ObjectiveTo investigate the clinical characteristics of non-tuberculous mycobacterium (NTM) pulmonary disease and pulmonary tuberculosis, as well as the bacterial distribution of NTM pulmonary disease. Methods The bacterial distribution and clinical characteristics of 104 patients with NTM lung disease hospitalized in Jiangxi Provincial People’s Hospital from May 2017 to May 2020 were retrospectively analyzed, as well as the clinicplal characteristics of 155 patients with tuberculosis hospitalized during the same period. Results The age of NTM lung disease group [(60±15) years] was higher than that of tuberculosis group [(55±19) years]. There were statistically significant differences in basic diseases (such as malignant tumor, type 2 diabetes, old tuberculosis, bronchiectasis), laboratory examination (such as blood routine examination, albumin) and chest imaging characteristics between the two groups (P<0.05). There was no significant difference in clinical symptoms (such as cough, sputum or fever) (P>0.05). The common underlying diseases of NTM lung disease were malignant tumor (29%), bronchiectasis (21%), chronic obstructive pulmonary disease (19%), etc. The common clinical symptoms of NTM lung disease included cough, sputum, fever, hemoptysis, chest tightness and shortness of breath, and other non-specific respiratory symptoms. The common manifestations of NTM lung disease on chest high-resolution CT (HRCT) included patchy images (82%), mediastinal lymph node enalargement (35%), pleural thickening (31%), pleural effusion (26%) and other signs. The isolates of NTM included Mycobacterium avium (50%), Mycobacterium intracellulare (21%), Mycobacterium chelonae/abscessus (14%), Mycobacterium fortuitum (5%), Mycobacterium gordonae (4%), Mycobacterium gilvum (3%), and Mycobacterium smegmatis (3%). Multivariate Logistic regression analysis showed that advanced age (OR=1.027) was a risk factor for NTM lung disease. Conclusions The clinical manifestations of NTM lung disease and tuberculosis are similar and difficult to distinguish. For male patients over 60 years old with malignant tumor, old tuberculosis, bronchiectasis and other basic diseases, and the chest HRCT findings are mainly bronchiectasis, NTM lung disease should be actively excluded. There is little difference in clinical manifestations between different strains of NTM lung disease, and the treatment cycle of NTM lung disease is long and easy to be interrupted, requiring enhanced follow-up.
Objective To describe the underlying conditions of chronic pulmonary aspergillosis (CPA). Methods A retrospective study was performed. Details of the clinical, imaging features, and the underlying conditions of CPA patients admitted to a tertiary university teaching hospital from January 2009 to December 2016 were extracted from clinical records. The classification distribution of CPA, and underlying conditions were analyzed. Results Among the 108 CPA patients, 87 cases had underlying conditions, 21 cases had no underlying conditions. Seventy two (66.7%) patients were engaged in agriculture, the proportion of which was significantly higher in the cases without underlying conditions (85.7% vs. 62.1%). Chronic necrotizing pulmonary aspergillosis (CNPA) was the most common type of these CPA cases. The cases without underlying conditions had significantly more proportion of CNPA than the cases with underlying conditions (85.7% vs. 62.1%). The cases with systemic underlying conditions had significantly more proportion of CNPA than the cases only with pulmonary underlying conditions (82.8% vs. 51.7%). Chronic cavity pulmonary aspergillosis (24/108, 22.2%) only existed in the cases with pulmonary underlying conditions. Underlying conditions were identified in 87 cases of CPA, with 85.1% (74/87) pulmonary and 33.3% (29/87) systemic underlying diseases. Previous tuberculosis mycobacterial infection, bronchiectasis and chronic obstructive pulmonary disease were the most common pulmonary underlying conditions (40.2%, 39.1% and 35.6%, respectively). Diabetes (16.1%) and glucocorticoid using (13.8%) were the most two common systemic underlying conditions. Conclusions CPA can occur in patients with and without underlying diseases. CNPA is the most common type of these CPA, the proportion of which is higher in cases without underlying conditions and cases with systemic underlying conditions. Farming maybe the risk factors of CPA. Chronic pulmonary primary diseases are the most common underlying conditions. The most common systemic factors are diabetes and glucocorticoid using.
