Pulmonary Tuberculosis In China Research Articles

The correlation between the need for continuing care services, influencing factors, and social support and discharge readiness among discharged patients with pulmonary tuberculosis in China: A cross-sectional study

ObjectiveTo understand the relationship between the need for continuing care services and influencing factors, social support, readiness for discharge among discharged pulmonary tuberculosis (PTB) patients. MethodsA cross-sectional study was conducted among 170 patients from a database of discharged patients with PTB from September 2023 to January 2024. A demographic and disease characteristics questionnaire, continuing care services basic modality questionnaire, continuing care services need questionnaire, the Social Support Rating Scale (SSRS), and the Readiness for Hospital Discharge Scale (RHDS) were used for this investigation. Univariate analysis and multiple linear regression analysis were used to analyze the associated factors. ResultsThe mean total score for the need for continuing care services among patients with PTB discharged from the hospital was (121.61 ± 22.98). The dimension with the highest score was health education guidance need. Compared to the the original hospital medical personnel, the primary source of care information after discharge was the local medical institutions was statistically significant and negatively correlated with continuing care service need (P = 0.005). Social support was positively associated with need for continuing care services (P = 0.042). ConclusionDischarged PTB patients had a high degree of continuing care service need. Factors influencing the need for continuing care services are the primary source of care information after discharge was the local medical institutions, the social support. Medical staff need to provide targeted continuing care services based on relevant influencing factors to meet the discharge needs of patients.

Factors affecting the incidence of pulmonary tuberculosis based on the GTWR model in China, 2004-2021.

Contra-posing panel data on the incidence of pulmonary tuberculosis (PTB) at the provincial level in China through the years of 2004-2021 and introducing a geographically and temporally weighted regression (GTWR) model were used to explore the effect of various factors on the incidence of PTB from the perspective of spatial heterogeneity. The principal component analysis (PCA) was used to extract the main information from twenty-two indexes under six macro-factors. The main influencing factors were determined by the Spearman correlation and multi-collinearity tests. After fitting different models, the GTWR model was used to analyse and obtain the distribution changes of regression coefficients. Six macro-factors and incidence of PTB were both correlated, and there was no collinearity between the variables. The fitting effect of the GTWR model was better than ordinary least-squares (OLS) and geographically weighted regression (GWR) models. The incidence of PTB in China was mainly affected by six macro-factors, namely medicine and health, transportation, environment, economy, disease, and educational quality. The influence degree showed an unbalanced trend in the spatial and temporal distribution.

Expert consensus on diagnosis and treatment of elderly pulmonary tuberculosis

With the ageing of the population, the incidence of pulmonary tuberculosis in the elderly has peaked. Elderly patients with pulmonary tuberculosis are easily misdiagnosed. In terms of treatment, the elderly are characterized by low success rate of treatment and high mortality. In particular, elderly pulmonary tuberculosis patients who are not detected in time and treated effectively, are the source of infection in places where people congregate, such as nursing homes and hospitals. The seriousness of pulmonary tuberculosis in elderly deserves greater recognition from the medical staff, especially respiratory physicians, infectious disease physicians and geriatricians. It is important to formulate and implement expert consensus on diagnosis and treatment of elderly pulmonary tuberculosis in accordance with China's national conditions in order to improve the early diagnosis rate of elderly pulmonary tuberculosis in China, standardize the treatment plan, improve the treatment outcome and to reduce the risk of transmission. This consensus covers the definition, epidemiology, immune status, risk factors, diagnosis and treatment of pulmonary tuberculosis in the elderly, and provides 20 recommendations for clinicians.

Incidence, causes, and risk factors for unplanned readmission in patients admitted with pulmonary tuberculosis in China.

To investigate the incidence, causes, and risk factors for unplanned readmission within 30 days of discharge in patients with pulmonary tuberculosis (TB). The clinical data of 1,062 patients with confirmed pulmonary TB who were admitted to our hospital from October 2018 to October 2021 were analysed retrospectively. The subjects were divided into a readmission group (354 cases) and a non-readmission group (708 cases) according to whether there was an unplanned admission within 30 days of discharge. We analysed the risk factors for unplanned readmission within 30 days after discharge with pulmonary TB. The incidence of unplanned readmission in patients with pulmonary TB was 5.2%. Being female (OR = 0.63, 95% CI: 0.434-0.942) and living in cities (OR = 0.218, 95% CI: 0.151-0.315) were protective factors for the readmission of patients with TB (p < 0.05). However, being ≥ 65 years old (OR = 2.574, 95% CI: 1.709-3.870), being a smoker (OR = 2.773, 95% CI: 1.751-4.390), having chronic obstructive pulmonary disease (COPD) (OR = 3.373, 95% CI: 1.708-6.660), having viral hepatitis (OR= 2.079, 95% CI: 1.067-4.052), receiving non-standard treatment (OR = 15.620, 95% CI: 10.413-23.431), having medical side effects (OR = 6.138, 95% CI: 3.798-9.922) and l unauthorised discharge (OR = 2.570, 95% CI: 1.509-4.376) were risk factors for the readmission to hospital of patients with TB (p < 0.05). Gender, age, place of residence, smoking, COPD, hepatitis, non-standard treatment, adverse drug reactions and unauthorised discharge were risk factors of TB for unplanned readmission.

