Current Issue

2023 Vol.8 No.5 Published:31 October 2023

Original Articles

Analysis of risk factors influencing the early curative effect of multidrug-resistant pulmonary tuberculosis Niu Yulan, Kong Jun, Huang Yan, Yang Yan, Liu Yi, Zeng Yi, Zhang Xia, Zhang Xiangrong 2023, 8 (5):  1-5.  DOI: 10.19871/j.cnki.xfcrbzz.2023.05.001 Abstract ( 191)    PDF (871KB) ( 289 )    Objective To explore the relevant factors affecting the early curative effect of multidrug-resistant pulmonary tuberculosis, and to provide the basis for the early curative effect evaluation and precise treatment of multidrug-resistant pulmonary tuberculosis. Method Patients with multidrug-resistant pulmonary tuberculosis who were diagnosed by sputum culture and drug sensitivity in the Department of Tuberculosis, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine between November 2020 and January 2022 were selected as the research subjects. According to the treatment effect of anti-tuberculosis treatment at the end of 3 months, the patients were divided into: poor curative effect group (n=35) and good curative effect group (n=117). The clinical data of the two groups were compared, to analyze the risk factors of poor early curative effect. Result Univariate variance analysis showed that: gender, age, occupation, retreatment, T2DM, infections with other pathogens, fluoroquinolone resistance, lesions involving lung fields≥3, cavity, cavity diameter, Hb level, albumin, and BMI index were associated with poor efficacy at the end of 3 months (all P<0.05); Logistic regression multivariate analysis Shows: Retreatment of tuberculosis (OR=4.138, 95%CI 1.063-16.110), quinolone resistance (OR=6.677, 95%CI 1.526-29.211), and pulmonary cavitation (OR=18.879, 95%CI 3.585-99.411) were independent risk factors for poor outcomes after 3 months of MDR-TB treatment. Conclusion There are multiple factors affecting the early treatment effect of MDR-TB. Retreatment of pulmonary tuberculosis, combined with pulmonary cavitary lesions and resistance to fluoroquinolone are independent risk factors for poor early treatment effect. Patients with the above risk factors should be detected earlier, and accurate anti-tuberculosis treatment should be performed in order to improve the prognosis.

Analysis of drug resistance characteristics in elderly tuberculosis of Guangdong province from 2014-2020 Zhuo Wenji, Zhang Chenchen, Chen Xunxun, Chen Yanmei, Yu Meiling, Wei Wenjing, Xu Liaoyue, Peng Kehao, Lai Xiaoyu 2023, 8 (5):  6-10.  DOI: 10.19871/j.cnki.xfcrbzz.2023.05.002 Abstract ( 194)    PDF (853KB) ( 231 )    Objective To investigate the drug resistance of tuberculosis (TB) strains isolated from elderly patients (aged≥60 years) in Guangdong Province from 2014 to 2020 and to evaluate the characteristics of drug resistance of Mycobacterium tuberculosis (MTB) from different sources. Method MTB strains in elderly patients were collected from 32 sentinel sites of TB resistance surveillance in Guangdong province from January, 2014 to December, 2020.Drug sensitivity tests for first - and second-line of anti-tuberculosis drugs [including isoniazid (INH), ethambutol (EMB), rifampicin (RFP), streptomycin (Sm) and kanamycin (Km), capreomycin (Cm), protionamide (Pto), ofloxacin (Ofx), sodium p-aminosalicylate (PAS)] were conducted according to a proportional method. The data of drug resistance of TB was analyzed. Result A total of 9590 MTB isolates were collected during 2014-2020, accounting for 24.6% of the total detection rate of MTB (9590/39046). There was significant difference in the detection rate of MTB during study period (Ptrend<0.001).The drug resistance rate, monoresistance rate, polyresistance rate, multidrug resistance rate (MDR) and extensively drug resistance rate (XDR) of MTB was 26.7%, 13.0%, 5.0%, 5.0%, and 2.1%, respectively. There was significant difference in the the distribution of monoresistance rate, MDR rate and XDR rate of MTB during study period (P<0.05). The rates of MDR and XDR in female patients were significantly higher than those in male patients (P<0.05), the rates of polyresistance rate, MDR and XDR in elderly patients living in the Pearl River Delta region were significantly higher than those living in eastern and northwestern Guangdong province (P<0.05). The resistance rate of the isolates to any one of the first- and second-line anti-tuberculosis drugs from high to low was Sm(14.9%)>INH(11.6%)>EMB(7.5%)>RFP(7.1%)>Ofx(5.8%)>PAS(5.0%)>Pto(4.6%)>Cm(4.0%)>Km(3.7%). Except for EMB and Pto, the distribution of those 9 drug resistance rate of MTB during study period was significance (Ptrend<0.05). The XDR of MTB in retreated patients was significantly higher than that in initially treated patients (P=0.006). Conclusion The drug resistance rate of TB in elder patients is high. The MTB resistance in patients whom living in Pearl River Delta, whom were female and whom were retreated patients should be paid special attention by clinical workers.

