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Objective To determine the genotype and clustering characteristics of multidrug-resistant (MDR) mycobacterium tuberculosis in Wuhan City. Methods A total of 149 mycobacterium tuberculosis strains from MDR tuberculosis (MDR-TB) patients were genotyped by DTM-PCR, mycobacterial interspersed repetitive unit–variable number tandem repeat typing (MIRU-VNTR) and sequencing of drug-resistant associated genes. The Hunter-Gaston discriminatory index (HGDI), clustering rate and recent minimum estimated infection rate were calculated. Results The cumulative HGDI of all MIRU loci was 0.9944. Gene locus with the highest HGDI（0.6467）was QUB11b. Combing MIRU-VNTR and DTM-PCR, 111 unique genotypes and 11 clustered genotypes（38 strains）from 149 isolates were identified. The clustering rate was 25.50%, and the recent minimum infection rate was estimated to be 18.12%. After further genotyping by sequencing of drug-resistant associated genes, the results showed that 17 (44.74%) strains in each cluster shared the same mutation sites, while the other strains had different mutation sites. Conclusion The combination of DTM-PCR, 24 locus MIRU-VNTR typing and drug resistance gene sequencing demonstrates a relatively high discriminatory power, which is suitable for the genotyping of multi drug resistant mycobacterium tuberculosis in Wuhan. The epidemic of MDR-TB in Wuhan is mainly caused by reactivation, and the recent transmission rate is not high.
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Objective To explore the epidemic characteristics and spatial clustering of pulmonary tuberculosis in Wuhan from 2011 to 2019, and to provide a scientific basis for formulating intervention strategies and measures. Methods Descriptive statistical analysis was conducted on the epidemic characteristics of tuberculosis data in Wuhan registered in the national tuberculosis information management system in the last 9 years, and spatial autocorrelation analysis was performed on the incidence of tuberculosis in 155 communities or in the city using Arcgis10.5 software. Results From 2011 to 2019, there were 56,432 cases of tuberculosis reported in Wuhan, and the annual average reported incidence rate of tuberculosis was 59.24/100 000. The overall incidence rate showed a fluctuating downward trend, with an average annual decline rate of 1.99%. The ratio of the number of cases between men and women was 2.35:1, and the incidence rate in males was higher than that in females (χ2=285.36，P0,P<0.001), and the high-high aggregation areas of tuberculosis were mainly distributed in Erqi community, Baibuting community, Liujiaoting community, Yijiadun community, Heping Street, Changqian Street, Tonghu farm, Yuxian Town, Zhifang Town, Wulijie Town, Fenghuang Street, Liji Street, and Daoguanhe Street. Conclusion The overall epidemic situation of pulmonary tuberculosis in Wuhan showed a slow downward trend. The main population and the clustering time of cases were relatively fixed, and the overall epidemic showed a certain spatial clustering. Active screening should be carried out for high-risk populations and high-aggregation areas, and effective prevention and control strategies should be developed based on time and location classification.
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Objective@#To analyze the epidemiological characteristics, trend and related factors of tuberculosis patients that delayed for care, in Wuhan from 2008 to 2017.@*Methods@#Data regarding tuberculosis (TB) patients was collected from the tuberculosis management information system (TMIS), a part of the China information system for disease control and prevention from 2008 to 2017. A total of 64 208 tuberculosis patients, aged 0 to 95 years were included for the analysis. Unconditional logistic regression method was used to estimate those factors that associated with this study.@*Results@#Days of delay among TB patients appeared as M=10 (P25-P75: 3-28) day, in Wuhan, 2008-2017. The prevalence of the delay was 52.5% (33 703/64 208), presenting a downward trend from 2008 to 2017 (trend χ2=10.64, P<0.001), but the proportions of women and ≥65 year-olds were gradually increasing. Results from the multivariate logistic regression analysis showed that factors as: patients living far away from the city vs. near the city (OR=1.29, 95%CI: 1.25-1.35), and age above 45 years vs. younger than 25 years (the age 45-64 years group vs. aged less than 25 years group, OR=1.22, 95%CI: 1.15-1.29; the age 65 or above group vs. aged less than 25 years group, the OR=1.30, 95%CI: 1.22-1.39) were under higher risk on the delay of seeking care. Occupation, way of case-finding and classification of tuberculosis patients also appeared as influencing factors on this issue.@*Conclusions@#Prevalence on the delay of care was 52.5% among tuberculosis patients in Wuhan, 2008-2017, but with an annual decrease. Attention should be paid to female, wrinkly or elderly tuberculosis patients regarding the delay of care on TB, in Wuhan.