Changes in Notified Incidence of Pulmonary Tuberculosis in China, 2005–2020

ObjectiveTo evaluate the trend of notified incidence of pulmonary tuberculosis (PTB) in China at different periods by population and region and to explore the effect of TB prevention and control in recent years. MethodsUsing pooled data on TB cases reported by the TB Information Management Reporting System (TBIMS) from 2005 to 2020, we calculated the annual percentage change (APC) using the Joinpoint regression model. ResultsFrom 2005 to 2020, a total of 16.2 million cases of PTB were reported in China, with an average notified incidence of 75.5 per 100,000 population. The age standardization rate (ASR) continued to decline from 116.9 (/100,000) in 2005 to 47.6 (/100,000) in 2020, with an average annual decrease of 5.6% [APC = –5.6, 95% confidence interval (CI): –7.0 to –4.2]. The smallest decline occurred in 2011–2018 (APC = –3.4, 95% CI: –4.6 to –2.3) and the largest decrease in 2018–2020 (APC = –9.2, 95% CI: –16.4 to –1.3). From 2005 to 2020, the ASR in males (159.8 per 100,000 in 2005, 72.0 per 100,000 in 2020) was higher than that in females (62.2 per 100,000 in 2005, 32.3 per 100,000 in 2020), with an average annual decline of 6.0% for male and 4.9% for female. The average notified incidence was the highest among older adults (65 years and over) (182.3/100,000), with an average annual decline of 6.4%; children (0–14 years) were the lowest (4.8/100,000), with an average annual decline of 7.3%, but a significant increase of 3.3% between 2014 and 2020 (APC = 3.3, 95% CI: 1.4 to 5.2); middle-aged (35–64 years) decreased by 5.8%; and youth (15–34 years) decreased by an average annual rate of 4.2%. The average ASR in rural areas (81.3/100,000) is higher than that in urban areas (76.1/100,000). The average annual decline in rural areas was 4.5% and 6.3% in urban areas. South China had the highest average ASR (103.2/100,000), with an average annual decline of 5.9%, while North China had the lowest (56.5/100,000), with an average annual decline of 5.9%. The average ASR in the southwest was 95.3 (/100,000), with the smallest annual decline (APC = –4.5, 95% CI: –5.5 to –3.5); the average ASR in the Northwest China was 100.1 (/100,000), with the largest annual decline (APC = –6.4, 95% CI: –10.0 to –2.7); Central, Northeastern, and Eastern China declined by an average of 5.2%, 6.2%, and 6.1% per year, respectively. ConclusionsFrom 2005 to 2020, the notified incidence of PTB in China continued to decline, falling by 55%. For high-risk groups such as males, older adults, high-burden areas in South, Southwest, and Northwest China, and rural regions, proactive screening should be strengthened to provide timely and effective anti-TB treatment and patient management services for confirmed cases. There is also a necessity to be vigilant about the upward trend of children in recent years, the specific reasons for which need to be further studied.

Expert consensus on surgical treatment of multidrug-resistant and rifampicin-resistant pulmonary tuberculosis in China (2022 edition)

The cure rate of multidrug-resistant and rifampicin-resistant pulmonary tuberculosis in the world is about 60%, and timely surgical intervention can increase the cure rate to more than 85%. The treatment of multidrug-resistant and rifampicin-resistant pulmonary tuberculosis requires multidisciplinary involvement of tuberculosis department, thoracic surgery department, imaging department, laboratory department and other disciplines to significantly reduce its morbidity and mortality. Although the World Health Organization has defined the role and status of surgery in the treatment of multidrug-resistant and rifampicin-resistant pulmonary tuberculosis, there are significant differences in the cognition and diagnosis and treatment methods of domestic clinicians on multidrug-resistant and rifampicin-resistant pulmonary tuberculosis. Therefore, it is urgent to develop expert consensus on surgical treatment of multidrug-resistant and rifampicin-resistant pulmonary tuberculosis for clinicians to learn from in clinical diagnosis and treatment practice. The Chinese Society for Tuberculosis,Chinese Medical Association organized experts in tuberculosis thoracic surgery to write the first draft of consensus based on the expert suggestion on surgical diagnosis and treatment of multidrug-resistant pulmonary tuberculosis written by the European Office of the World Health Organization in 2014 and the 2019 version of China's multidrug-resistant and rifampicin-resistant pulmonary tuberculosis expert consensus, and combined with China's national situation. This consensus systematically elaborated seven aspects, including surgical indications, contraindications to surgery, conditions and timing of surgery, surgical methods and indications of various surgical procedures, preoperative and postoperative chemotherapy, treatment of surgical complications, and perioperative management of patients with multidrug-resistant and rifampin-resistant pulmonary tuberculosis. After discussion and voting by experts, six recommendations were formed, aiming to provide reference for clinicians in the treatment of multidrug-resistant and rifampin-resistant pulmonary tuberculosis and further improve the standardized diagnosis and treatment level of multidrug-resistant and rifampin-resistant pulmonary tuberculosis in China.

