Around 85% of the cases of Tuberculosis (TB) are pulmonary in origin and the routine diagnosis usually depends on sputum microscopy. The conventional direct Ziehl-Nelson (ZN) staining technique has been found to have ...Around 85% of the cases of Tuberculosis (TB) are pulmonary in origin and the routine diagnosis usually depends on sputum microscopy. The conventional direct Ziehl-Nelson (ZN) staining technique has been found to have a low sensitivity. The main objective of the study was to verify whether the bleach concentration method increases the sensitivity of sputum smear microscopy for AFB or not and also to see whether the first single morning sample alone is sufficient and better than the three pooled samples after bleach concentration followed by ZN staining. A total of 365 samples were studied from 131 clinically suspected cases of pulmonary TB which included sputum (112), gastric aspirate (5), endotracheal tube washing (2), and bronchial lavage (12). All these samples were processed for conventional ZN staining and Bleach concentration method followed by ZN staining. An increase in positivity was observed in all the cases after using the bleach concentration method and the most significantly useful was that in the case of first morning sputum samples where it increased from 11.6% to 41.96%. Bleach concentration is a simple, cheap and easily available method and also very safe because it kills the Mycobacteria in the process. Its positivity rate is better as compared to direct conventional ZN staining.展开更多
Background:Pulmonary tuberculosis(PTB,both smear positive and smear negative)is an airborne infectious disease of major public health concern in China and other parts of the world where PTB endemicity is reported.This...Background:Pulmonary tuberculosis(PTB,both smear positive and smear negative)is an airborne infectious disease of major public health concern in China and other parts of the world where PTB endemicity is reported.This study aims at identifying PTB spatio-temporal clusters and associated risk factors in Zhaotong prefecture-level city,located in southwest China,where the PTB notification rate was higher than the average rate in the entire country.Methods:Space-time scan statistics were carried out using PTB registered data in the nationwide TB online registration system from 2011 to 2015,to identify spatial clusters.PTB patients diagnosed between October 2015 and February 2016 were selected and a structured questionnaire was administered to collect a set of variables that includes socio-economic status,behavioural characteristics,local environmental and biological characteristics.Based on the discovery of detailed town-level spatio-temporal PTB clusters,we divided selected subjects into two groups including the cases that resides within and outside identified clusters.Then,logistic regression analysis was applied comparing the results of variables between the two groups.Results:A total of 1508 subjects consented and participated in the survey.Clusters for PTB cases were identified in 38 towns distributed over south-western Zhaotong.Logistic regression analysis showed that history of chronic bronchitis(OR=3.683,95%CI:2.180-6.223),living in an urban area(OR=5.876,95%CI:2.381-14.502)and using coal as the main fuel(OR=9.356,95%CI:5.620-15.576)were independently associated with clustering.While,not smoking(OR=0.340,95%CI:0.137-0.843)is the protection factor of spatial clustering.Conclusions:We found PTB specially clustered in south-western Zhaotong.The strong associated factors influencing the PTB spatial cluster including:the history of chronic bronchitis,living in the urban area,smoking and the use of coal as the main fuel for cooking and heating.Therefore,efforts should be made to curtail these associated factors.展开更多
Background:PTB is an infectious disease,which not only seriously affects people's health,but also causes a heavier disease economic burden on patients.At present,reform of the medical insurance payment can be an e...Background:PTB is an infectious disease,which not only seriously affects people's health,but also causes a heavier disease economic burden on patients.At present,reform of the medical insurance payment can be an effective method to control medical expenses.Therefore,our study is to explore the compensation mechanism for pulmonary tuberculosis(PTB)patients with a full period of treatment,to alleviate the financial burden of PTB patients and provide a reference and basis for the reform of PTB payment methods in other regions and countries.展开更多
Background:Tuberculosis(TB)remains a major threat to human health,and TB diagnostic methods remain unsatisfactory.Nucleic acid amplification tests(NAATs)show higher sensitivity compared with culture for the diagnosis ...Background:Tuberculosis(TB)remains a major threat to human health,and TB diagnostic methods remain unsatisfactory.Nucleic acid amplification tests(NAATs)show higher sensitivity compared with culture for the diagnosis of pulmonary TB(PTB).However,NAATs are expensive and cannot be easily implemented outside major medical centers.To improve the sensitivity of NAATs for PTB diagnosis,we investigated the predictive factors that might optimize NAAT utilization.Methods:A total of 1263 patients with suspected PTB were enrolled for evaluation.The sensitivity,specificity,and accuracy of methods including smear-microbiology,culture of Mtb and NAAT for Mycobacterium tuberculosis(Mtb)detection in sputum and bronchoalveolar lavage fluid samples were compared.Odds ratios and 95%confidence intervals were used to assess variables that might be associated with positive NAAT results for sputum and bronchoalveolar lavage fluid from patients with suspected PTB.Results:NAAT showed higher sensitivity for Mtb detection(61.1%)when compared with smear(9.0%)and Mtb culture(47.8%).We found that an elevated erythrocyte sedimentation rate,the presence of cavities,and positive interferon-𝛾release assay(IGRA)results were indicative of positive Mtb detection by NAAT.Moreover,individuals who had all three of these characteristics showed an 86%diagnostic positivity for PTB from Mtb detection by NAAT.Conclusions:Our study suggests that an elevated erythrocyte sedimentation rate,a positive IGRA result,and the presence of pulmonary cavities are helpful factors for predicting positive Mtb detection by NAAT.Patients with the three positive clinical markers should undergo NAAT for Mtb detection because they are the most likely individuals to be bacteriologically confirmed as having TB.展开更多
文摘Around 85% of the cases of Tuberculosis (TB) are pulmonary in origin and the routine diagnosis usually depends on sputum microscopy. The conventional direct Ziehl-Nelson (ZN) staining technique has been found to have a low sensitivity. The main objective of the study was to verify whether the bleach concentration method increases the sensitivity of sputum smear microscopy for AFB or not and also to see whether the first single morning sample alone is sufficient and better than the three pooled samples after bleach concentration followed by ZN staining. A total of 365 samples were studied from 131 clinically suspected cases of pulmonary TB which included sputum (112), gastric aspirate (5), endotracheal tube washing (2), and bronchial lavage (12). All these samples were processed for conventional ZN staining and Bleach concentration method followed by ZN staining. An increase in positivity was observed in all the cases after using the bleach concentration method and the most significantly useful was that in the case of first morning sputum samples where it increased from 11.6% to 41.96%. Bleach concentration is a simple, cheap and easily available method and also very safe because it kills the Mycobacteria in the process. Its positivity rate is better as compared to direct conventional ZN staining.
