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Ulain N, Ali A, Khan M, Ullah Z, Shaheen L, Shareef N, Yasir M, Mustafa T. Improving diagnosis of tuberculous lymphadenitis by combination of cytomorphology and MPT64 immunostaining on cell blocks from the fine needle aspirates. PLoS One 2022; 17:e0276064. [PMID: 36228032 PMCID: PMC9560136 DOI: 10.1371/journal.pone.0276064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 08/15/2022] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Extra pulmonary tuberculosis (EPTB) constitutes 18% of all tuberculosis (TB) cases and tuberculous lymphadenitis (TBL) constitutes 20-40% of EPTB. Diagnosis of TBL is challenging because of the paucibacillary nature of the disease. OBJECTIVE To investigate the diagnostic potential of a new antigen detection test based on the detection of M. tuberculosis complex specific antigen MPT64 from fine needle aspirate (FNA) cytology smears and biopsies obtained from patients with clinically suspected TBL using immunohistochemistry (IHC). MATERIALS AND METHODS This study was conducted at Khyber Teaching Hospital and Rehman Medical Institute, Peshawar, Pakistan, from January 2018 to April 2019. Samples, including FNA (n = 100) and biopsies (n = 8), were collected from 100 patients with presumptive TBL. Direct smears and cell blocks were prepared from the FNA samples. All samples were subjected to hematoxylin-eosin (H&E) staining, Ziehl-Neelsen (ZN) staining, and immunostaining with polyclonal anti-MPT64 antibody. The culture was performed only for biopsy specimens. All patients were followed until the completion of anti-TB treatment. The response to treatment was included in the composite reference standard (CRS) and used as the gold standard to validate the diagnostic tests. RESULTS The sensitivity, specificity, positive and negative predictive values for ZN staining were 4.4%,100%,100%,56%, for culture were 66%,100%,100%,50%, for cytomorphology were 100%,90.91%,90%,100%, and for immunostaining with anti-MPT64 were all 100%,respectively. The morphology and performance of immunohistochemistry were better with cell blocks than with smears. CONCLUSION MPT64 antigen detection test performed better than ZN and cytomorphology in diagnosing TBL. This test applied to cell blocks from FNA is robust, simple, and relatively rapid, and improves the diagnosis of TBL.
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Affiliation(s)
- Noor Ulain
- Department of Microbiology, Institute of Pathology and Diagnostic Medicine, Khyber Medical University, Peshawar, Pakistan
| | - Asif Ali
- Department of Histopathology, Institute of Pathology and Diagnostic Medicine, Khyber Medical University, Peshawar, Pakistan
- School of Medicine, University of Glasgow, Scotland, United Kingdom
| | - Momin Khan
- Department of Microbiology, Institute of Pathology and Diagnostic Medicine, Khyber Medical University, Peshawar, Pakistan
| | - Zakir Ullah
- Department of Otolaryngology, Khyber Teaching Hospital, Peshawar, Pakistan
| | - Lubna Shaheen
- Department of Otolaryngology, Khyber Teaching Hospital, Peshawar, Pakistan
| | - Naveed Shareef
- Department of Pathology, Khyber Teaching Hospital, Peshawar, Pakistan
| | - Muhammad Yasir
- Department of Histopathology, Institute of Pathology and Diagnostic Medicine, Khyber Medical University, Peshawar, Pakistan
| | - Tehmina Mustafa
- Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway
- * E-mail:
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Yi WJ, Han YS, Wei LL, Shi LY, Huang H, Jiang TT, Li ZB, Chen J, Hu YT, Tu HH, Li JC. l-Histidine, arachidonic acid, biliverdin, and l-cysteine-glutathione disulfide as potential biomarkers for cured pulmonary tuberculosis. Biomed Pharmacother 2019; 116:108980. [PMID: 31125821 DOI: 10.1016/j.biopha.2019.108980] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 04/15/2019] [Accepted: 05/08/2019] [Indexed: 11/25/2022] Open
Abstract
Lack of laboratory standards for cured tuberculosis (TB) can lead to early discharge of untreated TB patients from the hospital, resulting in increased risk of TB spread and of developing drug resistant Mycobacterium tuberculosis (Mtb). We used ultra-high performance liquid chromatography coupled with mass spectrometry (LC-MS) to detect heparin anticoagulant in plasma of untreated TB patients, two-month treated TB patients, cured TB subjects, and healthy controls. Screening of differentially expressed metabolites resulted in identification of four differentially expressed metabolites such as, l-Histidine, Arachidonic acid (AA), Biliverdin, and l-Cysteine-glutathione disulfide after 6 months of TB treatment. Among them, l-Cysteine-glutathione disulfide and AA could be identified after 2 months of TB treatment. We established a cured TB model with an area under the curve (AUC) of 0.909 (95% CI, 0.802-0.970), 86.2% sensitivity, and 85.2% specificity. The diagnostic model fitted from the four differential metabolites in combination (l-Histidine, AA, Biliverdin, and l-Cysteine-glutathione disulfide) can be used as potential biomarkers for cured TB. Our study provided laboratory standards for hospital discharge of TB patients, as well as experimental basis for evaluating the efficacy of anti-TB drugs.