Rate of Patient Delay among Students with Pulmonary Tuberculosis in China: A Meta-Analysis

Objective: To systematically review the rate of patient delay of pulmonary tuberculosis (PTB) patients among students in China. Methods: Databases including Web of Science Core Collection, PubMed, The Cochrane Library, CBM, CNKI, VIP, and WANFANG DATA were electronically searched to collect cross-sectional studies on the incidence of delayed consultation in students with PTB in China from January 1, 2000, to November 15, 2022. Two researchers independently screened studies, extracted data, and assessed the risk of bias of the included studies. Meta-analysis was then performed by Stata 16.0 software. Results: In total, 60 cross-sectional studies with 260,707 cases involving 136,701 delayed consultation PTB patients were included. The results of meta-analysis showed that the rate of patient delay was 46.4% (95% CI 44.3% to 48.4%) among students with PTB in China. Results of subgroup analyses showed that: 1) The rates were 46.8% and 50.4% for male and female students, respectively. 2) The rates for the East, Central and West parts of China were 42.3%, 45.6% and 50.5%, respectively. 3) The rates were increased first and then decreased during 2007 to 2020. 4) The rates of students from primary school, junior high school, senior high school and university were 50.3%, 49.8%, 40.7% and 44.9%, respectively. 5) The rates for the Han and the other nationalities were 50.3% and 53.9%, respectively. 6) The rates for local and non-local students were 47.2% and 50.5%, respectively. 7) The rates of patients detected by consultation due to symptoms, recommendation due to symptoms, referral, tracking and healthy physical examination were 50.5%, 51.6%, 46.6%, 55.6% and 16.2%, respectively. 8) The rates of patients with initial PTB and retreatment PTB were 53.1% and 59.6%, respectively. 9) The rates of patients with positive etiology, negative etiology and without etiological results were 55.9%, 47.0% and 51.6%, respectively. 10) The rates of severe and non-severe patients were 59.4% and 52.9%, respectively. Conclusion: The patient delay rate for Chinese students with PTB is generally at a high level. There are substantial differences in the patient delay rate for students with PTB among different genders, regions, study stages, nationalities, household registration types, detection methods, and treatment classifications.

Diagnostic accuracy of loop-mediated isothermal amplification for pulmonary tuberculosis in China

ObjectivesTo evaluate the diagnostic accuracy of Loop-Mediated Isothermal Amplification Platform (LAMP) in detecting pulmonary tuberculosis (PTB).MethodsThis multicenter prospective study was conducted at six sites in China from June, 2018 to December, 2019. Patients with suspected PTB were consecutively recruited and respiratory samples were collected from all patients. LAMP, Xpert MTB/RIF assay (Xpert), fluorescence smear microscopy, and BACTEC MGIT 960 liquid culture (Mtb culture) were performed for each sample. Diagnostic accuracy indices were calculated against Mtb culture results.ResultsA total of 845 participants were enrolled, but only 799 were included in the analysis. The sensitivities of LAMP, Xpert, and smear microscopy were 78.6% (239/304), 82.2% (250/304), and 63.8% (194/304), respectively, and their specificities were 88.7% (439/495), 86.1% (426/495), and 94.9% (470/495), respectively. The LAMP assay showed substantial agreement with other tests (kappa 0.64–0.79).ConclusionThe LAMP assay performs as well as Xpert MTB/RIF assay and Mtb culture in tertiary-care hospitals. It can be used as an alternative test for detecting PTB with the advantages of being fast, inexpensive, and easy to operate.

