Association between NOS 2 gene polymorphisms and susceptibility of anti-tuberculous drug induced liver injury / 中华传染病杂志

Objective Inducible isoform of NO synthase(iNOS),coded by NOS2,is one of the antioxidant enzymes. The aim of this study is to explore the association between NOS2 gene polymorphisms and susceptibility of anti-tuberculous drug induced liver injury(ATDILI).Methods Sixteen tagSNP of NOS2 gene were selected using systematic bioinformatic analysis(HWE-P> 0.001, MAF>0.1,r2>0.8).A population based case-control study was performed to genotype 16 tagSNP of NOS2 gene in 461 ATDILI patients and 466 non-ATDILI patients using SNPscanTMtechnology.The genotype and haplotype frequencies were compared between case and control groups.Three genetic models including dominant,recessive and additive models were used to analyze the association between all the selected SNP polymorphisms and susceptibility of ATDILI.Results All the alleles frequencies of these SNP were in Hardy-Weinberg equilibrium.NOS2 rs9906835 G/A genotype,rs944725 T/C genotype, rs3794763 G/A genotype,rs3794764 G/A and A/A genotype,rs6505469 T/A genotype were associated with increased risk for developing ATDILI(all P< 0.05).NOS2 rs9906835,rs944725,rs3794763, rs3794764 and rs6505469 were associated with susceptibility of ATDILI in dominant model(all P<0.05).NOS2 rs944725,rs3794763 and rs3794764 were associated with increased risk for developing ATDILI in recessive model(all P< 0.05).In addition,CGCATT,AC and AAA haplotypes of NOS2 gene were found to have association with susceptibility of ATDILI(all P<0.05).Conclusion Our study showed that NOS2 gene is a susceptible gene of ATDILI.

Risk factors of anti-tuberculosis drugs induced liver injury and its impact on the treatment outcome of patients treated with first line anti-tuberculosis drugs: a historic retrospective cohort study / 中华传染病杂志

Objective To explore the incidence and risk factors of anti-tuberculosis (TB) drugs induced liver injury (ATDILI) and to discuss its impact on the treatment outcome of patients treated with first line anti-TB drugs.Methods Among the patients who received anti-TB treatment with directly-observed treatment strategy (DOTS),121 patients with ATDILI and 817 patients without ATDILI were included in this retrospective cohort study.Binary Logistic regression model was used to analyze the risk factors of ATDILI in univariate and multivariate analysis.The x2 test was used to compare the treatment success rates and drug resistant rates.Kaplan-Meier analysis and Log-rank test were used to compare the sputum smear/culture conversion rates and cavity closure rates.Results The incidence of ATDILI was 12.9％ (121/938) in this cohort.Multivariate Logistic regression showed that hepatitis B virus carrier with both hepatitis B surface antigen (HBsAg) and hepatitis B e antigen (HBeAg) positive (OR=4.29,95％CI:2.15-8.58,P＜0.01),complicated with systemic lupus erythematosus (OR=3.34,95％CI:1.46-7.63,P=0.004),serum albumin ≤25 g/L (OR=3.14,95％CI:1.50-6.58,P=0.002) and alcoholism (OR=1.79,95％CI:1.14-2.82,P=0.012) were independent risk factors of ATDILI.The treatment failure rate in patients with ATDILI was significantly higher than that in patients without ATDILI (19.1％[24/121] vs8.0％[65/817],OR=2.86,95％CI:1.71-4.78,P＜0.01).The drug resistant rates of two groups were not significant different (4.1％[5/121] vs 1.7％[14/817],P＞0.05).The sputum smear/culture conversion rate (85.4％[41/48] vs 94.0％ [298/317],x2 =38.912,P＜0.01) and cavity closure rate (84.6％[22/26] vs 93.0％[198/213],x2 =20.709,P＜0.01) in patients with ATDILI were both significantly lower than those in patients without ATDILI.Conclusions The incidence of ATDILI is relatively high in hospitalized patients treated with first line anti-TB drugs.ATDILI has negative effects on treatment outcome of TB patient.Hepatitis B carrier with positive HBsAg and HBeAg,systemic lupus erythematosus,albumin ≤25 g/L and alcoholism may increase the risk of developing ATDILI.