The diagnostic value of a nomogram scoring model based on clinical indicators for active and inactive pulmonary tuberculosis Zheng Hong, Qin Zhihua, Chen Xiaoli, Ming Xianghong, Yuan Ying 2023, 8 (5):  11-15.  DOI: 10.19871/j.cnki.xfcrbzz.2023.05.003 Abstract ( 187)    PDF (1563KB) ( 303 )    Objective To construct a new nomogram model based on clinical indicators to distinguish between active pulmonary tuberculosis (APTB) and inactive pulmonary tuberculosis (IPTB). Method: A total of 622 patients diagnosed with tuberculosis in the Sixth People's Hospital of Nantong from January 2019 to December 2022 were retrospectively summarized, and were randomly divided into 421 patients in the training set and 201 patients in the verification set by 2:1. The clinical data and blood biochemical indexes of APTB and IPTB patients in the training set were compared, the predictive factors of APTB were screened by multivariate Logistic regression analysis, and the R software was used to establish a column graph. Result There was no significant difference between 271 (64.4%) and 116 (57.7%) patients diagnosed with APTB in the training set and the verification set (χ2=2.566, P=0.109). Compared with APTB and IPTB patients, APTB has typical symptoms and an increased number of diabetic cases,white blood cell count (WBC), percentage of neutrophils, platelet count (PLT), platelet-lymphocyte ratio (PLR), neutrophil to lymphocyte ratio (NLR), highly sensitive C-reactive protein (hs-CRP), hs-CRP to albumin ratio (HSCAR), hs-CRP to prealbumin ratio (HSCPR) The ratio of hs-CRP to lymphocyte (HSCLR), erythrocyte sedimentation rate (ESR), monocyte to high-density lipoprotein (MHR), procalcitonin (PCT), lactate dehydrogenase (LDH), alkaline phosphatase (ALP) and adenosine deaminase (ADA) were significantly increased. Mean erythrocyte volume (MCV), erythrocyte specific volume (HCT), hemoglobin (Hb), mean erythrocyte hemoglobin concentration (MCHC), mean platelet volume (MPV), platelet volume distribution width (PDW), urea nitrogen, blood sodium, LDH to adenylate dehydrogenase ratio (LAR) and albumin were significantly decreased (P＜0.05). MCV, ESR, albumin, ADA, MHR and HSCLR were independent predictors of APTB (P＜0.05). The area under the curve (AUC) of the receiver operating curve (ROC) calculation training set and verification set were 0.956 and 0.876, respectively, indicating good model differentiation. The calibration curve and decision curve showed a good agreement between the model and the clinical net benefit ratio. A scoring system was developed based on the nomogram. The AUC calculated by ROC was 0.899, the optimal critical value was 15 points, the sensitivity was 85.6%, and the specificity was 93.7%. Conclusion Using the most readily available blood biochemical indexes to construct the column chart scoring model has good application value to guide the clinical differential diagnosis of APTB and IPTB.

