Objective To evaluate the diagnostic value of all diagnostic tests detecting the ethambutol resistance in Mycobacterium tuberculosis. Methods PubMed, EMbase, Chinese Biomedical Database (CBM), Chinese Scientific Journals Full-Text Database (CSJD), and Chinese Journal Full-text Database (CJFD) were searched, and QUADAS items were used to evaluate the quality of included studies. Meta-disc software was used to handle data from included studies. Such index as sensitivity, specificity, and SROC were applied to assess the diagnostic value of individual diagnostic test. Results Nine studies were included. The results of meta-analyses showed that compared with proportion method, the summary sensitivity, summary specificity, positive likelihood ratio, negative likelihood ratio, and SROC area under curve of a nitrate reductase assay were 92%, 99%, 30.50, 0.13, and 0.975 2, respectively, while compared with BACTEC 460 TB, the above mentioned indexes of BACTEC MGIT 960 System were 92%, 99%, 6.27, 0.11, and 0.9, respectively. Bacteriophage biological amplification method revealed relative good analysis effectiveness on MB/BacT. Conclusion According to the results, it is recommended that nitrate reductase assay can replace proportion method as screening test of ethambutol resistance in Mycobacterium tuberculosis, and BACTEC MGIT 960 System can replace BACTEC 460 as final diagnostic test of ethambutol resistance in Mycobacterium tuberculosis.
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.
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.
Objective To investigate the initial drug resistance of Mycobacterium tuberculosis ( M.tuberculosis) in patients with culture positive pulmonary tuberculosis. Methods 1184 patients who hospitalized in Shandong Provincial Chest Hospital with culture positive pulmonary tuberculosis were enrolled. The absolute density method was used to assess the drug resistance of M. tuberculosis. Results M.tuberculosis were sensitive to all anti-tuberculosis drugs in 834 cases( 70. 44% ) , and resistant in 350 cases( 29. 56% ) , in which initial resistance and secondary resistance accounted for 44. 86% ( 157/350) and 55. 14% ( 193 /350) respectively. In 157 cases with initial resistance, 53 cases ( 33. 8% ) were mono-drug resistant tuberculosis( MonoDR-TB) , of which 38 cases were resistance to Streptomycin( 24. 2% ) ; 72 cases( 45. 9% ) were polydrug-resistant tuberculosis ( PDR-TB) ; 20 cases ( 12. 7% ) were multidrug-resistant tuberculosis ( MDR-TB) ; 12 cases ( 7. 6% ) were extensively drug resistant tuberculosis ( XDR-TB) . There was no totally drug-resistant tuberculosis ( TDR-TB) . Conclusions The initial drug resistance of M.tuberculosis in patients with pulmonary tuberculosis is still serious. Unified management of TB control programs and full supervision of chemotherapy are very imperative.
Objective To investigate diagnosis and treatment strategies of patients with pulmonary tuberculosis （TB） complicated by Aspergillus infection. Methods Clinical data of 38 patients with pulmonary TB complicated by Aspergillus infection who underwent surgical treatment from January 2008 to December 2010 in Chengdu Infectious Disease Hospital were retrospectively analyzed. There were 23 male patients and 15 female patients with their average age of 37.8 （23-59） years. Preoperatively，all the patients received regular anti-TB treatment for more than 2 weeks，and patients with definite Aspergillus infection received anti-Aspergillus therapy for more than 3 days with consultation of infectious disease physicians. After above treatment，26 patients underwent lobectomy，1 patient underwent right pneumonectomy，and 11 patients underwent left pneumonectomy. All the patients were followed up at the outpatient department after discharge. They were evaluated every 2 weeks in the first 3 months，every 1 month after 3 months，and every 6 months after 1 year. During follow-up，they received acid-fast bacillus smear and sputum culture to check Aspergillus，as well as CT chest scan. Results All the patients successfully received surgical resection of the pulmonary lesion without perioperative death or severe complication. Postoperative pathology examination confirmed pulmonary TB with Aspergillosis infection in all the 38 patients，whose basic diseases included TB cavity in 17 patients，TB-destroyed lung in 12 patients，and post-TB bronchiectasis in 9 patients. All the patients were followed up after discharge for 1.5-4.5 years. During follow-up，they received regular anti-TB therapy for adequate duration in addition to antifungal medications such as voriconazole. None of the 38 patients had recurrence of Aspergillus infection or pulmonary TB. One patient had hemoptysis which was controlled after proper treatment during follow-up. Conclusion Missed diagnosis rate of pulmonary TB complicated by Aspergillus infection is high. Surgical resection of the pulmonary lesion and postoperative medication treatment are the most effective treatment strategies for patients with pulmonary TB complicated by Aspergillus infection.
