Immunogenicty and immunoprotective effect of Mycobacterium tuberculosis Ag85B-Fc2a DNA vaccine / 中国生物制品学杂志

@#Objective To evaluate the immunogenicity and protective effect of Mycobacterium tuberculosis(M.tb) Ag85B-Fc2a DNA vaccine in mice,so as to provide experimental basis for the development of the vaccine.Methods The recombinant plasmid pcD-Ag85B-Fc2a was identified by double digestion and sequencing,and then transfected into CHO-K1 cells.The expression of fusion protein Ag85B-Fc2a was detected by Western blot.Vector pcDNA3.1(+) and recombinant plasmid pcDAg85B-Fc2a were injected into female C57BL/6J mice through thigh muscle respectively(control group and immunization group),with 10 mice in each group,and booster immunization was carried out two weeks after the initial immunization.At14 d,28 d and 42 d after the initial immunization,serum samples was separated,and the titers of IgG antibody in the serum were detected by indirect ELISA.At 42 d after the initial immunization,the spleen of mice was taken aseptically and made into single cell suspension,and the proportions of CD4~+and CD8~+T cells were detected by flow cytometry.The remaining mice were injected with M.tb H37Ra through the tail vein 42 d after the initial immunization at a dose of 10~6 CFU/mouse.After 28 d of challenge,the lung and spleen of mice were collected aseptically.The number of bacteria in the left lung and spleen was measured by plate method,and the bacteria in the right lung was detected by auramine O fluorescence staining.Results Double digestion and sequencing results showed that the recombinant plasmid pcD-Ag85B-Fc2a was constructed correctly.After transfection into CHO-K1 cells,the fusion protein Ag85B-Fc2a with a relative molecular mass of about 70 000was detected.The Ag85B-specific IgG antibody titer in serum of mice in the immunization group was 1:3 200,1:12 160,and 1:12 800 at 14 d,28 d,and 42 d after the initial immunization,respectively,but no antibody titer was detected in the serum samples of control group.At 42 d after the initial immunization,the percentages of CD4~+ T cells in mouse spleen of control group and immunization group were(23.61±0.64)% and(26.92±0.80)%,and the percentages of CD8~+T cells were(14.12±0.87)% and(18.78±0.94)%,respectively,with significant differences(t=3.23 and 3.64,respectively,each P <0.05).After infection with M.tb H37Ra for 28 d,the numbers of bacteria were(4.73±0.13) and(3.81±0.14)CFU in the left lung,and(5.02±0.19) and(4.30±0.13) C.FU in the spleen of control group and immunization group,respectively,with significant differences(t=4.65 and 3.12,respectively,each P <0.01).The bacteria loading in the right lung was consistent with that in the left lung.Conclusion Ag85B-Fc2a DNA vaccine can induce specific humoral and cellular immune effects in mice,and can produce good protective effect against M.tb H37Ra infection.

Comparison of Four Methods in the Diagnosis of Bone Tuberculosis / 昆明医科大学学报

Objective To compare the diagnostic value of smear acid-fast staining,TB-DNA,X-pert MTB/RIF and culture of Mycobacterium tuberculosis.Methods Four methods were used to detect the perifocal pus of the patients with bone destruction in orthopaedics department within one year,and the results were analyzed statistically,the indexes included sensitivity,specificity,positive predictive value and negative predictive value.Results The sensitivity,specificity,positive predictive value,negative predictive value,and Youden index were 31.75%,100.00%,100.00%,53.74%and 0.32 respectively.TB-DNA had a sensitivity of 88.89%,a specificity of 98.00%,a positive predictive value of 98.25%,a negative predictive value of 87.50%,and a Youden Index of 0.87.Xpert MTB/Rif had a sensitivity of 95.23%,a specificity of 68.00%,and a positive predictive value of 78.95%,the negative predictive value was 91.90%,the Youden index was 0.63.The sensitivity,the specificity,the positive predictive value,the negative predictive value and the Youden index were 41.27%,100.00%,100.00%,57.47%and 0.41 respectively,(χ2 = 77.354,P<0.005).Conclusion Among the four methods,TB-DNA has a good Sensitivity and specificity,Xpert mtbrif has a good sensitivity,TB-DNA and Xpert mtbrif ha a good authenticity,and both positive and negative predictive values are high,it has good value in the diagnosis of bone tuberculosis.