Meta analysis on the validity of clinical laboratory diagnostic techniques for pulmonary tuberculosis in China Ren Guoli, Zhao Junpeng, Qin Li, Di Baochun, Tian Jie, Mo Minghua, Li Guogang 2023, 8 (5):  16-24.  DOI: 10.19871/j.cnki.xfcrbzz.2023.05.004 Abstract ( 199)    PDF (2719KB) ( 297 )    Objective To evaluate the validity of laboratory phenotype technology, immunology technology and molecular biology technology in clinical laboratory diagnosis of tuberculosis (TB). Method A comprehensive search was conducted such as Chinese core journal (selection) database, retrieved from database establishment to April 2023. Covering bacteriology, immunologic, and molecular biological laboratory diagnostic studies of TB. The retrieved documents were screened, extracted, and systematically evaluated for quality. Meta analysis was performed on qualified documents. The combined effect values such as sensitivity (SEN), specificity (SPE), positive likelihood ratio (+LR), negative likelihood ratio (-LR), diagnostic odds ratio (DOR), and area under the summary operating characteristic curve (SROC AUC) were calculated. Result A total of 271 relevant articles were retrieved, 49 qualified articles were included, including 54 bacteriology TB experiments, 39 immunologic TB experiments, and 25 molecular biological TB experiments. Combined SEN, SPE,+LR, -LR, DOR and AUC were 0.47(0.41-0.53)、0.99(0.98-0.99)、40.40(21.80-75.00)、0.53(0.48-0.60)、76.00(40.00-144.00)、0.85(0.82-0.88) in bacteriology experiments, 0.72(0.65-0.78)、0.89(0.85-0.93)、6.70(4.60-9.80)、0.31(0.25-0.39)、22.00(13.00-36.00)、0.88(0.85-0.91) in immunological experiments, 0.78(0.69-0.85)、0.97(0.95-0.98)、26.10(15.10-44.80)、0.23(0.16-0.32)、115.00(62.00-210.00)、0.96(0.94-0.97). Conclusion Bacteriology experiments have a high specificity for diagnosing TB, molecular biology experiments have a high sensitivity for diagnosing TB, and molecular biology experiments have a good validity for diagnosing or excluding TB. The validity of immunological experiments in diagnosing TB is between the above two experiments. Appropriate testing methods could be selected based on different levels and functions of TB diagnostic laboratories.

Analysis of the effect of three anesthesia methods on bronchoscopy in patients with tuberculosis Ma Panpan, Zhang Xiaodong, Li Jinpei, Zhang liang, Yu Dehui, Yang Xiaorui, He Renliang 2023, 8 (5):  25-28.  DOI: 10.19871/j.cnki.xfcrbzz.2023.05.005 Abstract ( 173)    PDF (866KB) ( 236 )    Objective To compare the effect of three different anesthesia methods on bronchoscopy in patients with tuberculosis. Method 90 painless bronchoscopy cases admitted to the Third People's Hospital of Shenzhen from December 2021 to March 2022 were selected, and were randomly divided into three groups with 30 cases in each group: local anesthesia group (group C), midazolam combined with remifentanil group (group M), midazolam combined with meperidine combined with cricothyroid membrane puncture group (group T). BP, HR, and SpO2 were recorded before anesthesia (T0), after anesthesia induction (T1), bronchoscope inserted into the glottis (T2), and during operation (T3). The recovery time, steward recovery score, and the incidence of adverse reactions were recorded. And the patient's satisfaction, the anesthetic effect were observed. Result Compared with T0, MBP and HR at T2 and T3 time points in group C were significantly increased;BP and HR at T1 time point in group M were significantly decreased (P<0.05);There was no significant difference in group T. Compared with group C, BP and HR at T1, T2 and T3 time points were lower in group M, MBP and HR at T2 and T3 time points were lower in group T (P<0.05). In group C, the incidence of adverse reactions was higher, the anesthesia excellence rate was lower, and the patients’ satisfaction was decreased (P<0.05). The recovery time was significantly shortened in group T, and the recovery score, anesthesia effect were significantly increased (P<0.05). Oxygen protection below 90% in 5 patients in group M only. Conclusion Midazolam compound pethidine combined with Cricothyroid membrane puncture is used for painless bronchoscopy in tuberculosis patients, which can effectively reduce the incidence of adverse reactions such as respiratory depression and cough, and the hemodynamics is more stable.