Long-term exposure to ambient air pollution and greenness in relation to pulmonary tuberculosis in China: A nationwide modelling study

Previous studies have attempted to clarify the relationship between the occurrence of pulmonary tuberculosis (PTB) and exposure to air pollutants. However, evidence from multi-centres, particularly at the national level, is scarce, and no study has examined the modifying effect of greenness on air pollution–TB associations. In this study, we examined the association between long-term exposure to ambient air pollutants (PM10 p.m.2.5, and O3) and monthly PTB or smear-positive pulmonary tuberculosis (SPPTB) incidence to further evaluate whether these associations were affected by greenness in mainland China using a two-stage analytic procedure. PM2.5 was positively associated with both PTB and SPPTB incidence, with relative risk (RR) of 1.12 (95% confidence interval [CI]: 1.03, 1.22) and 1.08 (95% CI: 1.02, 1.10) per 10 μg/m3 increase, respectively. Furthermore, PM10 was positively associated with PTB incidence, with RR of 1.07 (95% CI: 1.01, 1.13). However, O3 was not associated with the monthly incidence of PTB or SPPTB. The normalized difference vegetation index (NDVI) exhibited a modifying effect on the association between PM2.5 exposure and SPPTB incidence in northern areas, with RR of 1.16 (95% CI: 1.03, 1.31) in lower mean annual NDVI areas than in the higher areas (RR = 0.98, 95% CI: 0.87, 1.09). This nationwide analysis indicated that NDVI could reduce the effect of air pollutants on TB incidence particularly in the northern areas. Long-term exposure to particulate matter (PM) may increase the occurrence of PTB or SPPTB in China, and further studies involving larger numbers of SPPTB cases are required to confirm the effects of PM exposure on SPPTB incidence in the future.

Unbalanced Risk of Pulmonary Tuberculosis in China at the Subnational Scale: Spatiotemporal Analysis.

BackgroundChina has one of the highest tuberculosis (TB) burdens in the world. However, the unbalanced spatial and temporal trends of TB risk at a fine level remain unclear.ObjectiveWe aimed to investigate the unbalanced risks of pulmonary tuberculosis (PTB) at different levels and how they evolved from both temporal and spatial aspects using PTB notification data from 2851 counties over a decade in China.MethodsCounty-level notified PTB case data were collected from 2009 to 2018 in mainland China. A Bayesian hierarchical model was constructed to analyze the unbalanced spatiotemporal patterns of PTB notification rates during this period at subnational scales. The Gini coefficient was calculated to assess the inequality of the relative risk (RR) of PTB across counties.ResultsFrom 2009 to 2018, the number of notified PTB cases in mainland China decreased from 946,086 to 747,700. The average number of PTB cases in counties was 301 (SD 26) and the overall average notification rate was 60 (SD 6) per 100,000 people. There were obvious regional differences in the RRs for PTB (Gini coefficient 0.32, 95% CI 0.31-0.33). Xinjiang had the highest PTB notification rate, with a multiyear average of 155/100,000 (RR 2.3, 95% CI 1.6-2.8; P<.001), followed by Guizhou (117/100,000; RR 1.8, 95% CI 1.3-1.9; P<.001) and Tibet (108/100,000; RR 1.7, 95% CI 1.3-2.1; P<.001). The RR for PTB showed a steady downward trend. Gansu (local trend [LT] 0.95, 95% CI 0.93-0.96; P<.001) and Shanxi (LT 0.94, 95% CI 0.92-0.96; P<.001) experienced the fastest declines. However, the RRs for PTB in the western region (such as counties in Xinjiang, Guizhou, and Tibet) were significantly higher than those in the eastern and central regions (P<.001), and the decline rate of the RR for PTB was lower than the overall level (P<.001).ConclusionsPTB risk showed significant regional inequality among counties in China, and western China presented a high plateau of disease burden. Improvements in economic and medical service levels are required to boost PTB case detection and eventually reduce PTB risk in the whole country.

Epidemiological characteristics of extrapulmonary tuberculosis patients with or without pulmonary tuberculosis.

Our study aimed to investigate the epidemiology of extrapulmonary tuberculosis (EPTB) and analyse the epidemiological characteristics of EPTB patients with or without pulmonary tuberculosis (PTB). EPTB cases admitted in our hospital from January 2015 to December 2020 were included. Uni- and multi-variable logistic regression analysis was carried out to identify risk factors and prognostic factors of concomitant EPTB and PTB or exclusively EPTB. A total of 3488 EPTB patients were reviewed, including 2086 patients with concurrent PTB and EPTB, and 1402 patients with exclusively EPTB. Logistic regression analysis showed that age >60 years (OR = 1.674, 95% CI = 1.438-1.949, P < 0.001) and female (OR = 1.325, 95% CI = 1.155-1.520, P < 0.001) were risk factors of exclusively EPTB, while co-morbidities (OR = 0.676, 95% CI = 0.492-0.929, P = 0.016) and severe symptoms (OR = 0.613, 95% CI = 0.405-0.929, P = 0.021) were risk factors for concurrence of EPTB and PTB. Age >60 years was an independent prognostic factor in EPTB patients with or without PTB (HR = 11.059, 95%CI = 5.097-23.999, P < 0.001; HR = 23.994, 95%CI = 3.093-186.151, P = 0.0020). Female gender was an independent prognostic factor in patients with concurrent PTB and EPTB (HR = 23.994, 95%CI = 3.093-186.151, P = 0.002). Our study disclosed the differential epidemiological characteristics of EPTB patients with or without PTB in China.

