Value of metagenomic next-generation sequencing in children with severe infectious diseases / 中国当代儿科杂志

OBJECTIVES@#To study the application value of metagenomic next-generation sequencing (mNGS) in children with severe infectious diseases.@*METHODS@#An analysis was performed on the clinical data and laboratory test results of 29 children with severe infection who were admitted to the Second Affiliated Hospital of Wenzhou Medical University from June 2018 to December 2020. Conventional pathogen culture was performed for the 29 specimens (27 peripheral blood specimens and 2 pleural effusion specimens) from the 29 children, and mNGS pathogen detection was performed at the same time.@*RESULTS@#Among the 29 children, 2 tested positive by conventional pathogen culture with 2 strains of pathogen, and the detection rate was 7% (2/29); however, 20 children tested positive by mNGS with 38 strains of pathogen, and the detection rate was 69% (20/29). The pathogen detection rate of mNGS was significantly higher than that of conventional pathogen culture (P<0.05), and mNGS could detect the viruses, fungi, and other special pathogens that conventional pathogen culture failed to detect, such as Orientia tsutsugamushi. The univariate analysis showed that gender, routine blood test results, C-reactive protein, procalcitonin, D-dimer, radiological findings, and whether antibiotics were used before admission did not affect the results of mNGS (P>0.05).@*CONCLUSIONS@#Compared with conventional pathogen culture, mNGS is more sensitive for pathogen detection, with fewer interference factors. Therefore, it is a better pathogenic diagnosis method for severe infectious diseases in children.

GeneXpert MTB/RIF evaluated in diagnosis of pulmonary tuberculosis / 上海预防医学

Objective To evaluate GeneXpert MTB/RIF in diagnosis of pulmonary tuberculosis by comparing the lab results of diagnosed patients. Methods A total of 97 diagnosed pulmonary tuberculosis patients were enrolled from July 2017 to June 2018.Sputum smear microscopy (Ziehl-Neelsen stain), sputum culture (MGIT liquid culture) and Xpert MTB/RIF were conducted in all patients.Drug susceptibility test and strain identification by PNB were done for culture positive sputum samples.Consistency rate was calculated. Results In terms of M.tuberculosis detection, sensitivity and specificity of GeneXpert were 93.44% and 55.55%, respectively, compared with bacteriological examination (consistency rate 79.38%).Consistency rate of GeneXpert and PNB is 94.55%.In terms of RIF resistance test, sensitivity and specificity of GeneXpert were 66.67% and 98.08%, respectively, compared with phenotypic drug-susceptibility testing (consistency rate 96.36%). Conclusion GeneXpert MTB/RIF can be utilized in combination with smear microscopy and liquid culture to diagnose more etiologically positive patients, and can spot RIF resistance patients early.But strain identification and drug susceptibility test are still needed for individualized therapy and optimal treatment outcome.

GeneXpert MTB/RIF evaluated in diagnosis of pulmonary tuberculosis / 上海预防医学

Objective To evaluate GeneXpert MTB/RIF in diagnosis of pulmonary tuberculosis by comparing the lab results of diagnosed patients. Methods A total of 97 diagnosed pulmonary tuberculosis patients were enrolled from July 2017 to June 2018.Sputum smear microscopy (Ziehl-Neelsen stain), sputum culture (MGIT liquid culture) and Xpert MTB/RIF were conducted in all patients.Drug susceptibility test and strain identification by PNB were done for culture positive sputum samples.Consistency rate was calculated. Results In terms of M.tuberculosis detection, sensitivity and specificity of GeneXpert were 93.44% and 55.55%, respectively, compared with bacteriological examination (consistency rate 79.38%).Consistency rate of GeneXpert and PNB is 94.55%.In terms of RIF resistance test, sensitivity and specificity of GeneXpert were 66.67% and 98.08%, respectively, compared with phenotypic drug-susceptibility testing (consistency rate 96.36%). Conclusion GeneXpert MTB/RIF can be utilized in combination with smear microscopy and liquid culture to diagnose more etiologically positive patients, and can spot RIF resistance patients early.But strain identification and drug susceptibility test are still needed for individualized therapy and optimal treatment outcome.

Acceptance of Chemo-prophylaxis for Latent Tuberculosis Infection among High School/College Student Contacts of Tuberculosis Patients in Shanghai, China / 生物医学与环境科学（英文）

Student contacts of tuberculosis (TB) cases are susceptible to latent tuberculosis infection (LTBI), and chemo-prophylaxis can reduce the risk of active TB among them. This study aimed to assess the acceptance of chemo-prophylaxis for LTBI among students, and their concerns regarding TB and its preventive treatment. A total of 560 students contacts were included in the investigation. The extent of contact was categorized from high to low (4 levels) with 12.9% of the students being close contacts. About 87.0% of the students were willing to receive chemo-prophylaxis if diagnosed with, LTBI, whereas 73 students declined. Students with a higher level of knowledge about TB (aOR = 1.11) or close contact with TB patients (aOR = 4.30) were more likely to accept treatment. To conclude, education regarding TB transmission is necessary. Moreover, LTBI detection should be integrated into the current school-based TB contact investigation.

