Analysis of the current status and associated factors of tuberculosis knowledge, attitudes, and practices among elderly people in Shenzhen: a cross-sectional study.

BACKGROUND: The incidence and risk of tuberculosis (TB) among the elderly population have increased with the ageing population in China. This study aimed to assess the current status and associated factors of TB knowledge, attitudes, and practices among elderly people in Shenzhen City, China, which may provide references for the development of TB prevention and treatment policies targeting elderly people. METHODS: A multistage random sampling method was used to collect data with a self-designed questionnaire from 1078 elderly people (response rate, 90.66%) living in Bao'an District of Shenzhen between September and October 2019. Univariate and multiple linear regression analyses were used to analyse factors associated with TB knowledge, attitudes, and practices among elderly people. RESULTS: Among the respondents, 3.13% had previously been treated for TB, and 3.09% of respondents had family members or friends with a previous TB history. The percentages of elderly people who were aware of TB and had positive attitudes and practices regarding TB were 69.23%, 48.87%, and 42.62%, respectively. Multiple linear stepwise regression analysis showed that elderly people with a junior high school education or higher, a family annual income per capita of less than 100,000 RMB, a better self-perceived health status, and family members or friends with a previous TB history had higher TB knowledge scores (P < 0.05). Elderly people with medical insurance, a junior high school or higher education, a family annual income per capita of less than 100,000 RMB, and family members and friends with a previous TB history had higher TB attitude scores (P < 0.05). In addition, elderly people who were older, had medical insurance, had a junior high school education or higher, and had a family annual income per capita less than 100,000 RMB had higher TB practice scores (P < 0.05). CONCLUSIONS: Elderly people were aware of TB, but their positive attitudes and practices were at a low level. Corresponding prevention and treatment policies should be developed according to these influencing factors to reduce the incidence of TB among elderly people and improve their quality of life.

Profiling the human immune response to Mycobacterium tuberculosis by human cytokine array.

OBJECT: Tuberculosis (TB) continues to be one of the most serious infectious diseases in the world, however, no effective biomarkers can be used for rapid screening of latent tuberculosis infection (LTBI) and active TB. In this study, serum cytokines were screened and tested as potential biomarker for TB diagnosis. METHOD: Cytokine array was used to track the cytokine profile and its dynamic change after TB infection. The different expressions of cytokines were confirmed by ELISA assay. ROC curve analyses were used to evaluate the efficacy of a cytokine or cytokine combination for diagnosis. RESULTS: Eotaxin-2, ICAM-1, MCSF, IL-12p70, and IL-11 were significantly higher in the LTBI individuals. I-309, MIG, Eotaxin-2, IL-8, ICAM-1, IL-6sR, and Eotaxin were significantly higher in active TB patients. ROC curve analyses gave AUCs of 0.843, 0.898, and 0.888 for I-309, MIG, and IL-8, respectively, and 0.894 for the combination panel in active TB diagnosis. IFN-γ/IL-4 and IL-2/TNF-α ratios exhibit dynamic changes in the healthy control and LTBI to different stages of active TB. CONCLUSIONS: Serum cytokines, including I-309 and MIG, IL-8, Extoxin-2, ICAM-1 and combinations of cytokines, including IFN-γ/IL-4 and IL-2/TNF-α, can be used as serum biomarkers for LTBI and active TB screening, thus indicating prospective clinical applications.

Lower cytotoxicity, high stability, and long-term antibacterial activity of a poly(methacrylic acid)/isoniazid/rifampin nanogel against multidrug-resistant intestinal Mycobacterium tuberculosis.

