ABSTRACT
Objective To understand the recent transmission of Mycobacterium tuberculosis (MTB),and to identify the influencing factors of recent transmission among pulmonary tuberculosis (TB) patients in Jing'an district,Shanghai.Methods The genotypes and drug resistances of MTB isolated from TB patients registered in the TB designated hospitals in Jing'an district during 2010-2015 were analyzed through 12-loci Mycobacterial interspersed repetitive unit-variable number tandem repeat (MIRU-VNTR)(QUB1 lb,QUB18,Mtub21,Mira26,QUB26,Mtub04,Miru31,Miru40,VNTR2372,VNTR3820,3232,4120),and tested for drug susceptibility as well.With the results of field epidemiological investigation,univariate and multivariate analyses were performed to analyze the distribution of the clusters and influencing factors on recent transmission.Results This study enrolled 80 TB patients,23 (28.75％) had a resistance to at least one anti-TB drug,and the prevalence of multidrug-resistant tuberculosis (MDR-TB) was 16.25％.A total of 65 genotypes were identified with 58 (72.50％,58/80) being unique and 7 clusters with 2-10 isolated in each cluster.The proportion of clustering was 27.50％ (22/80).Results from the multivariate analysis revealed that multidrug-resistance (OR=35.799,95％CI:4.239-302.346) and having comorbidity with TB (0R=7.695,95％CI:1.421-41.658) were independently associated with the clustering,which suggesting a recent transmission.The field investigation to the clustered cases proved that the patients in two clusters had epidemiological links,one was between family members,and the other contained 10 MDR-TB patients with 9 knowing each other which have a definite connection and 1 having the possible connection with them.Conclusion Recent transmission of tuberculosis happened among TB patients in Jing'an district,with high risks among the MDR-TB patients.
ABSTRACT
Objective To understand the recent transmission of Mycobacterium tuberculosis (MTB),and to identify the influencing factors of recent transmission among pulmonary tuberculosis (TB) patients in Jing'an district,Shanghai.Methods The genotypes and drug resistances of MTB isolated from TB patients registered in the TB designated hospitals in Jing'an district during 2010-2015 were analyzed through 12-loci Mycobacterial interspersed repetitive unit-variable number tandem repeat (MIRU-VNTR)(QUB1 lb,QUB18,Mtub21,Mira26,QUB26,Mtub04,Miru31,Miru40,VNTR2372,VNTR3820,3232,4120),and tested for drug susceptibility as well.With the results of field epidemiological investigation,univariate and multivariate analyses were performed to analyze the distribution of the clusters and influencing factors on recent transmission.Results This study enrolled 80 TB patients,23 (28.75％) had a resistance to at least one anti-TB drug,and the prevalence of multidrug-resistant tuberculosis (MDR-TB) was 16.25％.A total of 65 genotypes were identified with 58 (72.50％,58/80) being unique and 7 clusters with 2-10 isolated in each cluster.The proportion of clustering was 27.50％ (22/80).Results from the multivariate analysis revealed that multidrug-resistance (OR=35.799,95％CI:4.239-302.346) and having comorbidity with TB (0R=7.695,95％CI:1.421-41.658) were independently associated with the clustering,which suggesting a recent transmission.The field investigation to the clustered cases proved that the patients in two clusters had epidemiological links,one was between family members,and the other contained 10 MDR-TB patients with 9 knowing each other which have a definite connection and 1 having the possible connection with them.Conclusion Recent transmission of tuberculosis happened among TB patients in Jing'an district,with high risks among the MDR-TB patients.
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Objective To evaluate the relationship between CD4+ T lymphocyte count and results of enzyme-linked immunospot (ELISPOT) assay in human immunodeficiency virus (HIV)-Mycobacterium tuberculosis (M.tb) coinfected patients.Methods A total of 193 HIV-infected individuals in Yunnan Province and Shanghai were enrolled.T-SPOT.TB assay was employed to detect M.tb specific T lymphocyte in the peripheral blood mononuclear cells (PBMC).CD4+ T lymphocyte in PBMC from the enrolled subjects was detected by flow cytometry.Data were analyzed using t test.ResultsThe incidence of latent tuberculosis in HIV-infected individuals was 30.6％.The CD4+ T lymphocyte counts in HIV-infected individuals with active tuberculosis were 190×106/L,which were significantly lower than those in HIV-infected individuals with latent tuberculosis (484×106/L; t=6.665,P＜0.01).The HIV-infected individuals were stratified according to CD4+ T lymphocyte counts of ＞500×106/L,200×106-500×106/L,and ＜200×106/L and the constituent ratios of active tuberculosis/latent tuberculosis were 1∶16.2,1∶1.3 and 5.6∶1,respectively.Among 79 subjects with positive T-SPOT.TB results,20 were coinfected with active tuberculosis,in which 14 had CD4+ T lymphocyte counts of ＜200 ×106/L,5 had 200×105-500×106/L and 1 had ＞500×106/L.Fifty-two in 59 HIV/latent tuberculosis patients individuals had CD4+ T lymphocyte counts of ＞200×106/L.ConclusionsThe prevalence of latent tuberculosis in HIV-infected individuals is high in China.Cellular immunity in HIV-infected individuals with active tuberculosis is severely impaired.With the decrease of CD4 ′ T lymphocyte counts,patients with latent tuberculosis are prone to develop active tuberculosis in HIV-infected individuals.The negative predictive value of T-SPOT.TB is significantly diminished in patient with low CD4+ T lymphocyte counts,especially less than 200×106/L.
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Objective To analyze the situation of inquirer in Shanghai Jing'an district AIDS voluntary coun-seling and testing(VCT). Methods Inquirer were serviced by trained counselors before and after HIV antibody tes-ring,each inquirer were asked to complete a "Advisory Cases Registration Form". Results Inquirer were male-domi-nated,accounting for 85.7%. And inquirer's age were mainly 25 ～ 34 years old, which accounting for 55.8%. The types of inquirer were mainly because of male non-married heterosexual sexual contact, female non-married heterosex-ual contact, male homosexual sexual sexual contact, which accounted for 77.4%, 11.8% and 3.7%, respectively. For the total of three categories accounted for 92.9%. Inquirer aged 25 ～ 34 years old in 2007 were more than 2006 ,and inquirer because of male non-married heterosexual sexual contact in 2007 were more than 2006. There were 2 infectors because of male homosexual sexual contact in 3 positive infectors who were screened in 2007. Conclusion VCT played more and more important role in AIDS prevention and control, and it should be further strengthened and ex-panded.