The detection value of tuberculosis-specific QFT-TB in different types of specimens of tuberculosis patients / 实用医学杂志

Objective The study aimed to compare the diagnostic efficacy of QuantiFERON-TB Gold(QFT-TB)detection of specific cellular immune IGRAs in tuberculosis diagnostic laboratory for pulmonary tuberculosis,extrapulmonary tuberculosis and special population samples in vitro,which may provide evidence for clinical diagnosis and treatment.Methods A total of 546 patients with tuberculosis(AFB + 146 cases,AFB-247 cases),117 patients with molecular biology positive tuberculosis(Xpert 69 cases,TB-DNA 48 cases)and 36 patients with histopathological positive were collected from January to July 2023.There were 72 cases of extrapulmonary tuberculosis,276 cases of pleural effusion and 25 cases of ascites.QFT-TB method was used for detection,chi-square test was applied for com-parison between groups,and the methodological evaluation of positive rate and coincidence rate were all compared.Results The positive rates of QFT-TB in pulmonary tuberculosis,extrapulmonary tuberculosis and close contacts were 83.69%,69.44%,and 32.41%,respectively.The coincidence rates of QFT-TB in AFB +,GeneXpert,TB-DNA and pathological confirmed tuberculosis patients were 91.09%,88.40%,81.25%,and 72.22%,respectively.The positive rate of pleural effusion in patients with tuberculous pleurisy was 60.50%,and the uncertainty rate was 29.71%.The positive rate of ascites was 44.00%and the uncertainty was 36.00%.Conclusion QFT-TB test has good value in the auxiliary diagnosis of pulmonary tuberculosis,and has certain reference significance for the diagnosis of extrapulmonary tuberculosis based on the detection of pleural fluids and ascites.

Diagnostic efficacy of optimized T-SPOT.TB in differentiating spinal tu-berculosis from other spinal infection / 中国感染控制杂志

Objective To explore the efficacy of T-cell spot test of tuberculosis infection(T-SPOT.TB)in the differential diagnosis of spinal tuberculosis(STB),and optimize diagnostic efficacy through the optimal cut-off value of receiver operating characteristic(ROC)curve.Methods Clinical data of patients with spinal infection in a hospi-tal from January 2010 to May 2019 were collected,including preoperative T-SPOT.TB test results,white blood cell count,C-reactive protein,erythrocyte sedimentation rate,procalcitonin,and tuberculosis antibodies,etal.Clinical diagnosis was conducted based on diagnostic criteria.The sensitivity and specificity of T-SPOT.TB in preoperative diagnosis of STB and other spinal infection was analyzed,and the diagnostic efficacy of the optimized T-SPOT.TB indicators was evaluated.Results A total of 132 patients were included in this study,out of whom 78 patients(59.09％)were diagnosed with STB,and 54(40.91％)were diagnosed with non-tuberculosis(non-TB)spinal in-fection.The sensitivity and specificity of T-SPOT.TB in differential diagnosis of STB were 67.68％and 66.67％,respectively.Univariate logistic regression analysis showed that compared with non-TB spinal infection,the OR va-lue of T-SPOT.TB test in diagnosing STB was 4.188(95％CI:1.847-9.974,P＜0.001).The optimized T-SPOT.TB evaluation index through ROC curve to determine the optimal cut-off values of ESAT-6,CFP-10,and CFP-10+ESAT-6 for differential diagnosis of STB and non-TB spinal infection were 12.5,19.5,and 36,respec-tively,and area under curve(AUC)values were 0.765 6,0.741 5,and 0.778 6,respectively,all with good diag-nostic efficacy.CFP-10+ESAT-6 had the highest AUC.CFP-10+ESAT-6 specific spot count had higher efficacy in the diagnosis of STB,with a diagnostic accuracy of 75.56％,higher than 67.42％of pre-optimized T-SPOT.TB.Conclusion T-SPOT.TB test has high diagnostic efficacy in differentiating STB from non-TB spinal infection.Posi-tivity in T-SPOT.TB test,especially with spot count of CFP-10+ESAT-6 over 36,indicates a higher likelihood of STB.