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Affiliation(s)
- Wen-Jing Yi
- Institute of Cell Biology, Zhejiang University School of Medicine, Hangzhou, 310058, China.
| | - Yu-Shuai Han
- Institute of Cell Biology, Zhejiang University School of Medicine, Hangzhou, 310058, China.
| | - Li-Liang Wei
- Department of Pneumology, Shaoxing Municipal Hospital, Shaoxing, 312000, China.
| | - Li-Ying Shi
- Department of Clinical Laboratory, Zhejiang Hospital, Hangzhou, 310058, China.
| | - Huai Huang
- School of Medicine, South China University of Technology, Guangzhou, 510000, China.
| | - Ting-Ting Jiang
- School of Medicine, South China University of Technology, Guangzhou, 510000, China.
| | - Zhi-Bin Li
- Institute of Cell Biology, Zhejiang University School of Medicine, Hangzhou, 310058, China.
| | - Jing Chen
- Institute of Cell Biology, Zhejiang University School of Medicine, Hangzhou, 310058, China.
| | - Yu-Ting Hu
- School of Medicine, South China University of Technology, Guangzhou, 510000, China.
| | - Hui-Hui Tu
- Institute of Cell Biology, Zhejiang University School of Medicine, Hangzhou, 310058, China.
| | - Ji-Cheng Li
- Institute of Cell Biology, Zhejiang University School of Medicine, Hangzhou, 310058, China.
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Yuan L, Zhang H, Zhou C, Jiang W, Zhao Q, Biao X. Better care provided to patients with tuberculosis at county designated TB hospitals (CTD) compared to non-CTDs in rural China. BMC Infect Dis 2017; 17:71. [PMID: 28086753 PMCID: PMC5237123 DOI: 10.1186/s12879-016-2108-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 12/10/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The primary unit of tuberculosis (TB) medical care in China is the county TB dispensary or county designated hospital (CTD), where patients can receive free diagnosis and treatment. However, a substantial number of patients seek their anti-TB treatment from general health facilities (Non-CTDs). This study aimed to investigate the first anti-TB treatment experience and choice of health facilities of retreated TB patients and their determinants. METHODS A cross-sectional study was conducted in Jiangsu, Shandong and Sichuan provinces. All registered re-treated TB patients were investigated using a structured questionnaire covering information on demographics, socio-economic characteristics, and previous anti-TB treatment experiences. RESULTS Totally, 75.3% of 544 patients visited CTD directly for initial treatment. Patients who were female (OR:1.71, 95% CI: 1.01-2.87), over 40 years of age (OR:2.80, 95% CI: 1.24-6.33), from Jiangsu (OR:3.07, 95% CI: 1.57-6.01) and Sichuan (OR:4.47, 95% CI: 2.29-8.73) and those diagnosed before 2005 (OR:6.87, 95% CI: 4.24-11.13) had a significant higher risk receiving their initial treatment at a non-CTD. Patients were more likely to have standardized diagnosis and treatment regimens in CTD (89.8%) than in non-CTDs (65.9%). Patients treated in non-CTDs versus in CTD had a lower possibility to complete their treatment course during first TB episode (χ 2 = 3.926, P = 0.048), but there was no significant difference in the cure rate between different facilities (CTD 60.8%, Non-CTDs 59.1%). Patients in non-CTDs incurred higher costs (1,360 CNY) than those treated in CTD (920CNY). CONCLUSION CTD play a key role in the National Tuberculosis Control Program. Patients should be guided to seek health care in county designated hospital, where they are more likely to receive appropriate examinations, treatment regimens and rigorous supervision, and to bear a lighter economic burden.