Objective To formulate an evidence-based treatment for a patient with pulmonary tuberculosis combined with tuberculous meningitis and tuberculous pericarditis. Methods According to the principles of evidencebased clinical practice, we searched The Cochrane Library (Issue 2, 2008), Ovid-Reviews (1991 to 2008), MEDLINE (1950 to 2008), and http://www.guideline.org. to identify the best evidence for treating a patient with pulmonary tuberculosis combined with tuberculous meningitis and tuberculous pericarditis. Results Nine guidelines, 2 systematic reviews, and 11 randomized controlled trials were included. The evidence showed that corticosteroids could help reduce the risk of death and disabling residual neurological deficiencies in patients with tuberculous meningitis. After adjusting for age and gender, the overall death rate of patients with tuberculous pericarditis was significantly reduced by prednisolone (P=0.044), as well as the risk of death from pericarditis (P=0.004). But for patients with pulmonary tuberculosis, there was still a controversy about the use of corticosteroids. Given the evidence, the patient’s clinical conditions, and his preferences, dexamethasone was used for the boy in question. After 7 weeks of treatment, his cerebrospinal fluid returned to normal and pericardial effusion disappeared. Conclusion Corticosteroids should be recommended in HIV-negative people with tuberculous meningitis or/and tuberculous pericarditis. The difference in the effectiveness of various corticosteroids such as dexamethasone, prednisolone, or methylprednisolone and the optimal duration of corticosteroid therapy is still unknown.
ObjectiveTo compare the clinical data of pulmonary lobectomy in patients with massive hemoptysis of pulmonary tuberculosis after bronchial artery embolization in the short and long term, so as to provide a reference for clinical choices of appropriate operation time.MethodsA retrospective analysis was conducted on 33 patients with massive hemoptysis of pulmonary tuberculosis, who had received pulmonary lobectomy after bronchial artery embolization in Wuhan Pulmonary Hospital from January 2015 to November 2017, including 29 males and 4 females aged of 23-66 (52.64±9.70) years. According to the time interval between bronchial artery embolization and lobectomy, the patients were divided into a short-term group (<2 weeks, 14 patients) and a long-term group (>1 month, 19 patients). The clinical data, such as operation time, intraoperative blood loss, postoperative extubation time and serious postoperative complications, were observed in the two groups for statistical analysis.ResultsThe operative time (297.13±75.69 min vs. 231.32±67.57 min, P=0.013), intraoperative blood loss (685.74±325.51 mL vs. 355.83±259.11 mL, P=0.002), postoperative extubation time (14.07±5.24 d vs. 8.90±3.57 d, P=0.003) of the short-term group were all higher than those in the long-term group.ConclusionFor the patients with massive hemoptysis of pulmonary tuberculosis, who had surgical indications and no risk of early rebleeding after bronchial artery embolization, pulmonary lobectomy should be performed late until the patient's physical condition and the primary disease was stable.
Objective To access the effectiveness and safety of levofloxacin in controlling multidrug resistant tuberculosis (MDR-TB). Methods The electronic searches in databases of PubMed, EMbase, The Cochrane Library, CNKI, CBM and VIP, handsearches and other searches were conducted from the date of their establishment to April 2011 for collecting randomized controlled trials (RCTs) on levofloxacin treating MDR-TB. Two researchers independently screened the literature according to the inclusive and exclusive criteria, extracted the data, assessed the quality of the included studies by adopting the Jadad scale, and performed Meta-analysis by using RevMan 5.0 software. Results A total of 31 RCTs involving 2836 cases were included. The results of meta-analysis showed: a) Compared with the placebo group, levofloxacin could increase the sputum negative conversion rate after 3-month taking and at the end of the treatment period; b) Compared with the ofloxacin group, levofloxacin could increase the sputum negative conversion rate after 3 months and at the end of the treatment period; c) levofloxacin replacing either ethambutol or streptomycin could increase the sputum negative conversion rate after 3 months and at the end of the treatment period; d) Compared with the levofloxacin group, gatifloxacin and moxifloxacin could increase the sputum negative conversion rate after 3 months and at the end of the treatment period; e) There was no significant difference in the adverse reaction rate between each of the medication regimens (P=0.19). Conclusion Levofloxacin is more effective for MDR-TB than ofloxacin, ethambutol and streptomycin, but it is inferior to gatifloxacin or moxifloxacin. Its adverse reaction rate is equivalent to other medicines’.