Study on the detailed features of enhanced MRI in brain parenchymal tuberculosis and comparative analysis with brain metastases Liang Ruiyun, Ren Huili, Li Huiru, Li Chengcheng, Fang Weijun, Song Min, Zhang Hui 2023, 8 (5):  29-35.  DOI: 10.19871/j.cnki.xfcrbzz.2023.05.006 Abstract ( 173)    PDF (1391KB) ( 223 )    Objective To analyze the detailed features of contrast-enhanced MRI in patients with brain parenchymal tuberculosis and metastasis,and explore the similarities and differences between the two. Method A retrospective analysis of 72 cases of brain parenchyma tuberculosis（research group） clinically diagnosed in Guangzhou Chest Hospital from January 2019 to December 2020,at the same time, 72 patients (control group) with brain metastases who met the inclusion criteria in the same period were collected for comparative analysis,the matching principle was the same sex and age difference within 2 years. Through the comparison of the detailed signs of enhanced MRI in the two groups,objective to analyze the detailed features of brain parenchyma tuberculosis on enhanced MRI. Result ①Multiple lesions of brain parenchyma tuberculosis（research group）: 65 cases (90.28%);when the focus was < 0.3cm,it mainly enhanced by the whole nodule, the detection rate in this group was 22 cases (35.56%);when the focus was ≥0.3cm,it mainly annular strengthening,the detection rate in this group was 58 cases (80.56%). ②In the research Group,the detection rates of lustered enhancement, no enhanced low signal ring around the lesion, uniform thickness of annular enhancement wall, small central partition, and mild central enhancement ring (ring in the ring) were 30.56%(22/72), 44.44%(32/72), 63.89%(46/72), 38.89(28/72)、16.67%(12/72) respectively; In the control group, they were 13.89%(10/72), 23.61%(17/72), 31.94%(23/72), 16.67%(12/72), 4.17%(3/72) respectively;The difference between the two groups was statistically significant（All P<0.05）.In the control group,the detection rates of uneven thickness of annular enhanced wall and inner wall nodules were 61.11%(44/72) and 30.56%(22/72) respectively;In the study group,they were 38.89%(28/72)、 8.33% (6/72) respectively;The difference between the two groups was statistically significant(χ2=7.111、11.350,P=0.008、0.001 respectively). Conclusion Multiple lesions was the main manifestations of cerebral tuberculosis,when the focus was <0.3cm, the enhancement of the whole nodule was the main manifestation,when the focus was ≥0.3cm, annular enhancement was the main manifestation.The enhanced MRI scanning of brain parenchyma tuberculosis was easier to detect clustered enhancement, no enhanced low signal ring around the lesion, uniform thickness of annular enhancement wall, small central partition, and mild central enhancement ring (ring in the ring).The enhanced MRI scan of brain metastasis was easier to detect the uneven thickness of annular enhanced wall and the inner wall nodule.Both have their own detailed signs of enhanced MRI,it can provide help for early clinical diagnosis and treatment.

Disposable non-invasive gastric specimen collection string-based genetic testing for Helicobacter pylori drug resistance and its clinical application Weng Meiting, Yang Lili, Zou Ao, Wu Huihua, Guo Hai, Zhang Yanyan, Li Xi, Wang Junping 2023, 8 (5):  36-40.  DOI: 10.19871/j.cnki.xfcrbzz.2023.05.007 Abstract ( 211)    PDF (866KB) ( 307 )    Objective We explored the clinical application value of using disposable non-invasive gastric specimen collection string to collect patient gastric material followed by antibiotic resistance detection to facilitate susceptibility-guided Helicobacter pylori (H. pylori) eradication therapy. Method Fifty patients with refractory H. pylori infection who previously failed twice or more H. pylori eradication to Peking University Shenzhen Hospital from May 2021 to May 2022, therapies performed a disposable non-invasive gastric specimen collection string that involves swallowing and retrieval of a disposable string to obtain their gastric specimen for drug resistance detection via quantitative PCR. Based on the test results, patients were prescribed with susceptibility-guided bismuth-based quadruple eradication therapy for 14 days. A follow-up urea breath test was performed at least 4 weeks after the completion of treatment to confirm eradication. Result Of 50 recruited patients, 43 were tested positive for H. pylori infection by the qPCR test and received individualized treatment. Successful H. pylori eradication was confirmed in 41 patients, with an eradication rate of 95.35% (95%CI 84.19% to 99.43%) in the intention-to-treat analysis and 97.62% (95%CI 87.43% to 99.94%) based on per-protocol analysis, which were significantly better than that of the conventional bismuth-based eradication therapy (P<0.001). Conclusion Based on disposable non-invasive gastric specimen collection string,the qPCR test has been shown to be clinically effective in guiding our use of personalized H. pylori eradication therapy for treating patients with antibiotic-resistant H. pylori infection.