Pancreatic tuberculosis mimicking as pancreatic malignancy: Surgeon's dilemma

Pancreatic tuberculosis is a rare form of Tuberculosis (TB) which requires a high index of suspicion to diagnose. Here, we report a case of middle-aged gentleman presenting with abdominal pain and constitutional symptoms who was diagnosed with pancreatic tuberculosis on imaging, which was confirmed by Fine Needle Aspiration (FNA) from the lesion. The patient was given Anti-Tubercular Treatment (ATT) as per conventional protocol. Follow-up showed recovery from the entity. A review of patient presentation, patho-physiology, diagnosis, and management of pancreatic tuberculosis is mentioned in this article.

Social vulnerability and tuberculosis: a vicious circle

A B S T R A C T Tuberculosis (TB) represents an important cause of morbidity and one of the top ten causes of mortality in the world, associated with economic problems, vulnerability marginalization, stigma and discrimination. From a mixed study that triangulates quantitative data and qualitative information, the main results of the characterization of the social vulnerability of people with TB in the municipality of Cali - Colombia are presented, based on the AVEO model that analyzes the social vulnerability related to assets and liabilities that people possess and the opportunities that the context offers. The results show assets, liabilities and opportunities related to TB treatment, articulated through demographic, biological, socioeconomic, psychosocial and habitat dimensions. It is concluded that there is a vicious circle between conditions of social vulnerability and tuberculosis, in which people with higher levels of social vulnerability are more affected by the disease in all dimensions of their existence, increasing or maintaining levels of vulnerability which that requires multisectoral interventions that go beyond health services.

La tuberculosis (TB) representa una importante causa de morbilidad y una de las diez primeras causas de mortalidad en el mundo, asociada con problemas económicos, vulnerabilidad, marginación, estigma y discriminación. A partir de un estudio mixto que triangula datos cuantitativos e información cualitativa, se presentan los principales resultados de la caracterización de la vulnerabilidad social de personas con TB en el municipio de Cali - Colombia, basado en el modelo AVEO que analiza la vulnerabilidad social relacionado los activos y los pasivos que poseen las personas y las oportunidades que ofrece el contexto. Los resultados muestran activos, pasivos y oportunidades relacionadas con el tratamiento de la TB, articuladas a través de dimensiones demográficas, biológicas, socioeconómicas, psicosociales y de hábitat. Se concluye que existe un círculo vicioso entre condiciones de vulnerabilidad social y tuberculosis, en el que las personas con mayores niveles de vulnerabilidad social se ven más afectadas por la enfermedad en todas las dimensiones de su existencia, aumentando o mantenido los niveles de vulnerabilidad, lo que requiere intervenciones multisectoriales que sobrepasan los servicios de salud.

Tuberculose; vulnerabilidade no mundo, associada a problemas econômicos, vulnerabilidade, marginalização, estigma e discriminação. Com social; saúde; saúde pública. base em um estudo misto que triangula dados quantitativos e informações qualitativas, são apresentados os principais resultados da caracterização da vulnerabilidade social das pessoas com TB no município de Cali -Colômbia, com base no modelo AVEO que analisa a vulnerabilidade social em relação aos ativos e passivos que as pessoas possuem e as oportunidades oferecidas pelo contexto. Os resultados mostram ativos, passivos e oportunidades relacionadas ao tratamento da TB, articuladas através das dimensões demográfica, biológica, sócio-econômica, psicossocial e de habitat. Conclui-se que existe um círculo vicioso entre as condições de vulnerabilidade social e a tuberculose, no qual as pessoas com níveis mais elevados de vulnerabilidade social são mais afetadas pela doença em todas as dimensões de sua existência, aumentando ou mantendo os níveis de vulnerabilidade, o que requer intervenções multisetoriais que vão além dos serviços de saúde.

A rare case of smear positive tuberculous arthritis

TB arthritis is a very rare extrapulmonary presentation in an immunocompetent host. It is usually the result of direct hematogenous spread from the primary focus. Our patient presented with pain and swelling of the right knee for 6 months. The blood investigations and CT chest revealed findings consistent with active tuberculosis. Synovial fluid was positive for acid-fast bacilli (AFB) which is a very rare finding. Cartridge-based nucleic acid amplification test (CBNAAT) revealed Mycobacterium tuberculosis and sensitivity to rifampicin. Establishing the diagnosis of Mycobacterium tuberculosis beyond doubt is very important, and early initiation of antitubercular treatment (ATT) is important as delay in treatment may lead to irreversible damage to the joint and restriction of joint mobility.