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Affiliation(s)
- Li Yuan
- Department of Epidemiology, School of Public Health, Fudan University, 138 Yi Xue Yuan Rd, Shanghai, 200032, China.,Key Laboratory of Public Health Safety (Ministry of Education), 138 Yi Xue Yuan Rd, Shanghai, 200032, China
| | - Hui Zhang
- National Center for TB Control and Prevention, National center for TB control and prevention, 155 Changbai Road, Beijing, 102206, China
| | - Changming Zhou
- Department of Epidemiology, School of Public Health, Fudan University, 138 Yi Xue Yuan Rd, Shanghai, 200032, China.,Key Laboratory of Public Health Safety (Ministry of Education), 138 Yi Xue Yuan Rd, Shanghai, 200032, China
| | - Weili Jiang
- Department of Epidemiology, School of Public Health, Fudan University, 138 Yi Xue Yuan Rd, Shanghai, 200032, China.,Key Laboratory of Public Health Safety (Ministry of Education), 138 Yi Xue Yuan Rd, Shanghai, 200032, China
| | - Qi Zhao
- Department of Epidemiology, School of Public Health, Fudan University, 138 Yi Xue Yuan Rd, Shanghai, 200032, China. .,Key Laboratory of Public Health Safety (Ministry of Education), 138 Yi Xue Yuan Rd, Shanghai, 200032, China. .,Centre for Global Health, Department of Public Health Science (IHCAR), Karolinska Institutet, S-171 77, Stockholm, Sweden.
| | - Xu Biao
- Department of Epidemiology, School of Public Health, Fudan University, 138 Yi Xue Yuan Rd, Shanghai, 200032, China.,Key Laboratory of Public Health Safety (Ministry of Education), 138 Yi Xue Yuan Rd, Shanghai, 200032, China.,Centre for Global Health, Department of Public Health Science (IHCAR), Karolinska Institutet, S-171 77, Stockholm, Sweden
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Huang F, Zhang H, Lv Q, Sato KD, Qu Y, Huan S, Cheng J, Zhao F, Wang L. Use of anti-tuberculosis drugs among newly diagnosed pulmonary tuberculosis inpatients in China: a retrospective study. Infect Dis Poverty 2016; 5:2. [PMID: 26792535 PMCID: PMC4720996 DOI: 10.1186/s40249-016-0098-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 01/04/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND China's national tuberculosis control program (NTP) provides free, first-line anti-tuberculosis (TB) drugs to pulmonary TB patients. This treatment regimen follows the World Health Organization's (WHO) guideline. The objective of this paper is to evaluate the current status of anti-TB drug use for newly diagnosed pulmonary TB inpatients treated in prefecture- and county-level designated hospitals. METHODS Three prefecture-level hospitals and nine county-level hospitals were selected for the study. All newly diagnosed pulmonary TB inpatient medical records from 2012 were reviewed and doubly examined by two national senior physicians. The rational use of anti-TB drugs was evaluated based on criteria in line with WHO's guideline. RESULTS Of the 2,060 total treatment regimens for TB, 53.1 % were found to be rational (1093/2060). The percentages in prefecture-level and county-level hospitals were 50.3 % (761/1513) and 60.7 % (332/547), respectively. The difference between the two levels of hospitals was statistically significant (Chi-square value = 17.44, P < 0.01). The percentages of rational treatment regimens for first-time hospitalizations and for two or more hospitalizations were 59.5 % (983/1653) and 27.0 % (110/407), respectively, with a statistically significant difference (Chi-square value = 138.00, P < 0.01). The overall use of second-line drugs (SLD) was 54.9 % (1131/2060). The percentages for prefecture-level and county-level hospitals were 50.6 % (766/1513) and 66.7 % (365/547), respectively. A statistically significant difference was found (Chi-square value = 42.06, P < 0.01). The use of SLD for inpatients hospitalized once and inpatients hospitalized twice or more was 58.4 % (966/1653) and 40.5 % (165/407), respectively, with a statistically significant difference (Chi-square value = 42.26, P < 0.01). CONCLUSIONS Half of inpatients might be treated with irrational regimens, and the use of SLD was more appropriately dispensed in city-level hospitals than in county-level hospitals. Trainings and guidelines for health personnel, supervision led by health authorities and increased investment to designated hospitals may help to improve the rational use of anti-TB drugs.