Objective To analyze the report status of the pulmonary tuberculosis in the elderly people aged ≥ 65 years old. Methods The reported data of senile pulmonary tuberculosis and the whole population pulmonary tuberculosis at West China Hospital of Sichuan University between January 1, 2012 and December 31, 2022 were retrospective selection. Descriptive methods were used to analyze the different characteristics and etiology of senile pulmonary tuberculosis. Results A total of 2 182 senile pulmonary tuberculosis were reported. The report was mainly positive reports of etiology [1091 cases (50.00%)], and the component ratio increased year by year (χ2=49.986, P<0.001). The proportion of senile pulmonary tuberculosis in the whole population pulmonary tuberculosis increased from 17.62% in 2012 to 29.04% in 2022, and the difference between different years was statistically significant (χ2=40.261, P<0.001). In the reported patients, the male to female ratio was 2.30∶1. There were 7 cases of rifampicin resistant, 1 091 cases of etiology positivity, 674 cases of etiology negativity, and 410 cases of no etiology results. The number of reported cases in the age group of 65-74 was higher than that in the age group of 75 and above. The seasonal distribution was not obvious (concentration<0.3). The patients were mainly from other cities of the province [919 cases (42.12%)], and the Department of Pulmonary and Critical Care Medicine (including the Tuberculosis Ward) was reported the most [1439 cases (65.95%)]. The majority of occupations were retired individuals [952 cases (43.63%)]. Conclusions From 2012 to 2022, the prevention and treatment of senile pulmonary tuberculosis has achieved some results, but the overall burden is still very heavy. The detection of senile pulmonary tuberculosis should be strengthened.
Objective To assess the effect of astragaulus membranaceus in the treatment of pulmonary tuberculosis. Methods Through applying the methods provided by the Cochrane Collaboration, the randomized controlled trials (RCTs) or quasi-RCTs of astragaulus membranaceus in the treatment of pulmonary tuberculosis were searched in The Cochrane Library (Issue 3, 2010), CNKI (1991 to May 2010), VIP (1989 to May 2010), EMbase (1981 to May 2010), and PubMed (1981 to May 2010). Two reviewers independently screened the included studies, extracted the data, assessed the quality, and cross checked then. The RevMan 5.0 software was used to conduct meta-analyses. Results Twelve RCTs involving 1 054 patients were included. All trials were tested in the mainland China. The results of meta-analyses showed that: a) The astragaulus membranaceus could assist the conventional drug to cure pulmonary tuberculosis, promote sputum negative conversion, focal absorption and cavity reduction in lung; b) The astragaulus membranaceus could reduce the adverse reactions of the conventional drug; c) The astragaulus membranaceus combined with the conventional drug could improve the patients’ symptoms and signs; and d) The astragaulus membranaceus combined with the conventional drug could reduce the bacterial relapse rates in follow-up after treatment. Conclusion The current evidence shows that the astragaulus membranaceus has some effects and is relatively safe to treat pulmonary tuberculosis. However, it is far from enough to recommend astragaulus membranaceus as a conventional adjuvant therapy for pulmonary tuberculosis because of no sufficient evidence obtained from this study for its small sample and low methodology quality. Therefore, more double-blind multi-center RCTs with high quality, large sample, and adequate follow up are required for further verification.