Induction in vitro and stability of Mycobacterium tuberculosis resistance to ofloxacin / 中华预防医学杂志

<p><b>OBJECTIVE</b>To induce Mycobacterium tuberculosis (MTB) resistance with ofloxacin (Ofx) of stepwise increasing concentration in vitro, investigate stability to fluoroquinolone (FQs) antibiotic of MTB, and analyze the molecular mechanism and mutation specialty of drug resistance preliminarily.</p><p><b>METHODS</b>MTB Standard strain H37RV and 24 clinical isolates susceptible to Ofx were selected and experimentally serially subcultured in liquid culture medium containing increasing concentration of Ofx and induced the drug resistance to Ofx. Variety of Minimal Inhibitory Concentrations (MICs) to FQs drugs were detected by microwell-MIC-test method. Mutations of quinolone resistance determining region (QRDR) of gyrA gene were sequenced and identified. Relationship of different mutation sites and drug resistant degree were analyzed. A total of 6 MTB clinical isolates resistant to Ofx and induced drug resistant isolates in vitro were serially subcultured in liquid culture medium without drug. Variety of drug resistant stability, including MIC and mutation of gyrA gene were detected.</p><p><b>RESULTS</b>MIC values of 21 Ofx susceptible isolates after induction were eight times higher than before, which were induced to drug resistant strains successfully and also resistant to Lfx and Mfx. Hot mutations of QRDR of gyrA gene were detected by sequencing, except one strain. Mutation of codon 94 occurred in 60% (12/20) of the strains with mutations and corresponding value of 50% Minimal Inhibitory Concentrations(MIC50) was ≥ 8 µg/ml. In all, 4 of 6 MTB clinical isolates resistant to Ofx harbored mutation of codon 90 (67%) , but the corresponding value of MIC50 was 2 µg/ml. After 21 serially subcultured in liquid culture medium without drug, MIC values of 6 clinical isolates resistant to Ofx were not changed obviously and mutations were also not changed. After 11 times serially subcultured in culture medium without drug, MIC values of induced drug resistant strains were also not changed obviously, but new mutations were detected in QRDR of 3 isolates.</p><p><b>CONCLUSION</b>MTB strains resistant to three kinds of FQs antibiotic were obtained by induction in vitro with Ofx. Codons 88, 94 mutations of QRDR of gyrA gene were related to the high level FQs drug resistance of MTB. Drug resistant stability of MTB to FQs was strong, and it is difficult for MTB to resume susceptibility.</p>

Clinical diagnostic performance of the simultaneous amplification and testing methods for detection of the Mycobacterium tuberculosis complex for smear-negative or sputum-scarce pulmonary tuberculosis in China / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>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 Mycobacterium 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.</p><p><b>METHODS</b>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.</p><p><b>RESULTS</b>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% CI, 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 fluids were 90% (95% CI, 74%-98%), 100% (95% CI, 85%-100%), 100% (95% CI, 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).</p><p><b>CONCLUSIONS</b>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.</p>

Clinical value of peripheral platelet count in assessing active pulmonary tuberculosis / 中国感染与化疗杂志

