Current Issue

2017 Vol.2 No.4 Published:30 November 2017

Forum of Specialist

Hepatitis A outbreak in California reflexs the complexity and challenges in viral hepatitis A prevention WU Shi-pin 2017, 2 (4):  193-195.  Abstract ( 139)    PDF (854KB) ( 617 )    The incidence of viral hepatitis A has decreased significantly in recent years in China due to the improvement of people's living standard and the promotion of vaccination for viral hepatitis A. However, outbreak of viral hepatitis A recently in California in the United States has reminded us the complexity and great challenges in the prevention of viral hepatitis A. The prevention of viral hepatitis A is still long-term existed, complex and arduous. This paper reviews the epidemic situation of viral hepatitis A in California within 1 year, analyzes its possible causes, and puts forward some measures of the prevention of viral hepatitis A, including the promotion of vaccination for viral hepatitis A, strengthening to the public health campaign, strengthening to tealth inspection and quarantine of food and strengthening to the study of epidemiology of viral hepatitis A. The vaccination for viral hepatitis A is the most economical and effective measures in the prevention of viral hepatitis A.

Original Articles

Eexpression of IP-10 in patients with tuberculosis and its value in diagnosis of tuberculosis YANG Qian-ting, DENG Guo-fang, YOU Xin-xin, CHEN Qi, ZHANG Ming-xia, DENG Qun-yi, ZHOU Yi-ping 2017, 2 (4):  198-201.  Abstract ( 731)    PDF (1146KB) ( 707 )    Objective To analyze the expression of interferon-inducible protein 10 (IP-10) in whole blood of different group of people and different type of specimens and evaluate its value in diagnosis of tuberculosis. Methods Immune enzyme-linked adsorption test (ELISA) was employed to detect IP-10 expression in plasma of 24 cases of healthy control (HC), 24 cases of latent tuberculosis（LTBI）and 34 cases of patients with tuberculosis (TB), to detect IP-10 expression in pleural fluid of 23 patients with tuberculosis and 15 cases of non-tuberculosis, and to detect IP-10 expression in cerebrospinal fluid of 23 patients with tuberculosis and 15 cases of non-tuberculosis. Subsequently, ROC curve was drawn to evaluate the value of IP-10 in diagnosis of TB. Results The level of IP-10 in plasma of TB patients was significantly higher than those of HC and LTBI. The IP-10 level in plasma of TB gradually reduced after anti-TB treatment. The level of IP-10 in cerebrospinal fluid and pleural effusion of TB were significantly higher than those in the patients with non-tuberculosis. Conclusion IP-10 could be used as a biomarker in diagnosis of TB.

Association between LTA4H gene polymorphism and susceptibility to tuberculosis WANG Wen-fei, ZHU Yu-zhen, CHUI Shu-jun, DUAN Yan-hui, ZHANG Fu-ping, ZHANG Jie-yun, CHEN Xin-chun, HUANG Gong-hua, ZHANG Ming-xia 2017, 2 (4):  202-204.  Abstract ( 272)    PDF (908KB) ( 554 )    Objective The aim of this study was to survey the relationship between polymorphism of LTA4H gene and susceptibility to tuberculosis(TB)in Han nationality, and to screen functional SNP by incorporating withclinical data. Methods The single SNP site was detected by TaqMan probe technology. Polymorphism of susceptibility gene site was analyzed between 958 patients and 945 healthy controls. The relationship between polymorphism of LTA4H gene and susceptibility to tuberculosis in Han nationality was investigated. Results After analyzing the genotypic-frequency, CC in the patient groups was significantly higher than that of control groups(P<0.05)．Similarly, The C allele frequency in patient groups was significantly higher than that of control groups (χ2=6.20 P=0.0064). Conclusion The LTA4H gene polymorphism site rs17525495 may be associated with susceptibility to TB. Although rs17525495 may not be a functional SNP site, allele T may be responsible for protection.