Efficacy of integrating short-course chemotherapy with Chinese herbs to treat multi-drug resistant pulmonary tuberculosis in China: a study protocol

BackgroundTuberculosis (TB) caused Mycobacterium tuberculosis (M.tb) is one of infectious disease that lead a large number of morbidity and mortality all over the world. Although no reliable evidence has been found, it is considered that combining chemotherapeutic drugs with Chinese herbs can significantly improves the cure rate and the clinical therapeutic effect.MethodsMulti-drug resistant pulmonary tuberculosis (MDR-PTB, n = 258) patients with Qi-yin deficiency syndrome will be randomly assigned into a treatment group (n = 172) or control/placebo group (n = 86). The treatment group will receive the chemotherapeutic drugs combined with Chinese herbs granules (1 + 3 granules), while the control group will receive the chemotherapeutic drugs combined with Chinese herbs placebo (1 + 3 placebo granules). In addition, MDR-PTB (n = 312) patients with Yin deficiency lung heat syndrome will be randomly assigned to a treatment (n = 208) or control/placebo (n = 104) group. The treatment group will receive the chemotherapeutic regimen combined with Chinese herbs granules (2 + 4 granules), while the control group will receive the chemotherapeutic drugs and Chinese herbs placebo (2 + 4 placebo granules). The primary outcome is cure rate, the secondary outcomes included time to sputum culture conversion, lesion absorption rate and cavity closure rate. BACTEC™ MGIT™ automated mycobacterial detection system will be used to evaluate the M.tb infection and drug resistance. Chi-square test and Cox regression will be conducted with SAS 9.4 Statistical software to analyze the data.DiscussionThe treatment cycle for MDR-PTB using standardized modern medicine could cause lengthy substantial side effects. Chinese herbs have been used for many years to treat MDR-PTB, but are without high-quality evidence. Hence, it is unknown whether Chinese herbs enhances the clinical therapeutic effect of synthetic drugs for treating MDR-PTB. Therefore, this study will be conducted to evaluate the clinical therapeutic effect of combining Chinese herbs and chemotherapeutic drugs to treat MDR-PTB cases. It will assist in screening new therapeutic drugs and establishing treatment plan that aims to improve the clinical therapeutic effect for MDR-PTB patients.Trial registrationThis trial was registered at ClinicalTrials.gov (ChiCTR1900027720) on 24 November 2019 (prospective registered).Graphical

Prevalence and Correlates of Anxiety and Depressive Symptoms in Patients With and Without Multi-Drug Resistant Pulmonary Tuberculosis in China.

China is still among the 30 high-burden tuberculosis (TB) countries in the world and TB remains a public health concern. TB can be a cause of mental illness, with prolonged treatment and several anti-TB drugs leading to extreme mental health problems such as depression and anxiety in TB patients. To investigate the prevalence of anxiety and depressive symptoms among TB patients, and to explore whether drug resistance is a covariate for depressive and anxiety symptoms, a total of 167 pulmonary tuberculosis patients were enrolled in this study, which was conducted from January 1 to September 30, 2020. Data were collected, using a structured questionnaire with a demographic component, the Hospital Anxiety and Depression Scale (HADS), General Health Questionnaire 20 (GHQ-20), the Tuberculosis-related Stigma Scale (TSS) and the Social Support Rating Scale (SSRS). Association between demographics, disease/treatment characteristics, stigma, social support, and anxiety/depression symptoms were investigated either based on Pearson's correlation coefficient or group comparisons based on independent t-test (or Mann-Whitney U-test) Multiple linear stepwise regression analysis was used for determining the predictors of anxiety and depression. The results showed that multi-drug resistance pulmonary tuberculosis patients were associated with anxiety challenges. Multiple linear regression analysis indicated that self-esteem accounted for 33.5 and 38% of the variation in anxiety and depression, respectively. This shows that among tuberculosis patients, self-esteem is the factor that could most explains the depression and anxiety symptoms of patients, suggesting that we may could through improving the environment, society, and family respect and tolerance of tuberculosis patients, thereby improving the mental health of tuberculosis patients.