Objective To understand the role of increasing peripheral blood platelet count in the diagnosis and prognosis of patients with active pulmonary tuberculosis.Methods This analysis included 80 inpatients with active pulmonary tuberculosis evidenced by positive sputum smear,43 patients in recovery and 89 healthy controls during the period from January to June in 2012.Peripheral white blood cell,platelet count,and neutrophil percentage were assayed.Erythrocyte sedimentation rate (ESR)and serum C-reactive protein (CRP)were measured and compared.The data were analyzed by using SPSS 13.0 software.Results ESR and CRP values were significantly higher in the patients with active pulmonary tuberculosis than in the patients in recovery (P=0.006 5 and P=0.007 3,respectively).The peripheral blood platelet count exceeded normal range in 41.94% of the patients with active pulmonary tuberculosis,which was significantly higher than that in the patients in recovery (P=0.001 4)and controls (P=0.000 0).Platelet count was positively correlated with CPR (r=0.515,P<0.000 1)and ESR (r=0.398,P<0.001)value.However,peripheral white cell count and neutrophil count were not different from the corresponding values of controls.Conclusions Increasing peripheral platelet count may play a role in assessment of tuberculosis disease activity and the effect of anti-tuberculosis treatment.

Risk factors of pulmonary non-tuberculous mycobacterial infection in 489 patients with sputum acid-fast bacilli positive and/or mycobacteria culture positive / 中华传染病杂志

Objective To analyze the risk factors of pulmonary non-tuberculous mycobacterial (NTM) infection in sputum acid-fast bacilli positive and/or mycobacteria culture positive patients.Methods One hundred and sixty-three patients with pulmonary NTM infection were recruited from Jan 2006 to Jun 2011 in Shanghai Pulmonary Hospital and 326 patients with sputum positive pulmonary tuberculosis who were selected by random systemic sampling method in the same period were recruited as control.The data were retrospectively analyzed.The related factors were compared between groups by chi-square test.The risk factors of pulmonary NTM infection were analyzed by binary Logistic regression model.Results There were statistically significant differences of age,history of smoking,chronic obstructive pulmonary disease (COPD),bronchiectasis,thin walled cavities focus,purified protein derivative (PPD) test between patients with pulmonary NTM infection and patients with pulmonary tuberculosis (all P＜0.05).Univariate analysis showed that age [45-60year (OR=2.637,95％CI:1.631-4.264; P＜0.001); ＞60 year (OR=4.194,95％CI:2.581-6,813 ; P＜0.001)],history of smoking [10-20 year (OR=1.842,95％CI:1.0843.070; P=0.024),＞20 year (OR=2.040,95％CI:1.167-3.567; P=0.012)],COPD (OR=2.698,95％CI:1.588-4.583; P＜0.001),bronchiectasis (OR=3.566,95％CI:2.343-5.427;P＜0.001),thin walled cavities focus (OR=2.592,95％CI:1.581-4.250; P＜0.001) and a weak-positive reaction of PPD test (OR=2.389,95％CI:1.276-4.472; P=0.006) were all risk factors of pulmonary NTM infection.Multivariate analysis showed that age＞60 year (OR=3.961,95％CI:2.183-7.189 ; P＜0.001),bronchiectasis (OR =3.880,95 ％ CI:2.342-6.487 ; P＜0.001),thin walled cavities focus (OR=2.898,95％CI:1.567-5.360; P＜0.001),COPD (OR=2.503,95％ CI:1.289-4.857; P=0.007),age45-60 year (OR=2.452,95％CI:1.391 4.325; P=0.002)anda weak-positive reaction of PPD test (OR=2.295,95％CI..1.132-4.652; P=0.021) were independent risk factors of pulmonary NTM infection.Conclusion In sputum acid-fast bacilli positive and/or mycobacteria culture positive patients,age≥ 45 year,COPD,bronchiectasis,thin walled cavities focus and a weak-positive reaction of PPD test are risk factors of pulmonary NTM infection.The clinicians should pay close attention to the results of species identification.