Screening of Non-Communicable Diseases and their Risk Factors among Tuberculosis Patients in Delhi: A Mix Method Study

Background: India has the highest burden of tuberculosis in the world. It is experiencing an increasing burden of noncommunicable diseases, thereby facing a dual disease burden. Recent evidence shows an association between TB and noncommunicable diseases like diabetes, CVD and chronic respiratory infections. Aims and Objectives: To assess the feasibility of screening for NCDs and risk factors for NCDs among patients with TB in DOTS centers of a medical college in Delhi and ascertain challenges for the same among providers and patients. Methodology: It was a mixed-methods study with a quantitative component (cross-sectional study using questionnaires, anthropometric measurements and records review) and a qualitative component (descriptive study using interview data). Results: Among the 139 patients screened, ten new cases of hypertension and six new patients were diagnosed with DM. Outof- pocket expenditure for tests was a concern of the patients. Health care providers found the screening tool easy to use but were apprehensive about increased workload Conclusion: The study provide useful visions for incorporating NCDs into routine TB care through DOTS centers under RNTCP/NTEP.

Perceptions of Private Practitioners Regarding Revised National Tuberculosis Control Program- A Cross-sectional Study in Sonepat, Haryana

Background: A substantial proportion of tuberculosis patients either take treatment from private care providers or first-time visit private hospitals to diagnose tuberculosis. Hence the role of private providers is too essential to ignore to realize the ambition of tuberculosis elimination in India. Aim and Objectives: To understand the perception of private practitioners of Sonepat district of Haryana state regarding. Setting and Design: A cross-sectional study was done among the private practitioners of the Sonepat district of Haryana Methods and Material: 78 randomly selected practitioners from the list provided by the district health authority were interviewed using a pretested semi-structured questionnaire. The ethics committee of the study institute approved the study. Statistical analysis used: Descriptive analysis in terms of proportion and percentages was conducted. Results: One-third of the study participants were in the age group of 30-40 years. Half of the practitioners were reportedly practicing medicine for less than twenty years. A significant proportion agreed that the government could not single-handedly eliminate tuberculosis without collaborating with private providers. Mostly agreed on the effectiveness of Tuberculosis regimens under the program; however, over-relying on the sputum examination was perceived as a negative component of the program. Conclusions: Private providers understand their pivotal role in tuberculosis-related programs. However, their full participation has not been realized in the program.

An Analysis of The Trend of Incidences and Fatality of Pulmonary Tuberculosis in East Java from 2015-2020: A Lesson From COVID-19

Background: Pulmonary tuberculosis is still a public health problem, and surveillance data analysis has not been done much. Recently a global pandemic of COVID-19 has the potential in disturbing TB elimination pro-grams and treatment. This study aims to comprehensively analyse the incidence rate (IR) and Case Fatality Rate (CFR) of pulmonary tuberculosis in East Java from 2015–2020 and during COVID-19 and the strategies for optimizing tuberculosis disease control. Methodology: The study analyzed annual surveillance data using an analytical descriptive design. The Varia-bles were analyzed with Spearman correlation with a level of evidence of 95% (p<0.05). Results: The prevalence of pulmonary tuberculosis in East Java fluctuated from 2015–2020. In 2020 and dur-ing the COVID-19 pandemic, the number of cases and morbidity rates increased. Statistic results confirm the presence of a significant correlation between the values of Incidence rate (IR) and Case Fatality rate (CFR) (p = 0.032), IR and Treatment Success Rate (TSR) (p = 0.020), and CFR and TSR (p = 0.002). Population density is not correlated with the number of new cases (p = 0.667). Treatment rates have increased to 51%; cure and treatment rates have decreased to 76% and 89%, respectively, and there was a 4% increase in mortality dur-ing COVID-19. Conclusions: COVID-19 has tremendously affected the treatment of pulmonary TB cases in East Java, Indone-sia by increasing the incidence rate and decreasing the fatality rate. The pandemic promotes fear in the com-munity to check their medical status and improve the quality of their health in East Java.