Analysis of early warning indicators of severe fever with thrombocytopenia syndrome Huo Xueping, Liu Zhenjun, Xie Qinxiu 2023, 8 (5):  41-45.  DOI: 10.19871/j.cnki.xfcrbzz.2023.05.008 Abstract ( 220)    PDF (852KB) ( 295 )    Objective The laboratory data and clinical features of 90 patients with fever with thrombocytopenia syndrome (SFTS) were analyzed to find out the warning indicators of severe patients and provide basis for timely intervention. Method From March 2020 to September 2021, 90 patients with SFTS were collected from the Infection Department of Anqing Municipal Hospital. They were divided into mild group and severe group according to the severity of the disease, including 44 cases of mild group and 46 cases of severe group. The epidemiological characteristics, clinical characteristics and laboratory indicators of the two groups were compared. Result All 90 cases were sporadic cases, with 88 being farmers, 62 females, and 28 males. The peak of incidence was mainly from April to September. Compared with the mild group, the median age of the severe group was higher (66 years and 62 years, respectively, Z=-2.032, P=0.042); The severe group had a longer heat course (Z=-2.558, P=0.010) and skin ecchymosis and ecchymosis has a higher incidence rate（χ2=9.406, P=0.002); The indexes of calcitonin, creactive protein, creatinine, blood urea nitrogen, aspartate aminotransferase, lactate dehydrogenase, and C reatine kinase in the severe group were higher than those in the mild group (Z values were -2.041, -2.054, -3.576, -4.571, -4.452, -4.993, and -4.500, respectively, P<0.05), while blood calcium (t=-3.471), platelet (Z=-8.124), and lymphocyte count (Z=-1.959) were lower than those in the mild group, with statistical significance (all P<0.05); The incidence rates of central nervous system abnormalities, pneumonia, myocardial damage, bradycardia, liver insufficiency and rhabdomyolysis in the severe group were higher than those in the mild group (χ2=4.155, 8.897, 12.018, 9.961, 16.365, 6.123, all P<0.05). Logistic regression analysis showed that central nervous system abnormalities (OR=20.314, 95%CI:0.886-45.695), PLT(OR=0.93, 95%CI:0.888-0.973), and myocardial damage (OR=4.813, 95%CI:1.149-20.162) are independent risk factors for severe warning. Conclusion The clinical symptoms of SFTS are diverse. If there is a significant decrease in platelets, abnormalities in the central nervous system, or abnormalities in the myocardial enzyme spectrum, patients should be vigilant that they may progress to severe SFTS.

Analysis of clinical diagnostic value of four detection methods in Helicobacter pylori infection Chen Haiting, Zhang Shuzhen, Li Xuehong, Liu Aijun, Yang Weiqing 2023, 8 (5):  46-51.  DOI: 10.19871/j.cnki.xfcrbzz.2023.05.009 Abstract ( 233)    PDF (928KB) ( 305 )    Objective To evaluate the clinical performance and application values of common detection tools for Helicobacter pylori (H.pylori) infection, and provide guidance for the clinical diagnosis of H.pylori. Method From January 2020 to January 2022, a total of 276 patients who had upper gastrointestinal symptoms were selected to undertake the electronic gastroscopy and 13C-urea breath examination (13C-UBT) in the Gastroenterology Department of Shenzhen Dapeng New District Kuichong People's Hospital. Their gastric mucosa samples were collected for rapid urease test (RUT), bacterial culture and histopathological tests. In this study, the results of histopathological tests were taken as the "gold standard", other detection methods were compared and statistically analyzed. Result The positive rates of 13C-UBT, electronic gastroscopy, RUT, bacterial culture and histology were 91.30% (252/276), 65.58% (181/276), 79.71% (220/276), 73.19% (223/276) and 90.22% (249/276) respectively. The efficiency of various detection methods was ranked from high to low. Sensitivity：13C-UBT>RUT>bacterial culture >gastroscopy; Specificity：bacterial culture >13C-UBT> gastroscopy >RUT. The consistency test of 13C-UBT (Kappa=0.935) was the best. The Kappa value of bacterial culture and RUT were 0.624 and 0.431 respectively. But the Kappa value of (Kappa=0.246) gastroscopy was poor. ROC curve was used to compare and analyze the diagnostic effect of various detection methods: combination test (13C-UBT+ histology) >13C-UBT >bacterial culture >RUT >gastroscopy. Conclusion 13C-UBT is the best non-invasive method to detect H.pylori infection. The sensitivity and accuracy of electronic gastroscopy of H.pylori infection diagnosis are poor. Although the specificity of bacterial culture is high, its sensitivity is relatively low. It costs long time and requires complex techniques. The performance of RUT is obviously inferior to that of histopathological examination. At present, gastroscopy plus histopathological examination has become a clinical routine. For patients requiring gastroscopy, 13C-UBT combined with histopathological examination is the optimal detection mode for the clinical diagnosis of H.pylori infection.