Clinical application of first line anti-tuberculous drug susceptibility test by phage amplified biologically assay / 中华临床感染病杂志

Objective To evaluate clinical application of phage amplified biologically assay (PhaB) in susceptibility test of Mycobacterium tuberculosis (MTB) in sputum. Methods The drug susceptibility of MTB was detected by PhaB in 143 patients with sputum-positive pulmonary tuberculosis (PTB),and the chemotherapy regimens were adjusted according to the results of susceptibility test.Independent samples t-tests were used for comparison of means.Count numbers were compared with Chisquare test.If there were count number of 0,Fisher probabilities should be used.ResultsThe total positive rate of PhaB was 94.4％ (135/143) with no differences between three types of PTB (x2 =1.886,P ＞ 0.05 ).The duration of testing for PhaB group was (6.6 ± 1.8) days,while for control was (29.4 ±8.7) days (t =29.01,P ＜ 0.01 ).Compared with control group,the 2-month negative-conversion rate (63.2％ vs.35.1％,x2 =3.989,P ＜ 0.05 ) and cure rate ( 100％ vs.78.4％,P ＜ 0.05 ) of PhaB group in type Ⅱ patients were significantly higher.But there were no differences between PhaB and control groups in type Ⅰ and Ⅲ PTB patients.ConclusionThe results of PhaB drug susceptibility test can be helpful for choosing effective chemotherapy regimen for PTB patients rapidly.

Factors related to in-hospital deaths in patients co-infected with human immunodeficiency virus and tuberculosis / 中华传染病杂志

Objective To evaluate the risk factors associated with in-hospital death in patients co-infected with human immunodeficiency virus and Mycobacterium tuberculosis (HIV-TB). Methods A retrospective case-control study was performed in patients admitted to Shanghai Public Health Clinical Center from November 2004 to May 2009. Fifty-three HIV-TB patients who died during hospitalization were matched with 79 HIV-TB co-infected patients who survived during hospitalization.Clinical, demographic, and radiological characteristics of the two groups were compared by the retrospective case-control study method. Multivariate Logistic stepwise regression analysis was performed to explore the risk factors contributing to death in HIV-TB co-infected patients. Results Among the 459 co-infected patients, 53 (11.5%) cases died during hospitalization and 25 cases died during the first week in hospital. Sixty-four point two percent dead patients (34/53) died from tuberculosis. Several factors were associated with worse prognosis in the death group compared to the survival group, which included body weight≤50 kg (χ2 = 7.50), positive for acid-fast bacilli in sputum smear or culture exam (χ2= 4. 04, 14. 27), drug-resistant/multi-drug resistant Mycobacterium tuberculosis infection (χ2 =9.00,6.39), extra-pulmonary tuberculosis infection (χ2 =6.99), retreated tuberculosis (χ2 = 5. 92), non-standardized anti-tuberculosis treatment (χ2 = 12. 07), extensive pulmonary TB infection (lesions ≥50% of lung fields, χ2 = 20. 21), co-infection with fungi (χ2 =3.46), respiratory failure (χ2 = 4.27), non-pulmonary organ impairment (χ2 = 3.46), HIV infection longer than 5 years (χ2 = 7. 19), non-standardized highly active antiretroviral therary treatment (χ2 =5.16) and CD4+ T lymphocyte count ≤ 200 × 106/L (χ2= 12.99) (all P＜0. 05). Multivariate Logistic regression analysis showed that non-standardized anti-TB treatment, extensive pulmonary TB infection, multi-drug resistant TB infection and CD4+ T lymphocyte count ≤ 200 × 106/L were the major risk factors related to in-hospital mortality. Conclusions Non-standardized anti-TB treatment,extensive pulmonary TB infection, multi-drug resistant TB infection and CD4+ T lymphocyte count ≤200 × 106/L are the major risk factors related to in-hospital mortality in the patients co-infected with TB and HIV.