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Affiliation(s)
- Fei Huang
- National Center for TB control and prevention, No 155 Changbai Road, Changping District, Beijing, 102206, China.
| | - Hui Zhang
- National Center for TB control and prevention, No 155 Changbai Road, Changping District, Beijing, 102206, China.
| | - Qing Lv
- National Center for TB control and prevention, No 155 Changbai Road, Changping District, Beijing, 102206, China.
| | | | - Yan Qu
- National Center for TB control and prevention, No 155 Changbai Road, Changping District, Beijing, 102206, China.
| | - Shitong Huan
- Bill & Melinda Gates Foundation, Beijing office, Beijing, China.
| | - Jun Cheng
- National Center for TB control and prevention, No 155 Changbai Road, Changping District, Beijing, 102206, China.
| | - Fei Zhao
- National Center for TB control and prevention, No 155 Changbai Road, Changping District, Beijing, 102206, China.
| | - Lixia Wang
- National Center for TB control and prevention, No 155 Changbai Road, Changping District, Beijing, 102206, China.
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Hu Y, Zhao Q, Werngren J, Hoffner S, Diwan VK, Xu B. Drug resistance characteristics and cluster analysis of M. tuberculosis in Chinese patients with multiple episodes of anti-tuberculosis treatment. BMC Infect Dis 2016; 16:4. [PMID: 26739444 PMCID: PMC4704432 DOI: 10.1186/s12879-015-1331-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Accepted: 12/30/2015] [Indexed: 11/20/2022] Open
Abstract
Background Tuberculosis (TB) patients with multiple episodes of anti-TB treatment represent an important source of TB transmission, as well as a serious threat to the control of drug resistant TB, due to the high risk of multidrug and extensively drug resistance (MDR/XDR) and elongating infectiousness of this patient group. In this study we analyzed the possible risk of development and transmission of MDR and XDR in TB patients with multiple episodes of previous treatment history. Methods The study subjects were pulmonary TB patients who had at least two episodes of previous anti-TB treatment. A total of 166 eligible patients were identified from 10 counties/districts distributed in east, west, north, south and central China. Drug susceptibility test (DST) was performed by proportion method on LJ-media for the 1st line anti-TB drugs and a line probe assay was used to detect mutations related to resistance of the key 2nd-line drugs. Genotyping of M. tuberculosis (Mtb) was performed with MIRU-VNTR and Spoligotyping. Results Resistances to 1st-line drugs was observed in 122 (73.5 %) of the 166 Mtb isolates with 97 (58.4 %) being MDR-TB. Mutations relevant to 2nd-line drug resistance was seen in 63 isolates, including 35 MDR-TB isolates (30 pre-XDR, 5 XDR-TB). The Spoligotyping revealed 83.1 % Mtb isolates belonged to the Beijing family. The MIRU-VNTR based genotyping revealed 32 (19.3 %) of patients were infected with more than one strain. The number of previous TB treatment episode was found being significantly associated with the risk of MDR-TB and XDR-TB. Among the remaining 134 patients infected with a single Mtb strain, MIRU-VNTR revealed a high homogeneity of strain especially within Beijing family despite the polymorphic variations along with geographic locations. Conclusions The high genetic relatedness and risk of MDR-TB and subsequent pre-XDR and XDR-TB among repeatedly treated patients suggest the establishment of M/XDR Mtb in this specific patient population. It highlights the urgent needs of providing DST of both 1st- and 2nd-line drugs before and during the medication in China’s MDR-TB control program. Furthermore, the possibility of infection with multiple strains should also be considered to be associated with the drug resistance, which calls for the modification of treatment regimen. Electronic supplementary material The online version of this article (doi:10.1186/s12879-015-1331-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yi Hu
- Department of Epidemiology, School of Public Health, Fudan University, 138 Yi Xue Yuan Rd, Shanghai, 200032, China. .,Key Laboratory of Public Health Safety, Fudan University, Ministry of Education, Shanghai, China. .,Microbiology and Tumor Biology Center (MTC), Karolinska Institutet, S-171 77, Stockholm, Sweden.