The usefulness of 2 dimensional ultrasound scoring in grading of liver fibrosis in patients with chronic hepatitis B LUO Yong-fang, DONG Chang-feng, ZHANG Ding-ping, ZHANG Yu, LIU Ying-xia, ZHANG Xin-yu, CHEN-Xin 2017, 2 (4):  205-209.  Abstract ( 552)    PDF (956KB) ( 670 )    Objective To investigate the usefulness of 2 dimensional ultrasound scoring based on semi-quantitative analysis of ultrasound images in grading of liver fibrosis in patients with chronic hepatitis B (CHB). Methods A total of 140 patients were enrolled in the study and divided into 4 groups(F1-F4) according to pathological grading using METAVIR scores system; 47 randomly chose healthy volunteers were enrolled as the control group(F0). An ultrasound examination were double-blindly evaluated by 2 radiologists who have more than 5 years’ working experiences in one hospital specialized in hepatic diseases. Results The liver fibrosis grade correlation coefficient between ultrasound images and histological images was assessed as 0.883 and 0.881 respectively by the two radiologists and combined and finalized as 0.910(P<0.0001). The sensitivity, specificity and consistency of moderate fibrosis (group F2, F3 and F4) grading are 83.2%, 96.3%, and 88.8%, respectively. The sensitivity, specificity and consistency of severe fibrosis(group F3 and F4) grading are 75.4%, 93.2%, and 86.6%, respectively and those for cirrhosis (group F4) are 97.7%, 88.2%, and 90.4%, respectively. Conclusion 2D-mode ultrasound scoring is highly correlated with pathological grading of liver fibrosis in patients with chronic hepatitis B(CHB). High specificity was demonstrated ingrading of liver fibrosis ≥F2 groups, therefore, less invasive procedure of liver biopsy is feasible. 2D-mode ultrasound scoring based on semi-quantitative analysis of ultrasound images is easy to obtain, and worth applying.

Infection status of food-borne parasitic diseases among outpatients in Shenzhen JIANG Dong-xian, TANG Yi-jun, ZHANG Ren-li, YANG Fan, WU Chun-li, LI Yue, HUANG Da-na 2017, 2 (4):  210-213.  Abstract ( 198)    PDF (1070KB) ( 709 )    Objective To analyze the infection status and the awareness of preventing knowledge of food-borne parasitic diseases in Shenzhen and provide prevention and control strategies for food-borne parasitic diseases. Methods Specific antibodies of Clonorchissinensis, Hydatid, Paragonimus, Trichinellaspiralis, Cysticercus, Sparganum and Angiostrongyluscantonensis were detected by ELISA and characteristics of parasite infection were analyzed using descriptive epidemiological method. Meanwhile, the questionnaire about preventing food-borne parasitic diseases was carried out in outpatients. Results The total serum antibody positive rate of food-borne parasitic diseases was about 28.14% in 757 outpatients. The serum antibody positive rates of Clonorchissinensis, Hydatid, Paragonimus, Trichinellaspiralis, Cysticercus, Sparganum and Angiostrongyluscantonensis were 11.40%, 4.78%, 1.06%, 0.67%, 8.72%, 4.62%, and 4.62% respectively. The infection rate of males was higher than that of the females. The 21-50 years old group have the highest infection rate. There were no significant differences between gender and age as for infection rate（P>0.05）. The awareness rate about preventing food-borne parasitic diseases was 69.15% in outpatient. 60.73% of outpatients knew the ways of food-borne parasitic infection. Conclusion The serum antibody positive rates of Clonorchissinensis are relatively high in Shenzhen and the distribution of food-borne parasitic diseases show gender and age related features. In addition, the food-borne parasitic diseases are the major parasitic disease to be prevented in Shenzhen areas and the healthy diet habit should be widely educated.