Cerebrospinal fluid adenosine deaminase activity for the diagnosis of tuberculous meningitis / 中华临床感染病杂志

Objective To evaluate cerebrospinal fluid adenosine deaminase(CSF-ADA)activity in the diagnosis of tuberculous meningitis(TMB), and to observe its dynamic changes. Methods A total of 160 patients were included and were divided into two groups: 76 cases of TBM and 84 cases of non-TBM.Among the cases of non-TBM, there were 36 cases of bacterial meningitis, 30 cases of viral meningitis and 18 cases of cryptocoocal meningitis. All the patients were measured with their CSF-ADA activity by Enzymecoupled assay(Trinder method)and 47 patients of TBM were measured again after 2 weeks' and 6 weeks'antitubercular therapy. Results were expressed as(-x)± s. Mann-Whitney U test and paired-samples t test were used. Results CSF-ADA activity in TBM group was(12.9 ±6.4)U/L, while that in the non-TBM group was(6.0 ± 4.1)U/L, the difference was of statistical significance(U = 7.860, P ＜ 0.05). With the cutoff value of 9 U/L, the sensitivity and specificity to differentiate TBM from non-TBM was 84.21% and 83. 33%, respectively. CSF-ADA activity decreased in TBM patients after antitubercular treatment.Conclusions CSF-ADA activity can be an effective laboratory marker for early differential diagnosis of TMB with the cut-off value of 9 U/L. Dynamic changes of CSF-ADA activity may be a indicator for the effect of antitubercular treatment.

Pharmacokinetics of levofloxacin in rat pancreas / 中华胰腺病杂志

Objective To investigate the pharmaeokinetics of levofloxacin in rat's pancreatic tissue. Methods Pancreatic tissue and blood were sampled in vivo by microdialysis simultaneously. The concentrations of levofloxacin in beth blood and tissues were measured by high performance liquid chromatography. All date were analyzed by WinNonlin software. Results The maximum concentration of free levofloxacin in blood and pancreatic tissue were (65.23 ± 12.9) μg/ml at 10min and (30.56±3.22) μg/ml at 20 min, respectively, then beth continuously decreased. Concentration of free levofloxacin in pancreatic tissue was higher than that in blood from 20min to 100min, then returned to similar level. The area under the concentration curve(AUC)of unbound levofloxacin was(2465.11±258.56)min·μg~(-1)·ml~(-1) in pancreas,and (2914.38±205.73)min·μg~(-1)·ml~(-1) in blood.Conclusions Microdialysis with reversed phase high performance liquid chromatography established in this essay could be used to determine the pharmacokinetics of levofloxacin objectively. High concentration of levofloxacin in pancreatic tissue and blood was observed.

Comparative Study on Cancer Cell Apoptosis between Gastric and Intestinal-type Human Gastric Carcinoma / 华中科技大学学报（医学）（英德文版）

Apoptosis of cancer cells between the gastric and intestinal-type human gastric carcinoma were compared in terms of the expression of oncogene MDM2 and CD68, the histological types, the infiltration depth, and lymph node metastasis. Terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end-labeling (TUNEL) assay was employed to stain apoptotic cells.Histochemical method(AB-PAS) was applied to stain mucus that is neutral or acidic in nature. Immunohistochemical method (SABC) was used to detect expression of MDM2 and CD6. The results showed that the mean apoptosis index (AI) of total 48 cases was 8.60±2.60. AI in the 30 intestinal type cases was significantly higher than that in the 18 gastric type cases (t=4.67, P＜0.01). In the 30intestinal type cases, the spontaneous apoptosis index of MDM2 negative cases was significantly higher than that of the positive cases (t=7.16, P＜0.01). And in the 18 gastric type cases, the same result was found. (t=11.39, P＜0.01). The MDM2 positive ratio in gastric type cases was higher than that in intestinal type cases (x2=4.68, P＜0.05). There is no significant difference in AI between cases of lymph node metastasis and non-metastasis cases in intestinal type cases (t=0.26, P＞0.05). But in the gastric type cases, a significant difference existed (t=5.87, P＜0.01). A significant difference in lymph node metastasis ratio was found between the two gastric carcinoma types (x2=4.48, P＜0.05).The CD68 expression ratio in the 30 intestinal type cases was much lower than that in the 18 gastric type cases (t=4.29, P＜0.01). AI of 25 MDM2-positive cases was much lower than that of the 23MDM2-negative cases (t=7.80, P＜0.01). CD68 positive ratio in the 25 MDM2-negative cases was much lower than that in the 23 negative cases. The difference was statistically significant (t=10.90,P＜0.01). Except for few cells scattering within the cancer nest, most CD68 positive cells infiltrated in the interstitium around the cancer tissue. In the high-AI cases, CD68-positive cells increased. And the CD68-positive cells decreased in low-AI cases (r=0.96, P＜0.01). Logistic regression analysis suggested that among the control variables, only AI was a statistically significant factor in the regression model (x2=9.64, P＜0.01). We concluded that (1) the spontaneous apoptosis index in gastric-type cases of gastric carcinoma was significantly lower than that in intestinal type cases; (2) AI in the two types was influenced by the expression of MDM2 and lymph node metastasis, but no visible connection was found between AI and the infiltration depth or histological types; (3) in the intestinal type cases,AI and the CD68-positive cells increased in MDM2-negative cases.