Case Report

Child Q fever in report of 3 cases Wang Peiwen, Yu Shaofei, Chai Shaoqing 2023, 8 (5):  52-55.  DOI: 10.19871/j.cnki.xfcrbzz.2023.05.010 Abstract ( 191)    PDF (978KB) ( 325 )    Q fever is a zoonosis caused by infection with Coxiella burnetii (CB) . It has a variety of clinical manifestations, including acute and chronic infections. Q fever in children is characterized by non-specific symptoms or no obvious symptoms, so it is easy to be misdiagnosed and missed. At present, laboratory examination is the main diagnostic standard, metagenomics next generation sequencing (mNGS) plays an important role in the early diagnosis of Q fever. Q fever is not uncommon in China. Most of the patients come from rural or remote areas. However, the doctors at the grass-roots level do not know enough about q fever and their diagnostic techniques are single, which results in the delay of diagnosis and treatment, increased risk of Q fever complications in children. Three cases of children with Q fever admitted to Inner Mongolia autonomous region people's hospital were analyzed retrospectively, the aim of this study is to improve the awareness of the grass-roots doctors to Q fever, to make early diagnosis and treatment, to reduce the occurrence of the corresponding complications, and to strengthen the health education of the high-risk population of the disease by grass-roots doctors, and take timely measures to prevent the occurrence of Q fever.

One case of pancreatic tuberculosis and literature review Zhu Hongmei, Shi Zhengyu, Huang Tao, Li Xiu 2023, 8 (5):  56-58.  DOI: 10.19871/j.cnki.xfcrbzz.2023.05.011 Abstract ( 188)    PDF (951KB) ( 376 )    Pancreatic tuberculosis is a rare extra-pulmonary tuberculosis. Its clinical symptoms and imaging findings are nonspecific, so it is easy to be confused with other pancreatic diseases, resulting in delayed anti-tuberculosis treatment or unnecessary surgery. The possibility of pancreatic tuberculosis should be considered in young patients with obstructive jaundice with enlarged abdominal lymph nodes, especially in isolated space-occupying lesions of the pancreas without elevated tumor markers. Improve the relevant laboratory examination, pathological biopsy can help differential diagnosis, if necessary, feasible surgical exploration and drainage. In this paper, the clinical data and imaging findings of a patient with pancreatic tuberculosis admitted to the Chengdu Public Health Clinical Medical Center were retrospectively analyzed, and the relevant literature was reviewed to improve the clinical diagnosis and treatment of pancreatic tuberculosis,and reduce missed diagnosis and misdiagnosis.