To overcome the undesirable side effects and reduce the cytotoxicity of isoniazid (INH) and rifampin (RMP) in the digestive tract, a poly(methacrylic acid) (PMAA) nanogel was developed as a carrier of INH and RMP. This PMAA/INH/RMP nanogel was prepared as a treatment for intestinal tuberculosis caused by multidrug-resistant Mycobacterium tuberculosis (MTB). The morphology, size, and in vitro release properties were evaluated in a simulated gastrointestinal medium, and long-term antibacterial performance, cytotoxicity, stability, and activity of this novel PMAA/INH/RMP nanogel against multidrug-resistant MTB in the intestine were investigated. Our results indicate that the PMAA/INH/RMP nanogel exhibited extended antibacterial activity by virtue of its long-term release of INH and RMP in the simulated gastrointestinal medium. Further, this PMAA/INH/RMP nanogel exhibited lower cytotoxicity than did INH or RMP alone, suggesting that this PMAA/INH/RMP nanogel could be a more useful dosage form than separate doses of INH and RMP for intestinal MTB. The novel aspects of this study include the cytotoxicity study and the three-phase release profile study, which might be useful for other researchers in this field.

[The dynamic changes of tuberculosis related cytokines during disease progression].

OBJECTIVE: To study the dynamic changes of tuberculosis related cytokines among patients during the different courses of treatment, and to analyze their influences on the development and prognoses of tuberculosis. METHODS: All patients with active tuberculosis were enrolled from Guangzhou, Shenzhen and Foshan TB control institutes. There were a total of 68 cases, 36 males and 32 females, aged 19 to 50 years [ average (30±9) years]. All the TB patients received standard chemotherapy regimen of anti-tuberculosis, and were divided into 2 groups: one completed treatment group (cured or clinically cured 38 cases) and 1 uncompleted treatment group (treatment failure or need to extend treatment, 30 cases). Peripheral blood serum at 0, 2, 6 month during the treatment from 68 tuberculosis patients were collected, and the concentration of IFN-γ,IL-4,IL-17,TGF-ß,TNF-α and IL-10 were detected by ELISA tests. RESULTS: The concentration of IFN-γ, TGF-ß and IL-4 in all enrolled patients showed significant decrease (from 23.2 ng/L to 22.3 ng/L, from 169.1 ng/L to 123.2 ng/L; 65.0 ng/L to 31.9 ng/L) (t=2.67, 2.35 and 3.41, P<0.05) along with the extension of treatment. IL-10 increased significantly (12.9 ng/L) in the uncompleted treatment group but declined significantly (5.38 ng/L) (P<0.05) in the completed treatment group at the end of 6 month. Meanwhile, IL-4 decreased significantly (P<0.05) in the completed treatment group but no significant changes were observed in the uncompleted treatment group. Th1/Th2 (IFN-γ/IL-4) raised gradually in the completed treatment group (0 month <2 month <6 month, t=6.32, 6.03 and 5.85, P<0.05), while it was only at 6 month in the uncompleted treatment group (0 month <6 month, t=3.7, P<0.05). And the ratio of Th1/Th2 in the completed treatment group was significantly higher than that in the uncompleted group treatment (P<0.05). CONCLUSION: It suggests that the changes of Th1 cytokines (IFN-γ, TGF-ß) and the Th1/Th2 balance play an important role in the pathogenesis, development and prognosis of TB. The suppression of IFN-γ, TGF-ß or Th1/Th2 balance may be an important factor influencing the prognosis of TB.

Cytokine and Antibody Based Diagnostic Algorithms for Sputum Culture-Positive Pulmonary Tuberculosis.

BACKGROUND: Tuberculosis (TB) is one of the most serious infectious diseases globally and has high mortality rates. A variety of diagnostic tests are available, yet none are wholly reliable. Serum cytokines, although significantly and frequently induced by different diseases and thus good biomarkers for disease diagnosis and prognosis, are not sufficiently disease-specific. TB-specific antibody detection, on the other hand, has been reported to be highly specific but not sufficiently sensitive. In this study, our aim was to improve the sensitivity and specificity of TB diagnosis by combining detection of TB-related cytokines and TB-specific antibodies in peripheral blood samples. METHODS: TB-related serum cytokines were screened using a human cytokine array. TB-related cytokines and TB-specific antibodies were detected in parallel with microarray technology. The diagnostic performance of the new protocol for active TB was systematically compared with other traditional methods. RESULTS: Here, we show that cytokines I-309, IL-8 and MIG are capable of distinguishing patients with active TB from healthy controls, patients with latent TB infection, and those with a range of other pulmonary diseases, and that these cytokines, and their presence alongside antibodies for TB-specific antigens Ag14-16kDa, Ag32kDa, Ag38kDa and Ag85B, are specific markers for active TB. The diagnostic protocol for active TB developed here, which combines the detection of three TB-related cytokines and TB-specific antibodies, is highly sensitive (91.03%), specific (90.77%) and accurate (90.87%). CONCLUSIONS: Our results show that combining detection of TB-related cytokines and TB-specific antibodies significantly enhances diagnostic accuracy for active TB, providing greater accuracy than conventional diagnostic methods such as interferon gamma release assays (IGRAs), TB antibody Colloidal Gold Assays and microbiological culture, and suggest that this diagnostic protocol has potential for clinical application.