The thoracic and abdominal CT manifestations of the disseminated penicillium marnefei infection in patients with AIDS REN Mei-ji, LI Li, ZHAO Jing, DING Jin-li, LI Hong-jun 2017, 2 (4):  214-217.  Abstract ( 303)    PDF (1259KB) ( 913 )    Objective To discuss the thoracic and abdominal CT manifestations and the diagnostic value for AIDS patients complicated with penicillium marneffei infection. Methods Totally 16 AIDS patients complicated with penicillium marneffei infection were retrospectively analyzed for their thoracic CT findings, while 9 cases for abdominal CT findings. Results Regarding to the thoracic CT findings, 5 cases were showed with lateral (1 case) or bi-lateral (4 cases) patchy consolidations of lung tissue (31.25%); 5 cases with pulmonary nodules including 2 cases of miliary shadow (31.25%); 4 cases with single (3 cases) or clustering (1 case) cavities(25%); 4 cases with bi-lateral ground-glass opacity(25.00%); 3 cases were found with pulmonary portal and mediastinal lymphadenopathy(18.87%); 2 cases with hydrothorax(12.50%); 1 case with pulmonary mass(6.25%); 1 case with hydropericardium(6.25%); and 1 case with axillary lymphadenopathy(6.25%). As for abdominal CT findings, 5 cases were found with retroperitoneal and mesenteric lymphadenopathy(55.56%); 4 cases with hepatic low-density(44.44%), including 3 cases of focal distributions and 1 cases of diffuse distribution; 4 cases with hepatomegaly(44.44%); 2 cases with spleen low-density(22.22%); 2 cases with ascites(22.22%); 1 case with intestinal wall thickening(11.11%); and 1 case with splenomegaly(11.11%). Conclusion Thoracic and abdominal CT findings of AIDS patients complicated with penicillium marneffei infection are various and complex. The thoracic CT findings are primary patchy consolidations of lung tissue, pulmonary nodules, cavities, ground-glass opacity, and pulmonary portal and mediastinal lymphadenopathy. The abdominal CT findings are primary retroperitoneal and mesenteric lymphadenopathy, hepatic low-density, hepatomegaly, spleen low-density, and splenomegaly. Multiple and complicated findings can be observed in single paitent.

The comparative analysis of Color Doppler Ultrasonography and Multi-slice CT scan in the diagnosis of cervical lymph node tuberculosis ZHENG Qiu-ting, DONG Chang-feng, LU Pu-xuan, CHEN Xiao-fang, LUO Ting-ting, LE Xiao-hua, ZHANG Yun, LIU Li 2017, 2 (4):  218-222.  Abstract ( 588)    PDF (2766KB) ( 909 )    Objective To compare the two methods of Color Doppler Ultrasonography and Multi-slice Computed Tomography scans in the diagnosis of cervical lymph node tuberculosis. Methods Forty patients diagnosed with cervical lymph node tuberculosis which confirmed by pathology from January 2014 to December 2016 in Shenzhen Center for Chronic Disease Control and Shenzhen third people's hospital were selected as the research objects. And the patients were both diagnosed with Color Doppler Ultrasonography and Multi-slice Computed Tomography scans at the same time. All patients' imaging features were retrospectively analyzed. Accuracy rate of cervical lymph node tuberculosis and imaging findings of the two methods were compared. The sensitivity, concordance rate and kappa value of the two methods were calculated. Results In 40 patients, 27 cases with cervical lymph node tuberculosis were diagnosed by the Color Doppler Ultrasonography, which accounted for 67.5% of all patient; and 28 cases were confirmed by Multi-slice Computed Tomography scans, which accounted for 70.0%. The difference of two methods showed no statistical significance（P﹥0.05). The accuracy rate of the two approaches combined method was 90.0%. Conclusion Color Doppler Ultrasonography and Multi-slice Computed Tomography scans show distinguishable characteristics in the detection of cervical lymph node tuberculosis. Contrast-enhanced CT scanning has higher accuracy than Color Doppler Ultrasonography. Ultrasounography combined with enhanced CT scan can improve the accuracy of diagnosis of cervical lymph node tuberculosis obviously.