Pharmacological intervention and monitoring of a baby with tuberculous meningitis combined with purulent meningitis Wei Wenfang, Yu Haiwei, Qin Simei, Jiang Changyue 2023, 8 (5):  59-62.  DOI: 10.19871/j.cnki.xfcrbzz.2023.05.012 Abstract ( 169)    PDF (844KB) ( 275 )    This article reviews on the proactive intervention and monitoring of a scientific pharmacist in the administration of an child with tuberculous meningitis blended with purulent meningitis. The patient, a 6-month and 3-day-old child, was diagnosed with tuberculous meningitis, purulent meningitis, and secondary epilepsy. The clinical pharmacist notified the clinic about the potential drug interactions between meropenem and sodium valproate, which could worsen the seizures. After consulting with the healthcare team, the child's convulsions were gradually controlled. The frequency of linezolid was adjusted from every 8 hours to every 12 hours. After adjusting the frequency of linezolid for three days, the child exhibited the ability to track light and objects with both eyes. Following this improvement, the child was discharged and scheduled for regular check-ups. The anti-tuberculosis regimen was continued for nearly 10 months with adjusted frequency of linezolid, and no further adverse drug reactions were reported.

Guidelines and Consensus

Expert consensus on imaging diagnosis of drug-resistant pulmonary tuberculosis Infectious Disease Imaging Group of Infectious Disease Branch for Chinese Research Hospital Association, Infectious Diseases Group of Chinese Medical Association of Radiology, Digital Health Committee of China Association for the Promotion of Science and Technology Industrialization, et al 2023, 8 (5):  63-74.  DOI: 10.19871/j.cnki.xfcrbzz.2023.05.013 Abstract ( 216)    PDF (4120KB) ( 219 )    Tuberculosis (TB) is still one of the major infectious diseases in the world, and the incidence of Drug-resistant pulmonary tuberculosis (DR-PTB) is the focus and difficulty of tuberculosis control. Early, rapid and accurate diagnosis of DR-PTB is essential for selecting appropriate and personalized treatment and is an important means of reducing disease transmission and mortality. In recent years, the imaging diagnosis of DR-PTB has developed rapidly, but there is a lack of consistent understanding. To this end, Infectious Disease Imaging Group, Infectious Disease Branch, Chinese Research Hospital Association; Infectious Diseases Group of Chinese Medical Association of Radiology Digital Health Committee of China Association for the Promotion of Science and Technology Industrialization.et.led the organization of tuberculosis clinical and imaging experts across the country, referring to the diagnosis and treatment status of DR-PTB at home and abroad, combined with China's clinical practice and evidence-based medicine on the methodological requirements of guidelines and standards. After repeated discussion, the expert consensus of imaging diagnosis of DR-PTB was formed. Its contents include clinical diagnosis and classification of DR-PTB, selection of etiology and imaging examination, imaging manifestations, diagnosis and differential diagnosis. This expert consensus is expected to improve the understanding of the imaging changes of DR-PTB, as a starting point for timely detection of suspected DR-PTB patients, and can effectively improve the efficiency of clinical diagnosis and achieve the purpose of early diagnosis and treatment of DR-PTB.

Review

Application of linezolid serum concentration monitoring in patients with drug-resistant tu-berculosis Hu Qiumeng, Zhang Peize 2023, 8 (5):  75-79.  DOI: 10.19871/j.cnki.xfcrbzz.2023.05.014 Abstract ( 228)    PDF (853KB) ( 324 )    Linezolid is a novel oxazolidinone antibiotics and a key drug for treatment of drug-resistant tuberculosis. With narrow therapeutic window, linezolid is characterized with great efficacy, and high incidence of adverse reaction. How to tailor optimal dosage for every patient to balance efficacy and safety is still a problem for clinician. Therapeutic drug monitoring (TDM) remains a standard clinical technique for using plasma drug concentrations to make informed dosing decisions. Many studies worldwide have demonstrated the possible optimal dosage of linezolid in drug-resistant TB patients, explored the relationship between the trough concentration, peak concentration and the incidence of adverse reactions of linezolid by TDM, particularly for fragile patients, like the aged, children and patients with injured liver and kidney function. We hereby review the mechanism of linezolid, the relationship between dosage and safety of linezolid, risk factors affecting the concentration of linezolid, evidence and available methods of TDM of linezolid, so as to provide a reference for clinician to do TDM of linezolid during the treatment of drug-resistant tuberculosis.

