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.