Study of side effect profile of bedaquiline containing regimen among patients with extensively drug-resistant tuberculosis at a nodal drug-resistant center

Background: Extensively drug-resistant tuberculosis (XDR TB) is a type of tuberculosis (TB) characterized by resistance to isoniazid and rifampicin, along with resistance to one of the fluoroquinolones and at least one of the second line injectable drugs. Bedaquiline is a diarylquinoline antimycobacterial agent approved for the treatment of adults with pulmonary multidrug-resistant TB (MDR-TB) and XDR-TB by the food and drug administration. Aim and Objective: The aim of this study was to study the side effect profile of bedaquiline containing regimen among XDR TB patients. Materials and Methods: This study was conducted at outpatient and wards of nodal drug-resistant TB Center, Department of Pulmonary Medicine, SVRRGGH, Tirupati, for a period of 1 year. Forty patients of more than 18 years age and diagnosed with XDR TB were included in the study. Bedaquiline was started and daily monitoring was done with ECG and all organ function tests were repeated every 15 days. Results: All 40 cases were retreatment cases; no new XDR TB case was reported in study period. Most common age group of presentation in our study was 46 to 55 years (32.5%). Gastrointestinal adverse drug reactions were found to be more common (37.5%), cardiovascular QTc changes were observed in 10% of patients, 5% of patients had neurological reactions (Headache), 2.5% of patients had peripheral neuropathy, and 2.5% of patients had arthralgia. Conclusions: Bedaquiline containing regimen is very effective for the treatment of XDR TB cases. The study shows that compliance with this regimen is very good. Bedaquiline has minimal adverse reactions and even these are easily manageable. Bedaquiline has good safety profile and patients have improved quality of life.

Revisiting the Chingleput BCG vaccination trial for the impact of BCG revaccination on the incidence of tuberculosis disease

Background & objectives: Vaccines play a crucial role in the prevention of tuberculosis (TB). Revaccination with Bacille Calmette–Guerin (BCG) for the prevention of TB is an important strategy that is currently gaining interest. The objective of this study was to reanalyze the community-based Chingleput BCG vaccination trial for protective efficacy of BCG revaccination against incident TB disease. Methods: A retrospective analysis of the Chingleput BCG vaccination trial (conducted in 1968) data was carried out. Data on participants with evidence of prior BCG vaccination at trial intake and randomized to BCG vaccine [low dose (0.01 mg), high dose (0.1 mg)] and placebo arms were analyzed. The incidence of TB disease, which was based on sputum culture and/or chest X-ray was compared between the BCG and placebo arms over a 15 yr follow up period. Results: Of the 269,727 individuals randomized in the trial; 263,158 had no evidence of TB at baseline, of which 4436 (1.68%) had evidence of BCG vaccination at trial intake (2890 in the BCG vaccine and 1546 in the placebo arms, respectively). There were 77 (190 per 100,000) and 64 (296 per 100,000) incident TB cases in the BCG and placebo arm, respectively, at 15 yr post-vaccination. The incidence of TB disease was significantly lower in the BCG arm [Hazard ratio of BCG arm (95% confidence interval): 0.64 (0.46-0.89)]. Interpretation & conclusions: Retrospective data analysis of this community-based trial revealed that BCG revaccination in a community offered modest protection against the development of TB disease at the end of 15 years which, however, requires further evaluation.

Tuberculosis treatment and factors associated with unsuccessful tuberculosis treatment outcome among TB/HIV co-infected patients in Rwanda: A retrospective cohort study

Introduction Mycobacterium tuberculosis remains the main cause of death as an infectious agent of Tuberculosis in humans, particularly in resource-poor settings. Worldwide, Tuberculosis is one of the top 10 causes of mortality. Objective of the study This study aims to determine the outcomes of TB treatment and assess the factors associated with unsuccessful TB treatment outcome among TB/HIV co-infected patients in Rwanda. Methods This was a retrospective cohort study of all TB/HIV co-infected patients reported in the national electronic TB reporting system (e-TB) by all health facilities from July 2019 to June 2020. Frequencies, proportions, bivariate and multivariate logistic regression were performed to determine factors associated with unsuccessful TB treatment. Results There were 1,144 people reported in the e-TB, however, only 987 were included in the study because 157 patients did not meet the inclusion criteria.The TB/HIV coinfected patients who were not given nutritional support, OR 7.3, 95%CI [1.4, 37.6] and those who were not on ART,OR15.3, 95%CI [3.6, 69.6],were more likely to have unsuccessful treatment outcome than their counterparts. Conclusion Unsuccessful TB treatment outcomes were highly observed among TB/HIV coinfected patients. The study recommended reinforcing nutritional support and early initiation of ART among TB/HIV co-infected patients.