Monitoring results analysis on acute respiratory infections monitoring point hospital in Putuo District of Shanghai / 上海预防医学

Objective To ascertain characteristics of the pathogen spectrum and epidemiology with acute respiratory tract infection at monitoring point hospital of Shanghai,and provide a scientific basis for strategies and measures in prevention and control of the respiratory tract infectious disease.Methods The nasopharyngeal swabs of ARTI patients were collected by interval sampling for pathogen identification,who visited the fever clinic at monitoring point hospital from November 2014 to March 2016 The epidemiological characteristics and pathogenic detection of acute respiratory tract infection were analyzed.Results A total of 2 630 ILI cases were registered in this study,peaking in spring,summer and winter.There were 407 positive cases that were detected among 533 nasopharyngeal swabs,accounting for 76.36%.The top five isolating rates of the strains were Influenza virus,Klebsiella pneumoniae,Staphylococcus aureus,nasal/enteric virus and adenovirus.The virus detection rate of different age groups was different (P<0.05).The total positive rate and virus detection rate of those who had cough were higher than those without cough symptoms (P<0.05).Conclusion Influenza virus infection proves to be the main cause of acute respiratory tract infection in Putuo District.Thus more attention and prevention and control measures should be strengthened with influenza.In the peak season,it is necessary to take measures to prevent aggregation epidemic of respiratory virus.

Epidemic characteristics and trend analysis on tuberculosis in registered population in Putuo District ;of Shanghai / 上海预防医学

[ Objective ] To analyze the incidence level and epidemiological characteristics of tuberculosis ( TB) from 2004 to 2013 in Putuo District , Shanghai and to provide basis for the development of targeted prevention strategies against tuberculosis . [ Methods] By means of descriptive and comparative approaches , 2 ,434 cases of TB were retrospectively analyzed in epidemiological characteristics , treatment outcome, complications and so on . [ Results] The registration rate of TB in Putuo District in 2004-2013 decreased from 27.57/100,000 to 26.59/100,000, with an annual descending rate of 0.36%. Annual registration rate and smear positive rate in men were higher than those in women , and three increasing peaks appeared in age-specific registration rates , as 20-29 years, 50-59 years, and 70-79 years. In cases of 0-29 years, the ratio of male to female was 1.21∶1, of which students accounted for about one-third mainly in initial treatment (95.50%) and with smear-negativeness 69.59%.In patients at the age of 30-59, the ratio of male to female was 3.16∶1, of whom the unemployed at home and workers accounted for about two fifths, more of them being in initial treatment (82.29%) and with smear positiveness 46.13%. Sex ratio was 2 .84∶1 in cases of 60 or above , of which the retired accounted for two-thirds and smear-positiveness was 61.78%, more of them having complications (36.39%).TB cure rates decreased with the increase of age , and the mortality rate reached a peak in the higher age group . [ Conclusion] Although the epidemic of tuberculosis in registered population declined in Putuo District , targeted policies should be formulated to control tuberculosis , such as strengthening TB control management in school , improving the patient compliance with treatment , and strengthening the comprehensive treatment which may reduce TB mortality .

Study on factors causing the delay of access to tuberculosis diagnosis and its influencing factors in migrating tuberculosis patients in Putuo district, Shanghai / 中华流行病学杂志

<p><b>OBJECTIVE</b>To describe factors causing the delay of diagnosis among non-resident tuberculosis (TB) patients and to study its implications from demographic, socio-economic aspects in order to provide information to policy makers for TB control programs in Shanghai.</p><p><b>METHODS</b>A historical cohort study through questionnaire interview was conducted in 146 newly diagnosed TB patients. The questionnaire covered the general information of subjects and information on patients' health care seeking experiences from the first symptom to the TB diagnosis in health facilities. Index adopted to reflect the access to TB diagnosis would include the days due to delayed diagnosis consisting the days from both patient's and doctor's responsibilities.</p><p><b>RESULTS</b>The median days due to patients' delay was 19 (7-33.5) days, which was 3.8 times longer than 5 (2.5-10) days caused by doctor's. The median of total diagnostic delay was 31 (11-59) days. Female TB patients, patients with lower than annual 5000 Yuan income had an increased risk of a longer diagnostic delay with an OR of 3.226 and 11.958 relatively. Smear positive patients had a shorter delay (OR = 0.280, P < 0.05).</p><p><b>CONCLUSION</b>Delayed diagnosis was mostly caused by the patients, suggesting that TB control strategy for non-residents should aim at improving the access to TB diagnosis among patients with lower income and female non-residents.</p>