| | - Qi Zhao
- Department of Epidemiology, School of Public Health, Fudan University, 138 Yi Xue Yuan Rd, Shanghai, 200032, China. .,Key Laboratory of Public Health Safety, Fudan University, Ministry of Education, Shanghai, China.
| | - Jim Werngren
- The Public Health Agency of Sweden, Solna, Sweden.
| | - Sven Hoffner
- Microbiology and Tumor Biology Center (MTC), Karolinska Institutet, S-171 77, Stockholm, Sweden. .,The Public Health Agency of Sweden, Solna, Sweden.
| | - Vinod K Diwan
- School of Public Health, Centre for Global Health, Karolinska Institutet, Stockholm, Sweden.
| | - Biao Xu
- Department of Epidemiology, School of Public Health, Fudan University, 138 Yi Xue Yuan Rd, Shanghai, 200032, China. .,Key Laboratory of Public Health Safety, Fudan University, Ministry of Education, Shanghai, China.
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Qiu S, Pan H, Zhang S, Peng X, Zheng X, Xu G, Wang M, Wang J, Lu H. Is tuberculosis treatment really free in China? A study comparing two areas with different management models. PLoS One 2015; 10:e0126770. [PMID: 25993411 PMCID: PMC4439067 DOI: 10.1371/journal.pone.0126770] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Accepted: 04/07/2015] [Indexed: 11/25/2022] Open
Abstract
Objective China has implemented a free-service policy for tuberculosis. However, patients still have to pay a substantial proportion of their annual income for treatment of this disease. This study describes the economic burden on patients with tuberculosis; identifies related factors by comparing two areas with different management models; and provides policy recommendation for tuberculosis control reform in China. Methods There are three tuberculosis management models in China: the tuberculosis dispensary model, specialist model and integrated model. We selected Zhangjiagang (ZJG) and Taixing (TX) as the study sites, which correspond to areas implementing the integrated model and dispensary model, respectively. Patients diagnosed and treated for tuberculosis since January 2010 were recruited as study subjects. A total of 590 patients (316 patients from ZJG and 274 patients from TX) were interviewed with a response rate of 81%. The economic burden attributed to tuberculosis, including direct costs and indirect costs, was estimated and compared between the two study sites. The Mann-Whitney U Test was used to compare the cost differences between the two groups. Potential factors related to the total out-of-pocket costs were analyzed based on a step-by-step multivariate linear regression model after the logarithmic transformation of the costs. Results The average (median, interquartile range) total cost was 18793.33 (9965, 3200-24400) CNY for patients in ZJG, which was significantly higher than for patients in TX (mean: 6598.33, median: 2263, interquartile range: 983–6688) (Z = 10.42, P < 0.001). After excluding expenses covered by health insurance, the average out-of-pocket costs were 14304.4 CNY in ZJG and 5639.2 CNY in TX. Based on the multivariable linear regression analysis, factors related to the total out-of-pocket costs were study site, age, number of clinical visits, residence, diagnosis delay, hospitalization, intake of liver protective drugs and use of the second-line drugs. Conclusion Under the current “free of diagnosis and treatment” policy, the financial burden remains heavy on tuberculosis patients. Policy makers need to consider appropriate steps to lessen the burden of out-of-pocket costs for tuberculosis patients in China and how best to improve service delivery for poor patients.
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Affiliation(s)
- Sangsang Qiu
- Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Hongqiu Pan
- Department of Tuberculosis, Third Hospital of Zhenjiang City, Zhenjiang, China
| | - Simin Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Xianzhen Peng
- Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Xianzhi Zheng
- Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Guisheng Xu
- Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Min Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Jianming Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, China
- Department of Social Medicine and Health Education, School of Public Health, Nanjing Medical University, Nanjing, China
- The Innovation Center for Social Risk Governance in Health, Nanjing, China
- * E-mail: (JW); (HL)
| | - Hui Lu
- Department of Social Medicine and Health Education, School of Public Health, Nanjing Medical University, Nanjing, China
- * E-mail: (JW); (HL)
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