Comparative study on cancer cell apoptosis between gastric and intestinal-type human gastric carcinoma / 华中科技大学学报（医学）（英德文版）

Apoptosis of cancer cells between the gastric and intestinal-type human gastric carcinoma were compared in terms of the expression of oncogene MDM2 and CD68, the histological types, the infiltration depth, and lymph node metastasis. Terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end-labeling (TUNEL) assay was employed to stain apoptotic cells. Histochemical method(AB-PAS) was applied to stain mucus that is neutral or acidic in nature. Immunohistochemical method (SABC) was used to detect expression of MDM2 and CD6. The results showed that the mean apoptosis index (AI) of total 48 cases was 8.60+/-2.60. AI in the 30 intestinal type cases was significantly higher than that in the 18 gastric type cases (t=4.67, P0.05). But in the gastric type cases, a significant difference existed (t=5.87, P<0.01). A significant difference in lymph node metastasis ratio was found between the two gastric carcinoma types (chi2=4.48, P<0.05). The CD68 expression ratio in the 30 intestinal type cases was much lower than that in the 18 gastric type cases (t=4.29, P<0.01). AI of 25 MDM2-positive cases was much lower than that of the 23 MDM2-negative cases (t=7.80, P<0.01). CD68 positive ratio in the 25 MDM2-negative cases was much lower than that in the 23 negative cases. The difference was statistically significant (t=10.90, P<0.01). Except for few cells scattering within the cancer nest, most CD68 positive cells infiltrated in the interstitium around the cancer tissue. In the high-AI cases, CD68-positive cells increased. And the CD68-positive cells decreased in low-AI cases (r=0.96, P<0.01). Logistic regression analysis suggested that among the control variables, only AI was a statistically significant factor in the regression model (chi2=9.64, P<0.01). We concluded that (1) the spontaneous apoptosis index in gastric-type cases of gastric carcinoma was significantly lower than that in intestinal type cases; (2) AI in the two types was influenced by the expression of MDM2 and lymph node metastasis, but no visible connection was found between AI and the infiltration depth or histological types; (3) in the intestinal type cases, AI and the CD68-positive cells increased in MDM2-negative cases.

