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Objective To investigate status and risk factors of drug resistance of smear-positive pulmonary tuber-culosis (TB)patients in Hunan Province,and provide reference for the prevention and control of drug-resistant TB. Methods 1 935 Mycobacterium tuberculosis (MT)complex strains identified by 20 TB prevention and control insti-tutes in Hunan Province between 2012 and 2014 were collected and performed drug susceptibility testing,and influ-encing factors associated with drug resistance of TB were analyzed statistically.Results Of 1 935 MT complex strains,1 207 (62.38%)were sensitive to 6 kinds of antituberculosis drugs,728 were drug-resistant strains,overall drug resistance rate was 37.62%;467 (24.13%)were multidrug-resistant (MDR)strains,64 of which were exten-sively drug-resistant (XDR)strains,XDR rate was 3.31 %,resistance rates from high to low were as follows:isoniazid(INH)29.32%,rifampicin(RFP)25.84%,streptomycin(SM)20.73%,thambutol(EMB)9.00%,ofloxa-cin(OFX)7.83%,and kanamycin(KM)2.21 %.Multivariate logistic regression analysis showed that patients hav-ing a history of treatment,aged 20-39 and 40-60 years old were risk factors for drug resistance and MDR of pul-monary TB.Among patients who failed in retreatment,OR (95% CI )of resistance to INH,RFP,SM,EMB, OFX,KM,and MDR were 13.5(9.9-18.4),21 .2(15.2-29.5),5.3(3.9-7.2),11 .9(7.6-18.7),7.6(4.6-12.6),7.9(3.6-17.5),and 25.0(17.7-35.1 )respectively;among patients who had recurrence,OR(95% CI ) of resistance to INH,RFP,SM,EMB,OFX,and MDR were 7.4(5.5 -10.0),10.3 (7.4 -14.2),3.5 (2.5 -4.8),7.3(4.5 -11 .9),4.1 (2.5 -6.8),and 12.2(8.7 -17.1 )respectively;among patients who failed in initial treatment,OR (95% CI )of resistance to INH,RFP,SM,EMB,and MDR were 7.6 (4.7 - 12.3 ),9.8 (5.9 -16.0),4.1(2.5-6.8),12.1(6.5-22.7),and 11 .4(6.9-18.9)respectively.Among patients aged 20-39 years old,OR (95% CI )of resistance to INH,RFP,SM,and MDR were 2.5 (1 .8 -3.4),3.6(2.5 -5.2),2.9(2.0-4.1),and 4.1(2.8 -6.1 )respectively;among patients aged 40 -60 years old,the OR (95% CI )of resistance to INH,RFP,SM,and MDR were 2.2(1 .6-3.0),3.1(2.2-4.4),2.3(1 .6-3.2),and 3.3(2.3 -4.7)respectively. Conclusion Drug resistance of smear-positive pulmonary TB patients is serious in Hunan Province,patients receiv-ing anti-tuberculosis treatment and aged between 20-60 years old have high risk for drug resistance and MDR.
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Objective To evaluate the clinical significance of serum procalcitonin (PCT)in early diagnosis of pul-monary tuberculosis (PTB)complicated with pulmonary infection.Methods Clinical data of active PTB patients admitted to a hospital between August and December 2013 were collected,patients were divided into bacterial infec-tion group(n=104),fungal infection group(n=37)and control group (n=95)according to whether patients were associated with bacterial infection,fungal infection,and without infection,serum PCT concentrations in three groups were compared,receiver operating characteristic (ROC)curve analysis was conducted.Results The median PCT concentrations in bacterial infection and fungal infection group was 0.44ng/mL and 0.30ng/mL respectively, which was significantly higher than 0.16ng/mL of control group(Z =9.49,3.51 respectively,both P <0.001 ).The area under curve (AUC)was 0.89(0.84-0.93)and 0.69(0.61 -0.77)respectively;cut-off point was 0.31 ng/mL and 0.27 ng/mL respectively;sensitivity was 79.81%(70.57%-86.80%)and 59.46%(42.19%-74.80%)respectively;specificity was 83.16%(73.79%-89.78%)and 73.68%(63.48%-81.95%)respectively.Conclusion PCT level is a valuable predictor for early diagnosis of PTB complicated with pulmonary infection,and can provide reference for the rational use of antimicrobial agents.
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<p><b>BACKGROUND</b>The Xpert MTB/RIF showed high sensitivity and specificity in previous studies carried out in different epidemiological and geographical settings and patient populations in high-burden tuberculosis (TB) countries. However, there were little data obtained by validation or demonstration study of the assay in China. In this study, the performance of Xpert MTB/RIF was investigated in two county-level laboratories in Hunan Province, China.</p><p><b>METHODS</b>Consecutive patients with suspected pulmonary tuberculosis (PTB) and suspicion for multidrug-resistant tuberculosis (MDR-TB) were enrolled. For each patient suspected to have PTB, three sputum specimens (one spot sputum, one night sputum, and one morning sputum) were collected and each sputum was tested with smear microscopy, Löwenstein-Jensen (LJ) culture, and Xpert MTB/RIF test. For comparison across subgroups and testing methods, 95% confidence intervals were calculated. All analyses were done with SPSS 16.0, and P < 0.05 was regarded as significant.</p><p><b>RESULTS</b>For case detection, the sensitivity of Xpert MTB/RIF was 100% for smear- and culture-positive TB and 88.6% for smear-negative and culture-positive TB; the overall sensitivity was 94.5% for all culture-positive patients. The specificity was 99.8%. The sensitivity of Xpert MTB/RIF assay was 22.0% in clinical TB patients and the specificity reached 100.0% in the group of patients who are infected with nontuberculous mycobacteria. For the detection of rifampin resistance, the sensitivity of MTB/RIF RIF-resistance detection was 92.9%, and the specificity was 98.7%. Of the 26 Xpert MTB/RIF-positive and RIF-resistant patients confirmed by LJ proportion tests, 20 (76.9%) patients were infected by MDR-TB.</p><p><b>CONCLUSIONS</b>The Xpert MTB/RIF assay is a highly sensitive and specific method for diagnosis of TB and RIF resistance, which will enable it to have the potential to be used in county-level laboratories and lead to the reduction of the infectious pool and improvements in TB control in China. Further evaluations in county-level laboratories for implementing the assay are still required.</p>
Subject(s)
Adult , Female , Humans , Male , Middle Aged , Young Adult , Antibiotics, Antitubercular , Therapeutic Uses , China , Rifampin , Therapeutic Uses , Tuberculosis , Diagnosis , Drug Therapy , Tuberculosis, Multidrug-Resistant , Tuberculosis, Pulmonary , Diagnosis , Drug TherapyABSTRACT
ObjectiveTo immunoscreen the mimic peptides of Mycobacterium tuberculosis antigen from phage displayed 12-mer peptide library.MethodsSpecific IgG was purified from sera of patients with TB and used as the target to immunoscreen a phage random peptide library of 12 amino acids.Positive clones which were obtained after three rounds of biopanning were detected by ELISA and sequenced.The diagnostic value of the high frequent positive clones were observed by ELISA.Results After 3 rounds of immunoscreening,the eluted phages were enriched effectively.Six kinds of animo acid sequence were obtained from twelve positive phage clones.Sensitivity of the two high frequent positive clones were 71.4％ (A2)and 55.4％ (A7) respectively.ConclusionThe antigen-mimic peptide was successfully screened from 12 random phage peptide library and the peptides can be recognized by tuberculosis patients' polyclonal antibodies.