Expression and significance of C-X-C motif chemokine ligand 13 in common infectious pathogens infection Chen Zhihui, Tan Yingzheng, Long Yunzhu 2023, 8 (5):  80-84.  DOI: 10.19871/j.cnki.xfcrbzz.2023.05.015 Abstract ( 216)    PDF (855KB) ( 289 )    C-X-C motif chemokine ligand 13 (CXCI13) can promote B cell maturation and antibody response by binding to G protein-coupled chemokine receptor (CXCR5) that locating on B cells and Tfh cells.Consequently,the inhibition of virus replication, even the elimination of virus,can be realized,which conclusively facilitating to the rapid control of inflammation.However,it should be noted that excessive increase of CXCL13 may lead to impaired immune response and further deterioration of infection. In view of these important effects, the change of CXCL13 concentration is likely to become an effective index for evaluation of disease progression and antiviral efficacy, and will be helpful for future vaccine development. In summary, the paper mainly reviews the expression and significance of CXCL13 in common infectious pathogens such as human immunodeficiency virus, hepatitis B virus infection, tuberculosis and SARS-CoV-2.

Research progress on the updated medication regimens for less common nontuberculous mycobacterial disease Hu Yi, Tang Lixin, Li Tongxin, Tang Shengjie, Yang Song 2023, 8 (5):  85-91.  DOI: 10.19871/j.cnki.xfcrbzz.2023.05.016 Abstract ( 230)    PDF (867KB) ( 932 )    The global trends of nontuberculous mycobacterial disease（NTMD）are increasing. NTMD is one of worldwide public health burden associated with mounting morbidity, case fatality rate , and economic costs. Mycobacterial pathogens are intrinsically resistant to many available antibiotics, making treatment extremely challenging, especially in immunocompromised individuals and patients with chronic underlying conditions. Even if with lengthy therapy and the use of a combination of antibiotics, the cure rate for NTMD is lower. The need for novel medication regimens that are effective against NTMD is very urgent. A few available management guidelines for patients with common nontuberculous mycobacterial pulmonary disease(NTM-PD) in adults caused by Mycobacterium avium complex, and Mycobacterium abscessus complex have been issued. However, management options for diseases caused by other clinically relevant less common non-tuberculous mycobacteria(NTM), including Mycobacterium marinum, Mycobacterium gordonae, Mycobacterium ulcerans, Mycobacterium malmoense, Mycobacterium genavense, Mycobacterium celatum, Mycobacterium simiae, Mycobacterium paragordonae, Mycobacterium szulgai, Mycobacterium haemophilum, Mycobacterium scrofulaceum, are very insufficiency. The patients with NTMD should need multi-drug therapy based on current guideline-based treatment strategies and individualized treatment strategies. However, most NTMs had inherent resistance to a variety of first-line anti-bacterial drugs. The cure rate for especially the patients with immunocompromised and chronic diseases was lower than 50% and the treatment of NTMD were challenging.To save the lives of these patients, to improve the efficacy and to reduce side effects, new medications and treatment regimens with high efficacy and low toxicity are expected to be used in clinic as soon as possible. A systematical review on updated medication regimens for less common NTMD was developed.

Education Fields（Video）

Interpretation of Expert consensus on imaging diagnosis of Brucella spondylitis Guo Hui, Zhang Tieliang, Liu Wenya 2023, 8 (5):  92-96.  DOI: 10.19871/j.cnki.xfcrbzz.2023.05.017 Abstract ( 222)    PDF (1574KB) ( 377 )    Brucella spondylitis (BS) is a global distributed infectious disease and has become a public health problem. Imaging technology plays an important role in the early diagnosis, preoperative evaluation and curative effect monitoring of BS. Because there were not any special clinical symptom, so the imaging findings would play an important role for diagnosis and differential diagnosis. Imaging diagnostic criteria for BS was formulated by evidence-based medicine guideline methodology. Imaging methods including DR, CT and MRI were recommended for detecting the BS. Based on evidence-based medical evidence and expert opinions, it is concluded that the combined application of DR+MRI as the recommended detection means has higher accuracy, less inspection costs and lower radiation damage for BS patients.Staging for BS include acute, subacute and chronic stage. Combined epidemiological history, clinical manifestations, laboratory, imaging and histopathological examinations were regard as the diagnostic criteria for BS. In this paper, imaging manifestations of BS were systematically expounded so as to provide scientific basis for clinical accurate diagnosis and proper treatment.