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Objective To investigate the types,incidence rate and related factors of adverse drug reactions(ADRs)in pa-tients with concomitant multi-drug resistant pulmonary tuberculosis(MDR-TB)and diabetes mellitus(DM)and those with only MDR-TB in an attempt to improve the surveillance of patients with both MDR-TB and DM.Methods A total of 359 MDR-TB patients who were diagnosed in the first batch of the 5th round of China Global Fund project in Wuhan city from December 1, 2006 to June 30,2014 and enrolled in the whole supervision process were retrospectively analyzed.They fell into MDR-TB(DM+)group(n=74;20.6%,74/359)and MDR-TB(DM -)group(n=285;79.4%,285/359).The incidence and the occurrence time of ADRs were compared between the two groups.The patients with MDR-TB(DM +)group were divided into two sub-groups in terms of the occurrence of ADRs.The treatment success rate and the effects of age,body mass index,plasma albumin level before treatment,fasting blood glucose level,smoking,alcohol consumption and other diseases on ADRs were investiga-ted.Results ①The incidence of ADRs in MDR-TB(DM+)group(39 cases,52.7%)was not significantly different from that in MDR-TB(DM -)group(141 cases,49.5%)(c2=0.245,P>0.05). ② The incidence of hypothyroidism(c2=6.08,P<0.05), hypokalemia(c2=12.37,P<0.05)and QT interval prolongation(c2=4.32,P<0.05)was significantly higher in MDR-TB(DM+)group than in MDR-TB(DM -)group during the treatment. ③ The lower body mass index(F=6.289,P<0.05),the de-creased level of plasma albumin(F=9.743,P<0.05),concomitant chronic liver disease(c2=6.000,P<0.05)and other chronic diseases(c2= 4.125,P<0.05)were associated with ADRs in patients with both MDR-TB and DM.No associations of sex,age, mean fasting blood glucose level,smoking,alcohol consumption,duration of diabetes,initial treatment and retreatment,number of resistant drugs was found with ADRs. ④There were 17 cases(43.6%,17/39)cured in ADRs group and 25 cases(71.4%,25/35)cured in non-ADRs group,with significant difference found(c2=5.825,P<0.05).Conclusion The patients with concomi-tant MDR-TB and DM are more likely to develop hypothyroidism,hypokalemia,and QT interval prolongation during the treat-ment,and need periodic monitoring and adjustment of medication.Those with the worse nutritional status(lower BMI and plas-ma albumin level)and other concomitant diseases(such as chronic liver disease,etc.)are more likely to have ADRs.Those with ADRs tend to have lower success rate of cure,and they are more likely to suffer treatment failure,loss to follow-up,interruption of treatment and so on.
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Tuberculosis is recognized as a chronic respiratory infectious disease and still one of the important public health issues in the world.Douglas reported an unique seasonal pattern (summer peak) of tuberculosis,when compared with most other respiratory diseases in 1996.Since then,there had been many other researchers notified various patterns of seasonality on TB.This paper reviewed all the studies published in the last five years and analyzed the current findings on seasonal variability and influencing factors,in order to explore the risk factors to provide evidence for prevention and control strategies on tuberculosis.
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Tuberculosis is recognized as a chronic respiratory infectious disease and still one of the important public health issues in the world.Douglas reported an unique seasonal pattern (summer peak) of tuberculosis,when compared with most other respiratory diseases in 1996.Since then,there had been many other researchers notified various patterns of seasonality on TB.This paper reviewed all the studies published in the last five years and analyzed the current findings on seasonal variability and influencing factors,in order to explore the risk factors to provide evidence for prevention and control strategies on tuberculosis.
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Combined with method of ketoconazole resistance screening, a 7alpha,15alpha-diOH-DHEA high-producing mutant Colletotrichum lini ST-1 was obtained by compound mutation of NTG and low energy N+ ion beam implantation. With the substrate concentration of 10 g/L DHEA, the molar yield of 7alpha,15alpha-diOH-DHEA reached 34.2%, increased by 46.2% than that of the original strain. Then we optimized the medium. First, Plackett-Burman design was used to evaluate the effects of medium components on molar yield of the product. Results show that glucose, yeast extract and MgSO4 x 7H2O were the important parameters for the biotransformation process. Subsequently, the path of steepest ascent was used to approach the optimal levels. To obtain the optimal levels, central composite design and response surface analysis were carried out. The optimal medium was as follows (g/L): glucose 26.34, yeast extract 12.15, corn flour 3.00, FeSO4 x 7H2O 0.015, MgSO4 x 7H2O 0.14, KH2PO4 0.90. Under the optimal conditions, the molar yield of 7alpha,15alpha-diOH-DHEA reached 49.3%, which was 44.2% higher than that of using the medium before optimization.