Objectives Tumor necrosis factor-α (TNF-α) may play an important role in host's immune response to mycobacterium tuberculosis (M. tuberculosis) infection. This study was to investigate the association of TNF-α...Objectives Tumor necrosis factor-α (TNF-α) may play an important role in host's immune response to mycobacterium tuberculosis (M. tuberculosis) infection. This study was to investigate the association of TNF-α gene polymorphism with pulmonary tuberculosis (TB) among patients with coal worker's pneumoconiosis (CWP). Methods A case-control study was conducted in 113 patients with confirmed CWP complicated with pulmonary TB and 113 non-TB controls with CWP. They were matched in gender, age, job, and stage of pneumoconiosis. All participants were interviewed with questionnaires and their blood specimens were collected for genetic determination with informed consent. The TNF-α gene polymorphism was determined with polymerase chain reaction of restriction fragment length polymorphism (PCR-RFLP). Frequency of genotypes was assessed for Hardy-Weinberg equilibrium by chi-square test or Fisher's exact probability. Factors influencing the association of individual susceptibility with pulmonary TB were evaluated with logistic regression analysis. Gene-environment interaction was evaluated by a multiplieative model with combined OR. All data were analyzed using SAS version 8.2 software. Results No significant difference in frequency of the TNF-α-308 genotype was found between CWP complicated with pulmonary TB and non-TB controls (2,2=5.44, P=-0.07). But difference in frequency of the TNF-α-308 A allele was identified between them (2,2-5.14, P=0.02). No significant difference in frequencies of the TNF-α-238 genotype and allele (P=0.23 and P=0.09, respectively) was found between cases and controls either, with combined (GG and AA) OR of 3.96 (95% confidence interval of 1.30-12.09) at the -308 locus of the TNF-α gene, as compared to combination of the TNF-α-238 GG and TNF-α-308 GG genotypes. Multivariate-adjusted odds ratio of the TNF-α-238 GG and TNF-α-308 GA genotypes was 1.98 (95% CI of 1.06-3.71) for risk for pulmonary TB in patients with CWP. There was a synergic interaction between the TNF-a-308 GG genotype and body mass index (OR=4.92), as well as an interaction between the TNF-α-308 GG genotype and history of BCG immunization or history of TB exposure. And, the interaction of the TNF-α-238 GG genotype and history of BCG immunization or TB exposure with risk for pulmonary TB in them was also indicated. Conclusions TNF-α-308 A allele is associated with an elevated risk for pulmonary TB, whereas TNF-α-238 A allele was otherwise.展开更多
Tuberculosis is a chronic disease that is the leading cause of infectious disease deaths worldwide. In developed countries, incidences are minimal </span></span><span style="font-family:Verdana;&qu...Tuberculosis is a chronic disease that is the leading cause of infectious disease deaths worldwide. In developed countries, incidences are minimal </span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">and </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">however</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">,</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> complicated manifestations of tuberculosis are becoming a trend within </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">the prison system. This case report illustrates a patient within the United</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> States correctional system who demonstrated a rare infection of tuberculosis despite absent pulmonary findings. Our Patient was a 39-year-old inmate presenting </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">with fatigue, night sweats, weight loss, and progressive dyspnea. Pulmonary</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> imaging and cultures of sputum were negative for tuberculosis. Further imaging and laboratory workups demonstrated extensive spinal infections along with intracranial lesions that were positive for tuberculosis. Neurosurgery declined operative medicine due to advancement of the disease and appropriate antibiotic therapy was immediately initiated. Tuberculosis continues to exist in de</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">veloped countries with an increased emergence of complicated cases. Fur</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">thermore, incarceration dramatically increases an individual’s risk of worse infections. The clinical impact involves promoting awareness for a need to identify and prevent continued spread of disseminated infections. Therefore, further investigations of this trend in prisons are worth considering.展开更多
In this manuscript the authors have studied the first two patients who were successfully treated with the treatment regimen containing Bedaquiline as second-line drug. The patients were diagnosed with pre-extensively ...In this manuscript the authors have studied the first two patients who were successfully treated with the treatment regimen containing Bedaquiline as second-line drug. The patients were diagnosed with pre-extensively drug-resistant tuberculosis (preXDR TB) whose prognosis was fatal in Democratic Republic of Congo (DRC). Bedaquiline is arguably one of the molecules of the future in the management of ultra-resistant tuberculosis. However, a larger cohort study may help to establish its effectiveness. Case report: Patients 1, 29 years old, with a history of multidrug-resistant TB (MDR-TB) one year previously. He showed signs of TB impregnation again 6 months after the last treatment. Bascilloscopy was positive again. The pre-extensively tuberculosis (pre-XDR TB) diagnosis was made by the Hain test (GenoType®MTBDRsl, Hain Lifescience). Patient 2, brother of the first patient, with a history of MDR TB a year before. He had low back pain with right parietal dorso swelling four months after the last treatment. The x-ray of the column showed L4-L5 disc disease. Parietal ultrasound showed a parietal abscess to the right of thoracic vertebrae with fistulization. Surgical biopsy and pus culture confirmed the diagnosis of Pre-XDR Extrapulmonary TB. The treatment regimen was the same for both patients: 6 months with Amikacin (Am) Bedaquiline (Bdq) Prothionamide (Pto) Paraamino Salicylic acid (PAS) Linezolid (Lzd) Cycloserine (Cs) Pyrazinamide (Z) and 14 months with PAS Lzd Cs Z. The side effects were minor. Bacteriological controls (smears and cultures) after 20 months of treatment are negative to date.展开更多