Wind-driven roof turbines' effectiveness in enhancing household ventilation: a potential tool to reduce tuberculosis infection

Background: South Africa's overburdened healthcare systems have led to criticism of its unsustainable tuberculosis management interventions. In 2011, the National Department of Health implemented an outpatient, decentralised care model, but this increased costs and jeopardised the long-term viability of prevention measures. Home confinement is now recognised as a viable intervention option, when combined with safety precautions such as ventilation and medical support. However, little is known about the risk of infection in this context. Objectives: To assess the effectiveness of wind-driven roof turbines in enhancing ventilation and their potential to lower the risk of Mycobacterium tuberculosis infection in a residential setting. Methods: Eight houses were selected and divided equally into intervention (wind turbines installed) and control groups, using a pairwise comparison method. The CO2 decay method was used as a proxy to determine ventilation in the houses. The wind-driven roof turbines' potential to lower the risk of Mycobacterium tuberculosis infection was stochastically evaluated using the Wells-Riley mathematical model. Results: During two seasons, installation of a roof turbine resulted in twofold ventilation rates compared to the control houses. Consequently, the WellsRiley model predicted a twofold reduction in the probability of infection in the intervention compared to the control households. Conclusion: Low-cost, low-maintenance wind-driven roof turbines are effective in increasing ventilation in houses, and should be considered as an additional layer of protection against Mycobacterium tuberculosis and other infections in residential settings.

Advances in Bacillus Calmette-Guerin / 中国生物制品学杂志

@#Tuberculosis(TB) is a chronic and debilitating infectious disease caused by Mycobacterium tuberculosis(Mtb). It is a significant health concern that poses a serious threat to human well-being. Bacillus Calmette-Guerin(BCG)is the only approved vaccine for the prevention of TB. BCG is made from attenuated bovine Mtb and is highly effective in preventing tuberculous meningitis and granulomatous TB,which are particularly lethal in infants. However,BCG provides limited protection in both children and adults,and this protective effect decreases over time. Currently,there are ongoing improvements being made to BCG,which involve modifications in immunization routes and procedures. Additionally,researchers are working on the development of new TB vaccines. BCG is primarily used for the prevention of TB and the treatment of bladder cancer,although it also has other indications. This paper reviewed the recent research progress of BCG,focusing on its development history,improvements,and indications.

Clinical spectrum of Tuberculosis Otitis Media (TBOM) and management outcomes

Objectives@#To determine the initial clinical diagnoses of patients with tuberculous otitis media (TBOM), to determine the value of PCR test, biopsy, and ancillary diagnostic procedures in detecting middle ear TB infection, and to establish the differences in treatment outcomes. @*Methods@#The clinical records of twenty-eight patients identified with middle ear TB infection by PCR test and biopsy, from January 2010 to December 2016, were reviewed to determine their initial clinical diagnoses. The positivity rates of PCR test and biopsy were compared. The records of 12 patients included in a previous publication were revisited and included in the present study population. The combined cases were classified according to clinical diagnosis to constitute a summary of demographic characteristics, clinical diagnoses, laboratory tests, and treatment outcomes. Results of diagnostic and surgical procedures were reviewed and analyzed. Clinical findings and hearing test results before and after treatment were compared. @*Results@#Of the 28 patients, eight different clinical diagnoses of patients confirmed with middle ear TB were determined. PCR test diagnosed most cases belonging to the early and chronic stages of the disease process. Biopsy diagnosed mostly the chronic cases but failed to diagnose acute cases and late cases with diagnosis of chronic suppurative otitis media with cholesteatoma. By including the twelve cases that were published in 2011, the range of clinical diagnoses was expanded and an outcome of eleven clinical diagnoses confirmed with TB infection was established. Analysis of treatment outcomes showed that the clinical and hearing outcomes were better for patients managed at the early stage of the disease than for those presenting at the late stages of the disease process who underwent more complicated surgical procedures. @*Conclusion@#Our study supports the concept of tuberculous otitis media (TBOM) clinical spectrum, implying a paradigm shift in the established thinking that TBOM presents only as a chronic disease. The combined use of PCR and biopsy is a potential diagnostic tool to improve case detection rate, further broaden the scope of the clinical spectrum, and develop better control and preventive strategies for TBOM.