Non-adherence to anti-tuberculosis treatment among internal migrants with pulmonary tuberculosis in Shenzhen, China: a cross-sectional study.

BACKGROUND: Non-adherence to tuberculosis (TB) treatment threatens the success of treatment, increases the risk of TB spread, and leads to the development of drug resistance. The present study assessed non-adherence to anti-TB treatment among internal migrants with pulmonary TB living in Shenzhen, China, and examined risk factors for non-adherence in order to identify targets for intervention. METHODS: A total of 794 internal migrants with TB treated at Bao'an Hospital for Chronic Disease Prevention and Cure, Shenzhen, were recruited. Structured questionnaires were used to collect data on these patients' history and experiences with TB treatment. Ordinal logistic regression model were used to identify risk factors for non-adherence. RESULTS: The proportion of patients who had missed one dose of medication within two weeks was 93/794 (11.71%), and those who missed at least two doses of medication within two weeks was 167/794 (21.03%), with a total of 33.74% of patients not adhering to TB treatment. Lack of knowledge about TB treatment and longer travel time to the nearest community health centers are significant predictors for non-adherence. CONCLUSIONS: The present study shows that non-adherence is common among internal migrants with TB. Patients who lack knowledge about TB treatment or have to travel far to get treated are prone to miss one or more doses of medication. Interventions to improve health education and healthcare access are essential to reduce non-adherence to TB treatment among internal migrants.

Effect of Diagnostic and Treatment Delay on the Risk of Tuberculosis Transmission in Shenzhen, China: An Observational Cohort Study, 1993-2010.

INTRODUCTION: To understand better the risk of tuberculosis transmission with increasing delay in tuberculosis treatment, we undertook a retrospective cohort study in Shenzhen, China. METHODS: All pulmonary tuberculosis cases in the Shenzhen tuberculosis surveillance database from 1993-2010 were included. Sputum smear positivity and presence of pulmonary cavity were used as proxies for risk of tuberculosis transmission. RESULTS: Among 48,441pulmonary tuberculosis cases, 70% presented with symptoms of pulmonary TB, 62% were sputum smear positive, and 21% had a pulmonary cavity on chest x-ray. 95.3% of patients self-presented for evaluation of illness after a median 58 days of delay after symptoms began. The proportion presenting sputum smear positive (p<0.001) and with a pulmonary cavity (p<0.001) increased significantly with increasing duration of delay. CONCLUSIONS: Delayed diagnosis and treatment of tuberculosis is associated with a significantly increased risk of pulmonary sputum smear positivity and pulmonary cavity. To decrease risk of transmission, treatment delay needs to be reduced further.

Properties of plasma membrane H+ -ATPase in salt-treated Populus euphratica callus.

The plasma membrane (PM) vesicles from Populus euphratica (P. euphratica) callus were isolated to investigate the properties of the PM H(+)-ATPase. An enrichment of sealed and oriented right-side-out PM vesicles was demonstrated by measurement of the purity and orientation of membrane vesicles in the upper phase fraction. Analysis of pH optimum, temperature effects and kinetic properties showed that the properties of the PM H(+)-ATPase from woody plant P. euphratica callus were consistent with those from herbaceous species. Application of various thiol reagents to the reaction revealed that reduced thiol groups were essential to maintain the PM H(+)-ATPase activity. In addition, there was increased H(+)-ATPase activity in the PM vesicles when callus was exposed to NaCl. Western blotting analysis demonstrated an enhancement of H(+)-ATPase content in NaCl-treated P. euphratica callus compared with the control.