Alterations of gut microbiota in patients with active pulmonary tuberculosis in China: a pilot study

Background: The aim of this study was to identify the differences in diversity, composition, and function of the gut microbiota between tuberculosis (TB) patients and healthy controls (HCs).Methods: A cross-sectional study was conducted in three cities of China. Stool samples from 94 treatment-naive TB patients and 62 HCs were analyzed by 16S rRNA gene sequencing. TB patients were further divided into antibiotic-free and antibiotic-exposure according to their use of non-specific antibiotics before the TB diagnosis.Results: Compared with HCs, antibiotic-free TB patients presented a different gut microbial community (P < 0.005) and decreased Shannon diversity (P < 0.005). Among TB patients, the relative abundances of short-chain fatty acid (SCFA)-producing genera such as Lachnospiraceae ND3007 group (log2(FC) = −2.74) were lower, while several conditional pathogen-related genera such as Enterococcus (log2(FC) = 12.05) and Rothia (log2(FC) = 6.322) were at higher levels. In addition, 41% of patients received antibiotics before TB diagnosis. Antibiotic exposure was correlated with an additional reduction in α diversity and depletion of SCFA-producing bacteria. Microbial functional analysis revealed that the biosynthesis capacity of amino acids and fatty acids was lower among TB patients compared to HCs.Conclusions: Significant alterations in gut microbiota composition and metabolic pathways of TB patients were observed. Antibiotic exposure could alter the gut microbiota of TB patients, which should be considered in anti-TB treatment.

Risk factor for 31-day unplanned readmission to hospital in patients with pulmonary tuberculosis in China.

Objectives:To evaluate risk factors associated with 31-day unplanned readmission(s) for pulmonary tuberculosis (TB) in China.Methods:This retrospective study enrolled patients (age, >14 years) with pulmonary TB who experienced 31-day unplanned readmissions to a specialized hospital for TB between January 2018 and December 2019. For each confirmed readmission, 2 control subjects were randomly selected from among patients with pulmonary TB but did not experience an unplanned readmission within 31 days.Results:A total of 402 pulmonary TB patients (5.9%) experienced unplanned readmission within 31 days after discharge. In univariate analysis, readmission was associated with gender, age, insurance coverage, residing in a rural area, active smoking, chronic obstructive pulmonary disease (COPD), drug-induced hepatitis, and leaving hospital against medical advice. The final logistic regression model revealed that higher risks for unplanned readmissions were associated with male gender (odds ratio [OR] 1.44, [95% confidence interval (CI) : 1.06-1.95]), age >65 years (OR 2.94, 95%CI: 2.03-4.27), rural residence (OR 8.86, 95%CI: 6.61-11.87), active smoking (OR 2.15, 95% CI 1.37-3.40), COPD (OR 2.77, 95%CI: 1.59-4.81), and leaving hospital against physician advice (OR 4.11, 95%CI: 1.43-11.83). The median time to 31-day unplanned readmission was 24 days. Major reasons for unplanned readmission included fever, exacerbation of dyspnea, and hemoptysis.Conclusion:Unplanned readmission for pulmonary TB within 31 days of discharge was higher among older males residing in rural areas, active smokers, and those leaving hospital against medical advice.

Harnessing Big Data to Optimize an Algorithm for Rapid Diagnosis of Pulmonary Tuberculosis in a Real-World Setting.

BackgroundThe prompt diagnosis of pulmonary tuberculosis (PTB) remains a challenge in clinical practice. The present study aimed to optimize an algorithm for rapid diagnosis of PTB in a real-world setting.Methods28,171 adult inpatients suspected of having PTB in China were retrospectively analyzed. Bronchoalveolar lavage fluid (BALF) and/or sputum were used for acid-fast bacilli (AFB) smear, Xpert MTB/RIF (Xpert), and culture. A positive mycobacterial culture was used as the reference standard. Peripheral blood mononuclear cells (PBMC) were used for T-SPOT.TB. We analyzed specimen types’ effect on these assays’ performance, determined the number of smears for diagnosing PTB, and evaluated the ability of these assays performed alone, or in combination, to diagnose PTB and nontuberculous mycobacteria (NTM) infections.ResultsSputum and BALF showed moderate to substantial consistency when they were used for AFB smear or Xpert, with a higher positive detection rate by BALF. 3-4 smears had a higher sensitivity than 1-2 smears. Moreover, simultaneous combination of AFB and Xpert correctly identified 44/51 of AFB+/Xpert+ and 6/7 of AFB+/Xpert- cases as PTB and NTM, respectively. Lastly, when combined with AFB/Xpert sequentially, T-SPOT showed limited roles in patients that were either AFB+ or Xpert+. However, T-SPOTMDC (manufacturer-defined cut-off) showed a high negative predicative value (99.1%) and suboptimal sensitivity (74.4%), and TBAg/PHA (ratio of Mycobacterium tuberculosis-specific antigens to phytohaemagglutinin spot-forming cells, which is a modified method calculating T-SPOT.TB assay results) ≥0.3 demonstrated a high specificity (95.7%) and a relatively low sensitivity (16.3%) in AFB-/Xpert- patients.ConclusionsConcurrently performing AFB smear (at least 3 smears) and Xpert on sputum and/or BALF could aid in rapid diagnosis of PTB and NTM infections in a real-world high-burden setting. If available, BALF is preferred for both AFB smear and Xpert. Expanding this algorithm, PBMC T-SPOTMDC and TBAg/PHA ratios have a supplementary role for PTB diagnosis in AFB-/Xpert- patients (moderately ruling out PTB and ruling in PTB, respectively). Our findings may also inform policy makers’ decisions regarding prevention and control of TB in a high burden setting.