Epidemiology of tuberculosis in the Pacific island countries and areas, 2000–2020

@#Objective: Tuberculosis (TB) is one of the most important infectious diseases with an estimated 9.9 million people falling ill globally in 2020. We describe the epidemiology of TB in the Pacific island countries and areas (PICs) to inform potential priority actions to implement the Western Pacific Regional Framework to End TB 2021–2030. Methods: A descriptive analysis was conducted using annual TB surveillance data submitted by national TB programmes to the World Health Organization (WHO) and TB burden estimates (incidence rates and number of deaths) generated by WHO for the PICs, for the period 2000–2020. We also analysed TB case numbers, multidrug-resistant/rifampicin-resistant TB (MDR/RR-TB), recent risk factor indicators and treatment outcomes. Results: The estimated TB incidence rate in the PICs increased between 2000 and 2020 from 62 to 69 per 100 000 population, with an 8% reduction observed since 2015. TB cases increased by 29% during 2000–2020, with 1746 cases in 2020 and a high proportion in children (19%). Bacteriological diagnosis was used for 58% of total TB cases, although some countries reported clinical diagnoses in over 60% of cases. From 2015 to 2019, 52 MDR/RR-TB cases were reported and there were 94 TB/HIV coinfected cases in 2015–2020. Treatment success was 74% in 2019 due to 18% of cases being unevaluated. In 2020, the estimated proportion of TB cases attributable to smoking, malnutrition, alcohol abuse and diabetes was 17%, 16%, 11% and 9%, respectively. Discussion: There was an increasing trend in TB cases, estimated incidence and deaths between 2000 and 2020. Laboratory services were scaled up in some PICs and case-finding activities greatly contributed to the detection of cases. In order to end the incidence of TB, continued efforts on case finding, contact investigation and scaling up TB preventive treatment should be prioritized. At the same time, collaboration with other sectors for risk factor management and decentralized management need to be considered.

QuantiFERON-TB Gold Plus and QuantiFERON-TB Gold In-tube assays for detecting latent tuberculosis infection in Thai healthcare workers

ABSTRACT Detecting latent tuberculosis infection (LTBI) is important, especially in high-risk populations including healthcare workers (HCWs). QuantiFERON-TB Gold Plus (QFT-Plus) is a new version of the interferon-gamma release assays (IGRAs) to replace the QuantiFERON-TB Gold In-tube (QFT-GIT). However, data on the use of QFT-Plus for LTBI detection in high TB-burden countries are limited. This study was conducted in a TB-endemic setting in Thailand. HCWs were enrolled in the study and underwent both tests during the annual health screening. The testing results were compared and the concordance was determined. Of 102 HCWs, 11 (10.78%) were positive according to both tests, and 15 (14.71%) were positive according to QFT-Plus. The overall agreement between assays was 96.08%, with Cohen's kappa coefficient (k) at 0.82. All four discordant results occurred with QFT-GIT negative and QFT-Plus positive. The comparison between QFT-GIT and QFT-Plus based on each antigen tube (TB1 or TB2) exhibited similar concordance with 99.02% and 95.10% agreement, respectively. The intra-comparison between TB1 and TB2 of QFT-Plus also showed good concordance at 96.08%. Among this group of HCWs, the LTBI prevalence of any positive results in both tests was low. Overall, the study showed good agreement between QFT-Plus and QFT-GIT (k = 0.82) with a minimal difference, suggesting similar assay performance to that mainly carried out in TB-low incidence countries. The results support the use of QFT-Plus for detecting LTBI in a format similar to QFT-GIT.