Objective To assess the value of fluorine-18 fluorodeoxyglucose （18 F-FDG） positron emission tomography （PET） in patients with pulmonary tuberculosis. Methods Fifty-three patients with pulmonary tuberculosis were imaged with 18SF-FDG-PET. 18F-FDG-PET data were analyzed retrospectively with visual method and semiquantitative method. When pulmonary tuberculosis with abnormal 18F-FDG uptake appeared in PET scans confirmed by visual method, their maximum standard uptake value （SUVmax）, mean standard uptake value （SUVmean） and standard uptake value of normal lung （SUVlung） were measured using semiquantitative method. Results Thirty-six pulmonary tuberculous nodules could be detected by 18SF- FDG-PET, and were diagnosed active tuberculosis with visual method. SUVmax（2. 77±1. 20） and SUV mean（2.15±0.86） were higher than SUVlung（0.41± 0.09, Z=-5. 232, P〈0.01 ; Z=- 5. 232, P〈0.01）. Correlations were not found between SUVmax ,SUVmax and nodule size （Dmax, Dmin）, SUVlung, age, blood glucose level in these 36 patients （P〉0.05）. Seventeen fibrosis and calcification cases without caseous necrosis were not found abnormal in 18F-FDG-PET. Conclusion 18F- FDG- PET is useful in diagnosing active tuberculosis , extent of tuberculosis and guiding therapeutic regimen.
Objective To investigate the effectiveness in the treatment of single segment thoracic vertebra tuberculosis by limited decompression combined with epidural absorbable haemostat covering and vertebral plate reconstruction based on one-stage posterior approach, debridement, bone fusion, and internal fixation. Methods Between September 2005 and March 2010, 90 cases of single segment thoracic vertebra tuberculosis were treated by using limited decompression combined with epidural absorbable haemostat covering and vertebral plate reconstruction based on one-stage posterior approach, debridement, bone fusion, and internal fixation in 44 patients (treatment group) and by one-stage posterior approach, bone fusion, and internal fixation in 46 patients (control group). There was no significant difference in gender, age, disease duration, affected segment, Cobb angle, Frankle grade, erythrocyte sedimentation rate (ESR), and Oswestry disability index (ODI) between 2 groups (P gt; 0.05). Results All incisions healed by first intension. All 90 cases were followed up 24-44 months (mean, 38 months). There was no significant difference in ESR between 2 groups at 1 week and 3 months after operation (P gt; 0.05). Postoperative iconography indicated that the bone fusion rate of the treatment group was 100% and no epidural cicatricial tissue or failure of internal fixation was observed, showing significant difference when compared with control group (3 cases having failure of internal fixation) (P=0.032). The Cobb angles were significantly corrected after operation when compared with preoperative angles in 2 groups (P lt; 0.05). At 2 years after operation and at last follow-up, the Cobb angle and correction loss in treatment group were significantly better than those in control group (P lt; 0.05). The ODI and Frankel grade were significantly improved at last follow-up when compared with preoperative ones in 2 groups (P lt; 0.05); the treatment group was significantly better than the control group in the ODI, improvement rate of ODI (P lt; 0.05), and in Frankel grade (Uc=4.368, P=0.000). Conclusion Compared with conventional operation method, it is an ideal operation method to use limited decompression combined with epidural absorbable haemostat covering and vertebral plate reconstruction based on one-stage posterior approach, debridement, bone fusion, and internal fixation for treatment of single segment thoracic vertebra tuberculosis, with minimal wound, less complications, and good function recovery.
ObjectiveTo investigate the effectiveness of debridement and single-incision vertebral screw-rod fixation combined with pedicle screw-rod fixation and autograft bone fusion in treatment of thoracolumbar tuberculosis. MethodsBetween January 2008 and October 2010, 22 patients with thoracolumbar tuberculosis were treated by debridement and single-incision vertebral screw-rod fixation combined with pedicle screw-rod fixation and autograft bone fusion, and were given anti-tuberculosis therapy after operation. Of 22 patients, 14 were male and 8 were female with an average age of 42 years (range, 18-66 years). The disease duration was 2-16 months (mean, 6 months). Sixteen double-segment lesions included T7, 8 in 3 cases, T8, 9 in 1 case, T9, 10 in 3 cases, T11, 12 in 2 cases, L1, 2 in 4 cases, and L3, 4 in 3 cases; 6 three-segment lesions included T7-9 in 2 cases, T11-L1 in 1 case, and L2-4 in 3 cases. Preoperative visual analogue scale (VAS) score was 7.50 ± 0.63. According to Frankel classification of America Spinal Injury Association (ASIA), 2 cases were rated as grade B, 4 cases as grade C, 9 cases as grade D, and 7 cases as grade E. ResultsTwenty-two patients were followed up 15-36 months (mean, 25.2 months). Wound infection occurred in 1 case and was cured after corresponding treatment; incision healed by first intention in other patients. No loosening or breakage of internal fixator was found; the patients had no deteriorations in spinal cord injury or cerebrospinal fluid leakage. X-ray films and CT showed obvious bone fusion in the intervertebral space. The time of bone fusion was 3-6 months (mean, 5.2 months). The erythrocyte sedimentation rate after operation was significantly lower than that before operation (P lt; 0.05). The VAS scores were significantly improved to 2.90 ± 1.00 at 2 weeks after operation and 2.60 ± 0.81 at last follow-up (P lt; 0.05). At last follow-up, nerve function was significantly improved. According to Frankel classification, 2 cases were rated as grade C, 5 cases as grade D, and 15 cases as grade E. ConclusionSingle-incision vertebral screw-rod fixation combined with pedicle screw-rod fixation for thoracolumbar tuberculosis is a stable and minimally invasive method. However, the long-term effectiveness need further follow-up.