Spatial inequality, characteristics of internal migration, and pulmonary tuberculosis in China, 2011\u20132017: a spatial analysis

BackgroundHuman migration facilitate the spread of tuberculosis (TB). Migrants face an increased risk of TB infection. In this study, we aim to explore the spatial inequity of sputum smear-positive pulmonary TB (SS + PTB) in China; and the spatial heterogeneity between SS + PTB and internal migration.MethodsNotified SS + PTB cases in 31 provinces in mainland China were obtained from the national web-based PTB surveillance system database. Internal migrant data were extracted from the report on China’s migrant population development. Spatial autocorrelations were explored using the global Moran’s statistic and local indicators of spatial association. The spatial variation in temporal trends was performed using Kulldorff’s scan statistic. Fixed effect and spatial autoregressive models were used to explore the spatial inequity between SS + PTB and internal migration.ResultsA total of 2 380 233 SS + PTB cases were reported in China between 2011 and 2017, of which, 1 716 382 (72.11%) were male and 663 851 (27.89%) were female. Over 70% of internal migrants were from rural households and had lower income and less education. The spatial variation in temporal trend results showed that there was an 9.9% average annual decrease in the notification rate of SS + PTB from 2011 to 2017; and spatial clustering of SS + PTB cases was mainly located in western and southern China. The spatial autocorrelation results revealed spatial clustering of internal migration each year (2011–2017), and the clusters were stable within most provinces. Internal emigration, urban-to-rural migration and GDP per capita were significantly associated with SS + PTB, further, internal emigration could explain more variation in SS + PTB in the eastern region in mainland. However, internal immigration and rural-to-urban migration were not significantly associated with SS + PTB across China.ConclusionsOur study found the spatial inequity between SS + PTB and internal migration. Internal emigration, urban-to-rural migration and GDP per capita were statistically associated with SS + PTB; the negative association was identified between internal emigration, urban-to-rural migration and SS + PTB. Further, we found those migrants with lower income and less education, and most of them were from rural households. These findings can help stakeholders to implement effective PTB control strategies for areas at high risk of PTB and those with high rates of internal migration.

The prevalence and risks of major comorbidities among inpatients with pulmonary tuberculosis in China from a gender and age perspective: a large-scale multicenter observational study

In clinical practice, PTB patients have concurrent many types of comorbidities such as pneumonia, liver disorder, diabetes mellitus, hematological disorder, and malnutrition. Detecting and treating specific comorbidities and preventing their development are important for PTB patients. However, the prevalence of most comorbid conditions in patients with PTB is not well described. We conducted a large-scale, multicenter, observational study to elucidate and illustrate the prevalence rates of major comorbidities in inpatients at 21 hospitals in China. The 19 specific comorbidities were selected for analysis in this patient cohort, and stratified the inpatient cohort according to age and gender. A total of 355,929 PTB inpatients were included, with a male:female ratio of 1.98 and the proportion of ≥ 65years PTB inpatients was the most. Approximately 70% of PTB inpatients had at least one defined type of comorbidity. The prevalence of 19 specific comorbidities in inpatients with PTB was analyzed, with pneumonia being the most common comorbidity. The prevalence of most comorbidities was higher in males with PTB except thyroid disorders, mental health disorders, etc. The prevalence of defined most comorbidities in patients with PTB tended to increase with increasing age, although some specific comorbidities tended to increase initially then decrease with increasing age. Our study describes multiple clinically important comorbidities among PTB inpatients, and their prevalence between different gender and age groups. The results will enhance the clinical aptitude of physicians who treat patients with PTB to recognize, diagnose, and treat PTB comorbidities early.