The value of peripheral blood and pleural effusion T-SPOT.TB combined with pleural effusion adenosine deaminase in diagnosis of tuberculous pleurisy / 中国热带医学

@#Abstract: Objective To explore the relationship between peripheral blood and pleural effusion tuberculosis (TB) infection effector T cells, and to further evaluate the value of combined pleural effusion adenosine deaminase (ADA) for rapid diagnosis of tuberculous pleurisy. Methods The test data of 80 cases of tuberculous pleurisy and 70 cases of nontuberculous pleurisy treated in the Sixth People's Hospital of Nantong City from January 2017 to December 2020 were analyzed. The TBinfected effector T cells were also detected simultaneously in the peripheral blood and the pleural effusion by the T-SPOT technique, and the pleural effusion ADA was detected by the rate method. The subject operating characteristic curve (ROC) was applied to take the optimal pleural effusion ADA threshold to compare the sensitivity and specificity of different critical values. Person phase analysis was applied to analyze the correlation between peripheral blood and pleural effusion T-SPOT.TB. Data of peripheral blood, pleural effusion T-SPOT.TB and ADA were integrated. Results When pleural effusion ADA>45 U/L, the sensitivity and specificity for the diagnosis of tuberculous pleurisy were 50.0% and 94.3%, respectively; when ADA > 25.15 U/ L, the sensitivity and specificity were 80.0% and 72.9%. When ADA > 45 U / L, pleural/ blood T-SPOT.TB spot ratio (spot forming cells, SFCs) > 2 times, the specificity for the diagnosis of tuberculous pleurisy was 100% (highest); when 25.15 U/L< pleural effusion ADA ≤ 45 U/L, pleural/blood T-SPOT.TB spot ratio > 2 times, the specificity for the diagnosis of tuberculous pleurisy was 92.3% (second). When pleural effusion ADA ≤ 25.15 U/L, and the pleural effusion/blood T-SPOT.TB spot number ratio > 2 times, with 83.3% specificity (the lowest of the three groups). Conclusions The level of pleural effusion ADA is one of the most used methods for diagnosing tuberculous pleurisy. Further combination of pleural effusion and blood T-SPOT.TB, if the ratio of pleural effusion / blood T-SPOT. TB spots is greater than 2 times, it can further improve the diagnosis rate of tuberculous pleurisy.

Diagnosis and treatment of thyroid tuberculosis-case report and literature review / 中华内分泌外科杂志

Objective:To sum up the experience and improve the capability of clinical diagnosis and treatment of thyroid tuberculosis (TTB) .Methods:In Apr. 2020, the Second Department of General Surgery, Friendship Hospital of Yili Kazakh Autonomous Prefecture, Xinjiang, treated a patient with a huge thyroid cancer (TC), who had no history of tuberculosis. Thyroid cancer was considered for surgical treatment after the assessment by ultrasound and enhanced CT scan, yet the postoperative pathological diagnosis was thyroid tuberculosis. The clinical and pathological data of 357 cases of TTB reported in domestic literature were retrospectively analyzed by searching the relevant databases.Results:This reported case was diagnosed eventually with TTB by postoperative pathology, cured by operation, local and systemic anti-tuberculosis treatment. Among the 357 cases of TTB, there were 95 males and 262 females and the ratio of male to female was 1.0:2.8. Most patients had neck mass as the first symptom (95.5%, 256/268), and 53 patients (19.8%, 53/268) merged with tuberculosis poisoning symptoms. There were 59 cases (21%, 59/281) complicated with extra-thyroid tuberculosis. Among 51 cases, 37 cases (73%, 37/51) were diagnosed with TTB. Eighty cases (30%, 80/265) were suspected of TC before the operation.25 patients (8.5%, 25/294) received antituberculosis treatment, and 269 patients (91.5%, 269/294) received surgical treatment, among which 100 patients (37%, 100/269) underwent unilateral lobectomy. The caseation type was the most common pathology with 154 cases (57.9%, 154/266). Two patients died of TTB after an operation, and the remaining patients were followed up for 6 months to 33 years without recurrence.Conclusions:TTB often lacks typical clinical manifestations and is easily confused with TC. The diagnosis mainly relies on puncture pathological examination. Good results can be achieved with appropriate treatment based on a definite diagnosis.