Objective To investigate and analyze the epidemic characteristics and factors of pulmonary tuberculosis (PTB) to provide foundation and make prevention and treatment policy. Methods Statistical analysis was conducted to analyze the current existing PTB prevention and control data in the Center for Disease Control and Prevention of Zhushan County and corresponding prevention and treatment policy was proposed. Results Since 1997 when PTB was included into B infectious diseases in Zhushan County, 4 431 cases of PTB had been reported by the end of 2009. Annual reported incidence rate was 74.73 per 100 000 and the disease was found in 17 towns. All seasons witnessed the incidence but winter and summer had more sufferer. The youngest patient was 4 months whereas the oldest was 86 years old. The majority of the patients were from 20 to 59 years old, peasants were the main patients, and the incidence of male was higher than that of female. The use of chemotherapy resulted in a significant decline of PTB death rate. Poor immunity of elder group, population flow caused by poverty, low detection rate of patients and AIDS were the major causes to PTB epidemic. A lack of prevention and treatment in the grassroots hospital and difficulty to fully implement the Directly Observed Treatment, Short-course (DOTS) strategy in remote areas were also bottlenecks to PTB control process. Conclusion The followings should be performed to improve the quality of DOTS strategy implementation: strengthen the government’s commitment, provide policy and funding safeguard, conduct health education and health promotion widely, reinforce management according to the law, fully implement the DOTS strategy, and fortify the prevention and control construction.
ObjectiveTo investigate the diagnostic value of products triggered by endotoxin including cytokines and procalcitonin for differentiating bacterial pneumonia from pulmonary tuberculosis. MethodsFifty patients diagnosed to have hospital-acquired pneumonia and another 50 patients diagnosed with tuberculosis admitted into West China Hospital between January and August 2015 were recruited in this study. The frequencies of CD4+ interferon (IFN)-γ+, CD4+ tumor necrosis factor (TNF)-α+, CD4+ interleukin (IL)-2+, CD4+ IL-10+ as well as CD8+IFN-γ+, CD8+TNF-α+, CD8+IL-2+, CD8+IL-10+ populations in peripheral blood were detected by flow cytometry after endotoxin stimulation. Meanwhile, the levels of procalcitonin, IL-6 and C reactive protein were measured by immunofluorescence staining. ResultsThe frequencies of CD4+ IFN-γ+, CD4+ TNF-α+, CD4+ IL-2+, CD4+ IL-10+ as well as CD8+ IFN-γ+, CD8+ TNF-α+, CD8+ IL-2+, CD8+ IL-10+ populations in the pneumonia group increased significantly compared with those in the tuberculosis group (P < 0.05). The levels of procalcitonin, IL-6 and C-reactive protein in the pneumonia group increased statistically compared with the counterparts in the tuberculosis group (P < 0.05). The positive rates of procalcitonin, IL-6 and C-reactive protein in the pneumonia group were significantly higher than those in the tuberculosis group (P < 0.05). ConclusionMeasurement of products triggered by endotoxin is beneficial for differential diagnosis of pneumonia from tuberculosis.
Objective To study the effect of comprehensive nursing on the treatment compliance and depression of patients with pulmonary tuberculosis complicated with depression. Methods Fifty-seven patients with pulmonary tuberculosis complicated with depression treated between May 2012 and June 2014 were randomly divided into study group (n=30) which was given comprehensive nursing, and control group (n=27) which accepted routine nursing. The scores of depression, treatment compliance and clinical treatment outcome were compared between the two groups. Results The scores of Hamilton Depression Scale were respectively 19.18±2.36, 18.65±2.61, 17.43±1.78 and 16.57±2.05 at the time of 3, 4, 5 and 6 months after nursing intervention, while the same scores of the control group were 22.05±3.03, 21.88±2.85, 20.96±2.06 and 20.04±1.39. The sputum negative conversion rates in the study group at those time periods were respectively 66.7%, 76.7%, 80.0% and 86.7%, while the rates in the control group were 37.0%, 44.4%, 51.6% and 63.0%. The CT lung lesions absorption rates in the study group were 43.3%, 56.7%, 63.3% and 76.7%, while the rates in the control group were 18.5%, 25.9%, 35.3% and 40.7%. The above indicators between the two groups were all statistically significant (P<0.05). The compliance of treatment in the study group was 90.0%, which was significantly higher than that in the control group (63.0%) (P<0.05). Conclusion Comprehensive nursing can help to improve negative emotion, enhance treatment compliance and clinical treatment effect, and promote the early recovery of patients with pulmonary tuberculosis combined with depression.