The detection and analysis of enterovirus and EB virus in children ZHOU Jian-fang, CHEN Yu-ling, CHEN Zhi-yong, CHEN Gang, ZHANG Wen-hong, CHEN Jia-zhen 2017, 2 (4):  223-225.  Abstract ( 220)    PDF (885KB) ( 585 )    Objective To analysis of the correlation between enterovirus and EB virus co-infection in children. Method A total of 275 infants and young children with HFMD were collected from 2010 to 2014 in Fenghua people's Hospital, including 186 throat swabs and 89 plasma samples. At the same time, control group samples from a total of 165 cases, including 144 throat swabs and 121 plasma samples) were collected from the same age children, in the hospital who were clinically diagnosed with respiratory tract infection (including upper respiratory tract infection, tonsillitis, pharyngitis, pneumonia and septicemia). Difference in the proportion of EBV infection in the two groups of children was compared. Results It found that the detection rate of EBV DNA in throat swab or plasma of children with hand-foot-and-mouth disease group was significantly higher than that of control group, which reached about 32.8% and 14.6% respectively. Conclusion There is a high degree of EBV infection in children who were infected with enterovirus. It is suggested that the co-infection of EB virus and human enterovirus in children with hand-foot-and-mouth disease deserves attentions.

Image performance of 18F-FDG PET／CT inextrapulmonary tuberculosis MA Wei, XIAO Yong, LUO Zhe-huang, LIU Bao-liang, LI Hong-jun, YU Wei-ye, TAN Wei-guo, LU Pu-xuan 2017, 2 (4):  226-230.  Abstract ( 256)    PDF (1734KB) ( 906 )    Objective To investigate the image performance of 18F-FDG PET/CT in extrapulmonary tuberculosis and to improve its overall understanding. Methods 12 extrapulmonary tuberculosis patients were enrolled in this study, of which 10 were diagnosed by histopathology, 1 by witness of tuberculosis bacillus in ascites sample and 1 by clinical data. All patients underwent whole body 18F-FDG PET/CT imaging. Results Lymphatic tuberculosis(5 cases), Osteoarticular tuberculosis(4 cases), Pleural and peritoneal tuberculosis(2 cases), Intestinal tuberculosis(1 case) were confirmed. Lymphatic tuberculosis was found to be with lymph node enlargement (edge blur, partial fusion) and different degree of FDG uptake. Osteoarticular tuberculosis was found to have osteolytic destruction, with or without cold abscess, of which 2 cases showed high FDG uptake without bone destruction, 1 case of thoracic tuberculosis, 1 case of multiple bone tuberculosis, 1 case of pulmonary tuberculosis with multiple lymphnode tuberculosis, osteoarticular tuberculosisand spleen tuberculosis, and 1 case of sternoclavicular joint tuberculosis. Pleural and peritoneal tuberculosis were present with different degree of pleural and peritoneal effusion. pleural effusion showed no FDG uptake, peritoneal effusion showed lines and nodules FDG uptake.1intestinal tuberculosis with pulmonary tuberculosis, nodular thickening in ileocecal junction(Blurred the surrounding fat), nodules FDG uptake. Conclusion Extrapulmonary tuberculosis usually showed FDG uptake, imaging and metabolic activity are similar to tumors and can be easily misdiagnosed.