Susceptibility Pattern and Epidemiology of Nontuberculous Mycobacteria in Shanghai / 中华医院感染学杂志

OBJECTIVE To examine the prevalence and trends of drug resistance of nontuberculous mycobacteria(NTM)in Shanghai.METHODS All NTM strains isolated between 1998 and 2004 in Shanghai were identified with conventional biochemical tests.Antimicrobial susceptibility test for all NTM was performed by standard absolute concentration method.RESULTS The prevalence rate was determined as 1.49%,1.17%,1.98%,2.46%,2.66%,2.72% and 3.0% among mycobacteria culture positive patients per year in 1998,1999,2000,2001,2002,2003,and in 2004,respectively.These data indicated the prevalence rate has continuously increased.Distribution of NTM isolates was Group Ⅰ18.7%,Group Ⅱ 5.1%,Group Ⅲ 25.1%,and Group Ⅳ 51.1% accordingly.Group Ⅳ rapidly growing NTM accounted for majority of them.Most of NTM showed high drug resistance to general antituberculotic drug.In particular Group Ⅳ Mycobacterium chelonae and M.fortuitum appeared multi-drug resistance.CONCLUSIONS The prevalence rate of NTM in Shanghai shows increased tendency.Most of NTM isolates are Group Ⅳ rapidly growing NTM.NTM shows high drug resistance to first line antituberculotic substance.

Clinical application of enzyme-linked immunospot assay for rapid diagnosis of active tuberculosis / 中华检验医学杂志

Objective To evaluate the clinical application of enzyme-linked immunospot(ELISPOT) assay for detection of M.tuberculosis antigen specific T cells in the rapid diagnosis of active tuberculosis.Methods Using the rapid enzyme-linked immunospot assay for detection of T cells with secretion of IFN-? specific for M.tuberculosis antigens in blood samples from 112 patients with tuberculosis, 24 patients with hepatitis C, 30 healthy persons, and 65 with other respiratory diseases.Results 107 of 112 tuberculosis patients had detectable M. tuberculosis antigen-specific T cells, whereas 2 of 30 healthy subjects and 65 patients with non-tuberculosis illnesses responded. This assay has a sensitivity of 95.5%, specificity of 93.3%.Conclusions M.tuberculosis specific T cells could serve as accurate markers of M.tuberculosis infection in an area of high tuberculosis prevalence.ELISPOT is a rapid, sensitive and specific method for detecting M.tuberculosis specific T cells.It also gives objective evidence to the diagnosis of active tuberculosis.

Drug susceptibility results and clinical characteristics as well as their correlation analysis from 417 cases with positive culture of tubercle bacilli / 中国实用内科杂志

Objective To understand the bacteriology and the association between drug susceptibility and clinical features from recent hospitalization of tuberculosis(TB)patients with positive tuberculosis bacilli culture.Methods We collected the clinical data of inpatients due to tuberculosis or pulmonary disease with positive tuberculosis bacilli by BACTEC960 culture auto-analysis system and possessing anti-tuberculosis drug susceptibility testing results from January 2008 to November 2008.All isolated strains were tested with first-line drugs included Streptomycin(S),Isoniazid(H),Rifampicin(R)and Ethambutol(E).Some isolate strains were used to test Amikacin(Am),Capreomycin(Cm)and Ofloxacin(Ofx).We recorded the drug-tested results and clinical data and retrospectively analyzed them.The patients with pulmonary disease from nontuberculosis mycobacteria(NTM)were excluded.Results (1)There were 417 patients with positive culture of tuberculosis bacilli (included 294 male and 123 female).The mean age was(47.8 18.1)years(ranging from 6 to 91 years).There were 68 cases complicated with endobronchial tuberculosis(EBTB)and 56 cases with type 2 diabetes mellitus.(2)There were 271 cases for initial treatment and 146 cases of relapsing tuberculosis.The total drug resistant rate was 53.5 percent,and of oflx was as high as 31.86 percent.The initial drug resistant rate was S 22.5%,H 25.8%,R 17.3%,E 21.0%,Am 6.3%,Cm 10.0%,Ofx 16.6% respectively and the required rate was 67.8%,82.9%,68.5%,68.5%,19.9%,25.3%,58.2% respectively.(3)There were 143 patients with multi-drug resistant TB(MDR-TB).The mean age 44.59?16.31 was significantly younger than of other patients(P