positive by direct ZN was 138 （37.2%）, with a sensitivity of 66%. After treatment of direct ZN smear-negative specimens with 3.5% bleach and centrifugation, the total number of AFB smear-positive samples increased to 171 with an increase in sensitivity of 66% to 81.1% （15.1%）. Conclusion： In this study, bleach with centrifugation significantly increased the yield of sputum smear microscopy. Further evaluation of these techniques in routine programmes is required especially in settings where the burden of TB/HIV is high.
文摘Background Early detection of pulmonary tuberculosis （PTB） is a big challenge in smear negative and sputum scarce patients in China.Simultaneous amplification and testing methods for detection of the Mycobactedum tuberculosis （MTB） complex （SAT-TB assay） is a novel molecular technique established in our hospital.This method has a high sensitivity and specificity in the lab.In this study,the clinical diagnostic performance of this method in smear-negative or sputum-scarce PTB suspects was investigated and evaluated.Methods Two hundred smear negative and 80 sputum-scarce patients were recruited in this study.Samples that included sputum or bronchial washing fluid were collected and sent for both bacteria culture and SAT-TB assay.Diagnosis for these patients was based on the comprehensive evaluation of chestX-ray/CT study,histology examination,lab results,and treatment response.Sensitivity,specificity,positive predictive value （PPV） and negative predictive value （NPV） for each diagnostic test were investigated and calculated using confirmed tuberculosis （TB） and non-TB cases.The time required for detection of MTB was also measured for each method.Results Ninety-two patients （33％） were diagnosed as definitive TB,112 patients （40％） were probable PTB,and 76 （27％） were non-TB.The sensitivity,specificity,PPV,and NPV of SAT-TB in smear-negative PTB suspects were 93％ （95％ CI,84％-98％）,98％ （95％ CI,90％-100％）,98％ （95％ Cl,91％-100％）,and 93％ （95％ CI,83％-98％）.In sputum scarce PTB suspects,the sensitivity,specificity,PPV,and NPV of the SAT-TB assay on bronchial washing fiuids were 90％ （95％Cl,74％-98％）,100％ （95％ Cl,85％-100％）,100％ （95％ Cl,88％-100％）,and 88％ （95％ CI,69％-97％）.The accuracy of the SAT-TB assay is consistent with the bacteria culture assay.The median time required for detecting MTB in the SAT-TB assay was 0.5 day,which was much faster than bacteria culture （28 days）.Conclusions The SAT-TB assay is a fast and accurate method for the detection of MTB.It can be widely applied in the clinic and be an asset in early detection and management of PTB suspects,especially in those patients who are smear negative or sputum scarce.