Objective To evaluate the cl inical results of allogeneic bone graft for interbody fusion in cervical tuberculosis. Methods Between January 2000 and January 2008, 30 cases of cervical tuberculosis were treated with allogeneic (group A, n=15) or autologous (group B, n=15) il iac crest bone graft combined with anterior fixation after radical debridement. In group A, there were 8 males and 7 females with an average age of 38 years; the disease duration was 6 to 14 months; the preoperative kyphosis Cobb angle was (8.6 ± 11.3)°; the preoperative Japanese Orthopaedic Association (JOA) score was 13.0 ± 3.1 for neurological function; and the length of bone graft was 32 mm on average. In group B, there were 9males and 6 females with an average age of 42 years; the disease duration was 4 to 17 months; the preoperative kyphosis Cobb angle was (4.9 ± 7.4)°; the preoperative JOA score 12.3 ± 4.2; and the length of bone graft was 34 mm on average. There was no significant difference in general data between 2 groups (P gt; 0.05). Results The operation time and bleeding volume in group A were significantly less than those in group B (P lt; 0.05). Wound effusion were found in 2 cases of group A, and the other incisions healed by first intention. No infection occurred in group B. In group A, 13 cases were followed up 12-48 months; in group B, 14 cases were followed up 13-46 months. The time of bone graft heal ing in group A [(7.6 ± 2.1) months] was significantly longer than that in group B [(4.2 ± 1.1) months] (t=2.773, P=0.005). The kyphosis Cobb angles were significantly improved at 6 months and last follow-up after operation in 2 groups when compared with that before operation (P lt; 0.05), but no significant difference was found between 2 groups at different time after operation (P gt; 0.05). There was no significant difference in JOA score at 6 months after operation between group A (14.1 ± 2.6) and group B (14.3 ± 2.4) (t=1.655, P=0.162). The improvement rate for neural function were 83.7% in group A and 87.8% in group B, showing no significant difference (χ2=3.150, P=0.071). There was no loosening of internal fixation and recurrence of tuberculosis in 2 groups during follow-up. Five cases had chronic pain at il iac donor sites in group B. According to Bridwell et al. evaluation standard, the bone fusion was satisfactory in 11 cases (84.6%) and unsatisfactory in 2 cases (15.4%) in group A, and was satisfactory for all in 14 cases (100%) in group B. The satisfactory rate of bone fusion showed no significant difference between 2 groups (χ2=2.680, P=0.115).Conclusion Allogeneic bone grafting has a good cl inical result for spinal fusion in cervical tuberculosis surgery, which can treat tuberculosis bone defect effectively.
Objective To investigate the effectiveness and feasibil ity of modified single-stage transpedicular decompression, debridement, and posterior instrumentation in treatment of thoracic tuberculosis. Methods Between January 2005 and December 2009, 22 cases of thoracic tuberculosis were treated with modified single-stage transpedicular decompression, debridement, and posterior instrumentation. There were 12 males and 10 females with an average age of 39.4 years (range, 22-52 years). The mean disease duration was 1.2 years (range, 3 months to 10 years). The involved vertebral bodies were T5-12, including 2 segments in 17 cases and 3 segments in 5 cases. The kyphosis Cobb angle was (31.2 ± 14.5)° before operation. According to Frankel score system for neurological deficits, 2 cases were classified as grade A, 1 case as grade B, 8 cases as grade C, 5 cases as grade D, 1 case as grade E, and 5 cases had no neurological deficits before operation. Results All incisions healed by first intention. All patients were followed up 22.2 months on average (range, 12-65 months). Pain in low back was rel ieved in varying degrees 2 weeks after operation. Fusion was achieved in the bone implant area at 3 months after operation. According to Frankel score system, 1 case was rated as grade B, 2 cases as grade C, 4 cases as grade D, 7 cases as grade E, and 8 cases had no neurological deficits at last follow-up. The kyphosis Cobb angle was (16.2 ± 3.6)°, showing significant difference when compared with the value before operation (t=5.952, P=0.001). No loosening, emersion, breakage of internal fixation or pneumothorax occurred 1 year after operation. Conclusion Single-stage transpedicular decompression and posterior instrumentation is an effective and safe method in treatment of thoracic tuberculosis.