Analysis and predication of tuberculosis registration rates in Henan Province, China: an exponential smoothing model study

BackgroundThe World Health Organization End TB Strategy meant that compared with 2015 baseline, the reduction in pulmonary tuberculosis (PTB) incidence should be 20 and 50% in 2020 and 2025, respectively. The case number of PTB in China accounted for 9% of the global total in 2018, which ranked the second high in the world. From 2007 to 2019, 854 672 active PTB cases were registered and treated in Henan Province, China. This study was to assess whether the WHO milestones could be achieved in Henan Province.MethodsThe active PTB numbers in Henan Province from 2007 to 2019, registered in Chinese Tuberculosis Information Management System were analyzed to predict the active PTB registration rates in 2020 and 2025, which is conductive to early response measures to ensure the achievement of the WHO milestones. The time series model was created by monthly active PTB registration rates from 2007 to 2016, and the optimal model was verified by data from 2017 to 2019. The Ljung-Box Q statistic was used to evaluate the model. The statistically significant level is α = 0.05. Monthly active PTB registration rates and 95% confidence interval (CI) from 2020 to 2025 were predicted.ResultsHigh active PTB registration rates in March, April, May and June showed the seasonal variations. The exponential smoothing winter’s multiplication model was selected as the best-fitting model. The predicted values were approximately consistent with the observed ones from 2017 to 2019. The annual active PTB registration rates were predicted as 49.1 (95% CI: 36.2–62.0) per 100 000 population and 34.4 (95% CI: 18.6–50.2) per 100 000 population in 2020 and 2025, respectively. Compared with the active PTB registration rate in 2015, the reduction will reach 23.7% (95% CI, 3.2–44.1%) and 46.8% (95% CI, 21.4–72.1%) in 2020 and 2025, respectively.ConclusionsThe high active PTB registration rates in spring and early summer indicate that high risk of tuberculosis infection in late autumn and winter in Henan Province. Without regard to the CI, the first milestone of WHO End TB Strategy in 2020 will be achieved. However, the second milestone in 2025 will not be easily achieved unless there are early response measures in Henan Province, China.

Improvement cues of lesion absorption using the adjuvant therapy of traditional Chinese medicine Qinbudan tablet for retreatment pulmonary tuberculosis with standard anti-tuberculosis regimen

BackgroundChina is the second highest pulmonary tuberculosis (PTB) burden country worldwide. However, retreatment of PTB has often developed resistance to at least one of the four first-line anti-TB drugs. The cure rate (approximately 50.0–73.3%) and management of retreatment of PTB in China needs to be improved. Qinbudan decoction has been widely used to treat PTB in China since the 1960s. Previously clinical studies have shown that the Qinbudan tablet (QBDT) promoted sputum-culture negative conversion and lesion absorption. However, powerful evidence from a randomized controlled clinical trial is lacking. Therefore, the aim of this study was to compare the efficacy and safety of QBDT as an adjunct therapy for retreatment of PTB.MethodsWe conducted a multicenter, randomized, double-blind, placebo-controlled clinical trial in China. People diagnosed with PTB were enrolled who received previous anti-TB treatment from April 2011 to March 2013. The treatment group received an anti-TB regimen and QBDT, and the control group was administered an anti-TB regimen plus placebo. Anti-TB treatment options included isoniazid, rifampicin, pyrazinamide, ethambutol, streptomycin for 2 months (2HRZES), followed by isoniazid, rifampicin, ethambutol for 6 months (6HRE), daily for 8 months. Primary outcome was sputum-culture conversion using the MGIT 960 liquid medium method. Secondary outcomes included lung lesion absorption and cavity closure. Adverse events and reactions were observed after treatment. A structured questionnaire was used to record demographic information and clinical symptoms of all subjects. Data analysis was performed by SPSS 25.0 software in the full analysis set (FAS) population.ResultsOne hundred eighty-one cases of retreatment PTB were randomly divided into two groups: the placebo group (88 cases) and the QBDT group (93 cases). A total of 166 patients completed the trial and 15 patients lost to follow-up. The culture conversion rate of the QBDT group and placebo group did not show a noticeable improvement by using the covariate sites to correct the rate differences (79.6% vs 69.3%; rate difference = 0.10, 95% confidence interval (CI): - 0.02–0.23; F = 2.48, P = 0.12) after treatment. A significant 16.6% increase in lesion absorption was observed in the QBDT group when compared with the placebo group (67.7% vs 51.1%; rate difference = 0.17, 95% CI: 0.02–0.31; χ2 = 5.56, P = 0.02). The intervention and placebo group did not differ in terms of cavity closure (25.5% vs 21.1%; rate difference = 0.04, 95% CI: - 0.21–0.12; χ2 = 0.27, P = 0.60). Two patients who received chemotherapy and combined QBDT reported pruritus/nausea and vomiting.ConclusionsNo significant improvement in culture conversion was observed for retreatment PTB with traditional Chinese medicine plus standard anti-TB regimen. However, QBDT as an adjunct therapy significantly promoted lesion absorption, thereby reducing lung injury due to Mycobacterium tuberculosis infection.Trial registrationThis trial is registered at ClinicalTrials.gov, NCT02313610.