基金This study was supported by the National Special Science and Technology Project for Major Infectious Diseases of China(Grant No.2012ZX10004–220,2016ZX10004222–006)the China-UK Global Health Support Programme(Grant No.GHSP-CS-OP1–01)+1 种基金The Forth Round of Three-Year Public Health Action Plan of Shanghai,China(No.15GWZK0101,GWIV-29)The funders had no role in the study design,data collection and analysis,decision to publish,or preparation of the paper.
文摘Background:Pulmonary tuberculosis(PTB,both smear positive and smear negative)is an airborne infectious disease of major public health concern in China and other parts of the world where PTB endemicity is reported.This study aims at identifying PTB spatio-temporal clusters and associated risk factors in Zhaotong prefecture-level city,located in southwest China,where the PTB notification rate was higher than the average rate in the entire country.Methods:Space-time scan statistics were carried out using PTB registered data in the nationwide TB online registration system from 2011 to 2015,to identify spatial clusters.PTB patients diagnosed between October 2015 and February 2016 were selected and a structured questionnaire was administered to collect a set of variables that includes socio-economic status,behavioural characteristics,local environmental and biological characteristics.Based on the discovery of detailed town-level spatio-temporal PTB clusters,we divided selected subjects into two groups including the cases that resides within and outside identified clusters.Then,logistic regression analysis was applied comparing the results of variables between the two groups.Results:A total of 1508 subjects consented and participated in the survey.Clusters for PTB cases were identified in 38 towns distributed over south-western Zhaotong.Logistic regression analysis showed that history of chronic bronchitis(OR=3.683,95%CI:2.180-6.223),living in an urban area(OR=5.876,95%CI:2.381-14.502)and using coal as the main fuel(OR=9.356,95%CI:5.620-15.576)were independently associated with clustering.While,not smoking(OR=0.340,95%CI:0.137-0.843)is the protection factor of spatial clustering.Conclusions:We found PTB specially clustered in south-western Zhaotong.The strong associated factors influencing the PTB spatial cluster including:the history of chronic bronchitis,living in the urban area,smoking and the use of coal as the main fuel for cooking and heating.Therefore,efforts should be made to curtail these associated factors.
文摘Background:PTB is an infectious disease,which not only seriously affects people's health,but also causes a heavier disease economic burden on patients.At present,reform of the medical insurance payment can be an effective method to control medical expenses.Therefore,our study is to explore the compensation mechanism for pulmonary tuberculosis(PTB)patients with a full period of treatment,to alleviate the financial burden of PTB patients and provide a reference and basis for the reform of PTB payment methods in other regions and countries.
基金This work was supported by the Natural Science Foundation of China(No.81,873,958,81,802,058)the National Key Research and Development Plan(No.2019YFC0840602,2020YFA0907201)+2 种基金the Guang-dong Scientific and Technological Foundation(No.2019B1515120041,2020B1111170014)the Shen-zhen Scientific and Technological Foundation(No.JCYJ20180228162336873,JCYJ20180228162321234,KCXFZ202002011007083)the China Postdoctoral Science Foundation(No.2020M670085ZX).
文摘Background:Tuberculosis(TB)remains a major threat to human health,and TB diagnostic methods remain unsatisfactory.Nucleic acid amplification tests(NAATs)show higher sensitivity compared with culture for the diagnosis of pulmonary TB(PTB).However,NAATs are expensive and cannot be easily implemented outside major medical centers.To improve the sensitivity of NAATs for PTB diagnosis,we investigated the predictive factors that might optimize NAAT utilization.Methods:A total of 1263 patients with suspected PTB were enrolled for evaluation.The sensitivity,specificity,and accuracy of methods including smear-microbiology,culture of Mtb and NAAT for Mycobacterium tuberculosis(Mtb)detection in sputum and bronchoalveolar lavage fluid samples were compared.Odds ratios and 95%confidence intervals were used to assess variables that might be associated with positive NAAT results for sputum and bronchoalveolar lavage fluid from patients with suspected PTB.Results:NAAT showed higher sensitivity for Mtb detection(61.1%)when compared with smear(9.0%)and Mtb culture(47.8%).We found that an elevated erythrocyte sedimentation rate,the presence of cavities,and positive interferon-𝛾release assay(IGRA)results were indicative of positive Mtb detection by NAAT.Moreover,individuals who had all three of these characteristics showed an 86%diagnostic positivity for PTB from Mtb detection by NAAT.Conclusions:Our study suggests that an elevated erythrocyte sedimentation rate,a positive IGRA result,and the presence of pulmonary cavities are helpful factors for predicting positive Mtb detection by NAAT.Patients with the three positive clinical markers should undergo NAAT for Mtb detection because they are the most likely individuals to be bacteriologically confirmed as having TB.