基金National Natural Science Foundation of China(12175254,U1832119)National Key R&D Program of China(2021YFE0104800)+2 种基金International Partnership Program of Chinese Academy of Sciences(121631KYSB20200039)International Cooperation Project of Shanghai Science and Technology Commission(20520750200)National Centre for Research and Development(WPC2/1/SCAPOL/2021)。
基金supported by grants from China National Programs for Science and Technology Development (Grant No. 2003BA712A11-24)Scientific Research Fund of North China Coal Medical College (Grant No. 2005-14)
文摘Objectives Tumor necrosis factor-α (TNF-α) may play an important role in host's immune response to mycobacterium tuberculosis (M. tuberculosis) infection. This study was to investigate the association of TNF-α gene polymorphism with pulmonary tuberculosis (TB) among patients with coal worker's pneumoconiosis (CWP). Methods A case-control study was conducted in 113 patients with confirmed CWP complicated with pulmonary TB and 113 non-TB controls with CWP. They were matched in gender, age, job, and stage of pneumoconiosis. All participants were interviewed with questionnaires and their blood specimens were collected for genetic determination with informed consent. The TNF-α gene polymorphism was determined with polymerase chain reaction of restriction fragment length polymorphism (PCR-RFLP). Frequency of genotypes was assessed for Hardy-Weinberg equilibrium by chi-square test or Fisher's exact probability. Factors influencing the association of individual susceptibility with pulmonary TB were evaluated with logistic regression analysis. Gene-environment interaction was evaluated by a multiplieative model with combined OR. All data were analyzed using SAS version 8.2 software. Results No significant difference in frequency of the TNF-α-308 genotype was found between CWP complicated with pulmonary TB and non-TB controls (2,2=5.44, P=-0.07). But difference in frequency of the TNF-α-308 A allele was identified between them (2,2-5.14, P=0.02). No significant difference in frequencies of the TNF-α-238 genotype and allele (P=0.23 and P=0.09, respectively) was found between cases and controls either, with combined (GG and AA) OR of 3.96 (95% confidence interval of 1.30-12.09) at the -308 locus of the TNF-α gene, as compared to combination of the TNF-α-238 GG and TNF-α-308 GG genotypes. Multivariate-adjusted odds ratio of the TNF-α-238 GG and TNF-α-308 GA genotypes was 1.98 (95% CI of 1.06-3.71) for risk for pulmonary TB in patients with CWP. There was a synergic interaction between the TNF-a-308 GG genotype and body mass index (OR=4.92), as well as an interaction between the TNF-α-308 GG genotype and history of BCG immunization or history of TB exposure. And, the interaction of the TNF-α-238 GG genotype and history of BCG immunization or TB exposure with risk for pulmonary TB in them was also indicated. Conclusions TNF-α-308 A allele is associated with an elevated risk for pulmonary TB, whereas TNF-α-238 A allele was otherwise.
文摘Tuberculosis is a chronic disease that is the leading cause of infectious disease deaths worldwide. In developed countries, incidences are minimal </span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">and </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">however</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">,</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> complicated manifestations of tuberculosis are becoming a trend within </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">the prison system. This case report illustrates a patient within the United</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> States correctional system who demonstrated a rare infection of tuberculosis despite absent pulmonary findings. Our Patient was a 39-year-old inmate presenting </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">with fatigue, night sweats, weight loss, and progressive dyspnea. Pulmonary</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> imaging and cultures of sputum were negative for tuberculosis. Further imaging and laboratory workups demonstrated extensive spinal infections along with intracranial lesions that were positive for tuberculosis. Neurosurgery declined operative medicine due to advancement of the disease and appropriate antibiotic therapy was immediately initiated. Tuberculosis continues to exist in de</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">veloped countries with an increased emergence of complicated cases. Fur</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">thermore, incarceration dramatically increases an individual’s risk of worse infections. The clinical impact involves promoting awareness for a need to identify and prevent continued spread of disseminated infections. Therefore, further investigations of this trend in prisons are worth considering.
文摘In this manuscript the authors have studied the first two patients who were successfully treated with the treatment regimen containing Bedaquiline as second-line drug. The patients were diagnosed with pre-extensively drug-resistant tuberculosis (preXDR TB) whose prognosis was fatal in Democratic Republic of Congo (DRC). Bedaquiline is arguably one of the molecules of the future in the management of ultra-resistant tuberculosis. However, a larger cohort study may help to establish its effectiveness. Case report: Patients 1, 29 years old, with a history of multidrug-resistant TB (MDR-TB) one year previously. He showed signs of TB impregnation again 6 months after the last treatment. Bascilloscopy was positive again. The pre-extensively tuberculosis (pre-XDR TB) diagnosis was made by the Hain test (GenoType®MTBDRsl, Hain Lifescience). Patient 2, brother of the first patient, with a history of MDR TB a year before. He had low back pain with right parietal dorso swelling four months after the last treatment. The x-ray of the column showed L4-L5 disc disease. Parietal ultrasound showed a parietal abscess to the right of thoracic vertebrae with fistulization. Surgical biopsy and pus culture confirmed the diagnosis of Pre-XDR Extrapulmonary TB. The treatment regimen was the same for both patients: 6 months with Amikacin (Am) Bedaquiline (Bdq) Prothionamide (Pto) Paraamino Salicylic acid (PAS) Linezolid (Lzd) Cycloserine (Cs) Pyrazinamide (Z) and 14 months with PAS Lzd Cs Z. The side effects were minor. Bacteriological controls (smears and cultures) after 20 months of treatment are negative to date.