Clinical characteristics and pregnant outcome of 5 women with hematogenous pulmonary tuberculosis after in vitro fertilization and embryo transplant ZHANG Pei-ze, CAO Wei-peng, ZHENG Jun-feng, FU Liang, YE Tao-sheng, DENG Guo-fang 2017, 2 (4):  231-233.  Abstract ( 491)    PDF (885KB) ( 944 )    Objective To analyze the clinical characteristics and pregnant outcome of women with hematogenous pulmonary tuberculosis after in vitro fertilization and embryo transplant. Methods Clinical data of 5 women with hematogenous pulmonary tuberculosis after in vitro fertilization and embryo transplant in Third People Hospital of Shenzhen city from January 2012 to December 2015 were collected and analyzed. Results All patients were presented with fever, including one with headache and two with dyspnea. The onset of fever was at the average of 63.0 days after IVF-ET while the diagnosis was confirmed at the average of 82.4 days. One patient was compliant with tuberculous meningitis. Two patients were compliant with respiratory failure. Chest X-ray and CT showed typical miliary and infiltrate lesion. Pathogen study showed TB culture positive in sputum in a patient, positive in CSF in another patient. And one patient was found out TB-DNA positive in fetal membrane after abortion. TB specific INF-γElispot in blood showed 4 positive and 1 negative cases. Pregnant outcome: 1 case of spontaneous abortion, 1 case of inevitable abortion, 1 case of artificial abortion, 1 case of premature birth at 32th week, and 1 case of cesarean section at 39th week. All patients took anti-tuberculosis treatment and recovered. Two babies were healthy. Conclusions The main symptom of hematogenous pulmonary tuberculosis after IVF-ET is fever. Most patients are in critical conditions. Early diagnosis and anti-tuberculosis treatment may benefit the outcome of pregnancy and artificial abortion may be evitable.

Epidemiological analysis of tuberculosis in middle school students in Futian district of Shenzhen city YE Hai-ming, CHEN Wen-si, HU Rui-juan, CHEN Jie, JIANG Hui-jun, ZHANG Rui-you, ZHANG Sheng-nan 2017, 2 (4):  234-236.  Abstract ( 151)    PDF (828KB) ( 693 )    Objective To understand the epidemiological characteristics of pulmonary tuberculosis in middle school students in Futian District from 2011 to 2015, and to provide scientific basis for the development of more effective tuberculosis prevention and control measures in schools. Methods Descriptive epidemiological method was employed and the epidemiological characteristics of tuberculosis patients among high school students registered in Futian District from 2011 to 2015 were analyzed by using Excel 2007 and SPSS softwares. Results From 2011 to 2015, the average annual incidence of pulmonary tuberculosis among middle school students in Futian District was about 15.27/10 million, no significant difference was observed between years(χ2=2.47, p>0.05), the incidence of boys was higher than that of girls (χ2=4.06, p<0.05) and the incidence of senior high school students was higher than that of junior high school students (χ2=15.62, p<0.05). Referrals were the main way in the student patient, account for 40%, which were prevalent in April and May. The success rate of treatment among students was about 95%. Conclusion Tuberculosis prevention and control in Futian District have achieved some results. The incidence of tuberculosis in the whole population showed a downward trend while the incidence in students has no obvious change. It is essential to increase the intensity of prevention and treatment of tuberculosis in schools.

Imaging features of pulmonary tuberculosis in low CD4+T cell count HIV infected patients WEI Fang-jun, WANG Li-fei, ZHENG Guang-ping, YUN Yong-xing, HUANG Hua, CHEN Xiao-fang, LU Pu-xuan 2017, 2 (4):  237-239.  Abstract ( 172)    PDF (1560KB) ( 676 )    Objective The aim of this study is to retrospectively analyze the chest CT manifestations of pulmonary tuberculosis in patients with low CD4+T count of HIV infection, and to investigate the imaging features of pulmonary tuberculosis with low CD4+T count in HIV infected patients. Methods Chest CT of 32 patients who has been diagnosed with HIV infection and pulmonary tuberculosis and with CD4+T cell count less than 200/μl were analyzed. Results 32 cases of low CD4+T cell count of HIV infection of chest imaging features were mainly as follows: cavity shadow in 17 cases, consolidation shadow in 29 cases, diffuse miliary shadow in 14 cases, pleural effusion in 21 cases; 3 cases of calcification, 9 cases of fibrous lesions and 30 cases of mediastinal or hilum lymph node tuberculosis. Conclusions Low CD4+T cell count of HIV infection in patients with pulmonary tuberculosis showed a variety of imaging features, disseminated pulmonary tuberculosis and lymph node tuberculosis were easily found while calcification and fibrous lesions are rare, presenting imaging feature of atypical pulmonary tuberculosis.