Interferon-Gamma Release Assay is Not Appropriate for the Diagnosis of Active Tuberculosis in High-Burden Tuberculosis Settings: A Retrospective Multicenter Investigation / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Interferon-gamma release assay (IGRA) has been used in latent tuberculosis (TB) infection and TB diagnosis, but the results from different high TB-endemic countries are different. The aim of this study was to investigate the value of IGRA in the diagnosis of active pulmonary TB (PTB) in China.</p><p><b>METHODS</b>We conducted a large-scale retrospective multicenter investigation to further evaluate the role of IGRA in the diagnosis of active PTB in high TB-epidemic populations and the factors affecting the performance of the assay. All patients who underwent valid T-SPOT.TB assays from December 2012 to November 2015 in six large-scale specialized TB hospitals in China and met the study criteria were retrospectively evaluated. Patients were divided into three groups: Group 1, sputum culture-positive PTB patients, confirmed by positive Mycobacterium tuberculosis sputum culture; Group 2, sputum culture-negative PTB patients; and Group 3, non-TB respiratory diseases. The medical records of all patients were collected. Chi-square tests and Fisher's exact test were used to compare categorical data. Multivariable logistic analyses were performed to evaluate the relationship between the results of T-SPOT in TB patients and other factors.</p><p><b>RESULTS</b>A total of 3082 patients for whom complete information was available were included in the investigation, including 905 sputum culture-positive PTB cases, 914 sputum culture-negative PTB cases, and 1263 non-TB respiratory disease cases. The positive rate of T-SPOT.TB was 93.3% in the culture-positive PTB group and 86.1% in the culture-negative PTB group. In the non-PTB group, the positive rate of T-SPOT.TB was 43.6%. The positive rate of T-SPOT.TB in the culture-positive PTB group was significantly higher than that in the culture-negative PTB group (χ2 = 25.118, P < 0.01), which in turn was significantly higher than that in the non-TB group (χ2 = 566.116, P < 0.01). The overall results were as follows: sensitivity, 89.7%; specificity, 56.37%; positive predictive value, 74.75%; negative predictive value, 79.11%; and accuracy, 76.02%.</p><p><b>CONCLUSIONS</b>High false-positive rates of T-SPOT.TB assays in the non-TB group limit the usefulness as a single test to diagnose active TB in China. We highly recommend that IGRAs not be used for the diagnosis of active TB in high-burden TB settings.</p>

The Epidemiological Characteristics of Beijing Lineage Mycobacterium tuberculosis from a National Referral Center in China / 生物医学与环境科学（英文）

Our study was to investigate the epidemiological characteristics of M.tuberculosis from a national tuberculosis referral center in China. All strains isolated from TB patients, were genotyped by the RD105 deletion, 8 and 51 SNP loci and VNTR. The high differentiation SNPs of modern Beijing strains were analyzed for protein function and structure. 413 M. tuberculosis were included. Of 379 Beijing lineage M. tuberculosis, 'modern' and 'ancient' strains respectively represented 85.5% (324/379) and 14.5% (55/379). Rv2494 (V48A) and Rv0245 (S103F) were confirmed as high differentiation SNPs associated with modern strains. In a word, Modern Beijing lineage M.tuberculosis was dominant and the structural models suggested that modern sub-lineage may more easily survive in 'extreme' host condition.

Study on the efficacy and safety of short-term treatment including fluoroquinolones anti-tuberculosis drugs for rifampicin resistant pulmonary tuberculosis / 中华流行病学杂志

Objective To evaluate the efficacy and safety of short-term treatment including fluoroquinolones anti-tuberculosis drugs for rifampicin resistant pulmonary tuberculosis(TB)in those areas carrying out the 'TB control project'.Methods TB cases involved in this study were from TB drug resistance surveillance in Heilongiiang province,Zhejiang province and Shenzhen city from 2004 to 2006.TB cases with rifampicin resistant were randomly divided into the treatment group(including fluoroquinolones anti-tuberculosis drugs group)and the control group(re-treatment regimen group).The treatment group was treated wim 3RFT AM ofx Pto PAS-INH/5RFT ofx Pto PAS.INH while the control group was treated with 3 H3R323E3S3/5 H3R3E3.Efficacy of short-term treatment was analyzed by per-protocol analysis(PP analysis)and intention-to-treat analysis(ITT analysis)while drug adverse reactions was also observed.Results (1)154 patients with rifampicin resistant pulmonary tuberculosis were recruited among them,25(16.2%)were only resistant to rifampicin,114(74.0%)to MDR-TB and 15(9.8%)to others(resistant R+S,resistant R+E and resistant R+E+S).114 TB cases completed the fuIl course of treatment,with 71 in the treatment group and 43 in the control group.(2)Sputum negative conversion rate of the treatment group and the control group were 78.9%and 65.1%(X2CMH=4.558,P=0.011)respectively,by per-protocol analysis.Sputum negative conversion rate of the treatment group and the control group were 65.9%and 40.6%(X2CMH=0.272,P=0.001)respectively,by intention-to-treat analysis.The sputum negative conversion rate of the treatment group was higher than in the control group when treating rifampicm resistant pulmonary tuberculosis and MDR-TB patients.(3)Three patients withdrew in each of the two groups because ofadverse effects to the drugs.Rates of adverse reaction to drugs appeared to be 23.9%(17/71)and 18.6%(8/43)in the treatment and in the control groups,with no statistically significant difference between the two groups.Conclusion The efficacy of treatment including fluoroquinolones anti-tuberculosis drugs group seemed beaer than the re-treatment regimen group in treating patients with rifampicin resistant pulmonary tuberculosis and those MDR-TB patients.